Longitudinal Outcomes of Children with Hearing Impairment LOCHI

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Longitudinal Outcomes of Children with Hearing
Impairment (LOCHI)

• Ching,TYC., Dillon, H., Skinner, L., Day, J.,
  Massie, R., Crowe, K., Rankine, K.,
  Mahler-Thompson, N., Close, L., Jagger, A.,
  Hopkins, T. Youn, S.

5th National Deafness Sector Summit- Canberra,
2008
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Who do the work

• Emma van Wanrooy, Leanne Skinner, Patricia van
  Buynder, Robyn Massie, Lauren Burns, Joanne
  Maritz, Carina Law, Allison Baker, Irma Saldic,
  Gerrie Krynda, Angela Wong
• Julia Day, Kathryn Crowe, Alison Jagger, Nicole
  Mahler-Thompson, Laura Street, Vivienne Martin,
  Sonya Cornick
• Samantha Youn

• Emma Rushbrooke, Lynda Close (Hear Say)
• Greg Leigh, Alison Stretton (Royal Institute for
  Deaf and Blind Children)
• Jamie Leigh (CI centre, Victoria Eye Ear
  Hospital)
• Lynne Paul (St Gabriels School for Hearing
  impaired children, Strathfield Catholic Centre
  for hearing impaired children)
• Tracy Hopkins, Maree Doble (The Shepherd Centre)
• Kylie Rankine, Colleen Psarros, Sharan Westcott
  (Sydney Cochlear Implant Centre)

Others Gillian Zavos, Andrew Geyl, Anne
Fulcher, Isabelle Rousseau, Lyndal Carter , Lisa
Nailand, Ineke Woodhill
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Background

• How many children born with a hearing loss (Russ
  et al, 2003 Ching et al, 2006)
• 40 dB greater than a mild HL 1.05/1000
• Impact on children
• Ability to listen and hear (Sininger et al, 1999
  Ruben, 1997)
• Speech and language (Davis et al, 1997 Helfand
  et al, 2001)
• Social (Watson et al, 1990)
• Education (Punch et al, 2004)

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Early detection improves outcomes?

• The evidence on whether early intervention
  improves outcomes is inconclusive (Thompson et
  al, 2001 Cochrane Review, 2005)
• No long term studies comparing the same children
  with a hearing impairment identified early and
  later

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But,

• Ethically unacceptable to withhold intervention
  in regions with universal newborn hearing
  screening
• Comparison across different regions or countries
  or time may be confounded by differences in
  service provision
• Thompson et al, 2001 Yoshinaga-Itano, 2004

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State of the States in Australia(Leigh, 2006
Ching et al, 2006)
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Further, we have a National provider of hearing
services to all children

• Australian Hearing network
• Consistent service provision
• With parental consent NAL is able to contact
  families at Australian Hearing
• Better able to follow the same children

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We have commenced a Longitudinal comparison of
Outcomes of Children with Hearing Impairment
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Aims

• To establish evidence for the speech, language,
  functional, psycho-social and educational
  outcomes of children who use hearing aids and/or
  cochlear implants
• To measure the effect of a range of factors,
  including age of intervention, on different
  outcomes.

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Factors
Outcomes
Speech production Speech intelligibility Binaural
Speech perception Receptive Language Expressive
Language Vocabulary Phonological
awareness Reading words Reading
Comprehension Functional performance Psycho-social
skills Educational attainment
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Participants

• 400 children who first received amplification
  under 3 years of age
• All children who first presented for hearing aids
  at Australian Hearing paediatric centres in NSW,
  Queensland and Victoria after April 2005 and were
  fitted with hearing aids before the end of
  December, 2007are invited to participate.

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Method

• Fit hearing aids using NAL or DSL prescriptions
  (2 most commonly used prescriptions)
• Collect information about the child and their
  family, hearing loss and information about early
  intervention for each participant.
• Assess each childs speech, language, reading,
  functional, educational and social development
  over time.

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Method
First Fit
6m Post-fit
12m Post-fit
Age3 yrs
Age 5 yrs

• Assessing the children on multiple occasions
  overtime.

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Method

• With parents consent, we will be investigating
  the aetiology (cause) for hearing losses through
  genetic testing.
• This will only occur for those parents who wish
  to have this test.

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Progress to date
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No of Children
Fitted with hearing aids hearing aids 6m 45
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Early intervention leads to better language
development at 6 months after fitting
Significant effect of age of fitting p
0.001 Effect of prescription p 0.3
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Language ability at 6 months after implantation
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However,

• The effect of age of intervention is still open
  to question

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When all data become available

• Investigate the effect of multiple factors on
  performance
• Investigate if normal language scores early in
  life would be maintained through school-age
• Examine the impact of age of intervention on
  long-term speech, language, functional,
  psychosocial, educational attainment.

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A Big Thank You to

• All the Families and Children

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We thank the support, in kind or in cash, from

• NIH grant
• CRC for CI and HA Innovation
• OHS, Department of Health
• Australian Hearing
• NSW Department of Health
• Cochlear Implant Clinic, Royal Victorian Eye
  Ear Hospital
• Hear and Say Centre
• Matilda Rose Early Intervention Centre
• Royal Institute for Deaf and Blind Children
• St Gabriels School for Hearing impaired children
• The Shepherd Centre
• Strathfield Catholic Centre for hearing impaired
  children
• Sydney Cochlear Implant Centre

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To review information on outcomes study
www.outcomes.nal.gov.au www.nal.gov.au
For more information

• Teresa Ching, PhD
• National Acoustic Laboratories

• Teresa.Ching_at_nal.gov.au