CONTEXT: Permanent hearing loss affects 1 to 3 per 1000 children and interferes with typical communication development. Early detection through newborn hearing screening and hearing technology provide most children with the option of spoken language acquisition. However, no consensus exists on optimal interventions for spoken language development. OBJECTIVE:To conduct a systematic review of the effectiveness of early sign and oral language intervention compared with oral language intervention only for children with permanent hearing loss.DATA SOURCES: An a priori protocol was developed. Electronic databases (eg, Medline, Embase, CINAHL) from 1995 to June 2013 and gray literature sources were searched. Studies in English and French were included. STUDY SELECTION:Two reviewers screened potentially relevant articles. DATA EXTRACTION:Outcomes of interest were measures of auditory, vocabulary, language, and speech production skills. All data collection and risk of bias assessments were completed and then verified by a second person. Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) was used to judge the strength of evidence. RESULTS:Eleven cohort studies metinclusion criteria, of which 8 included only children with severe to profound hearing loss with cochlear implants. Language development was the most frequently reported outcome. Other reported outcomes included speech and speech perception.LIMITATIONS: Several measures and metrics were reported across studies, and descriptions of interventions were sometimes unclear.CONCLUSIONS: Very limited, and hence insufficient, high-quality evidence exists to determine whethersign language in combination with oral language is more effective than oral language therapy alone. More research is needed to supplement the evidence base. Ottawa, Ottawa, Ontario, Canada; b Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; c Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; d Translational Research in Biomedicine Graduate Program, University of Split School of Medicine, Split, Croatia; f Consultant, Moncton, New Brunswick; g Audiology Clinic, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; and h Voice for Hearing-Impaired Children, Toronto, Ontario, Canada Dr Fitzpatrick conceptualized the project, fi nalized the protocol, was involved in all stages of the analysis and interpretation, wrote the fi rst draft of this manuscript, and is the study guarantor; Ms Hamel and Ms Pratt were involved in screening articles and extracted data; Ms Hamel conducted the quality assessment; Ms Hamel, Ms Pratt, Ms Stevens, and Dr Moher provided input into the fi nal manuscript; Ms Stevens contributed to the development of the methods, oversaw the screening, Early detection of permanent childhood hearing loss through population-based newborn screening has become standard care in much of the world. Expectations are that early intervention through hearing technolog...

Overall, parents were satisfied with the second implant and identified benefits that are not easily quantifiable through traditional clinical measures.

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Organized in 1890 to encourage the teaching of speech, speechreading and the use of residual hearing to people who are deaf or hard of hearing, the Alexander Graham Bell Association for the Deaf and Hard of Hearing (AG Bell) welcomes to its membership all who are interested in improving educational, professional and vocational opportunities for people who are deaf or hard of hearing.

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