Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario, Canada.
Neurosciences & Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada.
Ear Hear. 2020 Jul/Aug;41(4):998-1008. doi: 10.1097/AUD.0000000000000821.
This study asks whether the LittlEARs Auditory Questionnaire (LEAQ), a caregiver measure, can differentiate between the early auditory development of children with bilateral cochlear implants (CIs), bilateral hearing aids (HAs), and children with Auditory Neuropathy Spectrum Disorder (ANSD) who wear CIs or HAs. The LEAQ is sensitive to impaired auditory development but has not previously been used to distinguish developmental changes between groups of children using different hearing technologies or with different types of hearing loss.
We collected retrospective longitudinal LEAQ results from 43 children with HAs, 43 with CIs, and 18 with ANSD. The children with ANSD wore hearing technology. They were a similar age to the children without ANSD (23 months; SD = 15), while the CI group (14 months; SD = 8) was younger than the HA group (24 months; SD = 18) [F(2,98.48) = 3.4; p = 0.04]. The CI group often participated in their first LEAQ pretreatment. Participants completed between one and seven LEAQs. Scores ranged between zero and 35 (mean = 18.36). We conducted a linear mixed-effects analysis, which included age or time since device fitting, hearing type (HA, CI, or ANSD), and presence of a comorbidity as fixed effects. A secondary analysis assessed effects of device audibility, measured by the Speech Intelligibility Index or Articulation Index, and consistency of device use obtained from device datalogs.
Children with CIs progressed faster than their peers with HAs or ANSD [χ2(8) = 24.51; p = 0.002]. However, within a subsample that included consistency of device use (β7 = -0.20 ± 0.38, t = -0.52; β8 = 0.93 ± 0.82, t = 1.13) and audibility (β6 = -0.70 ± 1.45, t = -1.87; β7 = 0.87 ± 0.89, t = 0.98), study group did not significantly influence rate of improvement on the LEAQ. In addition, children with developmental delays in all three study groups demonstrated significantly slower LEAQ score improvement [χ2(6) = 23.60; p < 0.001] and a trend toward decreased consistency of device use [F(1) = 3.31; p = 0.07]. As we expected, children in the CI and HA groups were more likely to achieve auditory skills indicated in early rather than later LEAQ questions. There was less variability in the responses of the ANSD group [CI: interquartile range (IQR) = 9; HA: IQR = 8; ANSD: IQR = 1]. There was no connection between LEAQ growth and speech perception outcomes in a subsample [r(6) = 0.42; p = 0.30].
The LEAQ is a useful tool for monitoring initial auditory development in very young children and can inform early treatment decisions.
本研究旨在探讨 LittlEARs 听觉问卷（LEAQ）能否区分双侧人工耳蜗植入（CI）、双侧助听器（HA）和患有听觉神经病谱系障碍（ANSD）并使用 CI 或 HA 的儿童的早期听觉发育。LEAQ 对听觉发育障碍敏感，但以前从未用于区分使用不同听力技术或具有不同听力损失的儿童群体之间的发育变化。
我们从 43 名使用 HA、43 名使用 CI 和 18 名患有 ANSD 的儿童中收集了回顾性纵向 LEAQ 结果。患有 ANSD 的儿童使用听力技术。他们与没有 ANSD 的儿童年龄相近（23 个月；SD=15），而 CI 组（14 个月；SD=8）比 HA 组（24 个月；SD=18）年龄更小[F(2,98.48)=3.4；p=0.04]。CI 组经常在首次接受 LEAQ 治疗前进行。参与者完成了 1 到 7 次 LEAQ。分数范围为 0 到 35（均值=18.36）。我们进行了线性混合效应分析，其中包括年龄或设备适配后时间、听力类型（HA、CI 或 ANSD）和合并症的存在作为固定效应。二次分析评估了设备可听度（由言语可懂度指数或清晰度指数测量）和设备数据日志中获得的设备使用一致性的影响。
与使用 HA 或 ANSD 的同龄人相比，使用 CI 的儿童进展更快[χ2(8)=24.51；p=0.002]。然而，在包括设备使用一致性的子样本中（β7=-0.20±0.38，t=-0.52；β8=0.93±0.82，t=1.13）和可听度（β6=-0.70±1.45，t=-1.87；β7=0.87±0.89，t=0.98），研究组并没有显著影响 LEAQ 的改善速度。此外，在所有三组研究对象中，有发育迟缓的儿童 LEAQ 评分的改善明显较慢[χ2(6)=23.60；p<0.001]，并且设备使用一致性呈下降趋势[F(1)=3.31；p=0.07]。正如我们所预期的那样，CI 和 HA 组的儿童更有可能在早期而非后期 LEAQ 问题中达到听觉技能。ANSD 组的反应变化较小[CI：四分位距（IQR）=9；HA：IQR=8；ANSD：IQR=1]。在一个子样本中，LEAQ 生长与言语感知结果之间没有联系[r(6)=0.42；p=0.30]。
LEAQ 是监测非常年幼儿童初始听觉发育的有用工具，并可提供早期治疗决策的信息。
