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The development of language and communication may play an important role in the emergence of behavioral problems in young children, but they are rarely included in predictive models of behavioral development. In this study, cross-sectional relationships between language, attention, and behavior problems were examined using parent report, videotaped observations, and performance measures in a sample of 116 severely and profoundly deaf and 69 normally hearing children ages 1.5 to 5 years. Secondary analyses were performed on data collected as part of the Childhood Development After Cochlear Implantation Study, funded by the National Institutes of Health. Hearing-impaired children showed more language, attention, and behavioral difficulties, and spent less time communicating with their parents than normally hearing children. Structural equation modeling indicated there were significant relationships between language, attention, and child behavior problems. Language was associated with behavior problems both directly and indirectly through effects on attention. Amount of parent–child communication was not related to behavior problems.

Cochlear implants in profoundly deaf children have a positive effect on quality of life at reasonable direct costs and appear to result in a net savings to society. JAMA. 2000;284:850-856

Cochlear implants have a significant impact on the quality of life of older deaf patients, and are a cost-effective intervention in this population. Improvements in speech perception are predictive of gains in health-related quality of life and associated emotional benefits after cochlear implantation.

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Objective To determine post-operative hearing outcomes following surgical plugging via middle cranial fossa approach for superior semicircular canal dehiscence syndrome (SCDS). Study Design Clinical Review Setting Tertiary Care Medical Center Patients 43 cases of SCDS based on history, physical examination, vestibular function testing, and computed tomography imaging confirming the presence of a dehiscence. All patients underwent surgical plugging of the superior semicircular canal via middle cranial fossa approach. Intervention Pure tone audiometry was performed pre-operatively and at 7 days and at least 1 month post-operatively. Main Outcome Measures Change in air-bone gap (ABG) and pure tone average (PTA). Results Pre-operative average ABG across 0.25, 0.5, 1, and 2 kHz was 16.0 dB (SD 7.5). At 7 days post-operatively, average ABG was 16.5 dB (SD 11.1, p=0.42), and at >1 month was 8.1 dB (SD 8.4, p<0.001). 53% (95% CI, 33–69) of affected ears had greater than 10 dB increase in their four frequency (0.5, 1, 2, 4 kHz) PTA measured by bone-conduction (BC) threshold 7 days postoperatively and 25% (95% CI 8–39) at 3–15 months post-operatively. Mean BC PTA of affected ears was 8.4 dB (SD 10.4) hearing loss (HL) pre-operatively. Compared to baseline, this declined to 19.2 dB HL (SD 12.6, p<0.001) at 7 days post-operatively and 16.4 dB HL (SD 18.8, p=0.01) at >1 month. No significant differences in speech discrimination score were noted (F=0.17). Conclusions Low-frequency air-bone gap decreases following surgical plugging, and appears to be due to both increased BC thresholds and decreased AC thresholds. Surgical plugging via a middle cranial fossa approach in SCDS is associated with mild high-frequency sensorineural hearing loss that persists in 25%, but no change in speech discrimination.

An aging American population carries a high prevalence of profound sensorineural hearing loss. We examined the performance of multichannel cochlear implant recipients in a large database of adult subjects. Design: Nonconcurrent prospective study of a national cohort with multivariate regression analysis of preoperative and postoperative performance variables in multichannel cochlear implant recipients. We applied models of prediction established in previous studies to the observed results. Setting: Referral centers with active cochlear implant programs. Patients: Adolescents and adults with profound hearing loss (N=749; age range, 14-91 years). Main Outcome Measure: Postoperative monosyllabic word recognition. Results: The population 65 years and older demonstrated a clinically insignificant 4.6%-smaller postoperative word score compared with the population younger than 65 years. When duration of deafness exceeded 25 years, elderly recipients demonstrated higher word scores than their younger counterparts. A more significant factor affecting outcomes is the ratio of duration of deafness to age at implantation. Conclusions: Age at implantation carried relatively little predictive value for postoperative performance in subjects 65 years and older. Although a small decrement in mean speech recognition scores was evident, the clinical significance of this difference is questionable when all of the results observed in elderly patients are considered. A shorter percentage of life spent in severe-toprofound sensorineural hearing loss suggests a foundation of acoustic/auditory processing in the elderly cohort that may mitigate potential physiological effects associated with advanced age. This study confirms and extends previous observations that duration of profound deafness and residual speech recognition carry higher predictive value than the age at which an individual receives an implant.

Objective To evaluate the associations between hearing loss and educational attainment, income, and unemployment/underemployment in US adults. Study design National cross-sectional survey. Setting Ambulatory examination centers. Patients Adults aged 20-69 years who participated in the 1999-2002 cycles of the National Health and Nutrition Examination Survey (NHANES) audiometric evaluation and income questionnaire (n = 3379). Intervention(s) Pure tone audiometry, with hearing loss defined by World Health Organization criteria of bilateral pure tone average >25 decibels (0.5,1,2,4 kHz). Main outcome measure(s) Low educational attainment, defined as not completing high school; low income, defined as family income less than $20,000/year, and unemployment or underemployment, defined as not having a job or working less than 35 hours per week. Results Individuals with hearing loss had 3.21 times higher odds of low educational attainment (95% CI: 2.20-4.68) compared to normal-hearing individuals. Controlling for education, age, sex, and race, individuals with hearing loss had 1.58 times higher odds of low income (95% CI: 1.16-2.15) and 1.98 times higher odds of being unemployed or underemployed (95% CI: 1.38-2.85) compared to normal-hearing individuals. Conclusions Hearing loss is associated with low educational attainment in US adults. Even after controlling for education and important demographic factors, hearing loss is independently associated with economic hardship, including both low income and unemployment/underemployment. The societal impact of hearing loss is profound in this nationally representative study and should be further evaluated with longitudinal cohorts.