UHL IMPact: Examining the effect of unilateral hearing loss on...
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UHL IMPact: Examining the
effect of unilateral hearing loss
on infant vocal development
Robyn Cantle Moore, PhD
Precis
UHL pilot study – infant vocal progress
relative to IMP hearing norms <12 mths.
a) Which UHL infants ‘at greater risk’ for speech
and language delay, relative to peers?
b) Any factors associated with ‘at risk’ potential?
Study in context– Working definition of Unilateral Hearing Loss
– UHL prevalence at birth
– Perspectives in the literature
Working definition of UHL
UHL = hearing loss in one ear only.
National Workshop on Mild and Unilateral Hearing Loss:
Workshop Proceedings, (2005). Breckenridge (CO):
Centres for Disease Control and Prevention.
PTA >20 dB HL in the affected ear
or
>25 dB HL at 2 or more frequencies above 2 kHz
Prevalence of congenital UHL
A unilateral hearing loss (UHL) is reported
in approx.15-30% of infants diagnosed with
HL through newborn hearing screening.
(De Capua et al., 2007; Fitzpatrick et al., 2014; Johnson et al., 2005;
Vohr et al., 2002; SWISH, 2010).
Healthy Hearing Q’land (2010)
UHL: 0.52/1000 births
SWISH (NSW) (2010)
UHL: 0.65/1000 births
Perspectives in the literature
Some young children with UHL experience
delays in speech & language development
(Lieu et al., 2010) while others do not (Briggs et al., 2011).
“…59% of the infants with UHL were within or
above ±2SE of normal preverbal vocalizations”
(p. 1132) however, “delayed auditory behaviour
and preverbal vocalizations were approximately
four and nine times more common in infants
with UHL compared to BNH respectively” (p. 1134).
Kishon-Rabin et al., 2015.
UHL IMPact pilot study
Infants identified with UHL through
state-wide newborn screening.
Diagnosis & follow-up at RIDBC Jim Patrick
Audiology Centre (JPAC), Sydney.
IMP assessment completed in conversation
with parents during infant ear & hearing
health appointments at 5 mths, 8 mths, and
12 mths of age.
Materials and Method
Infant Monitor of vocal Production (IMP) is a
normed assessment tool (Cantle Moore & Colyvas, in prep.)
IMP guides parent understanding as to nature &
pace of their infant’s progress toward speech.
IMP systematically monitors & documents
audition-led features of production in the
pre-linguistic vocalizations of infants <12 mths.
IMP supports informed parent-professional
decision making in early intervention.
IMP: Typical infant vocal development
(Kuhl, 2004; Lewkowicz & Hansen-Tift, 2012 *).
Production
1 2 3 4 5 6 7 8 9 10 11 12 MONTHS
Universal speech production
Language specific speech production
First words
Non-speech sounds
Vowel-like sounds
‘Canonical babbling’
* Visual attention shift to mouth seeks
redundant audio-visual speech cues Social attention
shift back to eyesVisual-social attention to eyes
BaselineIMP Transition Integrity
IMP assessment procedure
months
months
Chronological Age
(corrected)
Hearing Age
(HA) (CI)
Question ceiling
Innate … Transition to Audition-Production … Integrity of A-P Loop
Loop
Subject ages
Range 1: Baseline 4-5 months
2: Transition 8-10 months
3: Integrity 11-18 months
Mean 1: Baseline 4.3 months
2: Transition 8.4 months
3: Integrity 12.4 months
Mode 1: Baseline 4 months
2: Transition 8 months
3: Integrity 11 months
Subject characteristics
Case
No.#
Gender Birth
history
Birth order Aetiology Degree HL Ear (L/R)
1 Female WB Sibling ANSD (ABR) L
2 Male WB Sibling ANSD (ABR) R
3 Female WB Sibling ANSD (ABR) R
4 Female WB Sibling Sensorineural Mild-Mod R
5 Male WB Singleton Sensorineural Sev-Prof L
6 Female CMV Sibling Sensorineural Sev-Prof R
7 Male Intervene Sibling Conductive Mild-Mod L
8 Female WB Singleton Sensorineural Mild-Mod R
9 Female WB Sibling ANSD (ABR) R
10 Male WB Sibling ANSD (ABR) L
11 Female WB Singleton ANSD (ABR) R
12 Female WB Singleton Conductive Sev-Prof R
13 Male Premature Singleton Sensorineural Sev-Prof L
Individual subject results, IMP trend plots
Perception? Processing? Production?
