National Acoustic Laboratories, Sydney, Australia.
Ear Hear. 2013 Sep;34(5):535-52. doi: 10.1097/AUD.0b013e3182857718.
To address the question of whether, on a population level, early detection and amplification improve outcomes of children with hearing impairment.
All families of children who were born between 2002 and 2007, and who presented for hearing services below 3 years of age at Australian Hearing pediatric centers in New South Wales, Victoria, and Southern Queensland were invited to participate in a prospective study on outcomes. Children's speech, language, functional, and social outcomes were assessed at 3 years of age, using a battery of age-appropriate tests. Demographic information relating to the child, family, and educational intervention was solicited through the use of custom-designed questionnaires. Audiological data were collected from the national database of Australian Hearing and records held at educational intervention agencies for children. Regression analysis was used to investigate the effects of each of 15 predictor variables, including age of amplification, on outcomes.
Four hundred and fifty-one children enrolled in the study, 56% of whom received their first hearing aid fitting before 6 months of age. On the basis of clinical records, 44 children (10%) were diagnosed with auditory neuropathy spectrum disorder. There were 107 children (24%) reported to have additional disabilities. At 3 years of age, 317 children (70%) were hearing aid users and 134 children (30%) used cochlear implants. On the basis of parent reports, about 71% used an aural/oral mode of communication, and about 79% used English as the spoken language at home. Children's performance scores on standardized tests administered at 3 years of age were used in a factor analysis to derive a global development factor score. On average, the global score of hearing-impaired children was more than 1 SD below the mean of normal-hearing children at the same age. Regression analysis revealed that five factors, including female gender, absence of additional disabilities, less severe hearing loss, higher maternal education, and (for children with cochlear implants) earlier age of switch-on were associated with better outcomes at the 5% significance level. Whereas the effect of age of hearing aid fitting on child outcomes was weak, a younger age at cochlear implant switch-on was significantly associated with better outcomes for children with cochlear implants at 3 years of age.
Fifty-six percent of the 451 children were fitted with hearing aids before 6 months of age. At 3 years of age, 134 children used cochlear implants and the remaining children used hearing aids. On average, outcomes were well below population norms. Significant predictors of child outcomes include: presence/absence of additional disabilities, severity of hearing loss, gender, maternal education, together with age of switch-on for children with cochlear implants.
探讨在人群水平上，早期检测和放大是否能改善听力障碍儿童的预后。
新南威尔士州、维多利亚州和南昆士兰州澳大利亚听力儿科中心在 2002 年至 2007 年期间出生的所有儿童，以及在 3 岁以下接受听力服务的儿童的家庭，均受邀参加一项关于预后的前瞻性研究。使用一系列适合年龄的测试，在 3 岁时评估儿童的言语、语言、功能和社会结果。通过使用定制的调查问卷，收集与儿童、家庭和教育干预相关的人口统计学信息。从澳大利亚听力的国家数据库和教育干预机构保存的记录中收集听力数据。回归分析用于研究 15 个预测变量（包括放大年龄）中的每一个对结果的影响。
共有 451 名儿童参加了这项研究，其中 56%的儿童在 6 个月前接受了第一次助听器适配。根据临床记录，44 名儿童（10%）被诊断为听觉神经病谱系障碍。有 107 名儿童（24%）报告有其他残疾。3 岁时，317 名儿童（70%）为助听器使用者，134 名儿童（30%）使用了人工耳蜗。根据家长报告，约 71%的儿童使用听觉/口语模式进行交流，约 79%的儿童在家中使用英语作为口语。在 3 岁时，使用标准化测试对儿童进行测试，然后在因子分析中得出一个整体发育因子评分。平均而言，听力障碍儿童的全球得分比同龄正常听力儿童的平均得分低 1 个标准差以上。回归分析显示，五个因素与 5%显著水平的更好预后相关，包括女性、无其他残疾、听力损失较轻、母亲教育程度较高、（对于使用人工耳蜗的儿童）较早的开机年龄。虽然助听器适配年龄对儿童结果的影响较弱，但人工耳蜗开机年龄较早与 3 岁时使用人工耳蜗的儿童的结果显著相关。
在 451 名儿童中，56%的儿童在 6 个月前佩戴了助听器。3 岁时，134 名儿童使用人工耳蜗，其余儿童使用助听器。平均而言，结果远低于人群正常值。儿童预后的显著预测因素包括：有无其他残疾、听力损失程度、性别、母亲教育程度，以及人工耳蜗儿童的开机年龄。
