CNN optimizations for embedded systems and FFT

 NHS 2012 Conference Book of abstracts NHS 2012 i
In the past decade or so Early Intervention Programs for infant hearing disorders have undergone tremendous advancement. Technology for hearing aids, cochlear implants, audiological equipment and strategies for auditory habilitation and empowering Families are making continuous and impressive developments, thus offering increasingly reliable and affordable solutions. Early Intervention Programs for babies and infants with hearing loss has brought challenges to professionals across the care pathway in ensuring they have the right skills and competencies to provide safe and effective high quality screening, assessment and early intervention services. The Conference covers all domains of infant hearing and includes Keynote Addresses, Special Sessions and a number of Satellite Events as well as free oral communications and Poster Sessions, for a total of more than 140 platform presentations structured in 30 concurrent Sessions and a massive Poster Session with 145 Posters. Delegates are representing about 60 different countries, with a unique blend of developed and developing, or underserved, areas throughout the world, thus stimulating and facilitating exchanges of data, models, protocols and best practices. Thank you for coming and joining us in making this event a great success! Ferdi Grandori and Deborah Hayes NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy ii NHS 2012
Chairman Scientific Organisers Ferdi Grandori Ferdi Grandori Deborah Hayes Organising secretariat Venue Meet&Work srl Villa Erba Congress Center Abano Terme, Italy Largo Luchino Visconti 4, Cernobbio (Lake Como) Delegates are representing the following Countries Aruba Hong Kong Romania Australia India Russia Austria Indonesia Saudi Arabia Bangladesh Iran Serbia Belgium Israel Sierra Leone Brazil Italy Singapore Bulgaria Japan Slovenia Canada Kazakhstan South Africa Cuba Malaysia Spain Cyprus Mali Sweden Czech Republic Mexico Switzerland Denmark New Zeland Thailand Egypt Norway The Netherlands Estonia Palestine Turkey Finland Poland UAE France Portugal UK Gambia P.R. China Ukraine Germany Qatar USA Ghana Republic of Macedonia Venezuela NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 iii
This event has been made possible thanks to the contribution and support of the following Institutions and Organizations: Advanced Bionics Bill Daniels Center for Children’s Hearing at The Children’s Hospital – Colorado CDC ‐ National Center on Birth Defects and Developmental Disabilities Cochlear GN ReSound Interacoustics MAICO Diagnostic GmbH MED EL Network Udito ‐ ONLUS Northgate Public Services Oticon Paediatrics Otodynamics Ltd Otometrics OZ Systems Path Medical Solutions Sistemas Genomicos. Genomic Systems The Ear Foundation VIVOSONIC INC. Widex NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy iv NHS 2012
PROGRAM AT A GLANCE Tuesday, June 5, 2012
registration
10:00 - 14:00
Room DON GIOV A NNI
14:00 - 14:15
Welc om e
Ferdi Grandori, Deborah Hayes
Room B OHE M E
Room FA LS T A FF
-
-
-
-
A ppli c at ions of Tele-Healt h
M odels of E arl y Int erv ent i on
Keynote Address
Clos ing t he Gap: P rogres s f rom
14:15 - 15:15
P res c hool t o E lem ent ary Grades and
High S c hool i n Chil dren wi t h E arly
Coc hlear Im pl ant at ion - Ann Geers
15:15 - 16:00
Los t t o Follow-up
Coffee Break
16:00 - 16:30
16:30 - 17:30
E HDI in Unders erv ed P opul at ions
17:30 - 18:30
Quali t y A s s uranc e
Unilat eral and M ild-t o-Moderat e
E m powering P arent s
Hearing Los s
A udit ory Neuropat hy and A udit ory
P roc es s ing Dis orders
M odels of Trai ning and S upport
Wednesday, June 6, 2012
Room A IDA
Room B OHE M E
Room FA LS T A FF
New Diagnos t i c Tec hniques
-
Keynote Address
P redi c t ing dev elopm ent al out c om es of
09:00 - 09:45
early - and lat e-ident if i ed c hi ldren wit h
heari ng i m pai rm ent , inc ludi ng t hos e wit h
s pec ial needs : Findi ngs f rom a
populat ion s t udy - Teresa YC Ching
09:45 - 10:30
Coc hl ear Im plant s : Com pl ex Cas es
10:30 - 11:00
Coffee Break
11:00 - 12:30
Genet i c s of Hearing Los s
12:30 - 13:45
Web f or S oc ial and S k i ll
-
Dev elopm ent
Coffee Break
Satellite Event
Ot ic on P ediat ri c S y m pos i um
Nurs ery B as ed S c reeni ng
Lunch
Lunch
Special Session
Int ernat ional Report on E HDI P rogram s
13:45 - 15:15
Organized by the International Working Group
on Childhood Hearing and the CDC/National
Coc hlear Im plant S t udi es
S c reening B ey ond t he Newborn P eriod
Center on Birth Defects and Developmental
Disabilities
Mini-Symposium on
Frequenc y l owering t ec hnology f or
15:15 - 16:45
E HDI P olic ies
c hil dren: a rev iew of res earc h
Foc us on Tec hnologies
ev idenc e and rec om m endat ions f or
c linic ians - Teresa YC Ching
16:45 - 18:00
Poster Session and refreshments
19.30
Social Dinner
Thursday, June 7, 2012
09:00 - 10:30
Room A IDA
Room B OHE M E
Room FA LS T A FF
A udit ory B rains t em Res pons e
Hearing A ids and FM S y s t em s
Out c om e S t udies
S t udies of Work i ng M em ory and
Heari ng Los s and M edi c al
Reading
Condi t i ons
Coffee Break
10:30 - 11:00
11:00 - 12:00
12:00 - 13:00
E v idenc e B as ed NHS and Dat a
M anagem ent
Fac t ors Inf luenc i ng Out c om es
P arent S upport
E FA S GE NE RA L A S S E M B LY
End of meeting
NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 v
CONTENTS PROGRAM Oral Sessions vii
Poster Session xviii
ABSTRACTS Keynote Address: Closing the Gap: Progress from Preschool to Elementary Grades and High School in Children with Early Cochlear Implantation ‐ Ann Geers 1
Lost to Follow‐up 2
EHDI in Underserved Populations 4
Quality Assurance 7
Applications of Tele‐Health 10
Unilateral and Mild‐to‐Moderate Hearing Loss 12
Auditory Neuropathy and Auditory Processing Disorders 15
Models of Early Intervention 18
Empowering Parents 20
Models of Training and Support 23
Keynote Address: 25
Predicting developmental outcomes of early‐ and late‐identified children with hearing impairment, including those with special needs: Findings from a population study ‐ Teresa YC Ching Cochlear Implants: Complex Cases 26
Genetics of Hearing Loss 28
Special Session: 33
International Report on EHDI Programs. Organized by the International Working Group on Childhood Hearing and the CDC/National Center on Birth Defects and Developmental Disabilities (EHDI Team) EHDI Policies 43
New Diagnostic Techniques 47
Web for Social and Skill Development 49
Cochlear Implant Studies 51
Mini‐Symposium: Frequency lowering technology for children: a review of research evidence and recommendations for clinicians ‐ Teresa YC Ching Nursery Based Screening 55
56
NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy vi NHS 2012
Screening Beyond the Newborn Period 60
Focus on Technologies 64
Auditory Brainstem Response 68
Studies of Working Memory and Reading 72
Evidence Based NHS and Data Management 75
Hearing Aids and FM Systems 78
Hearing Loss and Medical Conditions 81
Factors Influencing Outcomes 84
Outcome Studies 87
Parent Support 91
Poster Session 95
EHDI Protocols and Technologies 95
Surveys on EHDI Programs 103
Screening and Assessment Beyond the newborn Period 119
Assessment Techniques 128
Hearing Loss and Medical Conditions 139
Genetics of Hearing Loss 147
Speech and Language 151
Outcome Studies 156
Training and Support 176
Focus on Families 178
List of contributors 182
NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 vii
June 5 ‐ ROOM DON GIOVANNI 14:00 ‐ 14:15 Welcome
F. Grandori, D. Hayes 14:15 ‐ 15:15 Keynote Address Closing the Gap: Progress from Preschool to Elementary Grades and High School in Children with Early Cochlear Implantation ‐ Ann Geers 15:15 ‐ 16:00 Lost to Follow‐up 15:15 ‐ 15:30 How can we improve follow up for Newborn Hearing Screening referrals? ‐ Wood SA 15:30 ‐ 15:45 Understanding non participation to follow up diagnostic testing after NHS ‐ Uilenburg N, Wiefferink K, Meuwese‐Jongejeugd A, Oudesluys‐Murphy HM 15:45 ‐ 16:00 Newborn hearing screening targeted follow–up: Our experience ‐ Spyridakou C, Ross K 16.00 ‐ 16.30 Coffee Break 16:30 ‐ 17:30 EHDI in Underserved Populations 16:30 ‐ 16:45 Identifying deaf babies and helping their families in the rural and remote islands of the Pacific ‐ Johnson J, Weirather Y 16:45 ‐ 17:00 Infant hearing screening at a community‐based obstetric unit: a comparative study of screening technology and outcomes ‐ De Kock T, Swanepoel DW 17:00 ‐ 17:15 A new model for Newborn Hearing Screening. First screening on the 42nd day after birth ‐ Zhang X, Yan S, Li X, Gu C, Zhang H 17:15 ‐ 17:30 The Universal Newborn Hearing Screening (UNHS) in mobile people in Beijing ‐ Qi B, Cheng X, En H, Liu B, Peng S, Zhen Y, Cai Z, Huang L, Zhang L 17:30 ‐ 18:30 Quality Assurance 17:30 ‐ 17:45 The impact of quality assurance on improving service provision of the hearing screening pathway ‐ Cameron C 17:45 ‐ 18:00 Monitoring the development of deaf and hard of hearing children: an important step towards more evidence‐based intervention ‐ Vermeij BAM, Van der Zee R, Kriens T, Kip P, Wiefferink CH 18:00 ‐ 18:15 Strategies to increase data quality and perform program evaluation: which benchmarks/strategies work better? ‐ Ederra M, Ascunce N, García M, Zubicaray J 18:15 ‐ 18:30 Strategies to reduce loss to follow‐up in population‐based Neonatal Hearing Screening ‐ Ederra M, Ascunce N, García M, Zubicaray J NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy viii NHS 2012
June 5 ‐ ROOM BOHEME 15:15 ‐ 16:00 Applications of Tele‐Health 15:15 ‐ 15:30 Computer based phonological intervention ‐ effects on phonological processing ‐ von Mentzer C, Lyxell B, Sahlén B, Wass M, Uhlén I, Lindgren M, Ors M, Kallioinen P, Engström E 15:30 ‐ 15:45 Remote programming of cochlear implants: Most practical solution in Indian scenario ‐ Wadhera M 16.00 ‐ 16.30 Coffee Break 15:45 ‐ 16:00 Cochlear implants remote fitting in Russian Federation: Current stage and future developments ‐ Bakhshinyan V, Belov O, Eikeland Ch, Büchner A, Winter M, Fray J, Tavartkiladze GA Unilateral and Mild‐to‐Moderate Hearing Loss 16:30 ‐ 17:30 16:30 ‐ 16:45 Language development in children with neonatal unilateral hearing loss compared to normal hearing controls ‐ Desloovere C, Zink I 16:45 ‐ 17:00 Demographic characteristics of children with unilateral hearing loss: A multicentric study in Turkey ‐ Genc GA, Konukseven O, Kirkim G, Basar Suren F, Tuncer U, Kayikci M, Topcu C, Turan Dizdar H, Kaynar F, Akar F, Kaya S, Coskun H, Bayar Muluk N, Ozdek A, Serbetcioglu B, Belgin E 17:00 ‐ 17:15 Prevalence and risk factors for mild sensorineural hearing loss: findings from the Avon Longitudinal Study of Parents and Children ‐ Hall AJ, Midgley E, Steer C, Humphriss R 17:15 ‐ 17:30 Language development of young children with moderate hearing loss ‐ Dirks E, Van der Zee R, Hoek J 17:30 ‐ 18:30 Auditory Neuropathy and Auditory Processing Disorders 17:30 ‐ 17:45 Characterizing speech pattern contrasts in Auditory Neuropathy Spectrum Disorder ‐ Runge C, Jensen J, Burg L, Friedland D 18:00 ‐ 18:15 Screening test for auditory processing: A preliminary report ‐ Yathiraj A, Maggu AR 17:45 ‐ 18:00 Speech‐evoked potential testing in central auditory processing disorders: An objective index for post‐training improvement ‐ El‐Kholy W, Hazzaa N, Abdel‐Maksoud A, Abdel‐Rahman T 18:15 ‐ 18:30 Auditory Neuropathy Spectrum Disorder: four case studies with four different outcomes ‐ Ioannou M, Aspris A, Kyamides Y NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 ix
June 5 ‐ ROOM FALSTAFF 15:15 ‐ 16:00 Models of Early Intervention 15:15 ‐ 15:30 Embedding evidence‐based practice in early intervention programs for deaf and hard of hearing children ‐ Dirks E, van Dijk M, Kip P, Kriens T 15:30 ‐ 15:45 Maximizing listening and speaking following early diagnosis: The research evidence ‐ Dornan DA 15:45 ‐ 16:00 Parent Child Mother Goose program ‐ Dann M 16.00 ‐ 16.30 Coffee Break 16:30 ‐ 17:30 Empowering Parents 16:30 ‐ 16:45 How to motivate Newborn Hearing Screening in the absence of a national program: A collaboration between parents and professionals ‐ The Italian Pediatric Federation Audiology Network ‐ Cutler J, Lenzi G, Berrettini S 16:45 ‐ 17:00 Empowering families of babies and young children with cochlear implants through early intervention home based education ‐ Supporting a new model of service and resource provision ‐ Rocca C, Lewis S, Driver S, Stark E 17:00 ‐ 17:15 Parental perceptions of the experience and impact of the early identification and management of unilateral hearing loss ‐ Carr G, Sutton G, Pattison E, Kean M 17:15 ‐ 17:00 Enhanced parental communication skills by the Muenster Parental Program ‐ Glanemann R, Reichmuth K, Matulat P, am Zehnhoff‐Dinnesen A 17:30 ‐ 18:30 Models of Training and Support 17:30 ‐ 17:45 CICFAST: Cochlear Implant Competencies ‐ Family and Staff Training ‐ Shipgood L, Reed‐
Beadle E 17:45 ‐ 18:00 Supporting tele‐intervention for infants and toddlers with hearing loss through a learning community ‐ Behl D, White K 18:00 ‐ 18:15 Promoting awareness and education on Auditory Neuropathy ‐ Landsvik B, Wingaard L, Ørn I 18:15 ‐ 18:30 The deaf educators and rehabilitation professionals views about Persian Cued Speech Website ‐ Movallali G, Malakooti B NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy x NHS 2012
Keynote Address Predicting developmental outcomes of early‐ and late‐identified children with hearing impairment, including those with special needs: Findings from a population study ‐ Teresa YC Ching 09:00 ‐ 09:45 June 6 ‐ ROOM AIDA 09:45 ‐ 10:30 Cochlear Implants: Complex Cases 09:45 ‐ 10:00 Brainstem and cortical responses evoked by stimulation with an Auditory Brain Stem Implant in a child with cochlear nerve aplasia ‐ Deggouj N, Gerard J‐M, Van Pesch V, El Ankari S, Rombaux P, Castelein S, Raftopoulos C 10:00 ‐ 10:15 Ten years of complex cases: procedures and outcomes of a large auditory implants program for very young deaf children ‐ Lilli G, Bracci Laudiero L, Mazzella G, Mariosa F, Cotecchia T, Pastore V, Diomaiuto I, Bojano A, Varriccho AM, Izzo R, della Volpe A 10:15 ‐ 10:30 The effectiveness of cochlear implantation in children with auditory neuropathy and cochlear nerve deficiency ‐ Huang L, Zhang Y, Chen X, Mo L, Zhang J, Liu H, Gong S, Li Y, Han D 10:30 ‐ 11:00 Coffee Break Genetics of Hearing loss 11:00 ‐ 11:15 Prevalence of MT‐RNR1 in the general population: is there a role for screening neonates requiring aminoglycosides ‐ Ibekwe TS, Bhimrao SK, Westerberg BD, Kozak FK 11:00 ‐ 12:30 11:15 ‐ 11:30 Genetic testing as an adjunct to newborn hearing screening in Ontario, Canada ‐ Stockley TL; Stanton SG; Brown C 11:30 ‐ 11:45 Genotype‐phenotype correlation for enlarged vestibular aqueduct related deafness ‐ Birkenhäger R, Aschendorff A, Arndt S, Maier W, Löhle E, Laszig R 11:45 ‐ 12:00 Audiological assessment of patients carrying mitochondrial 3243A>G mutation ‐ Iwanicka‐
Pronicka K, Pollak A, Skórka A, Lechowicz U, Pajdowska M, Furmanek M, Rzeski M, Korniszewski L, Płoski R 12:00 ‐ 12:15 The effect of consanguineous and non‐consanguineous marriage on hearing loss in newborn hearing screening: A multicenter study in Turkey ‐ Konukseven O, Genc A, Tuncer U, Kirkim G, Kaya S, Bolat H, Akar F, Dincol I, Bercin S, Serbetcioglu B, Belgin E 12:15 ‐ 12:30 Genetic screening and auditory follow‐up among neonates who failed universal newborn hearing screening ‐ Markova T, Lalaynts M, Bliznetz E, Polyakov A, Tsigankova E, Tavartkiladze GA 12:30 ‐ 13:45 Lunch NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 xi
Special Session International Report on EHDI Programs ‐ Organized by the International Working Group on Childhood Hearing and the CDC/National Center on Birth Defects and Developmental Disabilities (EHDI Team) Moderator: Gabriella Tognola 13:45 ‐ 13:50 Universal Hearing Screening Program in Russian Federation ‐ Tavartkiladze GA, Tsygankova ER (Russia) 13:50 ‐ 13:55 Does newborn screening deliver better outcomes for hearing impaired children and families in England? ‐ Davis A (UK) 13:55 ‐ 14:00 Socio‐demographic determinants of hearing impairment studied in 103835 term babies ‐ Van Kerschaver E, Wuyts FL (Belgium, Flanders) 13:45 ‐ 15:15 14:00 ‐ 14:05 Evolution and perspectives of a neonatal hearing screening program in the French Community of Belgium over 5 years (2007‐2011) ‐ Vos B, Lagasse R, Levêque A (Blegium, French Community)) 14:05 ‐ 14:10 Results of the Dutch hearing screening programme ‐ Van der Ploeg CPB, Uilenburg N, Van Zanten GA, Meuwese‐Jongejeugd A (The Netherlands) 14:10 ‐ 14:15 Evaluation of fourteen years AABR hearing screening in Dutch NICU’s ‐ van Straaten HLM, van Dommelen P, Verkerk PH (The Netherlands) 14:15 ‐ 14:20 Implementation and outcome of a two‐step UNHS program in North Rhine, Germany ‐ Fabian S, Weber A, Walger M, Lang‐Roth R (Germany) 14:20 ‐ 14:25 Effects and side effects of early identification, diagnosis and intervention of hearing impairment in Slovenia ‐ Zupan L, Spindler M (Slovenia) 14:25 ‐ 14:30 Universal Newborn Hearing Screening of Navarra (Spain): outcomes of twelve years ‐ Ederra Sanz M, Ascunce Elizaga N, García Pérez M, Zubicaray Ugarteche J (Spain) 14:30 ‐ 14:35 Newborn hearing screening programme in Turkey ‐ Konukseven O, Genc A, Bolat H (Turkey) 14:35 ‐ 14:40 Early Hearing Detection in Cyprus ‐ Thodi C, Vogazianos M (Cyprus) 14:40 ‐ 14:45 Comparative study of infant hearing loss in Southern Palestine ‐ Corradin L, Rahil M, Kanaan M (Palestine) 14:45 ‐ 14:50 The last results of national Newborn Hearing Screening in Iran ‐ Firozbakht M, Rafie M, Esmailzade A, Rahimi F, Ansari Dezfouli M, Mahmodian S (Iran) 14:50 ‐ 14:55 Newborn Hearing Screening in Brazil: recommendations and needs ‐ Lewis DR (Brazil) 14:55 ‐ 15:00 Early Hearing Screening, Detection and Intervention in public sector hospitals in Singapore ‐ Daniel LM, Joseph R, Ho S, Lim SB (Singapore) 15:00 ‐ 15:05 Newborn Hearing Screening in Indonesia: Limitations and challenges ‐ Suwento R, Anggraeni R, Zizlavsky S (Indonesia) 15:05 ‐ 15:10 Universal newborn screening and early intervention programme in New Zealand ‐ Tuohy PG (New Zeland) NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy xii NHS 2012
EHDI Policies 15:15 ‐ 15:30 Implementation of WHO newborn and infant hearing screening guiding principles for action in China ‐ Bu X 15:15 ‐ 16:45 15:30 ‐ 15:45 Quality and inequality in Newborn Hearing screening ‐ Tuohy PG 15:45 ‐ 16:00 ECD Policy In South Africa ‐ Economic And Financial Implications Of Excluding Children With Disabilities ‐ Störbeck C, Moodley S 16:00 ‐ 16:15 European Consensus Statement on Hearing Screening of Pre‐School and School‐Age Children ‐ Skarżyński H, Piotrowska A, Lorens A, Kamyk P, Ludwikowski M, Skarżyński PH 16:15 ‐ 16:30 Integrated systems and team working for children with auditory challenges: Health professional practice in interprofessional non‐healthcare contexts ‐ Ng S, Schryer C, Hibbert K, Regan S, Lingard L 16:30 ‐ 16:45 The goals for tracking and quality assurance for audiological screening ‐ Tavartkiladze GA, Belov OA, Tsygankova ER, Alexeeva NN NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 xiii
June 6 ‐ ROOM BOHEME 09:00 ‐ 09:15 Hearing Screening with multi‐Frequencyspecific Animal Sound Test (mFAST) ‐ Coninx F, Offei Y 09:15 ‐ 09:30 Speech intelligibility tested by the Pediatric Matrix Sentence test in 3 to 6 year old children ‐ Ozimek E, Kutzner D, Libiszewski P 09:30 ‐ 09:45 An objective, automatic, and non‐invasive method for sound localization measurements in infants and small children ‐ Asp F, Olofsson Å, Berninger E 09:45 ‐ 10:30 09:00 ‐ 9:45 New Diagnostic Techniques Web for Social and Skill Development 09:45 ‐ 10:00 Enhanced patient care – Exploiting the Social Web Environment ‐ Lehnhardt M 10:00 ‐ 10:15 The impact of social networks on deaf teenager’s communication ‐ Mikic B, Mikic M, Miric D, Asanovic M, Ostojic S 10:15 ‐ 10:30 SoundScape ‐ online listening activities for children using hearing devices ‐ Gasser C 11:00 ‐ 13:45 10:30 ‐ 11:00 Coffee Break Satellite event: OTICON Paediatric Symposium 13:45 ‐ 15:15 Cochlear Implant Studies 13:45 ‐ 14:00 Integrating cochlear implantation with newborn hearing screening using an evidence‐based approach ‐ Dowell RC, Dettman SJ, Leigh JR 14:00 ‐ 14:15 Benefits of acoustic and semantic enhancements on speech in noise recognition for children with normal hearing and children with cochlear implants ‐ Sladen D, Smiljanic R 14:15 ‐ 14:30 Lexical and semantic ability in children with cochlear implants ‐ Löfkvist U, Lyxell B, Tallberg IM 14:30 ‐ 14:45 Use of musical scales in fine tuning of cochlear implants ‐ Tani A 14:45 ‐ 15:00 Bilateral cochlear implantation in children: sensitivity of clinical assessments ‐ Bergeron F, Bussières R, Cöté M, Duchesne L, Losier C, Tremblay G 15:15 ‐ 16:45 15:00 ‐ 15:15 Premature and/or low birth weight infants: Speech processor programming considerations and communication outcomes ‐ Dettman SJ, Oh SY, Dowell RC Mini‐Symposium on Frequency lowering technology for children: A review of research evidence and recommendations for clinicians ‐ Ching TYC, Bagatto M, Bohnert A, Kuk F, King A NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy xiv NHS 2012
June 6 ‐ ROOM FALSTAFF
Nursery Based Screening 11:00 ‐ 12:30 11:00 ‐ 11:15 Sensitivity and specificity of a two‐step hearing screening protocol in the well infants nursery ‐ Levit Y, Dollberg S, Himmelfarb M 11:15 ‐ 11:30 Early detection of infant hearing loss in the private health care sector of South Africa ‐ Meyer ME, Swanepoel DW, Le Roux T, Van der Linde M 11:30 ‐ 11:45 Neonatal Hearing Screening in private medical centers ‐ Rajati M, Ghasemi MM, Tale MR, Bakhshaee M, Nourizadeh N 11:45 ‐ 12:00 Noise in neonatal intensive care unit (NICU): Measurement and effects ‐ Shalaby A, Hussanien S, EL Disouky E 12:00 ‐ 12:15 Hearing screening in high risk infants ‐ Dlouha O, Hrbkova M, Krejci H, Cerny L, Cerna P 12:15 ‐ 12:30 Infants admitted to the NICU need universal newborn hearing screening; referral to audiology alone is not enough ‐ Carew P, Poulakis Z, Barker M Lunch 12:30 ‐ 13:45 Screening Beyond the Newborn Period 13:45 ‐ 15:15 13:45 ‐ 14:00 Detection of postnatal hearing loss using a risk factor registry: Results of a 5‐year targeted surveillance program review ‐ Beswick R, Driscoll C, Kei J, Glennon S 14:00 ‐ 14:15 Identification of late onset hearing loss: Is targeted follow up from the newborn hearing screen effective? ‐ MacKinnon A, Campbell S, Stones M 14:15 ‐ 14:30 Second hearing screening after NHS using the LittlEARS® auditory questionnaire ‐ a German field study ‐ Coninx F, Schaefer K 14:30 ‐ 14:45 Comparison of pure tone and DPOAE screenings in a preschool population ‐ Niquette P, Chase M, O’Brien B 14:45 ‐ 15:00 Screening for delayed‐onset hearing loss in preschool children who previously passed the newborn hearing screening ‐ Lv J‐R, Huang Z‐W, Wu H 15:00 ‐ 15:15 Automated hearing screening for school children – a pilot study in China ‐ Kam ACS, Tong MCF Focus on Technologies 15:15 ‐ 16:45 15:15 ‐15:30 The School Entry Hearing Screen: Is this a ‘SMART’ way forward? ‐ Davis A, Manuel‐Barkin C 15:30 ‐15:45 GN Otometrics AccuScreenTM and Natus EchoScreenTM with mobile communication technology simplifies tracking for UNHS: Results of a field study ‐ Matulat P, Oswald H, Lepper I, Schmidt C‐M, am Zehnhoff‐Dinnesen A 15:45 ‐16:00 Using RITE hearing aids in the pediatric population ‐ Caporali SA, Roikjer M, Jeppesen AMK, Olszewski L, Malgorzata M 16:00 ‐16:15 Latest developments in soundfield technology ‐ Mülder HE 16:15 ‐ 16:30 ReSound Mini Microphone ‐ Strong Wireless Connections to the World ‐ Haastrup A 16:30 ‐16:45 Use of ClearVoice™ in everyday life: outcomes in children ‐ Noël‐Petroff N, Ulmann C, Van Den Abbeele T, Mathias N NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 xv
June 7 ‐ ROOM AIDA Auditory Brainstem Response 09:00 ‐ 10:30 09:00 ‐ 09:15 Peer and expert review reduces errors in newborn diagnostic ABR testing ‐ Sutton G 09:15 ‐ 09:30 A strategy for selecting the optimum artifact rejection level during diagnostic ABR testing ‐ Lightfoot G 09:30 ‐ 09:45 The effects of stimulus repetition rate and electrode montage to the Auditory Brainstem Response (ABR): Results in infants ‐ Dzulkarnain AAA, Abdul Hadi US, Jamaluddin SA, Ali Hanafiah N 09:45 ‐ 10:00 Auditory Brainstem Response morphology and analysis in very preterm neonatal intensive care unit infants ‐ Coenraad S, Toll MS, Hoeve LJ, Goedegebure A 10:00 ‐ 10:15 A novel screening protocol for the differentiation of type of hearing loss In Neonatal Intensive Care Unit (NICU) infants ‐ Shahnaz N, Millman T, Douglas C, Narne VK, Vijayasarathy S, Kumar KS, Mazlan R 10:15 ‐ 10:30 Electrically evoked auditory brainstem responses in children and adults ‐ Butinar D, Gros A, Battelino S, Vatovec J 10:30 ‐ 11:00 Coffee Break 11:00 ‐ 12:00 Studies of Working Memory and Reading 11:00 ‐ 11:15 Some preliminary findings using the missing scan task to measure working memory capacity in young children ‐ Roman A, Pisoni D 11:15 ‐ 11:30 The comparative study of reading comprehension in hearing and deaf student ‐ Nikkhoo F, Hassanzadeh S 11:30 ‐ 11:45 Reading difficulty in children: Auditory and visual modalitiesʹ affection ‐ Shalaby AA, Khalil LH, Elkabariti RH, Khalil SH, Nada MA, Khattab AN 11:45 ‐ 12:00 Influence of early intervention to the reading ability of deaf children ‐ Widuri A, Rianto D 12:00 ‐ 13:00 Evidence Based NHS and Data Management 12:00 ‐ 12:15 The Dutch NHS tracking system; a powerful tool for the screening programme ‐ Schuitema T, Van Oostrom S, Esveld M, Bouwens J, Uilenburg N 12:15 ‐ 12:30 How to follow up babies who failed: The Web Archive & data management ‐ Bolat H, Konukseven Ö, Genç A, Tezel B, Özbaş S, Köse MR 12:30 ‐ 12:45 Evidence based data with JCIH criteria for bilateral Hearing loss: A multicentric study in Turkey ‐ Konukseven O, Genc A, Muluk N, Basar Suren F, Kirkim G, Tuncer U, Kulakkayikci M, Karatas E, Bolat H, Akar F, Dincol I, Yorgun M, Kalcigolu T, Serbetcioglu B, Muzaffer Kiriş, Belgin E 12:45 ‐ 13:00 Public health Early Hearing Detection and Intervention programs in the era of health information technology standards – A bang or a whimper? ‐ Orlova A, Finitzo T NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy xvi NHS 2012
June 7 ‐ ROOM BOHEME 09:00 ‐ 10:30 Hearing Aids and FM Systems 09:00 ‐ 09:15 Evaluating the outcome of pediatric hearing aid fittings ‐ Bagatto M, Moodie S, Malandrino A, Richert F, Clench D, Scollie S 09:15 ‐ 09:30 A clinical trial of receiver‐in‐the‐ear hearing aids for newly diagnosed hearing‐impaired infants ‐ Smith J, Dann M 09:30 ‐ 09:45 Efficacy of frequency transposition on speech perception and production in hearing impaired Arabic–speaking children ‐ El Danasoury I ,Hazzaa N, Saber A, Elkabarity R 09:45 ‐ 10:00 Electroacoustic analysis of FM transparency and directional microphones ‐ Thibodeau L, Alford J, McLellan C 10:00 ‐ 10:15 FM technology use with pre‐school hearing aided children ‐ Mulla I, McCracken W 10:30 ‐ 11:00 Coffee Break 11:00 ‐ 12:00 Hearing Loss and Medical Conditions 11:00 ‐ 11:15 Silent diabetic cochleopathy: Affection of OHCs (Outer Hair Cells), olivocochlear bundle (OCB) and/or Inner hair cell in Type 1‐ Diabetes Mellitus (T1DM) among Egyptian children ‐ Elbarbary NS, El‐Kabarity RH 11:15 ‐ 11:30 The high prevalence of otitis media with effusion in children with cleft lip and palate as compared to children without clefts ‐ Flynn T, Möller C, Jönsson R, Lohmander A 11:30 ‐ 11:45 Aural atresia in newborn hearing screening: A multicentric study in Turkey ‐ Basar Suren F, Kirkim G, Gunduz B, Kulakkayikçi M, Genc A, Konukseven O, Gokdogan C, Guven AG 11:45 ‐ 12:00 Universal molecular screening for congenital CMV infection at birth to establish etiology for late onset prelingual hearing loss: Results from a pilot study ‐ Pandya A, Dodson KM, Xia XJ, Marshall B, Adler S 12.00 ‐ 13:00 Factors Influencing Outcomes 12:00 ‐ 12:15 Early diagnosis, leading to early implantation? ‐ Archbold S, Wheeler A, Gregory S 12:15 ‐ 12:30 Does early newborn screening tell us enough about deaf infants? Language outcomes of deaf children in a bilingual early intervention program ‐ Levesque E 12:30 ‐ 12:45 Effect of vocabulary intervention on verb production and syntax in two children with severe sensorineural hearing loss ‐ Moran C, Morgan K 12:45 ‐ 13:00 Sensory processing difficulties among children with hearing deficits and their relation to childʹs participation in leisure activities ‐ Engel‐Yeger B, Hamed S NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 xvii
June 7 ‐ ROOM FALSTAFF Outcome Studies 09:00 ‐ 10:30 09:00 ‐ 09:15 Child, adolescent and young adult outcomes in children born with congenital hearing loss before UNHS: The CHIVOS population‐based longitudinal study ‐ Wake M, Poulakis Z, Wirth K, Mensah F, Paatsch L, Bryson H, King A, Rickards F 09:15 – 09:30 Communication options for young CI children at mainstream settings ‐ Dionissieva K 09:30 – 09:45 How early is too early? Cochlear Implantation in infants under 6 months, 7‐9 months and 10‐
12 months old ‐ Abrahams Y, Davis A, Hopkins T, Sperandio D 09:45 – 10:00 Concurrent validity of scores from the Conditioned Assessment of Speech Production (CASP) and speech sample analyses ‐ Ertmer DJ 10:00 – 10:15 A comparative study of speech and language skills in cochlear implantees and normal hearing children with an age range of 3 years ‐ Arora S, Agarwal A, Sharma S, Lahiri AK 10:30 ‐ 11:00 Coffee Break 10:15 – 10:30 Mandarin language development following early cochlear implantation ‐ ZhengY, Soli SD, Tao Y, Meng Z, Li G 11:00 – 12:00 Parent Support 11:00 – 11:15 Empowered mothers promote the wellbeing of their deaf child. Experiences of mothers in Ethiopia and Finland ‐ Sume H, Lehtomäki E, Abey M 11:15 – 11:30 Creating /Enhancing Family Support Systems ‐ Beeler J, McCamy S, Chase P, Luckey J, Thibodeau L, Watts K, Sexton J 11:30 – 11:45 Increasing parents’ knowledge and comfort in caring for their child’s first hearing aids ‐ Harris A, Thibodeau L 12.00 ‐ 13:00 11:45 – 12:00 Parent stress, parent‐child relationships and child social/emotional and language outcomes for children with bilateral and unilateral cochlear implants ‐ Sarant JZ, Holland J, Bant S, Bennet L, Garrard P, Galvin KL, Busby PA, Blamey PJ, Rance G EFAS General Assembly NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy xviii NHS 2012
POSTER SESSION JUNE 6, 16.45 – 18.00 EHDI Protocols and Technologies 1 The benefit and value of quality assurance review of newborn ABR assessments ‐ Cameron C, Sutton G 2 Data collection and routing in the national audiological screening ‐ Belov OA, Alexeeva NN, Tavartkiladze GA 3 Newborn hearing screening vs later hearing screening: healthcare resource utilization in children with permanent childhood hearing impairment ‐ Schouten CS, Korver AMH, Konings S, Dekker FW, Frijns JMH, Van den Akker‐Marle, Oudesluys‐Murphy AM 4 Improvement of newborn hearing screening workflow ‐ Hurteau AM, Dalå J, Lund AS 5 Early hearing screening in high‐risk premature babies: ‘Early’ on the verge of ‘too early’ ‐ Royackers L, Desloovere C 6 Hearing screening based on auditory brainstem responses: comparison of Natus ALGO 3i and MAICO MB 11 ‐ Luts H, Hofmann M, Van Eeckhoutte M, Poelmans H, Wouters J 7 Newborn hearing screening with MB11 BERAphone® ‐ What have we achieved so far? ‐ Cebulla M, Keim R, Shehata‐Dieler W 8 Usability of two types of automated brainstem response in the screening of newborns admitted to intermediate neonatal units ‐ Sequi Canet JM, Lorente Mayor L 9 Introducing a new technology in children objective auditory explorations. Its impact within Early Detection Deafness Program in Catalonia ‐ De Muller A, Gambettola J, Torres Y, Lacima J, Clavería MA 10 New technology in children objective auditory exploration. ABR with no sedation/anaesthesia. Our experience and results ‐ Torres Y, Gambettola J, De Muller A, Lacima J, Clavería MA 11 The efficacy of a two‐stage protocol for newborn hearing screening using transient evoked otoacoustic emissions and automated auditory brainstem responses ‐ Ari‐Even Roth D, Kuint J, Hamburger A, Henkin Y, Hildesheimer M 12 Comparison of otoacoustic emissions and automated auditory brainstem response for newborn hearing screening ‐ Sargsyan A 13 Amplitudes of transient evoked otoacoustic emissions and distortion product otoacoustic emissions in pre‐
term and full‐term neonates: A survey ‐ Lata S, Ranjan P. 14 Prognostic factors for transiently evoked otoacoustic emissions measurement in children with changes of middle ear impedance ‐ Bojanovic M, Zivkovic‐Marinkov E, Stankovic M, Zivic M, Milisavljevic D, Ristic S NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 xix
Surveys on EHDI programs 15 16 Early Hearing Detection in Cyprus: Outcome Measures ‐ Thodi C, Vogazianos M Effects of a neonatal hearing screening program on a hearing rehabilitation center ‐ Vos B, Courtmans I, Ventura M, Lagasse R, Levêque A, Ligny C 17 Age of hearing aid fitting after NHS in the Netherlands ‐ Uilenburg N, Korver NM, Oudesluys‐Murphy HM, Meuwese‐Jongejeugd A 18 How a suburban community hospital improved the rates of newborn hearing re‐screens ‐ Wilson‐Phillips L, Spence T 19 Outcomes of newborn hearing screening. Etiological evaluation in bilateral and unilateral confirmed hearing loss ‐ Rolesi R, Fioretti M, Frezza S, Gallus R, Giannantonio S, Martina BM, Papacci P, Conti G 20 Neonatal hearing loss and impact of regional hearing screening legislation ‐ Bubbico L, Tognola G, Martini A, Grandori F 21 Universal Newborn hearing screening program in Modena ‐ Palma S, De Luca M, Reggiani S, Genovese E, Borsari S 22 Development of Newborn Hearing Screening Program in Republic of Macedonia ‐ Chakar M, Fakovikj N , Femikj N, Jovchevski S 23 Newborn Hearing Screening with an emphasis on high‐risk neonates ‐ Zivkovic‐Marinkov E, Bojanovic M, Stankovic M, Zivic M, Milisavljevic D, Ristic S, Conic M 24 The acting protocol of a deaf child is based on the interdisciplinary healthy‐education intervention in Catalonia’s public network (Spain), starting from the universal neonatal hearing screening implementation ‐ Clavería MA, Marro S, Calvo P, Coll N 25 Newborn Hearing Screening: Portuguese Reality ‐ Santos N, Martins J, Delgado T 26 Universal Neonatal Hearing Screening programme in Venezuela ‐ Hernández Villoria R 27 Cost benefit of Newborn Hearing Screening in a public hospital in Sao Paulo ‐ Brazil ‐ Fazion CB, Manas AV, Monteiro PC, Lewis DR 28 Newborn hearing program: From diagnosis to hearing aid fitting ‐ Bagni JM, Couto CM, Colella‐Santos MF 29 Hearing Health Program In Neonates In Intensive And/Or Intermediate Care Unit ‐ Colella‐Santos MF, Couto CM, Sartorato EL, Lima MCMP, Françozo MFC, TazinazzioTG, Marba ST 30 Unilateral hearing loss in children: some interim findings of a longitudinal prospective study ‐ Pupo A, Barzaghi L 31 Monitoring of children with risk indicators for hearing loss ‐ Eliene Silva Araújo, Fernanda de Souza Lima, Zucki F, Oliveira L, Lopes R, Chaves J, Alvarenga KF 32 EHDI Comes of Age in American Samoa ‐ Johnson J, Anderson‐Asuega J 33 Newborn and infant hearing screening programmes in a developing country: Exploring the procedures and protocols at immunisation clinics ‐ Petrocchi‐Bartal L, Khoza‐Shangase K 34 A three year outcome report of newborn and infant screening at All India Institute of Speech and Hearing (AIISH), Mysore in India ‐ Manjula R, Arunraj K, Savithri SR NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy xx NHS 2012
35 Impact of socio‐economic variables on outcomes of cochlear implantation in a developing country ‐ Agarwal A, Arora S, Sharma S, Lahiri AK 36 37 10 years of cochlear implantation in India: trends and outcomes ‐Agarwal A, Arora S, Sharma S, Lahiri AK Newborn Hearing Screening and genetic testing for deafness in Pakistani infants ‐ Ahmed ZM, Brown DK, Khan SN, Akram J, Riazuddin S, Riazuddin S 38 National Program For Early Detection of Hearing Loss in the state of Qatar ‐ Hadi AK, Al‐Sulaiteen M, Al‐
Alawi F 39 National Program for Detection of Hearing Loss in State of Qatar Stage No.3 Hearing screening (pre‐
School) ‐ Hadi AK, Al‐Sulaiteen M, Al‐Alawi F 40 Risk factors associated with hearing loss in premature infants ‐ Eras Z, Konukseven O, Genc A, Dincol I, Sungur VG, Belgin E, Dilmen U 41 Newborn Hearing Screening Program in Gazi University Hospital (Ankara, Turkey) between 2003 and 2011 ‐ Kemaloğlu YK, Gökdoğan Ç, Küçükünal S, Gündüz B, Seyrek M, Türkyılmaz C, Önal EE, Atalay Y 42 Intervention for the Hearing Impaired in the Development Perspective (IHIDP) in Bangladesh ‐ Motaleb A Screening and Assessment Beyond the newborn Period 43 The School Entry Hearing Screen: To do or not to do – that is the question? ‐ Atty G, Manuel‐Barkin C 44 A new test to assess central auditory processing of 4‐year‐old children: A psychoacoustic and MMN study ‐ Neumann K, Zaretsky Y, Euler HA, Kunz L, Looschen A, Beste C, Ocklenburg S, Lücke T, Dazert S, 45 Schirkonyer V, Oswald H. Preparing and validating LEAQ as a screening tool for Ghanaian children aged 6 – 36 months ‐ Offei YN, Coninx F 46 Targeted surveillance following Newborn Hearing Screening‐is it worth it? ‐ Wood SA, Davis AC, Sutton GJ 47 Etiology and severity of HL, school type and mode of communication, in NICU graduates at 3‐5 years of 48 age ‐ van de Ven EA, van Straaten HLM, Oudesluys‐Murphy AM, Korver AMH Development and quality of life in NICU graduates and healthy newborns with PCHI at 3‐5 years of age 49 after NHS ‐ van de Ven EA, van Straaten HLM, Oudesluys‐Murphy AM, Korver AMH Trends in hearing loss and Noise‐Included Hearing Loss (NIHL) in United States adolescents, 1966‐2008 ‐ 50 51 52 Hoffman HJ, Li C‐M, Themann CL, Dobie RA
Hearing Screening in preschool and school – Portuguese experience ‐ Martins JT, Delgado T Health hearing on 5/6 years old ‐ Serrano M Audiologic screening in the city of Lisbon ‐ Serrano M 53 Intervention Model in Occupational Hearing Loss ‐ Barbosa A, Sousa A, Oliveira V and Lopes P 54 Tinnitus as a problem among children during hearing screening program in school age children in Poland ‐ Skarzynski PH, Kochanek K, Skarzynski H, Piotrowska A, Sliwa L, Jedrzejczak WW, Pilka A, Bruski L 55 Hearing screening program in school age children in Poland ‐ Skarzynski PH, Kochanek K, Skarzynski H, Piotrowska A, Sliwa L, Jedrzejczak WW, Pilka A, Bruski L 56 57 Hearing and deaf preschool children in Serbia ‐ Savić MM, Savić MP, Savić VP, Nikolić SV Hearing screening and intervention from newborns to preschool‐age children ‐ Huang Z‐W, Wu H, Lv J‐R, Li Y, Huang Q NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 xxi
Assessment Techniques 58 Survey of follow‐up testing methodology for newborn hearing screening referrals ‐ A call for 59 standardization ‐ Delgado RE, Lim BG, Delgado CF Development of a simultaneous air‐ and bone‐conduction newborn hearing screening technique using ASSR Intensity‐Ramping stimuli ‐ Delgado RE, Hood LJ, Hatton K, Stangl S, Rentmeester L, and Savio G 60 Do frequency specific chirps offer a quicker ABR assessment in newborns compared to tone pips? ‐ Ferm I, Lightfoot G, Stevens J 61 ABR to bone‐conducted tones in infants with conductive or sensorineural hearing loss ‐ Hatton JH, Janssen RM, Stapells DR 62 Reducing recording time of brainstem auditory evoked responses by the use of randomized stimulation ‐ Valderrama J, Alvarez I, de la Torre A, Segura JC, Sainz M, Vargas J 63 Circular Phase Clustering based Auto‐Adaptation for the Objective Assessment of ABR Measurement Quality ‐ Strauss DJ, Corona‐Strauss FI 64 Effective masking levels at 500 and 2000 Hz for bone‐conduction auditory steady‐state responses in infants and adults with normal hearing ‐ Small SA, Leon G, Smyth A 65 Evoked potentials in young children – the challenge ‐ Linnebjerg LB, Wetke R 66 Hearing system maturation in normally hearing children: Long latency Auditory Evoked Potentials ‐ Alvarenga KF, Ventura LMP, Costa OA 67 Evaluation of brainstem timing in quiet and noise in children with learning disability ‐ Mamatha NM, Maggu AR, Uday K 68 A direct estimate of non‐linearity in Transient Evoked Otoacoustic Emissions: The bispectral approach ‐ Marchesi S, Tognola G, Paglialonga A 69 The decomposition of transient otoacoustic emissions on primary components as a tool for detection of small changes in TEOAE ‐ Belov OA, Alexeeva NN, Tavartkiladze GA 70 Distortion Product Otoacoustic Emission growth function in neonates ‐ Barbosa TA, Granato L, Durante A
71 Changes in transient evoked otoacoustic emissions contralateral suppression in newborns ‐ Martins PMF, Santos MFC 72 Using a derived otoacoustic emission criterion to improve the efficiency of a hearing assessment service for children under four years of age ‐ Liersch B, Mansfield D 73 Analysis of ear‐canal dynamic characteristics in neonates: theoretical considerations ‐ Murakoshi M, Takeda S, Wada H 74 Dynamic characteristics of the middle ear in newborns – study using the sweep frequency impedance (SFI) meter ‐ Wada H, Yoshida N, Kiyokawa H, Murakoshi M, Matsutani S, Kobayashi T 75 ‘Sign science’: Using international validated questionnaires in Sign language or sign supported language for epidemiological and quality of life research on hearing adolescents ‐ Smeijers AS, Bogaerde B, Ens‐
Dokkum M, Oudesluys‐Murphy AM NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy xxii NHS 2012
Hearing Loss and Medical Conditions 76 Analysis of risk factors associated with bilateral hearing loss identified through newborn hearing screening ‐ Dodson KM, Chapman DA, Wang S, Pandya A 77 Hearing tests on children with CLP treated at the Stockholm Craniofacial center Karolinska University Hospital ‐Tengroth B 78 Do Newborns with Craniosynostosis Have an Increased Incidence of Auditory Neuropathy? ‐ Scheele JE, Hubbard BA, Rice GB, Muzaffar AR 79 The paradox of maternal immunity as a risk factor for congenital cytomegalovirus infection: A population‐
based prediction model ‐ de Vries JJC, van Zwet EW, Kroes ACM, Verkerk PH, Vossen ACTM 80 Congenital cytomegalovirus (CMV) infection in the Netherlands: Birth prevalence and risk factors ‐ de Vries JJC, Korver AMH, Verkerk PH, Rusman L, Claas ECJ, Loeber JG, Kroes ACM, Vossen ACTM 81 Two examples of studies into rare populations made possible by the comprehensive collection of information by the universal Newborn Hearing Screening Programme in England ‐ Maier‐McAlpine J K, Davis AC 82 Could hypernatremia influence the neonatal hearing status? ‐ Boskabadi H, Nourizadeh N 83 Central auditory discrimination in toddlers is affected by recurrent acute otitis media ‐ Lapinlampi S, Niemitalo‐Haapola E, Kujala Tiia, Raappana A, Kujala Teija, Jansson‐Verkasalo E 84 Proposed clinical trial assessing the efficiency/effectiveness of xylitol nasal spray in preventing acute otitis media in the United States ‐ Johnson CE, Danhauer JL, Fisher SK, Hunt A, Piper C, Wilson L, Smith R, Teller C, Umeda C 85 Bjornstad syndrome ‐ Sensorineural Hearing Loss and Pili Torti ‐ Gomes, CA, Serrano, M 86 Evaluation of treatment thresholds for unconjugated hyperbilirubinemia on hearing loss in preterm infants ‐ Hulzebos CV, van Dommelen P, Verkerk PH, Dijk PH, van Straaten HLM 87 Follow‐up of newborns with hyperbilirubinemia compared to the healthy babies with no risk factor related with congenital hearing loss by auditory brainstem audiometry ‐ Toros M, Kemaloğlu YK, Türkyılmaz C, Önal EE, Gökdoğan Ç Genetics of Hearing Loss 88 Genetic screening of 40 genes in 140 Spanish familial cases of autosomal recessive non‐syndromic hearing impairment: towards the establishment of its genetic epidemiology in a Western European population ‐ Serrao de Castro L, Gandía M, Domínguez‐Ruiz M, Ruiz‐Palmero L, Rodríguez‐Ballesteros M, Charaf R, Olarte M, Aguirre LA, Garrido G, Gómez‐Rosas E, Moreno‐Pelayo MA, del Castillo FJ, Villamar M, Moreno F, del Castillo I 89 Massive targeted resequencing for the diagnosis of Hearing Impairment: a 69‐gene panel ‐Romera‐López A, Gómez‐Rosas E, Collado C , Rodríguez‐De Pablos R, Fernández‐Pedrosa V, Cantalapiedra D , Pérez‐
Cabornero L, Lázaro M, Rosa‐Rosa JM, Triviño JC, Zúñiga‐Trejos S, Miñambres R, Gil M, del Castillo I, Santillán S 90 Novel genetic tools to screen for deafness‐causing mutations in the tandemly‐duplicated region that contains the STRC (stereocilin) gene and pseudogen ‐ Ruiz‐Palmero L, Gandía M, Gómez‐Rosas E, Villamar M, Moreno F, del Castillo I, del Castillo FJ NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 xxiii
91 A novel splice‐site mutation in the GJB2 gene causing mild postlingual hearing impairment ‐ Gandía M, del Castillo FJ , Rodríguez‐Álvarez FJ, Garrido G, Moreno‐Pelayo MA, Villamar M, Moreno F, del Castillo I 92 Newborn hearing concurrent gene screening, deep analysis for predicting of genetic risks of hearing loss in Chinese neonates ‐ Wang Qiuju, Han Bing, Li Qian 93 The p.V37I exclusive genotype of GJB2: a genetic risk‐indicator of postnatal permanent childhood hearing impairment ‐ Li L, Lv J, Ma Y, Huang Z, Yang T, Wu H Speech and Language 94 Identifying sources of variability in normal‐hearing two‐year‐olds’ speech discrimination ‐ Lalonde KL, Holt RF 95 Early amplified infants: Speech Intelligibility Index as predictor of auditory behavior ‐ Figueiredo R, Novaes B 96 Computers as a resource of development of language for deaf bilingual children ‐ Levy CCAC, Adduci AV
97 The influence of belly dance in the constitution of the deaf individual ‐ Levy CCAC, Thomazinho CA 98 The LittlEARS® Early Speech Production Questionnaire: a validated questionnaire for very early speech production ‐ Hoffmann V, Schramm B, Keilmann A 99 Clinical Study of Nursery Rhymes and Music perception in Prelingual Cochlear Implanted Children ‐ Abdi S 100 Lexical stylistic specificity and hearing impaired children ‐ Nikolic VS 101 The Articulation of Children who are deaf and hard of hearing ‐ Nikolić SV, Savić MM, Savić MP, Savić VP Outcome Studies 102 Improving Outcomes for children with hearing loss: looking beyond the technology ‐ Abrahams Y, Davis A, Hopkins T, Sperandio D, Beresford S 103 From Newborn Screening to School: Long term audiological, speech and language outcomes after early intervention ‐ Abrahams Y, Davis A, Hopkins T, Sperandio D, Beresford S 104 Study of language and speech development in bilingual raising children with cochlear implants and/or hearing aid‐data collection in the long term ‐ Fabian A, Friese B, Hoffmann V, Keilmann A 105 Language outcomes of children with cochlear implants enrolled in different communication programs ‐ Erbaşi‐Yanbay E, Hickson L, Scarinci N, Constantinescu G, Dettman S 106 Psycho‐social development of deaf children with Cochlear Implants (CI) ‐ Fadda S 107 Quality of life and school success in children and adolescents with cochlear implant ‐ Duarte I, Rego G, Nunes R 108 Cognitive and communicative development in deaf and hearing‐impaired children with cochlear implants and/or hearing‐aids ‐ Wass M, Sahlén B, Uhlén I, Möller C, Henricson C, von Mentzer C and Mäki‐Torkko E 109 Phonological skills in children with cochlear implants two years after activation compared with typically developing peers ‐ Välimaa T1, Kunnari S Tolonen A‐K, Wallenius K, Löppönen H NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy xxiv NHS 2012
110 Performance of speech perception in children using hearing aids and cochlear implants: a comparative study ‐ Ranjan P, Lata S 111 Acquisition of early milestones with the cochlear implant ‐ Koren I, Geal‐Dor M, Adelman C, Adler M, Levi H 112 Auditory‐Verbal Rehabilitation after Cochlear Implantation ‐ Stefanescu C, Stanciu A 113 Best practices for pediatric speech and language assessment following early intervention to treat profound hearing impairment ‐ Zheng Y, Tao Y, Soli SD, Li G, Meng Z 114 Outcome assessment alternatives for young children during the first 12 months after pediatric hearing aid fittings ‐ Zheng Y, Soli SD, Xu K, Li G, Meng Z 115 Sign and spoken vocabulary in preschool children with cochlear implants and hearing aids ‐ Dimic N, Kovacevic T, Isakovic Lj, Djokovic S 116 Abstract thinking in children with CI and children with normal hearing ‐ Sokolovac I, Slavnić S, Kovačević J, Nadj Č, Komazec Z, Lemajić‐Komazec S 117 Bilateral hearing in pre‐school children with cochlear implants ‐ Obrycka A, Lorens A, Piotrowska A, Zgoda M, Lutek A, Skarżyński H 118 Experience with children with Med‐El Concerto Flex EAS cochlear implants ‐ Rødvik AK, Bunne M, Billermark E, Landsvik B 119 Listening difficulties of profoundly deaf children in everyday life situations ‐ Ostojić S, Mikić B, Mirić D, Mikić M, Đoković S, Radović D 120 Amplification challenges in ʺreverse‐slopeʺ hearing loss ‐ Tani A 121 The swimmable sound processor Neptune™: preliminary feedback ‐ Mathias N, Arnold L 122 CI in children with complex needs ‐ Herrmannova D 123 Comparision of fine structure processing (FSP) strategy with the new (FS4) strategy used in the MED‐EL cochlear implant system ‐ Meenakshi W, Nikhil M 124 Evaluation of auditory and speech development in Persian language children following cochlear Implantation and hearing aid use by IT‐MAIS & MUSS ‐ Riyasi M, Jahangiri N, Ghasemi MM, Tayarani Niknezhad H, Saidi S 125 Cross‐Modal‐Plasticity in deaf and deaf‐blind children: study with evoked potential. Preliminary results pre versus post ‐ cochlear implant ‐ Charroó‐Ruíz L, Pérez‐Abalo MC, Picó‐Bergantiños Th, Hernández‐
Cordero MC, Bermejo‐Guerra S, Bermejo‐Guerra B, Galán‐García L 126 Effect of early Intervention on the development of language skills of children with hearing impairment ‐ Ristic S, Kocic B, Bojanovic M, Marinkov Z M 127 ANSD and early language development ‐ Sollie A, Skagen AM 128 Hearing aid outcomes in Auditory Neuropathy children ‐ Sawaya K, Midgley E, Humpriss R, Children’s Audiology Team, Hearing Support Team 129 Speech Perception and P1 component in cochlear implant users with Auditory Neuropathy Spectrum Disorders ‐ Alvarenga KF, Amorim RB, Agostinho‐Pesse RS, Costa OA, Silva LTN, Bevilacqua MC 130 An investigation into the background factors that contribute to the language outcome of cochlear implant children ‐ Sadighi F, Rahimi M, Razeghi S 131 Long‐term documentation of the journey of congenitally deaf children ‐ Hellmuth‐Zweyer U, Tudor A, David L, Popescu R NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 xxv
132 The evaluation of auditory perception and language developments of hearing impaired newborns in Turkey ‐ Sevinc S, Sahli S, Belgin E 133 General profiles of hearing impaired newborns in Turkey: Characteristics of hearing loss, amplification and intervention ‐ Sahli S, Sevinc S, Belgin E 134 Benefit of deep electrode array in cochlear implantation: word discrimination and sentence recognition score in Serbian speaking children ‐ Andric Filipovic S, Miric D, Milovanovic J, Trajkovic G, Asanovic M, Ostojic S 135 Functional performance of children users of sensory hearing aids based on parents’ observations ‐ Bevilacqua MC, Moret ALM, Cruz AD, Morettin M, Alvarenga KF, Jacob RTS Training and Support 136 Pediatric audiology: a training curriculum ‐ Folsom RC, Mancl LR 137 Organization of the hospital‐based newborn hearing screening – a staff satisfaction survey as an essential instrument to identify aspects of improvement ‐ Depenbrock A, am Zehnhoff‐Dinnesen A, Matulat P 138 Provision of rehabilitation services after universal newborn hearing screening: a proposal for professional training in Brazil ‐ Bevilacqua MC, Ferrari DV, Morettin M, Silva MP, Moret ALM, Costa OA. Focus on Families 139 Parent course: ”How can I stimulate my child´s listening and spoken language?” ‐ Kilander R, Persson A 140 Early group intervention after UNHS: The concept of the Muenster Parental Program ‐ Reichmuth K, Glanemann R, Matulat P, am Zehnhoff‐Dinnesen A 141 Understanding outcomes in the context of families experience with an early intervention service ‐ Kean M, Carr G 142 Happy Family Food! ‐ Rogiers M 143 Holistic2 Family Coaching of children and families exhibiting a variety of behavioral, educational, physical, etc ‘issues’ ‐ Rogiers M 144 Stress in mothers of children who are cochlear implant candidates: preliminary results ‐ Aiello CP, Ferrari DV 145 Audiovisual on deafness and sign language: impact on deaf children’s hearing families ‐ Moura GM, Lichtig I NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy xxvi NHS 2012
NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 1
KEYNOTE ADDRESS CLOSING THE GAP: PROGRESS FROM PRESCHOOL TO ELEMENTARY GRADES AND HIGH SCHOOL IN CHILDREN WITH EARLY COCHLEAR IMPLANTATION Ann Geers University of Texas at Dallas and Southwestern Medical Center at Dallas, Texas, USA Children with prelingual severe‐profound deafness typically exhibit a verbal gap compared to hearing age mates that increases with age and is reflected in their speech, language and academic achievement. However over the past 20 years this expectation has been changing for children who receive a cochlear implant at a young age. These studies address the question: Can we expect children who receive a coch‐
lear implant as infants to catch up with their normal hearing peers by elementary grades and to remain caught up when they graduate high school? One study examines development between elementary grades and high school in 112 children from across North America who received a cochlear implant be‐
tween two and five years of age. A second study includes 60 children who were implanted even young‐
er, at one or two years of age. They were first tested at 3.5 and 4.5 years of age and then participated in a comprehensive follow‐up study when they were 10.5 years old. These studies assess progress in speech production, language and literacy and document auditory, cognitive and social skills associated with early cochlear implantation. Finally, we identify factors that predicted which children would achieve age‐appropriate outcomes in both elementary grades and high school. This Keynote Address Is Sponsored By Bill Daniels Center For Children’s Hearing At The Children’s Hospital – Colorado
NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 2 NHS 2012
LOST TO FOLLOW‐UP HOW CAN WE IMPROVE FOLLOW UP FOR NEWBORN HEARING SCREENING REFER‐
RALS? Wood SA NHS Newborn Hearing Screening Programme, Newborn Hearing Screening (NHSP) and Newborn and Infant Physical Ex‐
amination (NIPE) Programme Centre, London, England, UK Universal Newborn Hearing Screening was implemented across England between 2001 and 2006 in a centrally organised phased programme. Full implementation was achieved in March 2006. Since that time coverage has steadily improved and for the 2008/09 birth cohort coverage by 3 months of age was 96.4 %. Timeliness of audiological assessment following screen referral is improving as the programme matures; the percentage of screen referrals attending an audiological assessment within 4 weeks of screen completion improved from 40% to 83% between 2006 and 2011. Loss to follow up is an important and sometimes neglected outcome measure. Distinguishing “true loss to follow up” from “loss to docu‐
mentation” can be an issue. This paper presents data on loss to follow up for the English Newborn Hear‐
ing Screening Programme including the variability across the 117 constituent screening programmes. Both measures (attending an audiological assessment within 4 weeks of screen completion and loss to follow up at 6 months of age) show considerable variability across the 117 programmes that comprise the English NHSP. A recent survey of programmes that consistently perform well on these measures has highlighted areas of good practice and these will be discussed. UNDERSTANDING NON PARTICIPATION TO FOLLOW UP DIAGNOSTIC TESTING AFTER NHS Uilenburg N1, Wiefferink K1, Meuwese‐Jongejeugd A2, Oudesluys‐Murphy HM3 Dutch Foundation for the Deaf and Hard of Hearing Child, Amsterdam, The Netherlands; 2National Institute for Public Health and the Environment, Centre for Population Screening, Bilthoven, the Netherlands; 3University of Leiden, Leiden, The Netherlands 1
In the Netherlands we have established a good quality hearing screening programme for newborns. Since 2006 NHS was implemented nationwide. Participation rates are high (>99,5%) and the overall refer rate is 0,3%. The screening process is completed within six weeks after birth and 85% of all children start wearing hearing aids within 6 months after birth. All well within quality targets that were set nation‐
wide. However, the quality target for participation to diagnostic testing was set at 98%. During the im‐
plementation years (2002‐2006) the participation rate was only 93,5% and therefore it had to be im‐
proved. Because the same conditions (distance from home to a Speech and Hearing Centre) can lead to different behaviour (participation versus no participation) and different conditions (high SES versus low SES) can lead to the same behaviour (participation to diagnostic testing) we have developed a question‐
naire to study the reasons why parents refrain from participation after a positive screen result for their child and to gain insight in the underlying opinions of parents. In a systematic review of the literature issues were gathered from screening programmes in general and hearing screening in particular. Also 5 parents were interviewed in depth to study the arguments. The Health Believe Model and the Theory of planned behaviour are used as the basis of the questionnaire. After piloting the questionnaire amongst NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 3
parents, we have collected data from children born in 2008 and 2009. In our presentation we will demon‐
strate how the questionnaire was constructed and the results we have collected so far will be presented. NEWBORN HEARING SCREENING TARGETED FOLLOW–UP: OUR EXPERIENCE Spyridakou C, Ross K Department of Paediatric Audiological Medicine, Whittington Health Trust, London, England, UK Background information: In the UK following the implementation of universal newborn hearing screen‐
ing babies who have not completed their newborn hearing screening test or are at high risk of progres‐
sive hearing loss need to be referred for a targeted follow up at the age of 8 months. However current published literature shows that the targeted hearing screening follow up return is poor. A recent review by Wood, Davis and Sutton (2011) showed that in the UK the current uptake of targeted follow up is 55% for the risk factor group and 17% for the incomplete screen group. Objectives: To determine the newborn hearing screening targeted follow up return and to identify reasons of non attendance in our paediatric audiological medicine clinics. Design of study: Retrospective case review study and tele‐
phone survey on why families did not attend follow up appointments. Methods and material: Review of case notes of babies who were offered an appointment for targeted follow up between October 2011‐ February 2012. Families who failed to bring the babies to the clinic were contacted via telephone so as to identify causes of non attendance and try to facilitate future appointments. Results: We had poor follow up return <40%. The predominant reasons were families not receiving the appointment letter, due to in‐
correct details for address or just not receiving the letter despite correct details. The other predominant reason was parents not been concerned about their baby’s hearing. 50% of babies who attended the ap‐
pointment had mild hearing loss probably associated with otitis media with effusion. We did not iden‐
tify any babies with permanent hearing loss in our audit. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 4 NHS 2012
EHDI IN UNDERSERVED POPULATIONS IDENTIFYING DEAF BABIES AND HELPING THEIR FAMILIES IN THE RURAL AND REMOTE ISLANDS OF THE PACIFIC Johnson J1, Weirather Y2 University of Hawai, Honolulu, Hawai, USA; 2Kapiolani Medical Center for Women and Children, Honolulu, Hawaii, USA 1
All parents everywhere want to be able to communicate with their babies. However, communication is compromised when a baby is born with significant hearing loss and the family is unaware of that hear‐
ing loss. Fortunately, families in more‐developed areas are now having their children’s hearing tested at birth and receive training in communicating with their children who have hearing loss. But families who live in rural areas or on remote islands and face geographical obstacles deserve the same opportunities to have the hearing of their children tested; additionally, children with a significant hearing loss deserve the same chance to communicate with their parents, their siblings, their peers, and their teachers as do children in more‐developed communities. This presentation helps participants understand and appreci‐
ate the challenges in establishing Early Hearing Detection and Intervention (EHDI) programs in remote and rural Pacific Islands. This information is important to professionals who are working to develop and deliver quality services to children with disabilities and their families in challenging locations and envi‐
ronments. Included are descriptions of geographical, cultural, socio‐economic, and political challenges that confront efforts to provide state‐of‐the‐art services in remote and rural island locations. Challenges exist at every step in developing a comprehensive program, securing political support, obtaining equipment and training for the screening process, ensuring that audiological and otolaryngoligical diag‐
nostic services are available; creating quality early intervention programs; and providing services for parent‐to‐parent support. This presentation describes ways these challenges can be met. INFANT HEARING SCREENING AT A COMMUNITY‐BASED OBSTETRIC UNIT: A COMPARATIVE STUDY OF SCREENING TECHNOLOGY AND OUTCOMES De Kock T1,2, Swanepoel DW1,3 Dept of Communication Pathology, University of Pretoria, South Africa; 2Carel du Toit Centre, Cape Town, South Africa; 3Callier Centre for Communication Disorders, University of Texas at Dallas, USA 1
With less than 10% of babies born in South Africa having access to early hearing detection services, much still needs to be done to establish hearing screening as an integrated healthcare service. The di‐
verse healthcare contexts in South Africa necessitate pilot projects within each district to guide pro‐
gramme development in a way that will optimise screening coverage and cost‐effectiveness. The City of Cape Town Municipality was the first to implement a systematic community‐based infant hearing screening programme across eight primary health care immunization clinics. Recent research proved the programme partly effective with various intrinsic factors resulting in low coverage rates. Postnatal visits at community‐based midwife obstetric units (MOUs) are subsequently proposed as an alternative screening platform. The provincial government of the Western Cape, department of health, is supporting this project in MOU facilities and has established a newborn hearing screening (NHS) task team to drive the development of a provincial policy. This research project aims to describe the implementation of NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 5
hearing screening at a community‐based MOU as well as to compare the screening outcomes achieved by two different screening technologies. The target population are newborns attending postnatal visits at a community‐based MOU in Cape Town. Although newborns and their mothers are discharged from the birthing facilities within six to eight hours after birth, they return to the MOU for postnatal follow‐ups every second day until the umbilical cord falls off. This allows three to five screening opportunities be‐
fore the age of two weeks. A two group comparative design is used to investigate the screening out‐
comes of Distortion Product Otoacoustic Emissions (OAEs) and Automated Auditory Brainstem Re‐
sponse (AABR) screening in terms of specified benchmarks provided by the Early Hearing Detection and Intervention Position Statement of the Health Professions Council of South Africa (HPCSA). The Maico MB11 BERAphoneTM is utilised for the AABR measurements because of negligible disposable costs and proposed advantages in test‐time and ease of use. The results will provide key information to guide fu‐
ture policy development. A NEW MODEL FOR NEWBORN HEARING SCREENING. FIRST SCREENING ON THE 42ND DAY AFTER BIRTH Zhang X1, Yan S1, Li X2, Gu C1, Zhang H1 Maternity and child care of Ma’anshan, Ma’an shan, P.R.China; 2The 1st Affiliated Hospital of Nanjing Medical University, Dept. of Otolaryngology, Nanjing, P.R. China 1
Objective. To find a new screening model for the rural areas with lower hospital delivery rate. Besides, find an appropriate junction for the Newborn hearing screening program and child care system. Meth‐
ods. DPOAEs were used on two groups: one was composed of 2325 (M 1199/F 1126) 1‐42‐day old (3.53±1.339) neonates, the other was composed of 3507 (M 1898/F 1609) 20‐94‐day (43.06±4.123) infants. For those who failed in the test, they got a second screening test with DPOAEs in two weeks. If failed again, they were transferred to have ABR test. The first screening pass and refer rate, second screening rate and its pass, refer rate, transfer rate and diagnose rate were compared. Results. (1) First screening pass rate: neonates 83.4% (1940/2325), infants 92.9% (3257/3507), χ2=128.151, P=0.000; (2) First screening refer rate: neonates 16.6%, infants 7.1%, χ2=128.151, P=0.000; (3) Second screening rate: neonates 77.9% (300/385), infants 84.8% (212/250), χ2=4.591, P=0.032; (4) Second screening pass rate: neonates 85.7% (257/300), infants 71.7% (152/212), χ2=15.062, P=0.000; (5) Second screening refer rate: neonates14.3%, in‐
fants 28.3%, χ2=15.062, P=0.000; (6) Transfer rate: 100% both; (7) Diagnose rate: neonates 18.6% (8/43), in‐
fants 68.33% (41/60), χ2=21.080, P=0.000. Conclusions. Postpone the first hearing screening to 42‐day had a higher first screening pass rate, second screening rate and a more accurate diagnosis. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 6 NHS 2012
THE UNIVERSAL NEWBORN HEARING SCREENING (UNHS) IN MOBILE PEOPLE IN BEIJING Qi B, Cheng X, En H, Liu B, Peng S, Zhen Y, Cai Z, Huang L, Zhang L Beijing Tongren Hospital, Capital Medical University, Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing, China Objective. Universal newborn hearing screening (UNHS) program allows most permanent congenital and early‐onset hearing impairment (PCEHI) to be detected early enough for optimal intervention. In China, however, UNHS programs have been implemented unbalanced in different population group. The current study aims to revise the recommended UNHS protocol to fit the demographic characteristics of mobile population. Methods. A retrospective study of a UNHS program at a public hospital provid‐
ing the medical service for the mobile people from January 2007 to December 2009 was performed. The subjects were healthy newborns whose parents agreed to accept hearing screening test. Screening was conducted with Transient Evoked Otoacoustic Emissions (TEOAE) at least one time before discharge and at least one rescreening test within 8 weeks if referred. Diagnostic audiological assessments were performed on those infants referring the rescreen. Results. A total of 11347 healthy neonates were re‐
cruited, and 11221 newborns (98.89%) were tested. 1744 of 046 newborns who didn’t pass the inpatient OAE test underwent the adding hearing screening, 991 of them got a pass result. Prior to hospital dis‐
charge, the overall positive rate was significantly decreased from 27.15% to 18.31%. Only 1177 infants (57.27%) who failed the inpatient OAE test underwent a outpatient OAE at 1 month old, and 234 babies failed. 147 of them underwent the adding outpatient OAE test at 2 months old, and 41 infants got a pass result. The final referral rate was significantly declined from 2.09% to 1.72% based on the improved pro‐
tocol. Only 54 cases accepted the further auditory brainstem response testing. Ultimately, 35 babies (3.12‰) were diagnosed with sensorineural hearing loss. Conclusions. The results of this study indicate that carrying out UNHS in mobile people was feasible and essential, but we must establish a reasonable hearing screening protocol to progress the efficiency of hearing screening. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 7
QUALITY ASSURANCE THE IMPACT OF QUALITY ASSURANCE ON IMPROVING SERVICE PROVISION OF THE HEARING SCREENING PATHWAY Cameron C NHS Newborn Hearing Screening Programme, London, UK Quality assurance has a role to play in reassuring those who provide and commission a hearing screen‐
ing programme; and to families that use the service, that the services in a local hearing screening pro‐
gramme are actually performing in accordance with national standards and guidelines. The English Newborn Hearing Screening Programme (NHSP) has a well developed quality assurance (QA) pro‐
gramme which has assessed all the local programmes over three eighteen month cycles. The complete care pathway of screening, audiological assessment, management of identified hearing loss, aetiological investigations and early intervention has been included in the QA programme. Each of the services pro‐
viding these aspects are included in the assessment. Different processes have been used to conduct the QA programme, for example self assessment questionnaires, peer review visits, family experiences, and these will be described and evaluated. The QA programme has had considerable impact on enabling improvement of the quality and equity of services that are offered to families. This presentation aims • to review the outcomes of the QA programme through describing overall performance against stan‐
dards over a period of QA cycles; • to share lessons learnt by the experience; • to discuss the impact that quality assurance has had on improving local services for children and their families. MONITORING THE DEVELOPMENT OF DEAF AND HARD OF HEARING CHILDREN: AN IMPORTANT STEP TOWARDS MORE EVIDENCE‐BASED INTERVENTION Vermeij BAM, Van der Zee RB, Kriens T, Kip P, Wiefferink CH Dutch Foundation for the Deaf and Hard of Hearing Child, Amsterdam, The Netherlands It becomes more and more important to gain insight in the effect of intervention programs and specific elements of the intervention for deaf and hard of hearing children. If we don’t know which (element of) intervention is effective, how do we know what’s best for the children? Therefore, the Dutch Foundation for the Deaf and Hard of Hearing Child developed a monitor. This monitor is important for three rea‐
sons. First of all to create an overview of the development of the children at a certain moment in time, so we can set clear aims for intervention. Second, to measure the development of the children during the intervention period. Finally to gain insight into the target group and the effect of the intervention. A study group started with the development of the monitor. They decided to collect data on four domains: hearing development, language development, social and emotional development and cognitive devel‐
opment. Protocols have been developed for every domain and show on which moments data has to be collected. The data is stored in a web‐based database. This database is very useful for professionals as well, because the data can be converted into individual score profiles. The next step was implementation of the monitor. According to us, several factors contributed to the success of implementation: involving NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 8 NHS 2012
professionals at this process, creating support of the professionals and the management team, slow ad‐
justment of changes in the work process and evaluation. In this presentation the focus will be on the de‐
velopment and implementation of the monitor: an important step towards more evidence‐based inter‐
vention. STRATEGIES TO INCREASE DATA QUALITY AND PERFORM PROGRAM EVALUA‐
TION: WHICH BENCHMARKS/STRATEGIES WORK BETTER? Ederra M1, Ascunce N1, García M1, Zubicaray J2 Sección de Detección Precoz. Instituto de Salud Pública, Pamplona, Spain; 2Hospital Virgen del Camino, Pamplona, Spain 1
Background. In Spain in 2003, the Interterritorial Health Council established the minimal requirements that should be attained by all the Early Hearing Detection and Intervention (EHDI) population‐based programmes in the country. EHDI programmes do not end by the process of screening‐diagnosis‐
treatment. Regular measurements of performance and routine monitoring are essential to ensure the quality of its results at all levels. And it gives us also an opportunity to improve. Results. Spanish Pro‐
grammes monitor three types of indicators: Coverage Indicators. Percentage of target population to be offered screening (recommended benchmark: 100%); Percentage of participation in screening (recom‐
mended benchmark >95%); Percentage of participation in diagnosis (recommended benchmark >95%). Process Indicators. Percentage of children failing screening with confirmed diagnosis by 3 months of age (recommended benchmark >90%); Percentage of children with confirmed diagnosis receiving ampli‐
fication by 6 months of age (recommended benchmark >95%). Outcomes Indicators. Overall detection rate; Detection rate of bilateral hearing loss; Positive Predictive Value. Conclusions. Although there are many more indicators, we reckon it is better to have a few ones, but accessible to all the programmes, al‐
lowing comparisons and corrections among them. STRATEGIES TO REDUCE LOSS TO FOLLOW‐UP IN POPULATION‐BASED NEONATAL HEARING SCREENING Ederra M1, Ascunce N1, García M1, Zubicaray J2 Sección de Detección Precoz. Instituto de Salud Pública, Pamplona, Spain; 2Hospital Virgen del Camino, Pamplona, Spain 1
Background. The success of the newborn hearing screening program (NHSP) depends on far more than the initial step of screening. A program must include professional and family education and short and long‐term follow‐up. There are multiple points in the process at which a child might become lost (e.g., following screening, following diagnosis, following referral to intervention). Methods. Having analyzed our own experience and reviewed the literature, we have found same actions or strategies to minimise losses at any level. Results.  Staff involved in the supervision / coordination of the program.  Dissemination of the knowledge of the program at all levels.  Parent’s information prior to the screening (what the screening entails, the urgency of early diag‐
nosis, what the follow‐up process is).  Timely and accurate access to information to Pediatricians.  Communication / coordination among the program, physicians and other primary care profes‐
sionals NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 9
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Stable and well trained staff in conducting the tests and in communication with parents Inclusion of all births by matching with the stateʹs birth certificate registry Comprehensive information system that: (1) maintains current information on all babies screened, including those who do not pass the screen, (2) contains diagnostic results for babies who were referred based on the results of their NHS test, and (3) documents interventions for those infants who were diagnosed with hearing loss. Maintenance of consistent and stable state funding for NHS programs. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 10 NHS 2012
APPLICATIONS OF TELE‐HEALTH COMPUTER BASED PHONOLOGICAL INTERVENTION ‐ EFFECTS ON PHONOLOGI‐
CAL PROCESSING von Mentzer C1, Lyxell B1, Sahlén B2, Wass M1, Uhlén I3, Lindgren M4, Ors M2, Kallioinen P5, Engström E2 Department of Behavioral Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden; 2Linneaus centre HEAD, Lund University, Lund, Sweden; 3Karolinska University Hospital and Karolinska Institute, Rosenlunds sjukhus, Stockholm, Sweden; 4Department of Psychology, Lund University, Lund, Sweden; 5Department of Linguistics, Stockholm, Sweden 1
Children with mild to profound hearing impairment (HI) using cochlear implants (CI) and/or hearing aids (HA), and children with normal hearing (NH) participated in a phonological intervention study, by means of a computer‐based intervention program (Graphogame, Lyytinen et al., 2009). Children were 5, 6 and 7 years of age. Thirty‐two of the children used CI and/or HA. 16 children with NH served as the control group. The main design was a quasi‐experimental 3 x 3 design. Each test session was separated in time with four weeks. All children were asked to practice 10 minutes per day at home supported by their parents, with an intervention program primarily developed to enhance phonemic differentiation. Results showed that the children with HI displayed a heterogeneous pattern of results, specifically with respect to their performance on the phonological tasks. Approximately 20 percent performed within the range of NH children; these were all children with HA except one child with CI/HA. Children with CI displayed considerable difficulty with phonological working memory whereas children with HA showed less knowledge in letter tasks. Intervention revealed positive effects on accuracy of phoneme‐
grapheme correspondence for all children and a significant positive change on phonological processing skills for children with weak initial phonological skills. Enhanced phoneme‐grapheme connections may build associations between the phonological lexicon and the sub‐lexical phonological representations, thereby improving underlying skills essential for word learning and the development of literacy. Impli‐
cations of this are discussed within theoretical models of phonological and lexical processing (Goswami, 2000; Ramus, 2001). REMOTE PROGRAMMING OF COCHLEAR IMPLANTS: MOST PRACTICAL SOLUTION IN INDIAN SCENARIO Wadhera M Meenakshi speech & Hearing Clinics (P) Ltd, Delhi, India In India with spreading awareness more and more children are opting for Cochlear Implant and major‐
ity of these CI recipients have to travel really far and spend a lot to reach specialized implant clinics for programming. For this reason fitting CI recipients using telehealth technology i.e remote fitting needs to be evaluated. Objectives. To evaluate the technical practicality and difficulties of programming Cochle‐
ar Implant using internet and assessed the benefits for the user comparing the face to face CI program‐
ming versus the remote CI programming. Subjects and Methods. A randomized prospective study has been designed for comparing RPS to the standard on‐site CI programming. The remote programming was done by following the regular programming protocol. A total of 100 remote and 100 standard ses‐
sions of programming were carried out in same children and adults between different branches of our NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 11
clinic. Both modes were compared and analysed based on patient’s involvement and perception of the CI programming systems, technical aspects, risks and difficulties. Time required and cost involved for remote and direct programming were also compared. Results. Control of the local station from the remote station was carried out successfully and remote programming sessions were achieved completely and without incidents. Subjects were satisfied with both the remote and standard sessions. A very small delay was noticed that did not affect the ease of the fitting. The oral and video communication between the local and the remote equipment was established without difficulties and was of high quality. Also remote programming was found to be significantly cost effective and time saving procedure. Conclusions. Remote cochlear implant (CI) programming is a viable, safe, user‐friendly and cost‐effective procedure and this ability to remotely program cochlear im‐
plant patients gives the potential to extend cochlear implantation to underserved areas in India. COCHLEAR IMPLANTS REMOTE FITTING IN RUSSIAN FEDERATION: CURRENT STAGE AND FUTURE DEVELOPMENTS Bakhshinyan V1, Belov OA1, Eikeland C3, Büchner A2, Winter M3, Fray J4, Tavartkiladze GA1 National Research Center for Audiology and Hearing Rehabilitation, Moscow, Russia; 2Hearing Centre, Hannover, Germany; 3“Auric”, GmbH Germany; 4“Cochlear AG”, Switzerland 1
The aim of our study was to evaluate the possibility of remote cochlear implant fitting in current state of telecommunication infrastructure in Russian Federation. This topic became very important due to in‐
creasing number of CI recipients in Russia and a long distances between CI Centers and patients. It was important to understand how the possible signal delays and distortions can affect the efficiency and comfort of fitting procedure. We used the software created by “Auric” and Hannover Hearing Centre. Several fitting sessions were organized between two centers located in Moscow and Voronezh. Data transfer was performed via the Internet with and without data encryption. The “Remote Fitting System” consist of patient/clinic system environment, audiologist/clinic system environment and directory ser‐
ver. During the fitting session the audiologist and the patient can communicate in the best possible way by means of a specially designed videoconference‐module. Thereby the normal process of an on‐site clinic consultation and fitting is optimally simulated. The fitting software is executed on the patient side and is remotely controlled via Internet from the clinic side. In patient environment the telecommunica‐
tion module and the fitting software can deployed on two computers or in a single one using a virtual‐
ization software, whereas each system keeps its own operating system environment. The system envi‐
ronment of the audiologist provides the video conference‐, chat‐ and the remote control functions. The directory server can be used for management of a multi‐client configuration. The results of our clinical trials from our long‐distance remote fitting sessions will be presented. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 12 NHS 2012
UNILATERAL AND MILD‐TO‐MODERATE HEARING LOSS LANGUAGE DEVELOPMENT IN CHILDREN WITH NEONATAL UNILATERAL HEAR‐
ING LOSS COMPARED TO NORMAL HEARING CONTROLS Desloovere C1, Zink I1,2 ¹Department of ENT‐Head and Neck Surgery, University Hospitals Leuven, Belgium; ²Department of Neurosciences, ExpORL, Faculty of Medicine, Katholieke Universiteit Leuven, Belgium In a prospective way children with neonatal unilateral hearing loss (UHL) without any additional disa‐
bilities were compared to matched normal hearing controls (HC). They were matched on four criteria: gender, age, same educational setting and comparable intellectual capacities. The UHL children received no hearing amplification, special education or language therapy. The language development of all chil‐
dren was assessed with the Dutch version of the Reynell Developmental Language Scales (RDLS) and subtest productive vocabulary of the Schlichting Test for Language Production (STLP) at the age of 2 to 3 years and with the Dutch version of the Clinical Evaluation of Language Fundamentals (CELF) at the age of 5 to 6 years. The youngest age group consisted of 19 matched pairs and the oldest age group of 7 pairs. At the age of 2 to 3 years the UHL children had a significant lower total (p=0.01) and expressive language score (p=0.01) compared to the normal hearing children at the RDLS. The UHL children per‐
formed also significantly lower at the more difficult subscales 4 and 6 of the Reynell verbal comprehen‐
sion scale while they had similar results at the more easy ones. No significant differences could be found on productive vocabulary (STLP). At the second age interval of 5 to 6 years already 7 pairs could be evaluated, but no significant difference was shown until now. The results will be discussed with special attention to the age related evolution. In summary significant differences in language development could be shown in unaided children with neonatal unilateral hearing loss in comparison to normal hear‐
ing controls at the age of 2 to 3 years. In the older group some differences still exist but the group is too small to reach significance level. The project including the field study was funded by the states of North Rhine‐Westphalia and the European Union NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 13
DEMOGRAPHIC CHARACTERISTICS OF CHILDREN WITH UNILATERAL HEARING LOSS: A MULTICENTRIC STUDY IN TURKEY Genc A1, Konukseven O2, Kirkim G3, Basar Suren F4, Tuncer U5, Kayikci M1, Topcu C2, Turan Dizdar H6, Kaynar F6, Akar F5, Kaya S7, Coskun H7, Bayar Muluk N8, Ozdek A6, Serbetcioglu B3, Belgin E1 Division of Audiology, Department of Ear Nose and Throat and Head and Neck Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey; 2Hearing and Balance Disorders, Diagnose and Rehabilitation Center, Department of Ear Nose and Throat and Head and Neck Surgery, Ataturk Research and Training Hospital, Ankara, Turkey; 3Hearing, Speech and Bal‐
ance Unit, Department of Ear Nose and Throat and Head and Neck Surgery, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey; 4Subdepartment of Audiology and Department of Otolaryngology Head & Neck Surgery, Ondokuz Mayıs University School of Medicine, Samsun, Turkey; 5Division of Audiology, Department of Ear Nose and Throat and Head and Neck Surgery, Cukurova University Medical Faculty Balcalı Hospital, Adana, Turkey; 6Department of Ear Nose and Throat and Head and Neck Surgery, Ministry of Health Dıskapı Y.B. Hospital, Ankara, Turkey; 7Division of Audiology, Department of Ear Nose and Throat and Head and Neck Surgery, Uludağ University Faculty of Medicine, Bursa, Turkey; 8Department of Ear Nose and Throat, Kirikkale University Faculty of Medicine, Kirikkale, Turkey. 1
Objective. Newborn Hearing Screening works well for babies with bilateral hearing loss. However, for those with unilateral loss, some standard rules like age of diagnose, risk factors, hearing loss degree have yet to be established. Our aim is to identify the demographic characteristics of newborns with uni‐
lateral hearing loss to obtain evidence based data in order to see what we are supposed to do for unilat‐
eral hearing loss. Method. 124 babies with unilateral hearing loss, 71(57%) male and 54 (43%) female, were investigated retrospectively. Data provided from the archives of seven referral tertiary Audiology Centers in Turkey were determined in terms of the age of diagnosis, degree of the hearing loss, the consanguinity, family history of hereditary childhood and the prenatal, natal and postnatal risk factors. Result. The unilateral sensorineural hearing loss degrees were found as 30% moderate, 27% profound, 16% severe, 11% moderately severe. Mild and moderate conductive hearing loss was 5%. The age of di‐
agnose was found as 50% for 3‐6 month‐olds, 32% for 6‐12 month‐olds, 15% for 0‐3 month‐olds and 5% for those older than 12 months. The ages of diagnose for 0‐3 month, suggested by JCIH, were evaluated based on the degree of hearing loss, there were 56% profound, 16% moderate, 11% moderately severe and severe, 5% mild. The ratios of risk factors on hearing loss were obtained as 14,5% for the consan‐
guinity, 7% for the family history, and the total ratio of 76% for prenatal 13%, natal 14,5% and post natal 48%, with 33% of the post‐natal being hyperbilirubinemia, 23% intensive care and 10% infection. Con‐
clusion. This study indicates that the effect of postnatal risk factors, i.e. curable hyperbilirubinemia, in‐
