Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario, Canada.
Department of Communication Disorders, The Hospital for Sick Children, Toronto, Ontario, Canada.
JAMA Otolaryngol Head Neck Surg. 2021 Apr 1;147(4):368-376. doi: 10.1001/jamaoto.2020.5496.
The coronavirus disease 2019 (COVID-19) lockdowns in Ontario, Canada in the spring of 2020 created unprecedented changes in the lives of all children, including children with hearing loss.
To quantify how these lockdowns changed the spoken communication environments of children with cochlear implants by comparing the sounds they were exposed to before the Ontario provincial state of emergency in March 2020 and during the resulting closures of schools and nonessential businesses.
DESIGN, SETTING, AND PARTICIPANTS: This experimental cohort study comprised children with hearing loss who used cochlear implants to hear. These children were chosen because (1) their devices monitor and catalog levels and types of sounds during hourly use per day (datalogs), and (2) this group is particularly vulnerable to reduced sound exposure. Children were recruited from the Cochlear Implant Program at a tertiary pediatric hospital in Ontario, Canada. Children whose cochlear implant datalogs were captured between February 1 and March 16, 2020, shortly before lockdown (pre-COVID-19), were identified. Repeated measures were collected in 45 children during initial easing of lockdown restrictions (stages 1-2 of the provincial recovery plan); resulting datalogs encompassed the lockdown period (peri-COVID-19).
Hours of sound captured by the Cochlear Nucleus datalogging system (Cochlear Corporation) in 6 categories of input levels (<40, 40-49, 50-59, 60-69, 70-79, ≥80 A-weighted dB sound pressure levels [dBA]) and 6 auditory scene categories (quiet, speech, speech-in-noise, music, noise, and other). Mixed-model regression analyses revealed main effects with post hoc adjustment of confidence intervals using the Satterthwaite method.
A total of 45 children (mean [SD] age, 7.7 [5.0] years; 23 girls [51.1%]) participated in this cohort study. Results showed similar daily use of cochlear implants during the pre- and peri-COVID-19 periods (9.80 mean hours pre-COVID-19 and 9.34 mean hours peri-COVID-19). Despite consistent device use, these children experienced significant quieting of input sound levels peri-COVID-19 by 0.49 hour (95% CI, 0.21-0.80 hour) at 60 to 69 dBA and 1.70 hours (95% CI, 1.42-1.99 hours) at 70 to 79 dBA with clear reductions in speech exposure by 0.98 hour (95% CI, 0.49-1.47 hours). This outcome translated into a reduction of speech:quiet from 1.6:1.0 pre-COVID-19 to 0.9:1.0 during lockdowns. The greatest reductions in percentage of daily speech occurred in school-aged children (elementary, 12.32% [95% CI, 7.15%-17.49%]; middle school, 11.76% [95% CI, 5.00%-18.52%]; and high school, 9.60% [95% CI, 3.27%-15.93%]). Increased daily percentage of quiet (7.00% [95% CI, 4.27%-9.74%]) was most prevalent for children who had fewer numbers of people in their household (estimate [SE] = -1.12% [0.50%] per person; Cohen f = 0.31).
The findings of this cohort study indicate a clear association of COVID-19 lockdowns with a reduction in children's access to spoken communication.
重要性：2020 年春季，加拿大安大略省因新冠病毒病 2019（COVID-19）疫情实施封锁，这对所有儿童的生活造成了前所未有的改变，包括听力损失儿童。
目的：通过比较 2020 年 3 月安大略省进入紧急状态前和随之而来的学校和非必要企业关闭期间儿童接触的声音，量化这些封锁如何改变了使用人工耳蜗的儿童的口语交流环境。
设计、地点和参与者：这是一项实验性队列研究，参与者为使用人工耳蜗聆听的听力损失儿童。之所以选择这些儿童，是因为（1）他们的设备每天每小时都会监测和记录声音的水平和类型（数据日志），（2）这一群体特别容易受到声音暴露减少的影响。这些儿童是从安大略省一家三级儿科医院的人工耳蜗计划中招募的。确定了 2020 年 2 月 1 日至 3 月 16 日（封锁前）期间人工耳蜗数据日志被捕获的儿童。在封锁期间（省级恢复计划的第 1-2 阶段）收集了 45 名儿童的重复测量数据。
主要结果和措施： Cochlear Nucleus 数据记录系统（科利耳公司）记录的 6 个输入水平类别（<40、40-49、50-59、60-69、70-79、≥80 A 加权声压级 [dBA]）和 6 个听觉场景类别的声音小时数。使用 Satterthwaite 方法对置信区间进行事后调整的混合模型回归分析显示了主要影响。
结果：共有 45 名儿童（平均[标准差]年龄为 7.7[5.0]岁；23 名女孩[51.1%]）参与了这项队列研究。结果表明，在封锁前后期间，儿童使用人工耳蜗的日常情况相似（封锁前 9.80 小时，封锁期间 9.34 小时）。尽管设备使用情况一致，但这些儿童在 60 至 69 dBA 时输入声音水平显著降低了 0.49 小时（95%置信区间，0.21-0.80 小时），在 70 至 79 dBA 时降低了 1.70 小时（95%置信区间，1.42-1.99 小时），言语暴露明显减少了 0.98 小时（95%置信区间，0.49-1.47 小时）。这一结果导致言语：安静的比例从封锁前的 1.6:1.0 降至 0.9:1.0。在学校年龄的儿童中，言语百分比的降幅最大（小学，12.32%[95%置信区间，7.15%-17.49%]；初中，11.76%[95%置信区间，5.00%-18.52%]；高中，9.60%[95%置信区间，3.27%-15.93%]）。对于家中人数较少的儿童，每日安静时间的百分比增加（估计[SE]为-1.12%[0.50%]/人；Cohen f 为 0.31）是最常见的。
结论和相关性：该队列研究的结果表明，COVID-19 封锁与儿童获得口语交流的机会减少有明显关联。