Trend in vocal progress : IMP norms(10/13 infants, UHL pilot study)
4 6 8 10 12 14
68
10
12
14
16
Age - months
Q c
eili
ng
97th 85th
50th
15th
3rd
Transition to A-P Integrity of A-P
Loop Loop
Trend in vocal progress : IMP norms(13/13 infants, UHL pilot study)
4 6 8 10 12 14
68
10
12
14
16
Age - months
Q c
eili
ng
97th 85th
50th
15th
3rd
Transition to A-P Integrity of A-P
Loop Loop
__ Infant #4
__ Infant #6
__ Infant #13
Aetiology
4 6 8 10 12 14
68
10
12
14
16
Age - months
Q c
eili
ng
Transition to A-P Integrity of A-P
Loop Loop
__ Conductive
__ Sensorineural
__ ANSD
p=0.04
Trend plots X trajectory & aetiology
ANSD Conductive
Mild-Moderate SNHL
Severe-Profound SNHL
Gender
4 6 8 10 12 14
68
10
12
14
16
Age - months
Q c
eili
ng
Transition to A-P Integrity of A-P
Loop Loop
__ Male
__ Female
Rate p=0.57
Robustness p=0.44
Matched cases, variable (M/F) Gender
4 6 8 10 12 14
68
10
12
14
16
Age - months
Q c
eili
ng
Transition to A-P Integrity of A-P
Loop Loop
__ M Infant #10
__ F Infant #1
ANSD
Well baby
Left ear UHL
Sibling
Degree of HL < 65 dB HL : > 65 dB HL
4 6 8 10 12 14
68
10
12
14
16
Age - months
Q c
eili
ng
Transition to A-P Integrity of A-P
Loop Loop
__ <65 dB HL
__ >65 dB HL
UHL Ear
4 6 8 10 12 14
68
10
12
14
16
Age - months
Q c
eili
ng
Transition to A-P Integrity of A-P
Loop Loop
__ Left UHL
__ Right UHL
p=0.57
Matched cases, variable (L/R) Ear
4 6 8 10 12 14
68
10
12
14
16
Age - months
Q c
eili
ng
Transition to A-P Integrity of A-P
Loop Loop
__ Left ear (#10)
__ Left ear (#1)
__ Right ear (#2)
__ Right ear (#9)
ANSD
Well baby
Left ear UHL
Sibling
Birth Order
4 6 8 10 12 14
68
10
12
14
16
Age - months
Q c
eili
ng
Transition to A-P Integrity of A-P
Loop Loop
__ Singleton
__ Sibling
Birth History
4 6 8 10 12 14
68
10
12
14
16
Age - months
Q c
eili
ng
Transition to A-P Integrity of A-P
Loop Loop
__ Premature
__ Intervention
__ CMV
__ Well baby
Trend plots X trajectory & birth history
Premature Well baby
Intervention
CMV
‘At greater risk’
WB
Prem.
CMV
Mild-Moderate
Severe-Profound
Severe-Profound
Female
Female
Male
SNHL
SNHL
SNHL
p=0.04
Limitations of study
Small sample size, limited statistical analysis
No controls for socio-economic status,
parent education, language environment;
however… No relationship found in IMP
normative study between trajectory of vocal
progress and:
(a) maternal work status,
(b) maternal education,
(c) language environment.
Acknowledgement
Thanks to:
RIDBC Jim Patrick Audiology Centre
Irma Huiberts, research student Radboud University, Nijmegen, Netherlands.
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