fection and intensive care is relatively high on unilateral hearing loss, precautions should be taken re‐
garding their prevention. Additionally, further studies are needed with more comprehensive standard broad data for more evidence based consensus. PREVALENCE AND RISK FACTORS FOR MILD SENSORINEURAL HEARING LOSS: FINDINGS FROM THE AVON LONGITUDINAL STUDY OF PARENTS AND CHILDREN Hall AJ1, Midgley E1, Steer C2, Humphriss R1 Children’s Hearing Centre, St Michael’s Hospital, Bristol UK; 2Social and Community Medicine, University of Bristol, UK 1
This study aimed to assess prevalence and risk factors for mild/high‐frequency bilateral sensorineural hearing loss within a UK population of children at age 11 years1. Repeat hearing thresholds were meas‐
ured in 5032 children, as part of the Avon Longitudinal Study of Parents and Children (ALSPAC), a pro‐
NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 14 NHS 2012
spective birth cohort study at age 7, 9, and 11 years. Pregnancy, birth, and early medical history were ob‐
tained prospectively through parental questionnaires and medical records. Twenty children had mild and seven had high‐frequency bilateral sensorineural hearing loss, giving a combined prevalence of 0.5% (95% CI 0.4 – 0.8%). These children were more likely than the rest of the study sample to have been admitted to hospital at 6 – 18 months (OR 2.7, 95% CI 1.00 – 7.30). Parents of these children were more likely to have suspected a hearing problem when the children were 3 years old (OR 2.4, 95% CI 1.05 – 5.60). This is the first UK prospective cohort study to investigate the prevalence of mild and high‐
frequency hearing loss. This study, which has the advantage of a large sample size and repeat hearing measures over a four year period, reports lower prevalence values than US cross‐sectional studies. Hall AJ, Midgley E, Steer C, Humphriss R. Prevalence and risk factors for mild and high‐frequency bilateral sensorineural hearing loss at age 11 years old: A UK prospective cohort study. International Journal of Audiology 2011; 50: 809‐814. 1
LANGUAGE DEVELOPMENT OF YOUNG CHILDREN WITH MODERATE HEARING LOSS Dirks E, Van der Zee RB, Hoek J NSDSK, Amsterdam, The Netherlands Universal Newborn Hearing Screening programs have improved the prospects of children with hearing loss. Research indicated that early identified children have better prospects than later identified children. The screening program made it possible to identify children with moderate hearing impairments at an earlier age than before. Before the implementation of the program these children were identified even later than children with severe hearing losses. Children with moderate hearing impairments (40 to 70 dB) are less often focus of research. Most research is focused on children with profound hearing impair‐
ments (>80 dB) or no differentiation between moderate and profound impairments is made. Studies that did differentiate or focussed on children with moderate hearing loss showed difficulties in language and social‐emotional development. However, most of these studies focused on older children. Research con‐
cerning young children with moderate hearing impairments is needed. In the present study we investi‐
gated the language development of children with a moderate hearing loss in the age of 12 through 30 months who participated in an early intervention program. We compared their language development to a group of normal hearing children of the same age. In the presentation we will show preliminary re‐
sults and discuss the implications for early intervention programs. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 15
AUDITORY NEUROPATHY AND AUDITORY PRO‐
CESSING DISORDERS CHARACTERIZING SPEECH PATTERN CONTRASTS IN AUDITORY NEUROPATHY SPECTRUM DISORDER Runge C, Jensen J, Burg L, Friedland D Medical College of Wisconsin, Department of Otolaryngology and Communication Sciences ‐ Milwaukee, Wisconsin, USA Auditory neuropathy spectrum disorder (ANSD) is a result of impaired temporal processing in the pe‐
ripheral auditory system, unlike sensorineural hearing loss (SNHL) which represents impaired spectral encoding. Currently there are no clinically‐available tools to assess the degree of temporal impairment in infants and young children with ANSD, and particularly the effects on speech sound perception. This presents difficulty in determining optimal early clinical intervention including cochlear implant candi‐
dacy. The purpose of this study was to investigate phoneme discrimination in infants and young chil‐
dren with ANSD compared to SNHL and normal hearing (NH) controls. Consonant‐vowel (CV) pho‐
nemes were generated which represented temporal and spectral acoustic domain contrasts. Stimuli were presented in quiet and in background noise via automated software for assessing speech pattern con‐
trasts developed by Boothroyd and colleagues (Visual‐reinforcement and Interactive Play tests of the perception of Speech PAttern Contrasts; V.I.P.SPAC). Responses were obtained using Visual Reinforce‐
ment Assessment (VRA), conditioned play, or button‐pressing tasks. Performance was measured in per‐
cent confidence that discrimination responses were not random. It was hypothesized that phoneme dis‐
crimination performance correlates with the temporal impairment in ANSD and spectral impairment in SNHL, while cochlear implantation mitigates the effects of ANSD temporal impairment. At this time 13 children were tested ranging in age from 7 months to 6 years representing each hearing category. Dis‐
crimination responses were observed as young as 7 months; however, for children younger than 3 years additional test sessions are necessary for complete data. Preliminary data showed effects of acoustic properties and noise on phoneme discrimination. Assessment of speech pattern contrasts is feasible, and the patterns of discrimination performance may become a useful tool in assessment of infants and young children with ANSD. SCREENING TEST FOR AUDITORY PROCESSING: A PRELIMINARY REPORT Yathiraj A, Maggu AR Dept. of Audiology, All India Institute of Speech and Hearing, Mysore, India The prevalence of auditory processing disorder (APD) has been found to be 2‐3% in school‐age children (Chermak & Musiek, 1997; Muthuselvi & Yathiraj, 2009). This indicates the necessity to carryout screen‐
ing tests in order to make appropriate referrals. The existing screening tests for APD have been noted to be time consuming (Muthuselvi & Yathiraj, 2009) and evaluate limited auditory processes (Bellis, 1996). Hence, when screening large groups of school‐age children, it is essential for a screening test to be quick and tap several processes. The present study evaluated a newly developed screening test for auditory processing (STAP) on 267 school‐age children in the age range of 8 to 13 years. The developed test con‐
NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 16 NHS 2012
sisted of 4 sub‐sections [Speech‐in‐noise (SPIN), dichotic CV (DCV), gap detection (GD) and auditory memory (AM)] that tapped auditory separation, binaural integration, temporal resolution and auditory memory. Each sub‐section had limited number of stimuli enabling the test to be carried out within 12 minutes. The test, played through a laptop loaded with Adobe Audition (version 3.0) was heard by the children through TDH‐39 headphones. The responses of the children were scored and subjected to statis‐
tical analysis. Principal component analysis revealed the presence of 3 distinct components. The DCV sub‐section scores obtained the highest rotated factor loadings (right ear = 0.82, left ear = 0.88, double correct = 0.95) in component 1. The GD sub‐section scores had the highest rotated factor loadings (right ear = 0.95, left ear = 0.94) in component 2. However, component 3 consisted of both the SPIN sub‐section (right ear and left ear) and the AM sub‐section with rotated factor loadings of 0.87, 0.85 and 0.48, respec‐
tively. In total, the three components accounted for a total variance of 75.9% which is higher than what has been reported by Schow and Chermak (1999) for SCAN. SPEECH‐EVOKED POTENTIAL TESTING IN CENTRAL AUDITORY PROCESSING DIS‐
ORDERS: AN OBJECTIVE INDEX FOR POST‐TRAINING IMPROVEMENT El‐Kholy W, Hazzaa N, Abdel‐Maksoud A, Abdel‐Rahman T Audiology Unit, E.N.T. Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt Introduction. Speech‐evoked auditory responses represent the neural activity generated at different lev‐
els along the auditory pathway. Purpose. The first aim was to record the profile of children with (cen‐
tral) auditory processing disorders [(C)APD] using speech‐evoked sub‐cortical and cortical potentials, as compared to their normal peers. The second aim was to evaluate speech‐evoked Auditory Brainstem Re‐
sponse (S‐ABR) and Speech Mismatch Negativity (S‐MMN) tests as objective tools for documenting po‐
tential improvement following customized auditory rehabilitation. Methodology. S‐ABR and S‐MMN tests were recorded in 34 children with documented (C)APD ranging in age from 5 to 12 years. Results were compared to age‐ and sex‐matched group of 25 children with normal central auditory processing. Regular customized computer‐based auditory training was given to 18 children from the study group for a period of 3 months. A comparison was held between efficacy of psycho‐physical and electro‐physiological tests in documenting training‐induced physiological changes. Results. In (C)APD children, S‐ABR abnormality was encountered in 22 children (64.7%); the most prev‐
alent abnormality being in the onset response. Seventeen children (50%) showed abnormality in S‐
MMN. Following remediation, there was a significant decrease in S‐ABR wave V latency and an increase in wave O amplitude. Though there was improvement in S‐MMN measures in four children, group data showed no significant change in any of response parame‐
ters. There was significant correlation between psycho‐physical and electro‐physiologic improvement. Conclusions. Speech evoked potentials could be used for testing children who are too young to perform behavioral central test battery. They can also be used to monitor improvement following remediation. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 17
AUDITORY NEUROPATHY SPECTRUM DISORDER: FOUR CASE STUDIES WITH FOUR DIFFERENT OUTCOMES Ioannou M, Aspris A, Kyamides Y Nicosia General Hospital, ENT/Audiology Department, Nicosia, CYPRUS Auditory neuropathy spectrum disorder (ANSD) is characterized by presence of normal cochlear func‐
tion, i.e. otoacoustic emissions (OAE) and cochlear microphonic response, and absent or abnormal audi‐
tory brainstem response (ABR). Even when individuals have absent auditory nerve response, their be‐
havioral responses can vary ranging from that of normal to profound hearing loss. Significant variability is also seen in speech recognition and communication ability. Rehabilitation decisions are made based on the behavioral testing and communication ability of the individual. NHS can aid in the early detec‐
tion of hearing impairment and intervention. Some NHS programs use only OAE as the screening method. ANSD however may be missed with a purely OAE‐based screening program. Our hospital’s NICU NHS protocol involves an OAE screening before the newborns are dismissed from the NICU, and a mandatory ABR two months after their dismissal from the NICU. Using this protocol, infants with ANSD are usually diagnosed by 3 months of age. The objective of this study is to present four infants with different presentations of auditory neuropathy. One child had transient ANSD and now has normal hearing. One child has permanent ANSD with severe hearing loss and has been implanted with good outcome. The other two children present with moderate to severe hearing loss: one shows good outcome with hearing aids; the other is moderate and is being evaluated for implantation. The hearing of these in‐
fants was monitored closely and audiometric information was obtained every two weeks. OAEs, tym‐
panometry, reflexes, behavioral results and radiologic information are reported. The variability of re‐
sults, clinical management, rehabilitation and outcomes of these four cases will be discussed. We hope to illustrate that the rehabilitation decision e.g. hearing aids vs. cochlear implantation need to be consid‐
ered after frequent evaluations and follow ups; and simply not follow the regular protocol of very early implantation. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 18 NHS 2012
MODELS OF EARLY INTERVENTION EMBEDDING EVIDENCE‐BASED PRACTICE IN EARLY INTERVENTION PROGRAMS FOR DEAF AND HARD OF HEARING CHILDREN Dirks E, van Dijk M, Kip P, Kriens T NSDSK, Amsterdam, The Netherlands This presentation provides practitioners and researchers tools to develop and implement an early fami‐
ly‐centered intervention program for deaf and hard of hearing children based on principles of evidence‐
based practice. For a long time intervention programs have been based more closely on beliefs and atti‐
tudes than on empirical evidence. More and more, policy makers and financiers demand interventions that are proven to be effective. To improve the care for young deaf and hard of hearing children and their parents it is important to embed evidence‐ based practice in our intervention programs. We used a four‐stage model for the classification and development of effective interventions. This models provides practitioners a tool to develop evidence‐based treatments and also help them to gain insight in the effec‐
tiveness of their practice. We will illustrate this framework with examples from our family‐centered ear‐
ly intervention program for deaf and hard of hearing children. In our center (Dutch Foundation for the deaf and hard of hearing child) children with hearing loss enroll in the intervention program just after identification of their hearing loss through the age they start school (around 4 years of age). Profession‐
als like family counselors, child psychologists, speech and language therapists are part of the interven‐
tion program. A project group existing of family counselors, linguisticians, speech‐language therapists, preschool teachers and researchers was involved in the development of the intervention program. MAXIMIZING LISTENING AND SPEAKING FOLLOWING EARLY DIAGNOSIS: THE RESEARCH EVIDENCE Dornan DA Hear and Say, Toowong, Queensland, Australia The benefits of early diagnosis of hearing loss can be considerably enhanced by early fitting of appropri‐
ate hearing devices, and early family involvement in an education program such as auditory‐verbal therapy which has the potential to accelerate auditory brain development. This research‐based presenta‐
tion discusses the neurodevelopmental basis for the natural acquisition of listening and speaking, as well as the parent’s role, and how a child with congenital hearing loss can acquire listening and spoken lan‐
guage at the same rate as their peers with typical hearing. The clinical techniques which promote maxi‐
mal listening and speaking outcomes will be outlined. Research evidence presented will include a longi‐
tudinal controlled study of 19 children with hearing loss matched with children with typical hearing for initial language age, receptive vocabulary, gender, and socioeconomic level. Data over the 50 month study period will be presented showing that the group of children with hearing loss were able to pro‐
gress at the same rate as the control group in the development of listening and spoken language. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 19
PARENT CHILD MOTHER GOOSE PROGRAM Dann M Taralye Early Intervention Centre, Blackburn, Victoria, Australia The Parent‐Child Mother Goose Program which originated in Canada 20 years ago focuses specifically on promoting parent‐child bonding and increasing parental sensitivity to babies and young children. Through a relaxed, engaging program, parents are provided with space to set aside the stressors associ‐
ated with responding to a child with additional needs and focus specifically on interacting with their child in a positive manner. In addition PCMG provides opportunities for linking families with their local communities and for creating friendships. Taralye Early Intervention centre in Blackburn for families of children with impaired hearing has run PCMG programs for a number of years. It is often parents’ first entry point into group participation in the program. Through the use of interactive and engaging songs, rhymes, stories, dance and movement, the program creates warm, sharing situations in which parenting knowledge, skills and techniques can grow in supportive, enabling circumstances. Parental feedback indicates that PCMG leads to a greater appreciation of their child, and also provides them with the sensi‐
tivity to understand how their child is attempting to communicate; this in turn provides the parent with increased successful communication strategies specific to their child, resulting in more effective commu‐
nication. This presentation will provide a description of the program and will also discuss our findings of its efficacy, based on parental feedback and research findings which suggest that parents benefited from the program by developing an increased awareness of their childrenʹs skills and their communica‐
tion styles, demonstrated increased confidence in parenting and were able to more positively communi‐
cate with their child as well as with the facilitators and other parents, leading to stronger social net‐
works. Children demonstrated increased confidence and increased comfort in social situations, increased compliance and willingness to participate in group activities as well as overall improved social and emo‐
tional development. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 20 NHS 2012
EMPOWERING PARENTS HOW TO MOTIVATE NEWBORN HEARING SCREENING IN THE ABSENCE OF A NA‐
TIONAL PROGRAM: A COLLABORATION BETWEEN PARENTS AND PROFESSIONALS ‐ THE ITALIAN PEDIATRIC FEDERATION AUDIOLOGY NETWORK Cutler J1, Lenzi G1, Berrettini S2 FIMP Audiology Network (Italian Pediatric Federation), Grosseto, Italy; 2University of Pisa, U.O. Otorinolaringoiatria Au‐
diologia e Foniatria Universitaria, Pisa, Italy 1
In the absence of a National Newborn Hearing Screening program in Italy, the GPOD has been working together with the Italian Pediatric Federation (FIMP) and the Italian Society of Audiology and Foniatria (SIAF) to promote Guidelines, best practice and training courses in Early Hearing Detection Intervention that incorporate sensitivity‐training for professionals working with families of Deaf children. This case study describes the role of Pediatricians in the process and the responsibility of Audiology Associations and Clinics in providing educational courses for medical professionals, thereby providing insight and a successful model for action in countries where Newborn Hearing Screening has not been nationally ap‐
proved. The establishment of the Italian Pediatric Federation Audiology Network is the result of an in‐
ternational collaboration between Parents and Medical Professionals in order to promote an effective model in developing Early Hearing Detection Intervention Programs that recognize the role of parents as partners in the process. Among other factors, one important component frequently underestimated in most early intervention programs, both in the USA and other countries, involves the role of parental in‐
volvement within the Early Hearing Detection Intervention (EHDI) process. When analyzing the habili‐
tation process of a deaf child, the relationship between health professionals and the crucial role of par‐
ents in raising that child is a 50‐50 shared responsibility. An objective of EHDI programs must be to em‐
power parents by providing support from the beginning of the process. Distributing informative litera‐
ture regarding the newborn hearing screening process and providing parents with access to resources such as parental support groups upon diagnosis equips parents with the tools necessary to immediately begin advocating for their children. EMPOWERING FAMILIES OF BABIES AND YOUNG CHILDREN WITH COCHLEAR IM‐
PLANTS THROUGH EARLY INTERVENTION HOME BASED EDUCATION ‐ SUPPORT‐
ING A NEW MODEL OF SERVICE AND RESOURCE PROVISION Rocca C1, Lewis S2, Driver S3, Stark E3 Department of Education and Music Therapy, Mary Hare, UK; 2Department of Education, Mary Hare, UK; 3St Thomas’ Auditory Implant Programme, Guy’s and St Thomas’ Foundation Trust, UK. 1
Introduction. Cochlear implant centres are experiencing difficulties providing regular support for fami‐
lies of babies and young children with cochlear implants. Constrained by distance, plus sleeping and eating routines of babies, it is important to optimise family centred habilitation at home. The age of im‐
plantation has decreased, therefore family centred resources need to fully support the pre‐verbal stage; especially through musical activities which naturally develop the areas of attachment, listening and communication. For parents and young children home provides a safe and secure environment to de‐
NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 21
velop these skills. This presentation will illustrate a sustainable model, providing family guidance and practical resources that can be delivered at home and reflect the increasing benefits of early implantation and latest technology potential. Method. Ten families piloted a new series of resources in the home envi‐
ronment. The children ranged from 3 months to 2 years, with a mix of unilateral and bilaterally im‐
planted children. While working with the families, video and audio recordings were made and analysed offline for pre‐defined behaviour which might indicate successful use of the resources. In addition evaluation forms were completed by each family. Results. Parental feedback was generally positive and reflected the confidence gained through using the resources and having family guidance. Video con‐
firmed the age appropriate nature of the resources, and extracts will be shown which illustrate the flexi‐
bility of the resource. Results currently being collected, using age appropriate measures not directly connected to the resource will be shown that confirm progress in the development of musicality, interac‐
tion and communication abilities of the babies and young children. Summary. The resource has shown it is flexible enough to apply in an age appropriate manner for babies and young children. Parents found the materials practical to apply in their home environment and were positive about the suitability of the resource. PARENTAL PERCEPTIONS OF THE EXPERIENCE AND IMPACT OF THE EARLY IDEN‐
TIFICATION AND MANAGEMENT OF UNILATERAL HEARING LOSS Carr G, Sutton G, Pattison E, Kean M Newborn Hearing Screening Programme Before the introduction of Newborn Hearing Screening, unilateral hearing loss (UHL) was frequently not detected in children until they were of school age (Bess and Tharpe 1984). One consequence of this was that parents could understand the diagnosis in the light of their own first hand experience of their child’s auditory and language development. The impact and acceptance of the diagnosis, along with the suggestions for clinical management and intervention, could be seen in the context of existing parental knowledge of the child’s everyday functioning, and clinicians and parents could together make in‐
formed decisions. Now that deaf children with UHL are being identified within the first weeks and months of life, there are some major dilemmas for both service providers and parents. Unlike bilateral hearing loss there is no good evidence for the benefit of early intervention and aiding in UHL. Clinicians and parents therefore have to make decisions on management unsupported by clear evidence or consen‐
sus and crucially now without knowledge of how speech and communication are progressing. As part of a larger scale project aiming to look at issues in amplification for children with permanent congenital UHL, nine families whose children had been identified with UHL following newborn hearing screening took part in an interview study which sought to explore their experiences of the care pathway from screening onwards and to understand the impact of that journey on the family. Families experienced a range of different professional attitudes and advice and received significantly differing levels of service provision. Additionally general advice given by audiologists on managing UHL assumed an over‐
prominence in the families’ daily lives. This presentation will discuss the issues emerging from the struc‐
tured interviews in relation to a) the pattern of service provision received and b) the impact of the diag‐
nosis of UHL on parents. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 22 NHS 2012
ENHANCED PARENTAL COMMUNICATION SKILLS BY THE MUENSTER PARENTAL PROGRAM Glanemann R, Reichmuth K, Matulat P, am Zehnhoff‐Dinnesen A Clinic of Phoniatrics and Pedaudiology, University Hospital Muenster, Muenster, Germany Objective. To assess the effectivity of the Muenster Parental Program (MPP) on parents’ communication skills towards their hearing‐impaired infant. The MPP is a program that aims at empowering parents in communicating with their preverbal child (see abstract by Reichmuth et al., “Early group intervention after UNHS: The concept of the Muenster Parental Program”). Method. In a prospective pseudo‐
randomized clinical intervention study, 15 parents of hearing‐impaired infants (mean age: 7.6 months) participated in the MPP, 14 parents of other hearing‐impaired infants (mean age: 5.7 months) served as controls. Video samples were taken of semi‐structured parent‐child interactions to compare the parental communication behavior before and after participation in the MPP. Videos of control participants were taken over the same time period. In these video samples responsivity to verbal and non‐verbal signals of the child as well as parental initiative were measured. Results. Compared to the pre test trained parents showed more responsivity (p = .002) in the post test to the benefit of less initiative (p < .001). The control group showed no significant changes with respect to the three variables. Conclusion. The Muenster Pa‐
rental Program is an effective parent‐centered intervention after Newborn Hearing Screening. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 23
MODELS OF TRAINING AND SUPPORT CICFAST: COCHLEAR IMPLANT COMPETENCIES ‐ FAMILY AND STAFF TRAINING Shipgood L1, Reed‐Beadle E2 The Emmeline Centre for Hearing Implants, Addenbrookes Hospital, Cambridge, England, UK; 2Virtual School Sensory Sup‐
port, Norwich, Norfolk, UK 1
Introduction. On CICFAST is a structured teaching programme to ensure that all those associated with a child with an implant are confident about how the equipment works. Method. Training is a hands‐on dialogue with each participant, covering assembling and trouble shooting. There are 3 levels of knowl‐
edge (Basic, Intermediate and Advanced) for each device with certificates on completion. We invite par‐
ticipants to annual refreshers as knowledge grows from our experience and Company updates. Results. Each child has 5 possible trainees (parent, tod, slt, classroom support and themselves). Our database re‐
cords & tracks how many of these have been trained and to which level. Norfolk’s target for 2010 was for 85% coverage of TODs at Basic Level for all children with CI’s. We achieved 90%. Questionnaires confirm that CICFAST raises confidence levels. Conclusion. The CICFAST programme ensures that children with implants receive optimal technical support locally. SUPPORTING TELE‐INTERVENTION FOR INFANTS AND TODDLERS WITH HEARING LOSS THROUGH A LEARNING COMMUNITY Behl D, White K National Center for Hearing Assessment and Management, Utah State University, Logan, USA Advancements in early identification of infants with hearing loss have resulted in a growing need for ac‐
cess to early intervention services to support their optimal development. Tele‐intervention, defined as the application of distance technologies to deliver early intervention services, is being adopted as a way to provide infants and their families with access to providers with needed expertise. However, chal‐
lenges such as connectivity, licensure, security, and reimbursement require attention. Also, there is a paucity of specific guidelines for implementing effective tele‐intervention sessions. In response to these issues, a learning community comprised of early intervention providers throughout the United States was created. Learning communities are a useful platform for professionals who are interested in engag‐
ing with others around a topic of common interest and building a knowledge base. It is particularly ad‐
vantageous when the focus is on a fast‐growing practice and one for which the literature base is rela‐
tively undeveloped. The outcome of this learning community was the development of a comprehensive “Teleintervention Resource Guide” to support early intervention providers interested in knowing how to implement teleintervention. The formal evaluation of the learning community revealed high ratings from participants for the quality of activities, knowledge gained, and engagement with others. This presentation has two objectives. First, it will enhance the knowledge of persons involved in newborn hearing screening and diagnosis about the value of teleintervention as a viable service delivery method, particularly to serve those throughout the world that live in remote regions. Key facets of implementa‐
tion will be emphasized. Second, it will describe a learning community process and highlight its applica‐
tion to the field of early detection and intervention for children with hearing loss. Key elements of a NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 24 NHS 2012
learning community will be presented, offering guidance in selecting participants, structuring interac‐
tions, and achieving outcomes. PROMOTING AWARENESS AND EDUCATION ON AUDITORY NEUROPATHY Landsvik B1, Wingaard L1, Orn I2 OUS/Rikshospitalet/ENT Department, Oslo, Norway; 2Skadalen Resource Centre, Dept of Research and Development, Oslo, Norway 1
Auditory Neuropathy Spectrum Disorder (ANSD), also known as Auditory Neuropathy (AN), is a hear‐
ing disorder that can affect people of all ages. Although auditory neuropathy is not yet fully understood, research has made it possible to identify the condition. The main objectives of our project have been to increase expertise in auditory neuropathy within the project group and to raise awareness of the condi‐
tion by providing accessible information to patients, parents and professionals within the health‐ and education sectors. Intersectorial and interdisciplinary cooperation was essential to the project. To achieve our objectives, the main targets were to produce an information folder, organize a conference and estab‐
lish a Norwegian website for ANSD. The folder was published and distributed to hearing centers and hospitals, May 2010. The folder is also available online. A national conference with key note speakers from US was held in September 2010 with 120 participants. The websites will go live May 2012 and will be made available at Statped and Rikshospitalet public internet sites. From January 2005 until January 2012, 33 children (below the age of 18) have been diagnosed with ANSD at Rikshospitalet in Oslo. In most of the cases hearing aids have been tried out, but only seven children use HA on a regular basis. Six of the children use no amplification. 22 children have Cochlear Implant (CI). After some months of CI‐
use we observe better hearing performance and improved speech abilities in most of the children. De‐
velopments of language and vocabulary also improve, but this is still delayed after years of CI‐use. THE DEAF EDUCATORS AND REHABILITATION PROFESSIONALS VIEWS ABOUT PERSIAN CUED SPEECH WEBSITE Movallali G, Malakooti B Pediatric Neurorehabilitation Research Center, University of Social Welfare &Rehabilitation Sciences, Tehran, Iran An increasing number of people are using the internet to find information about medical and educa‐
tional issues. One of the simplest ways of obtaining information becomes the internet. Persian cued speech is a very new system to Iranian families with deaf children and the professionals working with them. Few educators have enough knowledge about it .So the purpose of this study was to introduce Persian cued speech website to deaf educators and rehabilitation professionals and assess their views about the website and their accessibility to important information through its use. The sample group was randomly selected from deaf educators and rehabilitation professionals working in different educa‐
tional settings for deaf children in Tehran. They completed a questionnaire which was adopted from dif‐
ferent website assessing questionnaires. Researchers also completed an interview with the sample group. Our findings indicate that he Persian cued speech website was a helpful and informing website from the views of deaf educators and rehabilitation professionals working with deaf children. Some parts of the website changed to be more usable for them. The Persian cued speech website and the users views will be discussed in this presentation. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 25
KEYNOTE ADDRESS PREDICTING DEVELOPMENTAL OUTCOMES OF EARLY‐ AND LATE‐IDENTIFIED CHILDREN WITH HEARING IMPAIRMENT, INCLUDING THOSE WITH SPECIAL NEEDS: FINDINGS FROM A POPULATION STUDY Teresa YC Ching National Acoustic Laboratories, Australian Hearing, Sydney, Australia; HEARing CRC, Australia Despite widespread implementation of universal newborn hearing screening (UNHS), the effectiveness of UNHS for improving outcomes of children with congenital permanent hearing loss, on a population ba‐
sis, is still uncertain. To address this question, we conducted a Longitudinal study on Outcomes of Chil‐
dren with Hearing Impairment (LOCHI) that directly compares outcomes of early‐ and late‐identified children. This population‐based prospective study evaluates the outcomes of children at 6 and 12 months after intervention, and at chronological ages of 3 and 5 years. About 450 children are enrolled in the study, including about 10% with auditory neuropathy spectrum disorder, and about 30% with addi‐
tional disabilities. All children received the same post‐diagnostic audiological services from the national service‐provider in Australia; and have similar access to the full range of educational intervention ser‐
vices. By 3 years of age, 70% use hearing aids and the remaining use cochlear implants. Within the con‐
text of the LOCHI study, two randomised controlled trials (RCT) were conducted for children with hear‐
ing aids. The first examined the impact of choice of prescription on children’s outcomes by randomly as‐
signing half of the eligible children to the NAL prescription and the other half to the DSL prescription for amplification. The second RCT examined the impact of frequency compression by randomly assign‐
ing the use of frequency compression to LOCHI children who were eligible for the trial. All evaluations were conducted by qualified professionals who were blinded to the hearing‐aid characteristics of chil‐
dren. In addition, genetic testing was conducted to determine the etiology of hearing loss. The outcomes of children will be presented together with factors influencing performance. The predictability of out‐
comes at 3 years from evaluations conducted shortly after initial intervention was also examined. The findings will be discussed with implications for effective management of children with hearing loss. The project described was partly supported by Award number R01DC008080 from the National Institute on Deafness and Other Communication Disorders. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Deafness and Other Communication Disorders of the National Institutes of Health. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 26 NHS 2012
COCHLEAR IMPLANTS: COMPLEX CASES BRAINSTEM AND CORTICAL RESPONSES EVOKED BY STIMULATION WITH AN AUDITORY BRAIN STEM IMPLANT IN A CHILD WITH COCHLEAR NERVE APLASIA Deggouj N1, Gerard J‐M1, Van Pesch V2, El Ankari S2, Rombaux P1, Castelein S1, Raftopoulos C3 ENT Department Academic Clinic of Louvain Saint‐Luc, Brussels, Belgium; 2Neurology Department Academic Clinic of Louvain Saint‐Luc, Brussels, Belgium; 3Neurosurgery Department Academic Clinic of Louvain Saint‐Luc, Brussels, Belgium 1
Objectives. First, to confirm that the central auditory pathway (CAP) possess intrinsic programs of dif‐
ferentiation that direct early auditory circuit assembly events even if disconnected from their spiral gan‐
glion axons. It has been described at the brainstem level but not at the cortical level. Second, to observe the early effect of auditory inputs delivered through a brain stem implant on the CAP responses: is there an activity‐dependent developmental plasticity? Design. The auditory and non auditory responses were recorded on a 3.5 years old child presenting a bilateral cochlear nerve aplasia associated with labyrinths dysplasia, psychomotor delay and autism. The measured outcomes are the behavioural reactions, the electrically evoked late auditory responses (EELAR) produced through acoustic stimulation of the mi‐
crophone of an auditory brainstem implant (ABI), and the electrically evoked auditory brainstem re‐
sponses (EABR) produced by electrical stimulations of electrodes groups. The tests were carried out in‐
tra‐operatively and repeated at the time of ABI activation and 3 months later. Results. The presence of EABR during surgery confirms that CAP development occurs without proper peripheral innervations. The behavioral reactions to acoustic stimulations evolve from inconstant and limited to loud to more constant even though limited. The first EELAR responses are more comparable to those of full‐term than pre‐term neonates with a positive wave (here called Baby‐P2) and absence of a sustained negativity. Af‐
ter 3 months of ABI use, the hearing function seems to trigger the appearance of new neural networks leading to various waves (N250, N450, decreased Baby‐P2). The speed of this network evolution is faster and different than for normal hearing neonates. Clear responses to the deviant stimuli are present only at 3 months of age. Conclusions. These observations confirm that CAP possesses intrinsic programs of differentiation giving “primitive” responses that may be secondary modified by an activity‐dependent developmental plasticity. TEN YEARS OF COMPLEX CASES: PROCEDURES AND OUTCOMES OF A LARGE AU‐
DITORY IMPLANTS PROGRAM FOR VERY YOUNG DEAF CHILDREN Lilli G1, Bracci Laudiero L2, Mazzella G2, Mariosa F2, Cotecchia T2, Pastore V1,2, Diomaiuto I1, Bojano A2, Varriccho AM1, Izzo R2, della Volpe A1 Otology and Cochlear Implant Unit, Regional Referral Centre, Santobono‐Pausilion Children Hospital, Naples, Italy; 2Audiology and Phoniatrics Unit, Santobono‐Pausilion Children Hospital, Naples, Italy 1
Background. the care of multiple involved hearing impaired children is one of the main challenges CI professionals encounter. Candidacy and surgical approaches have to be progressively updated in order provide good performances even for kids with associated pathologies or malformations. Objectives. this work aims to describe a long run experience in the treatment of deafness in very young kids of age espe‐
cially concerning procedures employed for a large amount of special cases. Methods. Data concerning surgery, anesthesia, postoperative tracking, and pre‐ and post‐implantation audiometry, neuropsy‐
NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 27
chological assessments were collected from the CI Unit database and evaluated. The group of 121 kids engaged in the study underwent early cochlear implant and BAHA system implantation. Many of them had a variety of inner ear malformations, mental retardation, very poor motricity development, congeni‐
tal cerebral infections, genetic syndromes and congenital profound HL. Results. 27 patients had an ab‐
normal position of the cochlea and concurring middle ear disease. A cerebrospinal fluid gusher was en‐
countered in 12 patients. An aberrant facial nerve was found in a group of 18. 13 patients showed a slight cochlear ossification. 4 had Mondini‐like syndromic inner ears. 4 children had a CMV and Rubella congenital infection. 1 patient had a Smith‐Lemli‐Opitz syndrome. A group of 28 children showed other associated pathologies. The patients with mild cochlear malformation showed good performances. Tak‐
ing into account the mental or neurological concerns, subjects with severe syndromes showed notewor‐
thy outcomes. Conclusions. an early intervention is always mandatory. Thus, we give confidence to the broadening of the paediatric auditory implantation. However, it is compulsory for a cochlear implant program to gather a multiprofessional team experienced in paediatric care in order to likely face unex‐
pected pitfalls or complex cases which audiology and otology professionals are progressively encounter‐
ing. THE EFFECTIVENESS OF COCHLEAR IMPLANTATION IN CHILDREN WITH AUDITO‐
RY NEUROPATHY AND COCHLEAR NERVE DEFICIENCY Huang L, Zhang Y, Chen X, Mo L, Zhang J, Liu H, Gong S, Li Y, Han D Beijing Tongren Hospital, Capital Medical University, Beijing, P.R.China and Beijing Institute of Otorhinolaryngology , Bei‐
jing, P.R.China Objective. The aim of this study is to assess of cochlear implantation in children with auditory neuropa‐
thy (AN) and cochlear nerve deficiency (CND) by using Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR). Method. 41 children with cochlear implants (CI) participated in this study. All children had hearing aid trial before surgery at least 3 months. The age at CI and the time af‐
ter surgery among these children were matched. Nine children were diagnosed with AN, twelve with CND, and twenty with sensorial neural hearing loss (SNHL). CAP and SIR were used to evaluate. 42 children with normal hearing served as a control group which was divided into three groups according to their age. Group A included 18 children aged under 2 yrs, group B consisted of 16 children aged from 2 to 4 yrs and group C comprised 8 children aged above 4 yrs. The scores were compared between chil‐
dren with CI and normal hearing. Results. No significant differences for age of all children with CI and group B. CAP scores were 4.44±1.50, 4.83±1.69, 4.55±1.66 and SIR scores were 2.66±1.11, 2.33±1.15, 2.40±0.75 for children with AN, CND, SNHL respectively. There were no significant differences for CAP and SIR scores among these three groups. No significant differences were shown between children with CI and those in group A. However, there were significant differences between children with CI and those in group B or C. Conclusion. The short‐term auditory and speech capabilities of children with AN and CND can catch up the level of children with SNHL but not achieve the level of those with normal hearing. Children with AN and CND can get benefits from CI. The long‐term effects still need to follow up and evaluate. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 28 NHS 2012
GENETICS OF HEARING LOSS PREVALENCE OF MT‐RNR1 IN THE GENERAL POPULATION: IS THERE A ROLE FOR SCREENING NEONATES REQUIRING AMINOGLYCOSIDES Ibekwe TS1,2,3, Bhimrao SK1,2, Westerberg BD2, Kozak FK1 BC Childrenʹs Hospital, Department of Otorhinolaryngology, Vancouver, Canada; 2St. Paulʹs Rotary Hearing Clinic Van‐
couver, Department of Otorhinolaryngology, Vancouver, Canada;; 3College of Health Sciences University of Abuja, Nigeria 1
Objective. To review the prevalence of MT‐RNR1 genetic mutation and to assess the need for neonatal screening prior to gentamicin therapy. Type of review. Systematic review. Search Strategy. A compre‐
hensive search of MEDLINE, EMBASE, Cochrane Library, Clinical Evidence and Cochrane Central Reg‐
ister of Trials was performed. The reference lists were cross‐referenced. Review was restricted to human studies in English language. Evaluation method. Studies describing the Prevalence/incidence of MT‐
RNR1 gene mutations (A1555G, C1494T, A7445G) in the population. Relevant studies screening for presence for MT‐RNR1 in patients receiving aminoglycoside therapy were included. Results. Twenty‐
two articles out of 67 full papers and 206 abstracts from 1948‐November 2011 met the inclusion criteria. These included 9 prospective case‐control studies, 12 case series and a case report. There is weak evi‐
dence to that MT‐RNR1 is globally prevalent with racial bias especially in Chinese, Spanish populations. The prevalence/incidence ranged from 0.09% ‐ 2.9% in the general population to 17% in the high‐risk population. Weak evidence of neonatal sensorineural hearing loss following aminoglycoside exposure was also seen. Conclusion. There is a need for large national epidemiological studies to assess the preva‐
lence of MT‐RNR. There is some evidence of a global prevalence of MT‐RNR1 with racial bias and link between aminoglycoside exposure and NSHL among at risk group. It is difficult to justify routine screening of patients for MT‐RNR1 with the available literature. GENETIC TESTING AS AN ADJUNCT TO NEWBORN HEARING SCREENING IN ONTARIO, CANADA Stockley TL1; Stanton SG1; Brown C2 Molecular Genetics Laboratory, The Hospital for Sick Children, Department of Paediatric Laboratory Medicine, Toronto, On‐
tario, Canada; 2National Centre for Audiology, School of Communications Sciences and Disorders, University of Western On‐
tario, London, Ontario, Canada 1
Each year in Ontario, Canada’s most populous province, approximately 400 infants are detected with hearing impairment at birth by the Ontario Infant Hearing Program (IHP) under standard, province‐
wide protocols implemented in 2006. Although Ontario has an exceptional IHP to detect infants with hearing impairment, access to genetic services for identified infants is a barrier both in Ontario and in Canada, even though up to 50% of congenital hearing loss is due to genetic factors. The current study was performed at one IHP clinical site (University of Western Ontario, London) to determine 1) feasibil‐
ity of linking genetic testing into the Infant Hearing Program at the point of hearing loss diagnosis 2) eti‐
ology of congenital hearing loss and 3) frequency of GJB2 and GJB6 mutations in this patient population. Subjects were infants and children (ages 1 month–8 years) who were referred for audiological assess‐
ment following their newborn hearing screen, received audiological assessment following a community NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 29
referral, or were under surveillance by the IHP due to the presence of hearing loss risk factors. Partici‐
pants were tested for GJB2 mutations by full gene sequencing and for GJB6 deletions by MLPA. In the group of 40 participants with genotype results, GJB2‐related hearing loss was confirmed in 6 cases (15%). The most common GJB2 mutation was c.35delG (p.Gly12fs) mutation, with 4 homozygous probands and one compound heterozygous proband with c.35delG and c.‐23+1G>A. One proband was a com‐
pound heterozygote with the c.167delT (p.Leu56fs) mutation and the variant c.101T>C (p.Met34Thr). Five additional proband were heterozygous for GJB2 mutations, including c.35delG (two siblings), c.249C>G (p.Phe83Leu) (two siblings) and c.428G>A (p.Arg143Gln). During testing for GJB6 deletions by MLPA we detected one male proband with a POU3F4 deletion. The successes and challenges of integrat‐
ing genetic services into the IHP at the point of diagnosis of hearing loss will be presented. GENOTYPE‐PHENOTYPE CORRELATION FOR ENLARGED VESTIBULAR AQUEDUCT RELATED DEAFNESS Birkenhäger R1, Aschendorff A1, Arndt S1, Maier W1, Löhle E1,2, Laszig R1 Department of Oto‐Rhino‐Laryngology, Head and Neck Surgery, University Medical Center Freiburg, Germany; 2Section Phoniatry and Pedaudiology, University Medical Center Freiburg, Germany 1
The enlarged vestibular aqueduct syndrome (EVA) is one of the most common inner ear malformations, a distinct clinical entity characterized by progressive sensorineural hearing impairment. It is often asso‐
ciated with Pendred‐ Syndrome (PDS), an autosomal‐recessive disorder characterized additionally with goiter. PDS is sometimes associated with temporal bone abnormalities ranging from isolated enlarge‐
ment of the vestibular aqueduct (EVA) to Mondini dysplasia, a more complex malformation that also in‐
cludes cochlear hypoplasia. Hearing loss is prelingual in the majority of the cases; only subset of patients has a progressive hearing loss later in life. EVA and PDS are caused by mutations in the SLC26A4 gene. The SLC26A4 gene is expressed in the non‐sensory epithelia of the inner ear. Additionally the genes FOXI1 and KCNJ10 are described which may also be responsible for Pendred‐Syndrome and inner ear malformations. The FOXI1 gene is involved in the transcriptional control of the SLC26A4 gene. The KCNJ10 gene encodes for a K+‐channel located in the stria vascularis. In this study we analysed 138 pa‐
tients with EVA and hearing loss to accomplish a phenotype genotype correlations for enlarged vestibu‐
lar aqueduct related deafness. Individual exon and intron transitions of the SLC26A4, FOXI1 and KCNJ10 genes of patients were sequenced. Audiometric thresholds were performed, and radiologically, the vestibular aqueduct midpoint and opercular width were measured. In the analysed patients with EVA, a total of 32 different SCL26A4 mutations were detected, mutations could not be detected in 68 % of the cases. FOXI1 and KCNJ10 analyses reveal only known polymorphisms but no mutation. The pre‐
sent results obtained in patients with EVA indicate that this phenotype is likely to be complex. More‐
over, analysis of FOXI1 and KCNJ10 genes in our cohort of enlarged vestibular aqueduct hearing loss suggests a minor implication of these two genes in the phenotype of non‐syndromic EVA and PDS. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 30 NHS 2012
AUDIOLOGICAL ASSESSMENT OF PATIENTS CARRYING MITOCHONDRIAL 3243A>G MUTATION Iwanicka‐Pronicka K1, Pollak A1, Skórka A3, Lechowicz U1, Pajdowska M4, Furmanek M1, Rzeski M1, Korniszewski L1, Płoski R2 Institute of Physiology and Pathology of Hearing, Warsaw, Poland; 2Department of Medical Genetics, Medical University of Warsaw, Poland; 3Department of Paediatrics, Medical University of Warsaw, Poland; 4Department of Biochemistry and Ex‐
perimental Medicine, The Children’s Memorial Health Institute, Warsaw, Poland 1
Introduction/Purpose. A natural history hearing loss (HL) associated with mitochondrial 3243A>G mu‐
tation is not known. The aim of the study was to assess the frequency of the m.3243A>G mutation among Polish HL patients and their audiological status. Patients/Methodology. The molecular search was undertaken in the archive blood DNA of 1482 unrelated patients with isolated HL beginning from 5 to 40 years. Then, maternal relatives of the probands were investigated. We analyzed heteroplasmy level of the 3243A>G mutation in nails, hair follicles, buccal smear, urine sediment. All carriers underwent audiological tests. Detailed clinical assessment was made according to NMDA scale, MRI of the brain with spectroscopy was performed and organic acid profile in urine was checked by GC‐MS. Principal Findings. The m.3243A>G mutation was found in 34 individuals including 16 probands (the frequency of 1.07%). Hearing impairment of cochlear origin was detected in 29 patients and the mean onset of HL was 26 years. Audiometric curves were pantonal in most patients with high frequencies affected the most. Progressive character of HL was observed in half of the carriers, mostly in women. Almost a half of the identified m.3243A>G carriers did not develop multisystem symptomatology during next 10 years. Mean heteroplasmy level of the m.3243A>G was the lowest in blood at the level of 13.5% and the highest in urine of 57.6%. The value was independent from the clinical severity of the disease in each pa‐
tient. Conclusions. At least one m.3243A>G carrier can be found per 100 individuals with postlingual hearing loss of unknown cause. Hearing loss connected with the m.3243A>G mutation is usually co‐
chlear, pantonal and may present progressive course. Urine is source of choice for a detection of m.3243A>G mutation and the diagnosis of mitochondrial inherited hearing loss. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 31
THE EFFECT OF CONSANGUINEOUS AND NON‐CONSANGUINEOUS MARRIAGE ON HEARING LOSS IN NEWBORN HEARING SCREENING: A MULTICENTER STUDY IN TURKEY Konukseven O1, Genc A2, Tuncer U3, Kirkim G4, Kaya S5, Bolat H6, Akar F3, Dincol I1, Bercin S1, Serbetcioglu B4, Belgin E2 Hearing & Balance Disorders, Diagnose and Rehabilitation Center, Department of Ear Nose and Throat and Head and Neck Surgery, Ankara Ataturk Research and Training Hospital, Ankara, Turkey; 2Division of Audiology, Department of Ear Nose and Throat and Head and Neck Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey; 3Division of Audiology, Department of Ear Nose and Throat and Head and Neck Surgery, Cukurova University Medical Faculty Balcalı Hospital, Adana, Turkey; 4Hearing Speech and Balance Center, Department of Ear Nose and Throat and Head and Neck Surgery, Do‐
kuz Eylül University Faculty of Medicine, Izmir, Turkey; 5Division of Audiology, Department of Ear Nose and Throat and Head and Neck Surgery, Uludağ University Faculty of Medicine, Bursa, Turkey; 6T.R. Ministry of Health, General directorete of mother and child health/ family planning (MCHFP), Ankara, Turkey 1
Introduction. Consanguineous marriage, commonly seen in Turkey, is one of the risk factors in hearing loss. Up to now studies have determined the effect of a consanguineous marriage only among babies with hearing loss. However, there is no known literature about the ratios of hearing loss among babies born out of consanguineous and non‐consanguineous marriage. In our study, our aim is to indicate the risk factor ratio of consanguineous and non‐consanguineous marriages on hearing loss according to the various areas of Turkey, by comparing the ratios of hearing loss between newborns of consanguineous marriages with those of non consanguineous marriages. Method. 6400 newborns from five major NHS tertiary centers, four of them in different areas of Turkey, were investigated retrospectively. The data of babies were provided from the newborn hearing screening archives in each center. Results. When all the patients were included, the ratio of hearing loss was 5,9% in newborns of consanguineous marriages, whilst it was 4,1% in those of non consanguineous marriages. There was a significant difference between the two groups with Chi‐square test (p<0.01). However, when the data of each center was analyzed sep‐
arately, some important differences were found among centers. The ratios of hearing loss were 1%, 12%, 14%, 10,4% in consanguineous marriages and 0.1%, 26%, 0%, 2,2% in non‐consanguineous marriages in Ankara, İzmir, Bursa and Adana, respectively. There was a significant correlation between consanguine‐
ous marriage and hearing loss (p<0.01) in Ankara and Adana, however, there was no relationship in İzmir (p>0.05) where the ratio of consanguineous marriage is lower (4%) than Ankara (13%) and Adana (%23). Conclusion. The differences of hearing loss ratios among centers were attributed to the differ‐
ences of frequencies of consanguineous marriage and the differences of the genetic structures in each ar‐
ea. Further studies covering all areas of Turkey together with genetic research are needed. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 32 NHS 2012
GENETIC SCREENING AND AUDITORY FOLLOW‐UP AMONG NEONATES WHO FAILED UNIVERSAL NEWBORN HEARING SCREENING Markova T1, Lalaynts M1, Bliznetz E2, Polyakov A2, Tsigankova ER1, Tavartkiladze GA1 National Research Centre for Audiology and Hearing Rehabilitation, Moscow, Russia; 2Moscow Medical Genetics Center, Moscow, Russia 1
Congenital deafness remains an acute problem owing to serious consequences of late diagnostics and rehabilitation. In 2011 the coverage of newborns underwent universal hearing screening has reached 96 % in our Country. 705 Russian patients were investigated with bilateral congenital deafness and the mu‐
tations in gene GJB2 were found out in 46% of cases. 20 various mutations and 8 different gene variant are revealed. Six mutations с.35delG, c.313_326del14, c.‐23+1G>A(IVS1+1G>A), c.235delC. c.167delT and p.Glu120del have covered 95 % pathological GJB2 alleles. On the basis of these results the optimal algo‐
rithm of molecular analysis of Russian patients with deafness was introduced into the practice. From 106 neonates of this group who failed the newborn hearing screening in 74 children (70%) the bilateral sensorineural hearing loss associated with GJB2‐mutations was revealed. It is concluded that genetic evaluation of patients who failed the audiological screening enables to detect hereditary hearing loss and plan the proper methods of rehabilitation and adequate family behavior. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 33
SPECIAL SESSION INTERNATIONAL REPORT ON EHDI PROGRAMS ‐ OR‐
GANIZED BY THE INTERNATIONAL WORKING GROUP ON CHILDHOOD HEARING AND THE CDC/NATIONAL CENTER ON BIRTH DEFECTS AND DEVELOPMENTAL DISABILITIES (EHDI TEAM) UNIVERSAL HEARING SCREENING PROGRAM IN RUSSIAN FEDERATION Tavartkiladze GA, Tsygankova ER National Research Centre for Audiology and Hearing Rehabilitation, Moscow, Russia The hearing screening programs started in Russia in 1996. They were based on the risk factors registry at all the maternity hospitals with the behavioral screening at pediatric outpatient departments and TEOAE recordings at the Audiological Centers. The second stage testing of children who have failed the first OAE screening included the additional TEOAE and ABR recordings with the consequent rehabilita‐
tion of the children with diagnosed hearing impairment. In 2007‐2008 universal newborn hearing screen‐
ing pilot projects were conducted in 4 regions of Russia and in 2008 universal hearing screening was in‐
cluded in the National Program “Health” with federal money available for 3 years. In 2008‐2010 100% of the maternity hospitals with the per year delivery rate more than 1000 and the pediatric units of all re‐
gions of the Russian Federation were equipped with the TEOAE units – 2549 devices; and equipment for the diagnostics and follow‐up were placed in 209 audiological centres (immittance meters and diagnostic systems including ABR, ASSR, TEOAE and DPOAE). Staff at these facilities were then trained in the use of this equipment. During 3 year 2100 specialist were trained and the training programs for audiologists, neonatologists, pediatricians and nurses will be continued permanently. Special protocols for ru‐
ral/community based screening were developed and introduced. In addition, a protocol for combining audiological and genetic screening was developed in 2009. In 2010 there were approximately 1,569 mln births in Russia. Depending on the regions 26‐97% of newborns were screened. The results from 61 re‐
gions (73.5%) were included in the analysis. Of the 4.6% of babies who failed the screening, 55% com‐
pleted diagnostic evaluation, and 4646 babies were identified with permanent hearing loss which corre‐
sponds to 0.46% of all newborns, 16.3% ‐ who went through the diagnostic evaluation and 9,1% ‐ who failed the screening at the first stage. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 34 NHS 2012
DOES NEWBORN SCREENING DELIVER BETTER OUTCOMES FOR HEARING IM‐
PAIRED CHILDREN AND FAMILIES IN ENGLAND? Davis A National Screening Programmes, c/o Royal Free Hampstead NHS trust, London, England, UK The Department of Health (DH) in England has enabled the NHS Newborn Hearing Screening Pro‐
gramme to identify about 7000 children, after seven years of universal commissioning, who have at least moderate bilateral permanent hearing impairment. The policy and implementation has been comple‐
mented by a rigorous quality improvement programme, which has identified major local and national shortcomings. DH is changing its role and in the year 2013/14 there will be a new public health executive agency that will oversee screening and other public health activity. The national NHSP programme cen‐
tre will work much more closely with other newborn and antenatal screening programmes across all ar‐
eas of policy, implementation and quality assurance. This is a good time therefore to reflect on the essen‐
tial and desirable characteristics of newborn hearing screening and associated diagnostic and care pro‐
grammes that achieve the best outcomes. Analyses will be presented that show the impact of quality as‐
surance and the long term service improvements that it brings. SOCIO‐DEMOGRAPHIC DETERMINANTS OF HEARING IMPAIRMENT STUDIED IN 103835 TERM BABIES Van Kerschaver E1, Wuyts FL2 Kind en Gezin, Brussels, Belgium; 2Statistical Centre University of Antwerp, University of Antwerp, Antwerp, Belgium 1
Background. Serious hearing problems appear in approximately 1 in 1000 new‐borns. In 2000 the Joint Committee on Infant Hearing defined a list of risk factors for neonatal hearing impairment relating to health, physical characteristics and family history. The aim of this study is to determine which personal, environmental and social factors are associated with the prevalence of congenital hearing impairment (CHI). Methods. The entire population of 103835 term newborns in Flanders, Belgium, was tested by a universal neonatal hearing screening (UNHS) program using automated auditory brainstem responses (AABR). In the case of a positive result, a CHI diagnosis was verified in specialized referral centres. Socio‐demographic risk factors were investigated across the entire population to study any relationship with CHI. Results. The prevalence of bilateral CHI of 35 dB nHL or more was 0.87 per 1000 newborns. The sensitivity and specificity of the screening test were 94.02% and 99.96% respectively. The socio‐
demographic factors of gender, birth order, birth length, feeding type, level of education and origin of the mother were found to be independent predictors of CHI. Conclusions. The socio‐demographic fac‐
tors found to be associated with CHI extend the list of classic risk factors as defined by the American Academy of Pediatrics (AAP). Assessment of these additional factors may alert the treating physician to the increased risk of newborn hearing impairment and urge the need for accurate follow‐up. Moreover, this extended assessment may improve decision making in medical practice and screening policy. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 35
EVOLUTION AND PERSPECTIVES OF A NEONATAL HEARING SCREENING PRO‐
GRAM IN THE FRENCH COMMUNITY OF BELGIUM OVER 5 YEARS (2007‐2011) Vos B1,2, Lagasse R1,2, Levêque A2 CEpiP Centre d’Epidémiologie Périnatale, Brussels, Belgium; 2Université Libre de Bruxelles, School of Public Health, Brus‐
sels, Belgium 1
A universal neonatal hearing screening (UNHS) program was implemented by the French Community of Belgium (FCB), at the end of 2006. Hospitals agreed on a protocol on a voluntary basis (43/46 hospitals in 2012). Protocol. Newborns without risk factors of hearing loss enter a two‐stage screening: AOAE have to be performed at the maternity ward on the second or third day of life and in case of ‘refer’, the same test has to be performed the day after. Newborns with risk factors and infants failing both tests are referred for an audiological assessment (diagnosis). Results and discussion. The acceptance of the UNHS by the parents was high: between 1% (2007) and 0.5% (2010) refused the screening. Also the or‐
ganization of the program in the hospitals improved: the proportion of newborns who did not undergo any test decreased from 10.5% (2007) to 5.8% (2010). The final hearing status (screening or audiological assessment) showed higher proportions of infants with a ‘normal hearing’ (from 84.8% in 2007 to 90.9% in 2010), due to a reduction in the newborns considered as lost to follow up, however these proportions of lost to follow up were still to be improved (4.5% in 2007; 3.0% in 2010). The deafness rate identified by the program (uni‐ and bilateral) increased from 1.1‰ in 2007 to 2.0‰ in 2010. We hypothesize that these improvements (reduction in lost to follow up and increase in the deafness rate) could be partly ex‐
plained by a more systematic transmission of the results. Conclusion. The results of the UNHS program in the FCB have improved since the beginning of the program. The current implementation of a comput‐
er data collection and a tracking system could also reduce the newborns considered as lost to documen‐
tation and the paperwork workload. RESULTS OF THE DUTCH HEARING SCREENING PROGRAMME Van der Ploeg CPB1, Uilenburg N2, Van Zanten GA3, Meuwese‐Jongejeugd A4 TNO/Child Health, Leiden, the Netherlands; 2Dutch foundation for the deaf and hard of hearing child, Amsterdam, the Neth‐
erlands; 3University Medical Center Utrecht, Audiological Center, the Netherlands; 4National Institute for Public Health and the Environment, Centre for Population Screening, Bilthoven, the Netherlands 1
Newborn hearing screening (NHS) has been available to every neonate in the Netherlands since 2006. Most children (approximately 181.000 annually) take part in the Dutch NHS programme, which is car‐
ried out by child health care employees. NHS is offered at home (75%) or at well‐baby clinics (25%), as the majority of Dutch newborns are either born at home or are discharged from hospital within 24 hours after birth. The OAE method is used in the first two rounds of the three‐stage screening protocol and the AABR method is used in the third round. Every year approximately 4.000 newborns are admitted to a neonatal intensive care unit (NICU). As these children are offered NHS through a separate NICU‐NHS programme, their results are not reported here. In 2010 participation rates were over 99% for all rounds. The refer rate after the first screening round was 5%. Overall, 0.27% of the children was referred to the audiological centre (AC) for diagnosis. The screening process was completed within seven weeks after birth in 90% of all children. The age at diagnosis was less than three months in 81% of the children. In 2009, 94% of the referred children were diagnosed at the AC. A total of 163 children were identified with a bilateral permanent hearing loss of at least 40 dB in the best hearing ear and 82 children were diag‐
NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 36 NHS 2012
nosed with a unilateral hearing loss (NICU children excluded). The positive predictive value with re‐
spect to a bilateral or unilateral hearing impairment in children referred to the audiological centre was 45%. In bilateral referrals the probability of diagnosing a bilateral hearing impairment was 64%. In 2008, 80% of the children with an indication for hearing amplification started with hearing aids before they were six months old. EVALUATION OF FOURTEEN YEARS AABR HEARING SCREENING IN DUTCH NICU’S van Straaten HLM1, van Dommelen P2, Verkerk PH2 Isala Clinics, Zwolle, The Netherlands; 2TNO, Leiden, The Netherlands 1
Aim. Evaluation of the nationwide Automated Auditory Brainstem Response (AABR) hearing screening program in Dutch Neonatal Intensive Care Units (NICU) in the period 1998‐2011. Design. As part of a nationwide hearing screening program two stage AABR hearing screening has been gradually intro‐
duced in all Dutch NICU’s (1998‐2001). From 1998 to June 2011 graduates with >1 risk factors according to the 2007 Joint Committee on Infant Hearing statement were included. Central registration of results facilitates screening, tracking, follow‐up after abnormal screening results and quality assurance of the program were established. Endpoints are prevalence of uni/bilateral hearing loss (HL) and referral rate after the 1st and 2nd test. Quality indicators are: participation rate 1st test (goal>98%), 2nd test (goal>95%), diagnostic examination (goal >95%), and percentage of neonates with an age corrected for gestational age at the 1st test <30 days (goal >90%), 2nd test <6 weeks (>90%), diagnosis <3 months (goal >90%). Results. In total 41,634 neonates have been screened. 9.4% of the neonates did not pass at the 1st test. In total, 3.0% (n=1,253) was referred for diagnostic examination. Bilateral HL was diagnosed in 58% of the referrals (prevalence 1.7%) and unilateral HL in 18% (prevalence 0.5%). The participation rates over years varied between 98.0%‐99.6% (1st test), 88.5%‐97.0% (2nd test), 83.9%‐95.1% (diagnostic ex‐
amination). 95.6% of the neonates had their 1st test <30 days and 81.4% of the referred neonates had their 2nd test <6 weeks. 68.5% of the referred neonates were diagnosed <3 months. Conclusion. The AABR neonatal hearing screening program in Dutch NICU graduates is highly effective in terms of participa‐
tion and referral rate. That not all goals of the high standard quality indicators were attained may be due to interference with severe concomitant pathology. The positive predictive value of the two stage pro‐
gram is 75.8%. IMPLEMENTATION AND OUTCOME OF A TWO‐STEP UNHS PROGRAM IN NORTH RHINE, GERMANY Fabian S, Weber A, Walger M, Lang‐Roth R Hearing‐Screening‐Centre North Rhine, ORL‐Department, University Hospital of Cologne, Cologne, Germany Since 1.1.2009 the universal newborn hearing screening (UNHS) in Germany was obligatory regulated by the “Gemeinsame Bundesausschuss”. Until today not in every German federal states the newborn hearing screening is established in cooperation with hearing‐screening‐centres to ensure the tracking and quality of screening procedures. For the area of North Rhine, a part of the federal state North Rhine‐
Westphalia, a quality based two step UNHS‐program according to the Hessian model was developed and implemented in 2006. Despite financial support from the government or insurance companies we could connect about 50% of the 96 birth hospitals and build up an effective network of follow‐up facili‐
ties. Until today we are able to track about 50% of the 80,000 newborns per year. In a retrospective cohort NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 37
study with more than 100,000 screened babies, the outcome of our UNHS program from 2009 to 2011 was analyzed on the basis of the follow‐up data. Therefore we evaluated (1) the incidence of sound con‐
ductive and sensori‐neural hearing loss, (2) risk factors in correlation to different types of hearing loss and (3) the importance of a quality management for an optimal outcome. The outcome of our program will be presented and discussed in detail. Knowing the fact, that without any tracking or quality man‐
agement of screening programs, the lost‐to‐follow‐up‐ rate may increase above 50%, we could drop the rate far below 10% to make sure that a high percentage of newborns will profit from early intervention and rehabilitation. EFFECTS AND SIDE EFFECTS OF EARLY IDENTIFICATION, DIAGNOSIS AND INTER‐
VENTION OF HEARING IMPAIRMENT IN SLOVENIA Zupan L1, Spindler M2 General Hospital Celje, Department of ENT, Celje, Slovenia; 2University Clinical Center Maribor, Department of ENT, Mar‐
ibor, Slovenia 1
Universal newborn hearing screening was introduced in Slovenia in May 2005 and in some hospitals it was performed even before. Infants who do not pass the screening are subjected to appropriate medical and audiological evaluation to confirm their hearing loss before the age of three months. Our goal is to supply infants who have permanent hearing loss with necessary services before the age of six months. The outcome of this screening programme is good because all the participants are motivated and under‐
stand the importance of early identification and intervention. From may 2005 until the end of 2011 139 770 infants were born in Slovenia. We identified 209 hearing impaired children (0.15 % of all live born infants) who have completed diagnostic follow‐up and received hearing aids. Among these children 43 received a cochlear implant. In this time span, 50 hard of hearing or deaf children were candidates for a cochlear implant. They present 0.04 % of all life‐born infants and 23.92 % of all identified hearing im‐
paired children. A cochlear implant was received by: 7 infants before the age of one year, 24 infants at the age of 1‐2 years, 12 children at the age of 2‐3 years, while 7 children are still waiting for it. We no‐
ticed very good results of rehabilitation of children with a cochlear implant. Hard of hearing children who did not receive a cochlear implant, also showed better results of rehabilitation after the introduction of universal newborn hearing screening because the intervention and amplification with hearing aids is now better. Greater improvement in outcome of rehabilitation of children with mild hearing impairment was obtained through adequate amplification, careful audiology follow‐up, and appropriate rehabilita‐
tion. UNIVERSAL NEWBORN HEARING SCREENING OF NAVARRA (SPAIN): OUTCOMES OF TWELVE YEARS Ederra M1, Ascunce Elizaga N1, García M1, Zubicaray J2 Sección de Detección Precoz, Instituto de Salud Pública, Pamplona, Spain; 2Hospital Virgen del Camino, Pamplona, Spain 1
Background. Navarra is an Autonomous Community located in the north of Spain. Its population is about 640.000 inhabitants. Over 6.500 children are born on average per year. The Universal Newborn Hearing Screening Program (UNHSP) in Navarra was launched in 1999. Its main goal is to detect all the congenital deafness in newborns of Navarre to the age of three months in order to carry out early thera‐
NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 38 NHS 2012
peutic intervention, providing the normal development of the babies. Methods. The universal screening has been carried out with inclusion of all the children born in Navarre since 1999 to date (over 74.000 ba‐
bies). Otoacoustic Emissions (OAE) has been used as screening test, and Auditory Evoked Potentials (AEP) to perform the definitive diagnosis of deafness. Children with hearing impairments were dis‐
patched to early auditory stimulation. They were also subjected to amplification, if necessary. In selected cases cochlear implants were performed. Results(*). The screening test was done to more than 74,000 newborns, with a participation rate of 99.5%. In 1.36% of them, diagnostic confirmation by EAP was nec‐
essary. 40% of EAP detected the presence of deafness of different degree. The total detection rate of hear‐
ing loss was 5.04 per thousand babies. Conclusions. Currently, the program is fully established in our community. The results, both in terms of percentages of ʺstepʺ of the OAS and the number of diagnosed hearing loss are consistent with those found in the literature. Provisional data. (*)
NEWBORN HEARING SCREENING PROGRAMME IN TURKEY Konukseven O1, Genc A2, Bolat H3 Hearing& Balance Disorders, Diagnose and Rehabilatation Center, Department of Ear Nose and Throat and Head and Neck Surgery, Ankara Ataturk Research and Training Hospital, Ankara, Turkey; 2Division of Audiology, Department of Ear Nose and Throat and Head and Neck Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey; 3T.R. Ministry of Health, General Directorete of Mother and Child Health, Family Planning (MCHFP), Ankara, Turkey 1
Newborn Hearing Screening has been implemented as National Programme under the responsibility of The Ministry of Health, General Directorate of Mother‐Child Health and Family Planning since 2004 in Turkey. NHS Programme was conducted by Screening Centers of 1st‐3rd Step in Turkey. 1st Step Newborn Hearing Screening Center (1stSNHSC): The first screening test, Automated Otoacoustic Emission Screening (AOAE) is performed 2‐3 days after birth in the Maternity Hospital, State Hospitals or University Hospitals. a) If the baby passes bilaterally, the family is given information. b) If the baby can not pass the AOAE, he/she will be controlled screening test after 15 days. If there is AABR device in 1stSNHSC, AABR is done. Babies who fail second AOAE or A‐ABR will be referred to 2ndSNHSC 2nd Step Newborn Hearing Screening Center (2ndSNHSC): AABR equipment and ENT doctor have to be present. Babies having risk factors and babies who fail AOAE have to be screened by AABR and ENT examination. a) If the baby passes bilaterally, the family is given information. b) If the baby fails from one or two ears, in case of normal ENT examination, he/she will be directed to 3rdSNHSC. The latest time to go to 3rdSNHSC is the babies’ 2‐month age. 3rd Step Newborn Hearing Screening Center (3rdSNHSC): Audiologist and equipment for pediatric audiological diagnosis must be present in the comprehensive Audiology Clinic. In diagnostic center; it was aimed to diagnose around 3 months by electrophysiological and behavioral tests; and then hearing aid fitting and orientation training started. 1,365,000 babies are born yearly in Turkey and in 2012, Turkish NHS ratio is reached 76.9% with ̴750 centers in all 81 cities. Turkish NHS data with multicentric studies in Turkey shows that follow up pro‐
tocols regarding precautions of risk factors should be customized according to the regions of Turkey. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 39
EARLY HEARING DETECTION IN CYPRUS Thodi C1, Vogazianos M2 Cyprus Audiology Center, European University Cyprus; 2Center for Preventive Paediatrics, Limassol, Cyprus 1
The Cyprus Universal Early Hearing Detection Program was initiated in 2005. The program screens over 95% of infants, with an initial referral rate for second round of Otoacoustic Emission screening of 3.14%. After second OAE screen, infants are referred for Automated ABR, resulting in 0.5% of referrals for di‐
agnostic audiology. Confirmed hearing loss is observed in approximately 2.8‰ of the population screened. The Cyprus UNHS is implemented by the Center for Preventive Pediatrics, an NGO relying partially to donations for support. Due to lack of organized follow‐up services the NGO undertook a follow‐up procedure in 2008, and has been completing the screening process with diagnostic assessment of the referred infants. As a result, complete hearing status data exist for infants screened after 2008. Age of diagnosis is under one month, whereas age of verification and intervention is around 2‐5 months. Early intervention services are available yet not equally accessible to all families or clearly defined. Work supported by the project Newborn and Infant Heaing (NIH), supported by the Cyprus Research Foundation, Contract HEALTH/PUBLIC HEALTH/0308(ΒΕ)/23 COMPARATIVE STUDY OF INFANT HEARING LOSS IN SOUTHERN PALESTINE Corradin L1, Rahil M2, Kanaan M3 Caritas Baby Hospital, Nursing Department ‐ Bethlehem, Palestine; 2Dar Al Kalima ‐ Bethlehem, Palestine; 3Bethlehem Uni‐
versity ‐ Bethlehem, Palestine 1
In the West Bank, with the construction of the wall there was a documented increase in consanguinity. This led to an increase in several genetic diseases, including infantile hereditary deafness which was contributed to the genetic mutations. In August 2006, Caritas Baby Hospital (CBH) in Bethlehem took the initiative to start newborn hearing screening. This was due to the high prevalence (3‐15%) of child‐
hood deafness in Palestine and to the absence of hearing screening in Bethlehem. CBH hearing screening was based on the recommendations of the American Academy of Pediatrics which considered the Oto‐
acoustic emissions as the ideal tool for screening. This recommendation was used between 2006 till 2011 when the AABR (Automated auditory brainstem response) was added for retesting suspected patients in order to reduce the false positives. Descriptive statistics was used to evaluate the data generated. Among the 8144 infants tested, 97% came from the districts of Bethlehem‐Hebron and 3% from other locations in the West Bank. Of the 8144 infants tested 1419 (17.4%) infants did not pass the 1st test. Of these 954 (67%) did not come for retesting and 465 (32.8%) failed the retest. Only 136 (29%) of the patients that failed re‐
testing went to an audiologist. The audiologist evaluation revealed that 79 (58%) patients presented with mild‐moderate or profound hearing loss according to the BIAP, while 10 (7.3%) patients presented with Otitis media. Chart review of the affected patients revealed that the risk factors included jaundice, sepsis and prematurity. As the prevalence of the cases is high and there is only one neonatal screening possibil‐
ity in all the area, it is necessary to implement the EHDI guidelines and extend the program to other lo‐
cal health facilities, recommending the local Minister of Health to start the screening in the villages rein‐
forcing the prevention program and family education. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 40 NHS 2012
THE LAST RESULTS OF NATIONAL NEWBORN HEARING SCREENING IN IRAN Firozbakht M, Rafie M, Esmailzade A, Rahimi F, Ansari Dezfouli M, Mahmodian S Welfare State Organization Tehran Iran It was about the 6 years ago that we presented the preliminary report of newborn hearing screening (NHS 2006). During this period, we have built a national infrastructure based on EHDI principals, what we have learned and challenged, would be discussed in this presentation. Spreading of this program from a small public center near the capital city of Tehran to distant small cities with the assistance of pri‐
vate sectors was a long way that could not be passed without support of all stakeholders along with con‐
sistent and comprehensive plan. Actually near fifty percent of newborn were screened at public and pri‐
vate hospitals and nurseries. At the moment near 700 thousands newborn were screened each year in near 300centers. The exponential rise of these centers was mainly belonging to two main factors 1‐ financial help of WSO ,welfare state organization, to private sector and 2‐ Growing public awareness about the importance of NHS. At the present time near 90 percent of newborn screening is carried out by private sectors. It should be stated that in our country the NHS is not committed to all principals of screening we have gathered a part of our financial requirement from the family of screened baby, other differences and details would be discussed in panel. What we mainly concerned after near 10 years of programming and implementa‐
tion is the lost to follow of near fifty percent of babies who had referred from screening to diagnostic part of the program nevertheless, our colleagues tried to overcome this failure through better registra‐
tion and persuasion of families. Statistical details will be discussed. NEWBORN HEARING SCREENING IN BRAZIL: RECOMMENDATIONS AND NEEDS Lewis DR Pontificia Universidade Católica de São Paulo, PUCS‐SP, São Paulo, Brazil Brazil is a large country, with five different regions, and geographical, climate, cultural, and socio‐
economical aspects vary among them. Also, the demand and offer for health services and care can show differences among the five regions. From 70‐90% of the inhabitants depend on Public Health Services, and this means that this proportion includes births, newborn hearing screening and follow up. Public and Private Health Services offer Newborn Hearing Screening (NHS) to parents in an assistematic way. In 2010, a federal law was published and NHS is now obligatory for all newborns. Many discussions were held during 2011, concerning the approach and organization of NHS in Brazil. Most Health Ser‐
vices have been waiting the publication from the Ministry of Health concerning the implementation of NHS in Brazil. The Brazilian scientific societies (audiology, language and speech pathology, othorinolar‐
ingology, otology and paediatrics) have published a guideline in order to help the implementation of NHS in Brazil. These recommendations were considered for the construction of the guidelines written by the Ministry of Health and about to be officially published. Meanwhile, a questionnaire is being sent to maternities, in order to have an overview of the amount of hospitals already performing NHS, tech‐
niques used, difficulties with human resources, equipment, and follow up. Also, the reasons for not hav‐
ing the NHS implemented yet are being questioned. This presentation will focus the Brazilian recom‐
mendations in order to gradually implement NHS in the country until 2014, and the results on the ques‐
tionnaire sent to hospitals. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 41
EARLY HEARING SCREENING, DETECTION AND INTERVENTION IN PUBLIC SEC‐
TOR HOSPITALS IN SINGAPORE Daniel LM1, Joseph R2, Ho S3, Lim SB4 Dept of Neonatology, KK Women’s and Children’s Hospital, Singapore; 2Dept of Pediatrics, National University Hospital, Singapore; 3Dept of Neonatology, Singapore General Hospital; 4Dept of Child Development, KK Women’s and Children’s Hospital, Singapore 1
This report analyses the outcome of newborn hearing screening in 3 public sector hospitals where 40‐
45% of the country’s births take place. The 1st stage screen is completed before hospital discharge. The 2nd stage screen is performed after discharge at 2‐6 weeks of life. Only the AABR is used for all newborn infants in Hospital 1 and for high risk infants in Hospital 2. In Hospitals 2 and 3, the 1st stage screen for well infants is the TEOAE, followed by an AABR if the infant does not pass. The 2nd stage screen is the AABR (in Hospital 2) and both the AABR and OAE (in Hospital 3). For high risk infants in Hospital 3, both the TEOAE and AABR are used for the 1st first stage screen. Very Low Birth Weight Infants (i.e. ≤ 1500g) who do not pass are referred for audiological evaluation. The others are recalled for a 2nd stage screen using the same test that they did not pass. Between 2003 and 2010, there were 155,724 live births in the 3 hospitals. Of these, 99.2% were screened prior to hospital discharge. 3.9% were recalled for out‐
patient screening of which 94.4% returned for screening. The Ministry of Health funded the screening program for the first 18 months in Hospital 1. Between 2003 and 2009, 88459 infants were screened in Hospital 1. The referral rate to otolaryngology for audiological assessment was 0.54%. Hearing loss was diagnosed in 261 infants, with a positive predictive value of 79.6% and a false positive rate of 0.25%. The median age of diagnosis of hearing loss was 4.8 months (range 1‐24months). Hearing aids were fitted in 84 children at a median of 7.6 months (2 – 45 months). 20 infants had a cochlear implant at a median age of 20 months (8 – 38 months). NEWBORN HEARING SCREENING IN INDONESIA: LIMITATIONS AND CHAL‐
LENGES Suwento R1, Anggraeni R2, Zizlavsky S1 Dep ENT, Dr Cipto Mangunkusumo National Hospital, Faculty of Medicine, University of Indonesia ‐ Jakarta, Indonesia; 2Dep. ENT, Dr Hasan Sadikin Public Hospital, Faculty of Medicine, University of Pajajaran ‐ Bandung, Indonesia 1
Although universal or targeted newborn hearing screening of newborns is widely implemented in de‐
veloped countries, its introduction in the developing world may be constrained by such problem. The health care systems in many developing countries are fragile and government funding is uncertain. Lack of adequate resources and infrastructure may limit services for early hearing detection and intervention. Indonesia as ‘a developing country with 237 million inhabitants is an archipelago consisting of 13,000 is‐
lands’ is also facing the problem mentioned above. The nationwide implementation may be hampered by low public awareness, resource constraints and lack of government and donor funding. Socio‐
demographic characteristics such as maternal education, economic status as well as infant medical his‐
tory such as prematurity, low birth weight, perinatal infection in the neonatal period have been associ‐
ated with follow‐up default in infant hearing screening programs. Modern or Electro physiologic NHS based on JCIH in Indonesia is known since 2004. We developed NHS Health Technology Assessment (HTA) in 2006. At present there is no National program for NHS, implemented in three out of the 33 provinces. Hearing screening services are provided most at private hospitals; but it has not been able to NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 42 NHS 2012
implement JCIH benchmark and no strategy for effective tracking. The coverage is generally poor and the follow‐up rates remain a challenge. UNIVERSAL NEWBORN SCREENING AND EARLY INTERVENTION PROGRAMME IN NEW ZEALAND Tuohy PG New Zealand Ministry of Health, Wellington, New Zealand Background. Before the introduction of universal newborn hearing screening and early intervention programme (UNHSEIP) the age of diagnosis of sensorineural hearing loss was approximately 4 years, and there were significant ethnic inequalities in the age of detection. In 2007 the New Zealand Govern‐
ment began implementation of a newborn hearing screening and early intervention programme, jointly funded and governed by the Ministries of Health and Education. The programme aims to screen all newborn infants by one month, to provide audiological assessments for all the infants with a “refer” screening result within three months, and to ensure that appropriate medical, audiological and early in‐
tervention education services are initiated by six months of age. Results to date. Over the six month pe‐
riod from October 2010 to March 2011, 95% of newborn infants were offered screening, and we identi‐
fied 73 infants with moderate to profound hearing loss. A summary of key results for the 6 months from this period is as follows: o
o
99% of babies whose parents consented completed screening, 93% within the 1 month target. 1.7% of the screened babies were referred to audiology, but to date only 2/3rds have completed audiological investigation within the specified 3 month period. o 0.3% of infants were found to have moderate or worse hearing loss o 22% of these infants had sensorineural hearing loss and the remainder had mixed/conductive losses o Maori and Pacific infants were slightly less likely to complete screening within 1 month, but had audiology referral rates twice that of European babies. Where to go from here. Up to date results from the programme will be reported to show how we are progressing, and how well we are addressing the needs of Maori and Pacific populations. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 43
EHDI POLICIES IMPLEMENTATION OF WHO NEWBORN AND INFANT HEARING SCREENING GUID‐
ING PRINCIPLES FOR ACTION IN CHINA Bu X Jiangsu Province Hospital Nanjing Medical University, WHO Collaborating Centre for the Prevention of Deafness and Hear‐
ing Impairment, HI‐IFOS‐ISA Jiangsu Ear & Hearing Centre, Nanjing, China Approximately 19.5 million babies are born every year and at least 20000 permanent hearing impaired newborns are added annually in China. Such large numbers of hearing impaired newborns create a se‐
vere public health and social problem. NHSP in a huge population country poses severe challenges, but it has been strongly recommended by China’s government and professional societies, and it has got great achievements since 1999. This presentation will introduce how WHO Newborn and Infant Hearing Screening Guiding Principles for Action (WHO Geneva Nov. 2009) have been implemented in China. It will describe and emphasise the enhancing effects of the WHO Guiding Principles in China’s NHSP in policy and regulative issues, national plans, screening strategies (approaches and methods), technical criteria, aetiology and training etc; it will also mention how to make the WHO document more effective. The latest results will be reported. QUALITY AND INEQUALITY IN NEWBORN HEARING SCREENING Tuohy PG New Zealand Ministry of Health, Wellington, New Zealand All screening programmes have benefits and harms. Setting standards and enabling ongoing quality im‐
provement for screening programmes minimizes harm, and maximises good outcomes. One of the major harms that screening programmes may cause is a worsening of pre‐existing inequalities or creation of new ones. The New Zealand Ministry of Health has recently developed Quality Policy and Standards for the Universal Newborn Hearing Screening and Early Intervention Programme (UNSEIP). In New Zea‐
land we have an explicit goal of ensuring our screening programme reduces health inequalities, espe‐
cially for low socioeconomic and indigenous populations. Although inequalities in outcome are docu‐
mented in many screening policies internationally, a response to this issue is not always built into the programme itself. We believe that this is an important aspect of quality because screening programmes, if not implemented carefully, have the potential to increase inequalities across population groups or in‐
crease inequalities which already exist. The approach we have taken is to place “Improving Maori Health” and “Reducing inequalities” as two the core policy goals of the UNHSEIP. Maori children in New Zealand have poorer health outcomes on a range of measures, and we used the Maori Health Strat‐
egy “He Korowai Oranga” to inform the actions we need to take to ensure that outcomes for all ethnic groups are equal. It is our belief that unless reducing inequalities is explicitly identified as a component of the quality performance measures for UNHSEIP, then the programme is likely to disproportionately fail to enrol, screen, test and follow‐up children at higher risk of poorer health outcomes. This presenta‐
tion will describe the approaches we have taken to address these important goals, and discuss the suc‐
cesses and challenges we face in implementing these policies. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 44 NHS 2012
ECD POLICY IN SOUTH AFRICA ‐ ECONOMIC AND FINANCIAL IMPLICATIONS OF EXCLUDING CHILDREN WITH DISABILITIES Störbeck C, Moodley S Centre for Deaf Studies – HI HOPES Programme, Johannesburg, South Africa The importance of the young child in South African policy has been recognized through the inclusion of ECD planning in documents relating to the National Departments of Health, Education Social Develop‐
ment. However, even though there has been inclusion of what needs to be in place for ECD, there has been no indication of how policy procedures will be implemented, and there is an exclusion of ECD pol‐
icy relating to children with disabilities. 17 children per day are born with a hearing loss in South Africa and without the provision of appropriate early intervention services, the cost of education and loss of productivity is estimated at $100,000 per child. This has serious implications for the financial and eco‐
nomic climate in South Africa. When it is considered that with appropriate early detection and interven‐
tion services typical development will occur, the cost of early detection and provision of early interven‐
tion should be weighed against the cost of future provision of specialised services and assistance. The ECD policy documents relating to the various departments in the South African government system will be discussed with a focus on the lack of provision of services for children with disabilities. Additions and amendments that can be made to various policies will be discussed. EUROPEAN CONSENSUS STATEMENT ON HEARING SCREENING OF PRE‐SCHOOL AND SCHOOL‐AGE CHILDREN Skarzynski H1, Piotrowska A1, Lorens A1, Kamyk P1, Ludwikowski M1, Skarzynski PH2 Institute of Physiology and Pathology of Hearing, Warsaw, Poland; 2Institute of Sensory Organs, Warsaw, Poland 1
The prevalence of hearing loss increases with age and may involve different types of hearing problems that cannot be identified by neonatal hearing screening. It is estimated that 9‐10 per 1000 children will have identifiable permanent hearing loss in one or both ears by school‐age. A distinguished panel of ex‐
perts discussed hearing screening of pre‐school and school‐age children during the 10th Congress of Eu‐
ropean Federation of Audiology Societies (EFAS), held in Warsaw, Poland, in 2011. The panel included experts in audiology, otolaryngology, communication disorders, speech language pathology, education and biomedical engineering. Consensus was reached on thirteen points. Key elements of the consensus, are: 1) defining the role of pre‐school and school screening programs in the identification and treatment of hearing problems; 2) identifying the target population; 3) recognizing the need for a quality control system in screening programs; 4) encouraging the appropriate authorities of the various countries in‐
volved to initiate obligatory hearing screening programs of pre‐school and school‐age children. The Consensus was brought before the European Union’s Member States as one of the documents welcomed during discussion and adoption of “Council Conclusions on early detection and treatment of communi‐
cation disorders in children, including the use of e‐Health tools and innovative solutions”. The docu‐
ment directs the attention of the society to the issue of communication disorders (hearing, vision and speech disorders) in childhood, and the consequences the undetected and untreated early enough dys‐
functions might have for the cognitive and emotional development of children affected, and therefore for their social and economic situation in adult life. Both – the Consensus and the Conclusion are aimed to encourage encourages governments, opinion makers and appropriate public institutions in the EU NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 45
countries to initiate actions and programs aiming at early detection and treatment of communication disorders in children. INTEGRATED SYSTEMS AND TEAM WORKING FOR CHILDREN WITH AUDITORY CHALLENGES: HEALTH PROFESSIONAL PRACTICE IN INTERPROFESSIONAL NON‐
HEALTHCARE CONTEXTS Ng S1,2, Schryer C2,3, Hibbert K1,4, Regan S5, Lingard L1,2,6 Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Canada; 2Health Care, Technology, & Place, University of Toronto, Toronto, Canada; 3Department of Professional Communication, Ryerson University, Toronto, Canada; 4Faculty of Education, The University of Western Ontario, London Canada; 5School of Nursing, Faculty of Health Sciences, The University of Western Ontario, London, Canada; 6Department of Medicine, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Canada 1
Children and youth with disabilities such as hearing loss require healthcare beyond the confines of tradi‐
tional healthcare settings. Internationally, 10‐15% of children receive special education services as a re‐
sult of disabilities and exceptionalities. Special education calls upon health professionals, including au‐
diologists and physicians, to practice at the interface of healthcare and education: integrated systems and team work (ISTW). A review of literature from the United Kingdom, where ISTW policies have been in place for over three decades suggests that critical challenges persist resulting from disparate institutional and professional cultures across sectors, despite the system‐wide policies. These challenges often mate‐
rialize in the development of the IEP: the Individual Education(al) Plan (or Program in some countries). In the IEP, health professionals’ (often written) recommendations are meant to be translated into educa‐
tional programming. However, the cultural gaps between professionals and sectors create tension at this junction, which can result in inefficient and insufficient care. We are employing Institutional Ethnogra‐
phy and Rhetorical Genre Studies in this research, seeking an understanding of how professionals from different sectors work together to support children in special education. Document review, observation, and interviews were conducted with the health and non‐health professionals and parents of children for whom an IEP was being developed. This research begins to expose the organizing power of documents such as medical notes, health professional reports, the IEP, and policy documents; thus, otherwise tacit factors that facilitate or constrain effective ISTW are revealed. By mapping these factors, this research supports the realization and re‐organization of ISTW for children with hearing loss and other exception‐
alities. In this presentation, the preliminary findings from our study of one team working to support a child with hearing loss will be explicated. THE GOALS FOR TRACKING AND QUALITY ASSURANCE FOR AUDIOLOGICAL SCREENING Tavartkiladze GA, Belov OA, Tsygankova ER, Alexeeva NN National Research Centre for Audiology and Hearing Rehabilitation, Moscow, Russia The effectiveness of the universal screening program is highly dependent not only on the quality of the first stage of screening but also on the succession between this stage and the follow‐up realization. The loss to follow‐up is mainly due to the absence or the unsuccessful functioning of the integrated health care and data systems, data management for newborn screening systems and limitations of current data NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 46 NHS 2012
systems. To improve the effectiveness of the follow‐up the development of standardized algorithms for follow‐up testing and monitoring of follow‐up results is recommended. The cost of follow‐up stage strongly depends on the probability of false positive detection of hearing loss. This probability can be tuned by settings in algorithm of data processing in the diagnostic equipment. Generally it is possible to make measurement faster or more accurate, but not both. Now we donʹt have the data necessary neither to choose the appropriate equipment or to estimate and optimize the cost of both stages of screening. We can not estimate the probability of mistakes made by staff and the cost of these mistakes, but we can ex‐
pect that this probability is different for different types of devices. To collect these data the program of raw data collection from equipment used in audiological screening was developed. The impersonal data are collected in relational database and are processed by automatic algorithms together with information about retests and treatment. It is planned to make this database open for the scientific society. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 47
NEW DIAGNOSTIC TECHNIQUES HEARING SCREENING WITH MULTI‐FREQUENCYSPECIFIC ANIMAL SOUND TEST (MFAST) Coninx F1,2, Offei YN1 University of Cologne, Faculty of Human Sciences, Department of Rehabilitation and Special Education, Cologne, Germany; 2IfAP, Institute for Audiopedagogics, Solingen, Germany 1
The use of pure tones as stimuli in frequency‐specific (detection) threshold tests is a golden standard but at the same time not without disadvantages. The use of spectrally more complex stimuli has been advo‐
cated in order to avoid effects caused by fine structure in the tone audiogram and to apply sounds that are more natural and used in daily life (Heise et al 2008; Massie et al, 2005). Particularly for young chil‐
dren application real‐life types of stimuli is expected to be preferred over pure tones. This is considered to be a relevant advantage in screening. The multi‐Frequencyspecific Animal Sound Test (mFAST) was developed for this purpose. mFAST is using four animal sounds (cow, dog, cat, bird) with different spec‐
tral contents, centered around four frequencies (500, 1k, 2k and 4kHz). Thresholds for each of the animal sounds are collected in a combined multi‐adaptive procedure; results are used to estimate the audiomet‐
rical thresholds at the given frequencies. In this procedure the screening is running independently i.e. not influenced by skills and experience of the test leader, fulfilling an important screening criterion. In a pilot study mFAST thresholds were compared with those based on pure tones as well as on bands of steady‐state noise having the same spectral contents as the animal sounds. Methods. With a group of N=45 students, aged between 20 and 30 years, N=89 normal ears were tested. The AuriCheck handheld device and calibrated HDA280 headphones were used. All subjects were tested with mFAST, duoTone (pure tones) and duoTone (noise bands). The order of tests was randomized. Results were plotted in 4‐
frequency audiograms and statistically evaluated and showed no significant difference in all of 3 thresh‐
old types, except for a 7dB threshold difference between the pure tone threshold and the mFAST / noise band thresholds, only at 4kHz. Conclusion. Findings of the research suggests that mFAST could be used as an alternative to pure tone audiometry to screen and test young children for hearing loss. SPEECH INTELLIGIBILITY TESTED BY THE PEDIATRIC MATRIX SENTENCE TEST IN 3 TO 6 YEAR OLD CHILDREN Ozimek E, Kutzner D, Libiszewski P Institute of Acoustics, A. Mickiewicz University, Poznań, Poland The study is aimed at the development and application of the Pediatric Matrix Sentence Test (PMST) for testing speech intelligibility in children aged 3‐6 years. The test is based on sentences of the subject‐verb‐
object pattern. It consists of sixteen statistically and phonemically equivalent sentence lists and is de‐
signed for accurate measurements of the SRT for preschool children. A group of 181 preschool children, aged 3‐6 years, with no history of hearing loss, was recruited and divided according to age into 4 groups. Pictures illustrating PMST utterances were prepared and a six‐alternative picture‐point (PP) method was used for administrating the 1‐up/1‐down adaptive procedure converging signal to noise ra‐
tio (SNR) to speech reception threshold (SRT) point. Correctness of verbal responses (VR), preceding PP NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 48 NHS 2012
responses, was also judged. Test optimization resulted in a reduction of lapse rate, thus data obtained for the PP method were mainly biased by the response guessing. The normative SRT for the PP method was shown to decrease with age; for the children aged 3 to 6 the mean SRTs for the PP method was ‐1.0 dB and ‐2.9 dB, respectively (for VR the corresponding values were 0.4 dB and ‐1.5 dB). SRTs were shown to be correlated with average pure tone thresholds. The final stage of the study was test valida‐
tion performed for hearing‐impaired (HI) children (41 persons) and an analysis of differences between the normative data and the data obtained for HI patients. It was found that the SRTs obtained for HI children were significantly higher than the normative data. The PMST test may be a useful tool in a pe‐
diatric speech audiometry. AN OBJECTIVE, AUTOMATIC, AND NON‐INVASIVE METHOD FOR SOUND LOCAL‐
IZATION MEASUREMENTS IN INFANTS AND SMALL CHILDREN Asp F, Olofsson Å, Berninger E Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden Deaf children receive bilateral cochlear implants (BiCIs) with the primary aim to provide binaural bene‐
fits in virtue of bilateral stimulation, such as for example improved sound localization accuracy com‐
pared to a single cochlear implant (CI). It is increasingly common to provide BiCIs before 12 months of age, which has raised a need for objective evaluation of binaural hearing in implanted infants and tod‐
dlers. A systematic improvement of normal‐hearing infant sound localization accuracy is shown from age 6 to 18 months. However, accuracy is not yet at the level of adults. Localization acuity (i.e. spatial resolution) of young children (26 – 36 months) using BiCIs is reported in the literature, whereas accuracy and acuity in infants using BiCIs remains unknown. In infants and adults alike, audition guides vision to spatial locations of interest. We have developed a method for sound localization measurements in in‐
fants from 6 months of age, based on the assumption that gaze direction may be a good estimate of the perceived sound‐source location. The infant is placed in front of twelve covered loudspeakers spanning a 110 degree arc in the frontal horizontal plane. Beneath each loudspeaker is a visual display. A continu‐
ous sound and visual stimulus is presented from a loudspeaker and a corresponding display in front of the infant. The sound is moved to a random loudspeaker, and the visual stimulus stops. After about 2 seconds, the visual stimulus reappears beneath the sounding loudspeaker. During this time period, the infant is guided by sound only as to where the visual stimulus will reappear. Infant pupil positions are analysed in real‐time, resulting in a gaze direction estimate within 1‐2 degrees. The aim is to study if in‐
fant gaze direction is a feasible method for sound localization accuracy assessment. Results from pilot testing will be presented and discussed. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 49
WEB FOR SOCIAL AND SKILL DEVELOPMENT ENHANCED PATIENT CARE – EXPLOITING THE SOCIAL WEB ENVIRONMENT Lehnhardt M Prof. Ernst Lehnhardt‐Stiftung Badenweiler, Germany “How mass collaboration changes everything” is the subtitle of “Wikinomics”, one of the fundamental books describing the new dimensions of Internet. A well known example is Wikipedia. In millions of weblogs, forums and thousands of social networks (Facebook with >550 Million users, half of them log‐
ging in daily) people can lead peer‐to‐peer conversations. What then is the impact of social web envi‐
ronments on health care and specifically on potentially enhanced patient care? PEW Research (Washing‐
ton) has shown that people turn to different sources for different kinds of information. When the issue involves technical aspects related to a health care problem, people prefer to contact professionals (62‐
91%). When the issue involves more personal /emotional aspects most patients prefer the non‐
professionals (46‐59%). Communication in Social Web Environments can happen on different levels: ‐ Inter‐disciplinary (e.g. medical doctors, audiologists, speech therapists and psychologists share their core competence knowledge to conclude on the most promising treatment for a patient; medical pro‐
fessionals refer their patients to medical professionals in another discipline) ‐ intra‐disciplinary (e.g. audiologists with different levels of education and experience join forces to enhance the quality of diagnosis and treatment for patients with specific problems; parents seeking treatment for their deaf children empower each other by sharing their knowledge and experience leading to “Participatory Medicine”) ‐ supra‐ or meta‐disciplinary (e.g. people access information available in the Internet) In this presentation we will illustrate how Social Web Environments could be exploited on all different levels during the process of consulting and deciding whether a Cochlear Implant is indicated for a cer‐
tain child. We will also describe where this communication and cooperation mode is already applied, list some key criteria for introducing innovations and propose how to encourage the use on a routine basis. THE IMPACT OF SOCIAL NETWORKS ON DEAF TEENAGER’S COMMUNICATION Mikic B1, Mikic M2, Miric D1, Asanovic M1, Ostojic S2 Clinical Center of Serbia, Clinicfor ENT&HNS/Audiology Rehabilitation Department, Belgrade, Serbia; 2Belgrade Univer‐
sity, Faculty for special education and rehabilitation, Surdoaudiology Department, Belgrade, Serbia 1
Introduction. Development of social networks, especially Facebook and Tweeter, has enabled complete‐
ly new way of communication between people, including deaf community as well. Facebook is consid‐
ered the third biggest “country” in the world having 845 million followers. Aim of the study: To reveal how social networks contribute to deaf teenager’s communication. Material and method. A group of 60 deaf teenagers have been included in the study. They have answered to a specially developed question‐
naire regarding the use of social networks and advantages of such communication modality. Forty of the participants are attending mainstream schools and twenty of them school for deaf. Linguistic qualities of their messages were analyzed by speech and language therapist. Results. All of the 40 mainstreamed teenagers are using Facebook and 10 of them Tweeter as well. Half of the teenagers in the school for deaf are using Facebook. All of them are happy using Facebook because it enables direct communication in‐
NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 50 NHS 2012
stead of making phone calls through third parties. It is easier and cheaper than SMS and less formal than e‐mails and includes sharing pictures as well. They could keep in touch with their deaf friends and avoid discrimination in communication with normal hearing people. Linguistic analysis has shown con‐
siderable improvement in the use of short forms, metaphors, humor and all sorts of abstract thinking. They tend to be more relaxed on Facebook than in direct conversation. Conclusion. Social networks are very important modality of deaf teenager’s communication. They can keep in touch with their friends anytime, exchange experiences, thus feeling less isolated or discriminated. Use of social networks im‐
proves their verbal skills as well. SOUNDSCAPE ‐ ONLINE LISTENING ACTIVITIES FOR CHILDREN USING HEARING DEVICES Gasser C MED‐EL Medical Electronics, Department for Clinical Research and Rehabilitation, Innsbruck, Austria The web is an additional medium for unlimited home listening or classroom practice. With this in mind, an international team of hearing and educational experts has created SoundScape: a collection of free in‐
teractive online activities that can be played alone, with some help, or with others. SoundScape’s activi‐
ties are designed for various age groups. From a pedagogical perspective, because the SoundScape activ‐
ities are fun, they encourage user motivation and foster a desire for life‐long learning; a desire which is especially important as users can find themselves at a communicative disadvantage in normal‐hearing society. The player is invited to develop different listening skills such as active listening, hearing atten‐
tion, auditory memory, word‐ and sentence‐level understanding, and to learn about topics which are in‐
teresting for their age group. Additional free downloads are available for each activity. They offer fur‐
ther listening exercises and tips for parents and caregivers to focus on everyday life situations and set achievable goals for the child’s communication development. The importance of enabling parents to help the child transfer the knowledge gained in the listening activities into real life is widely known. The best way to do this is simply converse with their child about topics related to the activities. Drawing on one game example you will find out how SoundScape is designed, the challenges involved in develop‐
ing online listening activities for children with hearing impairment, and why users just love it. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 51
COCHLEAR IMPLANT STUDIES INTEGRATING COCHLEAR IMPLANTATION WITH NEWBORN HEARING SCREEN‐
ING USING AN EVIDENCE‐BASED APPROACH Dowell RC1,2, Dettman SJ1, Leigh JR1,2 The University of Melbourne, Department of Audiology and Speech Pathology Victoria, Australia; 2Royal Victorian Eye and Ear Hospital, Victoria, Australia 1
Cochlear implantation has now become standard treatment for bilateral severe to profound hearing loss in children. Studies have shown that earlier cochlear implantation for congenitally deaf children leads to better outcomes for speech perception, speech production and language development (Dettman et al 2007). Newborn hearing screening has created the advantage of early diagnosis of significant hearing loss and this can lead to earlier cochlear implantation and improved outcomes. It does, however, create a problem for clinicians in providing recommendations about cochlear implantation for young hearing‐
impaired children. Below 6 months it is only possible to estimate the audiometric thresholds. Beyond this age, these estimates can be more reliable by using conditioned response techniques, but this infor‐
mation does not accurately predict the potential to develop speech and language using conventional hearing devices. Thus, it can be difficult to make a recommendation for cochlear implantation until the child is older and their progress can be measured. At the University of Melbourne, we have developed an evidence‐based approach to this problem which allows clinicians to make recommendations about cochlear implantation based on the audiogram (Leigh et al, 2011). We have used speech perception data from children using cochlear implants and hearing aids and compared these statistically to determine the audiometric levels where children are likely to benefit from a cochlear implant. This presentation will describe the approach taken and summarize the results and their implications. The data indicated that children using cochlear implants perform significantly better than children using hearing aids with profound losses (>90dB HL) and severe losses (70‐90dB HL), and similar to children with moderate losses (40‐65dB HL). The results suggest that young children with bilateral profound losses should re‐
ceive cochlear implant(s) as soon as practical and those with severe losses may also benefit from cochlear implantation. BENEFITS OF ACOUSTIC AND SEMANTIC ENHANCEMENTS ON SPEECH IN NOISE RECOGNITION FOR CHILDREN WITH NORMAL HEARING AND CHILDREN WITH COCHLEAR IMPLANTS Sladen D1, Smiljanic R2 Mayo Clinic, Dept of Otolayrngology, Rochester, USA; 2University of Texas at Austin, Dept of Linguistics, Austin, USA 1
Auditory development occurs most rapidly during the first few years of life and reaches adult‐like levels in early adolescence (Werner, 2007). The last stage of auditory development occurs between approxi‐
mately six and twelve years of age. During this time children learn flexibility in which cues available in the speech signal masked with noise (Hazan & Barrett, 2000). Beyond audition, speech understanding is influenced by central‐cognitive and linguistic factors related to language ability, memory, and attention. The quest to fully understand the mechanisms for speech in noise perception is of paramount im‐
NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 52 NHS 2012
portance for academic and practical reasons. For example, both theoretical and practical understanding of how children process speech in noise may lead to modifications to improve classroom instruction, which is hampered by notoriously poor acoustics and where children typically spend several hours a day. Children with cochlear implants are even more disadvantaged because they are listening through an imperfect system. The current study broadens our understanding of auditory development by testing children with normal hearing and children with cochlear implants from two age groups: 6 to 8 years of age and 10 to 12 years of age. The experiment included measures of speech in noise, receptive and ex‐
pressive language, non‐verbal IQ, attention and memory. Speech in noise was assessed using 60 low‐ and 60 high‐predictability sentences. The sentences were spoken by a single female talker, in both con‐
versational style and in clear style, a listener‐oriented intelligibility‐enhancing speaking style adaptation. Data inform our understanding of developmental changes in the ability to take advantage of enhance‐
ment of peripheral (low order) and central (high order) components. Further, the data increase our un‐
derstanding of altered auditory development among children with cochlear implants. LEXICAL AND SEMANTIC ABILITY IN CHILDREN WITH COCHLEAR IMPLANTS Löfkvist U1, Lyxell B2, Tallberg IM3 Division of Speech Language Pathology, Dept of Intervention, Science and Technology, Karolinska Institutet, Stockholm, Sweden; 2The Swedish Institute for Disability Research, Linköping & the Department of Behavioural Sciences and Learning, Linköping University, Sweden; 3HEAD Graduate School, Linneaus HEAD, Linköping University, Linköping, Sweden 1
Previous studies have shown that children with cochlear implants (CI) have a poorer vocabulary com‐
pared to children with normal hearing (NH). The purpose of this study was to examine lexico‐semantic ability in children with CI (6‐9 years) (n=34) compared to age‐matched children with NH (n=39) and children with Autism Spectrum Disorder (ASD) (n=12) and children with Language Impairment (LI) (n=12) in the same ages. Different vocabulary tests were used and a semantic response analysis of the er‐
roneous responses children made when naming pictures was also performed. We found no significant differences between children with CI and children with NH regarding the ability to retrieve words from the long‐term memory (picture naming). Children with CI had significantly better results on picture naming and receptive vocabulary understanding compared to children with LI and ASD. Children with NH had significantly better result on the receptive vocabulary test compared to all other groups. When analyzing the error responses we found that children with CI gave semantic relevant responses in the same way as children with NH, but to a higher degree. Children with ASD gave more semantic irrele‐
vant responses and children with LI had the highest number of omitted responses. There were signifi‐
cant differences between the groups which remained when we controlled for age and non‐verbal intelli‐
gence. To conclude, we found no significant differences between children with CI and NH regarding the ability to name pictures. We found some interesting group differences regarding error responses on the picture naming test. Children with CI made less serious errors and were more semantically accurate compared to children with LI and ASD. Children with CI had significantly better understanding of words compared to children with LI and ASD but worse compared to NH children. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 53
USE OF MUSICAL SCALES IN FINE TUNING OF COCHLEAR IMPLANTS Tani A Ospedali Riuniti di Bergamo, Italy The procedures of cochlear implant fitting are currently based on standardized procedures, substantially similar for the different kinds of devices available on the market. The fitting parameters are represented roughly by: 1. the amplitude rate of the bands of analysis of the acoustic signal originated from the mi‐
crophone, 2. the surveying of the dynamic range and 3. the formulation of the most comfortable loud‐
ness. All of this obviously with the purpose to get a listening situation suitable to the discrimination of the greatest possible number of phonetic tracts and, after all, to the understanding of the verbal message in real‐life conditions. Manifold situations exist however in which listening with a cochlear implant re‐
sults tiring or straight annoying, despite the good or rather excellent results in verbal discrimination. Since the strategies used during the fitting procedure and the functional gain evaluation tests are based on the administration of rather simple stimulations (pure tones, warble tones, narrow‐band noise, stan‐
dard speech‐audiometry material, and so on…), it is possible that the global programming of the system doesnʹt respect a suitable and more natural distribution of the spectral acoustic components. On this sub‐
ject some functional evaluations have been carried out using, instead of the tonal stimuli or the narrow‐
band noises, musical notes organized in scales characterized by extension boundaries within the limits of the hypothetical frequency range of the microphone/processor system. The purpose of the work is to appraise in selected subjects, exibiting a good speech discrimination performance, the level of pleasant‐
ness of the stimulation in global acoustic terms, particularly for the patients implanted with long‐
electrode devices, allowing a theoretically better distribution of the stimuli along the cochlear partition. BILATERAL COCHLEAR IMPLANTATION IN CHILDREN: SENSITIVITY OF CLINICAL ASSESSMENTS Bergeron F1, Bussières R2, Cöté M2, Duchesne L3, Losier C2, Tremblay G3 Université Laval, Québec, Canada; 2Centre Hospitalier Universitaire de Québec, Canada; 3Institut de réadaptation en déficience physique de Québec, Québec, Canada 1
Benefits from bilateral CI in children do not seem to be systematic. In consequence, decisions on imple‐
menting bilateral CI as a standard clinical practice are often postponed. From a project designed to add to the available knowledge some additional evidence on the impact of bilateral implantation in children where medical, perception and communicative issues were documented, issues were raised on the sensi‐
tivity of clinical tests. This project involved twenty children aged between 7 and 35 months who received sequential Nucleus cochlear implants within a 12 months maximal delay. The decision to undergo the second implantation was conditioned by a minimum of 4 months experience of constant use of the first implant with no medical complications, including no signs of imbalance. Auditory benefits were as‐
sessed with IT‐MAIS, MAIS, Little Ears, EARS, HINT and/or lateralisation tests according to the age of the child. Speech, language and communication were assessed with MUSS, RDLS, MCDI and/or VABS. Testing was performed at 0 and 3 months with the first implant, then at 6, 12 and 24 months after the fi‐
nal mapping of the second implant. At the 6 and 12 months follow‐up, while no medical complication were recorded, including no alteration of the vestibular condition, objective assessments did not show clear benefits of bilateral over unilateral implantation. On the other hand tests based on parents’ report showed significant benefits for speech recognition in quiet and in noise, and for localisation of sound NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 54 NHS 2012
sources. Thus, at least at medium term, clinical tests did not appear sensitive enough to confirm the per‐
ceptive and communicative benefits reported by parents. Other alternatives need to be explored. PREMATURE AND/OR LOW BIRTH WEIGHT INFANTS: SPEECH PROCESSOR PRO‐
GRAMMING CONSIDERATIONS AND COMMUNICATION OUTCOMES Dettman SJ1,2, Oh SY1, Dowell RC1,2,3 University of Melbourne, Parkville, Australia; 2HEARing CRC, Carlton, Australia; 3Eye and Ear Hospital, East Melbourne, Australia 1
Objectives. This study examined speech processor programming (mapping) and long term speech per‐
ception and language outcomes for children using cochlear implant(s) (CIs) who have a history of pre‐
term birth and/or low birth weight. It was hypothesized that there was a higher prevalence of additional disabilities in these children and that this would affect all subsequent mapping and communication out‐
comes. Methods. Retrospective analysis of 500+ paediatric medical records from the Melbourne Co‐
chlear Implant Clinic identified 25 children (10 females, 15 males) who met the inclusion criteria; born preterm (< 37 weeks gestational age), low birth weight ( < 2500 grams at birth), congenital profound bi‐
lateral hearing loss and implanted for at least one year. The average gestational age was 28.20 weeks (range 23.60 to 35 weeks; SD 3.76); the average birth weight was 1040 grams (range 524 to 2430 grams; SD 525.92). Mapping details such as the child’s response state, ‘T’ and ‘C’ levels at switch on and one year post‐CI were collected. Children completed cognitive tests, open‐set word (CNC) and sentence (BKB) tests and language measures (PPVT, RI‐TLS, CELF) where possible. Results. Additional medical conditions were present in 24 out of 25 children. 21 children completed standard mapping protocols, 13 completed open‐set tests and 19 completed one or more tests of language. For 3 subjects, only a loudness discomfort response was obtained at switch on and at 12 months post‐implant. There was a significant relationship between speech perception outcomes and cognitive status, but not gestational age/birth weight directly. Age at implant was associated with receptive language outcomes. Conclusions. Despite the study’s limitations (small sample size, lack of test data for some preterm children), it was apparent that a complex interrelationship of factors had to be considered when discussing outcomes for this population. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 55
MINI‐SYMPOSIUM ON FREQUENCY LOWERING TECHNOLOGY FOR CHILDREN: A REVIEW OF RESEARCH EVIDENCE AND RECOMMENDATIONS FOR CLINICIANS Ching TYC1, Bagatto M2, Bohnert A3, Kuk F4, King A5 National Acoustic Laboratories, Sydney, Australia; HEARing CRC, Australia; 2National Audiology Centre, University of Western Ontario, Canada; 3Mainz University, Mainz, Germany; 4Widex Office of Research in Clinical Amplification (ORCA), Lisle, USA; 5Australian Hearing, Australia 1
Many hearing‐impaired people have difficulty perceiving high‐frequency sounds, partly because they have greater loss for high frequencies than for lower frequencies, and partly because of cochlear distor‐
tions associated with the loss thereby preventing them from extracting useful information from the sig‐
nal even when it is amplified sufficiently to be audible. For such people to have access to the information that exists in the high frequencies, the information must be moved to some lower frequency region where the listener is more able to analyse sounds. This rationale of “Frequency lowering” has been im‐
plemented in different ways, and is available in various commercial hearing aids for children. Several research studies have been conducted to investigate the effectiveness of frequency lowering for children. In this symposium, research from four research groups, namely University of Western Ontario, Mainz University, National Acoustic Laboratories, and ORCA will be presented by members of the panel. The manager of paediatric services in Australia will chair a discussion of evidence with a view to determin‐
ing candidacy, fitting strategy, and outcomes for children. The objective of the symposium is to reach consensus and make recommendations about the applicability of frequency lowering technology for the paediatric population. The output is a document on recommendations for clinicians. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 56 NHS 2012
NURSERY BASED SCREENING SENSITIVITY AND SPECIFICITY OF A TWO‐STEP HEARING SCREENING PROTOCOL IN THE WELL INFANTS NURSERY Levit Y1,2, Dollberg S3, Himmelfarb M1,2 Tel Aviv Sourasky Medical Center, Speech and Hearing Institute, Tel Aviv, Israel; 2Ariel University Center, Communication Disorders Department, Ariel, Israel; 3Tel Aviv Sourasky Medical Center, Neonatology Departmen, Tel Aviv, Israel; 1
According to the Joint Committee on Infant Hearing 2007 Guidelines, screening protocols in the well‐
infant nursery (WIN) may include automated auditory brainstem response (A‐ABR), otoacoustic emis‐
sions (OAE) or a combination of both. A combined protocol was advocated by the Israeli Ministry of Health: for the WIN it includes OAE test followed by A‐ABR for infants who failed OAE. For the neona‐
tal intensive care unit (NICU) it includes both tests in all cases. The aim of this study was to assess the effect of A‐ABR as a second step on the sensitivity and specificity of the hearing screening. Methods. Re‐
sults of diagnostic ABR and transient evoked OAE (TEOAE) performed in the hearing institute on in‐
fants up to 1 year of age were retrospectively analyzed. The infants were referred due to existing risk factors or suspected hearing loss. Included were the test results of 3,748 ears for which both TEOAE and ABR threshold data were available and both tests were performed on the same day. Results. Applying the screening criteria, the TEOAE yielded 92% specificity and 91% sensitivity for ears with an ABR threshold >25dBHL. The ABR threshold distribution showed that 43% of ears with hearing loss had ABR thresholds ≤35dBHL and 69% had ABR thresholds ≤45dBHL. We estimate that these ears would have passed successfully A‐ABR in 35dBHL or 45dBHL respectively. Our sample showed a very low preva‐
lence of auditory neuropathy/dys‐synchrony (AN/AD) among infants without risk factors. Conclusions. Using A‐ABR as second step for WIN infants who failed TEOAE, may reduce screening sensitivity sig‐
nificantly. The effectiveness of such a step in detecting AN/AD is questionable, because of the very low prevalence of AN/AD among infants without risk factors and their high chance to be missed at the first TEOAE step. Other ways to improve TEOAE hearing screening specificity are suggested. EARLY DETECTION OF INFANT HEARING LOSS IN THE PRIVATE HEALTH CARE SECTOR OF SOUTH AFRICA Meyer ME1, Swanepoel DW1,2, Le Roux T1, Van der Linde M3 Department of Communication Pathology, University of Pretoria, South Africa; 2Callier Center for Communication Disor‐
ders, University of Texas at Dallas, USA; 3Department of Statistics, University of Pretoria, South Africa 1
Objective. A national survey was undertaken to describe the demographics, protocols and performance of early hearing detection, referral, follow‐up and data management practices in the private health care sector of South Africa. Methods. All private hospitals in South Africa with obstetric units (n=166) were surveyed telephonically. Data was incorporated with data collected from self‐administered question‐
naires subsequently distributed nationally to audiology private practices providing hearing screening at the respective hospitals reporting hearing screening services (n=87). Data was analyzed descriptively to yield percentages and frequency distributions. Possible statistical associations between variables were explored. Results. Newborn hearing screening was available in 53% of private health care obstetric units NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 57
in South Africa of which only 14% provided universal screening. The most prominent challenge to suc‐
cessful screening implementation was the omission of newborn hearing screening from birthing packag‐
es at hospitals. Most (81%) of the healthy baby screening programs used only otoacoustic emission screening. Auditory brainstem response (ABR) screening was employed by 24% of neonatal intensive care unit (NICU) screening programs with only 16% repeating ABR screening during the follow‐up screen. Consequently 84% of NICU hearing screening programs will not identify auditory neuropathy. Follow‐up return rates were reported to exceed 70% by only 28% of programs. Data management was mainly paper based with only 10% of programs using an electronic database primarily to manage screening data. Conclusions. The majority of newborns nationally are not screened for hearing loss. Ex‐
isting programs are not sufficiently systematic to ensure adequate coverage. A shortage of programs and suboptimal protocols for early hearing detection, follow‐up and data management mean the majori‐
ty of babies with hearing loss in the South African private health care sector will not be identified early. Newborn hearing screening must be integrated with hospital‐based birthing services, ideally with cen‐
tralized data management and quality control. NEONATAL HEARING SCREENING IN PRIVATE MEDICAL CENTERS Rajati M, Ghasemi MM, Tale MR, Bakhshaee M, Nourizadeh N Mashhad University of Medical Sciences, Department of Otorhinolaryngology, Mashhad, Iran Objective. Implementing the hearing screening guidelines in the private hospitals of Mashad, Iran. Ma‐
terials & Methods. A total number of 58.287 newborns were screened with OAE during 8 years (2004‐
2011) in two major private medical centers of the city. Those who failed the test were retested within one month and the second test failed ones were re‐evaluated by ABR at 3 months of age to make the definite diagnosis and to schedule for rehabilitative interventions. Results. 4.2% of the newborns failed the first OAE; 88.4% of these showed up for the second test (i.e. 11.6% didnʹt go on with the follow up). In the second OAE 92% passed the test and only 8% were referred for ABR; and 11% proved to be normal and the rest had hearing loss to variable extent. We also compared the figures in these successive years. In‐
terestingly we found that the hospitals authoritiesʹ cooperation rises; also, parentsʹ cooperation and fol‐
low‐up for the second OAE improves over the years showing the elevation of general understanding and parentsʹ knowledge of significance hearing in infants. On the other hand the number of those who showed up for ABR does not change significantly in this period, most probably due to referral to other centers. Conclusion. Public education through multimedia and professionals continued education in‐
cluding ENTists, pediatricians, NICU nurses, midwives, PHC workers all contributes to the better achievements in hearing screening programs. NOISE IN NEONATAL INTENSIVE CARE UNIT (NICU): MEASUREMENT AND EFFECTS Shalaby A1, Hussanien S2, EL Disouky E2 Audiology Unit, ENT department, Ain Shams University, Cairo, Egypt; 2Neonatology Unit, Pediatric department, Ain Shams University, Cairo, Egypt 1
The study was carried out in the NICU of obstetrics and gynecology hospital at Ain Shams University. The measurements of noise were taken in all ward rooms and inside different types of incubators. It was also measured at different time of the day and during the presence of noisy events. Three physiological NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 58 NHS 2012
aspects (heart rate, respiratory rate and O2 saturation level) were measured in full‐term and pre‐term neonates. The study demonstrated that the noise levels inside NICU exceeded the international permis‐
sible levels. The physiological aspects (heart rate, respiratory rate and O2 saturation level) were altered in both full‐term and pre‐term babies being obvious in pre‐term babies than full‐term. HEARING SCREENING IN HIGH RISK INFANTS Dlouha O, Hrbkova M, Krejci H, Cerny L, Cerna P Dept. of Phoniatrics of the 1st Faculty of Medicine and General Teaching Hospital, Prague, Czech Republic Introduction. The aim of our study was to evaluate the frequency of occurence of sensorineural hearing loss in preterm infants and to follow risk factors associated with hearing impairment. The findings of 15 years study of screening procedure of low birth weight neonates in risk of hearing impairment is pre‐
sented. Screening follows children from the neonatal intensive care unit (NICU) of our hospital. Prema‐
ture born infants sometimes show a large difference between chronological age and developmental age. We plan to ask children to evaluate between 8‐12 month of their age, but we make very often another appointment and we repeat investigation to exclude or to confirm hearing impairment. Method. Data from 1760 risk children were usable. Type of investigation: using TEOAE (transient evoked otoacoustic emission) like the first step and ABR (auditory brainstem response) as the second. The following risk fac‐
tors were studied: birth weight, gestational age, respiratory distress syndrome, sepsis, cerebral bleeding (intra‐ or periventricular) and infarction, administration of ototoxic antibiotics, bronchopulmonal dys‐
plasia. Results. Total number of preterm infants: 1760. Number of very low birth weight infants (under 1000 g): 474 children. Number of children with birth weigth between 1001 – 1500 g: 643 cases. Overall birth weight under 1500g is recorded in 1117 cases (63,5 %). Among all infants examined (1760), sen‐
sorineural hearing loss was identified in 33 cases. The occurence of hearing loss is 1,9 % in our group of preterm neonates. Conclusions. Our results confirm very good level of initial care of newborns in NICU of our hospital. The most specific risk factor is very low birth weight, especially under 1000 g, and pre‐
mature birth. For these infants the number of coexisting risk factors increase. This programme of preven‐
tive hearing screening continuing in recordings of the speech‐language development – our experience indicates treatment of the preterm infants to their school age. INFANTS ADMITTED TO THE NICU NEED UNIVERSAL NEWBORN HEARING SCREENING; REFERRAL TO AUDIOLOGY ALONE IS NOT ENOUGH Carew P1,2, Poulakis Z1,3,4, Barker M1,4 Centre for Community Child Health, Royal Children’s Hospital, Melbourne, Australia; 2Department of Audiology & Speech Pathology, The University of Melbourne, Australia; 3Murdoch Childrens Research Institute, Melbourne, Australia; 4Department of Paediatrics, The University of Melbourne, Australia 1
Background. Infants admitted into a NICU are at higher risk for progressive or late onset hearing loss than those in the well baby population. It is subsequently often argued that these infants should not un‐
dergo screening, and should instead all be referred for diagnostic audiology. Methods. In this study newborn hearing screen results using Automated Auditory Brainstem Response (AABR) technology, di‐
agnostic audiology results and individual risk factor profiles were examined for 191 infants admitted to the NICU over a six month period in 2005. This NICU has in place clinical guidelines that support the re‐
ferral of most admissions for a diagnostic audiology assessment. Results: Results indicated that the NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 59
presence of one or more risk factors for hearing loss was not a predictor for hearing screening outcome, or for ultimate hearing status based on diagnostic assessment. Furthermore, referral from NICU for di‐
agnostic assessment, regardless of screen result, was related to the number of risk factors present rather than any one specific risk factor. Thus, despite clinical recommendations suggesting referral was indi‐
cated, a significant number of infants who had strong risk factors for hearing loss did not get a referral to diagnostic audiology in the neonatal period, independent of their hearing screen results. This was also the case in an earlier study of a similar population, conducted when no newborn hearing screening was being undertaken. Implications. Despite the presence of clinical guidelines indicating referral to audiol‐
ogy, many infants in the NICU did not receive such a referral, even in the presence of a risk factor for hearing loss. Given a lack of predictive capacity of risk factors for hearing loss in identifying later‐onset or progressive hearing losses, these results support the importance of Universal Screening rather than only risk factor‐based screening in the NICU population. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 60 NHS 2012
SCREENING BEYOND THE NEWBORN PERIOD DETECTION OF POSTNATAL HEARING LOSS USING A RISK FACTOR REGISTRY: RE‐
SULTS OF A 5‐YEAR TARGETED SURVEILLANCE PROGRAM REVIEW Beswick R1,2, Driscoll C2, Kei J2, Glennon S1 Healthy Hearing‐Queensland Health, Brisbane, Queensland, Australia; 2School of Health and Rehabilitation Sciences, The University of Queensland‐St. Lucia, Queensland, Australia 1
The Joint Committee on Infant Hearing (2007) recommend targeted surveillance of at‐risk infants using a risk factor registry, in conjunction with parent and/or professional monitoring to detect hearing loss that develops post newborn hearing screen. However, criticisms of these recommendations are emerging as targeted surveillance programs are costly, resource intensive, and have poor follow‐up rates. The pur‐
pose of this presentation is to describe a targeted surveillance program using a risk factor registry to identify children with a postnatal hearing loss. This study involved a cohort of children born between September 2004 and December 2009 in Queensland, Australia, who passed newborn hearing screening but presented with one or more risk factor/s for postnatal hearing loss and were referred for targeted surveillance. During the study period, 7,320 (2.8% of 261,328) children were referred for targeted surveil‐
lance of which 56 were identified with a postnatal hearing loss (0.77%). The risk factors of syndrome, craniofacial anomalies, and severe asphyxia had the highest yield of positive cases of postnatal hearing loss, whereas, low birth weight, bacterial meningitis, and professional concern had a particularly low/nil yield. Limitations to the targeted surveillance program were noted and include: (1) a high lost contact rate; (2) delays in first assessment; (3) a large number of children required on‐going assessments; and (4) extensive testing was completed on children with normal hearing. Although positive cases of postnatal hearing loss were detected, the limitations of the targeted surveillance program question the usefulness of this service delivery model. IDENTIFICATION OF LATE ONSET HEARING LOSS: IS TARGETED FOLLOW UP FROM THE NEWBORN HEARING SCREEN EFFECTIVE? MacKinnon A, Campbell S, Stones M NHS Tayside, Kings Cross Health and Community Care Centre, Paediatric Audiology Department, Dundee, Scotland Current literature indicates that 1 to 2 per 1000 babies are born with a significant hearing loss (hearing level in the better ear >40 dB averaged over 0.5, 1, 2, and 4 kHz), but that the prevalence of permanent childhood hearing impairment rises until the age of at least 91. When newborn hearing screening was in‐
troduced in Scotland in 2005 guidelines were implemented for the follow up of babies who had risk fac‐
tors that were thought may put them at greater chance of developing late onset or progressive hearing loss. In Tayside babies identified with such risk factors are offered an appointment for a further hearing assessment at a corrected age of 8 to 9 months. In parallel with this, efforts have been made with primary care staff, speech and language therapists and nursery class teachers to raise awareness of signs that may suggest a possible hearing loss, and to inform these agencies how to refer pre‐school children for a hear‐
ing assessment. A review of Tayside children born between 1st January 2005 and 31st December 2010 identified with later onset hearing loss (i.e. not identified through newborn hearing screening) has been NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 61
undertaken. The number of children identified with late onset permanent significant hearing impair‐
ments from both the targeted follow up group of children and those who were referred for audiology as‐
sessment from another source were compared. More children were identified from the latter group. Early identification and management of hearing loss leads to better speech, language and learning out‐
comes for children. This highlights the need for vigilance amongst parents and professionals as to the signs that may indicate a hearing loss, and the need for paediatric audiology services to be able to offer timely appointments if there are concerns. References 1Fortnum H, Sommerfield Q et all (2001) Prevalence of permanent childhood hearing impairment in the United Kingdom and implications for universal neonatal hearing screening: questionnaire based ascertainment study. British Medical Journal 323(7312):536‐40 SECOND HEARING SCREENING AFTER NHS USING THE LITTLEARS® AUDITORY QUESTIONNAIRE ‐ A GERMAN FIELD STUDY Coninx F1,2, Schaefer K1 University of Cologne, Faculty of Human Sciences, Department of Rehabilitation and Special Education, Cologne, Germany; 2IfAP, Institute for Audiopedagogics, Solingen, Germany 1
Neonatal hearing screening was implemented in Germany in 2009 and is the preferred screening proce‐
dure now. Nevertheless there is a need for ongoing screening of hearing after NHS. The primary reason is to identify children with progressive or acquired hearing loss. A secondary reason is to compensate for NHS limitations: false negatives, drop‐outs in the follow‐up procedure. The aim of this study was therefore to develop and test a procedure for “second hearing screening” (SHS) for children between 3 months and 3 years of age. The LittlEARS® (MED‐EL) Auditory Questionnaire – LEAQ (Weichbold et al 2005; Coninx et al 2009) was used for this purpose. LEAQ consists of 35 yes/no questions that can easily be answered within 5‐7 minutes. Close to 5000 children were participating in a SHS. Screening was add‐
ed to a regular pediatrician check‐up visit at age 12 months. Three years later, the group of 50 pediatri‐
cians participated again in a follow‐up study collecting data on the hearing and general developmental status of the “refer” group at SHS. These data were statistically analyzed. Within the group of N=4991 children 7 infants with permanent hearing loss were identified at SHS and confirmed later. Also infants with recurrent otitis media in the first year of life, with speech or other developmental dysfunctions like autism and cognitive deficits were identified. It seems that LittlEARS® is an appropriate tool to identify haring loss at the age of 12 months. But, also other non‐auditory developmental delays caused positive screening results. This could be a chance to detect as many infants as possible who are not developing regular listening skills and offer rehabilitation services to them at a very young age. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 62 NHS 2012
COMPARISON OF PURE TONE AND DPOAE SCREENINGS IN A PRESCHOOL POPU‐
LATION Niquette P1, Chase M2, O’Brien B3 Etymotic Research, Inc. USA; 2United Cerebral Palsy Colorado, Denver,USA; 3Center for Hearing, Speech and Language, Denver, USA 1
In the United States, school districts are required to identify and evaluate all children with disabilities [IDEA, 20 U.S.C. §1412(a)(3)]. The National Center for Hearing Assessment and Management recom‐
mends otoacoustic emissions (OAEs) to screen children from birth to age three. The American Academy of Audiology’s (AAA) Childhood Hearing Screening Guidelines (2011) recommend pure tone screening (20 dB HL at 1000, 2000 and 4000 Hz) for children age 3 and older. The Guidelines stipulate that screen‐
ing must be performed in an acoustically appropriate environment, but most screenings are not con‐
ducted in sound‐treated rooms. Due to the high incidence of otitis media in this population, the Guide‐
lines recommend tympanometry in conjunction with pure tone screening. Hearing screenings should be easy to administer, tolerable and reliable; however, Halloran et al. (2005) found that 45% of 3‐year olds could not complete pure tone testing, which indicates the need to consider alternatives to pure tone screening in young children. This study compared screening outcomes from pure tone audiometry and distortion‐product otoacoustic emissions (DPOAEs). Otoacoustic emissions assess cochlear outer hair cell function and are present in a high percentage of normal ears. The two methods were compared on ease of administration, test time, patient tolerance and reliability. 391 children, ages 3‐5, from two Colo‐
rado preschools were screened using tympanometry, play audiometry and a robust DPOAE protocol in rooms provided for vision and hearing screening. Test time was measured for pure tone and DPOAE procedures on 118 children. DPOAEs were obtained in less than half the time of pure tone screening, were successfully completed on far more children (97% DPOAEs vs. 60% for pure tones), and had a higher pass rate (88% DPOAEs vs. 78% pure tones). Confounding factors to pure tone screening in‐
cluded inability to condition, inconsistent responses, uncooperative behavior, room noise and distracti‐
bility. SCREENING FOR DELAYED‐ONSET HEARING LOSS IN PRESCHOOL CHILDREN WHO PREVIOUSLY PASSED THE NEWBORN HEARING SCREENING Lv J‐R, Huang Z‐W, Wu H Department of Otolaryngology‐Head & Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Jiaotong University Ear Institute, Shanghai, P.R. of China Objective. The goal of this study was to investigate the prevalence of delayed‐onset hearing loss in pre‐
school children who previously passed newborn hearing screening in Shanghai, China. Methods. Be‐
tween October 2009 and September 2010, 21,427 preschool children were enrolled from five areas of Shanghai, who had passed newborn hearing screening. Children were screened for delayed‐onset hear‐
ing loss with pediatric audiometers. Children with positive results in initial and re‐screening tests were assessed audiologically and for risk indicators according to the Year 2007 Statement of the American Joint Committee on Infant Hearing (JCIH). Results. During the study period, 445 children (2.08%) were referred for audiologic assessment; 16 (0.75/1000, 95% CI 0.38–1.12) had permanent delayed‐onset hear‐
ing loss. Of these, five (0.23/1000) had bilateral moderate hearing loss; seven (0.33/1000) had mild bilat‐
eral hearing loss; and four (0.19/1000) had unilateral moderate or mild hearing loss. JCIH risk indicators NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 63
were established for six children (6/16, 37.5%), including parental concern regarding speech and lan‐
guage developmental delay, neonatal intensive care unit with assisted ventilation or hyperbilirubinemia, recurrent otitis media with effusion, craniofacial malformation, and family history (n = 1 for each). The remaining ten (62.5%) had no related risk factors. Conclusions: A significant proportion of preschool children have undiagnosed delayed‐onset hearing loss. Hearing screening in pre school is recommended for an early detection. AUTOMATED HEARING SCREENING FOR SCHOOL CHILDREN – A PILOT STUDY IN CHINA Kam ACS, Tong MCF Department of Otorhinolaryngology, Head & Neck Surgery, The Chinese University of Hong Kong, Hong Kong and The In‐
stitute of Human Communicative Research, The Chinese University of Hong Kong, Hong Kong Objective. To establish the reliability and validity of an automated pure‐tone hearing screening test for school children. Method. Subjects were 360 school children. All of them completed an automated hear‐
ing screening test via a computer, and a manual conventional hearing screening test via a screening au‐
diometer at schools. They also completed a diagnostic pure‐tone hearing test, tympanometry and DPOAE test in a sound‐proof booth on the same day. Ten percent of the subjects repeated the automated screening test for test‐retest reliability check. Results. Screening results obtained with the automated test were compared with those obtained with the manual conventional test. Sensitivity, specificity, positive predictive value and negative predictive value of the automated test were calculated. Test‐retest reliabil‐
ity of the automated screening test was measured. Conclusions. Tentative results suggest that the auto‐
mated hearing screening test is a feasible option for school children. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 64 NHS 2012
FOCUS ON TECHNOLOGIES THE SCHOOL ENTRY HEARING SCREEN: IS THIS A ′SMART′ WAY FORWARD? Davis A1, Manuel‐Barkin C2 UK Newborn Hearing Screening Programme, London, England; 2Northgate Information Solutions, Hemel Hempstead, Eng‐
land 1
Since commencement of the NHS Newborn Hearing Screen in 2003 some have questioned the necessity of the school entry hearing screen (SEHS) offered to UK children between 4 and 5 years old. A 2007 NHS HTA report criticised the SEHS for its lack of nationally consistent protocols for ensuring equitable de‐
livery and the lack of information systems to fine tune and evaluate the screen. Watkin et al. demon‐
strated in their study that 51% of the children with a permanent hearing impairment had required iden‐
tification by post‐neonatal care pathways. However, in this time of continuing cost pressures, with lim‐
ited understanding of the programmes’ cost‐effectives the SEHS is increasingly at risk of being decom‐
missioned. We have been working with a local school screening programme in Birmingham on a ‘proof of concept’ to specify and implement an information system that will collect and monitor robust data on screen protocol and performance in order to establish the value and effectiveness of the SEHS. Northgate’s Screening Management and Reporting Tool (‘SMART’) for Schools was used to collect data at the point of screen via a netbook with remote access to a network. ‘SMART’ provides a seamless view for each student including newborn screen, school screen and any follow up diagnostic assessment, thus allowing full analysis of data from screen to possible diagnosis of a PCHI. The first year of data collec‐
tion has established the benefits of having an information solution working alongside robust protocols: information can be used to identify performance outputs and outcomes, promote service equity and tar‐
get resources, and to support local performance management and service improvement. As the concept moves to pilot phase and is expanded across Birmingham, sufficient data will become available to estab‐
lish the value of new screening protocols and inform future of the school entry hearing screen in Eng‐
land. GN OTOMETRICS ACCUSCREENTM AND NATUS ECHOSCREENTM WITH MOBILE COMMUNICATION TECHNOLOGY SIMPLIFIES TRACKING FOR UNHS: RESULTS OF A FIELD STUDY Matulat P1, Oswald H2, Lepper I2, Schmidt C‐M1, am Zehnhoff‐Dinnesen A1 Department for Phoniatrics and Pedaudiology, University Hospital of Muenster, Germany; 2PATH medical GmbH, Muenchen and Muenster, Germany 1
An automated transmission of screening data based on mobile communication technology for the screening devices GN Otometrics AccuScreenTM and Natus EchoScreenTM was developed and applied in 14 clinics in Muenster region during a field study from 2010 to 2012. 924 mobile radio connections were compared with 7809 conventional transmissions (EchoScreen TM with analogue telephone line modem) with respect to session duration, volume of data, transmission rate, number of lost connections, and fre‐
quency of data transmission. Mobile communication technology offers advantages in average session duration (conventional: 108 seconds, mobile radio: 24 seconds), transmission rate (conventional: 181 NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 65
bytes per second, mobile radio: 1129 bytes per second) and the number of lost connections (conventional: 5.53%, mobile radio with a specially developed transfer protocol: 1.49%). Average volumes of data in the mobile radio groups (10595 to 36738 bytes) are in the range of the conventional transmission group (19686 bytes). At the user (behavioral) level, we observed an increase in the frequency of data transmis‐
sion in the mobile radio transmission groups (mean between transmissions 4.35 days) compared to the conventional transmissions (10.45 days). Bi‐directional transfer of configuration data and firmware up‐
dates significantly reduces support activities and the amount of work for on‐site support. In daily prax‐
is, regular maintenance activities (yearly inspections) for screening devices often result in wrong or in‐
complete configurations of replacement devices. Using bi‐directional data flow helped to overcome the‐
se issues completely. From the user perspective, the seamless integration of the mobile communication technology provides an out of the box solution. It can be configured completely prior to delivery and does not rely on IT departments in clinical environment. As a result, there is an enormous saving in time and costs for staff and support. These savings are to be compared to an increase in wireless services costs of less than 2 EUR per device and month. The use of mobile communication technology in neonatal hearing screening has to be considered to be an effective, secure, reliable, and cost‐effective alternative to conventional data transfer. The project including the field study was funded by the state of North Rhine‐Westphalia and the European Union. USING RITE HEARING AIDS IN THE PEDIATRIC POPULATION Caporali SA1, Roikjer M1, Jeppesen AMK1, Olszewski L2, Malgorzata M3 Widex A/S, Lynge, Denmark; 2Institute of Physiology and Pathology of Hearing, Warsaw, Poland; 3Widex Poland 1
Inconsistent hearing aid (HA) use in the pediatric group is one of the factors that may contribute to de‐
lays in early vocabulary development. This may be associated with the physical fit when using tradi‐
tional Behind‐the‐Ear (BTE) hearing aids, since they are relatively large in comparison with the small and soft infant ear. Receiver‐in‐the‐ear (RITE) HA’s may be advantageous for use in pediatric fittings, since they are small in size, lightweight and sit comfortably on a small soft ear. A clinical trial with RITE HA’s designed specifically for the pediatric population was conducted at the Institute of Physiology and Pathology of Hearing, Warsaw Poland. The objective was to evaluate hearing aid acceptance by the child, parent satisfaction with the HA and assess the auditory and language development of the infants. Five children with congenital hearing loss participated in the trial over a 6 months period. The average age of the initial HA fitting was 10 months. All children underwent a comprehensive audiological eval‐
uation before hearing aid fitting. The children attended several follow‐up visits. Each visit consisted of inspection of the HA, interview with parents concerning their observations, HA adjustments and verifi‐
cation of HA performance. The parent’s evaluation of the HA and the progress in the auditory and lan‐
guage development of the infant was performed based on questionnaires. The results show that the HA was used consistently during the hours that the child was awake, indicating good acceptance. All chil‐
dren attempted to remove the HA from time to time, but the security accessories provided with the HA proved useful in keeping the hearing aid in place. Parents evaluated the hearing aids to provide good physical fit to the infant’s small ear. All children showed age adequate auditory and language develop‐
ment, indicating that they were receiving the necessary auditory input from the device. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 66 NHS 2012
LATEST DEVELOPMENTS IN SOUNDFIELD TECHNOLOGY Mülder HE Phonak Communications AG, Murten, Switzerland A recently developed platform, dynamic soundfield, is capable of automatically adjusting its volume and frequency response settings based on ambient noise levels in the classroom. Classroom noise levels vary considerably during a school day and usually a teacher will not adjust volume settings or fre‐
quency response. The new platform has also a new way of designing loudspeaker units, that create less late reverberations (which are perceived as noise) by avoiding steering acoustical energy towards the ceiling or the floor. In a randomized, blinded trial with 20 normal hearing children aged 13 or 14 years the hypothesis was tested that a dynamic soundfield system would result in better speech recognition scores at higher noise levels than two different traditional soundfield systems, despite all three different systems being set at equal volume in quiet. Speech recognition in the condition ‘no soundfield’ amplifi‐
cation was also tested. Results will be presented and discussed. RESOUND MINI MICROPHONE ‐ STRONG WIRELESS CONNECTIONS TO THE WORLD Haastrup A GN ReSound, Global Audiology, Ballerup, Denmark Implementation of new born hearing screening programs in the public and private hearing care sectors in many countries has made it possible to minimize the negative effects on language development that result from late identification (Moeller et al., 2007; Yoshinaga‐Itano & Apuzzo, 1998). Audibility is neces‐
sary for hearing‐impaired children to develop speech and language at an age‐appropriate pace (Cun‐
ningham, 2009). Studies have shown that poor signal‐to‐noise ratios (SNR) can significantly reduce speech understanding for children both with‐ and without hearing loss (e.g., Crandell and Smaldino 2000; Finitzo et al. 2000). In addition, data suggest that listeners with hearing loss require significantly better SNR for equivalent speech recognition performance when compared to listeners with normal hearing (Boothroyd et al., 1996; Killion, 1997; Schum, 1996). Wireless connections to hearing instruments provide the end‐user with several benefits including better SNR when listening to signals transmitted wirelessly to the hearing instruments from e.g. microphone placed on a speaker, the TV, a mobile phone, an iPad etc. This presentation will introduce how Resound’s 2.4 GHz wireless technology pro‐
vides end user benefit and how this system can benefit the pediatric user population. The presentation will include results from studies done with a wireless microphone: ReSound Unite™ Mini Microphone, showing improved SNR even at long distances. USE OF CLEARVOICE™ IN EVERYDAY LIFE: OUTCOMES IN CHILDREN Noël‐Petroff N1, Ulmann C1, Van Den Abbeele T1, Mathias N2 Hôpital Robert Debré, Paris, France ; 2Advanced Bionics, Rixheim, France 1
Objectives. ClearVoice™ has been designed to improve speech understanding in difficult listening envi‐
ronments without compromising performance in quiet situations. The basic principle of this new algo‐
rithm is to reduce the stationary noise and emphasize the dynamic channels containing more speech. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 67
The aim of the study was to evaluate the benefits of ClearVoice in children. Study design. Children be‐
tween six and fourteen years of age using the HiRes 120™ sound coding strategy for at least one year were asked to randomly test two modalities of ClearVoice (“medium” and “high”) during one month each. The baseline program, HiRes 120, and both ClearVoice programs were then evaluated with a sen‐
tence test in quiet and noise. Parents and teachers were asked to complete a questionnaire related to everyday noisy situations. Results. Nine children were included. The switch‐over to ClearVoice was un‐
eventful for both modalities of ClearVoice. Seven out of nine children preferred a ClearVoice program compared to their usual program. Some difficulties were encountered with the test material, particularly in younger children. Nevertheless, among the five subjects where speech test results were usable, a sig‐
nificant improvement in scores in noise was observed for both ClearVoice modalities after one month of use compared to the HiRes 120 program. In addition, ClearVoice had no impact in quiet as the scores ob‐
tained with both ClearVoice programs were similar to the score with HiRes 120. Very positive comments were obtained through the questionnaires. Conclusion. ClearVoice improved speech understanding in noise in these children and showed clear benefit of using ClearVoice in their daily life as described by comments of both parents and children. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 68 NHS 2012
AUDITORY BRAINSTEM RESPONSE PEER AND EXPERT REVIEW REDUCES ERRORS IN NEWBORN DIAGNOSTIC ABR TESTING Sutton G MRC Hearing & Communication Group, Newborn Hearing Screening Programme (England), Royal Free Hospital, Manches‐
ter, England, UK This report reviews the ABR quality improvement pilot projects in two regions in England The purpose was to test a system of peer and expert review to improve ABR quality.  The project ran for 2 years to May 2011.  Some obstacles of governance, liability and data confidentiality had to be overcome.  Not all sites were equally willing to participate and some were slow to engage.  447 sets of ABR results were reviewed.  In 45% of the reviews some comments or suggestions for improvement were made.  In 3% of reviews the quality of traces or interpretation was judged to be poor.  In 10% of reviews further action beyond that planned by the site was recommended.  Most testers sent in fewer than 5 cases over the whole period: this raises concerns about what minimum activity level is required to maintain and develop expertise.  There was a marked and significant improvement in outcomes over the course of the project.  The administrative processes proved cumbersome, and the ability to transfer data electronically would be beneficial. This work demonstrates the value of peer review in quality improvement. We now have a clearer view of future peer review, which needs to be simpler and more sustainable. We have worked with local leaders in the 2 pilot regions and elsewhere to help them develop new schemes which are locally owned and managed, with training and backup from the Newborn Hearing Screening Programme Centre. A STRATEGY FOR SELECTING THE OPTIMUM ARTIFACT REJECTION LEVEL DUR‐
ING DIAGNOSTIC ABR TESTING Lightfoot G English Newborn Hearing Screening Programme, Clinical Group, Liverpool, England, UK A test parameter critical to the accurate recording of ABR hearing thresholds is the amplifier artefact re‐
jection level. The English NHSP guidance for post‐screening diagnostic ABR testing advocates an arte‐
fact rejection level in the range 5 to 10 μV. The lowest value guarantees high quality (low noise) wave‐
forms but if the baby is not in an ideal state total rejection occurs and a higher rejection level must be used. What is the most time‐efficient strategy when the baby is not in an ideal state? (a) increase the re‐
jection level by a small amount so that many but not all sweeps are rejected (takes longer but most noise is rejected), or (b) increase to a higher level; this allows more noise into the average, so averaging over a larger number of sweeps is necessary to reduce the level of residual noise; again this takes longer, or (c) use Bayesian averaging. A study was conducted in which near‐threshold and discharge level (30dBeHL) raw (unaveraged) ABR responses and EEG/EMG from well babies in a variety of test states were re‐
NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 69
corded during their post‐screening ABR. The ABR was then re‐averaged off‐line in 61 second blocks (this corresponds to presenting 3000 stimuli) at a number of artefact rejection levels using both conventional and Bayesian averaging. The signal to noise ratio (SNR) was noted. The most efficient artefact rejection level strategy was that which achieved the greatest SNR in this fixed time. The results will inform advice given to testers and future national guidance documents. THE EFFECTS OF STIMULUS REPETITION RATE AND ELECTRODE MONTAGE TO THE AUDITORY BRAINSTEM RESPONSE (ABR): RESULTS IN INFANTS Dzulkarnain AAA, Abdul Hadi US, Jamaluddin SA, Ali Hanafiah N Department of Audiology and Speech Language Pathology, Kulliyyah of Allied Health Sciences, International Islamic Univer‐
sity Malaysia, Kuantan, Malaysia Auditory Brainstem Response (ABR) is one of the tools used to estimate hearing sensitivity among in‐
fants and difficult to test populations. The ABR recording is made by placing three to four electrodes at certain area on the scalp and the stimulus can be presented using either slow or fast stimulus repetition rates. However, different electrode configurations and stimulus repetition rates may affect the overall ABR results. The aim of this study was to investigate the effects of different stimulus repetition rates and multiple electrode montages (ipsilateral, contralateral, horizontal and vertical recording montage) on ABR results in infants. 11 healthy normal infants with the mean age of 4.36 ± 1.951 months old were in‐
volved. Prior to actual data collection, several preliminary audiological assessments including otoscopic examination, tympanometry, otoacoustic emission and ABR screening were conducted to ensure all sub‐
jects have normal hearing sensitivity. Once they have qualified to participate, ABR were recorded via four electrode montages, each using 100 microseconds clicks and two stimulus repetition rates (19.1cps and 61.1cps). All stimulus tests were fixed at 35dBnHL. The results showed that ABRs were present in all four electrode montages and both stimulus repetition rates for all participants. In addition, the wave V amplitude was significantly larger (p < 0.05) in vertical and ipsilateral montage at both stimulus repeti‐
tion rates and changing the stimulus repetition rate from slow (19.1 cps) to fast (61.1 cps) had no signifi‐
cant effect to the wave V amplitude in all electrode montages ( p > 0.05). The wave V latency is signifi‐
cantly longer in contralateral montage followed by vertical, ipislateral and horizontal montages at both rates (p < 0.05) and changing the stimulus repetition rate from slow to fast had caused significant delay to the wave V latency across all electrode montages (p < 0.05). This study concluded that combination of vertical and ipsilateral montages and high stimulus repetition rate (up to 61.1 cps) are the optimum re‐
cording techniques for threshold seeking and hearing screening due to larger and stable wave V ampli‐
tude and time efficiency. AUDITORY BRAINSTEM RESPONSE MORPHOLOGY AND ANALYSIS IN VERY PRE‐
TERM NEONATAL INTENSIVE CARE UNIT INFANTS Coenraad S, Toll MS, Hoeve LJ, Goedegebure A Department of Otorhinolaryngology, Erasmus Medical Center, Sophia Children’s Hospital, Rotterdam, The Netherlands Objectives/Hypothesis. Analysis of auditory brainstem response (ABR) in very preterm infants can be difficult owing to the poor detectability of the various components of the ABR. We evaluated the ABR morphology and tried to extend the current assessment system. Study Design. Prospective cohort study. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 70 NHS 2012
Methods. We included 28 preterm very low birth weight infants admitted to the neonatal intensive care unit of Sophia Children’s Hospital. ABRs were measured between 26 and 34 weeks postconceptional age. The presence of the following ABR parameters was recorded: the ipsilateral peaks I, III and V, the contralateral peaks III and V, and the response threshold. Results. In 82% of our population, a typical bow tie response pattern was present as a sign of early auditory development. This bow tie pattern is the narrowest part of the response wave and is predominantly characterized by the ipsilateral negative peak III. This effect may be emphasized by the contralateral peak III. The bow tie pattern is seen approxi‐
mately 0.1 milliseconds before the ipsilateral peak III. From 30 weeks postconceptional age onward, a more extensive morphologic pattern is recorded in 90% of the infants. A flow chart was designed to ana‐
lyze the ABR morphology of preterm infants in an unambiguous stepwise fashion. Conclusions. A typi‐
cal bow tie pattern preceding peak III seems to be the earliest characteristic of the developing ABR mor‐
phology in preterm infants. As ABR characteristics will improve with increasing age, neonatal hearing screening should be postponed until after 34 weeks. A NOVEL SCREENING PROTOCOL FOR THE DIFFERENTIATION OF TYPE OF HEAR‐
ING LOSS IN NEONATAL INTENSIVE CARE UNIT (NICU) INFANTS Shahnaz N1, Millman T2, Douglas C3, Narne VK4, Vijayasarathy S4, Kumar KS4, Mazlan R5 School of Audiology & Speech Sciences, University of British Columbia, Vancouver, BC, Canada; 2Montreal Oral School for the Deaf, Montreal, QC, Canada; 3Royal University Hospital, Saskatoon, Sk, Canada; 4Department of Audiology, All India Institute of Speech and Hearing, University of Mysore, Mysore, in India; 5Department of Audiology and Speech Sciences, Faculty of are Allied Health Sciences University Kebangsaan in Malaysia 1
This study aim is to compare screening results from the standard AABR protocol in NICU babies with those involving the measures of 1‐kHz tympanometry, TEOAE, and ipsilateral BBN reflex at 1 kHz probe tone frequency. All these measures are currently being measured as a standard protocol at the Royal University Hospital (RUH) in Saskatoon in Canada and affiliated hospitals of Department of Audiology and Speech Sciences, Faculty of Allied Health Sciences University Kebangsaan in Malaysia, and Department of Audiology, All India Institute of Speech and Hearing, University of Mysore, My‐
sore, in India which provides a unique opportunity to compare them in terms of testing length, chal‐
lenges encountered while testing, and whether they generate equivalent results. In Canada, a total of 90 NICU infants (chronological age: 31.38 days) were recruited, of which 78 infants met the inclusion crite‐
ria. In India, 80 NICU infants (10 days to 6 months) were tested using the same protocol and diagnostic testing was done in the clinic for the same infants to note the efficiency of the different protocols. Our results from data gathered in Canada revealed that 70.6% of infants passed both the current AABR and novel protocols. TEOAE accounted for most of the referrals for infants who passed the current AABR screening protocol and referred on the novel protocol (70%) and for infants who referred on both proto‐
cols (83.3%). The results from the Indian site, suggest that AABR+TEOAE+1kHz immittance protocol yield the most information with the greatest efficiency. Acoustic reflexes may be added to the battery, but it failed to replace AABR as a screening tool, at least in the population tested. The novel protocol might provide more information regarding the reason for a screening referral, including the identifica‐
tion of middle‐ear dysfunction and the detection of mild hearing impairment. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 71
ELECTRICALLY EVOKED AUDITORY BRAINSTEM RESPONSES IN CHILDREN AND ADULTS Butinar D1, Gros A2, Battelino S2, Vatovec J2 Institute of Clinical Neurophysiology, Neurology Clinic, University Medical Centre, Ljubljana, Slovenia; 2Clinic for Oto‐
larygology and Maxilofacial surgery, University Medical Centre, Ljubljana, Slovenia 1
Background. Registration of electrically evoked auditory brainstem responses (EABR) is an objective functional method allowing assessment of the auditory nerve fibres function as well as of the auditory pathway in the brainstem till the mesencephalon. It is able to locate the site of dysfunction in deaf people where we can not use the auditory evoked brainstem responses. It was expected that it would contribute considerably to the success rate of cochlear implants by providing a better selection of patients suitable for the implantation. However, being technically demanding, the method has failed to become a routine procedure. Aim. The aim of the study was to present the normative data in patients who underwent the method before the cochlear implants and to discuss the difference among the age groups. Method and Patients. Preoperatively we performed EABR with “gulf” electrode across the round window in 25 can‐
didates (50 ears), 11 females and 14 males, age 5 months to 820 months, who were candidates for co‐
chlear implants. Measurements were done in generally anaesthetized patients. Nicolet Viking IV system and Nottingham University electrical stimulator were used to generate reversed electrical stimuli (inten‐
sity: from 200 μA to 1 mA, duration: 200 ms) and to record EABR. The stimuli were applied through a needle “gulf club” electrode which was placed on the edge of, or across the round window. The EABR were recorded between the opposite earlobe and the vertex. Results. Reliable EABR could be recorded in all cochlear implant candidates. In older patients the amplitudes were high and EABR easier to record. Discussion. Reasons for the difference in results among the age groups are probably due to myelinisa‐
tion and are discussed. Conclusion. We know that the position of the stimulating electrode is critical however the results suggest a role of myelinisation among the age groups investigated. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 72 NHS 2012
STUDIES OF WORKING MEMORY AND READING SOME PRELIMINARY FINDINGS USING THE MISSING SCAN TASK TO MEASURE WORKING MEMORY CAPACITY IN YOUNG CHILDREN Roman A, Pisoni D Indiana University, Department of Psychological and Brain Sciences, Bloomington, USA There is a pressing need for new measures of working memory in young children, especially children with hearing impairments. Working memory is employed in many complex cognitive tasks such as reading and listening comprehension, mathematics, acquisition of language, face recognition, spatial reasoning, and spoken language processing. Problems associated with poor working memory in chil‐
dren include low levels of achievement in reading and mathematics, poor general academic progress, difficulty in complex problem solving, and difficulty sustaining attention. We developed a novel method to assess working memory capacity in young children based on earlier work by Buschke (1963) using a technique known as the “missing scan” task. Conventional span tasks used to assess memory capacity, such as forward and backward digit spans, cannot be used with children under five years of age. This limitation encouraged us to develop novel methods to measure working memory capacity in young children to help identify delays and/or disturbances in their control processes used in memory. This pre‐
sent study tested normal hearing and cochlear implanted children between 3‐6 years in age using the “missing scan” task as well as several other standardized measures to assess aspects of executive func‐
tion. We found the “missing scan” task could be completed by children of all ages in both groups. We also found that the cochlear‐implanted children showed a delay on the longest set size correctly recalled from memory compared to normal‐hearing age‐matched peers. The children with CIs were also delayed on receptive vocabulary. The present findings on young children provide new methods to study with the development of control processes used in the encoding, storage, and retrieval of spoken words in working memory. These methods will be useful clinically in identifying deaf children who may be at high risk for poor speech and language outcomes as they become older. THE COMPARATIVE STUDY OF READING COMPREHENSION IN HEARING AND DEAF STUDENT Nikkhoo F, Hassanzadeh S Psychological & Educational Exceptional Children group, Psychological & educational science school, University of Tehran, Iran Aims. In Different language approaches, reading is considered as a skill. Language skills (listening, speaking, reading and writing) are fully interlinked together. Thus, if children apply listening and speaking skills actively, they will learn reading and writing skills easily. The aim of this research is a comparative study of reading literacy among deaf students studying at exceptional schools beside nor‐
mal students in different degrees. Materials and Methods. The research is done posttraumatical and us‐
ing standardized 2006 PIRLS test which was tested on 80 5th grade primary school, 1th grade high school, 4th grade high school deaf students which were selected using randomly sampling method and 80 normal students in normal school which were selected using available sampling method. Results. A NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 73
significant difference was observed between reading perception of deaf and normal students among all three grades(p<0.001). Also there was significant difference between male and female students. There was no significant difference between deaf students among all three grades (p<0.001). Discussion. This study showed that one of the significant problems among deaf students is reading perception. As re‐
spects reading literacy is one of the most important acquisitive abilities of students at school, the need of evaluation and recognition of strengths and weaknesses of students, especially deaf students, is essen‐
tial. READING DIFFICULTY IN CHILDREN: AUDITORY AND VISUAL MODALITIESʹ AF‐
FECTION Shalaby AA1, Khalil LH1, Elkabarity RH1, Khalil SH2, Nada MA2, Khattab AN3 Audiology Unit, ENT dept., Ain Shams University Hospitals, Cairo, Egypt; 2Neurology and Psychiatry dept., Ain Shams University Hospitals, Cairo, Egypt; 3Phoniatric Unit, ENT dept., Ain Shams University Hospitals,Cairo, Egypt 1
Background. Several researches support that an auditory processing deficit may underlie some forms of reading difficulties. However, deficit affects other modalities such as vision might be other potential con‐
tributing factor. Objectives. This research aimed to investigate both central auditory processing abilities and the visual pathway in children having scholastic underachievement with reading difficulties. Meth‐
odology: the study group consisted of 15 children ( 8 males and 7 females) age range 5‐15 years. They were referred to central auditory clinic due to scholastic underachievement and reading difficulties. On‐
ly children with normal peripheral hearing and average Intellectual ability (IQ) were included in this study. All children were submitted to Standardized Arabic Central Auditory test battery for children. It included tests for selective auditory attention, dichotic listening , memory and temporal processing abil‐
ities. Also, electrophysiologic measures; auditory event related potentials (P300) and visual evoked po‐
tential (P100) were examined. The Illinois test of psycholinguistic abilities and screening test for risk of dyslexia were also examined to verify reading complaint and to assess psycholinguistic abilities. Re‐
sults. The central auditory test battery revealed abnormal pattern included mainly temporal processing and memory abilities that was accompanied by abnormal auditory event related potentials (P300). However, some children had additional dichotic listening or selective auditory attention deficit. Abnor‐
mal Visual evoked potential (P100) was detected in the majority of children. The Illinois test revealed visual pattern affection in those children. Conclusion. Children with reading difficulty had temporal processing disorder and memory deficit pattern. There was associated visual affection that supports multimodality affection in those children. So a remediation program for these children should include both auditory and visual modalities. INFLUENCE OF EARLY INTERVENTION TO THE READING ABILITY OF DEAF CHIL‐
DREN Widuri A1, Rianto D2 Medical &Health Faculty Muhammadiyah University of Yogyakarta; 2Faculty of Medicine Gadjah Mada University Indonesia 1
Background. Reading activity is an important factor in almost all aspect of life and is significantly corre‐
lated with gaining information and knowledge. Speech perception, production and the development of NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 74 NHS 2012
language are closely associated as well as become the key of learning to read process. Deaf children who received early intervention at Karnnamanohara school Yogyakarta Indonesia, which improves verbal communication ability at the age of speech and language development were expected to have optimal language quotient in order to support their learning to read process and gain normal reading ability. The aim of this study was to identify the correlation between early intervention in deaf children and their reading ability. Methods. The design of this study was retrospective cohort. The subjects who met the inclusion and exclusion criteria were divided into two groups base on good prognosis (early interven‐
tion) and poor prognosis (conventional intervention). Reading skill test was conducted to both groups when the subjects had received 1 year education minimally. The correlation between reading ability and early intervention were statistically analyzed using t‐test and X2 test. Results. Each sample and control groups consisted of 35 deaf children. Early intervention influenced the reading ability with RR 3,674 (CI: 1,369‐9,858). Deaf children with early intervention had significantly better reading ability compared to conventional intervention with p 0.009. Conclusion. Early intervention to deaf children influence the reading ability. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 75
EVIDENCE BASED NHS AND DATA MANAGEMENT THE DUTCH NHS TRACKING SYSTEM; A POWERFUL TOOL FOR THE SCREENING PROGRAMME Schuitema T, Van Oostrom S, Esveld M, Bouwens J, Uilenburg N Dutch Foundation for the Deaf and Hard of Hearing Child, Amsterdam, the Netherlands In the Netherlands a three stage Newborn Hearing Screening programme has been implemented na‐
tionwide since 2006. The first and second screening stages are performed with OAE and the third screen‐
ing with A‐ABR. The results of the Newborn Hearing Screening are of good quality and consistent over time. Babies are screened within six weeks, the degree of participation is high en the refer rate is low. About 0,3% of the babies is referred to a Speech and Hearing Centre. A tracking system to monitor the Newborn Hearing Screening has been developed and implemented together with the screening itself. The Dutch tracking system of the Newborn Hearing Screening is quite unique. The system makes it pos‐
sible to monitor the results of the hearing screening closely. In 2011 the tracking system has been mod‐
ernized and a new web based version is being implemented throughout the country. The coordinators of the Newborn Hearing Screening use the tracking system intensively. It provides them with many help‐
ful tools to enhance the quality of the programme. The tracking system has also been developed to send data to other registrations, for example electronic patient files of the youth health care and of the Speech and Hearing Center. The system is a very useful tool in reaching a good quality screening programme. In our presentation we will demonstrate our tracking system and how the system contributes to the out‐
come of the Newborn Hearing Screening. HOW TO FOLLOW UP BABIES WHO FAILED: THE WEB ARCHIVE & DATA MANAGE‐
MENT Bolat H1, Konukseven O2, Genc A3, Tezel B1, Ozbaş S1, Köse MR4 T.R. Ministry of Health, General Directorate of Mother and Child Health, Family Planning (MCHFP), Ankara, Turkey; Atatürk Training and Research Hospita; 3Hacettepe University, Turkey; 4T.R. Ministry of Health, General Directorate of Mother and Child Health, Family Planning (MCHFP), Ankara, Turkey 1
2
1,300,000 babies are born yearly in Turkey. Screening centers had reached 24 cities in 2005 and 584 in all 81 cities in 2010. The Ministry of Health (MOH) invested in 240 AOAE and AABR combined devices in 2011. Turkish newborn hearing screening program (NHS) under the responsibility of MOH, General Di‐
rectorate of Mother‐Child Health and Family Planning (MCHFP), NHS rate reached 79,5% in 2011. The NHS has 3 different screening centers in Turkey. 1. First Step Centers; the first and second tests of infants who failed the first screening. 2. Second Step Centers; An ENT Specialist, the AABR, multi‐frequency measurements are available for infants referred from the second screening. 3. Third Step Diagnostic Centers; have ENT clinics and Departments of Audiology. To provide all these screenings and transfer infants to appropriate centers at the proper time, a web‐
based software called ʺTR MOH ‐NHS Web Applicationʺ. The demographic information, medical his‐
tory, diagnostic and audiological test results are registered on this web page in each three steps by the NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 76 NHS 2012
screening centers. Plus, screening data is registered in monthly forms by MCH‐FP Branch Offices of City’s Health Directorateʺ then reported by Decision Support Systems (Oracle Business Intelligence). So the infant screening stage can be followed by tracking reports, the system warns family physicians about incomplete screening, then directs the family to the related institutions to complete the screening. Our aim is presenting the procedures in tracking and monitoring data management of NHS in Turkey. To discuss with a view to a mutual exchange of ideas and experiences towards forming an Interna‐
tional Union Project i.e. ʺto perform a standard applicable international NHS Web Archive or data man‐
agement”. EVIDENCE BASED DATA WITH JCIH CRITERIA FOR BILATERAL HEARING LOSS: A MULTICENTRIC STUDY IN TURKEY Konukseven O1, Genc A2, Muluk N3, Basar Suren F4, Kirkim G5, Tuncer U6, Kulakkayikçi M2, Karatas E7, Bolat H8, Akar F6, Dincol I1, Yorgun M6, Kalcigolu T7, Serbetcioglu B5, Muzaffer Kiriş1, Belgin E2 Hearing& Balance Disorders, Diagnose and Rehabilatation Center, Department of Ear Nose and Throat and Head and Neck Surgery, Ankara Ataturk Research and Training Hospital, Ankara, Turkey; 2Division of Audiology, Department of Ear Nose and Throat and Head and Neck Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey; 3Ear Nose and Throat and Head and Neck Surgery, Kırıkkale University Faculty of Medicine, Kırıkkale, Turkey; 4Subdepartment of Audiology and Department of Otolaryngology Head & Neck Surgery, Ondokuz Mayıs University School of Medicine, Samsun, Turkey; 5Hearing Speech and Balance Center, Department of Ear Nose and Throat and Head and Neck Surgery, Dokuz Eylül Univer‐
sity Faculty of Medicine, Izmir, Turkey; 6Division of Audiology, Department of Ear Nose and Throat and Head and Neck Surgery, Cukurova University Medical Faculty Balcalı Hospital , Adana, Turkey; 7Turgut Ozal Medicine Center, Department of Otolarngology HNS, Inonu University, Faculty of Medicine, Malatya, Turkey; 8T.R. Ministry of Health, General Directorate of Mother and Child Health/ Family Planning (MCHFP) – Ankara, Turkey. 1
Objective. Newborn Hearing Screening Programme (NHS) has been effectively implemented in all cities of Turkey. Currently data of NHS is being increasingly important to take the evidence‐based precautions and to create general consensus. Our aim is to present the NHS data from different regions of Turkey as a pilot study which is supposed to contribute to the development of NHS data monitoring system with evidence‐based data for bilateral hearing loss. Method. 443 children with bilateral hearing loss were in‐
vestigated retrospectively. Data provided from the archives of six referral tertiary Audiology Centers were determined for demographic features, types and degrees of the hearing loss(HL), the age of diag‐
nosis, the consanguinity, familal HL and the prenatal, natal and postnatal risk factors. Results. Symmet‐
ric Sensorineural hearing loss (SSNHL) ,especially profound, was the most observed type of hearing loss in all Regions. The difference between age of diagnosis values in regions1‐5 were statistically significant (p=0.000, X2=93.570). Diagnosis of hearing loss was performed at the highest rates in 3‐6months (39.3%), In Region1; 0‐3months (76.7%) in Region2; 6months‐2 years (77.2%) in Region4; and 3‐6months (48.0%) in Region5. Hearing aid applications were performed in 3‐6months (31.1%) and 6months‐1 year (24.4%); in Region2, 6month‐1 year(43.1%) and 1‐2 years (16.4%); in region4, 3‐6months (16.7%) and 6month‐1 year (12.5%). There was statistically significant correlation between SSNHL and consanguinity and fa‐
milal HL (p=0.004, p=0.008) and SSNHL degree of those were detected as profound in all Regions (p=0.023, r=0.115). Risk factors (Prenatal, natal and postnatal) in all regions, risk factors were not present. In Region1, postnatal risk factors(31.1%), in region2, prenatal risk factors (13.8%), and in Region5, natal risk factors (24.0%) were detected. In Region2, as the severity of SSNHL increased, prenatal risk factors were detected more (p=0.001, r=‐0.323). Conclusion. Consanguinity, familial HL and prenatal, natal, postnatal risk factors were different in each region of Turkey. All regions should take their own precau‐
tions according to the their evidence based data. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 77
PUBLIC HEALTH EARLY HEARING DETECTION AND INTERVENTION PROGRAMS IN THE ERA OF HEALTH INFORMATION TECHNOLOGY STANDARDS – A BANG OR A WHIMPER? Orlova A1, Finitzo T2 Public Health Data Standards Consortium, Baltimore MD, USA; 2OZ Systems, Arlington, TX, USA 1
Health Information Technology (HIT) standards enable electronic communications between providers, public health Early Hearing Detection and Intervention (EHDI) programs and families for identification and timely follow‐up for children in need. Since 2008 the Public Health Data Standards Consortium (PHDSC) has been working with US public health EHDI programs and HIT vendors to define HIT stan‐
dards for interoperability between electronic health record (EHR) systems and public health EHDI in‐
formation systems to exchange information on newborn hearing screening results, the early hearing care plan (EHCP), and electronic quality measures (e‐Measures). The standards‐based data exchanges were successfully tested by vendors at the US national testing events in 2011 and 2012 and demonstrated at the 2011 and 2012 Health Information Management and Systems Society (HIMSS) Interoperability Showcases. Specifically, we demonstrated standards‐based reporting of newborn demographics and hearing screening results from birthing facilities to public health EHDI programs; communication of the EHCP to pediatricians; and reporting of defined EHDI quality e‐Measures, including the number of ba‐
bies screened at the birthing facility. In the future, we anticipate developing HIT standards to support clinical and public health workflows for the early hearing follow‐up. In August 2011, the US National Quality Forum announced the endorsement of five newborn hearing screening and follow‐up quality measures defined and submitted by the National Committee for Quality Assurance (NCQA) and the Centers for Disease Control and Prevention (CDC). These EHDI quality e‐Measures can assure timely and proper care for children with hearing loss and can be used for program quality assessment. We seek the review of our work by the international community and elicit opinions on whether this approach can be accepted by other countries, thus assuring electronic data exchanges across international EHDI com‐
munity. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 78 NHS 2012
HEARING AIDS AND FM SYSTEMS EVALUATING THE OUTCOME OF PEDIATRIC HEARING AID FITTINGS Bagatto M1, Moodie S1, Malandrino A2, Richert F3, Clench D4, Scollie S1 National Centre for Audiology, The University of Western Ontario, London, Ontario, Canada; 2Audiology Department, Humber River Regional Hospital, Toronto, Ontario, Canada; 3School of Communication Sciences and Disorders, The Univer‐
sity of Western Ontario, London, Ontario, Canada; 4Audiology Department, Centenary Hospital, Toronto, Ontario, Canada 1
Outcome evaluation is a key component of the pediatric hearing aid fitting process, however, there is lit‐
tle research related to what a typical outcome might be for an infant who wears hearing aids and how to systematically track the child’s auditory development and performance over time. This is in part due to the lack of well‐normed and validated outcome measures available for use with infants and children who wear hearing aids. The University of Western Ontario Pediatric Audiological Monitoring Protocol (UWO PedAMP) is a recently‐developed guideline for evaluating auditory‐related outcomes in infants and young children who wear hearing aids. It consists of functional outcome tools in the form of care‐
giver report questionnaires. These are supported by each child’s hearing aid fitting information (i.e., Speech Intelligibility Index [SII]). The UWO PedAMP was developed using an integrated knowledge translation approach by collaborating with a community of pediatric audiologists. This facilitates clinical uptake of an evidence‐based guideline. The UWO PedAMP has been implemented with children of varying ages, developmental abilities and degrees of hearing loss. The impact of these variables on out‐
come will be presented through group data as well as case examples. A CLINICAL TRIAL OF RECEIVER‐IN‐THE‐EAR HEARING AIDS FOR NEWLY DIAG‐
NOSED HEARING‐IMPAIRED INFANTS Smith J1, Dann M2 Jenny Smith Audiological Consultancy, South Yarra, Australia; 2Taralye Early Intervention Centre, Blackburn, Australia 1
One of the potential complications surrounding the early diagnosis of hearing loss is the fitting of ap‐
propriate amplification, to provide babies with early listening experiences. Using amplification all wak‐
ing hours in daily routines is fundamental to normal auditory and language development. Newly diag‐
nosed babies are typically supine when they enter the Parent‐Child Mother Goose Program® (PCMG) at Taralye Early Intervention Centre in Melbourne, Australia. Their heads are supported against the breast when feeding or cuddling, by a mattress in a pram or on the floor or a car baby capsule. A common problem with conventional hearing aids in these situations is acoustic feedback. Parents report ongoing feedback problems can be particularly frustrating and stressful. They are sensitive to the need for audi‐
tory stimulation, but their baby’s aids are constantly prone to whistling. A further problem is the rapid growth of infant ears and the consequent need for new ear moulds. Many parents comment on the stress of frequent return visits for ear impressions. This paper describes the trial of a receiver‐in‐the‐ear hear‐
ing aid with an instant tip option, designed specifically to address the issues of acoustic feedback and rapid ear growth. The goal was to enable increased hearing aid compliance and usage, and reduce the number of appointments for ear impressions and moulds. Eleven hearing impaired infants, aged 6 weeks to 2.1 years with moderate‐to‐severe hearing loss were fitted with receiver‐in‐the‐ear hearing aids NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 79
at hearing centres in Melbourne. Four babies were newly diagnosed, five were replacement fittings for identified feedback problems and two were bi‐modal aid users. The paper describes the observed clini‐
cal benefits for all children, with detailed analysis of the children attending the PCMG program. Out‐
comes measures include questionnaires to measure aid usage and auditory development and interviews with the early interventionist. EFFICACY OF FREQUENCY TRANSPOSITION ON SPEECH PERCEPTION AND PRO‐
DUCTION IN HEARING IMPAIRED ARABIC–SPEAKING CHILDREN El Danasoury I1, Hazzaa N1, Saber A2, Elkabarity RH1 ¹Audiology Unit, Faculty of Medicine, Ain Shams University, Egypt; ²Phoniatric Unit, Faculty of Medicine, Ain Shams Uni‐
versity, Egypt A key objective when fitting hearing aids to children with severe to profound hearing loss is to maxi‐
mize the audibility of high frequency speech cues which are critical in the understanding of spoken lan‐
guage. The current study was designed to investigate the clinical efficacy of frequency transposition on speech perception and production in Arabic speaking hearing impaired children. Thirteen hearing aid users were included in this study. Subjects’ performance was assessed using their own digital hearing aids and using the newly fitted hearing aid without and with the frequency transposition (FT) technol‐
ogy. Evaluation included aided sound field threshold estimation, Widex Infant Listening Skills Inven‐
tory (WILSI), Arabic Speech perception tests and spectroscopic analysis of their speech. Hearing im‐
paired children showed improvement in aided thresholds especially the high frequency region with the FT program. There was improvement in both speech perception and production. WILSI questionnaire showed improvement in the listening and production skills. Proper audibility of high frequency pho‐
nemes with proper speech therapy and sufficient duration of acclimatization yielded promising results. However, longer adaptation is needed to show the best results. ELECTROACOUSTIC ANALYSIS OF FM TRANSPARENCY AND DIRECTIONAL MI‐
CROPHONES Thibodeau L, Alford J, McLellan C University of Texas at Dallas, Callier Center for Communication Disorders, Dallas, Texas, USA Electroacoustic verification of a frequency modulated (FM) system is a vital step in the fitting process to ensure that a child can hear the teacher and speakers in the environment around him. New FM receiver technology features auto‐connect, which is designed to automatically adjust the impedance and reduce the need for adjustment of FM receiver settings. When the output of the hearing aid is within 3 dB of the output of the combined hearing aid + FM system, “transparency” has been achieved. Verification of the maximum output is also necessary because the effect of hearing aid and FM receiver settings may result in limiting the dynamic range of amplification. Directionality of HA microphones and FM transmitter microphones should also be considered because this may be altered in FM+Microphone (FM+M) mode. Differences exist across HA manufacturers for accessing FM+M programs; some aids automatically switch to FM+M when a shoe and/or receiver is attached while others require manual selection of an FM+M program. Some children wear their FM receivers outside of school, which may affect the direc‐
tionality of their HA microphones. The purpose of this study was to examine transparency for moderate NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 80 NHS 2012
and high level inputs and directionality of FM couplings across four aids when programmed for differ‐
ent hearing losses. Transparency varied across aids and receiver types. Directionality of the FM transmit‐
ter microphone was observed when in normal operating mode and absent when in verification mode as expected. Directionality of the HA microphone varied with the presence of the FM receiver such that with some aids, directionality was lost when the FM receiver was on the aid and not receiving any FM input. The effects on HA microphone directionality should be considered when making decisions re‐
garding the style of FM receiver and logistics of school versus home equipment arrangements. FM TECHNOLOGY USE WITH PRE‐SCHOOL HEARING AIDED CHILDREN Mulla I1,2, McCracken W1 University of Manchester, Audiology and Deafness Department, Manchester, UK; 2The Ear Foundation, Research Depart‐
ment, Nottingham, UK 1
In identifying the importance of early identification of hearing loss in children, very little attention has been given to how advanced FM technology may improve outcomes. Distance, noise and reverberation remain considerable challenges for individuals using hearing aids, more so in really young children. The aim of this present research was to evaluate and explore the benefits of advanced integrated FM amplifi‐
cation technology with pre‐school hearing aided children. The research was of a longitudinal prospec‐
tive design, including both quantitative and qualitative analysis of FM technology use with seven fami‐
lies of pre‐school hearing aided children. All children were provided with the latest hearing aid and in‐
tegrated FM amplification technology suited to their hearing loss. Quantitative analysis of FM device use was evaluated via daily diaries, FM data‐logging software and questionnaires. Five of the seven families were able to establish regular FM use in a range of environments and settings. The environments where the FM was used most frequently were the home, car, nursery, shopping and outdoors. Listening evaluation measures with FM technology demonstrated the greatest improvements were in noise and at distance. Significant improvements in language development were noticed for the three children whose language development was identified as “at risk” at the start of the study. Qualitative analysis explored the views and experiences of parents and carers on their use of FM technology. Thematic content analy‐
sis sought to acknowledge parents and carers as the experts and place them in the centre of knowledge generation. Six main themes were identified: access to speech, listening, communication, wellbeing, en‐
gagement/ownership and practicalities of FM use. More detailed sub‐themes were generated under the main six headings. Overall the analysis highlighted the potential benefits, barriers and challenges to pre‐
school use of FM technology. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 81
HEARING LOSS AND MEDICAL CONDITIONS SILENT DIABETIC COCHLEOPATHY: AFFECTION OF OHCs (OUTER HAIR CELLS), OLIVOCOCHLEAR BUNDLE (OCB) AND/OR INNER HAIR CELL IN TYPE 1‐ DIABETES MELLITUS (T1DM) AMONG EGYPTIAN CHILDREN Elbarbary NS1, Elkabarity RH2 Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt; 2Department of ENT ,Audiology Unit, Faculty of Medicine, Ain Shams University, Cairo, Egypt 1
Objective. Our study aimed to detect early asymptomatic hearing affection whether at the level of OHC and or IHCs and or olivocochlear bundle and its correlation with other neuropathies and symptomatol‐
ogy. Method. Eighty children and adolescents with long standing Type 1 DM and twenty age matched children and adolescents who served as a control group were recruited from the regular attendants of the Pediatric Diabetes Clinic, Children’s Hospital, Ain Shams University over 10 months period between January 2011 and May 2011. All underwent basic audiological assessment to ensure normal hearing and normal middle ear function. Any case showing abnormal Middle ear function or elevated hearing thresholds was excluded from the study. They were subjected to history taking with special emphasis on duration of DM, recent levels of Glycosylated Bhemoglobin (HbA1c), presence of eye and kidney affec‐
tion. They were enrolled in the following audiological studies: OAEs (testing OHCs), OAEs with contra‐
lateral suppression (testing the integrity of the olivo‐cochlear bundle) and TEN Test (testing IHCs as ev‐
idenced by dead regions within the cochlea). Result. This study showed early affection of hearing in the form of no suppression or release from suppression on testing with TEOAEs and showed minimal affec‐
tion of inner hair cells reflected by few cases with positive TEN test. There was correlation of TEOAEs results with symptoms of inability to hear in presence of background noise and intolerance to loud sounds. Conclusion. Early symptoms of inability to hear in presence of background noise and intoler‐
ance to loud sounds raises the suspicion of presence of early asymptomatic hearing loss. Proper control of DM is important for hearing preservation. THE HIGH PREVALENCE OF OTITIS MEDIA WITH EFFUSION IN CHILDREN WITH CLEFT LIP AND PALATE AS COMPARED TO CHILDREN WITHOUT CLEFTS Flynn T1, Möller C2, Jönsson R3, Lohmander A4 Institution for clinical neuroscience and physiology, Department of Audiology, Gothenburg, Sweden; 2The Swedish Institute for Disability Research, Örebro University Hospital, Örebro, Sweden; 3Sahlgrenska University Hospital, Department of Audi‐
ology, Gothenburg, Sweden; 4Institution for clinical science, intervention and technique, CLINTEC, Karolinska Institute, Stockholm, Sweden 1
Objective. Children with cleft lip and palate universally present with otitis media with effusion (OME). This prevalence has not, however, been systematically examined longitudinally with a control group. The effect of OME on hearing also needs to analyzed. The purpose of the present study was to examine and compare the prevalence of OME and hearing sensitivity in children with and without clefts. Meth‐
ods. Two groups of children (children with unilateral cleft lip and palate (UCLP), N=22, and children without clefts, N=20, were followed prospectively and longitudinally from 1 to 5 years of age. Data were NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 82 NHS 2012
collected at four points (1, 1.5, 3, and 5 years of age). Assessments at each of the four points included: (1) otomicroscopy, (2) tympanometry, and (3) hearing assessment. Results. Overall, the children with UCLP demonstrated a significantly higher prevalence of OME (121 ears, 74.7%) than children without clefts (31 ears, 19.4%) (p<0.001). This higher prevalence was significant at all ages. Of those ears with OME, 83.1 percent of all ears exhibited a hearing loss, with this loss more prevalent in the cleft group (89.7% UCLP and 70.0% without cleft). Hearing loss was mild to moderate in degree and was significantly more pro‐
nounced in the cleft group. Conclusions. This presentation will highlight the findings of children with UCLP demonstrating a significantly higher prevalence of OME than children without cleft. It will also discuss how often hearing loss is present when a child experiences OME and the degree of that hearing loss in children with UCLP and children without clefts. AURAL ATRESIA IN NEWBORN HEARING SCREENING: A MULTICENTRIC STUDY IN TURKEY Basar Suren F1, Kirkim G2, Gunduz B3, Kulakkayikçi M4, Genc A4, Konukseven O5, Gökdoğan Ç3, Guven AG1 Subdepartment of Audiology and Department of Otoloryngology Head & Neck Surgery, Ondokuz Mayis University School of Medicine, Samsun, Turkey; 2Hearing Speech and Balance Unit, Department of Ear Nose & Throat and Head & Neck Sur‐
gery, Dokuz Eylul University Faculty of Medicine, İzmir, Turkey; 3Subdepartment of Audiology & Speech Pathology and De‐
partment of Otoloryngology Head & Neck Surgery, Gazi University School of Medicine, Ankara, Turkey; 4Division of Audiol‐
ogy, Department of Ear Nose and Throat and Head & Neck Surgery, Hacettepe University Faculty of Medicine, Ankara, Tur‐
key; 5Division of Audiology and Balance Disorder, Department of Ear Nose and Throat and Head & Neck Surgery, Ministry of Health Ataturk Hospital, Ankara, Turkey 1
Aural atresia is a malformation of the temporal bone. It can be seen as microtia, auricle aplasia, external ear canal atresia, middle and inner ear atresia. Incidence of congenital aural atresia is 10.000‐20.000/1. The aim of our study is to define the percentage of external ear atresia in Newborn Hearing Screening. 45124 newborns over 14 years were included in our study from 5 different neonatal hearing screening centers. We detected 67 (0,1)aural atresia; 56 unilateral ( 0,1% ) and 11 bilateral(0.01%). Right ear atresia were more than left ear (60,7% / 39,2%) and males have more (42 newborn;62,6%) than females (25 new‐
born;37,3%). Only one baby whose uncle has unilateral atresia has a family history (1,4%). Consanguin‐
ity was found in 14 (20,8%) babies with different degrees. Seven babies (10,4%) were premature (birth weight below 2000 gr and gestational week below 36). In babies have unilateral atresia, the contralateral ear were evaluated with TEOAE. TEOAE were present in 51 contralateral ear, only 5 ear have mild or moderate sensorineural hearing loss. Thirtytwo babies (32,8%) have CT scan, only one baby with bilat‐
eral atresia had Michel deformity, 21 babies have normal inner ear structure in their CT scans. Nine ba‐
bies have additional anomalies, cleft lip/palate (5 babies), anal atresia (1 baby) and multiple congenital anomalia (3 babies) were found in our atresia population. In our study we defined the percentage of au‐
ral atresia in Newborn Hearing Screening programme (0,1%). Bilateral atresia cause hearing loss so that babies must directed to hearing rehabilitation, besides unilateral hearing loss also cause some difficulties like localization problems and diminished understanding of speech in noise. Babies have aural atresia must be followed frequently and rehabilitated as soon as possible if needed. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 83
UNIVERSAL MOLECULAR SCREENING FOR CONGENITAL CMV INFECTION AT BIRTH TO ESTABLISH ETIOLOGY FOR LATE ONSET PRELINGUAL HEARING LOSS: RESULTS FROM A PILOT STUDY Pandya A1, Dodson KM2, Xia XJ1, Marshall B3, Adler S3 Departments of Human and Molecular Genetics, Virginia Commonwealth University, USA; 2Departments of Otolaryngol‐
ogy, Head and Neck Surgery, Virginia Commonwealth University, USA; 3Departments of Pediatrics, Virginia Common‐
wealth University, USA 1
Congenital cytomegalovirus (CMV) infection causes HL and other neurologic disabilities in 15‐20% of infected infants. Lack of detectable clinical abnormalities at birth in 90% ‐ 95% of infected newborns re‐
sults in failure to pick up HL in half of these at risk cases with audiologic hearing screening with a delay in diagnosis. It is difficult to establish an accurate etiology for HL retrospectively, due to the narrow window around birth for detection of congenital CMV infection. The high incidence of congenital CMV infection, lack of apparent clinical signs at birth and the significant negative impact on language and neuro‐cognitive development with a delayed diagnosis of HL, makes it a suitable condition to screen for at birth. Obstacles to implementing screening in the United States include a lack of consensus on a sensi‐
tive high‐throughput screening test and a protocol for follow up of CMV‐infected infants. We report on a pilot study at our institute, where all newborns were offered CMV screening after an informed consent process. We ascertained 524 infants; forty one percent were African American, 19% Caucasian and 10% were Hispanic. Only filter paper blood spots were obtained from newborns in the initial phase, with buccal swabs being added in the later phase of the study. CMV viral load was measured using a sensi‐
tive real time PCR assay and the buccal swabs were tested for cytopathic effect. We detected three in‐
fants with a positive screen on the blood spot, who tested negative for a follow up urine culture and se‐
rology for CMV in the first 4 weeks of life. An infant born to a mother who sero‐converted during preg‐
nancy tested negative for CMV at birth on the blood spot. The mother had received intravenous immu‐
noglobulin treatment during pregnancy. Long term audiologic follow up for HL is ongoing. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 84 NHS 2012
FACTORS INFLUENCING OUTCOMES EARLY DIAGNOSIS, LEADING TO EARLY IMPLANTATION? Archbold S, Wheeler A, Gregory S The Ear Foundation, Nottingham, UK Early age at implantation has been shown to have a positive effect on outcomes for paediatric implanta‐
tion. With infant screening programmes and earlier diagnosis there is now the possibility for early im‐
plantation to be routine for appropriate children. This study interviewed parents of ten children in the UK who had received cochlear implants about their journey from diagnosis to implantation. A semi‐
structured interview schedule was used, covering the and the interview transcribed and analysed. The results showed that:  The advice they received was very varied  The path to implantation was complex  The speed at which the process moved forward depended on the interventions of parents  There was no clear consensus about when infants should be referred to the CI centre  There were no national guidelines on the minimum age for implantation, and this depended on local decisions  Children with progressive losses or auditory neuropathy spectrum disorder were at risk of “later” implantation Although a small group, the results of this study show that in spite of Newborn Hearing Screening and the evidence of the benefits of early implantation, there is still no clear pathway in the UK from early di‐
agnosis to implantation, and that parents remain key figures in ensuring their infants are assessed for implantation early in life. DOES EARLY NEWBORN SCREENING TELL US ENOUGH ABOUT DEAF INFANTS? LANGUAGE OUTCOMES OF DEAF CHILDREN IN A BILINGUAL EARLY INTERVEN‐
TION PROGRAM Levesque E Aurora Early Intervention, Melbourne, Australia This paper describes a research project which investigates deaf children’s communication and language development in a bimodal bilingual (English and Auslan) early childhood intervention program. In‐
depth case studies of eight prelingually deaf children and their hearing parents explore in detail the children’s bilingual development and the ways in which parents facilitate their children’s communica‐
tion and language skills. The children in the cohort were identified at the commencement of the study as cognitively normal with no additional developmental needs and wore assistive listening devices such as digital hearing aids or cochlear implants or a combination of both. Data were collected over an 18 month period, during which time parent‐child interactions were observed every 2 months. The analysis investi‐
gated the proportion of use of both languages, the children’s attention to each language, and the contexts in which they used their language skills. The results suggest that there are changes in children’s lan‐
guage modality preferences in their early developmental years and identify the factors contributing to NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 85
their choices. When the children have frequent access to spoken and signed languages, they have oppor‐
tunities to determine the modality that best suits their communication needs. The data also reveal that language outcomes for the children whose hearing loss was diagnosed through early newborn screening were not necessarily better than those children who were diagnosed later. Reasons for these differences will be discussed in this paper. Findings of this study suggest that a variety of developmental challenges may emerge after the initial diagnosis of hearing loss which have a significant impact on the ways in which young deaf children acquire language. These findings suggest that there should be a less prescrip‐
tive approach to determining language modality for young deaf children than is currently practised. EFFECT OF VOCABULARY INTERVENTION ON VERB PRODUCTION AND SYNTAX IN TWO CHILDREN WITH SEVERE SENSORINEURAL HEARING LOSS Moran C1, Morgan K2 University of Canterbury, Christchurch, New Zealand; 2Nuffield Hearing & Speech Centre, London, England, UK 1
Rationale. Despite earlier detection, children with hearing loss may still present with language delays at preschool and school‐entry despite receiving intervention (e.g. Ching et al., 2010; Geers, Moog, Bieden‐
stein, Brenner & Hayes, 2009). Language delays may include restricted expressive vocabulary develop‐
ment as well as poor syntax skills (e.g. Tye‐Murray, 2004; Geers et al., 2009). In children with normal hearing a close relationship between vocabulary size and development of grammar has been identified (Bates & Goodman, 1997). For instance, Devescovi, Caselli, Marchione, Reilly & Bates (2003) found chil‐
dren with larger expressive vocabularies produced longer utterances. A similar relationship for children with hearing loss was evident (Nott, Cowan, Brown & Wigglesworth, 2009a). Verbs are especially im‐
portant to syntactical development as they are used in creating well formed sentences (Hadley, 1998), and in expressing semantic relations. Verbs have been found to be limited in the early lexicons of chil‐
dren with hearing loss (Nott, Cowan, Brown & Wigglesworth, 2009b). Therefore, specific, teaching of verbs to children with hearing loss may facilitate both vocabulary and syntax. This study investigated the effects of a vocabulary intervention programme for: 1) verb production and 2) syntax, in young chil‐
dren with severe sensorineural loss. Method. A single‐subject design was employed with two partici‐
pants aged 4 and 5 years with severe sensorineural hearing loss. Both had been fitted with hearing aids prior to 3 years of age. Data was collected over three sessions prior to intervention to establish a baseline of performance. Target vocabulary was probed and MLU calculated from language samples. Twenty hours of intervention using a focused‐stimulation approach to language (e.g. Fey 1986) was conducted over 10 weeks. Post‐intervention testing was conducted over three sessions following the conclusion of therapy. Results. Change was measured using a 2‐standard deviation band method (Portney & Watkins, 2002). All participants demonstrated significant change in their use of the target verbs. Both participants showed improvement in the targeted vocabulary and one showed improvement in MLU. Discussion. Findings will be discussed relative to the language learning characteristics of children with hearing loss. Specific recommendations for intervention and future intervention research will be presented. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 86 NHS 2012
SENSORY PROCESSING DIFFICULTIES AMONG CHILDREN WITH HEARING DEFI‐
CITS AND THEIR RELATION TO CHILDʹS PARTICIPATION IN LEISURE ACTIVITIES Engel‐Yeger B, Hamed S Occupational Therapy Department, University of Haifa, Israel Sensory processing difficulties (SPD) are mainly expressed in hypo‐or hyper sensitivity and may impair childʹs development, behaviour, and participation in daily activities. While most studies about sensory processing abilities of children with hearing deficits focused on vestibular and visual stimuli, a lack of information exist in regard to their abilities to process stimuli in other modalities, and in daily life sce‐
narios. This study aimed to. (1) profile SPD among children with hearing deficits (2) examine the rela‐
tionship between SPD and participation in leisure activities among the study group. Participants were 25 children with hearing impairments and 25 normal hearing controls, aged 6‐11 years. All parents com‐
pleted the Short Sensory Profile which evaluates the childʹs sensory processing abilities in daily life, by referring to all modalities. All children completed the Childrenʹs Assessment of Participation and En‐
joyment (CAPE) (which refers to the type of leisure activities; where it is performed; with whom and what is the level of enjoyment). Results. SPD probability was higher among children with hearing defi‐
cits as compared to typical controls (χ2 = 16.42, p≤0.01). This was mainly expressed in hypersensitivity to vestibular stimuli; greater tendency for sensory seeking and greater difficulties in auditory filtering. SPD were related to limited participation in leisure activities of the study group. For example: hypersensitivi‐
ty to touch and to vestibular stimuli correlated with more activities performed at home (r=.46, p≤0.05; r=.59, p≤0.05, respectively). Difficulties in auditory filtering correlated with restricted participation in self improvement activities (r=.44, p≤0.05). Conclusions. Children with hearing impairment may suffer from SPD. These difficulties may negatively affect childʹs participation in leisure activities. Thus, intervention programs should refer to the sensory processing abilities of children with hearing deficits and also use an elaborated view which refers to childʹs participation patterns. This may enhance childʹs development, self confidence and well being. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 87
OUTCOME STUDIES CHILD, ADOLESCENT AND YOUNG ADULT OUTCOMES IN CHILDREN BORN WITH CONGENITAL HEARING LOSS BEFORE UNHS: THE CHIVOS POPULATION‐BASED LONGITUDINAL STUDY Wake M1,2,3, Poulakis Z1,2, Wirth K1,2, Mensah F2,3,4, Paatsch L5, Bryson H1,2, King A6, Rickards F7 Centre for Community Child Health, Royal Children’s Hospital, Melbourne, Australia; 2Murdoch Childrens Research Insti‐
tute, Melbourne, Australia; 3Department of Paediatrics, The University of Melbourne, Melbourne, Australia; 4Clinical Epi‐
demiology & Biostatistics Unit, Royal Children’s Hospital, Melbourne, Australia; 5Faculty of Arts and Education, Deakin University, Melbourne, Australia; 6Australian Hearing; 7Faculty of Education, The University of Melbourne, Melbourne, Australia 1
Background. The Children with Hearing Impairment in Victoria Outcomes Study (CHIVOS) is a long‐
running population‐based cohort of Australian children born just before the advent of universal new‐
born hearing screening. Here, we present (1) outcomes at age 17‐19 years, and (2) relationships between outcomes and hearing loss severity. Methods. The CHIVOS cohort was recruited from prospectively‐
ascertained records of children born in 1991‐3 requiring amplification by age 4.5 years for congenital hearing loss. Children were assessed at ages 7‐8 years (wave 1), 12‐14 years (wave 2), and 17‐19 years (wave 3). Outcomes at every wave: receptive and expressive language (CELF); academic achievement (WIAT‐II wave 2 & WRAT wave 3); mental health (SDQ); and parent‐ and child‐reported health related quality of life (HRQoL; CHQ wave 1, PedsQL waves 2 & 3). Predictor: 4‐frequency PTA in the better ear at wave 1 classified as mild, moderate, severe, profound. Analyses: (1) T‐tests, comparing CHIVOS with normative data; (2) general linear models, comparing marginal adjusted mean outcome scores by hear‐
ing loss severity. Results. Of the 85 (66% uptake) in Wave 1, 80 (94%) were retained at Wave 2 and 72 (85%) at Wave 3, with a mean non‐verbal IQ of just over 100 at each wave. The sample scored far below normative means for language (1.0‐1.7 SDs) and academic achievement (0.7‐1.0 SDs), with lesser impacts for psychosocial HRQoL (0.4‐0.7 SDs); these gaps were present by wave 1 then relatively stable through to young adulthood. Language and academic scores, but not mental health or HRQoL, declined steeply with increasing severity of hearing impairment. Conclusion. These findings emphasise the major chal‐
lenges facing young adults born pre‐UNHS, and the importance of the first 7 years of life in determining long‐term outcomes. Repeated population birth cohorts are needed to determine the full impact of UNHS, cochlear implantation, and subsequent innovations. COMMUNICATION OPTIONS FOR YOUNG CI CHILDREN AT MAINSTREAM SET‐
TINGS Dionissieva K South‐West University, Faculty of Public Health and Sports, Department of Logopedics, Blagoevgrad, Bulgaria Normally young CI children are expected to develop oral communication due to better access to infor‐
mation through spoken language as their hearing peers do. The child with prelingual hearing disorder starts his/her individual journey in the world of sounds at the first fitting sessions of the CI processor. The following years are very challenging both for the child and the professionals because of many social NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 88 NHS 2012
and environmental factors influencing his/her individual progress in development of communication. This presentation is about a research run with a group of randomly selected 12 preschool children with severe to profound hearing loss, implanted at age of 1‐3. All children were individually placed at main‐
stream settings in different urban regions of Bulgaria. For the purpose of the investigation some profes‐
sionals (regular preschool teachers and speech and language therapists) were interviewed. The main evaluation criteria in the study were: (a) type of rehabilitation before implantation; (b) level of parent involve‐
ment, and (c) presence of special services at mainstream setting. It was suggested that the development of oral communication in young CI children is strongly dependent on these factors. Results. Significant influ‐
ence was found of factors (b) and (c) on the type of communication used by the CI preschoolers in the in‐
teraction with hearing peers. Some practical suggestions were derived in order to support improvement of environment and professional services for the development of oral communication. Discussion. Early identified children with severe to profound hearing disorders are well benefiting of cochlear implants in means of spoken language acquisition. The interaction with hearing peers using oral communication is natural and supports mainstream placement. This process is strongly facilitated by parents fully in‐
volved in rehabilitation and cooperating with both regular preschool teachers and SL professionals. HOW EARLY IS TOO EARLY? COCHLEAR IMPLANTATION IN INFANTS UNDER 6 MONTHS, 7‐9 MONTHS AND 10‐12 MONTHS OLD Abrahams Y1, Davis A1,2, Hopkins T1, Sperandio D1 1
The Shepherd Centre, Sydney, Australia; 2Macquarie University , Sydney, Australia The purpose of this study was to determine if there were significant differences in the receptive and ex‐
pressive language skills of children who received at least one cochlear implant at 6 months of age or younger, compared with those implanted between 7‐9 months of age, and those implanted between 10 and 12 months of age. The typical profile for children in each group was also examined. The Preschool Language Scales were used to assess receptive and expressive language abilities of 30 children who re‐
ceived at least one cochlear implant prior to 12 months of age. Children were allocated to one of three groups: Group 1 (first CI 6 months of age or younger), Group 2 (first CI between 7 and 9 months of age) and Group 3 (first CI between 10 and 12 months of age). Other factors including parental attitudes and medical and audiological factors were examined. No significant issues were seen for any children receiv‐
ing CI as infants. With a combination of objective and behavioural MAPping techniques they were able to access sounds across the speech range. By 3 years of age the performance of the cochlear implant users who received their first cochlear implant before 12 months of age was significantly better than those who received their first cochlear implant after 12 months and was comparable to their hearing peers. For in‐
fants, those who were implanted at the earliest ages showed better performance than those implanted between 7‐12 months. Outcomes for children implanted 6 months of age and under indicate that with full‐time device use and engagement in an Auditory‐Verbal Therapy early intervention program age appropriate vocabulary and language can be reached by 3 years of age. A variety of factors influence age of implant, and these also influence longer term outcomes. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 89
CONCURRENT VALIDITY OF SCORES FROM THE CONDITIONED ASSESSMENT OF SPEECH PRODUCTION (CASP) AND SPEECH SAMPLE ANALYSES Ertmer DJ Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, USA Vocal development is the process by which infant and toddler utterances become increasingly complex, phonetically diverse, and speech‐like during the first 2 years of life. Prior to the advent of newborn hear‐
ing screening (NHS), children with severe‐profound hearing losses experienced considerable delays in vocal development due to limited auditory access to conversational speech models. More recently, wide‐
spread adoption of NHS and improved hearing technologies have greatly increased auditory access to speech models during the first 2 years of life. Thus, children who have well‐fitted hearing aids or co‐
chlear implants (CIs) can be expected to make substantial progress in vocal development. In research in‐
vestigations, these advancements are usually documented by collecting and analyzing speech samples. This approach, however, is very time‐consuming and likely to be impractical for widespread clinical use. The Conditioned Assessment of Speech Production (CASP; Ertmer & Stoel‐Gammon, 2008) was developed to be an easily administered and time‐efficient alternative to speech sample analysis. The main purpose of the current investigation was to examine the concurrent validity of the CASP when compared with data obtained from speech samples recorded at the same interval. Methods. Nineteen deaf children who re‐
ceived CIs before their third birthdays participated in the study (mean age at CI activation = 21.5 months; range 8 – 35 months). Speech samples and CASP scores were gathered at 6, 12, 18, and 24 months post‐activation. Correlation analyses were conducted to assess the concurrent validity of the two measures. Results. CASP scores showed strong concurrent validity with speech samples scores across all intervals (r = .752, p <.001). Conclusions. The CASP was found to be a valid, reliable, and time‐efficient tool for documenting progress in vocal development in very young CI recipients. A COMPARATIVE STUDY OF SPEECH AND LANGUAGE SKILLS IN COCHLEAR IM‐
PLANTEES AND NORMAL HEARING CHILDREN WITH AN AGE RANGE OF 3 YEARS Arora S, Agarwal A, Sharma S, Lahiri AK Asha Speech & Hearing Clinic, Sir Ganga Ram Hospital, New Delhi, India Objective. Early identification and intervention results in significant better language, speech and socio‐
emotional development. This study aims to compare speech and language development between co‐
chlear implant recipients and age matched normal hearing children. Methodology. A total of 100 co‐
chlear implanted children (group I) and 100 children with normal hearing (group II) were chosen for study at Asha Speech & Hearing Clinic, New Delhi. The inclusion criterion was that all the recipients were intervened at mean age of 18 months with no associated disabilities and anatomically normal ear structures. Parameters such as auditory perception and speech production skills in natural context, as‐
sessment of child’s control over their own voice and ability to recognize simple question were assessed at 36 months postoperative using a battery of tests like: CAP, SIR, MUSS, and GASP. The test scores of CI recipients were compared with normal hearing children (Mean Age of 36 months) to find out the children’s performance in everyday listening and speaking situations. Results. A total of 90% of the CI children’s performance in auditory perception and language comprehension skills matched with that of a similar 3 years aged normal hearing children, but speech production scores were slightly lower than the age matched normal hearing children (p value <0.001). Conclusion. CI at an early age can result in NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 90 NHS 2012
normal speech and language development, this was proved in our study as well, where all children who were implanted at mean age of 18 months were integrated into normal schools. Their speech, language and communication skills were found to be comparable to their peer groups. MANDARIN LANGUAGE DEVELOPMENT FOLLOWING EARLY COCHLEAR IMPLAN‐
TATION Zheng Y1, Soli SD2, Tao Y1, Meng Z1, Li G1 Sichuan University, West China Hospital, Hearing Center, Chengdu, China; 2House Research Institute, Los Angeles, Cali‐
fornia, USA 1
Purpose. The purpose of this research was to assess Mandarin language development following early cochlear implantation using the Simplified Short Form (SSF) of the Communicative Development Inven‐
tory (CDI). Norms for the SSF inventories express language development after implantation in terms of equivalent age. Method. Both SSF vocabulary inventories, Words & Gestures (W&G), a measure of re‐
ceptive and expressive vocabulary, and Words and Sentences (W&S), a measure of expressive vocabu‐
lary, were administered to a sample of 91 pediatric cochlear implant (CI) recipients at West China Hospi‐
tal of Sichuan University ranging in age at implantation from 1‐5 years. Subjects were evaluated longi‐
tudinally at baseline, and 3, 6, 12, and 24 months after implantation. Not all subjects in the sample had reached the 24‐month evaluation. The sample was divided into subgroups based on age at implantation, with the largest subgroup (2‐3 year olds) containing 39 subjects and the smallest (4‐5 year olds) contain‐
ing 16 subjects. Results. W&G and W&S results are expressed as mean equivalent age at each evaluation interval for each age at implantation subgroup, using the norms to determine equivalent age. All sub‐
groups reached ceiling (18 month equivalent age) on the W&G receptive and expressive vocabulary scales. The 1‐2 year subgroup had the lowest baseline scores and exhibited the largest improvements, while the 4‐5 year subgroup had the highest baseline scores and smallest improvements. The 1‐2 year subgroup exhibited similar results for W&S expressive vocabulary, achieving the highest equivalent age (32 months) at 24 months. Conclusions. The SSF version of the Mandarin CDI provides an effective tool for assessment of language development during the first two years after pediatric implantation. Chil‐
dren in the youngest age at implantation subgroup showed the greatest improvements in receptive and expressive vocabulary and reached the highest equivalent ages. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 91
PARENT SUPPORT EMPOWERED MOTHERS PROMOTE THE WELLBEING OF THEIR DEAF CHILD. EXPE‐
RIENCES OF MOTHERS IN ETHIOPIA AND FINLAND Sume H1, Lehtomäki E2, Abey M3 Department of Education, University of Jyväskylä, Jyväskylä, Finland; 2Faculty of Education, University of Jyväskylä, Jy‐
väskylä, Finland; 3College of Education and Behavioral Studies, Department of Special Needs Education, Addis Ababa Uni‐
versity, Addis Abeba, Ethiopia 1
There is hardly any cross‐cultural research on how parents and mothers, in particular, overcome the new challenges when learning about their child’s deafness and assume responsibilities for their deaf children. Research in the Northern and Western countries suggests that mothers of disabled children negotiate, manage and arrange their family daily lives, and encounter traditional and often oppressive ideologies regarding motherhood and a lack of enabling environments. The research questions addressed in this study are: what actions and decisions do the mothers have to undergo, and what supports their mother‐
hood in the new situation, facing their child’s deafness. In our presentation we analyze interview mate‐
rial, accounts of mothers with deaf children in two very different situations and cultures, in Ethiopia and Finland. Content analysis was used in examining changes in motherhood, from the initial concerns re‐
garding their child’s hearing and confirmation of deafness, to active planning for their child’s future. In‐
terviews of the four mothers deemed social support as being valuable in overcoming and fighting the social stigma attached to their children and families. The mothers assumed a level of responsibility be‐
yond social and cultural, and their own, expectations. The findings of this study emphasize the growing agency of mothers with deaf children and, in general, mothers of disabled children and their need for social support as the most important form of early intervention. Regardless of differences in socio‐
economic conditions and cultures, social networks and peer support are invaluable for empowering par‐
ents. Professionals who aim to promote wellbeing of young deaf children are encouraged to empower parents and strengthen their role in rehabilitation and care from very early stages. This study emphasiz‐
es the importance of early intervention, the growing agency of mothers with disabled children and their need for social support. CREATING/ENHANCING FAMILY SUPPORT SYSTEMS Beeler J1, McCamy S1, Chase P2, Luckey J3, Thibodeau L4, Watts K5, Sexton J6 TN EHDI Program, Knoxville, TN USA; 2East Tennessee State University, Johnson City, TN USA; 3West TN School for the Deaf, Jackson, TN USA; 4University of Texas at Dallas, Dallas, TX USA; 5NC EHDI Program, Raleigh, NC USA; 6 The CARE Project, Greensboro, NC, USA 1
When parents initially get the unexpected news that their child is deaf or hard of hearing, there are a va‐
riety of emotions experienced. Throughout the world, networks providing emotional support for fami‐
lies with children who are deaf or hard of hearing are limited. This presentation will share the plans and outcomes in several states in the USA (North Carolina, Tennessee, Texas, Vermont) that have partnered with The CARE Project to create local/regional parent support groups. These groups ensure that parents have a strong sense of community, comfort and connectedness with others who are on their same jour‐
NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 92 NHS 2012
ney. The plans focus on shared experiences through documentary film segments. These segments create a safe environment for families to talk openly about their own experiences and feelings regarding hear‐
ing loss. A variety of activities have been designed to allow families to begin this process and to move forward, eventually becoming a mentor family to newly identified families who are in need of support. A secondary benefit to use of the program has been the enhanced sensitivity on the part of professionals who provide services to the families. Data will be presented regarding both training and professional competency in providing emotional counseling to parents and young children with hearing loss. INCREASING PARENTS’ KNOWLEDGE AND COMFORT IN CARING FOR THEIR CHILD’S FIRST HEARING AIDS Harris A, Thibodeau L University of Texas at Dallas, Callier Center for Communication Disorders, Dallas, Texas, USA Parents of young children are frequently overwhelmed with information about the use and care of their child’s hearing aids in the period following the initial fitting. Although they may be carefully instructed by their audiologist, they report anxiety regarding hearing aid and earmold use, care, and placement. A book was created called “My Hearing Birthday” which was individualized for a young child with his/her name and photographs on the day of the initial hearing aid fitting. The left side of each page spread is directed toward parents or other adult caregivers. Clear and concise basic information regard‐
ing hearing aids is provided. The right side is directed toward the child and tells the story of the child receiving his/her first hearing aids in simple language. Photographs of the child are scattered throughout the book including one that illustrates the proper placement of the hearing aid and earmold. The book serves to empower parents in the management of their child’s hearing aids and facilitates sharing knowledge with extended family. Feedback from parents and audiologists was unanimous in support of the value of the book for easing a family’s adjustment to hearing aids. Based on this feedback, the con‐
tent was modified to include information about listening checks, battery usage, drying jars, and oto‐
clips. It also provides suggestions for keeping aids on young children. Parents and clinicians were unanimous in their belief that the individualization of the book is essential to its appeal and effective‐
ness. Professional reproduction of each child’s book can be accomplished through a photo‐management website. The impact of the book will be determined by parent questionnaires and datalogging results from children’s hearing aids during the initial post‐fitting period. PARENT STRESS, PARENT‐CHILD RELATIONSHIPS AND CHILD SO‐
CIAL/EMOTIONAL AND LANGUAGE OUTCOMES FOR CHILDREN WITH BILATERAL AND UNILATERAL COCHLEAR IMPLANTS Sarant JZ1, Holland J1, Bant S1, Bennet L1, Garrard P1, Galvin KL1, Busby PA2, Blamey PJ3, Rance G1 The University of Melbourne, Department of Audiology and Speech Pathology, Melbourne, Australia; 2Cochlear Ltd., Mel‐
bourne, Australia; 3The Bionics Institute, Melbourne, Australia 1
Aim. Research has shown that parents of children with disabilities are often more stressed than those of children without disabilities. Further, through measuring parent stress and coping, it is possible to make predictions about parent–child relationships and child development in areas such as cognition, language and social development. This study aims to explore stress and coping in parents participating in a five‐
year multi‐center study of the language, social, and academic development of children with unilateral NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 93
and bilateral cochlear implants. Relationships between parent stress and child social/emotional and lan‐
guage development will be explored. Outcomes for children with unilateral versus bilateral cochlear implants will be compared. Material and methods. The stress levels of 70 parents of children aged 5‐8 years were measured using the Parent Stress Index. Child language development was assessed using the Peabody Picture Vocabulary Test, the Preschool Language Scales and the Clinical Evaluation of Lan‐
guage Fundamentals. Social development was assessed using the Strengths and Difficulties Question‐
naire. Results. Stress and depression scores for these parents were higher than for parents of children without disabilities. The main stressors for parents, both in terms of child and parent characteristics, were examined. Parents were most stressed by demanding child behaviour, and almost 25% found ac‐
ceptance of their child difficult. Depression and lack of spousal support were also significant problems. The relationships between child social/emotional and language development and parent stress were also examined. Parent stress and child outcomes were compared for children with unilateral and bilateral implants. There was no significant difference in stress levels for parents of children with unilateral ver‐
sus bilateral implants, despite significant differences in some outcomes for these groups. Conclusions. These are initial findings from a relatively small sample. Results for larger numbers of parents and chil‐
dren will be reported as the study continues. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 94 NHS 2012
NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 95
POSTER SESSION EHDI PROTOCOLS AND TECHNOLOGIES N. 1 ‐ THE BENEFIT AND VALUE OF QUALITY ASSURANCE REVIEW OF NEWBORN ABR ASSESSMENTS Cameron C, Sutton G NHS Newborn Hearing Screening Programme, London, England, UK The English Newborn Hearing Screening Programme (NHSP) has a well developed quality assurance (QA) programme. In our first QA cycle of all local screening programmes it became evident that the quality of the audiological assessment of screen referrals varied widely between sites: some were unsafe and many others were not performing the required range of tests (tonepip, BC) or were not complying with NHSP guidance. Subsequently the review of ABR traces has become an integral part of the ongoing QA programme. In this paper we will present the outcomes of the latest review. All audiology depart‐
ments in England that received referrals from the hearing screen submitted five test cases, and these were reviewed by a small expert team using an agreed categorisation system. Results were communi‐
cated on a review form and by a phone call with the aim of ensuring understanding of the review out‐
come and that quality improvement measures could be put in place. We also sought the views of audi‐
ologists on the value of this exercise. The paper will present the findings and discuss the value and bene‐
fit of such audit. N. 2 ‐ DATA COLLECTION AND ROUTING IN THE NATIONAL AUDIOLOGICAL SCREENING Belov OA, Alexeeva NN, Tavartkiladze GA National Research Centre for Audiology and Hearing Rehabilitation, Moscow, Russia The distributed electronic health record (EHR) system for data collection and quality assurance during the audiological screening was designed. EHR records are created in a client program for maternity hos‐
pital, typically executed on portable computer. This program operates without permanent network con‐
nection and provides basic functions of EHR system. Several instances of this program can be used in one hospital, while the data is periodically synchronized between them. The collected data are periodi‐
cally sent to central databases in form of encrypted e‐mail attachment. In some situations we use GPRS modem for data delivery. Medical data including results of tests and, possibly, raw data from audiological devices are collected in a single relational database. This database is used both for automat‐
ic data analysis and as remote backup for data stored in client programs. The data are periodically pro‐
cessed by a set of automatic algorithms with the aim of finding problems in data acquisition. There are also algorithms intended to monitor the follow‐up stage. For privacy the database for medical data keeps only impersonal data. All private data are stored in dedicated data base. Client program in audiological clinic receives data on newborns who failed the screening. The data for a child born in any NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 96 NHS 2012
hospital involved in this system can be downloaded on demand from servers. The information about the retests and the rehabilitation procedures is sent back to the system and is used for quality assurance. N. 3 ‐ NEWBORN HEARING SCREENING VS LATER HEARING SCREENING: HEALTH‐
CARE RESOURCE UTILIZATION IN CHILDREN WITH PERMANENT CHILDHOOD HEARING IMPAIRMENT Schouten CS1, Korver AMH2, Konings S3, Dekker FW4, Frijns JMH3, Van den Akker‐Marle5, Oudesluys‐
Murphy AM6 Leiden University Medical Center, Leiden, The Netherlands; 2Willem‐Alexander Children’s Hospital, Leiden University Medical Center, Leiden, The Netherlands; 3Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, The Netherlands; 4Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands; 5Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands; 6Willem‐Alexander Children’s Hospital for the DECIBEL Collaborative Study Group, Leiden University Medical Center, Leiden, The Netherlands 1
Context. Newborn hearing screening programmes are already implemented in many countries, based on expected better developmental outcomes. Although policy decisions and prioritization of healthcare re‐
sources are usually based on evidence regarding cost‐effectiveness, newborn hearing screening in the Netherlands was introduced without detailed costs studies. Data on healthcare resource utilization are scarce. Objective. Study the effect of newborn hearing screening versus distraction hearing screening on healthcare resource utilization by hearing impaired children. Design, Setting and Participants. Between 2002 and 2006, distraction hearing screening was gradually replaced by newborn hearing screening in the Netherlands. Children participating in the DECIBEL‐study (born between 2003‐2005) on develop‐
mental outcomes were studied. At age three to five years all children with permanent childhood hearing impairment were identified. Parents were sent a questionnaire on healthcare resource utilization and quality of life. Evaluation ended December 2009. Main Outcome Measures. Healthcare resource utiliza‐
tion until the age of 36 months and quality of life per type of hearing screening programme. Results. Analysis of resource utilization included 52 hearing‐impaired children in newborn hearing screening and 35 in distraction hearing screening. There were no differences between groups in degree of hearing loss, type of amplification or additional handicaps. Overall, analysis showed that newborn hearing screening is not associated with higher healthcare resource utilization when compared to distraction hearing screening. On the other hand, quality of life was significantly higher in children in newborn hearing screening, with a mean between‐group difference of 4.9 (95% CI, 0.4 to 9.4). Conclusion. New‐
born hearing screening is not associated with increased healthcare resource utilization in the first 36 months of life. If anything costs should be higher in this group as hearing loss is detected much earlier and they begin to use medical services at a younger age. The results of the current study support the im‐
portance and cost‐effectiveness of newborn hearing screening programmes. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 97
N. 4 ‐ IMPROVEMENT OF NEWBORN HEARING SCREENING WORKFLOW Hurteau AM1, Dalå J2, Lund AS2 Montreal Children’s Hospital, McGill University Health Center, Audiology Department, Montreal, Canada; 2GN Otomet‐
rics, Taastrup, Danemark 1
There are many aspects of Newborn Hearing Screening programs that must be satisfied to meet interna‐
tional standards. One of those aspects is efficacy in screening workflow. Concerned with optimizing screening workflow, Madsen developed a new version of its Accuscreen automated ABR and DPOAE measurement system. The audiology department of the Montreal Children’s Hospital of the McGill Uni‐
versity Health Center volunteered to validate this new device’s algorithm as well as user‐friendliness. A total of 100 babies (ranging from a few days to 3 months of age) from both the well‐baby nursery or from the intensive care unit, were assessed with the older as well as the newer version of the Madsen Accuscreen. In all cases, both A‐ABR and A‐DPOAE test procedures were administered. Qualitative comparisons concerning the ease of use of both devices indicated that the newer version of the Accuscreen has an intuitive user interface that facilitates menu navigation, data entry and ease of learn‐
ing. The newer device was judged to be more ergonomic as well as parent and baby friendly. The new probe design is easy to insert and it fits snuggly in the ears of newborn babies. The audiologists as well as the dedicated screener appreciated the stand alone docking station and battery life of the new device. Preliminary data suggest that the new version of the algorithm provides similar test results than the old‐
er Accuscreen model. N. 5 ‐ EARLY HEARING SCREENING IN HIGH‐RISK PREMATURE BABIES: “EARLY” ON THE VERGE OF “TOO EARLY” Royackers L, Desloovere C Department of ENT‐Head and Neck Surgery & MUCLA, University Hospitals Leuven, Belgium Premature babies are at higher risk to have sensorineural hearing loss (SNHL) than full‐term babies. Al‐
so, prematurity is often associated with other risk factors potentially affecting the auditory pathway. Therefore, early hearing screening is recommended to be able to start early intervention, when required. However, in the context of such screening, the possibility of still incomplete or delayed maturation of the auditory nerve should be taken into account. Screening too early may produce false positive results and needlessly worrying parents. In this study, hearing screening was performed in 346 high‐risk premature babies (gestational age (GA) <37 weeks (w)), just before discharge from the neonatal intensive care unit of the University Hospitals Leuven, Belgium. Inclusion criterion was prematurity, in combination with at least one other risk factor for SNHL (asphyxia, hyperbilirubinemia…). All babies were born between 24w 6/7days and 36w 6/7days GA. 85.5% (296/346) of the babies passed initial hearing screening. 14.5% (50/346) failed initial screening for one or both ears. In case of failure, a new test was performed after a minimum of one week. For 5.5% (19/346), hearing loss was confirmed at retesting and later on. By con‐
trast, 9.0% (31/346) showed normal hearing upon such retesting or thereafter. In three cases only, tempo‐
rary hearing loss was caused by glue. In all other cases (28/346), hearing loss was most probably caused by incomplete maturation of the auditory nerve at the time of the first test. Four of them had a proved auditory neuropathy, which disappeared. For one baby, the auditory neuropathy disappeared at 3 months only. Conclusion. early hearing screening in high‐risk premature babies is recommended. Too early screening, however, may cause temporary false positive results. In this population, the possibility NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 98 NHS 2012
of incomplete or delayed maturation of the auditory nerve should be carefully considered when inter‐
preting the results. N. 6 ‐ HEARING SCREENING BASED ON AUDITORY BRAINSTEM RESPONSES: COM‐
PARISON OF NATUS ALGO 3I AND MAICO MB 11 Luts H, Hofmann M, Van Eeckhoutte M, Poelmans H, Wouters J Research Group ExpORL, Dept. Neurosciences, KU Leuven, Leuven, Belgium In Flanders, Natus ALGO devices are used for systematic newborn hearing screening. The screening program has been very successful since 1998. However, the costs for disposables (electrodes and ear‐
phones) are high and therefore alternative screening devices that don’t require the use of disposables are considered as a possible successor of the ALGO devices. A study was designed to compare Natus ALGO 3i with MAICO MB 11, a device with integrated electrodes. Both screening technologies are based on auditory brainstem responses, but they differ with regard to several stimulus characteristics and re‐
sponse detection methods. Natus ALGO 3i stimulates both ears simultaneously with alternating polarity clicks at a click rate which changes between 34 and 37 Hz every 20 seconds. An EEG pattern matching algorithm is used to evaluate the responses. MAICO MB 11 presents alternating polarity chirps at a rate of 93 Hz. Both ears are tested separately, and responses are evaluated in the frequency domain based on amplitude and phase information at eight harmonics of the presentation rate. The first phase of the study consisted of a technical evaluation. The output of both devices was recorded and the stimulus in‐
tensity, pulse shape and spectrum were examined. In a second phase, both ears of 85 babies were screened with both devices within the normal neonatal hearing screening program. Finally, a small number of babies that were referred for further diagnosis after a two‐stage ALGO screening, received an additional screening with the MB11. Results of the technical evaluation, as well as screening outcomes and practical considerations will be discussed. N. 7 ‐ NEWBORN HEARING SCREENING WITH MB11 BERAPHONE® ‐ WHAT HAVE WE ACHIEVED SO FAR? Cebulla M, Keim R, Shehata‐Dieler W Department of Otorhinolaryngology, Plastic, Aesthetic and reconstructive Head and Neck Surgery, Julius Maximilian‐
University Hospitals, Würzburg, Germany With the BERAphone® device the hearing screening of newborns was established at university hospitals in Würzburg in 1997. From the beginning an ABR based method were used for the screening. In 2002 the BERAphone® system was improved by implementing an automatic detection algorithm using click ASSR. Later in 2006 the performance of the screening system could be further boosted by introducing an optimized chirp stimulus. To date, we are using this technique with success in our routine newborn hearing screening. The screening is performed on a well baby nursery under moderate noise level. The stimulus level is 35 dB HL. The data presented here are from a period of 6 years of hearing screening. Overall 6866 healthy newborns were screened during this time period. As the result the specificity over this period was 97.3 % with a corresponding referral rate of 2.7 %. The MB11 BERAphone® works quite fast, the median of the raw detection time (without preparation) was 28 s. Within this analyze interval 47 newborns were identified with a hearing loss: 34 newborns with a bilateral loss and 13 with a unilateral loss. Based on this the observed prevalence is 0.68 %. The mean age of identification and diagnosis is be‐
NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 99
low three month and the treatment begins within an mean age of 6.7 months. From our experience, the MB11 BERAphone® is a reliable device for ABR based newborn hearing screening and it provides re‐
sults within a very short time with minimal cost of materials as no disposable electrodes are needed. N. 8 ‐ USABILITY OF TWO TYPES OF AUTOMATED BRAINSTEM RESPONSE IN THE SCREENING OF NEWBORNS ADMITTED TO INTERMEDIATE NEONATAL UNITS Sequi Canet JM, Lorente Mayor L AVS, Hosp, Fco. Borja, Pediatrics, Gandia, Spain Introduction. Following the recommendations of most people about potential use of automated ABR (AABR) in infants admitted to intensive care units of grade 3 or higher, we decided to test its application in units of grade 2b (intermediate) typical of regional hospitals where the stay is shorter and had less technified staff, because problems in these infants also increase the risk of hearing loss and are candi‐
dates for neural pathology undetectable by OAE. Material and Methods. First we carried out an OAE test, and then to all normal, we did a test of automated ABR with two different devices, the first month with an Algo3 (Natus ©) and the following month with an Aurix (Widex©), measuring the time of preparation of neonate and the performance, and assessing the ease of use with an inquiry to the nurses that did the test. Tests were performed by all nurses in the unit, at all hours of the day when the work permitted, being careful to keep the minimum ambient noise and the neonate as quiet as possible. Dis‐
cussion. Of the two AABR, nurses, in general, judged as easier to use the Algo 3i (90%), for being an in‐
tegrated unit and costs less to prepare the newborn, but if you ask a few nurses who used the two ma‐
chines more often the view is balanced (70%) and the difference is not so important. In terms of time, the OAE were much faster than any of the AABR and much easier to do, so is the recommended technique in very low risk neonates with short stay (i.e. observations). In terms of AABR, there were no significant differences with the execution time or results. Conclusions. Both methods are useful and most impor‐
tant thing to decide is who will do the tests. N. 9 ‐ INTRODUCING A NEW TECHNOLOGY IN CHILDREN OBJECTIVE AUDITORY EXPLORATIONS. ITS IMPACT WITHIN EARLY DETECTION DEAFNESS PROGRAM IN CATALONIA De Muller A, Gambettola J, Torres Y, Lacima J, Clavería MA Sant Joan de Dèu Universitary Hospital, Barcelona, Spain. New technological devices for objective hearing evaluation allow us to obtain Auditory Brainstem Re‐
sponses (ABR) in children during controlled muscular activity, making sedation / anaesthesia not needed. As a Reference Centre in Children Hearing Loss Diagnosis in Catalonia (Spain), we run as a first objective test an ABR with Vivosonic Integrity ™ 4.7 device. The initial diagnosis at a very early age (1‐3 months) in babies referred from the UNHS in Catalonia, allows us: A) To obtain a quick, early, non aggressive and trustworthy first ABR threshold. B) To considerably reduce the time for a conventional objective audiological evaluation. C) To reduce families’ anxiety (shorter waiting lists, no sedation/anaesthesia fear). D) An early interdisciplinary intervention in case of hearing loss. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 100 NHS 2012
Conclusion. Introducing this first ABR test, where sedation/anaesthesia is not needed, facilitates the complex interdisciplinary intervention in case of children’s hearing loss, allowing the implementation of the JCIH objectives. N. 10 ‐ NEW TECHNOLOGY IN CHILDREN OBJECTIVE AUDITORY EXPLORATION. ABR WITH NO SEDATION/ANAESTHESIA. OUR EXPERIENCE AND RESULTS Torres Y, Gambettola J, De Muller A, Lacima J, Clavería MA Sant Joan de Dèu Universitary Hospital. Barcelona, Spain New ABR technologies enable ABR recording in non sedated – anaesthetized patients , and offer the possibility of doing electrophysiology evaluations in electromagnetically harsh conditions. Since the in‐
troduction of this new technology in our hospital, we have tested 1123 patients between 1 month and 18 years old, where different associated pathologies /syndromes may be present (such as neurological / psychiatric diseases. Kawasaki Sd, Usher Sd, Treacher‐Collins Sd …). This new ABR technology brings us the possibility of: i) Safer explorations. ii) Testing children where sedation/anaesthesia is contraindi‐
cated. iii) Waiting list reductions. iv) No need for special acoustic conditions and mobility of equipment (possibility of testing in several places). Conclusion. i) Having this first step in objective evaluations allows us to save several anaesthesias. An‐
aesthesia just in case of suspicion of HL and for a complete objective electrophysiology diagnosis (ABR+ASSR). ii) Need of other subjective and/or objective tests to obtain a complete hearing diagnosis in each case. Implementation of the JCIH objectives (less waiting time, before final diagnosis, before treat‐
ment and hearing stimulation). N. 11 ‐ THE EFFICACY OF A TWO‐STAGE PROTOCOL FOR NEWBORN HEARING SCREENING USING TRANSIENT EVOKED OTOACOUSTIC EMISSIONS AND AUTO‐
MATED AUDITORY BRAINSTEM RESPONSES Ari‐Even Roth D1,2, Kuint J3, Hamburger A1,2, Henkin Y1,2, Hildesheimer M1,2 Speech and Hearing Center, The Chaim Sheba Medical Center, Tel Hashomer, Israel; 2Department of Communication Disor‐
ders, Sackler Faculty of Medicine, Tel Aviv University, Israel; 3Department of Neonatology, Edmond and Lily Safra Chil‐
drenʹs Hospital, Sackler Faculty of Medicine, Tel Aviv University, The Chaim Sheba Medical Center, Tel Hashomer, Israel 1
Since 1997, a universal newborn hearing screening (UNHS) program is successfully operating at the Sheba Medical Center using a transient evoked otoacoustic emissions (TEOAE) one‐stage protocol. All infants who fail in‐hospital screening and those at‐risk for hearing impairment (HI) (according to the Joint Committee on Infant Hearing) are further evaluated at the Sheba Speech and Hearing Center. Since January 2010, following the recommendations of the ministry of health, all children in Israel are screened prior to discharge from the hospital with a two‐stage protocol using TEOAE and automated auditory brainstem responses (A‐ABR) for those infants who fail TEOAE test and those at‐risk for auditory neu‐
ropathy (AN). The objective of our study was to evaluate the efficacy of the two‐stage protocol com‐
pared to the one‐stage protocol. During the period February 2010 – July 2010, 5,312 infants were born at Sheba and screened using the two‐stage protocol. Their screening results, audiological follow‐up using diagnostic ABR, tympanometry and behavioral audiometry and medical records were retrospectively examined. The results were compared to those of all children born between 1997‐2009. The results show: (1) A 51% decrease in false positive rates (from 6.3% to 3.1% for the one‐stage and two‐stage protocols, NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 101
respectively); (2) While 27% of infants at‐risk for AN passed TEOAE screening successfully but failed A‐
ABR screening prior to discharge, no cases of AN were identified at follow‐up in this cohort; (3) The prevalence of permanent HI was 1.9 (10 infants), similar to the prevalence found for the 1997‐2009 co‐
hort. Of these, two infants with mild‐to‐moderate sensory‐neural HI were detected following audiological follow‐up for high‐risk infants. Thus, the results of the present study confirm the advantage of a two‐stage protocol in reducing the false alarm rate, and further emphasize the importance of audiological follow‐up for the detection of mild‐to‐moderate HI and late onset cases. N. 12 ‐ COMPARISON OF OTOACOUSTIC EMISSIONS AND AUTOMATED AUDITORY BRAINSTEM RESPONSE FOR NEWBORN HEARING SCREENING Sargsyan A Yerevan State Medical University, ENT‐department; “Arabkir” Medical Centre, ENT‐department, Yerevan, Armenia Congenital hearing loss is the most widespread congenital pathology. Early identification and subse‐
quent intervention is associated with improved language development in hearing impaired children. The aim of our study was evaluation of two‐stage hearing screening program, using otoacoustic emis‐
sion (OAE) and automated auditory brainstem response (AABR) before discharge. Only 15,8‐ 29,7% of children who attended our hospital in 2008 and 2009 were in the age group below 3 years old. Among them only 21,5‐28,5% were children with mild hearing loss and only 10,5‐19,8% with unilateral hearing loss. This demonstrates that NHS is the only effective way for early detection of neonatal hearing im‐
pairments in Republic of Armenia. In our research in the first stage of NHS we used OAE for the begin‐
ning and then AABR for those, who hadn’t pass OAE. The study demonstrated that the refer rate dimin‐
ishes approximately two times for the first stage of NHS when we use AABR as an addition to OAE method of hearing examination. Besides it, comparative analyses demonstrated that a combined applica‐
tion of OAE and AABR methods is 4 times more beneficial than a duplicated testing with the application of an OAE registration methodology. N. 13 ‐ AMPLITUDES OF TRANSIENT EVOKED OTOACOUSTIC EMISSIONS AND DIS‐
TORTION PRODUCT OTOACOUSTIC EMISSIONS IN PRE‐TERM AND FULL‐TERM NEONATES: A SURVEY Lata S1, Ranjan P2 The City Hospital, Dubai, United Arab Emirates; 2MED‐EL India (P) ltd, New Delhi, India 1
The present study was conducted to evaluate the characteristics of Transient Evoked Otoacoustic Emis‐
sions (TEOAEs) and Distortion Product Otoacoustic Emissions (DPOAEs) for preterm neonates and full‐
term neonates. The sample included neonates with associated high risk factors for hearing loss. 70 neo‐
nates who had passed on Automated Auditory Brainstem Response Screening at 40 dBnHL participated in this study. 35 of these were preterm (28 to 35 weeks of gestation) and 35 were fullterm (36 weeks of gestation and more). The mean gestation age of the preterm neonates was 32.77 weeks (S.D. 2.14) while that of the fullterm neonates was 38.23 weeks (S.D. 1.75). TEOAEs and DPOAEs were administered and data of amplitude and signal‐to‐noise ratio (SNR) were recorded. Means and standard deviations were calculated. Further, paired t‐test, independent samples t‐test and alternative nonparametric Mann‐
Whitney U test were applied to establish if significant differences existed between the two groups. The NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 102 NHS 2012
result revealed statistically significant ear differences in preterm neonates for TEOAE amplitudes at 1000, 2000, 3000, and 4000 Hz and DPOAE amplitudes at 2000 and 3000 Hz. Overall no significant ear differences were found for signal‐to‐noise ratios (SNRs) in the same group. Fullterm neonates did not have any ear differences for amplitudes or signal‐to‐noise ratios (SNRs) for both TEOAEs and DPOAEs. A statistically significant difference was found between TEOAEs of preterm and fullterm neonates for both amplitude (at 2000, 3000, and 4000 Hz) and signal‐to‐noise ratio (SNR) (at 3000 and 4000 Hz). For DPOAEs, a statistically significant difference was found between preterm and fullterm neonates for both amplitude and signal‐to‐noise ratio (SNR) at 4000 Hz. It was observed that fullterm neonates exhibited higher mean amplitudes and signal‐to‐noise ratios (SNR) as compared to preterm neonates at these fre‐
quencies on both the tests, i.e., TEOAEs and DPOAEs. N. 14 ‐ PROGNOSTIC FACTORS FOR TRANSIENTLY EVOKED OTOACOUSTIC EMIS‐
SIONS MEASUREMENT IN CHILDREN WITH CHANGES OF MIDDLE EAR IMPED‐
ANCE Bojanovic M, Zivkovic‐Marinkov E, Stankovic M, Zivic M, Milisavljevic D, Ristic S ENT Clinic, CC Nis, Medical Faculty of Nis, Nis, Serbia Introduction. Measures of transiently evoked otoacoustic emissions (TEOAE) in children with middle ear disease are severely limited with respect to investigating the inner ear function. It is therefore neces‐
sary to determine the feasibility of such an application in young patients. The aim of this study was to examine the factors of interest for obtaining TEOAE measurements in patients with middle ear imped‐
ance changes. Materials and methods. A total of 50 children with secretory otitis media (SOM), 2 ‐ 15 year of age, were treated medically and surgically, from June 2009 to August 2010. Subjects with SOM were seen at entry, prior to commencement of therapy, and every 4 weeks following entry for the period of one year. Every exam consisted of an otomicroscopy, tympanometry, TEOAEs and audiometry. Re‐
sults. The most important factors associated with positive TEOAE at the start of the trial were normal rhinoscopic and otomicroscopic findings with a respective OR of 5.37 (CI 95%, 1.22‐23.65; p<0.05) vs 50.67 (CI 95%, 5.51‐466.0; p<0.01). A multivariate logistic regression analysis showed that, at the end of the study, the B and C2 types of tympanogram reduce the probability of obtaining TEOAE by 97.7% (95%CI, 70.3‐99.8%, p<0.01), and every worsening of hearing level for 1 dB at 500Hz reduces the prob‐
ability of a positive TEOAE finding by 17.6% (95%CI, 2.3‐30.4%, p<0.05). Conclusions. We hope that the results of this study show the necessity of TEOAE implementation in diagnostic protocols in children with middle ear impedance changes. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 103
SURVEYS ON EHDI PROGRAMS N. 15 ‐ EARLY HEARING DETECTION IN CYPRUS: OUTCOME MEASURES Thodi C1, Vogazianos M2 European University Cyprus, Cyprus Audiology Center, Nicosia, Cyprus; 2Center for Preventive Paediatrics, Limassol, Cy‐
prus 1
Early Hearing Detection has been implemented in Cyprus since 2004 by the Center for Preventive Pedi‐
atrics, an NGO responsible for all newborn screening on the island. In 2008, the Center initiated diag‐
nostic auditory evaluations for referred infants. The reported Newborn and Infant Hearing project measured outcomes among children referred since the beginning of the Screening Program. Participants were children between the ages of 1‐7 years, and families. Outcome measures included times of referral and diagnosis, hearing status, receptive and expressive vocabulary, and developmental questionnaires completed by parents. For children referred since 2008 age of diagnosis was around one month, and age of intervention between 4‐6 months. Over 98% of referred children were evaluated by the end of the first month. Over 60% of children referred before 2008 had not confirmed hearing status for years. Early in‐
tervention services in Cyprus are not equally available or accessible to all families, nor clearly defined. Age and outcomes of intervention varied between children. Comparison of developmental outcomes to age‐normed data is included in the study. Work supported by project Newborn and Infant Hearing (NIH), Cyprus Research Foundation, Contract HEALTH/PUBLIC HEALTH/0308(ΒΕ)/23 N. 16 ‐ EFFECTS OF A NEONATAL HEARING SCREENING PROGRAM ON A HEARING REHABILITATION CENTER Vos B1,2, Courtmans I3, Ventura M3, Lagasse R1,2, Levêque A2, Ligny C3 CEpiP Centre d’Epidémiologie Périnatale, Brussels, Belgium ; 2Université Libre de Bruxelles, School of Public Health, Brus‐
sels, Belgium; 3Centre Comprendre et Parler, Brussels, Belgium 1
A universal neonatal hearing screening (UNHS) program is organized in the French Community of Bel‐
gium (FCB) since the end of 2006. The protocol of the program recommends that the hearing tests are performed in the birth‐hospitals, before discharge. Results of the screening tests performed at the mater‐
nity ward and results of the audiological assessments performed at the ENT ward are collected by the UNHS program. Due to the organization of the preventive health care system in the FCB, the coordina‐
tion center cannot collect systematic information from the intervention services, like the age at the ad‐
mission to hearing rehabilitation centers or at the fitting of hearing aid, the services offered to the deaf child and his family, … The results of a hearing rehabilitation center in the FCB (2004‐2010) show that the median age of the children at diagnosis time (n=114) was higher than 6 months before the implemen‐
tation of the UNHS program and decreased to less than 6 months after this implementation. In the same way, the median age of the children at the admission to the center (n=167) decreased from more than 12 months to less than 12 months after the implementation of the program and the median age of the in‐
fants at fitting of hearing aid (n=103) decreased strongly for the deaf children born since 2007. These re‐
sults show an improvement in the age of identification of hearing loss and at the admission to a hearing NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 104 NHS 2012
rehabilitation center, but they should be strengthened to meet the recommendations of the Joint Com‐
mittee on Infant Hearing. They should also be confirmed for all the deaf infants in the FCB. Moreover the data collection for the hearing impaired children in the hearing rehabilitation centers should be for‐
mally organized as one of the main outcomes of the program is presently not monitored. N. 17 ‐ AGE OF HEARING AID FITTING AFTER NHS IN THE NETHERLANDS Uilenburg N1, Korver NM2, Oudesluys‐Murphy HM2, Meuwese‐Jongejeugd A3 Dutch Foundation for the Deaf and Hard of Hearing Child, Amsterdam, The Netherlands; 2University of Leiden, Leiden, The Netherlands; 3National Institute for Public Health and the Environment, Centre for Population Screening, Bilthoven, the Netherlands 1
A large scale study performed by the university of Leiden in the Netherlands revealed that during the implementation of NHS in the Netherlands (2002‐2006) the age of hearing aid fitting for children who were detected through NHS was about 12 months after birth. The current study was set up to investigate whether the age of hearing aid fitting has improved over time. In 2008, 602 children were referred for di‐
agnostic research after a positive screening result. Of these children 141 children were diagnosed with permanent congenital hearing loss of at least 40dB in both ears. For 58 children data concerning the age of hearing aid fitting were available. The recent data demonstrate that the age of hearing aid fitting has been reduced to 4,3 months after birth but with large variation (1‐9 months). 85% of all children that need hearing aids do receive them within 6 months after birth. There is variation between the Speech and Hearing Centres that perform the diagnostic testing and subsequent hearing aid fitting. Early hear‐
ing aid fitting of children with moderate hearing loss turns out to be most challenging in our data. Only 75% of these children receive their hearing aid within 6 months. Concluding we can say that there clearly is a reduction in the age of amplification, but there is still room for improvement. Discussion ses‐
sions with the Speech and Hearing Centres were organized to discuss this issue. N. 18 ‐ HOW A SUBURBAN COMMUNITY HOSPITAL IMPROVED THE RATES OF NEWBORN HEARING RE‐SCREENS Wilson‐Phillips L1, Spence T2 Decatur Pediatric Group, PA, Clarkston, Georgia, USA; 2Morehouse College School of Medicine, Atlanta, GA, USA 1
Childhood hearing loss affects 1 to 6 per 1,000 newborns (1). Identifying those newborns affected is im‐
portant for the future development of cognitive and linguistic skills (1). In 1999, it was mandated that every state have a universal newborn hearing screening program in order to ensure that treatment was implemented quickly to prevent disability. The American Academy of Pediatrics recommends that congenital hearing loss be detected by one month of age, diagnosed by two months of age, and receive intervention by 6 months of age for all infants born in the United States (2). In Georgia, the prevalence of newborns that fail the newborn hearing screen is 1.5 per 1,000 (3). In 2001, Dekalb Medical Center in De‐
catur, Georgia instituted their hearing screening program. In 2009, it was revamped to include a free re‐
screen within 2 weeks of discharge to all infants that fail the initial hearing screen. The protocol includes notifying the parents of the time and date of their re‐screen appointment prior to discharge and calling to ensure the follow up appointment is kept. These policies have helped to ensure a low percentage of babies lost to follow up and resolves the issue of those parents who cannot afford to pay their copay or may not have insurance. The screening rate since the institution of this protocol has been 98‐99% and a NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 105
referral rate of 3.68% to 4.25%. In comparison with other hospitals in the region, the institution of this new protocol has been the most successful with increasing abnormal test follow ups and rescreens. References: 1. Moeller MP. Early intervention and language development in children who are deaf and hard of hearing. Pediat‐
rics. 2000;106: E43. 2. American Academy of Pediatrics: Task Force on Newborn and Infant Hearing. Newborn and infant hearing loss: detection and intervention. Pediatrics. 1999;103:527– 530. 3. 2009 CDC EHDI Hearing Screening & Follow‐up Survey (HSFS) (www.cdc.gov/ncbddd/hearingloss/ehdi‐
data2009.html) N. 19 ‐ OUTCOMES OF NEWBORN HEARING SCREENING. ETIOLOGICAL EVALUA‐
TION IN BILATERAL AND UNILATERAL CONFIRMED HEARING LOSS Rolesi R1, Fioretti M2, Frezza S2, Gallus R1, Giannantonio S1, Martina BM1, Papacci P2, Conti G1 Institute of ENT Clinic of Otorhinolaryngology, Catholic University of the Sacred Heart, Rome, Italy; 2Department of Pediat‐
rics, Division of Neonatology, Catholic University of the Sacred Heart, Rome, Italy 1
At “A. Gemelli” Hospital, Catholic University of the Sacred Heart in Rome, Newborn Hearing Screening has been performed since 1985, but it was implemented as systematic and universal since March 1st 2009. The universal newborn hearing screening (UNHS) is based on a two‐step approach conducted with Madsen™ Accuscreen® portable device for TEOAEs and AABR. The screening procedures and the flow chart related to neonatal test and re‐test imply a different management for well born babies and newborns at high audiological risk. Since the beginning of the UNHS program 8.728 newborns were tested. Our study is focused on data obtained during 2011. In this period 3102 newborns were evaluated. We found a total of 233 refer (131 unilateral, 102 bilateral) results. Eleven newborns out of 233 refers were confirmed to be affected by permanent bilateral or unilateral hearing loss (HL) at the 3rd‐5th month audiological evaluation, and the observed prevalence was 3.54 ‰ (11/3102). Etiological evaluation of the affected newborns was performed, based on neonatological data recording and on further post‐natal tests, when needed. Results are discussed with reference to possible difference between bilateral and unilateral HL. N. 20 ‐ NEONATAL HEARING LOSS AND IMPACT OF REGIONAL HEARING SCREEN‐
ING LEGISLATION Bubbico L1, Tognola G2, Martini A3,4, Grandori F2 Don Gnocchi Fundation, Rome, Italy; 2Consiglio Nazionale delle Ricerche, Istituto di Ingegneria Biomedica (ISIB‐CNR), Mi‐
lano, Italy; 3Dipartimento di Neuroscienze Scienze NPSRR, Università di Padova, Padova, Italy; 4ORL Otochirurgia, Azienda Ospedaliera di Padova, Italy 1
Objective. This study was conducted to determine the state of Universal Newborn Hearing Screening during the period 2003‐2006 and 2008 in Italy and value the Impact of Regional Screening Legislation on implementation of UNHSPs. Method. Data of Neonatal Hearing Screening was compared from Nation‐
al Survey 2003 2006 and 2008 from all Birth Centers in Italy. The rate of newborns screened were com‐
pared between Regions with implemented legislation and Regions with no legislation. Result. The cov‐
erage and the penetration of UNHS programs in Italy was increased from 2003 (29,32% newborns screened), to 2008 (60,6%). At the end of 2008, 20% of Regions with implemented Universal Newborn NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 106 NHS 2012
Hearing Screening legislation reported screening at least 97,63% of infants. Conclusion. Our results sug‐
gest a quick diffusion of the newborn hearing screening programs in Italy from 2003 to 2008. Regional Health Legislation has had a positive effect on rates of hearing screening and is an important tool to use, especially in regions that are struggling to achieve adequate rates of screening. N. 21 ‐ UNIVERSAL NEWBORN HEARING SCREENING PROGRAM IN MODENA Palma S1, De Luca M1, Reggiani S2, Genovese E3, Borsari S4 Primary care Department, Modena Italy; 2Administration AUSL Dept., Modena Italy; 3ENT Dept. University Hospital, Modena Italy; 4AUSL General Management, Modena, Italy 1
The Joint Committee on Infant Hearing endorses early detection of and intervention for infants with hearing loss, in order to maximize linguistic competence and literacy development for deaf children. In accordance with this principle Emilia Romagna region enacted legislation requiring all birthing hospitals to conduct universal newborn hearing screening since 1 January 2012. The aim of this paper is to present our preliminary experience in organizing the hearing screening and to discuss the problems and the ad‐
vantages of our model. As reported in the year 2007 Position Statement the hearing of all infants should be screened at no later than 1 month of age, infants with confirmed hearing loss should receive appro‐
priate intervention no later than 6 months of age and separate protocols are recommended for NICU and well‐infant nurseries. More than 7000 babies are born in Modena every year in five birthing hospitals, about 3500 of them are born in the University hospital where a NICU is present. A screening program has been already conducted in the university hospital since a few years, we started since January 2012 in the others birthing hospitals; two ENT departments are present in the county. Regular measurements of performance are going to be made, in particular the percentage of all newborn infants who complete screening: at the moment all the 521 newborn infants of January of the birthing hospitals result enrolled in the screening. A critical point, as reported by others countries which have previously experienced screening organization, is still the need of a common data base. A multidisciplinary team of profession‐
als is working to establish the screening and to ensure high quality of the program. N. 22 ‐ DEVELOPMENT OF NEWBORN HEARING SCREENING PROGRAM IN REPUB‐
LIC OF MACEDONIA Chakar M1, Fakovikj N2, Femikj N3, Jovchevski S4 Centre for Audiology of the University ENT Clinic, Skopje, RMacedonia; 2Department for preventive health care, Ministry of Health, Skopje, RMacedonia; 3Centre for Research of Hearing and Communication Impairments, Bitola, RMacedonia; 4University Clinic of Gynecology and Obstetrics,Skopje,RMacedonia 1
Introduction. Despite of the difficult economic situation ,transition and efforts of the country on its road to join the Europe Union the Government and Ministry of Health of the Republic of Macedonia recog‐
nized and accepted the importance of NHSP.The initiative for introduction of the Newborn Screening Programme and for purchasing of hearing screening equipment came from Natasha Femikj, audiologist from Bitola (the Ministry of Health appointed her as a national coordinator). The equipment‐screening TEOAE‐OtoRead,Interacoustics‐ was delivered to the hospitals in 3 cities: Bitola, Tetovo and Strumica. Audiology Center of University ENT Clinic in the main city‐Skopje was supplied with diagnostic ABR, Interacoustics. In Republic of Macedonia an annual birth rate is approximately 23000 newborns. Our Re‐
port will include 4 main cities from 4 main country regions. In 2012 very important for the develop‐
NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 107
ment of the Program is introduction of NHSP in University Clinic of Gynecology and Obstetrics (with an annual birth rate for 2011‐ 5200 newborns and 670 newborns from NICU‐the only one for all babies in the country). Aim. The Government and Ministry of Health will continue with the development of the Programme/network and in the next phase they will supply screening TEOAE for next 3 cities in the Country. Our goal is to reduce the age at which infants with hearing loss were diagnosed and treated in the Republic of Macedonia. Strategic Aim: for the first time in the country to develop modular system and include as its core an integrated subsystem for high‐risk infants and babies from NICU, followed by the development‐enlargement of the subsystem for healthy babies. Methods. The protocol consisted of three stages. In the first two stages newborns were tested with transient click‐evoked otoacoustic emis‐
sions. The first TEOAE test was performed by 24h of age (before discharge from hospital). The second one after 30 days in case of referral (in some cases babies were screened with the second TEOAE before the discharge from the hospital).The third stage was performed by diagnostic ABR, for those babies who failed the second TEOAE stage. Results. The whole number of screened babies is 2100: 1940 without risk and 160 at risk of hearing impairment. Bilateral hearing impairment was identified in 8 newborns (5 from the no‐risk and 3 from the at‐risk population). Unilateral HL was found in 2 newborns from at‐risk population. Conclusions. The results show that the introduction and implementation of a hospital‐
based, universal neonatal hearing screening programme in the Republic of Macedonia, is feasible and ef‐
fective. All these support our wish and determination to work on further development of the NHSP in the country. N. 23 ‐ NEWBORN HEARING SCREENING WITH AN EMPHASIS ON HIGH‐RISK NEO‐
NATES Zivkovic‐Marinkov E, Bojanovic M, Stankovic M, Zivic M, Milisavljevic D, Ristic S, Conic M ENT Clinic, Clinical Center Nis, Serbia Objectives. The early detection and treatment of hearing impairment in newborns has a beneficial effect on language acquisition. The aim of the study was to compare the incidence of sensorineural hearing loss in newborns with and without risk factors. Methods. Newborn hearing screening was performed at the Neonatology ward of the Gynaecology and Obstetrics Clinic, Clinical Center in Nis, from July 2007 to February 2009. A two‐stage Transient Evoked Otoacoustic Emission (TEOAE) screening test was ad‐
ministered. The automated device we used for the screening was MAICO ERO SCAN. The newborns who failed the first screening unilaterally or bilaterally were rescreened using TEOAE 30 days later. The newborns with risk factors for hearing loss as well as those who failed the first screening twice were re‐
screened using an Auditory Brainstem Response (ABR) test. Results. From the total number of 3,109 newborns examined in this study, 98 (3.15%) newborns had one of the risk factors for hearing impairment. The incidence of hearing impairment in this group of newborns was 1.3 ‰. Three new‐
borns had bilateral and one had unilateral sensorineural hearing impairment. Conclusion. Universal neonatal hearing screening allows of timely diagnosis, and appropriate intervention, habilitation and rehabilitation in neonates with congenital hearing impairment. TEOAE and AEP are reliable and objec‐
tive audiological methods used for assessing the hearing function. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 108 NHS 2012
N. 24 ‐ THE ACTING PROTOCOL OF A DEAF CHILD IS BASED ON THE INTERDISCI‐
PLINARY HEALTHY‐EDUCATION INTERVENTION IN CATALONIA’S PUBLIC NET‐
WORK (SPAIN), STARTING FROM THE UNIVERSAL NEONATAL HEARING SCREEN‐
ING IMPLEMENTATION Clavería MA1, Marro S2, Calvo P3, Coll N4 Otorhinolaringologist, Sant Joan de Déu Universitary Hospital, Barcelona, Spain; 2Audio‐prothesist, Jordi Perelló Deaf Chil‐
dren Resources Center, Catalonia’s Generalitat Education Department, Sabadell, Spain; 3Psycho‐pedagogist, Deaf Children Resources Center Jordi Perelló, Education Department Catalonia’s Generalitat, Sabadell, Spain; 4Phonoaudiologist, Sant Joan de Déu Universitary Hospital, Barcelona, Spain 1
The implementation of the universal neonatal hearing screening (UNHS) in Catalonia (Spain) has, as a base document, an integral actuation protocol of the deaf child. In the mentioned protocol, four interdisciplinary working phases are considered: detection, diagnostic, treatment and follow‐up. In each of them, specific actuations from healthy and education ambits are collected as well as the grouped and complementary ones. The early diagnostic is an important factor during the deaf child evolution and currently the neonatal hearing screening is the most adequate tool to achieve it. We strongly remark that any diagnostic must be accompained with an early interdisciplinary intervention, specially in deaf children who are candidates to a cochlear implant. The protocolary co‐ordinated intervention of the Healthy and Education professionals from the universal neonatal hearing screening in Catalonia (Spain), makes possible to integrally tackle a deaf child, who is candidate or not to a cochlear implant and all of him/her family, inside the Public network system. N. 25 ‐ NEWBORN HEARING SCREENING: PORTUGUESE REALITY Santos N, Martins J, Delgado T APtA – Associação Portuguesa de Audiologistas (Portuguese Association of Audiologists), Lisbon, Portugal Neonatal Hearing Screening should be part of any national health policy. Unlike many European coun‐
tries, newborn hearing screening in Portugal is not mandatory. However, we have professionals sensi‐
tive to this cause that have been increasingly implementing this program in various hospitals all over the Country with great effort. APtA (Portuguese Association of Audiologists) collected data of 2011, in sev‐
eral national hospitals. Data was obtained through telephonic contact with various hospital staff. The re‐
sults show that although not mandatory, the coverage rate is high due to the strong commitment on the part of health professionals and parents. This study helps us to draw attention of national policy makers about the importance of screening and early detection and intervention. N. 26 ‐ UNIVERSAL NEONATAL HEARING SCREENING PROGRAMME IN VENEZUELA Hernández Villoria R Instituto Venezolano de la Audición y el Lenguaje & Ministerio del Poder Popular para la Salud, Caracas, Venezuela Introduction and aims of the study. Since 2011 it was began in Venezuela, a South America country, a Universal Neonatal Hearing Screening Programme (UNHSP), of public character and not yet obligatory by law. In Venezuela the birth rate is about 20‰ and near 500,000 babies were born in 2011. The aim of this presentation is to describe the design of the programme and the resources utilized for its onset. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 109
Methods. It was performed a mixture documental and information analysis on public released official files. Results. The programme comprises three phases. The first phase detects possible cases of hearing impairment utilizing otoacoustics emissions combined with AABR in the Rooms of Neonatology of nine‐
ty health centers, to the first 48 hours of life. The second phase utilizes ASSABR (by bone and air conduc‐
tion), for the confirmation of probable cases in the Pediatrics Services, it applies between the 4 and the 24 weeks of life. The third phase, for the final diagnosis of the cases utilizes SSBERA in the Services of Pedi‐
atrics, Neurological pediatrics, Otology or Phoniatrics of 120 centers linked with 20 diagnostic units. These twenty diagnostic units‐nodes correspond to Services of Phoniatrics that are linked with a net‐
work of seven Public Hearing Aids Laboratories and a National Cochlear Implant Protocol to develop. Conclusions. At present the UNHSP has an expected coverage of about 60% of the babies born in the country and expects to obtain the first hearing impairment incident results by December, 2012. N. 27 ‐ COST BENEFIT OF NEWBORN HEARING SCREENING IN A PUBLIC HOSPITAL IN SAO PAULO ‐ BRAZIL Fazion CB, Manas AV, Monteiro PC, Lewis DR Pontificia Universidade Católica de São Paulo, PUCS‐SP, São Paulo, Brazil Introduction. Since 2010, Otoacoustic Emissions should be applied to all newborns before hospital dis‐
charge, by law. Objective. To analyse the cost and the benefit for five different protocols for NHS. Methods. A combination of TOAE and AABR defined. Protocol 1‐ UNHS using TOAE, in two stages; Protocol 2: UNHS using TOAE in the first stage and AABR in case of refer as a second stage, prior to the hospital discharge; Protocol 3: UNHS – the TOAE was used on newborns without risk indicators for hearing loss in the first stage and the AABR was used on those who did not pass the first test before medical discharge. For the infants with Risk Indicators it was used only AABR on both stages; Protocol 4: NHS only in Risk newborns was carried out under TOAE and AABR combined in two stages; Protocol 5: NHS only in risk babies was carried out using only AABR in two stages. All the newborns who were referred were followed up in the Hearing Health Center which belongs to the university clinic. The effec‐
tiveness of protocols was analysed under the Joint Committee on Infant Hearing quality index (2007) and the cost was estimated using the National Center of Hearing Assessment and Management proposal (2003). Results. The costs varied between $10,52 and $52,68, but protocol 3 with a cost of $ 15,62 was considered more effective, since it could identify cochlear hearing loss in all babies and auditory neu‐
ropathy in high risk newborns. The benefits were analysed using a theoretical approach. Conclusion. Protocol 3, which uses TOAE in babies without risk and AABR for risk babies, and a second stage with AABR for any baby who failed in the first test, proved to be the most effective one, although its cost are higher. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 110 NHS 2012
N. 28 ‐ NEWBORN HEARING PROGRAM: FROM DIAGNOSIS TO HEARING AID FIT‐
TING Bagni JM, Couto CM, Colella‐Santos MF Departament of Human Development and Reabilitation, Faculty of Medical Sciences, University of Campinas, UNICAMP, Campinas, SP, Brazil Considering the socioeconomic importance of the development of newborn hearing health programs, as well as the current discussions and recommendations regarding the implementation of these, the analy‐
sis and reflection of the results is necessary, not only the hearing screening ones, but the following, pay‐
ing attention to the audiologic procedures and the characteristics of the population evaluated after ob‐
taining the diagnosis of hearing loss as an object of study for the improvement of protocols. The aim was to analyse the audiologic procedures performed and obtain a characterization of the neonates who are referred, after the audiologic diagnosis, to perform the hearing aid fitting. 14 medical records were ana‐
lyzed, being 7 of male children and 7 of female with ages not exceeding 5 years old that having been re‐
ceived at the hearing aid clinic of CEPRE between 2009 and 2010. It can be observed in this study that the average age of completion of diagnosis, 9 months and 10 days old, and the hearing aid fitting age, 12 months and 360 days, are above the idealized by JCIH (2007) that would be 3 and 6 months respectively. The most performed procedures during the hearing aid selection process were: visual reinforcement audiometry and immittance measurements. Regarding the referrals firstly is the referral to the otorhi‐
nolaringologist due to excess of earwax and in second due to otitis. It is observed in this study that the diagnostic finalization and the hearing aid fitting are realized in superior ages as the idealized by inter‐
national references. The procedures realized during the process of aid hearing selection reflect the diffi‐
culties to obtain more specific information on the hearing threshold. The need of frequent referrals to serviced not realized on the clinic consisted on a detrimental factor to the progress of the speech therapy care. N. 29 ‐ HEARING HEALTH PROGRAM IN NEONATES IN INTENSIVE AND/OR INTER‐
MEDIATE CARE UNIT Colella‐Santos MF, Couto CM, Sartorato EL, Lima MCMP, Françozo MFC, TazinazzioTG, Marba ST University of Campinas, UNICAMP, Faculty of Medical Sciences, Department of Human Development and Reabilitation, Campinas, Brazil The main objective of this study was to analyze the results of the hearing health program in neonates who remained hospitalized in the intensive care unit and/or intermediate care. Infants who remained in the Intensive Care Unit (ICU) and/or the Intermediate Care CAISM/FCM/Unicamp/Brazil for at least 48 hours, from March 2011 to January 2012, underwent hearing screening. The procedure used for hearing screening was AABR‐Accuscreen/Otodynamics, which was performed prior to hospital discharge. In‐
fants transferred as well as those who had no conditions for testing, were screened after hospital dis‐
charge, on a schedule. We considered that the child passed the test when he/she responded to click stimuli at 35 dB bilaterally. Children who failed were referred to audiological, otorhinolaringological and genetic diagnosis. Audiological evaluation was done with a clinical interview, assessment of the middle ear conditions, ABR assessment pathway), and evoked otoacoustic emissions. On otorhinolaryn‐
gology, physical evaluation and/or imaging examination were performed. The genetic screening was carried out by extracting DNA from bucal mucosa. A value below 95% of the children underwent hear‐
NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 111
ing screening. Regarding the period of hearing screening execution, 40% of the children were screened after the first month of life, because they to stay longer than one month in the hospital. All children who failed unilateral or bilateral hearing screening were referred to audiological assessment. We diagnosed cases of profound sensorineural and conductive hearing loss. From the analysis of the results it can be concluded that it was not possible to reach some JCIH (2007) recommendations made in the process of hearing screening and diagnosis of hearing loss in children who remained in the ICU and/or intermedi‐
ate neonatal care. N. 30 ‐ UNILATERAL HEARING LOSS IN CHILDREN: SOME INTERIM FINDINGS OF A LONGITUDINAL PROSPECTIVE STUDY Pupo A, Barzaghi L Pontifícia Universidade Católica de São Paulo, Brazil The increasing expansion of the services of the Hearing Health in Brazil has been favoring the identifica‐
tion and diagnosis of babies with unilateral hearing loss. The hearing difficulties resulting from unilat‐
eral hearing loss can interfere in children’s development. These difficulties tend to grow with increasing hearing loss degree. The aim of this research is to develop a longitudinal prospective study following children diagnosed with unilateral hearing loss. Eleven children with moderate unilateral conductive hearing loss (UCHL) and eight children with unilateral sensorineural hearing loss (USNHL), (one severe degree and seven profound) are being evaluated systematically, to audiological and language assess‐
ment. For the eleven subjects with UCHL, the partial results show: the audiology diagnosis remains sta‐
ble in nine cases; two children have presented disorder of the middle ear during the assessment period. Concerning speech and language, two children moderate UCHL are behind their age group. For the re‐
maining eight subjects with USNHL, the partial results show: the audiology diagnosis remains stable and the children have not presented any disorder of the outer or middle ear during the assessment peri‐
od (36 months). Concerning speech and language, only one child with profound unilateral hearing loss is behind its age group. For both groups, the aspects of cognitive development are considered normal for their respective ages. Following a systematic work with the families regarding the implications of the al‐
terations in the hearing and the conditions of the child, the interaction style has been modified and im‐
portant adjustments have been made. This study shows the difficulties of involving the family, in thera‐
peutic programs once the child is able to hear in everyday situations. N. 31 ‐ MONITORING OF CHILDREN WITH RISK INDICATORS FOR HEARING LOSS Eliene Silva Araújo1, Fernanda de Souza Lima1, Zucki F1, Oliveira L1, Lopes R1, Chaves J2, Alvarenga KF2 Post graduate student in the Department of Audiology and Speech Pathology at the School of Dentistry, University of São Paulo, Bauru campus, Brazil; 2Associate Professor in the Department of Audiology and Speech Pathology at the School of Dentistry, University of São Paulo, Bauru campus, Brazil 1
Aim. describe the monitoring proposal of children in the first year of life, who were not identified in the newborn hearing screening program but had risk factors for hearing loss. Method. the study included 258 children at risk who had obtained ʺpassʺ in the Universal Newborn Hearing Screening Program of Hospital Santa Isabel ‐ Bauru/SP, from June to November 2008. A questionnaire was applied by the tele‐
phone, validated in a previous study, containing questions about hearing and language. For each ques‐
NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 112 NHS 2012
tion there were two possible answers: ʺyesʺ or ʺnoʺ and we considered “failureʺ to obtain at least one ʺnoʺ answer. Such result reflected in the scheduling of the child to perform an immediate hearing evalu‐
ation. Results. the questionnaire was applied with 169 families; with the others, contact was not ob‐
tained. Of this total, 164 (97.04%) obtained ʺpassedʺ and five (2.96%) ʺfailedʺ. Among the five children, only three showed up for hearing evaluation and of these, one had no disorders and two presented con‐
ductive hearing loss. We observed distinct prevalence among the risk factors and there was no correla‐
tion (p>0.05) of the risk factors with the evasion in the monitoring process. Conclusion. the monitoring by means of a questionnaire applied by telephone proved to be feasible; however, it is necessary to de‐
velop strategies to support their execution. N. 32 ‐ EHDI COMES OF AGE IN AMERICAN SAMOA Johnson J1, Anderson‐Asuega J2 University of Hawaii, Honolulu, HI, USA; 2Lyndon Baines Johnson Tropical Medical Center, Pago Pago, American Samoa 1
American Samoa is the only United States territory in the Southern Hemisphere. American Samoa is also the last U.S. territory to implement the Early Hearing Detection and Intervention (EHDI) program. Im‐
plementing the program has been a challenge due to the lack of professional resources in the territory and the great geographical distance from other professional resources. Yet, the program has been suc‐
cessful in achieving the 1‐3‐6 goals of an EHDI program. To accomplish these goals, the program had to develop screening services, create audiological testing environments, recruit consulting audiologists, and identify trainers in early childhood deaf education. The program is also working to build support systems for families. This presentation discusses how American Samoa has accomplished these goals and describes challenges faced by other island‐nations in implementing EDHI programs in the South Pa‐
cific. N. 33 ‐ NEWBORN AND INFANT HEARING SCREENING PROGRAMMES IN A DEVEL‐
OPING COUNTRY: EXPLORING THE PROCEDURES AND PROTOCOLS AT IMMUNI‐
SATION CLINICS Petrocchi‐Bartal L1, Khoza‐Shangase K2 University of the Witwatersrand, Department of Speech Pathology and Audiology, Johannesburg, South Africa; 2University of the Witwatersrand/Department of Speech Pathology and Audiology, Johannesburg, South Africa 1
Purpose. To determine the newborn/infant hearing screening (NIHS) procedures used at South African primary health care (PHC) immunisation clinics. Sub‐aims included (a) exploring factors which may in‐
fluence the implementation of NIHS programmes and, (b) comparing existing hearing screening proce‐
dures to the Health Professions Council of South Africa (HPCSA, 2007) Early Hearing Detection and In‐
tervention (EHDI) position statement. Participants. Thirty primary healthcare immunisation clinic man‐
agers were interviewed in two South African sample groups. Design. An exploratory, non‐experimental, qualitative research design was employed incorporating both quantitative and qualitative data. Meth‐
ods and Materials. An interview using a designed questionnaire was administered with all participants. Data Analysis. Content analysis was used to code emergent themes into specific categories. Frequency calculations of the emergent themes were analysed and results described qualitatively. Results. Findings revealed lack of formalised NIHS at all sites as recommended by HPCSA (2007) guidelines; instead non‐
formalised hearing screening protocols based on Integrated Management of Childhood Illnesses (IMCI) NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 113
and Road to Health Chart (RtHC) protocols were in place; these demonstrated inconsistencies in their application across districts. Main factors influencing NIHS at this level of service delivery included lack of equipment, manpower, and reduced nurses’ knowledge. Other factors included reduced parental awareness of the importance of hearing screening, and caregiver cultural issues. Encouraging was a finding that the majority of participants were willing to implement formalised hearing screening to coin‐
cide with immunisation schedules if the factors listed above were addressed. Conclusions. Current study findings highlighted the need for context specific studies in NIHS which will ensure evidence‐
based practice, particularly in developing countries where resource constraints dictate success and/or failure of any well‐intentioned programme. Findings have implications for nurses training, future stud‐
ies, policy formulation, as well as clinical plans for EHDI in developing contexts. N. 34 ‐ A THREE YEAR OUTCOME REPORT OF NEWBORN AND INFANT SCREENING AT ALL INDIA INSTITUTE OF SPEECH AND HEARING (AIISH), MYSORE IN INDIA Manjula R1, Arunraj K2, Savithri SR3 Department of Speech Language Pathology, Karnataka, India; 2Department of Audiology, Karnataka, India 3Director All India Institute of Speech and Hearing, Manasagangothri, Mysore, Karnataka, India 1
The report presents the outcome of newborn/infant screening conducted at AIISH, Mysore, India for the period July 2008 to July 2011 as a focused activity to promote prevention and early identification of communication disorders where newborn/infant screening is conducted as a continuous activity at this institute. Twelve hospitals in Mysore including two immunization centres are covered under this pro‐
gram. An established protocol [Using three probes (Screening Oto Acoustic Emission (OAE), Behavioral Observation Audiometry (BOA) and High Risk Register (HRR)] which was extensively field tested was used for the purpose of screening the newborns and infants for risk factors leading to communication disorders including hearing as well as speech and language disorders in the developmental period. 39,313 infants were screened and data base collected. Infants who failed in the screening test were re‐
ferred for detailed evaluation within 3 months of age. The data was analyzed for various factors. 22% (8637) did not pass the screening, and were referred based on HRR [12.84% (5049)] BOA [0.2% (077)] and OAE [1.35% (533)]. Among the factors in HRR, 3.88% (1526) presented single pre‐natal causes, 0.49% (192) multiple pre‐natal causes, 4.74% (1863) single natal causes, 0.98% (385) multiple natal causes, 0.12% (48) single post natal causes, 0.002% (01) multiple post natal causes and 2.63% (1034) combined (pre‐
natal, natal & post natal) causes. Consanguineous marriage of parents was 18.40% (7233), and 2% (788) was due to other family history. Infants who failed the screening test were recommended for detailed evaluation within 3 months of age. A total of 345 (3.99%) reported of which 2.06% (174) revealed normal speech and listening milestones, 0.91% (79) hearing impairment and 0.15% (13) early signs of language and multiple disorders. The sensitivity of the protocol employed for newborn/infant screening is thus es‐
tabilished. Specificity of the protocol is under continuous evaluation. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 114 NHS 2012
N. 35 ‐ IMPACT OF SOCIO‐ECONOMIC VARIABLES ON OUTCOMES OF COCHLEAR IMPLANTATION IN A DEVELOPING COUNTRY Agarwal A, Arora S, Sharma S, Lahiri AK Asha Speech & Hearing Clinic, Sir Ganga Ram Hospital, New Delhi, India Background. Although speech perception outcomes for most recipients are usually excellent, there is still large variability in outcomes and rate of progress, and a host of variables that may impact on results. Factors such as age of implantation, type of habilitation, cognitive abilities, cochlea patency, and addi‐
tional disabilities have been well documented to affect outcomes. However social and demographic variables must also be considered and the impact of these have yet to be determined for developing countries. Methodology. The results from 250 (number of children implanted from 2006‐ till present) children implanted at Sir Ganga Ram Hospital and who received rehabilitation at Asha Speech & Hear‐
ing Clinic in Delhi, India between 2006 and 2011 were analysed. Scores for the CAP and MAIS were re‐
corded at 3, 6, 12, and 24‐months post‐surgery, along with scores for the Speech Intelligibility Rating scale. Results. Correlation and regression analyses were then performed to assess whether factors such as: parent education levels, socioeconomic status, number of languages spoken at home, distance the family resides from the clinic, and time spent in rehabilitation were associated with outcomes and/or rate of progress. Additionally these considerations were also correlated with age of hearing loss diagno‐
sis and age of implantation to assess whether socio‐economic factors contribute to delays in diagnosis or implantation (p<0.001). Conclusions. Although there has been research from western countries address‐
ing factors that may impact on CI outcomes, this has yet to be assessed for developing countries. For ex‐
ample, in India, access to clinics both in terms of distance, time, and travelling conditions, is vastly dif‐
ferent than for many western countries, and many families speak more than one language at home. With the expeditious growth of implantation in India, analyses of socio‐demographic factors that impact on outcomes can help with planning for the future, developing a sustainable model of clinical practice, and counselling. N. 36 ‐ 10 YEARS OF COCHLEAR IMPLANTATION IN INDIA: TRENDS AND OUT‐
COMES Agarwal A, Arora S, Sharma S, Lahiri AK Asha Speech & Hearing Clinic, Sir Ganga Ram Hospital, New Delhi, India Background. The growth of cochlear implantation in India has been prodigious, particularly in the last 5 years. In 2010, there were approximately 1000 implant surgeries in the country, with many clinics con‐
ducting approximately 100 surgeries per year. This is even more remarkable given that this is a fully private market, with patients paying for all of the costs. Cochlear implantation commenced around 1996, and there are currently over 10000 recipients, with 90‐95% of these being children. However, despite the large numbers of recipients, there is little published information about the trends and outcomes for these patients over this time. Methodology. This is a retrospective analysis of the data for all the patients who received rehabilitation at Asha Speech & Hearing Clinic in Delhi, India that commenced implantation in 2001. We currently have over 400 patients. Results. The presentation will show the trends in implanta‐
tion over the 10‐year period for factors such as the age of implantation, the number of surgeries, the age hearing loss was diagnosed, the number of cases seen each year, and staff numbers including audiologist & speech pathologist, rehabilitationist, etc. Further, outcomes for the patients over this time frame will NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 115
be reported, along with trends. The results show the tremendous growth in the number of surgeries and children seen per year, particularly in the last 5 years, with over 85% of the patients having been im‐
planted since 2006. Of the 400 patients, 15 were post‐lingually deafened adults. The results show that the age of implantation has decreased over this time, with a consistent improvement in outcomes. One other important consideration is that staff numbers have not increased substantially over this time (p <0.001). Conclusions. Despite the tremendous growth of implantation in India in the last 5 years, patient out‐
comes have not been affected, and are as good as those in many developed countries. As this growth is expected to continue, monitoring outcomes and trends is critical, and has large implications for clinics, surgeons, audiologists, therapists, the Government, and health insurance. N. 37 ‐ NEWBORN HEARING SCREENING AND GENETIC TESTING FOR DEAFNESS IN PAKISTANI INFANTS Ahmed ZM1,2, Brown DK1,3, Khan SN4, Akram J5, Riazuddin S5, Riazuddin S1,2 Divisions of Pediatric Otolaryngology Head and Neck Surgery, Cincinnati, USA; 2Ophthalmology, Cincinnati, USA; 3Audiology, Children Hospital Research Foundation, Cincinnati, USA; 4Centre for Excellence Molecular Biology (CEMB) La‐
hore, Pakistan; 5Allama Iqbal Medical College/Jinnah Hospital, Lahore, Pakistan 1
On a worldwide basis, approximately one in 1000 children is born profoundly deaf and many more are born with less severe degrees of hearing impairment. The prevalence of hearing impairment in Pakistan, however, is markedly higher than the world average. This is attributed to a high degree of consanguinity in the Pakistani population – a cultural tradition that has inadvertently set the country up for an in‐
creased amount of genetic mutations leading to phenotypic abnormalities, including deafness. The Uni‐
versal Newborn Hearing Screening (UNHS) is a tool used in many countries throughout the world to detect hearing deficits in infants. While the UNHS is not offered in Pakistan currently, an opportunity is present. In the largest Pakistani cities –the majority of births take place in hospitals; making it possible to implement such an audiologic screening program that would reach most newborns in the country. Ad‐
ditionally, through extensive studies conducted over the previous 12 years we have localized and identi‐
fied disease‐causing mutations in 30 deafness genes among 1,145 large consanguineous families from various regions of Pakistan. With the common allele variants of deafness‐causing genes in the Pakistani population already identified, early diagnosis of many different forms of inherited deafness in combina‐
tion with UNHS is possible. Through a pilot project we aim to establish UNHS and genetic testing ser‐
vices in one major hospital of Pakistan. Our goals are to (1) Establish a UNHS and follow‐up audiologic screening program in Jinnah Hospital of Pakistan. (2) Establish genetic screening for deafness genes in infants. UNHS and genetic testing programs already have yielded enormous personal, social and eco‐
nomic successes in countries all over the world. We plan to finally bring this technology and service to Pakistan, a country that can particularly benefit. N. 38 ‐ NATIONAL PROGRAM FOR EARLY DETECTION OF HEARING LOSS IN THE STATE OF QATAR Hadi AK, Al‐Sulaiteen M, Al‐Alawi F Hamad Medical Corporation, Audiology and Balance Unit, Doha, Qatar NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 116 NHS 2012
National program For Early Detection of Hearing Loss in state of Qatar depends on Oto Acostic Emis‐
sion and Automated Auditory Brain Response. Permanent congenital hearing loss affected 1‐2 babies in every 1000 born, which increased in NICU cases to reach up 5‐10 % with history 48 hours admission to NICU. The early identification and management will give opportunity to babies with congenital hearing impairment to develop and acquired speech and language with the normal range of their peers. The ob‐
jectives are: i) Early detection of hearing loss; ii) Early intervention; iii) Cost effectiveness; iv) Non inva‐
sive Methods. 1. Hearing screening with the use of OAE with follow up regularly till the pre school age through the 3 stages of testing: i) Prior to hospital discharge; ii) After 2 months; iii) Pre school screening. 2. Hearing screening with the use of (OAE +AABR) for NICU cases and New born with family history of hearing loss with follow up regularly till the pre school age through 4 stages of testing; i) Prior to hospi‐
tal discharge; ii) After 2 months; iii) At one year of age; iv) Pre school screening. Results. More than 11,000 babies are screened for hearing impairment annually, the results matches the international statistic of hearing impairment per 1000 birth, detail results will be discussed in the poster. Conclusion. Neonatal hearing screening is an effective program for early detection of hearing impair‐
ment. The test protocol has been shown an accepted and reliable result. N. 39 ‐ NATIONAL PROGRAM FOR DETECTION OF HEARING LOSS IN STATE OF QATAR STAGE NO.3 HEARING SCREENING (PRE‐SCHOOL) Hadi AK, Al‐Sulaiteen M, Al‐Alawi F Hamad Medical Corporation, Audiology and Balance Unit, Doha, Qatar The purpose of hearing screening is to identify students with possible hearing losses which may affect their intellectual, emotional, social, speech, and/or language development. The key to successful remedi‐
ation is early identification and intervention, which may prevent educational problems and permanent hearing losses. Even mild hearing losses may be educationally and medically significant. Objective. 1) Promote an optimal level of hearing for all students; 2) Identify students with potential hearing prob‐
lems; 3) Establish follow up procedures to ensure that each identified student will receive appropriate care. Methods. Hearing screening with the use of Otoscopy, Tympanometry and Audiometry. Results. More than 7000 students are screened for hearing impairment annually, the results matches the international statistic of hearing impairment, detail results will be discussed in the poster. Conclusion. Hearing screening for the age of school is an effective program for early detection of hearing impairment. The test protocol has shown an accepted and reliable result. N. 40 ‐ RISK FACTORS ASSOCIATED WITH HEARING LOSS IN PREMATURE INFANTS Eras Z1, Konukseven O2, Genc A3, Dincol I2, Sungur VG4, Belgin E3, Dilmen U5,6 Zekai Tahir Burak Maternity Hospital, Developmental Behavioral Pediatrics Unit, Ankara, Turkey; 2Hearing & Balance Dis‐
orders, Diagnose and Rehabilatation Center, Department of Ear Nose and Throat and Head and Neck Surgery, Ankara Ataturk Research and Training Hospital, Ankara, Turkey; 3Division of Audiology, Department of Ear Nose and Throat and Head and Neck Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey; 4Zekai Tahir Burak Maternity Hospital, Audiology Unit, Ankara, Turkey; 5Zekai Tahir Burak Maternity Hospital, Neonatal Intensive Care Unit, Ankara, Turkey; 6Yıldırım Beyazıt University, Department of Pediatrics, Ankara, Turkey 1
NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 117
Objectives: According to the literature consensus, low birth weight and prematurity may not have a se‐
vere impact on hearing in premature infants. It may also be commonly associated with multiple other risk factors. Our aim is to determine the risk factors associated with hearing loss as well as the preva‐
lence of permanent hearing loss in premature infants in newborn hearing screening. Methods: We de‐
signed a prospective controlled study of premature infants hospitalized in the neonatal intensive care unit between September 2009 and December 2011 in a big maternity hospital in Turkey. Babies were evaluated for high risk factors associated with hearing loss; low birth weight, prematurity, hyper‐
bilirubinemia, mechanical ventilation and intracranial hemorrhage. Newborn hearing screening proce‐
dure was performed before hospital discharge by automated auditory brainstem response and auto‐
mated evoked otoacoustic emission. Thirty‐four infants (2.6%) failed by two stage screening were re‐
ferred to a tertiary audiology center for further audiological evaluations. Results: A total of 1266 infants, 49.4% female, 50.6% male were assessed. Mean birth weight of the cohort was 1319 ± 350.85 g, mean ges‐
tational age was 29.77 ± 2.37 weeks. Persistant hearing loss was found in 8 (0.6%) infants; profound 37.5%, severe 12.5%, moderate 25% and mild 25%. Hyperbilirubinemia and intracranial hemorrhage were not associated with hearing loss. On the other hand, mechanical ventilation <5 days and sepsis were independent risk factors for hearing impairment. Conclusion: Mechanic ventilation and sepsis are two important factors which increase the risk of hearing loss in preterm infants. However, further com‐
prehensive and broader data is required to support an evidence‐based consensus and to take important precautions. N. 41 ‐ NEWBORN HEARING SCREENING PROGRAM IN GAZI UNIVERSITY HOSPI‐
TAL (ANKARA, TURKEY) BETWEEN 2003 AND 2011 Kemaloğlu YK1, Gökdoğan Ç1, Küçükünal S1, Gunduz B1, Seyrek M1, Türkyılmaz C2, Onal EE2, Atalay Y2 ORL‐ HNS Department, Audiology Subdivision, Gazi University Faculty of Medicine, Ankara, Turkey; 2Pediatrics, Neona‐
tology Department, Gazi University Faculty of Medicine, Ankara, Turkey 1
Newborn hearing screening (NHS) program in Turkey was started as nation‐wide in 2003. Since then, Gazi University Hospital (GUH) in Ankara has been one of the major referral centers. During these years, in the GUH‐based NHS program, totally 19148 babies were screened. While about 91% were the babies born in the GUH, rate of referral ones in any stage of the screening were gradually increased to 17% in 2011. Both transient otoacoustic emissions and auditory brainstem audiometry (ABR) were used in 3 step‐screening as suggested by Health Ministry (ABR in the risk groups, and both in the healthy ones). It was found that rate of bilateral hearing loss (HL) was 0.25% in healthy newborns, and 1.53% in the NICU and/or other risk group babies. This rate demonstrated substantial variation (0.14% to 0.27% in healthy babies and 1.02% to 1.83% in NICU and or risk groups) by years as related with number of the referrals. In any stage of screening, 2.58% of the babies did not come to the next step of the screening. To‐
tally 38 babies with HL (bilateral: 32, unilateral: 6, and auditory neuropathy in 10) were detected. In 48%, level of HL was severe or profound, and totally 48 and 19 cases were fitted by hearing aids and cochlear implants, respectively. These data showed that rate of bilateral HL in Turkey appears to be higher than the Western countries. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 118 NHS 2012
N. 42 ‐ INTERVENTION FOR THE HEARING IMPAIRED IN THE DEVELOPMENT PER‐
SPECTIVE (IHIDP) IN BANGLADESH Motaleb A Executive Director of Socio Economic Development Association For Disabled (SEDAD), Dhaka, Bangladesh The number of children worldwide with hearing impairment is increasing, and these children face a number of obstacles and burdens, given that spoken language is the predominant medium of communi‐
cation and social interaction. Adequate auditory stimulation, in early childhood in particular, is the foundation for optimal speech and language development as well as the acquisition of literacy skills. Failure to detect early and effectively manage within the first year of life a permanent hearing impair‐
ment that is congenital or that originates in the neonatal period has been associated with significant and irreversible deficits in speech and in linguistic, cognitive, and educational development. In recognition of the growing and significant burden of hearing impairment globally, the World Health Assembly (WHA) in 1995 passed a resolution on the prevention and control of major causes of avoidable hearing impairment and on early detection in “babies, toddlers, and children” within the framework of primary health care. The incidence of hearing impairment in Bangladesh is growing gradually due to poor knowledge and insufficiency of proper health care services. Although Bangladesh government is fighting to reduce this issue to take a small step, they are unable to completely finance quality programs, given the competing demands from existing this problem. The inability of governments to provide for diverse health needs with limited budgets has led to a growing trend towards local public–private part‐
nerships for health‐care delivery in our country, especially for the most vulnerable populations. As a re‐
sult, we struggle to achieve appropriate services for this population. Current global health priorities in Bangladesh have yet to pay attention to the WHA resolution on hearing impairment, which acknowl‐
edges this condition in early childhood as a significant health problem. The prospects of any immediate action are uncertain, since vital data required by the current approaches to global disease prioritization are inadequate and of limited value where available. Although external assistance constitutes a small proportion of total health expenditure in our countries, the priorities of multilateral/donor organizations still have a great influence on national health priorities and public sector–led systematic investment in requisite capacity‐building for early hearing detection and intervention services but it need to be more out‐of‐pocket spending by public‐private partnership to ensure quality intervention for permanent and early onset of hearing impairment. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 119
SCREENING AND ASSESSMENT BEYOND THE NEW‐
BORN PERIOD N. 43 ‐ THE SCHOOL ENTRY HEARING SCREEN: TO DO OR NOT TO DO – THAT IS THE QUESTION? Atty G1, Manuel‐Barkin C2 Programme Centre Specialist for Newborn Hearing Screening, London, England, UK; 2Principal Consultant, Northgate In‐
formation Solutions, Hemel Hempstead, England, UK 1
The present day School Entry Hearing Screen (SEHS) in England has no national protocols to follow, lit‐
tle uniformity in practice and a lack of even rudimentary data collection hence the true yield of the SEHS remains unknown. Without this knowledge it is hard to establish if it makes a useful contribution to the identification of permanent childhood hearing impairment (PCHI). Recent research (HTA 2007) high‐
lighted a need to look at the efficacy and efficiency of alternative approaches to the identification of PCHI post newborn screen. Since early 2011 the NHSP Programme Centre and Northgate Information Solutions have been working together with a local school screening programme in Birmingham develop‐
ing a new system for data collection and monitoring so that robust data on screen protocol and perfor‐
mance is available for analysis. The Screening Management and Reporting Tool (SMART) for Schools is built on the same platform as the national database for the newborn hearing screen programme known as eScreener plus. SMART for Schools is preloaded with student data including the newborn hearing screen test results and outcome for each child and the screener can access and enter data on the system at the school using a netbook with remote access to the local network. The system is also designed to en‐
able the diagnostic assessment results to be entered, thus allowing full analysis of data from screen to possible diagnosis of a PCHI. Data has been entered on to SMART for Schools for over a year now so please come and see our poster for more information and a summary of early findings. N. 44 ‐ A NEW TEST TO ASSESS CENTRAL AUDITORY PROCESSING OF 4‐YEAR‐OLD CHILDREN: A PSYCHOACOUSTIC AND MMN STUDY Neumann K1, Zaretsky Y1, Euler HA1, Kunz L1, Looschen A1, Beste C2, Ocklenburg S2, Lücke T3, Dazert S1, Schirkonyer V4, Oswald H4 Dept. of Phoniatrics and Pediatric Audiologie, ENT Clinic, University of Bochum, Germany; 2Dept. of Biopsychology, Insti‐
tute of Cognitive Neuroscience, University of Bochum, Germany; 3Dept.of Neuropediatrics and Social Pediatrics, University of Bochum, Germany; 4Path medical GmbH, Germering, Germany 1
Objective. At current, universal language screenings for children in kindergartens (age 4‐5 yrs.) are im‐
plemented in Germany. They should differentiate between (a) normal language development, (b) poor language development, e.g. due to social‐environmental reasons requiring language training, and (c) language impairment which needs therapy (de Langen‐Müller et al., in press). Because a part of the chil‐
dren is expected to suffer from a central auditory processing disorder (CAPD; 7% of children at school age; Musiek et al., 1990) and CAPDs often coincide with language abnormalities, there is a good chance to identify those children during the language screenings. Hence, a psychoacoustic CAPD‐screening is NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 120 NHS 2012
required which reliably detects CAPDs from age 4 on. Method. We developed a psychoacoustic test to assess the auditory processing abilities of 4 and 5 year old children using non‐speech stimuli and speech‐
containing stimuli. We validated and normed it (N= 160 so far). Furthermore, the test was applied to 60 children, aged between 4 and 4.5 years, who belonged to one of three groups (a)‐(c) described above. The test results have been compared to pre‐attentive measurements of event‐related potentials (mismatch negativity, MMN) using the same stimuli. Results. The development of the psychoacoustic test has been finished recently and the test has been implemented in a hand‐held device (Sentiero®, Path medical GmbH). Conclusion: The new test seems to reliably assess CAPDs and whether a developmental lan‐
guage abnormality is associated with difficulties in central auditory processing or not from age 4 on. The study was funded by the German Ministry of Education and Research, Grant number: DLR 01GJ0982 References: Musiek F (1990) Selected issues in screening for central auditory processing dysfunction. Seminars in Hearing, 11, 372‐383. de Langen‐Müller U, Kiese‐Himmel C, Neumann K, Noterdaeme M & Kauschke C. [Diagnostik von Sprachentwicklungsstörungen (SES)]. Interdisciplinary German Guidelines on Language Impairment. Peter Lang, in press). N. 45 ‐ PREPARING AND VALIDATING LEAQ AS A SCREENING TOOL FOR GHANA‐
IAN CHILDREN AGED 6 – 36 MONTHS Offei YN1,2, Coninx F1 University of Cologne, Germany; 2University of Winneba, Ghana 1
Background. The LittlEars (® MED‐EL) Auditory Questionnaire (LEAQ) was designed to monitor pre‐ and postoperative auditory development in children receiving cochlear implants (Weichbold et al, 2005). At the same time, LEAQ is providing a general picture of the auditory behavior and functioning of all children in the age range of 0‐24 months. The psychometric properties (like norm data) of LEAQ support its use as an assessment instrument for evaluating auditory behaviour in all children. One specific appli‐
cation is screening for hearing loss in the age range from 6 months to 3 years. This paper reports on preparation of LEAQ as a screening tool for Ghana, where no UNHS has been implemented. Aim. The current study aimed at adapting LEAQ to Ghanaian languages and at investigating influence of admini‐
stration mode (self‐administration or interview). Methods. The original LEAQ English version was adapted to three Akan languages using the translation/back‐translation procedure. For validation pur‐
poses, norm data were collected for N=1512 children. Results were in accordance with previous adapta‐
tion data (Coninx et al 2009). The effect of administration mode was investigated by collecting data from N=152 parents. They completed two “half” versions of LEAQ, one containing the odd items and the other the even items. One of the versions was completed by self‐administration, the other by interview. The order of the tests and the mode were balanced. Results. Age of the children ranged from 4‐18 months with a mean at 10.8 months. An ANOVA to test the mean group differences based on method of completing LEAQ was not significant F(4,147) = .196 p= .940. The findings suggest that the administra‐
tion mode does not influence the output scores. Conclusion. The present study supports the position that LEAQ is an appropriate screening tool for children and, it can be used in diverse groups of children including those in developing countries such as Ghana. References: Weichbold V., Tsiakpini L., Coninx F. and DʹHaese P. (2005). Development of a parent questionnaire for assessment of auditory behaviour of infants up to two years of age. Laryngorhinootologie 84(5):328‐34 (2005) Coninx F., Weichbold V., Tsiakpini L., ... Brachmaier J. (2009). Validation of the LittlEARS® Auditory Question‐
naire in children with normal hearing. Int J Pediatr Otorhinolaryngol 73(12):1761‐8 (2009) NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 121
N. 46 ‐ TARGETED SURVEILLANCE FOLLOWING NEWBORN HEARING SCREENING‐
IS IT WORTH IT? Wood SA, Davis A, Sutton G Newborn Hearing Screening (NHSP) and Newborn and Infant Physical Examination (NIPE) Programme Centre, London, England, UK Universal Newborn Hearing Screening was implemented across England between 2001 and 2006 in a centrally organised phased programme. Full implementation was achieved in March 2006. All constitu‐
ent programmes follow nationally agreed protocols and procedures including referral for targeted sur‐
veillance at the age of 7‐9 months. A review of targeted surveillance was undertaken in November 2011 in order to establish its effectiveness and to guide further practice. The review examined data for the birth cohort 01/04/2006 ‐ 30/09/09 (n=2318852). 4.98% were referred for targeted surveillance‐2% who did not complete the newborn screen (non screen completion group) and 2.98% who passed the screen but had one or more risk factors for later onset permanent hearing impairment (risk factor group). Take up of targeted surveillance was <20% in the non screen completion group and around 50% in the risk factor group. 147 children in the targeted surveillance groups have been identified with a moderate or worse PCHI (39 unilateral, 108 bilateral). Data for the age of identification and degree of hearing loss for these children will be presented. PPV for PCHI in the non screen completion group was 0.95/1000 and in the risk factor group was 1.49/1000. Data for all children were examined in order to identify risk factors that are most likely to identify PCHI in children who have passed the newborn hearing screen. The results of this analysis will be presented. This has led to a change in recommendations for routine targeted surveil‐
lance in the English newborn hearing screening programme. N. 47 ‐ ETIOLOGY AND SEVERITY OF HL, SCHOOL TYPE AND MODE OF COMMUNI‐
CATION, IN NICU GRADUATES AT 3‐5 YEARS OF AGE van de Ven EA1, van Straaten HLM1, Oudesluys‐Murphy AM2, Korver AMH2 Isala Clinics, Zwolle, The Netherlands; 2Leiden University Medical Center, Leiden, The Netherlands 1
Introduction. Little is known about follow up of NICU graduates with permanent hearing loss (HL) fol‐
lowing introduction of neonatal hearing screening. Aim. Evaluation of etiology, severity of HL, school type and mode of communication in NICU graduates. Method. As part of the Decibel study all NICU graduates with HL identified at the age of 3‐5 years at the speech and hearing centres in the Netherlands were included. Results of 2 stage AABR neonatal hearing screening, medical and audiologic follow up as well as performance measures for school type and primary mode of communication were evaluated. Results. Included were 91 newborns [BW 1990 g (sd 1070); GA 32,9 wks (sd 5,3)]. Of those 5,6% passed neonatal hearing screening. In 44,3% moderate HL (40‐60 dB), in 23,9% severe (60‐80 dB) and in 31,8% profound HL (>80 dB) was established. In 33/91 cases parental consent was obtained for adjuvant follow up data. In 30,3% HL was of hereditary origin, in 24,2% HL was caused by asphyxia, in 9,1% by CMV‐
infection. In 8 cases (24,2%) no cause was identified. Up to 71,4% of NICU graduates attended schools for deaf and hard of hearing, 1 (3,6%) different special education, while 25% visit regular education. In 82,8% a combination of spoken en signed language was used for communication. Conclusion. After in‐
troduction of AABR universal neonatal hearing screening and early intervention in NICU graduates most affected children have moderate to severe HL, attend schools for deaf and hard of hearing, and use a combination of signed and spoken language at age 3‐5 years. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 122 NHS 2012
N. 48 ‐ DEVELOPMENT AND QUALITY OF LIFE IN NICU GRADUATES AND HEALTHY NEWBORNS WITH PCHI AT 3‐5 YEARS OF AGE AFTER NHS van de Ven EA1, van Straaten HLM1, Oudesluys‐Murphy AM2, Korver AMH2 Isala Clinics, Zwolle, The Netherlands; 2Leiden University Medical Center, Leiden, The Netherlands 1
Objective. NICU graduates have both an increased risk of permanent childhood hearing impairment (PCHI) and delayed psychomotor development. Little follow up is available after introduction of neona‐
tal hearing screening (NHS). Aim. Comparison of language and psychomotor development as well as quality of life in NICU graduates vs. well baby clinic (WBC) newborns with PCHI at the age of 3‐5 years. Method. All children (born 2003‐2005) with PCHI identified in the Netherlands at speech and hearing centres were included. Development and quality of life (QOL) were measured at age 3‐5 yrs by using the MacArthur Communicative Development Inventory, Child Development Inventory (CDI), and Pediatric QOL Inventory 4.0. Results. Twenty‐six NICU graduates and 64 WBC newborns completed all meas‐
urements. Language development showed significant difference for total words signed (23,3 vs 10,6; p=0,009). All other scores in NICU graduates on subscales of MacArthur tend to be lower. Though CDI scores were not statistically significantly different, the scores of social (70,1 vs 75,2), self‐help (80,0 vs 86,2) and gross motor development (72,0 vs 83,4) were considered clinically significant. Total QOL score differed not significantly (79,4 vs 85,5), inclusive physical functioning (85,7 vs 90,4) but the subscales so‐
cial functioning (75,4 vs 85,3; p=0,004) and psychosocial health summary score (75,9 vs 82,4; p=0,018) did for NICU graduates. Conclusion. After NHS NICU graduates with PCHI pursuit to have an increased risk for delayed language and psychomotor development compared to their ‘healthy’ peers with PCHI. Also quality of life is negatively affected. N. 49 ‐ TRENDS IN HEARING LOSS AND NOISE‐INCLUDED HEARING LOSS (NIHL) IN UNITED STATES ADOLESCENTS, 1966‐2008 Hoffman HJ1, Li C‐M1, Themann CL2, Dobie RA3 National Institutes of Health (NIH), NIDCD, Division of Scientific Programs, Bethesda, MD, USA; 2Centers for Disease Control and Prevention (CDC), NIOSH, Hearing Loss Prevention Team, Cincinnati, OH, USA; 3University of Texas Health Science Center, Otolaryngology–Head & Neck Surgery Department, San Antonio, TX, USA 1
Noisy environments increase the risk of developing noise‐induced hearing loss (NIHL), a common pre‐
ventable type of hearing loss in children and young adults. To investigate trends in hearing loss (espe‐
cially NIHL) in adolescents, we analyzed three population‐based surveys: the National Health Examina‐
tion Survey (NHES), 1966–1970; National Health and Nutrition Examination Survey III (NHANES III), 1988–1994; NHANES, 2005–2008. Questions about risk factors were asked in household inter‐
views. Pure‐tone audiometry was conducted independently in mobile exam centers (thresholds deter‐
mined at 0.5–8 kilohertz [kHz] bilaterally). NIHL was operationally defined based on notches in both ears. Notches were identified when any threshold at 3, 4, or 6 kHz exceeded by 15 decibels (dB) hearing level (HL) the average threshold in the low/middle frequencies, 0.5 and 1 kHz, and the threshold for 8 kHz was at least 5 dB HL better (lower) than the maximum threshold at 3, 4, or 6 kHz. Hearing loss prevalence, defined by better‐ear, pure‐tone average (0.5, 1, 2, 4 kHz>15 dB HL, declined from 7.0% (NHES) to 2.5% (NHANES 2005–2008). In 1966–1970, bilateral notch prevalence was 19.9%; in 1988–1994, 6.0%; in 2005–2008, 5.4%. Notch prevalences increased with age and male sex earlier (NHES: odds ratio NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 123
(OR)=1.70, 95% confidence interval (CI):1.51–1.91; NHANES III: OR=1.77, CI:0.94–3.34), but not in NHANES 2005–2008. Race/ethnicity differences were non‐significant. Males with exposure to loud noise/music for 5+ hours/week had increased risk of bilateral notches, OR=1.64, CI:1.02–2.66. Males who worked jobs with loud noise (5+ hours/week) also had elevated OR=1.42 (not significant). NHANES 2005–2008 audiometric data have been used to track US Healthy People goals. With knowledge of risk factors, educational programs can be developed to warn of specific risks and increase awareness of the need for hearing protection when exposed to loud noise. N. 50 ‐ HEARING SCREENING IN PRESCHOOL AND SCHOOL – PORTUGUESE EXPERI‐
ENCE Martins JT1, Delgado T2 Widex, Reabilitação Auditiva, Faro, Portugal; 2HPP‐Hospital dos Lusíadas; Lisboa, Portugal 1
Introduction. Hearing is a complex sensory function and one of the most important senses of human be‐
ings. Hearing fluctuations caused by middle ear pathology is a common finding in preschool and school‐
ages population. It is known how hearing impairment may affect the speech and language development and learning ability and its consequences on personnel and social development. Therefore, hearing screening programs become a crucial tool to identify different hearing disorders. Aim of the study. De‐
scribe a preschool and school hearing screening program in a Portuguese town, and analyse the hearing disorders found in these group ages in two consecutive years. Material and methods. Hearing screening (HS) was conducted in a group of 353 children aged 4 to 12 years old, in 2010 and 2011. HS consisted of two phases, where children who failed the first phase were referred for further evaluation in a second phase. All the children underwent a test battery consisting of otoscopy, tympanogram (256Hz) and pass/refer audiometry at 20dB at 1, 2, 4KHZ. In the second screening phase was repeated the same bat‐
tery of tests. Children failed the screening for changes in Otoscopy, if the Tympanogram was type B or C2 unilaterally or bilaterally, and if they did not listen to 20 dB in at least one frequency in one ear. Chil‐
dren who failed the second phase screen were referred for ENT consultation. Results. In the first phase of screening 27.5% were forwarded to the second round. Of children forwarded to the second phase, 50.4% were referred for ENT consultation, i.e. at the end of the screening 14% of children were referred. Conclusion. These results highlights the importance of screening in school and pre‐school age children. The implementation of hearing screening is essential since it will allow detecting changes in asympto‐
matic phase. N. 51 ‐ HEALTH HEARING ON 5/6 YEARS OLD Serrano M School of Health Technology of Coimbra, Coimbra, Portugal This study aims to assess the routing method of audiological screening at the age of 5/6 adopted by the School of Health Technology of Coimbra, particularly if children with unilateral changes in tym‐
panogram should or should not continue to be further addressed. In order to reach the goal we defined eight issues of research from which resulted five databases with different screening results and their second phases. After the statistical analysis of data we concluded from the results obtained and the audiological/ENT conditions under the various screenings, that the routing of audiologic method fol‐
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lowed at the age of 5/6 conducted by the School of Health Technology of Coimbra should be maintained, excepted on routing children with unilateral type C2 tympanogram; we also concluded that the tech‐
niques used continue to be the correct ones because they permit to detect changes in the middle ear and hearing loss and the otoacoustic emissions shown to have moderate or low correlation with the tim‐
panograma; we also highlight the difficulty to get the ideal conditions for their capture in schools. If this conclusion/recommendation would be followed, according to the results of different surveys, 8% of chil‐
dren won’t need to be routed again. Despite this conclusion/recommendation we point the fact that the type C2 tympanogram could be worse or even improve in similar proportions in a short period of time, that is, these children still experiment a wide fluctuation of their audiological changes/hearing quality which will/could influence all their quality of life. N. 52 ‐ AUDIOLOGIC SCREENING IN THE CITY OF LISBON Serrano M School of Health Technology of Coimbra, Coimbra, Portugal This study aims to describe the results of the survey conducted in three academic years, by the trainee students of the Course of Audiology, School of Health Technology of Coimbra, to 4175 Children of the 1st year of primary school of Lisbon, highlighting the results in children with 6 years of age. Children failed the screening for changes in otoscopy, if the tympanogram was type B or C2 unilaterally or bilat‐
erally, and if did not listen to 20 dB in at least one frequency in one ear. The screenings took place be‐
tween the months of October and June. Children screened were distributed equally by both sexes and their average age was 6.24 years, with mode 6 years. From the total of screened children, 1111 were re‐
ferred (26.6%). Of the children who were referred 48% (533) had bilateral abnormalities. The percentage of children referred at 6 years old was 26.7%. Early detection of hearing disorders contributed to mini‐
mizing the impact of hearing loss, even slightly, to the overall development and learning ability of chil‐
dren, to enable timely medical intervention, so it may be that the audiological screening at pre and school age is something that increasingly, must be regular and repetitive because who listens well, learns best. N. 53 ‐ INTERVENTION MODEL IN OCCUPATIONAL HEARING LOSS Barbosa A, Sousa A, Oliveira V, Lopes P Escola Superior de Tecnologia da Saúde do Porto, Braga, Portugal Due the constant and permanent progress of medicine, its intervention and exercise in health care are more and more focused in prevention, on demand for a more efficient approach. For what occupational health is concerned, there are several consequences from exposure to harmful agents. Specially regard‐
ing to hearing loss, NIHL (Noise Induced Hearing Loss) is the most common occupational disease of Europe and its effects are permanent. Therefore an interventional model is proposed for occupational hearing health, which is suitable to intervene since childhood in a more significant way (through preven‐
tion) and later on to the rest of the population, taking into account prevention, diagnosis and hearing loss rehabilitation. The main reason why it is given additional attention to the young population instead of what is normally defined (active population) is due to the aim of this article, which is prevention as a mechanism of suppression of misconducts related with occupational hearing health in adult life. So, this model in divided into three different areas: audiology in schools, audiology in the community and occu‐
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pational audiology. As far as audiology in schools is concerned, the performance should have its main focus on prevention and hearing health promotion, through teaching programs and implementation of programmatic contents integrated into courses, among others. Finally children’s follow‐up and their evaluation as a complement to this intervention. As to audiology in the community, its intervention should be complementary and this action follows two main segments: a non‐occupational and occupa‐
tional performance. In occupational audiology the path of action should include specific measures due to its direct relation with the active population. For this reason, in order to achieve an efficient awareness for this theme, it is essential to implement a hearing conservation program suitable with the proposed objectives. N. 54 ‐ TINNITUS AS A PROBLEM AMONG CHILDREN DURING HEARING SCREEN‐
ING PROGRAM IN SCHOOL AGE CHILDREN IN POLAND Skarzynski PH1,2, Kochanek K1, Skarzynski H1, Piotrowska A1, Sliwa L1, Jedrzejczak WW1, Pilka A1, Bruski L2 Institute of Physiology and Pathology of Hearing, Warsaw, Poland; 2Institute of Sensory Organs, Kajetany, Poland 1
Aim. The aim of the program was to evaluate, during hearing screening program in school children, lev‐
el of tinnitus’s presence among children. Method. During program we used Pure Tonal Audiometry, Central tests (DDT and GDT) and questionnaires (special parts for children and parents). There was also special part dedicated for tinnitus. Questions was previously agreed by specialist from Our and coopera‐
tives centers. Program was dedicated to children from cities and villages lower than 5000 inhabitants. Program was performed on Sensory Examination Platform®. Results. Positive results on tinnitus ques‐
tion was 15,1%. Positive results based on PTA is 13,1%. Based on central tests like DDT is 15,6%. Total average result was 19.4% That result is based on homogenous group of 6‐7 years old children from vil‐
lages and cities lower than 5000 inhabitants. Number of children screened during 2008‐2011 was over 300.000. Conclusion. Presence of tinnitus is higher in bigger cites and on areas with higher level of noise. Over 65% of parents don’t realize about the problem. There is significant economic and social problem. We continue that program among others Countries in different continents. N. 55 ‐ HEARING SCREENING PROGRAM IN SCHOOL AGE CHILDREN IN POLAND Skarzynski PH1,2, Kochanek K1, Skarzynski H1, Piotrowska A1, Sliwa L1, Jedrzejczak WW1, Pilka A1, Bruski L2 Institute of Physiology and Pathology of Hearing, Warsaw, Poland; 2Institute of Sensory Organs, Kajetany, Poland 1
Aim. Our aim was to evaluate, during hearing screening program in school children, hearing impair‐
ments in children. Method. During program we used Pure Tonal Audiometry, Central tests (DDT and GDT) and questionnaires (special parts for children and parents). There was also special part dedicated for tinnitus. Questions was previously agreed by specialist from our and cooperatives centers. Program was dedicated to children from cities and villages lower than 5000 inhabitants. Results. Positive results based on PTA is 13,1%. Based on central tests like DDT is 15,6%. Total average result was 19.4% Aver‐
age level of complains about periodic or constant tinnitus was 15,1%. That result is based on homoge‐
nous group of 6‐7 years old children from villages and cities lower than 5000 inhabitants. Number of children screened during 2008‐2011 was over 300.000. Conclusion. Over 65% of parents don’t realize NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 126 NHS 2012
about the problem. There is significant economic and social problem. We continue that program among others Countries in different continents. N. 56 ‐ HEARING AND DEAF PRESCHOOL CHILDREN IN SERBIA Savić MM1, Savić MP2, Savić VP2, Nikolic VS3 General Hospital Šabac, Šabac, Serbia; 2Faculty of Philosophy Novi Sad, Serbia; 3Primary School for Children with Damaged Hearing, Zemun, Belgrade, Serbia 1
Introduction. Hearing impairment and deafness are relatively rare in preschool children in Serbia. On the other hand, the etiology of this phenomenon is very diverse and includes a variety of viral and infec‐
tious diseases at pregnant women, congenital profound deafness and very common inflammations of the middle and inner ear, various syndromes and congenital degenerative changes in the anatomy ear. The aim is to examine the incidence of ear disease and mastoid process as a potential etiology of pro‐
found deafness and hearing loss in preschool children in Serbia in 2010. The methodology: of monitor‐
ing data on the total number of preschool childrenʹs morbidity, monitoring data on the total number of ear and mastoid process of pre‐school children and data on the number of registered pre‐school deaf children in the Republic of Serbia in 2010. Results. Test results show that the incidence of ear disease and mastoid process of pre‐school children in Serbia in 2010 represented the 4.2% of the cases in relation to the overall morbidity of preschool children, deafness is recorded at 0.02062% of cases in relation to the overall morbidity of preschool children, the frequency of deafness is 0.489084% of the Ear and mastoid process of preschool children in the Republic of Serbia in 2010. Conclusion. Diseases of the ear and mas‐
toid are the more frequent etiologies of profound hearing loss in deaf preschool children in the Republic of Serbia in 2010. N. 57 ‐ HEARING SCREENING AND INTERVENTION FROM NEWBORNS TO PRE‐
SCHOOL‐AGE CHILDREN Huang Z‐W, Wu H, Lv J‐R, Li Y, Huang Q Department of Otolaryngology‐Head & Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Jiaotong University Ear Institute, Shanghai, P.R. of China Newborn hearing screening. Newborn hearing screening has been developed rapidly, including hear‐
ing screening, diagnostic evaluation, intervention and follow up, etc in China in past decade. From 2002 to 2010, in Shanghai, since implementation, the incidence of bilateral and unilateral congenital hearing loss was 1.39‰ (1591/1145249) and 1.34‰ (1532/1145249), respectively. Especially in the last five years, the program covered more than 95% of all newborn and the referral rate was over 90%. As of autumn 2010, the intervention has reached 85.1%. Preschool‐age children hearing screening. Nearly half of hearing loss in preschool children is delayed‐onse, Data from our study showed that the incidence of bi‐
lateral and unilateral congenital hearing loss was confirmed as 1.39% (1591/1145249), delayed‐onset bi‐
lateral hearing loss was 0.9‰ (5/5547) in 3‐year‐olds, based upon the results obtained, our study sug‐
gests that even children, who initially pass newborn hearing examinations, require further screening at preschool age for detection of delayed‐onset hearing loss. It is recommended that preschool hearing screening should combine to newborn hearing screening follow‐up session and childrenʹs hearing health care, in China. Intervention with hearing problem. A clinical audiological problem is how to make an effective intervention for hearing impaired infants and preschool‐age children. Following issues should NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 127
be particular concerned: The intervention of different ages (0‐3 months, 3‐6 months, the intervention of more than 6 months of age), and avoid no intervention or excessive intervention issues (such as concern the phenomenon of growth retardation, etc.). The evaluation of intervention result for infants and young children with mild hearing loss or only high‐frequency hearing loss. Hearing aid fitting and cochlear implantation indications and the mutual compatibility problems. The residual hearing assessment for in‐
fants aged less than 1 year‐old, objective testing (ABR no response, ABR and ASSR had no response, etc). NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 128 NHS 2012
ASSESSMENT TECHNIQUES N. 58 ‐ SURVEY OF FOLLOW‐UP TESTING METHODOLOGY FOR NEWBORN HEARING SCREENING REFERRALS ‐ A CALL FOR STANDARDIZATION Delgado RE1, Lim BG2, Delgado CF3 Intelligent Hearing Systems Corporation, Miami, Forida, USA; 2Pediatrix Medical Group, Sunrise, Florida, USA; 3University of Miami, Psychology Department, Coral Gables, Florida, USA 1
This study presents a survey of audiometric follow up testing methods conducted in 2010 to evaluate automated Auditory Brainstem Response (ABR)‐based referrals from 258 centers across 27 states in the United States. Although newborn hearing screening is currently universal throughout the United States, screening and follow‐up techniques vary considerably. Out of 1,760 newborns that were referred, fol‐
low‐up procedures were as follows: 73.13% diagnostic battery (initial OAE and/or automated ABR screening with full diagnostic battery as needed), 7.27% diagnostic click‐based ABR, 0.57% diagnostic frequency specific ABR, 6.25% automated ABR, 1.14% automated ABR and OAE combined, 11.93% OAEs only, 6.88% OAEs and tympanometry, and 0.68% tympanometry only. Of particular interest are the 19.49% of newborns that were followed up using OAE and/or tympanometry after failing an ABR screening. OAEs only provide information on portions of cochlear function and therefore are not appro‐
priate as follow‐up for ABR referrals which may have originated from eighth nerve or auditory brain‐
stem pathway dysfunctions. Neural conduction disorders or auditory neuropathy/dyssynchrony, with‐
out a sensory component, would not be detected by OAE follow‐up alone. This practice conflicts with the recommendations of the 2007 Joint Committee on Infant Hearing that states ʺInfants in the well‐
infant nursery who fail automated ABR testing should not be rescreened by OAE testing and ʹpassed,ʹ because such infants are presumed to be at risk of having a subsequent diagnosis of auditory neuropa‐
thy/dyssynchronyʺ (JCIH, 2007). This study highlights the need for standardization and enforcement of recommended follow‐up procedures in order to assure that newborns identified at birth for possible hearing impairment are not subsequently lost. References: JCIH. Year 2007 Position Statement: Principles and Guidelines for early hearing detection and intervention pro‐
grams, Pediatrics, Vol.120 No.4 Oct 1, 2007. N. 59 ‐ DEVELOPMENT OF A SIMULTANEOUS AIR‐ AND BONE‐CONDUCTION NEW‐
BORN HEARING SCREENING TECHNIQUE USING ASSR INTENSITY‐RAMPING STIMULI Delgado RE1, Hood LJ2, Hatton K2, Stangl S2, Rentmeester L2, Savio G1 Intelligent Hearing Systems Corporation, Miami, FL, USA; 2Vanderbilt University, Nashville, TN, USA 1
This study is part of a research project that aims to develop an improved neonatal hearing screening technique by incorporating novel testing procedures combining simultaneous air‐ and bone‐conduction testing to better and more efficiently detect mild hearing losses. The technique addresses the current need for a more sensitive hearing screening tool by stimulating at lower intensities and providing bone conduction stimulation to differentiate sensorineural and conductive components. The goal is to apply a NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 129
stimulus Intensity‐Ramping technique for quickly determining hearing thresholds using ASSRs to si‐
multaneous air‐ and bone‐conduction testing. In this preliminary study, behavioral hearing thresholds and ASSR data (without Intensity‐Ramping) were collected from 10 young adult subjects with normal hearing (mean PTA=6.5dB HL) without and with a simulated conductive hearing loss (mean conductive shift with modified ear tip = 28dB at 500Hz, 33dB at 2000Hz). Data were acquired using simultaneous dual tones: 500Hz (8ms) and 2000Hz (4ms), Blackman window, presented at 77Hz and 81Hz, respec‐
tively, at 70 to 10dB SPL. One signal was presented through an insert earphone while the other was pre‐
sented through a bone vibrator. Both air‐ and bone‐conduction data were obtained for each signal. Ini‐
tial results indicate that multi‐frequency ASSRs can be successfully recorded using simultaneous air‐ and bone‐conduction stimulation. ASSR and behavioral thresholds showed expected relationships (mean difference = 21dB at 500Hz, 17dB at 2000Hz). Test results show good identification of air‐bone gaps (ABG) with the simulated conductive loss (mean behavioral ABG = 29dB at 500Hz, 37dB at 2000Hz). Physiologic ABGs were consistent with behavioral findings though limited by the maximum test level utilized (mean >25dB at 500Hz, > 22dB at 2000Hz). Bone conduction ASSR and behavioral thresholds showed good consistency across the normal and simulated loss conditions. This study was funded by an NIH‐NIDCD grant to Intelligent Hearing Systems N. 60 ‐ DO FREQUENCY SPECIFIC CHIRPS OFFER A QUICKER ABR ASSESSMENT IN NEWBORNS COMPARED TO TONE PIPS? Ferm I1, Lightfoot G2, Stevens J2 Croydon University Hospital, England, UK; 2English Newborn Hearing Screening Programme, Clinical Group, England, UK 1
Tone pips (short tone bursts) offer the advantage of frequency specificity over broadband clicks but tone pips responses are typically only 70% of the size of click responses, making collection time substantially longer. Chirp stimuli maximise neural synchrony by anticipating the travelling wave delay of the coch‐
lea and this leads to a larger response. Chirps can be designed to have a similar spectrum to a click or a tone pip. Question. What are the relative response sizes evoked by 4kHz tone pips and 4kHz chirp stimuli in the typical post‐screening newborn population? Method. Babies referred from the national newborn hearing screen programme in England had their usual ABR hearing assessment starting with 4kHz 2:1:2 cycle pips. Babies passing the 4kHz 30dBeHL discharge level were selected for the study. A total of 14 babies (23 ears) have been tested to date using both 4kHz 2:1:2 tone pips and 4kHz narrow‐
band chirps at the same stimulus level. The equipment used was the Interacoustics Eclipse system. The response size, response quality measure (Fmp) and residual noise for the pips and chirps were com‐
pared. Results. Chirp responses were on average around 50% larger than their conventional tone pip counterparts, with the residual noise levels being similar. A fixed number of sweeps was used and, as would be expected from these results, the Fmp quality measure was significantly higher for chirps. For a fixed signal to noise ratio, these results suggest a halving of test time when chirps are used rather than tone pips. Conclusion. Chirps do provide an advantage over tone pips in terms of response size in this clinical population. We need to ensure that chirps offer the same degree of frequency specificity as tone pips, that the amplitude advantage extends to other frequencies and are satisfactory in cases of hearing loss. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 130 NHS 2012
N. 61 ‐ ABR TO BONE‐CONDUCTED TONES IN INFANTS WITH CONDUCTIVE OR SENSORINEURAL HEARING LOSS Hatton JH1,2,3, Janssen RM3, Stapells DR1,3 British Columbia Early Hearing Program, Victoria, BC, Canada; 2Audiology & Speech Department, British Columbia’s Chil‐
dren’s Hospital, Vancouver, BC, Canada; 3School of Audiology & Speech Sciences, The University of British Columbia, Van‐
couver, BC, Canada 1
The published bone‐conduction (BC) tone‐ABR literature, especially for infants with sensorineural hear‐
ing loss, is surprisingly lacking despite over two decades of successful clinical use. Importantly, no study has evaluated the test performance of the BC tone‐evoked ABR in infants. Therefore, the current studies investigated: (i) whether the BC tone ABR was successful in differentiating children with con‐
ductive versus sensorineural hearing loss (Study A), and (ii) the relationship between BC ABR and sub‐
sequent behavioural hearing loss severity (Study B). Study A. By comparing BC ABR results (normal vs elevated) to behavioural results, Study A evaluated the accuracy of the BC ABR in correctly identifying type of hearing loss in a large group of infants with hearing loss (Conductive: 66 ears; SNHL: 109 ears). Results demonstrate that the normal BC ABR levels (500 Hz: 20 dBnHL; 2000 Hz: 30 dBnHL) accurately differentiated normal versus elevated cochlear sensitivity (accuracy=96.7% for 2000 Hz; 96.2% for 500 Hz). Study B. A subset of infants in Study A with elevated BC ABR (i.e., no response at normal level) had additional testing at higher intensities (usually at the maximum levels), which allowed for the cate‐
gorization of the degree of cochlear impairment (normal, mild/moderate; moderate/severe). Results in‐
dicate that the BC ABR accurately categorizes the degree of cochlear hearing loss, for at least 2000 Hz (accuracy=92.8%). BC ABR categorization results at 500 Hz were similar to 2000 Hz; however, interpreta‐
tion is limited due to the small number of ears at 500 Hz. Finally, for a few cases with elevated BC ABR (N=10), actual BC ABR thresholds were obtained. These latter results were used to calculate preliminary dB nHL to dB HL correction factors (mean ‐0.5±9 dB) for 2000 Hz BC ABR. Overall, these findings pro‐
vide further support for the use of BC tone ABR for diagnostic ABR testing. N. 62 ‐ REDUCING RECORDING TIME OF BRAINSTEM AUDITORY EVOKED RE‐
SPONSES BY THE USE OF RANDOMIZED STIMULATION Valderrama J1, Alvarez I1, de la Torre A1, Segura JC1, Sainz M2,3, Vargas J2 Department of Signal Theory, Networking and Communications, CITIC‐UGR, University of Granada, Spain; 2ENT Service, San Cecilio University Hospital, Granada, Spain; 3Department of Surgery and Its Specialties, University of Granada, Spain 1
Many protocols for newborn and infant hearing screening incorporate the acquisition of Brainstem Au‐
ditory Evoked Responses (BAER). This evoked potential represents the neural activity associated with the auditory brainstem function in response to a sound stimulus. The biological response waveform is characterized by a series of positive waves that occur during the first 10msec after stimulus presentation. Since wave V is the most robust wave, it is usually used as indicator of hearing loss. The conventional acquisition technique elicit the biological response by presenting to the patient a pulse train with a fixed inter‐stimulus interval (ISI) and averaging then the response to each stimulus. Usually, more than 1500 responses must be averaged to obtain a reliable biological response. The exploration time is therefore the main limitation in the recording of these potentials. This preliminary study presents a novel technique to reduce the recording time. Instead of using a pulse train with a fixed ISI, we propose to elicit the biologi‐
cal response by using a pulse train with a random ISI. To analyze the feasibility of the proposed tech‐
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nique, the BAER of four normal hearing adults were acquired considering the following inter‐pulse in‐
tervals: ISI25 (conventional technique), ISI3‐8 (uniformly distributed random inter‐pulse interval in the range from 3 to 8msec), ISI5‐10, ISI8‐13, ISI10‐15, ISI15‐20 and ISI20‐25. The recordings confirm that the hearing threshold can be determined in a shorter time using the proposed technique since the sound intensity threshold at which wave V appears is similar in both conventional and proposed techniques. Although the waves recorded with the proposed technique present lesser amplitudes and greater latencies due to adaptation, a fast detection of the wave V facilitates the implementation of newborn and infant hearing screening protocols. N. 63 ‐ CIRCULAR PHASE CLUSTERING BASED AUTO‐ADAPTATION FOR THE OB‐
JECTIVE ASSESSMENT OF ABR MEASUREMENT QUALITY Strauss DJ, Corona‐Strauss FI Saarland University, Faculty of Medicine, Systems Neuroscience & Neurotechnology Unit, Homburg, Saar, Germany and Key Numerics, Saarbruecken, Germany The objective assessment of the measurement quality of auditory brainstem responses (ABRs) recently became an important component of clinical practice/hearing screening. Most of the known ABR quality measures are based on simple morphological time‐domain features such as amplitude and latency, e.g., by comparing single ABR sweeps to the averaged response. However, such morphological approaches may suffer in measurement conditions in which externally induced noise cannot be further reduced and thus result in a weak morphological stability of the ABR response. To approach this problem, we present a new quality measure which is based on the circular clustering of the instantaneous phase of ABR sin‐
gle trials, i.e., a correlate of neural synchronization processes. For this, band‐limited Hardy space projec‐
tions are employed to obtain the instantaneous phase of consecutive ABR single‐trials which are ar‐
ranged in a matrix representation. In this representation the instantaneous phase is evaluated along a fixed trace by means of directional statistics on the unit circle. The quality measure is now derived from the circular difference of the phase distribution of trials of the spontaneous activity, i.e., no auditory stimulation, from the distribution of trials after auditory stimulation. Twenty subjects (mean age approx. 25y, std: approx. 4y) with no history of hearing problems and normal hearing thresholds (below 15 dB (HL)) participated in our study. ABR single trials were obtained by calibrated broad band chirps at 20, 30, and 40 dB SPL and in the case of no stimulation, i.e., the spontaneous activity. Using these data, we show that our approach (a) allows for an auto‐adaptation to the measurement condition, (b) allows for a robust and objective quantification of the measurement quality, and (c) can also be used for the objective ABR detection with a minimum number of trials by combining it with novelty detection machines. N. 64 ‐ EFFECTIVE MASKING LEVELS AT 500 AND 2000 HZ FOR BONE‐CONDUCTION AUDITORY STEADY‐STATE RESPONSES IN INFANTS AND ADULTS WITH NORMAL HEARING Small SA, Leon G, Smyth A University of British Columbia, School of Audiology & Speech Sciences, Vancouver, Canada Objective. Few studies have investigated appropriate masking levels for obtaining ear‐specific bone‐
conduction thresholds in infants. In this study, effective masking levels (EMLs) for auditory steady‐state NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 132 NHS 2012
responses (ASSRs) elicited by bone‐conducted stimuli at 500 and 2000 Hz were determined for a group of normal‐hearing infants and adults. Design. Participants were 12 infants (1.5‐8.0 months) and 16 adults, all with normal hearing. Stimuli were single bone‐conducted tones that were 100 % amplitude modulated and 25% frequency modulated at 77 and 93 Hz for 500 and 2000 Hz, respectively. The stimuli were calibrated in dB HL (ANSI S3.6‐1996) and presented at 25‐35 dB HL at 500 and 35‐45 dB HL at 2000 Hz. The binaural air‐conducted maskers were 0.5‐ and 2‐kHz narrow‐band noise. Unmasked and masked ASSRs and real‐ear‐to‐coupler differences (RECDs) were obtained for each participant. Results. Infants required 12 dB more masking to eliminate the ASSR at 500 Hz compared to adults; however, there was no significant difference in EMLs at 2000 Hz between age groups. EMLs were 15 and 33 dB higher for 500 compared to 2000 Hz for adults and infants, respectively. When the masker was adjusted for RECDs, infant EMLs were 22 dB higher at 500 Hz and similar at 2000 Hz compared to adults. Con‐
clusions. Our findings indicate that lower frequencies require more masking than higher frequencies in‐
dependent of age (stimuli in dB HL); however, infants require more masking than adults, similar to pre‐
viously reported findings (Hansen & Small, in press). These results also confirm that a 500‐Hz stimulus is 22 dB more effective for infants compared to adults. The following preliminary masking levels are recommended for infants: (i) 500 Hz: 62 & 73 at 25 & 35 dB HL, respectively, and (ii) 2000 Hz: 40 & 49 dB SPL at 35 & 45 dB, respectively. N. 65 ‐ EVOKED POTENTIALS IN YOUNG CHILDREN – THE CHALLENGE Linnebjerg LB, Wetke R Aarhus University Hospital, Audiology Department, Aarhus, Denmark The diagnosis of hearing loss in very young children requires that the child be evaluated while asleep. This represents a challenge to the investigator and can postpone the time of initial diagnosis and the ini‐
tiation of proper treatment. In this study 84 children underwent auditory brainstem response (ABR) with click stimuli and auditory steady state response (ASSR) after administration of melatonin. The group of children from age 1 to 3.9 years responded best to this treatment. The success rate for test completion was 46.9 % for the control group not receiving melatonin and increased to 65,9 % for children given me‐
latonin prior to testing. Use of melatonin in uncooperative children increased the success rate of a com‐
plete examination, it meant fewer visits for these young patients and enabled our Audiology Depart‐
ment to schedule more patients in a day. Melatonin is thus considered a useful drug in order to help children sleep naturally while undergoing ABR and ASSR. N. 66 ‐ HEARING SYSTEM MATURATION IN NORMALLY HEARING CHILDREN: LONG LATENCY AUDITORY EVOKED POTENTIALS Alvarenga KF1, Ventura LMP2, Costa OA1,2 Department of Audiology and Speech Pathology at the School of Dentistry, University of São Paulo, Bauru campus, Brazil; 2Center for Audiological Research at the University of São Paulo, Bauru campus, Brazil; 1
The long latency auditory evoked potentials provide objective data on the function of hearing cortical structures. Aim: to characterize the maturation of the central hearing system, in normally hearing chil‐
dren, through these potentials. Fifty‐six subjects from both genders, with hearing within normality pat‐
terns, being 46 children in the age range 3‐12, and 10 young adults, who were included for comparison with the infantile sample. The equipment utilized had two recording channels: one to catch the long la‐
NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 133
tency auditory evoked potentials, and the other, to record the artifact generated by ocular movement, aiming at its control. The potentials were recorded with subjects alert, while watching a mute video, through electrodes positioned in Cz (active) and A2 (reference), and the ocular movements, through elec‐
trodes in left supra and infra‐orbital position and the ground electrode was placed in A1. Values of laten‐
cy and of amplitude for components P1, N1 and P2, as well as the morphology of these components, ac‐
cording to age, were analyzed. In order to verify the reproducibility of the recorded potentials, a double blind study was carried out, by introducing the analysis of an experienced Electrophysiology evaluator, whose analysis did not show statistically significant differences, as compared to that performed by the author of the research. Thus, as to morphology, improvement in the definition of components was seen, as age increased. A decrease in latency values of components P1, N1 and P2 was observed, as age ad‐
vanced. No variation was verified in amplitude values, as age increased, for components N1 and P2, ex‐
cept for component P1, whose amplitude was diminished. No statistically significant difference was seen between genders. It was verified that the maturational process of the central hearing system takes place in a gradual fashion, being the greatest modifications seen, when comparing children and adults. N. 67 ‐ EVALUATION OF BRAINSTEM TIMING IN QUIET AND NOISE IN CHILDREN WITH LEARNING DISABILITY Mamatha NM, Maggu AR, Uday K Dept. of Audiology, All India Institute of Speech and Hearing, Mysore, India The present study aimed at evaluating the brainstem timing in response to speech stimulus (BioMARK) in typically developing children and children with learning disability in quiet and in noise. Ten normal children and 5 children with learning disability in the age range of 8 to 12 years were selected for the study. All participants underwent the routine audiological test to rule out the influence of peripheral hearing loss. BioMARK response was obtained in the participants using 40 ms /da/, sampling rate of 10 KHz (Cunningham et al., 2001) and the standard protocol recommended by Kraus et al. (2008). The re‐
sponse was obtained at 80 dB nHL at 10.9/sec repetition rate and for 2000 sweeps. The recording was done in quiet as well as in presence of white noise (+30 dB SNR) presented ipsilaterally. The V, A, C, D, E, F and O peaks were marked on this calculated (weighted‐average) waveform. This was done to obtain and compare a latency measure among the two groups. Mann‐Whitney U‐test revealed a significant dif‐
ference between the two groups in terms of latency of waves. Wilcoxon signed ranks test also revealed a significant difference that in both the groups in the presence of noise (p > 0.05). The spectral data ob‐
tained by BT‐10 loaded on MATLAB version 7.8 was analyzed individual‐wise and it was found that there was no significant difference (p > 0.05) in the spectral details of the response of the LD children and typically developing children, in quiet condition. However, the spectral details of the LD group in the noise condition were significantly deviant (p < 0.05). Children with LD were found to have a brainstem timing deficit which was reflected in their BioMARK responses, which is further delayed significantly in presence of noise. This preliminary study throws light on the failure of the usage of a higher dB SNR for the children with learning disability. This study concludes that it is not enough to just increase the SNR for a better understanding and further goes ahead to emphasize on deficit specific intervention for the children with LD who have problems in auditory processing deficit. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 134 NHS 2012
N. 68 ‐ A DIRECT ESTIMATE OF NON‐LINEARITY IN TRANSIENT EVOKED OTO‐
ACOUSTIC EMISSIONS: THE BISPECTRAL APPROACH Marchesi S, Tognola G, Paglialonga A Consiglio Nazionale delle Ricerche, Istituto di Ingegneria Biomedica (ISIB‐CNR), Milano, Italy The aim of this study is to present a new method based on the bispectrum for the direct estimate of non‐
linearity in transient evoked otoacoustic emissions (TEOAEs). Non‐linearity of TEOAEs was studied by means of the third‐order scaled polyperiodogram, which is able to find out quadratic frequency cou‐
plings (QFCs). QFCs arise when there is a harmonic component in the recorded TEOAE which is not on‐
ly generated by an independent cochlear generator but is the effect of a linear combination of other two independent cochlear sources. Simulated TEOAEs were designed to test the performance of the third‐
order scaled polyperiodogram in the detection of QFCs as a function of the duration, amplitude and phase of the independent components at frequencies f1 and f2, and of the amplitude of the non‐linear component at frequency f3. Then the third‐order scaled polyperiodogram applied to TEOAEs of normal hearing adults and full‐term neonates. Results revealed that adult TEOAEs had QFCs at 2kHz, whereas neonatal TEOAEs showed QFCs between 3.5 and 4 kHz. Statistical tests revealed that QFC distribution in this two groups of subjects are significant (p<0.01). N. 69 ‐ THE DECOMPOSITION OF TRANSIENT OTOACOUSTIC EMISSIONS ON PRI‐
MARY COMPONENTS AS A TOOL FOR DETECTION OF SMALL CHANGES IN TEOAE Belov OA, Alexeeva NN, Tavartkiladze GA National Research Centre for Audiology and Hearing Rehabilitation, Moscow, Russia he primary goal of this work was to develop a stable and reliable metrics for a TEOAE signal. We sup‐
posed that significant part of TEOAE signal is generated in several loci of the cochlea, and therefore it consists of a small number of independent components. Also, in accordance with space invariance hy‐
pothesis, we supposed that all components have the similar shape, but the time scale of this shape is proportional to the component latency. We developed an algorithm for the TEOAE decomposition based on this hypothesis. The signal was re‐sampled to the nonlinear time grid. In terms of the above assump‐
tions, the signal in this grid may be expressed as a convolution of some pattern and a sequence of events, both unknown. To find them the ʹblindʹ or predictive deconvolution was used. The scheme of adaptive regularization for blind deconvolution of the signal averaged to several buffers was also designed. For fine tuning of the algorithm on a wide set of modeled data we used a cluster of Moscow University. It was found that TEOAE can be decomposed to two set of components. First set consists of typically 10 to 30 responses with shape which is close to tone burst with sharp cut‐off. The components of the second set are close to tones with constant decay. Although the developed algorithm is very time consuming it is possible to create the simplified version suitable for practical needs. The decomposition was studied on a set of TEOAE records collected using different stimulation levels with and without noise presented before recording. The results obtained will be discussed. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 135
N. 70 ‐ DISTORTION PRODUCT OTOACOUSTIC EMISSION GROWTH FUNCTION IN NEONATES Barbosa TA, Granato L, Durante A FCMSCSP, São Paulo, SP, Brazil Introduction. Distortion product otoacoustic emissions (DPOAEs) are thought to be by‐products of an active amplification process in the cochlea and thus serve as a metric for evaluating the integrity of this process. Because the cochlear amplifier functions in a level‐dependent fashion, DPOAEs recorded as a function of stimulus level, a DPOAE growth function (GF), may provide important information about the range and operational characteristic of cochlear amplifier. Objective To estimate the DPOAE slope in neonates according to the DPOAE growth curve at 2 kHz, with stimulus presentation ranging between 20 and 65 dB SPL. Methods. Participants were 10 term neonates without risk for hearing loss. Equip‐
ment was ILO V 6 –Otodynamics. Procedure the neonates were tested in a sound‐treated booth while they were sleeping. Experiment 1 DPOAE GF at 2000Hz with primary tones ranging from 20 to 65 dB SPL. Experiment 2 DPOAE GF at 2000Hz with two paradigms of primary tones Paradigm 1 primary tones ranging from 20 to 40 dB SPL. Paradigm 2 primary tones ranging from 40 to 65 dB SPL. Results. Significant differences was found through statistical analysis. Experiment 1: Right ear Slope ranged from 6.18 to 18.28 with an average of 10.68. Left ear Slope ranged from 2.87 to 17.03 with an average of 10.4. Experiment 2 Paradigm 1 Right ear Slope ranged from 1.11 to 8.08 with an aver‐
age of 3.75. Left ear Slope ranged from 0.33 to 6.89 with an average of 3.04. Experiment 2 Paradigm 2 Right ear Slope ranged from 2.26 to 9.19 with an average 5.55. Left ear Slope ranged from 1.1 to 10.6 and average of 5.19. Conclusion. The procedure was feasible for the neonatal population revealing that the slope was different depending on the method used (p<0.05). The results and methods of this evaluation will be shared in detail. N. 71 ‐ CHANGES IN TRANSIENT EVOKED OTOACOUSTIC EMISSIONS CONTRA‐
LATERAL SUPPRESSION IN NEWBORNS Martins PMF, Santos MFC University of Campinas – UNICAMP, Faculty of Medical Sciences, Department of Human Development and Reabilitation, Campinas, Brazil Studies suggest that the medial olivocochlear system function, as measured by suppression of otoacous‐
tic emissions (TEOAE), might indicate a reduced auditory inhibitory function in infants with risk indica‐
tors for hearing loss. The research of TEOAE suppression in infants at risk for retrocochlear hearing loss can be a measure of differential diagnosis of this modification. Studies with neurologically impaired in‐
dividuals suggest that they do not have the effect of TEOAE suppression. The main objective of this study was check the activity of the efferent auditory system in neonates who present and not present risk indicators for hearing loss, through research of TEOAE suppression. The research of TEOAE sup‐
pression is taking place at Faculty of Medical Sciences/Department of Human Development and Reabili‐
tation/Unicamp, through the Cochlear Emission Analyzer ILO V6 ‐ OTODYNAMICS coupled to a com‐
puter and probes for contralateral suppression., 92 newborns of Maternity Center of Integral Attention to Womenʹs Health/Unicamp participated in the research. Of these, 23 failed (group I) and 52 passed (group II) the hearing screening performed with the AABR. Group III consists of 17 full‐term newborns NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 136 NHS 2012
without risk factors for hearing loss. Results: In group I, all newborns showed absence of suppression. In group II, approximately 60.2% showed no suppression and in the group III, 14.6% presented absence of suppression. We observed significant amount of reduced levels of suppression in newborns who have at least one risk factor for hearing loss, both those who pass the hearing screening, as in that fail. The in‐
fants who failed the screening were referred directly for audiological diagnosis. We can conclude from our of partial results that there is a reduction in the values of TEOAE suppression in neonates who present risk indicators for hearing loss. N. 72 ‐ USING A DERIVED OTOACOUSTIC EMISSION CRITERION TO IMPROVE THE EFFICIENCY OF A HEARING ASSESSMENT SERVICE FOR CHILDREN UNDER FOUR YEARS OF AGE Liersch B, Mansfield D Child and Family Health Service, Newborn and Children’s Hearing, Adelaide SA, Australia In South Australia, almost ten per cent of children under four years are referred to the hearing assess‐
ment service despite implementation of Newborn Hearing Screening. Previously, all children seen in clinic were assessed by an age‐appropriate form of behavioural audiometry, requiring attendance of two appropriately‐trained staff, with a wait for appointment of about five months. Three‐quarters of children seen showed no abnormality of hearing or ear health. Objective physiological tests, viz., otoacoustic emission (OAE) measurement and tympanometry, can be administered more quickly, and by just one staff member, than can behavioural testing of this age group. The OAE profile (Transient‐Evoked OAE measured in half‐octave frequency bands) of a group of children under four years with normal middle ear function and behavioural hearing response was reviewed to derive a “pass/fail” criterion that could be applied to all referred children to select with acceptable safety and efficiency those requiring full be‐
havioural hearing assessment and otological examination. Implementation over the past year of these objective tests for initial assessment of young children has resulted in large improvements in length of wait for an appointment, attendance at appointments, numbers of children assessed and effective use of staff time. N. 73 ‐ ANALYSIS OF EAR‐CANAL DYNAMIC CHARACTERISTICS IN NEONATES: THEORETICAL CONSIDERATIONS Murakoshi M, Takeda S, Wada H Department of Bioengineering and Robotics, Tohoku University, Sendai, Japan The sweep frequency impedance (SFI) meter was designed to measure the dynamic characteristics of the middle ear in adults and children [Wada et al., Ear. Hear., 1998]. It measures sound pressure level (SPL) in the external ear canal when a sound of the sweeping sinusoidal frequency between 0.1 kHz and 2.0 kHz is delivered into this canal. During the measurement, the ear‐canal static pressure is changed from 200 daPa to ‐200 daPa. While the SFI meter has been successfully used to detect middle ear problems in adults and children, its application to neonates has never been explored. To extend its versatility, the SFI meter has been redesigned, and SFI tests were performed in neonates. As a result, the SPL was found to show two variations at around 0.3 kHz and 1.3 kHz. Since the SPL shows a variation at 1.3 ± 0.3 kHz due to the resonance of the middle ear in normally hearing adults and children [Zhao, Wada et al., Ear. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 137
Hear., 2002], the variation found around 1.3 kHz is probably related to such resonance in neonates. However, the source of the variation at around 0.3 kHz is still unclear. One possibility is the movement of the wall of the external ear canal because this wall is known to be much softer than that of adults and easily deforms. In the present study, therefore, to investigate the dynamic characteristics of the neonatal external ear canal, finite‐element models of the canal were developed. Modal analyses were then per‐
formed in these models by a commercially available finite element analysis program. As a result, a reso‐
nance was found at around 0.3 kHz. This result suggests that the first variation of the SPL curve found in neonates may be related to the resonance of their external ear canal. N. 74 ‐ DYNAMIC CHARACTERISTICS OF THE MIDDLE EAR IN NEWBORNS – STUDY USING THE SWEEP FREQUENCY IMPEDANCE (SFI) METER Wada H1, Yoshida N1, Kiyokawa H3, Murakoshi M1, Matsutani S2, Kobayashi T3 Department of Bioengineering and Robotics, Tohoku University, Sendai, Japan; 2Department of Otorhinolaryngology, Japa‐
nese Red Cross Sendai Hospital, Sendai, Japan; 3Department of Otorhinolaryngology, Head and Neck Surgery, Tohoku Uni‐
versity School of Medicine, Sendai, Japan 1
Hearing disorders occur in about 1 out of every 1,000 neonates. Although early diagnosis and treatment of such disorders in neonates is highly effective for realization of linguistic competence and intellectual development, it is difficult to diagnose hearing disorders in neonates. In our previous studies, to objec‐
tively and quickly evaluate the dynamic characteristics of the middle ear, a sweep frequency impedance (SFI) meter was developed, which allowed the diagnosis of the middle‐ear dysfunction in adults and children [Wada et al., Ear. Hear., 1998]. The SFI utilizes a different approach from conventional and cur‐
rent multi‐frequency tympanometers. That is, it does not measure the admittance of the middle ear; in‐
stead, it measures the sound pressure level (SPL) in the ear canal. A sound of the sweeping sinusoidal frequency between 0.1 kHz and 2.0 kHz is presented to the ear canal by a probe earphone while the static pressure of the ear canal is held constant by an air pump incorporated in this apparatus. During this procedure, the SPL is measured. The measurements are performed at 50‐daPa intervals of the static pressure from 200 daPa thorough ‐200 daPa. In the present study, the SFI meter was redesigned for neo‐
nates, i.e., the size of the measurement probe was reduced to match the diameter of ear canal entrance of neonates. By using this newly designed SFI meter, the SFI test was performed in healthy neonates. As a result, it was found that the SPL showed two variations at around 0.3 kHz and 1.3 kHz, while the SPL usually shows only one variation at 1.3 ± 0.3 kHz in normally hearing adults and children [Zhao, Wada et al., Ear. Hear., 2002]. This result suggests that the dynamic characteristics of the middle ear in neonates differ from those in adults and children. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 138 NHS 2012
N. 75 ‐ ‘SIGN SCIENCE’: USING INTERNATIONAL VALIDATED QUESTIONNAIRES IN SIGN LANGUAGE OR SIGN SUPPORTED LANGUAGE FOR EPIDEMIOLOGICAL AND QUALITY OF LIFE RESEARCH ON HEARING ADOLESCENTS Smeijers AS1, Bogaerde B2, Ens‐Dokkum M3, Oudesluys‐Murphy AM1 Willem‐Alexander Children’s Hospital, Leiden University Medical Centre ‐ Department of social paediatrics, Leiden, The Netherlands; 2Utrecht University of Applied Sciences ‐ Department of Sign, Language and Deaf Studies, Utrecht, The Nether‐
lands; 3Kentalis School for the Deaf, Medical department, Zoetermeer, The Netherlands. 1
International research has shown that deaf adults have a significantly poorer quality of life than the gen‐
eral population with regard to the physical and psychological domains. This is why some countries, like England, Austria and Japan, have specialised health care facilities for deaf people. In the Netherlands such facilities are not available. We are presently performing a large epidemiological and quality of life study of deaf and hard of hearing adolescents and adults in the Netherlands. Though it has long been known that hearing impaired clients are often misdiagnosed, little scientific attention has been paid to the tests used with this group. Although these clients may have poor spoken language skills and a dif‐
ferent (cultural) background to mainstream clients, regular diagnostic tests are used, even in specialized settings. To enable the use of standardized questionnaires without language barriers, we developed a guideline for adapting internationally validated questionnaires and translating them into sign language. We used this guideline to adapt and translate four questionnaires into Sign Language of the Netherlands (Nederlandse Gebarentaal, NGT). The questionnaires were pre‐tested and administered to a sample of 350 adult participants. The questionnaires in NGT and sign supported Dutch showed a high level of internal consistency. The same methodology is currently being used in a group of adolescents. We will debscribe the process of selecting and translating research instruments for testing hearing impaired people and translating into sign language of the Netherlands (SLN). We will also present the protocol we have de‐
veloped, discuss the problems, dilemmas and ethical issues we encountered and elaborate on the choices we have made. This methodology may prove very useful for international researchers and clinicians working with sign language users as it may also be applied to other sign languages. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 139
HEARING LOSS AND MEDICAL CONDITIONS N. 76 ‐ ANALYSIS OF RISK FACTORS ASSOCIATED WITH BILATERAL HEARING LOSS IDENTIFIED THROUGH NEWBORN HEARING SCREENING Dodson KM1, Chapman DA2,3, Wang S3, Pandya A4 Virginia Commonwealth University Departments of 1Otolaryngology/Head and Neck Surgery, 2Epidemiology, and 4Human and Molecular Genetics. 3Virginia Department of Health. Objective. To analyze the incidence of Joint Committee on Infant Hearing (JCIH) risk factors and co‐
occurring birth defects in children with bilateral hearing loss (BHL). Methods. Retrospective record re‐
view of 694 children with confirmed BHL identified through universal newborn hearing screening (UNHS) program in Virginia from 2002‐2008. Summary of Results. Of the 694 children with confirmed bilateral hearing loss, 674 (97.1%) were identified through failed UNHS. Of those who failed UNHS, 478 (71%) had no JCIH risk factors and 196 (29%) infants had one or more risk factor reported. Twenty chil‐
dren (2.8%) with one or more risk factors passed UNHS but had later onset BHL. Family history of per‐
manent childhood hearing loss was the most commonly reported JCIH risk factor in 85 (43.4%) children. Neonatal indicators (such as hyperbilirubinemia, persistent pulmonary hypertension, and use of ECMO) were present in 15% of children, and stigmata or other factors associated with a syndrome including hearing loss were present in 18%. Overall, a co‐occurring birth defect was identified in 236 children with bilateral hearing loss (34.4%), and in 103 ( 53%) of the 196 children with BHL and a JCIH risk factor. Cardiovascular anomalies were most the most common co‐occurring birth defect, followed by muscu‐
loskeletal anomalies. Conclusion. Nearly thirty percent of children with confirmed BHL had a JCIH risk factor, most commonly family history of hearing loss, stigmata of syndromes associated with hearing loss, and neonatal indicators. In addition over thirty percent of children with confirmed bilateral hearing loss had a comorbid birth defect. However, a lack of JCIH risk factors does not preclude development of hearing loss and further studies assessing the etiology of BHL and risk factor and comorbid birth defect associations are warranted. N. 77 ‐ HEARING TESTS ON CHILDREN WITH CLP TREATED AT THE STOCKHOLM CRANIOFACIAL CENTER KAROLINSKA UNIVERSITY HOSPITAL Tengroth B Departement of Audiology and Neurootology; Karolinska University Hospital, Solna, Sweden Background. Cleft lip palate (CLP) children often have delays in speech and language development. As CLP is generally associated with otitis media with effusion (OME) many reports suggest OME to con‐
tribute to a delayed speech and language development. The question if OME and the resulting conduc‐
tive hearing loss will cause a delayed speech and language development is still to be answered. The aim of the present study was to elucidate the occurrence of OME and hearing impairment and number of VT treatments in children with CLP without any associated diagnoses, treated at The Stockholm Craniofa‐
cial center, Karolinska University Hospital during 2005‐2011. Method. Medical records from 19 consecu‐
tive children born with CLP in 2005 were reviewed. The results of neonatal hearing screening tests us‐
ing TOAE and/or ABR, VT treatment,BOEL test at the age of 2,5‐24 months were recorded. The final NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 140 NHS 2012
outcome was elucidated by hearing tests at 5‐6 years of age. Result. Thirteen CLP children were tested neonatally with OAE and 5 passed. One of eight children tested with ABR had normal thresholds. Six out of twelve children tested with Boel‐test passed bilaterally. 18/19 children were treated with VT. At the age of 5‐6 years 7 of 15 tested children presented normal hearing results. Six children had increased thresholds between 25‐50 dB bilaterally, 2 children had unilaterally increased thresholds 25‐30 dB and in 4 children there were no available information. Conclusion. The results show that CLP children have a high risk of not passing the regular early infant hearing screening tests. It is thus possible that the OME generally occurring in CLP children and causing impaired hearing will influence the speech and lan‐
guage development in CLP children. However if this differs from children with OME without CLP has to be elucidated. Such a controlled study is in progress at the Karolinska University Hospital. N. 78 ‐ DO NEWBORNS WITH CRANIOSYNOSTOSIS HAVE AN INCREASED INCI‐
DENCE OF AUDITORY NEUROPATHY? Scheele JE1, Hubbard BA2, Rice GB3, Muzaffar AR4 Division of Plastic Surgery University of Missouri, Columbia, MO, USA; 2Department of Plastic Surgery University of Texas, USA; 3Department of Communication Disorders and Deaf Education, Fontbonne University St. Louis, MO, USA; 4Division of Plastic Surgery, University of Missouri, Columbia, MO, USA 1
Craniosynostosis is the premature fusion of cranial sutures. A possible consequence of this fusion is in‐
creased intracranial pressure which is associated with auditory neuropathy. This poster presentation will report the results of a study conducted to investigate the incidence of auditory neuropathy in new‐
borns with craniosynostosis compared to published standards. The study consisted of a retrospective re‐
view of consecutive babies diagnosed with single or multiple‐suture craniosynostosis who were evalu‐
ated between 2002 and 2009 at a single craniofacial center. Babies were assigned to groups based on su‐
ture involvement. The newborn ABR screening and diagnostic results of audiologic assessment were obtained from the Missouri Department of Health. Institutional review board approval was obtained prior to data collection. One hundred and thirty‐five subjects were identified. Seventy‐two were ex‐
cluded because they were listed as “missed” (3) or were not born in‐state (69). The 63 subjects included in the study were grouped by involved sutures; 2 left coronal, 7 right coronal, 2 nonsyndromic bicoronal, 3 syndromic bicoronal, 13 sagittal, 17 operative metopic, 15 nonoperative metopic, 1 pansynostosis, and 3 multiple‐suture. Of the 63 babies, 94% (59/63) passed their ABR screening. Four (6%) were referred for audiologic assessment. Of these, one had a normal exam (right coronal synostosis) and three did not have diagnostic exams on file (right coronal, bicoronal syndromic, and bicoronal non‐syndromic). Ac‐
cording to the U.S. Centers for Disease Control, 1.8% of newborns failed their ABR screening in 2007. Of those, 37% were found to have normal hearing on diagnostic exam. Although our study was inconclu‐
sive due to inadequate state records, results do demonstrate an increased incidence of abnormal screen‐
ing ABR’s in infants with coronal craniosynostosis, consistent with results of other studies. Since these abnormalities are present at birth, it is unlikely that they are related to increased intracranial pressures. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 141
N. 79 ‐ THE PARADOX OF MATERNAL IMMUNITY AS A RISK FACTOR FOR CON‐
GENITAL CYTOMEGALOVIRUS INFECTION: A POPULATION‐BASED PREDICTION MODEL de Vries JJC1, van Zwet EW2, Kroes ACM1, Verkerk PH3, Vossen ACTM1 Department of Medical Microbiology, Leiden University Medical Center; 2Mathematical Institute, Leiden University Medical Center; 3TNO Child Health, Leiden, the Netherlands 1
Context. Maternal immunity to cytomegalovirus (CMV) provides substantial protection against severe congenital CMV disease. Paradoxically, the prevalence of congenital CMV increases with CMV seroprevalence in the underlying population. Objective. To quantify the contribution of non‐primary maternal CMV infection on the disease burden of congenital CMV as a function of the seroprevalence in the population. Design. On population‐based prediction model was developed and applied for a wide range of CMV seroprevalence. Main outcome measures. The estimated proportion of children with con‐
genital CMV and CMV‐related sequelae attributable to non‐primary maternal infection, with CMV seroprevalence in the population as independent variable. Additionally, the risk for preconceptionally seropositive pregnant women of having a congenitally‐infected newborn, compared to this risk for seronegative pregnant women, as a function of the seroprevalence. Results. Both the proportion of new‐
borns with congenital CMV and the proportion of newborns with sequeale, attributable to non‐primary maternal infections increased with CMV seroprevalence in the underlying population. These propor‐
tions ranged up to 96% (95%CI 88‐99%) and 89% (95%CI 26‐97%), respectively, in populations with seroprevalence of 95%. Furthermore, seropositive pregnant women were found to be at higher risk of having a congenitally infected newborn than seronegative pregnant women, for all population CMV seroprevalence values. In contrast, seropositive pregnant women were at lower risk of having a newborn sequelae related to congenital CMV than seronegative pregnant women. Conclusions. Our data stress the impact of non‐primary congenital CMV infection on the disease burden of congenital CMV, among all (sub)populations. Awareness of the risk for seropositive women of having a newborn with CMV‐
related sequelae will have significant consequences for preventive strategies including hygienic counsel‐
ing, maternal serological screening, and immunization studies. N. 80 ‐ CONGENITAL CYTOMEGALOVIRUS (CMV) INFECTION IN THE NETHER‐
LANDS: BIRTH PREVALENCE AND RISK FACTORS de Vries JJC1, Korver AMH2, Verkerk PH3, Rusman L1, Claas ECJ1, Loeber JG4, Kroes ACM1, Vossen ACTM1 Department of Medical Microbiology, Leiden University Medical Center, The Netherlands; 2 Willem‐Alexander Children and Youth Center, Sub‐Department of Social Pediatrics, Leiden University Medical Center, The Netherlands; 3 TNO Child Health, Leiden, The Netherlands; 4 National Institute for Public Health and the Environment, Laboratory for Infectious Diseases and Perinatal Screening, Bilthoven, The Netherlands 1
Congenital cytomegalovirus (CMV) infection is the most common congenital viral infection worldwide. The sequela encountered most frequently is hearing impairment, affecting approximately one out of five congenitally infected infants. Data on the birth prevalence and risk factors of congenital CMV infection in the Netherlands are scarce. The aim of this study was to determine the birth prevalence of congenital CMV in the Netherlands. A sample of 6500 dried blood spots (DBS) from infants born in the Netherlands was tested anonymously for CMV DNA. The sample was stratified by the number of live births in dif‐
NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 142 NHS 2012
ferent regions of the Netherlands of the year 2007. Additionally, on a regional level, risk factors for con‐
genital CMV were analyzed. The birth prevalence of congenital CMV in the Netherlands was 0.54% (35/6433, 95%CI 0.36‐0.72). Congenital CMV infection was significantly higher in regions with more than 15% young children (0‐5 years) compared with regions with a lower proportion of young children (OR 5.9, 95%CI 1.4‐25.2). Furthermore, congenital CMV infection was significantly higher in regions with more than 30% immigrants compared with regions with a lower proportion of immigrants (OR 2.2, 95%CI 1.1‐4.6). This association was strongest for regions with more than 30% non‐Western immigrants (OR 3.3, 95%CI 1.5‐7.5). Based on the knowledge of the natural history of congenital CMV infection, ap‐
proximately 1000 children are born with congenital CMV infection in the Netherlands annually, of whom eventually approximately 180 children (0.1% of all newborns) will be affected by long term seque‐
lae, with hearing loss being the most frequently encountered symptom. N. 81 ‐ TWO EXAMPLES OF STUDIES INTO RARE POPULATIONS MADE POSSIBLE BY THE COMPREHENSIVE COLLECTION OF INFORMATION BY THE UNIVERSAL NEW‐
BORN HEARING SCREENING PROGRAMME IN ENGLAND Maier‐McAlpine J K, Davis A MRC Hearing & Communication Group, c/o Royal Free Hampstead NHS Trust, London, United Kingdom Very often research into rare populations leads to no results and little information that clinicians and families can use. The comprehensive information system of the Newborn Hearing Screening Programme in England has enabled us to carry out research on two conditions – Sudden Infant Death Syndrome (SIDS) and children affected by Congenital Cytomegalovirus (cCMV). I. SIDS accounts for approxi‐
mately one fifth of infant deaths under one year of age in the in UK. Although risk factors are now well defined, the aetiology of SIDS remains obscure. As part of the UK’s Newborn Hearing Screening Pro‐
gramme, hearing is assessed by sound stimulation that evokes so called oto‐acoustic emissions (OAEs), a physiological biomarker for hearing function. A potential link between hearing function and SIDS was demonstrated (Rubens, 2007), whereby the OAE profile of SIDS cases was found to be altered compared with those of control infants. This finding points to an association between inner ear function and SIDS, and suggests that infants at risk of SIDS might be identified through routine, non‐invasive hearing screening. We are planning to assess the relationship between OAEs and SIDS and to determine whether an altered OAE profile in SIDS infants is associated with neurotransmitter abnormalities in brainstem pathways related both to cardio‐respiratory and auditory processing. II. cCMV infection can lead to pro‐
gressive childhood hearing loss. To allow for treatment it is crucial to test newborns within the first 28 days of life for cCMV. We are currently involved in a feasibility study on screening for cCMV in new‐
borns referred to audiological assessment following the newborn hearing screen. Five hospitals across the UK are currently included in the feasibility study. Based on the outcome we are seeking to establish routine newborn screening for cCMV, potentially as part of the UK’s Newborn Hearing Screening Pro‐
gramme. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 143
N. 82 ‐ COULD HYPERNATREMIA INFLUENCE THE NEONATAL HEARING STATUS? Boskabadi H1, Nourizadeh N2 Mashhad university of medical sciences, Qaem hospital, Pediatric department, Mashhad, Iran; 2Mashhad university of medi‐
cal sciences, Imam Reza hospital, Otolaryngology department, Mashhad, Iran 1
Introduction. This study is designed to evaluate the hypernatremia effect on neonatal hearing status. Material & Method. Neonates with hypernatremia who were admitted to NICU were introduced to the study and screening OAE was taken from these patients and if a patient refers by this test it would con‐
firm by ABR test and repeated one month later. These results compared with the control group results. Results. From 50 case group members, 4 had impaired hearing status instead of none in the control group. This was not a significant difference between two groups. (p value = 0.83). After 1 month all of the case members had normal hearing level. Conclusion. Hypernatremia could not have a significant ef‐
fect on hearing level of neonates. N. 83 ‐ CENTRAL AUDITORY DISCRIMINATION IN TODDLERS IS AFFECTED BY RE‐
CURRENT ACUTE OTITIS MEDIA Lapinlampi S1,2, Niemitalo‐Haapola E2,3, Kujala Tiia4, Raappana A4, Kujala Teija5,6, Jansson‐Verkasalo E1,2 University of Turku, Faculty of Social Sciences, Department of Behavioural Sciences and Philosophy, Logopedics, Turku, Finland; 2Oulu University Hospital, Neurocognitive Unit, Oulu, Finland; 3University of Oulu, Faculty of Humanities, Logopedics, Oulu, Finland; 4University of Oulu, Institute of Clinical Medicine, Department of Otorhinolaryngology, Oulu, Finland; 5Cicero Learning, University of Helsinki, Helsinki, Finland; 6University of Helsinki, Institute of Behavioural Sci‐
ences, Cognitive Brain Research Unit, Helsinki, Finland 1
Introduction. In early childhood, about 30% of children undergo recurrent acute otitis media (RAOM) episodes causing fluctuant hearing loss. The effects of this temporary hearing loss on central auditory processing in the period of rapid linguistic development are still unclear. Methods. An electrophysio‐
logical tool, the multi‐feature mismatch negativity (MMN) paradigm with semisynthetic syllable stimuli, was used to investigate cortical auditory discrimination of frequency and vowel duration changes. Chil‐
dren were 22‐26 months of age in both RAOM (N=20) and control (N=19) group. At the time of the measurement, clinically healthy ears were required. Results. Significant MMN responses for both devi‐
ants were elicited in both groups of children. In the RAOM group, MMN peak amplitude for the fre‐
quency deviant was strongest at the left‐side electrode C3 and in the control group at the right‐side elec‐
trode C4. This difference was statistically significant. No statistical differences were found in the MMNs for the vowel duration change or the processing speed of stimuli. Conclusions. According these pre‐
liminary results, children with RAOM had a left hemispheric lateralisation, whereas in the control group the MMN for the frequency change was right hemispheric dominant as usually reported in adults. The difference may represent physiologic changes in central auditory processes and signify slower matura‐
tion of efficient speech sound processing in children with RAOM compared to healthy controls. In con‐
trast, children with RAOM were able to cortically discriminate vowel duration change as well as con‐
trols. This may be due the fact that vowel duration change, being more salient than frequency change and having a semantically distinctive role in Finnish language, is very easy to discriminate already at the age of two. However, a more extensive analysis is needed to obtain a comprehensive view about the ef‐
fects of RAOM on central auditory processing and possible effects on language development. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 144 NHS 2012
N. 84 ‐ PROPOSED CLINICAL TRIAL ASSESSING THE EFFICIENCY/EFFECTIVENESS OF XYLITOL NASAL SPRAY IN PREVENTING ACUTE OTITIS MEDIA IN THE UNITED STATES Johnson CE1, Danhauer JL2, Fisher SK1, Hunt A1, Piper C1, Wilson L1, Smith R2, Teller C2, Umeda C2 Dept. of Communication Disorders, Auburn University, Alabama, USA; 2Dept. Speech and Hearing Sciences, University of California Santa Barbara, USA 1
Xylitol may prevent acute otitis media (AOM) in children when chewed in gum or consumed in syrup. Unfortunately, young children cannot chew gum, parents exhibit difficulty complying with dosage regimens, and audiologists and physicians in the United States are unfamiliar with and do not use xyli‐
tol for these purposes. Xylitol nasal spray may be a more effective and efficient vehicle. A double‐
blinded, prospective, randomized, controlled clinical trial (DBPRCT) is proposed here to evaluate the ef‐
ficacy of xylitol nasal spray for preventing AOM in children. The DBPRCT will be conducted as part of a community AOM prevention program for families and health‐care professionals to provide information about prophylactic measures, signs/symptoms, and use of a xylitol nasal spray in preventing AOM. Families and their health‐care providers will be randomly assigned to treatment/control groups with double‐blinded administration of the xylitol nasal spray and placebo (saline solution). Assigned coun‐
selors will maintain regular contact with families to facilitate compliance with the protocol and adher‐
ence to documentation. Parents must agree to visit their pediatrician/family physician when their child displays symptoms of AOM for accurate diagnosis. Dependent variables will include the number of di‐
agnoses of AOM and problems encountered in executing the DBPRCT. Dropouts will be accounted for through intention‐to‐treat analyses. Data management will be handled through an independent center. Design and execution of the DBPRCT will be strengthened through interaction with colleagues in an in‐
ternational venue. A small DBPRCT assessing xylitol nasal spray in the prevention of AOM will be the foundation for future studies of its effectiveness and efficiency. N. 85 ‐ BJORNSTAD SYNDROME ‐ SENSORINEURAL HEARING LOSS AND PILI TORTI Gomes CA, Serrano M College of Health Technology of Coimbra, Portugal Bjornstad syndrome is an extremely rare congenital condition involving deafness and hair abnormalities. It was first characterized in 1965, in Oslo, by prof. Roar Theodor Bjørnstad and thirty‐eight cases have been reported after it was described. The Bjornstad syndrome is characterized by sensorineural hearing loss and pili torti. The hearing loss is congenital, typically sensorineural, affects both ears and with vari‐
able severity. The hearing deficit may become evident in the first three to four years of life. The hearing problems vary from deafness to reduced hearing in defined frequencies. Pili torti (twisted hairs), is a condition in which the hair shafts are flattened at irregular intervals and twisted 180 degrees from the normal axis, making the hair extremely brittle, and it is usually recognized early in childhood. Both autosomal dominant and recessive inheritance patterns have been reported in the medical literature. Currently, an autosomal recessive mode of inheritance is suggested for the syndrome, and the gene lo‐
cus has been mapped to the 2q34‐q36. However, when pilli torti is seen without associated findings is of‐
ten inherited autosomal dominantly. There are two possible candidate genes of causing Bjornstad syn‐
drome: 1) the IFAP gene and closely linked genes coinheritance in the 2q34‐q36 region, who products are intermediate filament and intermediate filament‐associated proteins and 2) the BCS1L gene that disrupts NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 145
the assembly of mitochondrial respirasomes, which are the basic unit for respiration in human mito‐
chondria. The aim of the present work is to describe a rare disorder associated with sensorineural hear‐
ing loss. N. 86 ‐ EVALUATION OF TREATMENT THRESHOLDS FOR UNCONJUGATED HYPER‐
BILIRUBINEMIA ON HEARING LOSS IN PRETERM INFANTS Hulzebos CV1, van Dommelen P2, Verkerk PH2, Dijk PH1, van Straaten HLM3 Department of Pediatrics, Division of Neonatology, Beatrix Children’s Hospital, UMC Groningen, Groningen, The Nether‐
lands; 2Department of Behavioural and Societal Sciences, TNO, Leiden, The Netherlands 3Department of Pediatrics, Division of Neonatology, Isala Clinics Zwolle, Zwolle, The Netherlands 1
Aim: To determine the incidence of hearing loss in jaundiced preterm infants treated at high and low To‐
tal Serum Bilirubin (TSB) thresholds. Design: In this retrospective study, Dutch NICU graduates (gesta‐
tional age < 32 weeks) were included when treated with phototherapy for unconjugated hyper‐
bilirubinemia at high or low TSB thresholds, i.e. according to old or new guidelines. Low TSB thresholds comes down to a reduction of approximately 25% depending on birth weight and hour. Infants with ma‐
jor congenital malformations, syndromes, chromosomal abnormalities or toxoplasmosis, rubella, cy‐
tomegalovirus, herpes, syphilis, and human immunodeficiency viral infections were excluded. Back‐
ground characteristics, clinical characteristics and repeated TSB levels in the first 10 postnatal days were collected. The two‐stage automated auditory brainstem response (AABR) screening programme and re‐
sults on the diagnostic Audiology Brainstem Response (ABR) defined a normal hearing status or unilat‐
eral or bilateral hearing loss (>35 dB). Results: A total of 479 and 144 patients were included in respec‐
tively the high and low threshold group. Gestational age (29.5  1.7 wks vs. 29.5  1.6 wks) and birth weight (1300  351 g vs. 1312  311 g) were similar in both groups. Mean measured TSB levels differed significantly: 152  43 μmol/L in the high threshold group and 131  37 μmol/L in the low threshold group (p<0.001). The incidence of hearing loss was 2.7% in the high and 1.4% in the low TSB threshold group (OR=1.98, 95%; CI:0.44‐8.88). Conclusion: The incidence of hearing impairment in jaundiced pre‐
term infants treated at high TSB thresholds is almost two times higher compared to infants treated at low TSB thresholds. Further research with a larger sample size is warranted to establish this potential ef‐
fect of high level hyperbilirubinemaia on the incidence of hearing loss in very preterm infants. N. 87 ‐ FOLLOW‐UP OF NEWBORNS WITH HYPERBILIRUBINEMIA COMPARED TO THE HEALTHY BABIES WITH NO RISK FACTOR RELATED WITH CONGENITAL HEARING LOSS BY AUDITORY BRAINSTEM AUDIOMETRY Toros M1, Kemaloğlu YK1, Türkyılmaz C2, Onal EE2, Gökdoğan Ç1 ORL‐ HNS Department, Audiology Subdivision, Gazi University Faculty of Medicine, Ankara, Turkey; 2Pediatrics – Neona‐
tology Department, Gazi University Faculty of Medicine, Ankara, Turkey 1
Neonatal hyperbilirubinemia (NHB) is an important deteriorating factor of the auditory system and brainstem. This study included 34 babies with NHB in which phototherapy were required, and 36 babies without either NHB/jaundice or any known risk factor. The data of the newborn hearing screening (NHS) program and the clinic tests by auditory brainstem response (ABR) at the 3rd and 6th months were prospectively followed. The first fail‐ratios by automated ABR (a‐ABR) were 26.5% and 8.33% in NHB NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 146 NHS 2012
and control groups, respectively. In the 3rd month, the fail rates were found to be 8.7% in NHB (n:23) and 5.26% in the control (n:19) groups; clinical ABR tests presented abnormal wave‐morphology with coch‐
lear microphonics (CM) in 13% and 5.3% of NHB and control groups, respectively. Although no differ‐
ence was found in absolute latency (AL) and amplitudes and normal hearing were detected, rate of the subjects in which both AL and inter‐peak latency (IPL) were out of range of +/‐1 standard deviation (SD) was significantly higher in NHB group. In the 6th month, in neither NHB (n:16) nor control (n:11) groups neither CM nor differences in any latency or amplitude values were detected. The rate of the subjects in which IPL was out of range of +/‐1 SD was higher in NHB group. Further, both III‐ and V‐AL and I‐III and I‐V IPL values in the 3rd month were longer than in the 6th month. This data showed that, in the 6th month, apparent hearing loss might not be detected in the NHB‐babies presenting fails by a‐ABR and even CMs in the 3rd month. Besides, extreme latency values appeared to be more common in NHB group, even if they passed NHS. Therefore, longer follow‐up of the babies with NHB (even more than 6 months) will prevent not only mislead or overrate but also overlook. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 147
GENETICS OF HEARING LOSS N. 88 ‐ GENETIC SCREENING OF 40 GENES IN 140 SPANISH FAMILIAL CASES OF AUTOSOMAL RECESSIVE NON‐SYNDROMIC HEARING IMPAIRMENT: TOWARDS THE ESTABLISHMENT OF ITS GENETIC EPIDEMIOLOGY IN A WESTERN EUROPEAN POPULATION Serrao de Castro L, Gandía M, Domínguez‐Ruiz M, Ruiz‐Palmero L, Rodríguez‐Ballesteros M, Charaf R, Olarte M, Aguirre LA, Garrido G, Gómez‐Rosas E, Moreno‐Pelayo MA, del Castillo FJ, Villamar M, Moreno F, del Castillo I Hospital Universitario Ramón y Cajal, IRYCIS, Unidad de Genética Molecular, Madrid, Spain and Centro de Investigación Biomédica en Red de Enfermedades Raras, Unidad 728, Madrid, Spain Up to 80% of cases of hereditary childhood non‐syndromic hearing impairment (NSHI) follow an auto‐
somal recessive (AR) pattern of inheritance. To date, forty genes are known whose mutations cause AR‐
NSHI. Most of these mutations were found in large consanguineous families from Asian or African ori‐
gin. The spectrum and frequency of mutations in those 40 genes are poorly known in Europe, where the predominant type of familial case contains just two or three affected subjects. We have investigated this issue in 140 Spanish familial cases of AR‐NSHI, each one containing at least two affected siblings. All siblings from each family and their parents were genotyped for microsatellite markers closely linked to each gene. In families showing compatibility with linkage to a specific gene, we sequenced all exons and intronic flanking regions of one affected family member. The segregation of sequence variants was sub‐
sequently followed in other family members. We found causative mutations in 101 of 140 investigated families (72.9%). As expected, the largest contribution corresponds to the DFNB1 locus (GJB2 and GJB6 genes), with 63 cases (45.0% of the investigated families). Eight other genes show significant contribu‐
tions: OTOF (9 cases, 6.4%), MYO15A (7 cases, 5.0%), SLC26A4 (4 cases, 2.9%), STRC (4 cases, 2.9%), TMC1 (3 cases, 2.1%), MYO7A (2 cases, 1.4%), TMPRSS3 (2 cases, 1.4%), and PCDH15 (2 cases, 1.4%). In addition, CDH23, TECTA, TRIOBP, PJVK, TMHS and LOXHD1. contributed just one case (0.7%) each. Most mutations were novel and private. To our knowledge, this is the first comprehensive study on the genetic epidemiology of AR‐NSHI in a Western European population. Our data suggest that diagnostic strategies based on re‐sequencing will significantly increase the elucidation rate. The high proportion of private mutations indicates that microarray‐based techniques for detecting specific mutations should be much less efficient. N. 89 ‐ MASSIVE TARGETED RESEQUENCING FOR THE DIAGNOSIS OF HEARING IMPAIRMENT: A 69‐GENE PANEL Romera‐López A1, Gómez‐Rosas E2,3, Collado C1, Rodríguez‐De Pablos R1, Fernández‐Pedrosa V1, Cantalapiedra D1, Pérez‐Cabornero L1, Lázaro M, Rosa‐Rosa JM1, Triviño JC1, Zúñiga‐Trejos S1, Miñambres R1, Gil M1, del Castillo I2,3, Santillán S1 Sistemas Genómicos, Paterna, Valencia, Spain; 2Hospital Universitario Ramón y Cajal, IRYCIS, Unidad de Genética Molecular, Madrid, Spain; 3Centro de Investigación Biomédica en Red de Enfermedades Raras, Unidad 728, Madrid, Spain 1
NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 148 NHS 2012
Hearing impairment (HI) is the most frequent sensory disorder, with a big impact in the quality of life of affected individuals. About 1 of 500 children present with prelingual HI. In addition, the prevalence of postlingual HI increases with age. Genetic causes underlie over 60% of cases. Early detection is essential for the success of special education and treatments, so genetic testing is being increasingly demanded. To date, conventional techniques have been insufficient to provide a comprehensive molecular diagno‐
sis, given the high number of genes that are implicated in HI. We designed an NGS targeted resequencing panel for 69 genes, including: i) all genes currently known to be involved in non‐
syndromic HI (NSHI), with autosomal dominant, recessive, X‐linked and maternal‐mitochondrial inher‐
itance patterns; ii) genes involved in some syndromic conditions, especially those in which HI is the clin‐
ical sign that is earliest observed, usually resulting in a primary diagnosis of NSHI (e.g. Usher syn‐
drome). The panel includes a total of 0.49 Mb comprising coding exons, splice sites and 5’ and 3‘ un‐
translated (UTR) regions of the 69 genes. These regions were fully sequenced in 12 control patients with known mutations and in two HapMap cell lines (NA12144 and NA12892). Enrichment of the exonic re‐
gions was carried out using SureSelect Enrichment System (Agilent) and sequencing was performed with a SOLiD 4 Genetic Analyzer (Life Technologies). Sequencing reads were mapped and aligned against a ref‐
erence sequence (GRCh37/hg19); variants were identified and classified into point mutations, structural variations, small indels or transcriptional‐level‐implicated variations. We present the results obtained during the validation of our panel, showing its a high level of efficiency. Our targeted re‐sequencing sys‐
tem offers massive analysis of 69 genes involved in HI, making the comprehensive molecular diagnosis of this disorder feasible. N. 90 ‐ NOVEL GENETIC TOOLS TO SCREEN FOR DEAFNESS‐CAUSING MUTATIONS IN THE TANDEMLY‐DUPLICATED REGION THAT CONTAINS THE STRC (STEREO‐
CILIN) GENE AND PSEUDOGEN Ruiz‐Palmero L, Gandía M, Gómez‐Rosas E, Villamar M, Moreno F, del Castillo I, del Castillo FJ Hospital Universitario Ramón y Cajal, IRYCIS, Unidad de Genética Molecular, Madrid, Spain and Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain Devising successful molecular diagnostic strategies for recessive hereditary hearing impairment (HHI) meets two major hurdles: the extraordinary genetic heterogeneity of this condition and the lack in most cases of distinctive clinical signs that provide clues about which genes may underlie HHI in a given pa‐
tient. Thus, current molecular diagnosis of HHI is usually restricted to screening those genes or muta‐
tions most prevalent in each population. Usually, over half of patients with recessive HHI remain undi‐
agnosed after this screening. We report here a novel protocol for the molecular screening of the STRC gene, encoding the hair‐bundle protein stereocilin, at the DFNB16 locus. The 29‐exon STRC gene lies on chromosome 15q15 within an 83‐kb region, harbouring 4 genes, which is duplicated in tandem. The dis‐
tal duplication contains a non‐processed STRC pseudogene with 99.97% sequence identity to STRC, which has hampered diagnostic efforts so far. Critically, the existence of this highly similar non‐
processed STRC pseudogene prevents screening the region by current next‐generation sequencing tech‐
niques, since any sequence variants detected cannot be assigned to either STRC gene or pseudogene with certainty. Data gleaned from human structural variation databases suggest that deletions in this tandem‐duplicated region are common. We have developed and validated quantitative real‐time PCR (qRT‐PCR) and fluorescent restriction fragment length polymorphism (RFLP) assays to specifically de‐
tect STRC deletions. We have also developed a long‐range PCR protocol to specifically amplify and se‐
quence the STRC gene without interference of the STRC pseudogene. By applying our novel protocol, NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 149
we have detected biallelic STRC mutations in both sporadic and familial cases of recessive HHI. All af‐
fected individuals present with moderate hearing loss across all frequencies, with down‐sloping or flat audiometric profiles. Our results suggest that the STRC gene should be screened in all cases of recessive HHI who present with moderate hearing loss. N. 91 ‐ A NOVEL SPLICE‐SITE MUTATION IN THE GJB2 GENE CAUSING MILD POST‐
LINGUAL HEARING IMPAIRMENT Gandía M, del Castillo FJ, Rodríguez‐Álvarez FJ, Garrido G, Moreno‐Pelayo MA, Villamar M, Moreno F, del Castillo I Hospital Universitario Ramón y Cajal, IRYCIS, Unidad de Genética Molecular, Madrid, Spain and Centro de Investigación Biomédica en Red de Enfermedades Raras, Unidad 728, Madrid, Spain DFNB1 deafness, caused by mutations in the GJB2 gene (connexin‐26), is the most frequent subtype of autosomal recessive non‐syndromic hearing impairment. GJB2 contains just two exons, with the coding region fully contained within the second exon. To date, more than 100 pathogenic mutations have been identified in the GJB2 coding region, but some DFNB1 patients carry mutations in non‐coding parts of the gene or in distant regulatory regions. Previously, a mutation inactivating the donor splice site of GJB2 intron 1 (c.‐23+1G>A or IVS1+1G>A) was reported in hearing‐impaired subjects in compound het‐
erozygosity with another GJB2 mutation. Sequencing of cDNA from a lymphoblastoid cell line derived from a c.‐23+1G>A mutation carrier did not detect the mutant transcript. We have identified a novel sub‐
stitution mutation that replaces one of the invariant nucleotides at the acceptor splice site of GJB2 intron 1 (c.‐22‐2A>C or IVS1‐2A>C). Three affected siblings from the same family harbored this mutation in compound heterozygosity with the frameshift mutation c.35delG and presented with mild postlingual deafness. Bioinformatic analyses predicted the existence of a cryptic acceptor splice site located 38 bp upstream of the standard acceptor site. Taking advantage of our recent finding that GJB2 transcripts can be detected in total RNA extracted from saliva, we generated GJB2 cDNAs from saliva samples obtained from the three affected siblings. Transcripts generated by use of the standard acceptor splice site were only detected for the 35delG allele, indicating that the c.‐22‐2A>C mutation abolished the standard ac‐
ceptor splice site. However, we did detect longer transcripts harboring the c.‐22‐2A>C mutation. Se‐
quencing confirmed the use of the upstream cryptic acceptor splice site predicted in silico, although with much lower efficiency than that of the standard acceptor splice site. This residual expression may under‐
lie the mild hearing phenotype observed in these c.‐22‐2A>C/c.35delG heterozygotes. N. 92 ‐ NEWBORN HEARING CONCURRENT GENE SCREENING, DEEP ANALYSIS FOR PREDICTING OF GENETIC RISKS OF HEARING LOSS IN CHINESE NEONATES Wang Qiuju, Han Bing, Li Qian Institute of Otolaryngology, Chinese People’s Liberation Army General, Hospital Department of Otolaryngology‐Head and Neck Surgery, Beijing, China Objective. Universal newborn hearing screening is undergoing rapid expansion in many countries. The traditional screening protocol has been proposed to detect apparent auditory disorders. This study re‐
ports a new protocol combining deafness genes screening with neonatal hearing screening in China. Methods. From 2009 to 2011, 9,788 neonates in China have accepted newborn hearing concurrent genetic NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 150 NHS 2012
screening. The hearing screening was performed with OAE or AABR. Infant’s blood sample was col‐
lected with a special newborn genetic screening card. Three high risk deafness genes GJB2, SLC26A4 and mt.DNA12S rRNA were screened by a genetic screening kit that utilized the method of amplification re‐
fractory mutation system (ARMS) technology. Results. In all cases, 89.63% (8,773/9,788) newborns passed hearing screening, while 2.41% (236/9,788) referred gene screening among which 90.25% (213/236) passed hearing screening. Moreover, 2.43% (213/8,773) infants passed hearing screening but re‐
ferred genetic screening. Among all newborns, 1.29% (126/9,788) cases had GJB2 c.235 delC mutation, in‐
cluding 124 heterozygote carriers and 2 homozygotes. There were 87.90% (109/124) babies of GJB2 het‐
erozygotes passed hearing screening, and 100% (2/2) homozygotes referred in hearing screening. Fur‐
thermore, 0.91% (89/9788) cases had SLC26A4 c.919‐2 A>G mutation, in which 92.13% (82/89) passed hearing screening. In addition, 0.21% (21/9788) infants were identified mutation of 12S rRNA mt.1555A>G or 1494 C>T, with refer rate of 0.18% (18/9788) and 0.03% (3/9788), respectively, who have normal hearing but would suffer from sudden hearing loss once applying aminoglycoside drugs. All samples with mutations were further validated with Sanger sequencing. No false positive was found. Conclusions. Newborn hearing concurrent gene screening may help to confirm the abnormal results of hearing screening tests, and improve it for hearing impairment, better recognize infants with risk factors for late‐onset hearing impairment. N. 93 ‐ THE P.V37I EXCLUSIVE GENOTYPE OF GJB2: A GENETIC RISK‐INDICATOR OF POSTNATAL PERMANENT CHILDHOOD HEARING IMPAIRMENT Li L, Lv J‐R, Ma Y, Huang Z‐W, Yang T, Wu H Department of Otolaryngology Head & Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine; 2Shanghai Jiaotong University Ear Institute 1
Objectives. To identify a genetic indicator of risk for permanent childhood hearing impairment (PCHI). Methods. 45 unrelated Chinese subjects with confirmed or suspected postnatal PCHI and 1677 subjects from all stage of hearing screen were recruited. GJB2 mutation screening of the subjects was performed by PCR amplification and bidirectional sequencing. Results. The p.V37I exclusive genotype (V37I/V37I, V37I/del) of GJB2 was present in 3 (21.4%) of 14 children with confirmed postnatal PCHI and in 6 (19.4%) of 31 children with suspected postnatal PCHI. In contrast, this genotype was present in only 6 (0.4%) of the 1516 control Chinese newborns; in the hearing screen group, the p.V37I exclusive genotype was pre‐
sent in: 0.14% (2/1405) of control newborns who passed the initial screen; 2.0% (2/99, P = 0.024) of new‐
borns who failed the initial screen but passed a repeat screen; and 5.8% (10/173, P = 1.7×10‐8) of newborns who failed both screens but were diagnosed with normal hearing on the referral evaluation. Conclu‐
sions. Based on our studies, we propose that genetic testing for the GJB2 p.V37I exclusive genotype is warranted in Asian newborns who fail at least one newborn hearing screen. Continued audiologic moni‐
toring should be offered to children who carry this genetic variant to facilitate prompt detection and in‐
tervention of postnatal PCHI. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 151
SPEECH AND LANGUAGE N. 94 ‐ IDENTIFYING SOURCES OF VARIABILITY IN NORMAL‐HEARING TWO‐YEAR‐
OLDS’ SPEECH DISCRIMINATION Lalonde KL, Holt RF Indiana University, Department of Speech and Hearing Science, Bloomington, IN USA Speech discrimination testing holds promise as a method for evaluating the benefit of sensory aids in toddlers and young children. It is a valuable tool for determining whether children of varying ages have the auditory capacity to perceptually discriminate speech contrasts that are important for the develop‐
ment of phonetic representations required to develop spoken language. Toddlers rely on incomplete, highly variable cognitive and linguistic skills to complete speech discrimination testing. This constrains testing methods, complicates interpretation of results, and introduces individual variability. Whereas Metsala and Walley (1998) proposed that children’s discrimination improves as their phonetic represen‐
tations develop the specificity necessary to distinguish between items in their growing lexicons, it may not be possible to completely eliminate variance caused by non‐sensory, task‐related demands from be‐
havioral measures with pediatric populations, particularly in toddlers. An experiment was conducted to identify cognitive‐linguistic sources of variance in performance on the Toddler Change/No‐Change pro‐
cedure (Holt & Lalonde, in press). Twenty normal‐hearing two‐year‐olds completed the speech‐sound discrimination task. Vocabulary, nonverbal intelligence, executive functioning, and short‐term and working memory were assessed using standardized tests and psychometrically rigorous parent‐report inventories. Consistent with the literature, discrimination sensitivity was highly variable. Further, a complex relationship between cognitive‐linguistic factors and speech discrimination emerged. After con‐
trolling for age, better short‐term memory and a larger receptive and expressive vocabulary predicted better discrimination sensitivity. These results support and extend Metsala and Walley’s work by reveal‐
ing that vocabulary accounts for some variability in normal‐hearing toddlers’ speech‐sound discrimina‐
tion and suggest that speech‐sound discrimination in toddlers is influenced by the non‐sensory demands of the task. Identifying factors contributing to individual variability in pediatric speech perception is im‐
portant for interpreting speech discrimination measures in the clinic and for understanding both typical and atypical speech perception development. (Work supported by NIH T32 DC000012‐32). N. 95 ‐ EARLY AMPLIFIED INFANTS: SPEECH INTELLIGIBILITY INDEX AS PREDICTOR OF AUDITORY BEHAVIOR Figueiredo R, Novaes B PUC‐SP/ DERDIC‐CeAC, São Paulo, Brazil Objectives. To analyze SII values, hearing loss degree and configuration, fitting adequacy aiming at, through case studies, describe auditory behavior for speech stimulus after the first month of use of am‐
plification in children up to a year of life considering variables that influence the auditory response. Methods. For analysis of SII values, 78 ears were studied considering the thresholds used to fit hearing aids (frequencies‐0,25;0,5;1;2;4KHz), hearing loss configuration and fitting adequacy using DSL[i/o]v5. All data were entered into Excel database to Cluster Analysis which established five groups. From these NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 152 NHS 2012
groups, five individuals were selected, one of each group. Auditory response for speech stimulus was observed (the Ling six and four onomatopoeias) controlled by a decibel meter in different distances be‐
tween evaluator and hearing aid microphone (0,5;1e2 meters). Other variables were considered for anal‐
ysis of quality auditory response, besides SII values: cognitive development, consistency of hearing aid use and family involvement. Results. SII values are highly correlated with hearing levels, considering fit to target (DSL[i/o]v5). Of the five cases studied, those with the SII values worse than 50% (se‐
vere/profound hearing loss) had worse scores for the detection of speech in the situation established for behavior auditory observation, after the first month of hearing aid adaptation. The responses were ob‐
served just for smaller distances. Those cases with better SII values, showed better response to all speech stimulus at early weeks of consistency use. Cognitive development is related with the quality of re‐
sponse behavior. Conclusion. Individual differences among infants with hearing loss fit with hearing aids were predicted by aided SII. A protocol of auditory behavior observation and cognitive develop‐
ment can help in assessing results of amplification in the short term and benefit the clinical decisions ear‐
lier. SII index can help clinicians to fine tune expectations of auditory responses for speech in infants. N. 96 ‐ COMPUTERS AS A RESOURCE OF DEVELOPMENT OF LANGUAGE FOR DEAF BILINGUAL CHILDREN Levy CCAC, Adduci AV FCMSCSP, São Paulo, Brazil Persons who have hearing thresholds not low enough to hear the human voice have difficulties in learn‐
ing oral language, so they need to develop another form of communication beyond the one that is used and there are different approaches to this work. The bilingual approach makes use of two different mo‐
dalities of language, using the Sing Language as a first language and oral or written production as a sec‐
ond language. Speech therapy, specifically in deaf children, aims at stimulating the hearing and lan‐
guage, and no doubt it becomes a challenging activity because it entertains children and adolescents in activities that promote a specific work determined by specific planning for the child. Most children have fun playing and the computer is a tool present in many of the children’s life. In the case of deaf children the creation of a software can help develop language skills, being more interesting when used in a play‐
ful manner, which makes the child maintain attention, increases motivation and participation. Thus, the choice of this topic was motivated by interest in discovering how technology can serve as a resource for language development in deafness. This work aims at the development and implementation of software for language development in deaf bilingual children. Based on the results five games were elaborated: Wordsearch; Hangman, Space Trip, and Maze. Every game has as a basic principle that expands both oral and Sign Language vocabulary; improve reading and writing in Portuguese language and typing; associates significant to meaning; categorize words. The development of the software was a challenge both for authors and for patients who evaluated the program, because after every challenge presented, solutions emerged according to demand and need of language upgrading. We emphasize that the devel‐
opment of this software has brought interest in Portuguese language improving and linking vocabulary to linguistic modalities. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 153
N. 97 ‐ THE INFLUENCE OF BELLY DANCE IN THE CONSTITUTION OF THE DEAF IN‐
DIVIDUAL Levy CCAC, Thomazinho CA FCMSCSP, São Paulo, Brazil The deaf person is totally capable of reacting to a song and show their pace through the vibration that the body is able to capture and lead (Fux, 1983). Throughout the body you can pick up the vibrations of sound waves and these can be seen throughout the skin and bones. The objectives of dance as educa‐
tional practice are: to rescue the expression, work the individual as a whole, to stimulate cooperation in a pleasant way. Getting the idea that the dance is directly involved in the teaching/learning process we can suggest some aspects that are part of this: attention, comprehension of oneself and others and self‐
improvement. The dance chosen for the study was the Belly Dance unhewn with intrinsic and subjective questions of the individual, and the greater value is given to emotion and feeling that is dance, not only the technique. Therefore our main questions were: what is body language, how can body language help in the interpretation, and how the expression through belly dance can contribute to self‐esteem of deaf individuals. Objectives. To describe the influence of belly dance in the development of body language expression of the deaf individual. To relate the development of body language on self‐esteem of deaf in‐
dividuals through a questionnaire on aspects of quality of life and school performance. We have ob‐
served that dance acted positively to the development of body language and how this development has favored the improvement of sign language and improvement in school performance and quality of life, because children started to understand the concept of responsibility and apply it during dance classes, the comprehension of more subjective and intrinsic questions of themselves, they were better under‐
stood, self‐improvement was seen throughout all the time and the children said that the dance makes them feel included in their own family. Conclusion. The benefits of dance interfere positively in the es‐
sence of the deaf person what makes it essential and extremely important in their development as an in‐
dividual. N. 98 ‐ THE LITTLEARS® EARLY SPEECH PRODUCTION QUESTIONNAIRE: A VALI‐
DATED QUESTIONNAIRE FOR VERY EARLY SPEECH PRODUCTION Hoffmann V, Schramm B, Keilmann A MED‐EL Germany GmbH; 2Division for Communication Disorders, University Medical Center of the Johannes Gutenberg‐
University Mainz, Germany (form.); 3 Division for Communication Disorders, University Medical Center of the Johannes Gutenberg‐University Mainz, Germany 1
Until now no standardized assessment tool for the early milestones of speech and language production during the first 18 months of life is available, especially for German language. We developed and vali‐
dated a new tool, the LittlEARS® Early Speech Production Questionnaire (LEESPQ). Based on data from a longitudinal study in German speaking infants with normal hearing and with cochlear implants (Schramm B., Bohnert A., Keilmann A., 2009; 2010), we first developed a questionnaire with 24 questions to assess the following stages: reflexive behaviours, crying, early vocalization, babbling, jargon and first words. In addition, each question contains an example, like: “Does your child produce individual sylla‐
bles?” Eg. “bah”, “mam” or “Does your child produce vowels?” E.g.: /a, e, i, o, u/. After the item and scale analysis of 352 questionnaires a reduction to 22 questions with 47 possibilities for yes/no answers followed. The questions were arranged according to the age children typically develop this behaviour. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 154 NHS 2012
For this final questionnaire expected values and minimal values for children between 1 and 18 months are available. In the tested group we found no sex differences and a continuous growth of positive an‐
swers with age [r=.780 (p<.001)]. Reliability [λ=.908 ] and homogeneity [Cronbach´s Alpha α = .915 ] were satisfactory. The LEESPQ seems to be a useful instrument to assess early development of speech in chil‐
dren under the age of 18 months. Learning Outcome: Participants will hear about the content and struc‐
ture of the questionnaire. Moreover, they will learn that we believe that the early milestones in speech and language could be predictors to be alert of hearing disorders in early life. N. 99 ‐ CLINICAL STUDY OF NURSERY RHYMES AND MUSIC PERCEPTION IN PRELINGUAL COCHLEAR IMPLANTED CHILDREN
Abdi S Audiological Scientist and Director of Clinical Research, Teheran, Iran Objective: Nursery rhymes are an indispensable part of the development and education of normal chil‐
dren, and have a crucial role in language and speech education for them. The same thing applies to prelinguall deaf children, they need a through habilitation program, which in an ideal program should include all the auditory aspects of life. This is clinical study of teaching nursery rhymes to our cochlear implanted prelingual children who have musical habilitation programs. Materials & Method: We tried teaching rhymes to 65 CI children alongside the musical melody of them. A single music trainer both teaches the children how to play simple (like xylophone) or more sophisticated instruments(like se‐tar, a traditional string instrument and Piano), and evaluates their ability in performing the melody and sing‐
ing some usual nursery rhymes. Children were evaluated by open questioning using a score from 0 to 10. Results: By this time, there are 65 children who have received music training. The time in the music training ranges from 5 to 41 months. Considering all the evaluation results of their ability to sing nursery rhymes while they perform the background melody for those rhymes, the mean score was 6.25 and the median score was 8. Including the best score for each child, the mean increased to 8.14 and the median to 10. Discussion: Their speech abilities, especially vocal tonality also have improved since those training programme, although measured in a subjective level. Conclusion: Using this combined method for teaching music and singing to children helps them in better engaging in vocal abilities like singing. Cochlear implanted children can successfully learn singing nursery rhymes, especially if they learn how to play the melody for each rhyme, using this combined method for teaching music and singing to chil‐
dren helps them in better engaging in vocal abilities like singing. N. 100 ‐ LEXICAL STYLISTIC SPECIFICITY AND HEARING IMPAIRED CHILDREN Nikolic VS Primary School for Children with Damaged Hearing, Zemun, Belgrade, Serbia In the speech of our people, especially those who were born and live in solitary places, the number of words that they use becomes smaller. Two, three or more different lexemes usually get down to one so that it assumes the meaning of others. This then leads to a reduction of active vocabulary fund of certain speakers, but also to the vocabulary impoverishment of language in general, and thus reduces the possi‐
bility of a clear, hue and precise expression. For the development of speech and general literacy it is nec‐
essary that children should adopt grammar and spelling rules that are relatively abstract. For achieve‐
NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 155
ment of appropriate grammatical and spelling issues it access should be planned to language and stylis‐
tic analysis of each text. Stylistic exercises are not strictly confined from the lexical‐semantic. They should be increased indirectly with the teaching of grammar, but they differ from the grammar, a wide range of associations and the development of imagination are required. Therefore, all the exercises aimed at developing observations of opinion, association and imagination appertain in style training. While performing the style exercises students should be interested and get used to gradually carry out their own practical and thoughtful action: to recognize, explain and eliminate errors and to make appro‐
priate comparisons and generalization. The subject of this study was to determine the lexical stylistic specificity in the language of the deaf and hard of hearing students of higher grades. The ʺLanguage Corps for evaluation of the lexical‐stylistic specificityʺ (Dimic, Isakovic), was used in the research. This corpus contains 10 tasks in which the students have different requirements. The survey was conducted on a sample of 20 examinees – students of higher grades from school for children with impaired hearing and speech ʺRadivoj Popovicʺ. Depending on the degree of hearing impairment, (according to World Health Organization) students were divided into three groups: very severe impaired hearing, hard hear‐
ing impairment and medium hearing impairment. Intelligence was in the normal limits for the hearing impaired population. Based on the gained results it can be concluded that students of higher grades re‐
gardless of the class gave similar answers. The words that the students meet every day were understood and recognized. N. 101 ‐ THE ARTICULATION OF CHILDREN WHO ARE DEAF AND HARD OF HEAR‐
ING Nikolic VS1, Savić MM2, Savić MP3, Savić VP3 Primary School for Children with Damaged Hearing, Zemun, Belgrade, Serbia; 2General Hospital Šabac, Šabac, Serbia; 3Faculty of Philosophy Novi Sad, Serbia 1
Adequate articulation presupposes the auditive differentiation of sounds. The analysis of articulation ability can, thus, correlate with speech, which depends on the degree of hearing impairment, because there is a close connection between the auditive discrimination and the precision of sounds pronuncia‐
tion. The goal of this survey was to determine the level of articulation of children who are deaf and hard of hearing depending on the level of hearing impairment. The authors wanted to see if gender plays a role in the features of articulation ability of children with hearing impairment. In order to find a link be‐
tween the hearing status and the adequate articulation we also examined whether there was a regularity in articulative inconsistency between groups of sounds depending on the level of hearing impairment. The estimation of articulative ability was based on the Triage Articulative Test (by Kostić, Vladisavljević and Blagojević). The survey was performed upon the sample consisting of 34 children aged 10 – 15 who regularly attend the Radivoj Popović primary school for children with hearing and speech impairment in Zemun. According to the WHO classification, children with hearing impairment were classified into three groups: moderately severe, severe and profound hearing impairment. The results were qualita‐
tively and quantitatively analysed. The results indicate that there is a correlation between the level of hearing damage and the precision of pronunciation. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 156 NHS 2012
OUTCOME STUDIES N. 102 ‐ IMPROVING OUTCOMES FOR CHILDREN WITH HEARING LOSS: LOOKING BEYOND THE TECHNOLOGY Abrahams Y1, Davis A1,2, Hopkins T1, Sperandio D1, Beresford S1 1
The Shepherd Centre, Sydney, Australia; 2Macquarie University , Sydney, Australia This study examines improvements in outcomes that can be obtained beyond technological advances alone. The Longitudinal outcomes of children with a range of hearing devices were reviewed and chal‐
lenges working with different populations were identified in order to improve future service provision. A review of the listening, speech and language outcomes of 80 children using hearing devices was com‐
pleted. Children were divided into a ‘standard’ group (entered early intervention prior to 12months of age, English speaking background, no additional disabilities) and a ‘non‐standard’ group (entered early intervention after 12months of age, non‐English speaking background, additional disabilities to their hearing loss). Outcomes were measured at regular intervals using a combination of formal and informal assessment tools. In depth case reviews were conducted on the ‘non‐standard’ children to identify the challenges in working with these families and strategies used to address these challenges. Children in the ‘standard’ group achieved better outcomes than those in the ‘non‐standard’ group with the majority developing age appropriate language and vocabulary by 5 years of age. The outcomes of children in the ‘non‐standard’ group showed variability, however a proportion of this group still developed age appro‐
priate language in early intervention despite their additional challenges. These included communication barriers, family engagement, participation and ownership of the intervention process. Strategies used to address these challenges included the use of interpreters, joint therapy sessions with other service pro‐
viders, individual family service planning meetings and involvement of a multidisciplinary team. In 2012, outcomes for children with hearing loss are more predictable than in the past however overall out‐
comes are still variable and can no longer be determined by level of hearing loss. Clinical practices in‐
cluding delivery modes for therapy and supporting families need to be guided by the evidence provided from outcomes and managed creatively to assist in optimising potential for all children with hearing loss. N. 103 ‐ FROM NEWBORN SCREENING TO SCHOOL: LONG TERM AUDIOLOGICAL, SPEECH AND LANGUAGE OUTCOMES AFTER EARLY INTERVENTION Abrahams Y1, Davis A1,2, Hopkins T1, Sperandio D1, Beresford S1 1
The Shepherd Centre, Sydney, Australia; 2Macquarie University , Sydney, Australia Ongoing research on the longitudinal educational outcomes of children with hearing loss in mainstream school systems is necessary for professionals working with children in the mainstream setting in order to determine the optimal type and amount of support required. Empirical data on performance by this population also provides an evidence base to guide government lobbying and policy development and facilitates continuous quality improvement in early intervention programs. A group of over 130 children between the ages of birth and twelve years of age were assessed on a range of standardized speech, lan‐
guage and speech perception measures over a 10 year period. All of the group attended an Auditory‐
NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 157
Verbal Early Intervention Program in Sydney, Australia before transitioning to mainstream school. The outcomes indicate the long‐term listening, speech and language skills for children transitioning to school are varied. Individual trajectories of children’s rate of progress showed that for children entering the main stream schooling environment with above average scores in language continued to do well, how‐
ever as a group, children with standard scores of under the typical mean struggled to maintain age ap‐
propriate levels. A range of factors were investigated and their complex interaction and impact on this group will be discussed. Review of these outcomes and variances provides evidence base for planning efficient and effective support services for children with hearing loss. Attendees will gain an under‐
standing of the long term listening, speech and language outcomes for children with hearing loss and of the factors that impact on these outcomes, so as to be able to apply this in the development of support systems that facilitate optimal educational outcomes. N. 104 ‐ STUDY OF LANGUAGE AND SPEECH DEVELOPMENT IN BILINGUAL RAIS‐
ING CHILDREN WITH COCHLEAR IMPLANTS AND/OR HEARING AID‐DATA COL‐
LECTION IN THE LONG TERM Fabian A1, Friese B1, Hoffmann V2, Keilmann A1 Division for Communication Disorders, University Medical Center of the Johannes Gutenberg‐University Mainz, Germany; 2MED‐EL Deutschland GmbH, Starnberg, Germany 1
Due to a steady increase in the number of migrants to Germany in recent years, diagnostics aimed at clarifying language impairments in bilingual individuals is becoming increasingly important. The basic requirements for physiologically acquiring bilingual language skills are defined early on when the fetus first begins to develop the ability to hear sounds and the linguistic input of reference persons. Children who suffer from pre‐lingual hearing disorders either do not meet these prerequisites or meet them only to an insufficient extent. Hardly any studies have been conducted to date on how children with hearing disorders whose second language is German develop language skills. Therefore, we compare the lingual development of children with hearing disorders who have been raised with German as their second lan‐
guage and received a CI and/or hearing aid with those of monolingual children with impaired hearing in a prospective longitudinal study. The study can be divided into two substudies. Substudy I examines the language development of children of between 0 and 2 years and 11 months of age following the initial fitting of hearing aids or speech processors. Here, the parents receive the “LittlEARS® Early Speech Pro‐
duction Questionnaire” (LEESPQ) (Schramm, Brachmaier, Keilmann, 2009) and later the SETK‐2 (Grimm, Aktas, Frevert, 2000). Bilingual parents are asked to complete the questionnaires in both lan‐
guages. In addition, the parents of children of 21 up to 24 months of age are assessed with the SBE‐2‐KT (Suchodoletz, Sachse, 2008). In substudy II children between 3 and 10 years and 11 months of age are in‐
cluded. A detailed anamnesis is performed and children are examined for their linguistic skills depend‐
ing on the child’s age. Up to now, 60 children have been included. Due to small subgroups only prelimi‐
nary results can be presented. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 158 NHS 2012
N. 105 ‐ LANGUAGE OUTCOMES OF CHILDREN WITH COCHLEAR IMPLANTS EN‐
ROLLED IN DIFFERENT COMMUNICATION PROGRAMS Erbaşi‐Yanbay E1,2, Hickson L1,2, Scarinci N1,2, Constantinescu G1,3, Dettman SJ1,4 The HEARing Cooperative Research Centre, Australia; 2 Communication Disability Centre, The University of Queensland, Brisbane, Australia; 3 Research and Innovation, Hear and Say, Australia; 4Department of Otolaryngology, The University of Melbourne, Victoria, Australia 1 A range of communication approaches are offered to children with hearing loss and their families. This study examined the language outcomes for a group of Australian children enrolled in auditory‐oral (AO; n = 14), auditory‐verbal therapy (AVT; n = 18), and sign and spoken language (SS; n = 10) programs. Children in the SS group used spoken English and a natural sign language for communication. All three groups were identified as having similar demographic characteristics at the onset of the study. Partici‐
pants included 19 males and 23 females who received cochlear implant(s) before 3;6 years of age. Stan‐
dard scores on the Peabody Picture Vocabulary Test (PPVT) and the Preschool Language Scale (PLS‐4) were retrospectively collected at 0.51 to 5.2 years post‐implantation (M = 3.22; SD = 1.21). Early interven‐
tion history, device details, and demographic information were obtained for each child. Family partici‐
pation (FP) was evaluated using Moeller’s (2000) FP rating scale. After adjusting for FP and socio‐
economic status, mean scores of the PPVT were 87.49, 88.30, and 89.22 for AO, AVT, and SS groups, re‐
spectively. Mean scores of the PLS‐4 (auditory comprehension) were 87.74, 88, and 81.57 for AO, AVT, and SS groups, respectively. These were adjusted for FP, socio‐economic status, age at diagnosis of hear‐
ing loss, and age at implantation. Results demonstrated no significant differences between the three groups of children. Age at diagnosis and FP were significantly associated with language scores. Regard‐
less of the type of communication approach received, children diagnosed with hearing loss at an early age and children with a high level of FP had better post‐implant language scores than children diag‐
nosed later and with lower levels of FP. These results emphasize the importance of early diagnosis and highlight the contribution families make to the language outcomes of children with cochlear implants. N. 106 ‐ PSYCHO‐SOCIAL DEVELOPMENT OF DEAF CHILDREN WITH COCHLEAR IM‐
PLANTS (CI) Fadda S Centro Assistenza per Bambini Sordi e Sordociechi Onlus, Roma, Italy The poster focuses on the latest debate on Cochlear Implants (CI) ‐ the role they play during the devel‐
opment of a deaf child, analyzing the psychological aspects which characterize the experiences of fami‐
lies of children who do get implanted, starting from the detection of deafness until after implantation. The aim is to demonstrate how in these experiences and during all developmental phases the significant role the psychologist plays and how important timely intervention of specific programs is for both child and parents. Subsequently, the poster focuses on the development of implanted children, specifically in relation to issues such as selective attention, shared attention, problem‐solving skills, symbolic play and social functioning. Finally, the poster demonstrates that during all stages of development in children with CI, a healthy relationship with parents is crucial for the development of a secure attachment, the construction of cognitive and behavioral skills and the opportunity to engage in meaningful communica‐
tion experiences. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 159
N. 107 ‐ QUALITY OF LIFE AND SCHOOL SUCCESS IN CHILDREN AND ADOLES‐
CENTS WITH COCHLEAR IMPLANT Duarte I, Rego G, Nunes R Department of Bioethics and Medical Ethics, Oporto Medical School, Oporto, Portugal Deafness is currently considered a public health problem because not only of its prevalence but also due to the multiple consequences that entails under various angles. It interferes permanently in child devel‐
opment. Among the ways that medicine has to address hearing loss, cochlear implants represent one of the most important technological advances in the rehabilitation of deafness. Indeed, this surgical tech‐
nique offers a new and promising way to improve the communication skills. More than 40,000 children worldwide have cochlear implants. However, some doubts remain regarding the real benefits of this type of intervention in prelingual profound deafness. This study aimed to assess the benefits of cochlear implants of prelingual profound deafness in children and adolescents in relation to school success, as well as their quality of life, in order to promote the best strategies to lessen the impact of hearing loss in childhood. Our sample consisted of deaf children and adolescents with cochlear implants and two con‐
trol groups, children and young listeners and deaf children and adolescents. Age ranked between 8 and 18 years. The results suggest a statistically significant difference between groups. The cochlear implanta‐
tion seems to favor academic success and perception of quality of life by children and adolescents. Al‐
though the implanted children fail to achieve the same level of performance and satisfaction of hearing children, it can be stated that they reach a higher level than deaf children without cochlear implant. Also, deafness can be considered as an aggravating factor in school performance and perception of quality of life. The results indicate that deaf children, with or without implants, feel discrimination by peers, char‐
acterized by feelings of provocation that could be considered as bullying, which draws attention to the need to work carefully these aspects in the school community. N. 108 ‐ COGNITIVE AND COMMUNICATIVE DEVELOPMENT IN DEAF AND HEAR‐
ING‐IMPAIRED CHILDREN WITH COCHLEAR IMPLANTS AND/OR HEARING‐AIDS Wass M, Sahlén B, Uhlén I, Möller C, Henricson C, von Mentzer C, Mäki‐Torkko E Linköping University, Karolinska Institute, Lund University The purpose of the study was to examine neurophysiological, cognitive and linguistic development in deaf and hearing‐impaired children (5–7 years of age) with CI and/or hearing‐aids and how a phonolog‐
ical intervention programme may influence this development. The deaf and hearing‐impaired children were compared with age‐matched hearing children. The results reveal that deaf and hearing‐impaired children had equivalent or close to equivalent performance levels compared to hearing children for cog‐
nitive and linguistic tasks with relatively low demands on phonological processing, whereas there was a substantial and significant difference between the groups for cognitive tasks involving explicit phono‐
logical processing. The results indicate that there is a relationship between age at implant and neuro‐
physiological, cognitive and linguistic development, where early implantation promotes faster devel‐
opment. The childrens´ cognitive performance increased as a function of phonological intervention. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 160 NHS 2012
N. 109 ‐ PHONOLOGICAL SKILLS IN CHILDREN WITH COCHLEAR IMPLANTS TWO YEARS AFTER ACTIVATION COMPARED WITH TYPICALLY DEVELOPING PEERS Välimaa T1, Kunnari S1, Tolonen A‐K1, Wallenius K1, Löppönen H2 Faculty of Humanities, Logopedics University of Oulu, Oulu, Finland; 2Institute of Public Health and Clinical Nutrition, Department of Otorhinolaryngology, University of Eastern Finland, Kuopio, Finland 1
The aim of this study was to provide preliminary results of the phonological skills of children with coch‐
lear implants (CI) acquiring Finnish. Due to universal neonatal hearing screening, the age of the average ascertainment of hearing impairment has been lowered. The age criterion for implantation also has been lowered. Hence, substantial gains have been reported in phonological skills in CI children acquiring Germanic languages, but reports on CI children acquiring Finnish are almost non‐existent. The subjects of this study were five CI children. The mean age of implantation was 1;2 years, the mean length of CI use 2;0 years (hearing age, HA) and the mean chronological age 3;2 years. A Finnish Test of Phonology (Kunnari, Savinainen‐Makkonen, & Saaristo‐Helin, in press) with 36 items was administered. Two inde‐
pendent researchers transcribed the data phonemically, the Inter‐rater agreement being 92%. The test gives a total score for phonological skills and sub‐test scores for phonotactic and paradigmatic skills. The CI children’s scores were compared to the developmental norms of typically developing 2‐year olds matched for hearing age (TD‐HA peers) and 3‐year olds matched for chronological age (TD‐A peers). The results showed that the mean total score of the CI children was 38.8 (SD=10.2), the mean scores of the TD‐HA and TD‐A children being 36.7 (SD=14.2) and 53.1 (SD=7.8), respectively. Obviously, the CI children’s phonotactic skills were comparable to the average level of the TD‐HA peers but clearly below the level of TD‐A peers. The phoneme inventory of the CI children was found to be smaller compared with the TD‐A children but somewhat larger compared with the TD‐HA children. These preliminary re‐
sults indicate that the CI children’s phonological skills were comparable to the skills of the TD‐HA peers. Age‐level performance was not acquired after two years of CI use. N. 110 ‐ PERFORMANCE OF SPEECH PERCEPTION IN CHILDREN USING HEARING AIDS AND COCHLEAR IMPLANTS: A COMPARATIVE STUDY Ranjan P1, Lata S2 MED‐EL India (P) ltd, New Delhi, India; 2The City Hospital, Dubai, United Arab Emirates 1
The aim of this study was to compare the performance of children using hearing aids and cochlear im‐
plants on Early Speech Perception Test. The subjects consisted of two groups of children with hearing impairment who were using hearing aids and cochlear implants. The age range for both the groups of children was 5 to 13 years with mean age of children using hearing aids was 7.5 years (S.D. 21.09) and the mean of children using cochlear implant was 5.2 years (S.D. 23.36). They were all undergoing aural‐
oral therapy. Early Speech Perception test was used for testing the performance on speech perception. Means and standard deviations were found out. Further, t‐test was used to establish if a significant dif‐
ferent existed in the performance of the two groups. The results revealed statistically significant differ‐
ence in speech perception between the two groups. It was found that the group of children using co‐
chlear implant was better than the group of children using hearing aids on pattern perception, spondee identification, and monosyllable identification subtests of Early Speech Perception test. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 161
N. 111 ‐ ACQUISITION OF EARLY MILESTONES WITH THE COCHLEAR IMPLANT Koren I, Geal‐Dor M, Adelman C, Adler M, Levi H Dept. of Speech and Hearing, Hadassah University Hospital and Dept. of Communication Disorders, Hadassah Academic Col‐
lege, Jerusalem, Israel Speech acquisition after cochlear implant is a long process. Various studies have followed the milestones in the early period after implantation. The aim of the present study was to track the development of hearing skills in the early period after cochlear implantation and see which factors influence the process. 232 records of children implanted in the Hadassah Medical Center were examined retrospectively. Data on etiology, age of onset, age at implantation and type of implant were collected. In addition, informa‐
tion on the rate of progress was measured: the first time that there was detection and identification of Ling sounds, the first time it was possible to obtain SDT, SRT and an audiogram, and the first accurate repetition of VCV sounds. Results show a constant pattern of milestone acquisition similar to normal development, from milestones that don’t require decoding beginning with SDT, detection of Ling sounds and then an audiogram which requires cooperation, to tasks that involve decoding starting with SRT and repetition of Ling sounds and finally VCV repetition. The children implanted before 24 months of age achieved the milestones later than children implanted between 2‐6 years, apparently since these tasks involve cognitive abilities which are not yet developed in the youngest children. When comparing type of implant there was an advantage to the newer models and we assume that the advances in speech coding strategies and mapping methods lead to earlier acquisition of milestones. Experience in hearing improved the rate of acquisition of the milestones and the progress was faster in the second implanted ear compared to the first implanted ear. More research is needed to address the relationship between ac‐
quisition of early milestones and performance with the cochlear implant later on. N. 112 ‐ AUDITORY‐VERBAL REHABILITATION AFTER COCHLEAR IMPLANTATION Stefanescu C1, Stanciu A2 Inclusive Rehabilitation Center No. 2, Sibiu, Romania; 2”Politehnica” University of Timisoara, Romania 1
Introduction. Goal of the study: implementing and checking a program for toddlers’ rehabilitation, for starting and developing the oral communication capabilities. Materials and method. The retrospective study (started in march 2003) was made over a group of 52 implanted children, included in a program of auditory and verbal rehabilitation, structured on two age groups: 0 to 3 years old, and 3 to 7 years old. The program contains: hearing education (both nonverbal and verbal hearing training), developing oral communication capabilities, correction of verbal anomalies, rhythm, and “Parents‐Children” group (a kind of activity which includes the parents as an active party in implanted children’s rehabilitation). One of the conditions for the program’s success is hearing “restoration” (obtained through a correct fitting of the audio processor, and the measurement of the artificial hearing by using audiometry techniques.) Re‐
sults. Very young children, having a correct fitting and following the auditory and verbal rehabilitation program, developed, immediately after implantation, the verbal communication capabilities like similar age normal hearing children and were able to be integrated into mainstream kindergartens or schools, meaning a real integration. In other words, out of the total of 52 children in the program, 21 are included in mainstream kindergarten, 2 are in the special kindergarten for hearing impaired children, 24 are in the mainstream school, and 5 are in the special school for hearing impaired children. Conclusion. For the cochlear implant to produce significant benefits for the early implanted child it is necessary: NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 162 NHS 2012
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To optimally fit the audio processor; To regularly check and measure the hearing abilities using audiometry investigation techniques; To include the child in a auditory and verbal rehabilitation program, rigorously structured by the speech therapist and closely followed by the parents (or caretakers); Active participation of the parents (or caretakers) to the rehabilitation program, as co‐therapists. N. 113 ‐ BEST PRACTICES FOR PEDIATRIC SPEECH AND LANGUAGE ASSESSMENT FOLLOWING EARLY INTERVENTION TO TREAT PROFOUND HEARING IMPAIR‐
MENT Zheng Y1, Tao Y1, Soli SD2, Li G1, Meng Z1 Sichuan University/West China Hospital/Hearing Center, Chengdu, China; 2House Research Institute, Los Angeles, USA 1
Purpose. An important goal of early intervention programs is to facilitate speech and language devel‐
opment. Current intervention guidelines do not specify appropriate assessment tools and protocols to evaluate achievement of this goal; nor do they define the normative references needed to interpret as‐
sessment. Such practical information is necessary to ensure that best practices for pediatric speech and language assessment are adhered to. The purpose of this presentation is to establish practical guidelines for use in clinical assessment of Mandarin speech and language development after early intervention. Method. Assessment guidelines and normative references have been based on experience gained during the four‐year Extended Outcome Study (EOS) at West China Hospital of Sichuan University. The EOS is a longitudinal outcome study objectively assessing speech and language development in children under the age of 5 who have received a CI (N=120) or a HA (N=120). A sample of normally hearing children (N=50) is also being followed. A hierarchical battery of norm‐referenced Mandarin speech and language assessment tools is used. The battery consists of a measure of early prelingual auditory development, speech perception, and language development. Experience with these assessment tools is used to rec‐
ommend specific assessment protocols and to interpret the results of these assessments. Results. Specific assessment tools and protocols are recommended for baseline and follow up evaluations. Evaluation in‐
tervals are also recommended. Separate recommendations are made for CI and HA interventions and for age at intervention. Results are to be expressed in terms of equivalent ages allowing comparison with normal speech and language development. Conclusions. Best practices for pediatric speech and lan‐
guage assessment require practical assessment tools and explicit guidelines for use of these tools. This project represents an initial effort to establish best practices for assessment of early Mandarin speech and language development. N. 114 ‐ OUTCOME ASSESSMENT ALTERNATIVES FOR YOUNG CHILDREN DURING THE FIRST 12 MONTHS AFTER PEDIATRIC HEARING AID FITTINGS Zheng Y1, Soli SD2, Xu K1, Li G1, Meng Z1 Sichuan University/West China Hospital/Hearing Center, Chengdu, China; 2House Research Institute, Los Angeles, USA 1
Objective. Perform longitudinal evaluations of young children during initial 12 months after initial hearing aid fitting. Document evidence of early prelingual auditory development (EPLAD), identify fac‐
tors that affect EPLAD, and define performance milestones that can guide best practices. Method. Un‐
blinded, prospective, within‐subject, repeated‐measures design was used in this study. Audiological NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 163
measures and measures of EPLAD were taken at baseline, 3, 6, and 12 months after hearing aid fitting in 45 children initially fitted with hearing aids between 1 and 5.5 years of age. Four groups were formed for analysis purposes based on severity of hearing loss (moderate‐to‐severe and profound) and initial fitting age (≤ 30 months and > 30 months). Results. All groups exhibited significant increases in EPLAD within 3 months, and those with profound losses exhibited further significant improvement between 6 and 12 months. Similar EPLAD levels were reached at 12 months regardless of severity of hearing loss. Aided sound field thresholds and duration of daily hearing aid use significantly impacted EPLAD. The EPLAD trajectory was similar to that following early cochlear implantation. Conclusions. Measures of EPLAD provide a means of evaluating outcomes following early pediatric hearing aid intervention, supplement‐
ing behavioral audiological measures. N. 115 ‐ SIGN AND SPOKEN VOCABULARY IN PRESCHOOL CHILDREN WITH CO‐
CHLEAR IMPLANTS AND HEARING AIDS Dimic N, Kovacevic T, Isakovic Lj, Djokovic S University of Belgrade, Faculty of Special Education and Rehabilitation, Special Education and Rehabilitation of Deaf and Hard of Hearing Persons, Belgrade, Serbia The enrichment of a child’s vocabulary represents the development of his or her thought process and expansion of experiences which are transformed into speech and sign (gesture). The stock of sign gestures is continually enhanced, expanded, enriched and a gesture (sign) becomes a synonym for a word, or better said an aid in mastering speech. Development and enrichment of the child’s voculabarly encompasses the establishment of the quantity and quality of the vocabulary of each child individually within the scope of its linguistic status. A picture, utilized as a stimulus, is a suitable medium for evaluating speech‐language abilities. Depending on their maturity level and the development of their sign and spoken language expression, children will either individually list the entities and activities which can be seen in a picture, or they will form a whole, resulting in a story. A picture influences the feelings of children, it contributes to the development of visual perception, enrichment of their vocabularies and their imagination. The aim of our study was to evaluate the relationships between sign and spoken vocabulary in deaf and hard of hearing children of preschool age, when describing pictures. The sample consisted of 11 preschool aged children. Five children had a cochlear implants, whilst six had hearing aids. The study utilized two pictures as stimuli: Autumn in the City and Autumn in the Village. In describing the pictures, the preschool aged children showed better results when using sign language, in comparision with their use of their spoken vocabulary. The acquired results showed a higher level of competence when describing the picture Autumn in the City then Autumn in the Village. Deaf and hard of hearing children do not utilize all types of words with equal success. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 164 NHS 2012
N. 116 ‐ ABSTRACT THINKING IN CHILDREN WITH CI AND CHILDREN WITH NOR‐
MAL HEARING Sokolovac I1, Slavnić S2, Kovačević J2, Nadj Č3, Komazec Z1, Lemajić‐Komazec S1 Universiti ENT Clinikl, Clinical Center of Vojvodina Novi Sad, Serbia; 2Faculty of special education and rehabilitation, Beo‐
grad, Serbia; 3Universiti Clinikl Department of Neurology Clinical Center of Vojvodina Novi Sad, Serbia 1
Children with hearing impairment lack auditory stimulation through sound stimuli perception, hence can not develop abstract thinking the way children with normal hearing do. Cochlear implant mitigates this problem to a great extent. Numerous studies dealt with number and types of words used by children with cochlear implants, while their abstract thinking was not studied enough. The aim of the study was to assess the abstract thinking in children with cochlear implants. Materials and methods. This trial was conveyed on fifty girls and boys, aged 4‐8, split in two groups consisting of 25 children each. The experimental group consisted of children with cochlear implants, while in the control group were the children with no hearing impairment. The children responded to ten concrete and ten abstract questions. We considered a successful response if the children answer the question concretely and ab‐
stractly. The results obtained were compared between the two groups. Results. Children with cochlear implant during the first and second year of hearing age did not use abstract thinking . Response to an abstract question firts appear during the third year of hearing age and rehabilitation (25‐36 months of age). The abstract level of thinking has 75% of children with CI after 5 years of rehabilitation. Success‐
fully responded with 3 girls (75%) and 1 boy (25%). No answer 10 girls (47%) and 11 boys (52.4%). In the control group response to the abstract question whether the 8 boys (57.1%) and 6 girls (42.9%). No an‐
swer 7 boys (63.6%) and 4 girls (36.3%). Conclusion. Children with CI later achieved the level of abstract thinking in relation to children very prominent, but there is a positive linear trend depending on age and length of auditory rehabilitation. N. 117 ‐ BILATERAL HEARING IN PRE‐SCHOOL CHILDREN WITH COCHLEAR IM‐
PLANTS Obrycka A, Lorens A, Piotrowska A, Zgoda M, Lutek A, Skarzynski H Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany, Poland Regardless of increasing number of studies concerning bilateral implantation in children there is still lack of compelling evidences in favor of the benefit from two devices. Most studies compare the benefit from one implant to the outcomes in two implants within the group of bilaterally implanted children. There is a need for comparison between two groups: unilaterally implanted and bilaterally implanted. Another important question is whether the bilateral advantage is sufficient to close a gap in speech out‐
comes between bilaterally implanted children and normal hearing children. The aim of the study is to assess the speech perception capacity in bilaterally implanted children and to compare the results of three groups of children: bilaterally implanted, unilaterally implanted, and normal hearing. Three groups of patient were included in the study. First group ‐ 17 bilaterally implanted children with at least one year experience with two implants. Mean age of first implantation was 2.3 years, mean age of se‐
cond implantation was 6.5 years. The children from the group were implanted in a sequential procedure, mean interimplant delay was 4.3 years. Second group ‐ 32 unilaterally implanted children, mean age at implantation ‐ 2.7 years. Third group – 58 normal hearing children. Age of implantation matching was obtained in first and second group. The Polish version of the Adaptive Auditory Speech Test (AAST) NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 165
was used in order to assess the benefit and to facilitate the within and between group comparison. Sig‐
nificant speech discrimination improvement in bilateral conditions compared to unilateral conditions was observed. Bilaterally implanted children perform significantly better than unilaterally implanted ones but still worse than normal hearing. Bilateral cochlear implantation is beneficial for children com‐
paring to unilateral implantation. Two implants reduce the gap in speech outcomes between one im‐
plant users and normal hearing subject. N. 118 ‐ EXPERIENCE WITH CHILDREN WITH MED‐EL CONCERTO FLEX EAS CO‐
CHLEAR IMPLANTS Rødvik AK, Bunne M, Billermark E, Landsvik B Oslo University Hospital, Rikshospitalet, ENT Department, Oslo, Norway Background and objective. Atraumatic surgery technique and electrodes at cochlear implantation (CI) have increased the probability of low frequency hearing preservation by preserving neural elements in the apical part of the cochlea. Candidates for Electric Acoustic Stimulation (EAS) are usually first fitted with hybrid hearing devices, a combined CI speech processor and hearing aid. The selection of candi‐
dates is mainly based on pure tone audiometry showing good low frequency hearing, and hearing should not be progressive. We wish to share our experience with EAS in the two Norwegian children who received this implant so far. Patients and method. A boy was bilaterally, sequentially implanted at 8 years and 6 months, and at 9 years and 3 months, and a girl was unilaterally implanted at 5 years and 7 months. Both candidates were first implanted with a Med‐El Concerto Flex EAS implant and fitted with a Med‐El Duet 2, as the residual hearing had decreased slightly postoperatively. The boy switched from using Duet 2 to Opus 2 after 9 months, as his residual hearing then had improved to almost the preop‐
erative level. The girl is still using Duet 2, and she also continued for a while after the operation to use an Inteo transposition hearing aid on the non‐CI ear, on and off. Results. We noticed a considerable im‐
provement in the phoneme perception of both children, particularly in the Ling’s 6 sounds test. The re‐
sults of the speech perception tests preoperatively and after certain months of use are presented. The in‐
vestigation of the benefit of the EAS CI was performed by stimulating the CIs using an induction loop. This method will be described in the presentation. Conclusion. Our preliminary results indicate that the cochlear implantations and the sound adaptations with EAS implants have been successful. N. 119 ‐ LISTENING DIFFICULTIES OF PROFOUNDLY DEAF CHILDREN IN EVERYDAY LIFE SITUATIONS Ostojic S1, Mikic B2, Miric D2, Mikic M1, Đoković S1, Radović D2 ¹Belgrade University, Faculty for Special Education and Rehabilitation, Department for special education and rehabilitation of deaf and hard of hearing; ²Clinical Center of Serbia, Institute for ENT‐HNS, Audiology Rehabilitation Department Introduction. Profoundly deaf children experience a lot of listening difficulties in everyday life in spite of using cochlear implant or hearing aids. Their auditory capacity is often not sufficient for normal communication, in noisy places or in the open space, althouh they seem quite competent to understand the teacher at a close range, in a quiet room. Information obtained from parents could be helpful in get‐
ing full insight in communication capacity and listening difficulties of hearing impaired children in eve‐
ryday life. Aim of the study. To assess listening difficulties of profoundly deaf children with cochlear NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 166 NHS 2012
implants or hearing aids in everyday life situations and fid out if type of amplification affects auditory performance at home. Sample and methodology. Forty profoundly deaf children with prelingual deaf‐
ness, aged 3 to 10, were enrolled in the study. Twenty children had cochlear implant, while the other 20 children had bilateral hearing aids. The children in both groups were matched by hearing experience and it ranged from 6 months to 4 years. C.H.I.L.D. (Children Home Inventory for Listening Difficulties, Anderson, K.L., Smaldino, J.J., 2000; Oticon, 2007) was used and answered by parents for kids aged 3 to 8 or by children themselves for older ones. Results. The resuts of this study that the children with cochler implant have shown better overall listening in everyday situations with average score of 6 out of 8, as compared to profoundly deaf children with hearing aids whose average score was 5.27. Conclu‐
sion. Profoundly deaf children with cochlear implant have shown better listening abilities in everyday life situations (at home, in the car, in the street, in the shopping mall or at a playground) than children with simmilar degree of hearing loss who were using hearing instruments. N. 120 ‐ AMPLIFICATION CHALLENGES IN ʺREVERSE‐SLOPEʺ HEARING LOSS Tani A Ospedali Riuniti di Bergamo Congenital ʺreverse‐slopeʺ hearing losses are characterized by an inverted pattern in comparison to the majority of sensoryneural losses, in the sense that the auditory damage interests the low‐mid range fre‐
quencies, while high frequencies are generally less compromised or entirely normal. Detection is often late, partly because of clinical errors (wrong diagnosis of conductive loss or “Meniere‐like” pathologies), partly because of the apparent absence of troubles in language acquisition and production. The preser‐
vation of high frequencies actually allows a good discrimination of many phonetic tracts (especially con‐
sonants), contrary to how it happens for most of sensoryneural losses. Besides, paradoxically, low‐mid frequency loss involves a decrese of masking towards the high components, with the result sometimes of a better auditory sensitivity for some sounds (i.e. consonants, prosodic tracts and whisper). Nevertheless patients suffering from this kind of loss require an auditory aid, since the amount of phonetic informa‐
tion and environmental sounds contained in this wide range of frequency is quantitatively and qualita‐
tively very important for a suitable development of the cognitive/discriminative functions and of the knowledge of acoustic environments. Hearing aid fitting involves many troubles, tied up partly to the rarity and consequent scarce experience of audiologists with this kind of loss, partly to the inappropri‐
ateness of many hearing instruments to the purpose. In this work are exposed the results obtained in 5 cases of congenital ʺreverse‐slopeʺ loss, underlining the difficulties met in the preselection of amplifica‐
tion parameters with regards to the audiometric pattern and the residual dynamic range, to the choice of an appropriate acoustic instrument, to the fitting procedures and the monitoring of the results. The use of digital aids with advanced management of the signal allowed excellent results in all the cases, induc‐
ing a good spontaneous recovery of phonetic discrimination and auditory bearings after a brief period of use. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 167
N. 121 ‐ THE SWIMMABLE SOUND PROCESSOR NEPTUNE™: PRELIMINARY FEED‐
BACK Mathias N, Arnold L Advanced Bionics, Rixheim, France Objectives. Advanced Bionics™ recently launched their latest generation sound processor called Nep‐
tune™. Neptune is a freestyle design swimmable processor, which makes it possible to hear underwater and enjoy an active life without worrying about the robustness of the processor. It offers a variety of wearing options for different persons and situations. The objective of this survey was to evaluate the practicality, comfort and ease of use of the Neptune processor and its various wearing configurations. Study design. Two separate surveys were conducted: a short one online and a longer questionnaire spe‐
cifically handed out to existing users who were upgraded to Neptune. Adults and children participated. They tested the Neptune and the wearing options for a minimum of four weeks before completing the surveys. Upgraded subjects compared their previous processor to the Neptune and both new and exist‐
ing users answered questions on the Neptune processor about the wearing options, comfort, ease of use and sound quality. Results. Data collection is still ongoing; results from the first Neptune users will be presented, with particular focus on the ergonomic aspects in active situations in the paediatric popula‐
tion. Conclusion. Although only preliminary results are available so far, the Neptune processor appears to deliver up to its promises: it allows users to live an active life without compromising their hearing performance. More data are expected to confirm these preliminary observations on a larger scale. N. 122 ‐ CI IN CHILDREN WITH COMPLEX NEEDS Herrmannova D MEDEL, Prague, Czech Republic Many studies confirm that during the last two decades the population of children with complex needs has grown. In particular, a greatly increased number of very premature babies are now surviving through advanced medical care where this is available. However, up to 40% of very early born babies have significant and permanent disabilities. These frequently include difficulties in the areas of hearing, vision, kidney function and respiration. Society can now offer much to premature babies. Significant changes have taken place, and continue to take place, in the tools and technology to support them. One example is the Cochlear Implant (CI): this can benefit children who are profoundly deaf, including those with complex additional needs. In the last years the inclusion criteria for cochlear implantation have been widened. The consensus is growing that additional disabilities are no longer a contraindication. Therefore more deaf children with complex needs receive cochlear implants. Cochlear implants can bring benefits across a range of areas, including listening, the development of communication, psycho‐
social skills, and pre‐academic and academic function. However, there are differences in the type of benefits cochlear implantation will bring to children who are deaf with complex additional needs and to those whose primary need is caused by deafness alone. The lecture will go through the statistics of CI users, different systems of outcomes monitoring, strategies in rehabilitation and finally different benefits that children with complex needs can have from a cochlear implant. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 168 NHS 2012
N. 123 ‐ COMPARISION OF FINE STRUCTURE PROCESSING (FSP) STRATEGY WITH THE NEW (FS4) STRATEGY USED IN THE MED‐EL COCHLEAR IMPLANT SYSTEM Meenakshi W, Nikhil M Meenakshi Speech and Hearing clinics, New Delhi, India Objective. The aim of the present study was to evaluate MED‐EL’s Fine Structure Processing (FSP) strat‐
egy in comparison with the new variations of the Fine Structure Processing at 4 channels up to 1khz. Study Sample. 30 experienced adult CI users participated in the study in connection with upgrading to a new speech coding strategy with 6 months to 12 months follow up. A pre‐upgrade Standardized ques‐
tionnaire and post‐upgrade Questionnaire was performed for speech intelligibility and music sound quality. Standard speech recognition tests in quiet and in noise were also accomplished to monitor the participants’ actual performance and to evaluate long‐term outcomes. Results. The results showed the FS4 speech coding strategy were more preferred and liked over the FSP speech coding strategy. The user also experienced better speech perception and music perception using FS4 coding strategy. Conclusions. The new FS4 coding strategy gives the user an extended low frequency up to 1 KHz, giving the user a rich and satisfied experience with the better speech perception and the music perception. Making the new FS4 coding strategy preferred over FSP coding strategy. N. 124 ‐ EVALUATION OF AUDITORY AND SPEECH DEVELOPMENT IN PERSIAN LANGUAGE CHILDREN FOLLOWING COCHLEAR IMPLANTATION AND HEARING AID USE BY IT‐MAIS & MUSS Riyasi M1, Jahangiri N2, Ghasemi MM3, Tayarani Niknezhad H1, Saidi S4 Cochlear Implant Center, Mashad, Iran; 2Department of Linguistics, Ferdosi University, Mashhad, Iran; 3Department of Otorhinolaryngology, Head and Neck Surgery, Quem Educational Hospital, Mashad University of Medical Sciences, Mashad, Iran; 4Ferdos Azad University, Iran 1
There is a great difficulty in determining whether cochlear implantation would be beneficial and neces‐
sary for all hearing impaired children or not, especially because of the great efficiency of new and mod‐
ern hearing aid devices. Objectives. The main purpose of this study was to assess the changes in audi‐
tory and speech skill development in two groups of deaf children after receiving hearing aid (HA) and cochlear implant (CI), and to evaluate the benefits of cochlear implantation in comparison to hearing aid use. The second purpose of this study was also to administer the Infant‐Toddler Meaningful Auditory Integration Scale (IT‐MAIS) and Meaningful Use of Speech Scale (MUSS) to Persian‐ language hearing impaired children for the first time. Materials and Methods. eighty children were enrolled for this study. These children were divided into two groups as per their device (CI or HA). Each group included forty children. Group 1 received cochlear implant and their ages were between 3 to 6; Group 2 were us‐
ing hearing aid and their ages were less than 5 years. Children in both groups were all prelingual, with severe to profound hearing loss. Auditory and speech skill development of each group were assessed us‐
ing the Infant‐Toddler Meaningful Auditory Integration Scale (IT‐MAIS) and Meaningful Use of Speech Scale (MUSS). Results. Improvement in performance on all measures was recorded in both groups of children over a period of six months following implantation or use of hearing aid. Our results indicated that both groups in our study had shown improvement in auditory and speech performance during six months of device use, but auditory and speech skill development of implanted children were more im‐
pressive than hearing aid children. We also found a direct relation between the auditory and speech per‐
NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 169
formance of our studied groups and the probes of these two scales. Conclusions. Children with severe to profound hearing loss who received cochlear implant have better opportunity to acquire auditory and speech skill development than of those who received hearing aid. So we can conclude that the efficiency of cochlear implant is greater than hearing aid, although we should always consider hearing aid device as a probable and first option. N. 125 ‐ CROSS‐MODAL‐PLASTICITY IN DEAF AND DEAF‐BLIND CHILDREN: STUDY WITH EVOKED POTENTIAL. PRELIMINARY RESULTS PRE VERSUS POST ‐ CO‐
CHLEAR IMPLANT Charroó‐Ruíz L1, Pérez‐Abalo MC1, Picó‐Bergantiños Th1, Hernández‐Cordero MC1, Bermejo‐Guerra S2, Bermejo‐Guerra B3, Galán‐García L1 Cuban Neuroscience Center, Clinical Neurophysiology, Habana, Cuba; 2“Marfán” Pediatric Hospital, Audiology, Habana, Cuba; 3“La Pradera” Internacional Clinical Health, Rehabilitation, Habana, Cuba 1
This research focuses on Cross‐Modal‐Plasticity in deaf and deaf‐blind children candidates for Cochlear Implants (CI) through the evaluation of the maps topography of the Visual Evoked Potentials by flash stimulation (VEP) and Somatosensory Evoked Potentials by stimulation of median (SSEP‐N20) and tibial (SSEP‐P40) nerves. Also shown are the preliminary results pre versus post CI after rehabilitation audito‐
ry of 9 deaf and deaf‐blind children. In deaf children (n=14) and deaf‐blind children (n=12) topographic distribution maps of the SSEP‐N20 showed expansion of activation. Cortical areas: temporal in deaf and temporal‐occipital in deaf‐blind children were activated. These regions under physiological conditions process auditory and visual information but not somatosensory. Whereas, SSEP‐P40 no showed changes with strictly localized in the central‐parietal mid‐line (area of somesthetic information representation of the foot). Maps topographic of the VEP showed no changes. The expansion of the cortical response of the SSEP‐N20 to the left temporal region in deaf and deaf‐blind children with 7 o more age was interpreted as evidence of Cross‐Modal‐Plasticity, although in deaf children the over‐representation of SSEP‐N20 was less extensive that in deaf‐blind children. Also shown for the first time, evidence of Cross‐Modal‐
Plasticity through a study pre versus post CI. Deaf and deaf‐blind children who were implanted before the age of 7 showed no change; by contrast, in children implanted after 7 years of age there are changes in the SSEP‐N20, in the study pre and post CI. These results are pointing neuroplastic changes that occur as result of the lost input of the sensory information during the critical period of neurodevelopment, as well as the effect that may have the use of the hands for communication in these children, with conse‐
quent implications of the Cross‐Modal‐Plasticity to the optimal use of the CI during auditory rehabilita‐
tion. N. 126 ‐ EFFECT OF EARLY INTERVENTION ON THE DEVELOPMENT OF LANGUAGE SKILLS OF CHILDREN WITH HEARING IMPAIRMENT Ristic S, Kocic B, Bojanovic M, Marinkov ZM Clinical Center, ENT Clinic, Nis, Serbia Objective. Early diagnosis of hearing loss in children allows for timely intervention in the form of: hear‐
ing aids or cochlear implant (CI), after which the rehabilitation process begins. The aim was to discover to what extent and at what time they developed their verbal skills. Methods. Our study is a multi center NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 170 NHS 2012
observational study of children in which the damage was discovered during the period of commence‐
ment and duration of speech formation (lingual phase). The degree of hearing impairment ranged from mild to profound. All the children underwent a rehabilitation program focused on developing language skills. They are rated by experts battery of standardized tests and are interviewed and take into account the opinions and attitudes of their parents. Results. Results showed that the development of language skills have a greater impact age periods using technology and auditory habilitation process than the be‐
ginning level of hearing loss. Better results are shown with built in CI children compared to children with a hearing aid, even though there were children with lesser degrees of damage. Conclusion. Results indicate that children with all degrees of hearing loss that can fit into the auditory technology and who have undergone the rehabilitation process during the pre‐school period show potential to develop speech‐language communication skills. They were late in comparison to normal hearing peers the map of development and had difficulty in acquiring articulation, but they quickly develop speech and lan‐
guage skills and were less distorted than in the voices of children who were later applied to hearing technologies. N. 127 ‐ ANSD AND EARLY LANGUAGE DEVELOPMENT Sollie A, Skagen AM Møller‐Trøndelag Resouce Centre, department of hearing and sign language, Trondheim, Norway Background. In our work we meet preschool age children with different kinds of hearing impairment, among these the phenomenon of Auditory Neuropathy Spectrum Disorder (ANSD). The research con‐
cerning this disorder is very limited in Norway. The most characteristic feature regarding ANSD is de‐
scribed as being able to hear, but not understanding what you hear. To explain the consequences of this to parents is a major challenge. International research is unanimous in the conclusion that the disorder constitutes a risk regarding language development. Aim. The aim is to give an account of the early lan‐
guage development for a child with the diagnosis ANSD. We want to increase people`s knowledge about the disorder and the consequences this may have for language development. Our thesis question is as follows: How does early speech development progress for a child with auditory neuropathy spectrum disor‐
der? Method. The study contains a single case‐study where our analysis is based on a girl diagnosed with ANSD, who also has a sensorineural hearing impairment. We have used video‐observations and assessment tools including, amongst others, MacArthur‐Bates CDI and Auditory‐Verbal Therapy in ad‐
dition to tests as Reynell and BPVS. Conclusions. Findings show that the child has little benefit from amplification through hearing aids, causing delayed development in auditory skills and spoken lan‐
guage. Despite late detection of the hearing loss, the child has an age equivalent cognitive development. After cochlear implantation we see a great progress in auditory and language skills. Findings show that the child goes through many stages of language development during this study. Theoretical descriptions of 2 year old normal hearing childrenʹs language development, matches the childʹs language level at the end of the study, as measured by Reynell. The child then has a chronological age of 3 years and 8 months, and a hearing age of 9 months. This means that the child, within a period of 9 months, has caught up with the language development of a 2‐year old. We believe this to be associated with cochlear implantation giving an improved auditory function. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 171
N. 128 ‐ HEARING AID OUTCOMES IN AUDITORY NEUROPATHY CHILDREN Sawaya K1, Midgley E1, Humphriss R1, Children’s Audiology Team1, Hearing Support Team2 Children’s Hearing Centre University Hospitals Bristol, UK; 2Sensory Support Service – Hearing Elmfield House, Bristol, UK 1
Newborn hearing screening allows us to identify neonates with Auditory Neuropathy Spectrum Disor‐
der (ANSD) within the first month (corrected age) of life. These children’s eventual hearing thresholds tend to vary from essentially normal to moderate to profound and are difficult to establish early. Speech and language ability also tends to fluctuate and hearing aids do not always guarantee positive speech outcomes. Having a better understanding of ANSD, good management strategies and possible outcomes allows us to better counsel parents and provide good management for our patients. Children diagnosed with ANSD from Bristol Children’s hearing centre in the last 10 years were examined. All children that were fitted with hearing aids were reviewed with regards to results, management and outcomes includ‐
ing the following: birth history, ABR levels and pattern, behavioural thresholds, aided results and recep‐
tive and expressive communication age levels. Communication outcomes were reported by hearing support teachers and local speech and language therapist if involved. Aided levels generally showed positive outcomes in all children. Speech outcomes, in terms of receptive and expressive communication tended to vary between children. Children with severe to profound hearing thresholds were all recom‐
mended for cochlear implant assessment. N. 129 ‐ SPEECH PERCEPTION AND P1 COMPONENT IN COCHLEAR IMPLANT USERS WITH AUDITORY NEUROPATHY SPECTRUM DISORDERS Alvarenga KF1, Amorim RB2, Agostinho‐Pesse RS2, Costa OA3, Silva LTN4, Bevilacqua MC3 Associate Professor in the Department of Audiology and Speech Pathology at the School of Dentistry, University of São Pau‐
lo, Bauru campus, Brazil; 2Audiologist in the Department of Audiology and Speech Pathology at the School of Dentistry, Uni‐
versity of São Paulo, Bauru campus, Brazil; 3Full Professor in the Department of Audiology and Speech Pathology at the School of Dentistry and Coordinator of the Center for Audiological Research, University of São Paulo, Bauru campus, Brazil; 4Audiologist in the Center for Audiological Research at the University of São Paulo, Bauru campus, Brazil 1
Several studies have focused on the evaluation of auditory function in cochlear implant users in order to verify how the acoustic signal processing occurs. Among procedures used to attain this objective, the long latency auditory evoked potential (LLAEP) has been used. Aim: To characterize the long‐latency auditory evoked potentials of the P1 component in implanted individuals who suffer from auditory neu‐
ropathy spectrum disorder and correlate it with the performance in speech perception and secondarily to other variables related to cochlear implants. Method: This study was conducted at the Center for Audiological Research at the University of São Paulo (USP). The sample comprised 14 children, cochlear implant users with Auditory Neuropathy Spectrum Disorder of both sexes, ages 4‐11 years. The P1 component was conducted with the equipment Smart EP USB Jr by IHS, which provides two recording channels: channel A recorded the evoked potentials and channel B the eye movements and blinking to minimize the artifact of eye movement interference. The speech stimulus /ba/ was presented with inten‐
sity of 70 dB HL. In order to evaluate the speech perception of individuals, tests 1, 5, and 6 of the GASP (Bevilacqua and Tech,1996). The procedures were performed in an open field, with the speaker posi‐
tioned at 90º azimuth. Results: There was significant and positive correlation (p = 0.007 *, r = 0.7278) be‐
tween the duration of sensorial hearing deprivation, speech perception and P1component latency, with‐
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out correlation with time of CI use. Conclusions: In children with ANSD, the P1 component can serve as a predictor for the implanted childʹs performance for speech perception. N. 130 ‐ AN INVESTIGATION INTO THE BACKGROUND FACTORS THAT CONTRIB‐
UTE TO THE LANGUAGE OUTCOME OF COCHLEAR IMPLANT CHILDREN Sadighi F, Rahimi M, Razeghi S Department of Foreign Languages and Linguistics, Shiraz University, Shiraz, Iran In this work, it has been tried to determine the level of language skills of children with cochlear implant (CI) between the age of 5 to 8 years old. In addition it has been aimed to assess the relationship between the language outcomes of these children with regard to background factors such as age at implantation, chronological age, gender and IQ which contributed to the language production, language comprehen‐
sion and language development as a whole. Test of Language Development was administered to 30 pre‐
lingual, severe‐to‐profound CI children between the ages of 5 to 8. The obtained raw scores were then converted into T and Z scores. All data calculation has been performed by SPSS 16. Results indicated that current age, age at implantation, gender and IQ appeared to be respectively influential in different aspects of language development in these children. N. 131 ‐ LONG‐TERM DOCUMENTATION OF THE JOURNEY OF CONGENITALLY DEAF CHILDREN Hellmuth‐Zweyer U1, Tudor A2, David L3, Popescu R4 MED‐EL GmbH, Innsbruck, Austria; 2Children’s hospital “Grigore Alexandrescu”, ORL, Bucharest, Romania; 3Ear Clinic, Bucharest, Romania; 4“Lucian Blaga” University, phsychology department, Sibiu, Romania 1
Objective. Enhance decision for early CI‐implantation after diagnosis and efficient postoperative sup‐
port for congenitally deaf children and their environment. Method. The evolution of 11 implanted chil‐
dren has been documented via video recording. From a cohort of 100 implanted children, who are mem‐
bers in a CI‐users association, 11 children (6 boys and 5 girls) were selected as random subjects. Their age at implantation varied from 12 month to 5 ½ years. Each subjects evolution process of hearing based communication skills was documented over a 3 year time span by performing a video documentation every 4 month comprising: a) an interview of parents assessment regarding their child’s progress in lis‐
tening, speech understanding and speech production and b) real life situations such as speech therapy with a professional, home rehabilitation and every day communication. Results. Parents involvement is of utmost importance from the very beginning and ensures that rehabili‐
tation training comprising communication and acoustic stimulation starts directly after CI implantation, omissions within the first two years cannot be compensated later. Independent of the age at implanta‐
tion significant speech production (first 5 words) will not occur before one year after activation of the implant. In line with other studies early CI ‐ implantation supports natural language acquisition of con‐
genitally deaf children, facilitating rehabilitation and increasing chances to successfully attend main‐
stream education facilities. Conclusion. This work encourages parents and family members to be active and take their role as natural co‐therapists and supporters. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 173
N. 132 ‐ THE EVALUATION OF AUDITORY PERCEPTION AND LANGUAGE DEVEL‐
OPMENTS OF HEARING IMPAIRED NEWBORNS IN TURKEY Sevinc S, Sahli S, Belgin E Hacettepe University, Faculty of Medicine, ENT Department, Audiology and Speech Pathology Section, Ankara, Turkey Aim. Newborns with hearing loss are deprived of an important source of sensory input. The auditory stimuli that a child perceives in the first few months of life form the basis of speech, language, and cog‐
nitive development. If lacking, auditory perception, language and comprehensive development can be adversely affected. The purpose of this study is to evaluate the results of auditory perception and speech‐language skills of newborns of hearing screening programme in maximum first 5 years at Hacettepe University in Ankara, Turkey. Materials and methods. We performed a descriptive study of the maximum first 5 years after starting of the newborns in Hacettepe University in Ankara, Turkey. The auditory perception performances of newborns were evaluated on first coming, 1st, 2nd, 3th, 4th and 5th years with the help of Ling’s six sounds test (detection and recognition), and IT‐MAIS/ MAIS (Infant‐
Toddler/ Meaningful Auditory Integration Scale). Also, skills of receptive and expressive language of newborns were evaluated by PLS–4 (Preschool Language Scale‐Fourth Edition) at the same time inter‐
vals. Results. We found out that there was a significant increase especially in the first and second years, on analyzing performances of detection and recognition of Ling’s six sounds of the newborns and IT‐
MAIS/MAIS scores. In addition, receptive and expressive language performances of newborns were in‐
creasing gradually and reached level of chronologic age at the end of the second year. Discussion. Uni‐
versal Newborn Hearing Screening enables early identification and intervention prior to 6 months of age, such that near‐age appropriate language skills and auditory perception performance can be achieved. N. 133 ‐ GENERAL PROFILES OF HEARING IMPAIRED NEWBORNS IN TURKEY: CHARACTERISTICS OF HEARING LOSS, AMPLIFICATION AND INTERVENTION Sahli S, Sevinc S, Belgin E Hacettepe University, Medicine of Faculty, ENT Department, Audiology and Speech Pathology Section, Ankara, Turkey Aim. Hearing is so critical to the normal development and acquisition of receptive and expressive lan‐
guage skills. Hearing impaired infants who are not identified before 6 months of age have delays in speech and language development. The aim of this study is to present the general features (degree, type and etiology of hearing loss, amplification and intervention) of newborns of hearing screening pro‐
gramme at Hacettepe University in Ankara, Turkey. Materials and methods. In our study, the data of 30 newborns were evaluated retrospectively. Informations of newborns were collected from hospital records. We analyzed gender, chronologic age, hearing aid/cochlear implant age, age of starting audito‐
ry‐verbal therapy of newborns. Results. When the results were analyzed, we found that average chrono‐
logical age of the 30 newborns was 48.70 (SD:17.191) months (range 5‐75 months), hearing aid wearing age was 5.83 months (SD:1.533) starting to auditory verbal therapy age was 6.70 months (SD:1.878). In addition to this, 17 (%56.6) of 30 newborns underwent cochlear implantation. Cochlear implantation age of newborns was 13.17 months (SD:15.159) and duration of cochlear implant was 14.83 months (SD:16.564). Discussion. Early identification and intervention of hearing loss can prevent severe psycho‐
social, educational, and linguistic effects. Amplification and intervention at or before 6 months of age al‐
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lows a newborn with hearing loss to develop normal speech and language, alongside his or her hearing peers. N. 134 ‐ BENEFIT OF DEEP ELECTRODE ARRAY IN COCHLEAR IMPLANTATION: WORD DISCRIMINATION AND SENTENCE RECOGNITION SCORE IN SERBIAN SPEAKING CHILDREN Andric Filipovic S1, Miric D1, Milovanovic J1, Trajkovic G2, Asanovic M1, Ostojic S1 Clinical Center of Serbia, Clinic for ENT and Maxillofacial surgery, Belgrade, Serbia; 2Institute for Medical Statistics and In‐
formatics, Belgrade, Serbia 1
The appical part of cochlea plays an important role in the first formant discrimination of vowels and consonants. Many authors compared speech performance between patients with different electrode in‐
sertion depth. Some vowels and nasals in Serbian language have the first and second formants at low frequency region and the tonotopic stimulation of the whole cochlea is very important for its discrimina‐
tion. Objective: to assess the contribution of complete cochlear caverage in the discrimination score of word test and the influence of hearing age in the open sentence recognition score. Method: Standardize Serbian language word and sentence open set test was given to 24 praelingualy deaf children with one side cochlear implants. The children were divided into two groups: L group with deep electrode array and K group with electrode array 25 mm or less. The test was performed by live voice at 60 dB in sound field. Results: there was no difference between the groups considering their age, the age at implantation and at hearing age. The mean age was 72 months in L group, and 83 months in K group. The children with deep electrode array insertion had better scores in I, II, III and V subtest. The results did not reveal a significant difference between groups. The hearing age significantly influenced sentence recognition. Conclusion: Complete cochlear caverage is important in some vowels (O and U) and consonants (nasal: M and N) discriminated in Serbian language. N. 135 ‐ FUNCTIONAL PERFORMANCE OF CHILDREN USERS OF SENSORY HEARING AIDS BASED ON PARENTS’ OBSERVATIONS Bevilacqua MC1,2, Moret ALM1,2, Cruz AD2, Morettin M1,2, Alvarenga KF1,2, Jacob RTS2 University of Sao Paulo, Craniofacial Anomalies Rehabilitation Hospital, Audiological Research Center, Bauru, São Paulo, Brazil; 2University of São Paulo, Department of Speech Pathology and Audiology, Bauru, São Paulo, Brazil 1
Permanent childhood hearing loss has negative effects on children’s typical communication develop‐
ment, literacy, psychosocial functioning and academic achievement. In recent years, considerable atten‐
tion has been placed on the early identification and management of hearing loss and on the basis that early access to hearing will improve communication outcomes. The objective of this study was to evalu‐
ate the benefit of the use of sensory hearing aids in 35 hearing impaired children users of individual sound amplification devices (hearing aids) and/or cochlear implant (CI) aged 1 year and 6 months to 14 years. The scale used was Parent’s Evaluation of Aural/Oral Performance of Children (PEACH) developed to measure functional performance in everyday life, based on the systematic use of parents’ observations. The scale comprised 14 items, including two items on device usage, one item on listening comfort, six items on listening to speech in relatively quiet environments, four items on listening to speech in noisy environments or when multiple talkers are present, and one item on awareness and recognition of envi‐
ronmental sounds. The children studied showed better hearing performance in the activities developed NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 175
in quiet environments than in the activities developed in noisy environments, regardless of age and du‐
ration of use of the device. More than half of the group showed benefits to the auditory perception of speech and environmental sounds, including advanced listening skills to the use of the telephone. There was a significantly better total score result on the PEACH scale in children users of cochlear implant (CI) and hearing aids (HA) in the contralateral ear, than in users of bilateral HA and only one CI. There were no correlations between total score obtained on PEACH scale and education and socioeconomic status of parents or guardians. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 176 NHS 2012
TRAINING AND SUPPORT N. 136 ‐ PEDIATRIC AUDIOLOGY: A TRAINING CURRICULUM Folsom RC, Mancl LR University of Washington, Department of Speech and Hearing Sciences, Center on Human Development and Disability, Seattle, Washington, USA Newborn hearing screening and early diagnosis of hearing loss have created unique challenges for pedi‐
atric audiologists in working with families. Hearing loss is diagnosed in infants prior to their parents having any concerns and is therefore “institution‐initiated” rather than “parent‐initiated”. As such, the role of the audiologist is crucial in the support of families by providing them with content counseling as well as emotional‐support counseling, all the while serving as the case manager to help the family access resources. With increasing numbers of infants and children being diagnosed with hearing loss and need‐
ing long‐tem audiological follow‐up, there is a need for qualified pediatric audiologists to serve this growing population. The shortage of qualified pediatric audiologists is one of the leading barriers to di‐
agnosis and intervention of hearing loss in infants and children. Many audiologists report feeling un‐
prepared for counseling families. Feedback from parents routinely describe that audiologists are typi‐
cally unable to provide the emotional support that families need. The LEND program at the Center on Human Development and Disability (CHDD) at the University of Washington has developed a curricu‐
lum for a Pediatric Audiology Training Emphasis (PATE) as part of the Doctor of Audiology graduate program in the Department of Speech and Hearing Sciences. The Leadership in Education in Neurode‐
velopmental and Related Disabilities (LEND) at CHDD is a graduate level interdisciplinary training program that prepares trainees to assume leadership roles in their respective fields and insures a high level of interdisciplinary clinical competence in providing health and related services for children with neurodevelopmental disabilities and their families. N. 137 ‐ ORGANIZATION OF THE HOSPITAL‐BASED NEWBORN HEARING SCREEN‐
ING – A STAFF SATISFACTION SURVEY AS AN ESSENTIAL INSTRUMENT TO IDEN‐
TIFY ASPECTS OF IMPROVEMENT Depenbrock A, am Zehnhoff‐Dinnesen A, Matulat P Clinic and Policlinic of Phoniatrics and Pedaudiology, University Hospital Muenster, Germany Objectives. So far, papers discussing quality management in the UNHS have focused mainly on objec‐
tive, quantifiable screening parameters. Studies drawing information not only from technical data, but also from surveying human resources behind the UNHS appear to be a rarity. A high level of quality re‐
quires consideration of the state of both knowledge and practical skills among the staff screening. Estab‐
lishing this aspect as a part of future quality management has given reason to conduct this survey. Methods. A self‐made questionnaire was sent out to hospital staff in the German area of Westphalia‐
Lippe, addressing to 710 nurses who were registered to have received a training course for carrying out the UNHS. A response rate of 50.1% was obtained. The questions aimed at aspects of organization, the staff’s personal practical skills, present problems and improvement opportunities. Participants were giv‐
en the opportunity to add their own commentaries. Results. 78% thought they had enough certified staff NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 177
to handle the UNHS workload. However, high rates of occupancy, lack of trained personnel, technical issues and noise disturbance were factors that increased time pressure and slowed down procedures. 67% felt their training course prepared them sufficiently for screening, although it was indicated that some temporarily recruited nurses had learned only from watching and never got officially certified. 15 % consider communicating a “Refer”‐result to parents a difficult step; 8% feel insecure when explaining aim and procedure to parents. Screeners are highly interested in further training sessions. Conclusions. In order to optimize screening procedures in hospitals and meet the staff’s needs, this survey served well to reveal aspects of improvement. All nurses should be instructed to do the screening and there should be more opportunities for repetitive training sessions. As those were particular areas of their in‐
terest, sessions should outline practical conduction and also professional, sensitive communication to parents. N. 138 ‐ PROVISION OF REHABILITATION SERVICES AFTER UNIVERSAL NEWBORN HEARING SCREENING: A PROPOSAL FOR PROFESSIONAL TRAINING IN BRAZIL Bevilacqua MC, Ferrari DV, Morettin M, Silva MP, Moret ALM, Costa OA University of Sao Paulo, Craniofacial Anomalies Rehabilitation Hospital, Audiological Research Center, Bauru, São Paulo, Brazil and University of São Paulo, Department of Speech Pathology and Audiology, Bauru, São Paulo, Brazil The implementation of Newborn Hearing Screening favored hearing loss early identification and diag‐
nosis and protocols for pediatric hearing aid fitting and cochlear implantation are established. However, one of the greatest existing challenges is: how the rehabilitation process of the hearing impaired babies and engagement of their families are carried out to the greater use of current technology and scientific knowledge? Regardless of the referral for rehabilitation being an educational setting or, as in Brazil, a clinical setting, it is essential to make sure that professionals who serve this population are adequately skilled. In Brazil, over the past two years, a federal law was passed requiring universal newborn hearing screening (UNHS) in all hospitals, and a new police for people with disabilities, giving priority to UNHS, was also established. That increased the demand for pediatric services, intensifying the need for well articulated hearing healthcare networks as well as the solid formation of professionals who provide such services. This study presents a specialization course proposal for such professionals, aiming to de‐
velop skills and attitudes appropriate to a model of comprehensive care. The course has five thematic axes: Reality Recognition, Integrality and Humanization, Hearing Health in Childhood, Qualification of Clinical Practices and Support for the Conclusion Monograph. The pedagogical methodology focuses the teaching/service relationship. The 360 hours of training, made predominantly by distance learning, is centered on the use of active and problem‐solving methodologies that allow reflection on practice and challenges, while encouraging the attainment of skills required to changing them. This proposal was ap‐
proved by the Brazilian Ministry of Health and will be carried out during the years of 2012 and 2013. The expected result is that the course participants will be modifiers of their work reality, creating a net‐
work targeted to improve services to hearing impaired children and their families. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 178 NHS 2012
FOCUS ON FAMILIES N. 139 ‐ PARENT COURSE: ”HOW CAN I STIMULATE MY CHILD´S LISTENING AND SPOKEN LANGUAGE?” Kilander R, Persson A Karolinska University Hospital, Department of Audiology and Balance, Stockholm, Sweden Objectives: The purpose of this parent course was to provide families with a shorter alternative of inter‐
vention. Many parents in Stockholm seem to have less time to be involved in programs that stretches over a longer period of time. Methods: To take out some parts of the Hanen Program in combination with techniques and strategies that is used in the Auditory Verbal Approach. The target group is parents of children from birth to three years with all degrees of hearing loss. The course is scheduled as four half‐days and covers topics like early communication, communication types and how they interact, speech and spoken language development, creating optimal listening environments and tech‐
niques/strategies that support listening. Parents are encouraged to bring video recordings from home so we can analyze them together. Results: Since the course started in 2005 there has been eleven groups al‐
together, with about five to twelve parent per group. Parent evaluations have been very positive and all parents have reported that they would recommend this course to others. Evaluations also showed that most information was new to the parents and that the course content has increased their knowledge and awareness about how they can stimulate their children´s speech and spoken language development in everyday situations. Conclusions: This kind of short and focused intervention can reach groups of par‐
ents who otherwise would not go through a longer period of intervention. Furthermore, many parents report talking to other parents in the same situation is of great help and comfort. The course content seemed to cover most important parts of the parents needs and gave them useful tools to use in every‐
day communication with their children. N. 140 ‐ EARLY GROUP INTERVENTION AFTER UNHS: THE CONCEPT OF THE MUEN‐
STER PARENTAL PROGRAM Reichmuth K, Glanemann R, Matulat P, am Zehnhoff‐Dinnesen A Clinic of Phoniatrics and Pedaudiology, University Hospital Muenster, Germany Background. Oral speech and language development of hearing‐impaired infants is best supported by an intervention with early onset and a high level of family involvement (Moeller, 2000). Existing con‐
cepts of early intervention have to be adapted to the needs of parents of these young children. Aim. To develop and implement a parental group program that aims at extending communication‐enhancing be‐
haviour (responsivity) and reducing communication‐inhibiting behaviour (initiative) in parents of hear‐
ing‐impaired preverbal infants. Method/Concept. The Muenster Parental Program is specific to the needs of parents of hearing‐impaired infants immediately after diagnosis by UNHS. It is based on a communi‐
cation‐oriented natural auditory oral approach and trains parental responsivity on verbal and non‐
verbal signals of the child. The course is developed for groups of 3‐6 parents. It takes two months and comprises six group meetings (without children) and two individual parent‐child sessions with video‐
feedback. The children are at the preverbal stage (birth to maximum age of 2;6 ys) and have a confirmed NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 179
uni‐ or bilateral hearing‐impairment with/without an additional developmental impairment. It also suits parents of pediatric CI candidates pre and post implantation. Conclusions. Since 2009, the Muenster Pa‐
rental Program is implemented with ongoing evaluation (see abstract by Glanemann et al., “Enhanced parental communication skills by the Muenster Parental Program”). It meets the criteria of an effective intervention after UNHS. N. 141 ‐ UNDERSTANDING OUTCOMES IN THE CONTEXT OF FAMILIES EXPERIENCE WITH AN EARLY INTERVENTION SERVICE Kean M, Carr G Newborn Hearing Screening Programme England, UK Newborn hearing screening was implemented in England over five phases, achieving countrywide cov‐
erage in 2006. Since 2006, the newborn hearing screening programme (NHSP) has had in place a quality assurance programme, covering the full care pathway including early intervention. For more than thirty years early intervention has been a focal aspect of education services, with clear recognition of the im‐
portance of providing early provision to deaf infants, children and their families. Working towards a na‐
tionwide audit of children’s communication and language outcomes, NHSP began working with a num‐
ber of education services providing early intervention. These services were all deemed to be of very good quality, as assessed by the Newborn Hearing Screening Quality Assurance standards. The project is gathering standardised outcomes data for each child, identified through NHSP, using the MacArthur –Bates Communicative Development Inventories together with a detailed questionnaire to gather con‐
textual information. The combination of these measures enables the project to develop a deeper under‐
standing of each child’s and family’s journey and the support they have routinely experienced. All the babies and children involved received a ‘typical’ service with commonality of provision and none were enrolled in a research study. This poster aims, through the presentation of individualised case studies, to identify some common themes in service provision and family experience. N. 142 ‐ HAPPY FAMILY FOOD! Rogiers M LifeStyle Office, Rüti, Switzerland To carry a family, perform daily and master challenges. To further develop oneself on a daily basis. It all requires strength and energy. What and how we eat affects how well we are able to function as a person, as a couple and as a family. Our body consists of about 5 trillion cells – each and every cell wants to be fed properly. Every day our bodily functions work to renew or replace approximately 2 billion cells. The right kind of “fuel” and “building material” provide the body with the best conditions for optimal de‐
velopment, performance and balance. They bring more vitality, wellbeing and energy in the individual and family life. The paper will dissolve some of the common myths and will bring with case studies to share new insights and solutions regarding e.g. nutrition, learning, nutrients, family dynamics, and much more. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 180 NHS 2012
N. 143 ‐ HOLISTIC2 FAMILY COACHING OF CHILDREN AND FAMILIES EXHIBITING A VARIETY OF BEHAVIORAL, EDUCATIONAL, PHYSICAL, ETC ‘ISSUES’ Rogiers M Alles Liebe Consulting, Rüti, Switzerland More ‘traditional’ speech‐language therapy and audiology methods focus on the issues a given child has, will attribute those symptoms to a given pathology and will determine the type of intervention needed to target the issues observed. Holistic2 Family Coaching adds to that the aim of identifying the underlying factors (on a mental, emotional and physical level), that contributed to the development and/or the existence of the so‐called 3D‐symptoms, as observed by parents, teachers or professionals, in the first place. It also takes into account how people interact on a variety of levels and includes the mind‐
soul‐body link at all times and for all parties involved. Also, the ‘traditional’ approach to speech‐
language therapy and audiology will typically work with the child primarily and to a lesser extent with the parents. In Holistic2 Family Coaching we work primarily with the parents and coach them to become their child’s optimal coach. The child’s ‘therapeutic part’ of the program is but a part of the program. The Selfness & Energy approach is ‘holistic2’: it deals with microkosmos and macrokosmos matters, looks at physical and metaphysical aspects and integrates Western as well as Eastern knowledge, phi‐
losophy and tools. As a result, Holistic2 Family Coaching allows for de‐pathologisation of intervention. This paper will demonstrate the rationale behind the method via a series of case studies. N. 144 ‐ STRESS IN MOTHERS OF CHILDREN WHO ARE COCHLEAR IMPLANT CAN‐
DIDATES: PRELIMINARY RESULTS Aiello CP, Ferrari DV University of São Paulo, Bauru School of Dentistry, Department of Speech Language Pathology and Audiology, Bauru, São Paulo, Brazil Introduction. The parents of hearing impaired children often make important decisions about the reha‐
bilitation process while they learn to deal with new situations and feelings, which can lead to increased parental stress. Aim. To examine the stress in mothers of hearing impaired children who are cochlear implant candidates. Method: Participated in the study 24 mothers. Experimental group (EG): comprised of 16 mothers (mean age: 27 years) of profoundly deaf children (age varying from 10 to 31 months, mean age: 21 months) candidates to CI surgery in a public hearing healthcare facility. The control group (CG) was formed by 8 mothers (mean age: 28 years) of normal hearing children with age varying from 6 to 32 months (mean age: 19 months). Stress levels for both groups were measured using the Parenting Stress Index‐Short Form (PSI/SF)1 which presents 36 questions divided in three domains: Parental Distress (PD), Dysfunctional Parent‐Child Interactions (DPCI) and Difficult Child (DC). Results. The mean PSI/SF scores for experimental group were: PD=22,6; DPCI=16,2; DC=21,2; Total=60,1. For control group the scores were: PD=29; DPCI=14,1; DC=18 and Total=61,1. There were no significant differences between groups at the 5% level. Conclusion. The parental stress of mothers of hearing impaired children was similar to those of normal hearing children. Abidin RR. Professional Manual: Parenting stress índex. Psychological Assessment Resources, Inc. Odessa, Florida. 1995. 1
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N. 145 ‐ AUDIOVISUAL ON DEAFNESS AND SIGN LANGUAGE: IMPACT ON DEAF CHILDREN’S HEARING FAMILIES Moura GM, Lichtig I Universidade de São Paulo, Medical School, Course of Speech and Hearing Sciences, São Paulo, Brazil Introduction and aims. To develop a DVD on deafness and sign language (SL) and to ascertain the im‐
pact of the exhibition of this material upon deaf children’s hearing families. Methods. This study com‐
prised two stages: 1) creation, production and edition of the DVD; 2) presentation of the DVD to 28 deaf children’s hearing families. Procedure. pre and post‐intervention protocols were administered, interme‐
diated by the DVD exhibition (intervention). In pre‐ intervention phase, subjects filled the identification form and signed the informed consent term. In the post‐intervention phase, they answered a question‐
naire. Results. The first stage comprised: creation and edition of a 15 minutes DVD. Themes on deafness and sign language were presented by the researcher and an articulated puppet (a foam character). In the second stage the opinions about the DVD were analyzed and the results were: 75% of participants con‐
sidered the video very good , 25% good; 100% considered it a good way to clarify doubts; 92.86% stated that if they would have watched it when their children’s deafness was diagnosed, it could have contrib‐
uted to diminish their anguish; the video was considered “very easy” and “easy” to understand by 96,43; DVD topics were considered sufficient by 92,86%. Data was submitted to statistical analysis by us‐
ing sign test with significance level of 5%. Possible responses to the 12 questionnaire questions were classified as “positive” or “negative” aspects. Eleven of the 12 questions received significantly more pos‐
itive than negative evaluation. Conclusions. The video produced a positive impact upon subjects’ opin‐
ion, indicating that it fulfilled its role as an informative educative material, evidencing its relevance in health, education and communication areas. NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 182 NHS 2012
LIST OF CONTRIBUTORS A B Abdel‐Maksoud A ........................................................ 16 Abdel‐Rahman T .......................................................... 16 Abdi S ........................................................................... 154 Abdul Hadi US ............................................................. 69 Abey M .......................................................................... 91 Abrahams Y ........................................................... 88; 156 Adduci AV .................................................................. 152 Adelman C .................................................................. 161 Adler M ........................................................................ 161 Adler S ........................................................................... 83 Agarwal A ............................................................. 89; 114 Agostinho‐Pesse RS .................................................... 171 Aguirre LA .................................................................. 147 Ahmed ZM .................................................................. 115 Aiello CP ...................................................................... 180 Akar F ................................................................. 13; 31; 76 Akram J ........................................................................ 115 Al‐Alawi F ........................................................... 115; 116 Alexeeva NN ................................................... 45; 95; 134 Alford J ........................................................................... 79 Ali Hanafiah N .............................................................. 69 Al‐Sulaiteen M .................................................... 115; 116 Alvarenga KF .......................................111; 132; 171; 174 Alvarez I ...................................................................... 130 am Zehnhoff‐Dinnesen A ...................... 22; 64; 176; 178 Amorim RB .................................................................. 171 Anderson‐Asuega J .................................................... 112 Andric Filipovic S ....................................................... 174 Anggraeni R .................................................................. 41 Ansari Dezfouli M ........................................................ 40 Archbold S ..................................................................... 84 Ari‐Even Roth D ......................................................... 100 Arndt S ........................................................................... 29 Arnold L....................................................................... 167 Arora S ................................................................... 89; 114 Arunraj K ..................................................................... 113 Asanovic M............................................................ 49; 174 Aschendorff A ............................................................... 29 Ascunce Elizaga N ........................................................ 37 Ascunce N ....................................................................... 8 Asp F .............................................................................. 48 Aspris A ......................................................................... 17 Atalay Y ....................................................................... 117 Atty G ........................................................................... 119 Bagatto M ................................................................. 55; 78 Bagni JM ....................................................................... 110 Bakhshaee M .................................................................. 57 Bakhshinyan V............................................................... 11 Bant S .............................................................................. 92 Barbosa A ..................................................................... 124 Barbosa TA ................................................................... 135 Barker M ......................................................................... 58 Barzaghi L .................................................................... 111 Basar Suren F ..................................................... 13; 76; 82 Battelino S ...................................................................... 71 Bayar Muluk N .............................................................. 13 Beeler J ............................................................................ 91 Behl D ............................................................................. 23 Belgin E ............................................... 13; 31; 76; 116; 173 Belov OA .................................................... 11; 45; 95; 134 Bennet L .......................................................................... 92 Bercin S ........................................................................... 31 Beresford S ................................................................... 156 Bergeron F ...................................................................... 53 Bermejo‐Guerra B ........................................................ 169 Bermejo‐Guerra S ........................................................ 169 Berninger E .................................................................... 48 Berrettini S ...................................................................... 20 Beste C .......................................................................... 119 Beswick R ....................................................................... 60 Bevilacqua MC ............................................ 171; 174; 177 Bhimrao SK .................................................................... 28 Billermark E ................................................................. 165 Birkenhäger R ................................................................ 29 Blamey PJ ....................................................................... 92 Bliznetz E ........................................................................ 32 Bogaerde B ................................................................... 138 Bohnert A ....................................................................... 55 Bojano A ......................................................................... 26 Bojanovic M ................................................. 102; 107; 169 Bolat H .......................................................... 31; 38; 75; 76 Borsari S ........................................................................ 106 Boskabadi H ................................................................. 143 Bouwens J ....................................................................... 75 Bracci Laudiero L .......................................................... 26 Brown C .......................................................................... 28 Brown DK ..................................................................... 115 Bruski L ........................................................................ 125 Bryson H ......................................................................... 87 Bu X ................................................................................. 43 NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 183
Bubbico L ..................................................................... 105 Büchner A ...................................................................... 11 Bunne M ....................................................................... 165 Burg L ............................................................................. 15 Busby PA ....................................................................... 92 Bussières R ..................................................................... 53 Butinar D ....................................................................... 71 Couto CM ..................................................................... 110 Cruz AD ....................................................................... 174 Cutler J ............................................................................ 20 D Dalå J ............................................................................... 97 Danhauer JL ................................................................. 144 Daniel LM....................................................................... 41 Dann M ..................................................................... 19; 78 David L ......................................................................... 172 Davis A ....................................... 34; 64; 88; 121; 142; 156 Dazert S ........................................................................ 119 De Kock T ......................................................................... 4 de la Torre A ................................................................ 130 De Luca M .................................................................... 106 De Muller A ........................................................... 99; 100 de Vries JJC .................................................................. 141 Deggouj N ...................................................................... 26 Dekker FW ..................................................................... 96 del Castillo FJ ............................................... 147; 148; 149 del Castillo I ................................................. 147; 148; 149 Delgado CF .................................................................. 128 Delgado RE .................................................................. 128 Delgado T ............................................................. 108; 123 della Volpe A ................................................................. 26 Depenbrock A .............................................................. 176 Desloovere C ............................................................ 12; 97 Dettman SJ ....................................................... 51; 54; 158 Dijk PH ......................................................................... 145 Dilmen U ...................................................................... 116 Dimic N ........................................................................ 163 Dincol I ............................................................. 31; 76; 116 Diomaiuto I .................................................................... 26 Dionissieva K ................................................................. 87 Dirks E ...................................................................... 14; 18 Djokovic S .................................................................... 163 Dlouha O ........................................................................ 58 Dobie RA ...................................................................... 122 Dodson KM ............................................................ 83; 139 Đoković S ..................................................................... 165 Dollberg S ....................................................................... 56 Domínguez‐Ruiz M .................................................... 147 Dornan DA ..................................................................... 18 Douglas C ....................................................................... 70 Dowell RC ................................................................ 51; 54 Driscoll C ........................................................................ 60 Driver S ........................................................................... 20 Duarte I ......................................................................... 159 Duchesne L..................................................................... 53 Durante A ..................................................................... 135 C Cai Z ................................................................................. 6 Calvo P ......................................................................... 108 Cameron C ................................................................. 7; 95 Campbell S .................................................................... 60 Cantalapiedra D .......................................................... 147 Caporali SA ................................................................... 65 Carew P .......................................................................... 58 Carr G ..................................................................... 21; 179 Castelein S ..................................................................... 26 Cebulla M ...................................................................... 98 Cerna P ........................................................................... 58 Cerny L .......................................................................... 58 Chakar M ..................................................................... 106 Chapman DA .............................................................. 139 Charaf R ....................................................................... 147 Charroó‐Ruíz L ........................................................... 169 Chase M ......................................................................... 62 Chase P ........................................................................... 91 Chaves J ....................................................................... 111 Chen X ............................................................................ 27 Cheng X ........................................................................... 6 Children’s Audiology Team ..................................... 171 Ching TYC ............................................................... 25; 55 Claas ECJ ..................................................................... 141 Clavería MA .................................................. 99; 100; 108 Clench D ........................................................................ 78 Coenraad S .................................................................... 69 Colella‐Santos MF....................................................... 110 Coll N ........................................................................... 108 Collado C ..................................................................... 147 Conic M ........................................................................ 107 Coninx F ........................................................... 47; 61; 120 Constantinescu G ........................................................ 158 Conti G ......................................................................... 105 Corona‐Strauss FI ....................................................... 131 Corradin L ..................................................................... 39 Coskun H ....................................................................... 13 Costa OA ..................................................... 132; 171; 177 Cöté M ............................................................................ 53 Cotecchia T .................................................................... 26 Courtmans I ................................................................. 103 NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 184 NHS 2012
Dzulkarnain AAA ........................................................ 69 E Ederra M .................................................................... 8; 37 Eikeland C ..................................................................... 11 El Ankari S ..................................................................... 26 El Danasoury I .............................................................. 79 EL Disouky E ................................................................ 57 Elbarbary NS ................................................................. 81 Eliene Silva Araújo ..................................................... 111 Elkabarity RH.................................................... 73; 79; 81 El‐Kholy W .................................................................... 16 En H .................................................................................. 6 Engel‐Yeger B ................................................................ 86 Engström E .................................................................... 10 Ens‐Dokkum M ........................................................... 138 Eras Z ........................................................................... 116 Erbaşi‐Yanbay E .......................................................... 158 Ertmer DJ ....................................................................... 89 Esmailzade A ................................................................ 40 Esveld M ........................................................................ 75 Euler HA ...................................................................... 119 F Fabian A ....................................................................... 157 Fabian S .......................................................................... 36 Fadda S ......................................................................... 158 Fakovikj N ................................................................... 106 Fazion CB ..................................................................... 109 Femikj N ...................................................................... 106 Ferm I ........................................................................... 129 Fernanda de Souza Lima ........................................... 111 Fernández‐Pedrosa V ................................................. 147 Ferrari DV ............................................................ 177; 180 Figueiredo R ................................................................ 151 Finitzo T ......................................................................... 77 Fioretti M ..................................................................... 105 Firozbakht M ................................................................. 40 Fisher SK ...................................................................... 144 Flynn T ........................................................................... 81 Folsom RC ................................................................... 176 Françozo MFC ............................................................. 110 Fray J .............................................................................. 11 Frezza S ........................................................................ 105 Friedland D ................................................................... 15 Friese B ......................................................................... 157 Frijns JMH ..................................................................... 96 Furmanek M .................................................................. 30 G Galán‐García L ............................................................. 169 Gallus R ........................................................................ 105 Galvin KL ....................................................................... 92 Gambettola J .......................................................... 99; 100 Gandía M ...................................................... 147; 148; 149 García M ..................................................................... 8; 37 Garrard P ........................................................................ 92 Garrido G ............................................................. 147; 149 Gasser C .......................................................................... 50 Geal‐Dor M .................................................................. 161 Geers A ............................................................................. 1 Genc A ...................................... 13; 31; 38; 75; 76; 82; 116 Genovese E ................................................................... 106 Gerard J‐M ..................................................................... 26 Ghasemi MM ......................................................... 57; 168 Giannantonio S ............................................................ 105 Gil M ............................................................................. 147 Glanemann R ......................................................... 22; 178 Glennon S ....................................................................... 60 Goedegebure A .............................................................. 69 Gökdoğan Ç ................................................... 82; 117; 145 Gomes CA .................................................................... 144 Gómez‐Rosas E .................................................... 147; 148 Gong S ............................................................................ 27 Granato L...................................................................... 135 Grandori F .................................................................... 105 Gregory S ........................................................................ 84 Gros A ............................................................................. 71 Gu C .................................................................................. 5 Gunduz B ............................................................... 82; 117 Guven AG ...................................................................... 82 H Haastrup A ..................................................................... 66 Hadi AK ............................................................... 115; 116 Hall AJ ............................................................................ 13 Hamburger A ............................................................... 100 Hamed S ......................................................................... 86 Han Bing ....................................................................... 149 Han D .............................................................................. 27 Harris A .......................................................................... 92 Hassanzadeh S ............................................................... 72 Hatton JH ..................................................................... 130 Hatton K ....................................................................... 128 Hazzaa N .................................................................. 16; 79 Hearing Support Team ............................................... 171 Hellmuth‐Zweyer U ................................................... 172 Henkin Y ...................................................................... 100 NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 185
Jovchevski S ................................................................. 106 Henricson C ................................................................. 159 Hernández Villoria R ................................................. 108 Hernández‐Cordero MC ........................................... 169 Herrmannova D .......................................................... 167 Hibbert K ....................................................................... 45 Hickson L ..................................................................... 158 Hildesheimer M .......................................................... 100 Himmelfarb M .............................................................. 56 Ho S ................................................................................ 41 Hoek J ............................................................................. 14 Hoeve LJ ........................................................................ 69 Hoffman HJ ................................................................. 122 Hoffmann V ......................................................... 153; 157 Hofmann M ................................................................... 98 Holland J ........................................................................ 92 Holt RF ......................................................................... 151 Hood LJ ........................................................................ 128 Hopkins T .............................................................. 88; 156 Hrbkova M .................................................................... 58 Huang L ..................................................................... 6; 27 Huang Q ...................................................................... 126 Huang Z‐W.................................................... 62; 126; 150 Hubbard BA ................................................................ 140 Hulzebos CV ............................................................... 145 Humphriss R ......................................................... 13; 171 Hunt A ......................................................................... 144 Hurteau AM .................................................................. 97 Hussanien S ................................................................... 57 K Kalcigolu T ..................................................................... 76 Kallioinen P .................................................................... 10 Kam ACS ........................................................................ 63 Kamyk P ......................................................................... 44 Kanaan M ....................................................................... 39 Karatas E ........................................................................ 76 Kaya S ....................................................................... 13; 31 Kayikci M ....................................................................... 13 Kaynar F ......................................................................... 13 Kean M ................................................................... 21; 179 Kei J ................................................................................. 60 Keilmann A .......................................................... 153; 157 Keim R ............................................................................ 98 Kemaloğlu YK ..................................................... 117; 145 Khalil LH ........................................................................ 73 Khalil SH ........................................................................ 73 Khan SN ....................................................................... 115 Khattab AN .................................................................... 73 Khoza‐Shangase K ...................................................... 112 Kilander R .................................................................... 178 King A ....................................................................... 55; 87 Kip P ........................................................................... 7; 18 Kirkim G ....................................................... 13; 31; 76; 82 Kiyokawa H ................................................................. 137 Kobayashi T ................................................................. 137 Kochanek K .................................................................. 125 Kocic B .......................................................................... 169 Komazec Z ................................................................... 164 Konings S ....................................................................... 96 Konukseven O ......................... 13; 31; 38; 75; 76; 82; 116 Koren I .......................................................................... 161 Korniszewski L .............................................................. 30 Korver AMH .......................................... 96; 121; 122; 141 Korver NM ................................................................... 104 Köse MR ......................................................................... 75 Kovačević J ................................................................... 164 Kovacevic T .................................................................. 163 Kozak FK ........................................................................ 28 Krejci H ........................................................................... 58 Kriens T ...................................................................... 7; 18 Kroes ACM .................................................................. 141 Küçükünal S ................................................................. 117 Kuint J ........................................................................... 100 Kujala Teija ................................................................... 143 Kujala Tiia .................................................................... 143 Kuk F ............................................................................... 55 Kulakkayikçi M ....................................................... 76; 82 I Ibekwe TS ...................................................................... 28 Ioannou M ..................................................................... 17 Isakovic Lj .................................................................... 163 Iwanicka‐Pronicka K .................................................... 30 Izzo R.............................................................................. 26 J Jacob RTS ..................................................................... 174 Jahangiri N .................................................................. 168 Jamaluddin SA .............................................................. 69 Janssen RM .................................................................. 130 Jansson‐Verkasalo E ................................................... 143 Jedrzejczak WW .......................................................... 125 Jensen J ........................................................................... 15 Jeppesen AMK .............................................................. 65 Johnson CE .................................................................. 144 Johnson J .................................................................. 4; 112 Jönsson R ....................................................................... 81 Joseph R ......................................................................... 41 NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 186 NHS 2012
Kumar KS ...................................................................... 70 Kunnari S ..................................................................... 160 Kunz L .......................................................................... 119 Kutzner D ...................................................................... 47 Kyamides Y ................................................................... 17 L Lacima J.................................................................. 99; 100 Lagasse R ............................................................... 35; 103 Lahiri AK ............................................................... 89; 114 Lalaynts M ..................................................................... 32 Lalonde KL .................................................................. 151 Landsvik B ............................................................. 24; 165 Lang‐Roth R .................................................................. 36 Lapinlampi S ............................................................... 143 Laszig R .......................................................................... 29 Lata S .................................................................... 101; 160 Lázaro M ...................................................................... 147 Le Roux T ....................................................................... 56 Lechowicz U .................................................................. 30 Lehnhardt M ................................................................. 49 Lehtomäki E .................................................................. 91 Leigh JR .......................................................................... 51 Lemajić‐Komazec S .................................................... 164 Lenzi G ........................................................................... 20 Leon G .......................................................................... 131 Lepper I .......................................................................... 64 Levêque A .............................................................. 35; 103 Levesque E ..................................................................... 84 Levi H ........................................................................... 161 Levit Y ............................................................................ 56 Levy CCAC ......................................................... 152; 153 Lewis DR ............................................................... 40; 109 Lewis S ........................................................................... 20 Li C‐M .......................................................................... 122 Li G ......................................................................... 90; 162 Li L ................................................................................ 150 Li Qian ......................................................................... 149 Li X ................................................................................... 5 Li Y ......................................................................... 27; 126 Libiszewski P ................................................................ 47 Lichtig I ........................................................................ 181 Liersch B ...................................................................... 136 Lightfoot G ............................................................ 68; 129 Ligny C......................................................................... 103 Lilli G .............................................................................. 26 Lim BG ......................................................................... 128 Lim SB ............................................................................ 41 Lima MCMP ................................................................ 110 Lindgren M .................................................................... 10 Lingard L ........................................................................ 45 Linnebjerg LB............................................................... 132 Liu B .................................................................................. 6 Liu H ............................................................................... 27 Loeber JG ...................................................................... 141 Löfkvist U ....................................................................... 52 Löhle E ............................................................................ 29 Lohmander A ................................................................. 81 Looschen A .................................................................. 119 Lopes P ......................................................................... 124 Lopes R ......................................................................... 111 Löppönen H ................................................................. 160 Lorens A ................................................................. 44; 164 Lorente Mayor L ............................................................ 99 Losier C ........................................................................... 53 Luckey J .......................................................................... 91 Ludwikowski M ............................................................ 44 Lücke T ......................................................................... 119 Lund AS .......................................................................... 97 Lutek A ......................................................................... 164 Luts H ............................................................................. 98 Lv J‐R .............................................................. 62; 126; 150 Lyxell B ..................................................................... 10; 52 M Ma Y .............................................................................. 150 MacKinnon A ................................................................. 60 Maggu AR .............................................................. 15; 133 Mahmodian S ................................................................. 40 Maier W .......................................................................... 29 Maier‐McAlpine J K .................................................... 142 Mäki‐Torkko E ............................................................. 159 Malakooti B .................................................................... 24 Malandrino A ................................................................ 78 Malgorzata M ................................................................ 65 Mamatha NM .............................................................. 133 Manas AV ..................................................................... 109 Mancl LR ...................................................................... 176 Manjula R ..................................................................... 113 Mansfield D.................................................................. 136 Manuel‐Barkin C ................................................... 64; 119 Marba ST ...................................................................... 110 Marchesi S .................................................................... 134 Marinkov ZM .............................................................. 169 Mariosa F ........................................................................ 26 Markova T ...................................................................... 32 Marro S ......................................................................... 108 Marshall B ...................................................................... 83 Martina BM .................................................................. 105 Martini A ...................................................................... 105 NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 187
Martins J ....................................................................... 108 Martins JT .................................................................... 123 Martins PMF ................................................................ 135 Mathias N .............................................................. 66; 167 Matsutani S .................................................................. 137 Matulat P ................................................. 22; 64; 176; 178 Mazlan R ........................................................................ 70 Mazzella G ..................................................................... 26 McCamy S ...................................................................... 91 McCracken W ................................................................ 80 McLellan C .................................................................... 79 Meenakshi W .............................................................. 168 Meng Z ................................................................... 90; 162 Mensah F ....................................................................... 87 Meuwese‐Jongejeugd A ................................... 2; 35; 104 Meyer ME ...................................................................... 56 Midgley E .............................................................. 13; 171 Mikic B ................................................................... 49; 165 Mikic M .................................................................. 49; 165 Milisavljevic D .................................................... 102; 107 Millman T ...................................................................... 70 Milovanovic J .............................................................. 174 Miñambres R ............................................................... 147 Miric D ........................................................... 49; 165; 174 Mo L ............................................................................... 27 Möller C ................................................................. 81; 159 Monteiro PC ................................................................ 109 Moodie S ........................................................................ 78 Moodley S ...................................................................... 44 Moran C ......................................................................... 85 Moreno F ...................................................... 147; 148; 149 Moreno‐Pelayo MA ............................................ 147; 149 Moret ALM .......................................................... 174; 177 Morettin M .......................................................... 174; 177 Morgan K ....................................................................... 85 Motaleb A .................................................................... 118 Moura GM ................................................................... 181 Movallali G .................................................................... 24 Mülder HE ..................................................................... 66 Mulla I ............................................................................ 80 Muluk N ........................................................................ 76 Murakoshi M ....................................................... 136; 137 Muzaffar AR ................................................................ 140 Muzaffer Kiriş ............................................................... 76 Ng S ................................................................................. 45 Niemitalo‐Haapola E .................................................. 143 Nikhil M ....................................................................... 168 Nikkhoo F ....................................................................... 72 Nikolic VS .................................................... 126; 154; 155 Niquette P ...................................................................... 62 Noël‐Petroff N ............................................................... 66 Nourizadeh N ........................................................ 57; 143 Novaes B ....................................................................... 151 Nunes R ........................................................................ 159 O O’Brien B ........................................................................ 62 Obrycka A .................................................................... 164 Ocklenburg S ............................................................... 119 Offei YN ................................................................. 47; 120 Oh SY .............................................................................. 54 Olarte M ....................................................................... 147 Oliveira L ...................................................................... 111 Oliveira V ..................................................................... 124 Olofsson Å ...................................................................... 48 Olszewski L .................................................................... 65 Onal EE ................................................................. 117; 145 Orlova A ......................................................................... 77 Orn I ................................................................................ 24 Ors M .............................................................................. 10 Ostojic S .......................................................... 49; 165; 174 Oswald H ............................................................... 64; 119 Oudesluys‐Murphy AM ....................... 96; 121; 122; 138 Oudesluys‐Murphy HM ........................................ 2; 104 Ozbaş S ........................................................................... 75 Ozdek A .......................................................................... 13 Ozimek E ........................................................................ 47 P Paatsch L ........................................................................ 87 Paglialonga A .............................................................. 134 Pajdowska M ................................................................. 30 Palma S ......................................................................... 106 Pandya A ................................................................ 83; 139 Papacci P ...................................................................... 105 Pastore V ........................................................................ 26 Pattison E ........................................................................ 21 Peng S ............................................................................... 6 Pérez‐Abalo MC .......................................................... 169 Pérez‐Cabornero L ...................................................... 147 Persson A ..................................................................... 178 Petrocchi‐Bartal L ........................................................ 112 Picó‐Bergantiños Th .................................................... 169 N Nada MA ....................................................................... 73 Nadj Č .......................................................................... 164 Narne VK ....................................................................... 70 Neumann K ................................................................. 119 NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 188 NHS 2012
Pilka A .......................................................................... 125 Piotrowska A ................................................. 44; 125; 164 Piper C ......................................................................... 144 Pisoni D .......................................................................... 72 Płoski R .......................................................................... 30 Poelmans H ................................................................... 98 Pollak A ......................................................................... 30 Polyakov A .................................................................... 32 Popescu R .................................................................... 172 Poulakis Z ................................................................ 58; 87 Pupo A ......................................................................... 111 Q Qi B ................................................................................... 6 R Raappana A ................................................................. 143 Radović D .................................................................... 165 Rafie M ........................................................................... 40 Raftopoulos C ............................................................... 26 Rahil M ........................................................................... 39 Rahimi F ......................................................................... 40 Rahimi M ..................................................................... 172 Rajati M .......................................................................... 57 Rance G .......................................................................... 92 Ranjan P ............................................................... 101; 160 Razeghi S ..................................................................... 172 Reed‐Beadle E ............................................................... 23 Regan S........................................................................... 45 Reggiani S .................................................................... 106 Rego G .......................................................................... 159 Reichmuth K ......................................................... 22; 178 Rentmeester L ............................................................. 128 Rianto D ......................................................................... 73 Riazuddin S ................................................................. 115 Rice GB ......................................................................... 140 Richert F ......................................................................... 78 Rickards F ...................................................................... 87 Ristic S .......................................................... 102; 107; 169 Riyasi M ....................................................................... 168 Rocca C........................................................................... 20 Rodríguez‐Álvarez FJ ................................................ 149 Rodríguez‐Ballesteros M ........................................... 147 Rodríguez‐De Pablos R .............................................. 147 Rødvik AK ................................................................... 165 Rogiers M ............................................................. 179; 180 Roikjer M ....................................................................... 65 Rolesi R ........................................................................ 105 Roman A ........................................................................ 72 Rombaux P .................................................................... 26 Romera‐López A ......................................................... 147 Rosa‐Rosa JM ............................................................... 147 Ross K ............................................................................... 3 Royackers L .................................................................... 97 Ruiz‐Palmero L .................................................... 147; 148 Runge C .......................................................................... 15 Rusman L ..................................................................... 141 Rzeski M ......................................................................... 30 S Saber A ........................................................................... 79 Sadighi F ....................................................................... 172 Sahlén B .................................................................. 10; 159 Sahli S ........................................................................... 173 Saidi S ........................................................................... 168 Sainz M ......................................................................... 130 Santillán S ..................................................................... 147 Santos MFC .................................................................. 135 Santos N ....................................................................... 108 Sarant JZ ......................................................................... 92 Sargsyan A ................................................................... 101 Sartorato EL ................................................................. 110 Savić MM .............................................................. 126; 155 Savić MP ............................................................... 126; 155 Savić VP ................................................................ 126; 155 Savio G .......................................................................... 128 Savithri SR .................................................................... 113 Sawaya K ...................................................................... 171 Scarinci N ..................................................................... 158 Schaefer K ....................................................................... 61 Scheele JE...................................................................... 140 Schirkonyer V .............................................................. 119 Schmidt C‐M .................................................................. 64 Schouten CS ................................................................... 96 Schramm B ................................................................... 153 Schryer C ........................................................................ 45 Schuitema T ................................................................... 75 Scollie S ........................................................................... 78 Segura JC ...................................................................... 130 Sequi Canet JM .............................................................. 99 Serbetcioglu B .................................................... 13; 31; 76 Serrano M ..................................................... 123; 124; 144 Serrao de Castro L ....................................................... 147 Sevinc S ......................................................................... 173 Sexton J ........................................................................... 91 Seyrek M ....................................................................... 117 Shahnaz N ...................................................................... 70 Shalaby A ....................................................................... 57 Shalaby AA .................................................................... 73 Sharma S ................................................................. 89; 114 NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 189
Shehata‐Dieler W .......................................................... 98 Shipgood L .................................................................... 23 Silva LTN ..................................................................... 171 Silva MP ....................................................................... 177 Skagen AM .................................................................. 170 Skarzynski H ................................................. 44; 125; 164 Skarzynski PH ....................................................... 44; 125 Skórka A ........................................................................ 30 Sladen D ......................................................................... 51 Slavnić S ....................................................................... 164 Sliwa L .......................................................................... 125 Small SA ....................................................................... 131 Smeijers AS .................................................................. 138 Smiljanic R ..................................................................... 51 Smith J ............................................................................ 78 Smith R ......................................................................... 144 Smyth A ....................................................................... 131 Sokolovac I .................................................................. 164 Soli SD .................................................................... 90; 162 Sollie A ......................................................................... 170 Sousa A ........................................................................ 124 Spence T ....................................................................... 104 Sperandio D ........................................................... 88; 156 Spindler M ..................................................................... 37 Spyridakou C .................................................................. 3 Stanciu A ...................................................................... 161 Stangl S......................................................................... 128 Stankovic M ......................................................... 102; 107 Stanton SG ..................................................................... 28 Stapells DR .................................................................. 130 Stark E ............................................................................ 20 Steer C ............................................................................ 13 Stefanescu C ................................................................ 161 Stevens J ....................................................................... 129 Stockley TL .................................................................... 28 Stones M ........................................................................ 60 Störbeck C ...................................................................... 44 Strauss DJ ..................................................................... 131 Sume H .......................................................................... 91 Sungur VG ................................................................... 116 Sutton G ..................................................... 21; 68; 95; 121 Suwento R ...................................................................... 41 Swanepoel DW ......................................................... 4; 56 Tavartkiladze GA .......................... 11; 32; 33; 45; 95; 134 Tayarani Niknezhad H ............................................... 168 TazinazzioTG ............................................................... 110 Teller C ......................................................................... 144 Tengroth B .................................................................... 139 Tezel B ............................................................................ 75 Themann CL ................................................................ 122 Thibodeau L ....................................................... 79; 91; 92 Thodi C ................................................................... 39; 103 Thomazinho CA .......................................................... 153 Tognola G ............................................................. 105; 134 Toll MS............................................................................ 69 Tolonen A‐K ................................................................. 160 Tong MCF ...................................................................... 63 Topcu C .......................................................................... 13 Toros M ........................................................................ 145 Torres Y .................................................................. 99; 100 Trajkovic G ................................................................... 174 Tremblay G .................................................................... 53 Triviño JC ..................................................................... 147 Tsigankova ER ............................................................... 32 Tsygankova ER ........................................................ 33; 45 Tudor A ........................................................................ 172 Türkyılmaz C ....................................................... 117; 145 Tuncer U ............................................................. 13; 31; 76 Tuohy PG ................................................................. 42; 43 Turan Dizdar H ............................................................. 13 U Uday K .......................................................................... 133 Uhlén I .................................................................... 10; 159 Uilenburg N ................................................. 2; 35; 75; 104 Ulmann C ....................................................................... 66 Umeda C ....................................................................... 144 V Valderrama J ................................................................ 130 Välimaa T ..................................................................... 160 van de Ven EA ..................................................... 121; 122 Van Den Abbeele T ....................................................... 66 Van den Akker‐Marle ................................................... 96 Van der Linde M ........................................................... 56 Van der Ploeg CPB ........................................................ 35 Van der Zee RB .......................................................... 7; 14 van Dijk M ...................................................................... 18 van Dommelen P ................................................... 36; 145 Van Eeckhoutte M ......................................................... 98 Van Kerschaver E .......................................................... 34 Van Oostrom S ............................................................... 75 T Takeda S ....................................................................... 136 Tale MR .......................................................................... 57 Tallberg IM .................................................................... 52 Tani A ..................................................................... 53; 166 Tao Y ...................................................................... 90; 162 NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 190 NHS 2012
Van Pesch V ................................................................... 26 van Straaten HLM ................................ 36; 121; 122; 145 Van Zanten GA ............................................................. 35 van Zwet EW ............................................................... 141 Vargas J ........................................................................ 130 Varriccho AM ................................................................ 26 Vatovec J ........................................................................ 71 Ventura LMP ............................................................... 132 Ventura M .................................................................... 103 Verkerk PH .................................................... 36; 141; 145 Vermeij BAM ................................................................... 7 Vijayasarathy S ............................................................. 70 Villamar M................................................... 147; 148; 149 Vogazianos M ....................................................... 39; 103 von Mentzer C ...................................................... 10; 159 Vos B....................................................................... 35; 103 Vossen ACTM ............................................................. 141 W Wada H ................................................................ 136; 137 Wadhera M .................................................................... 10 Wake M .......................................................................... 87 Walger M ....................................................................... 36 Wallenius K ................................................................. 160 Wang Qiuju ................................................................. 149 Wang S ......................................................................... 139 Wass M ................................................................... 10; 159 Watts K ........................................................................... 91 Weber A ......................................................................... 36 Weirather Y ..................................................................... 4 Westerberg BD .............................................................. 28 Wetke R ........................................................................ 132 Wheeler A ...................................................................... 84 White K .......................................................................... 23 Widuri A ........................................................................ 73 Wiefferink CH ................................................................. 7 Wiefferink K .................................................................... 2 Wilson L ....................................................................... 144 Wilson‐Phillips L ........................................................ 104 Wingaard L .................................................................... 24 Winter M ........................................................................ 11 Wirth K ........................................................................... 87 Wood SA .................................................................. 2; 121 Wouters J ........................................................................ 98 Wu H ............................................................... 62; 126; 150 Wuyts FL ........................................................................ 34 X Xia XJ............................................................................... 83 Xu K .............................................................................. 162 Y Yan S ................................................................................. 5 Yang T ........................................................................... 150 Yathiraj A ....................................................................... 15 Yorgun M ....................................................................... 76 Yoshida N ..................................................................... 137 Z Zaretsky Y .................................................................... 119 Zgoda M ....................................................................... 164 Zhang H ........................................................................... 5 Zhang J ........................................................................... 27 Zhang L ............................................................................ 6 Zhang X ............................................................................ 5 Zhang Y .......................................................................... 27 Zhen Y .............................................................................. 6 Zheng Y .................................................................. 90; 162 Zink I ............................................................................... 12 Zivic M .................................................................. 102; 107 Zivkovic‐Marinkov E .......................................... 102; 107 Zizlavsky S ..................................................................... 41 Zubicaray J ................................................................. 8; 37 Zucki F .......................................................................... 111 Zúñiga‐Trejos S ........................................................... 147 Zupan L .......................................................................... 37 NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy NHS 2012 191
NOTES
NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 192 NHS 2012
NOTES
NHS 2012 ‐ June 5 – 7, 2012 – Cernobbio (Lake Como), Italy 
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