Implementation of the PMSTB in clinical practice and dissemination of associated data are both critical for achieving the next level of success for children with hearing loss and for elevating pediatric hearing health care ensuring evidence-based practice for (re)habilitative audiology.

Although trends emerged, there is a lack of consistency in the selection of speech perception measures utilized across centers for children <36 months of age. The development of a working group to establish a standard minimum pediatric test battery (similar to the adult Minimum Speech Test Battery) would promote uniformity in clinical protocols used to assess children who receive CIs.

This study found a reversal of previous findings with up to 14 dB lower thresholds found when using the ASSR technique with "Next-Generation" detection as compared with ABR using an automated detection (FMP). The test time for an audiogram prediction was significantly lower when using ASSR than ABR but was excellent by clinical standards for both techniques. ASSRs improved threshold performance was attributed to advancements in response detection including utilization of information at multiple harmonics of the modulation frequency. The stimulation paradigm which utilized narrow band CE-Chirps also contributed to the low absolute levels of the thresholds in nHL found with both techniques.

The CI users in this case study, who were implanted between 12 and 16 mo of age, were able to master the phoneme contrasts regardless of bilateral or unilateral CI, socioeconomic status, or language spoken at home.

Background Speech perception measures have long been considered an integral piece of the audiological assessment battery. Currently, a prelinguistic, standardized measure of speech perception is missing in the clinical assessment battery for infants and young toddlers. Such a measure would allow systematic assessment of speech perception abilities of infants as well as the potential to investigate the impact early identification of hearing loss and early fitting of amplification have on the auditory pathways. Purpose To investigate the impact of sensation level (SL) on the ability of infants with NH to discriminate /a-i/ and /ba-da/ and to determine if performance on the two contrasts are significantly different in predicting the discrimination criterion. Research Design The design was based on a survival analysis model for event occurrence and a repeated measures logistic model for binary outcomes. The outcome for survival analysis was the minimum SL for criterion and the outcome for the logistic regression model was the presence/absence of achieving the criterion. Criterion achievement was designated when an infant’s proportion correct score was ≥0.75 on the discrimination performance task. Study Sample Twenty-two infants with NH sensitivity participated in this study. There were 9 males and 13 females, aged 6–14 months. Data Collection and Analysis Testing took place over two to three sessions. The first session consisted of a hearing test, threshold assessment of the two speech sounds (/a/ and /i/), and if time and attention allowed, Visual Reinforcement Infant Speech Discrimination (VRISD). The second session consisted of VRISD assessment for the two test contrasts (/a-i/ and /ba-da/). The presentation level started at 50 dBA. If the infant was unable to successfully achieve criterion (≥0.75) at 50 dBA, the presentation level was increased to 70 dBA followed by 60 dBA. Data examination included an event analysis, which provided the probability of criterion distribution across SL. The second stage of the analysis was a repeated measures logistic regression where SL and contrast were used to predict the likelihood of speech discrimination criterion. Results Infants were able to reach criterion for the /a-i/ contrast at statistically lower SLs when compared to /ba-da/. There were six infants who never reached criterion for /ba-da/ and one never reached criterion for /a-i/. The conditional probability of not reaching criterion by 70 dB SL was 0% for /a-i/ and 21% for /ba-da/. The predictive logistic regression model showed that children were more likely to discriminate the /a-i/ even when controlling for SL. Conclusions Nearly all normal-hearing infants can demonstrate discrimination criterion of a vowel contrast at 60 dB SL, while a level of 70 dB SL may be needed to allow all infants to demonstrate discrimination criterion of a difficult consonant contrast.

BackgroundOddball paradigms are frequently used to study auditory discrimination by comparing event-related potential (ERP) responses from a standard, high probability sound and to a deviant, low probability sound. Previous research has established that such paradigms, such as the mismatch response or mismatch negativity, are useful for examining auditory processes in young children and infants across various sleep and attention states. The extent to which oddball ERP responses may reflect subtle discrimination effects, such as speech discrimination, is largely unknown, especially in infants that have not yet acquired speech and language.ResultsMismatch responses for three contrasts (non-speech, vowel, and consonant) were computed as a spectral-temporal probability function in 24 infants, and analyzed at the group level by a modified multidimensional scaling. Immediately following an onset gamma response (30–50 Hz), the emergence of a beta oscillation (12–30 Hz) was temporally coupled with a lower frequency theta oscillation (2–8 Hz). The spectral-temporal probability of this coupling effect relative to a subsequent theta modulation corresponds with discrimination difficulty for non-speech, vowel, and consonant contrast features.DiscussionThe theta modulation effect suggests that unexpected sounds are encoded as a probabilistic measure of surprise. These results support the notion that auditory discrimination is driven by the development of brain networks for predictive processing, and can be measured in infants during sleep. The results presented here have implications for the interpretation of discrimination as a probabilistic process, and may provide a basis for the development of single-subject and single-trial classification in a clinically useful context.ConclusionAn infant’s brain is processing information about the environment and performing computations, even during sleep. These computations reflect subtle differences in acoustic feature processing that are necessary for language-learning. Results from this study suggest that brain responses to deviant sounds in an oddball paradigm follow a cascade of oscillatory modulations. This cascade begins with a gamma response that later emerges as a beta synchronization, which is temporally coupled with a theta modulation, and followed by a second, subsequent theta modulation. The difference in frequency and timing of the theta modulations appears to reflect a measure of surprise. These insights into the neurophysiological mechanisms of auditory discrimination provide a basis for exploring the clinically utility of the MMR TF and other auditory oddball responses.

Purpose The aim of this study was to determine how a large metropolitan children's hospital's practices align with the Joint Committee on Infant Hearing (JCIH) 1-3-6 guidelines (diagnose hearing loss by 3 months of age, fitted with hearing aids within 1 month of diagnosis, and enroll in early intervention by 6 months of age) and examine variables that have impacted meeting these guidelines. This hospital is not a birthing hospital. Therefore, the first recommendation (hearing screen by 1 month of age) was not evaluated. Method One hundred forty-one auditory evoked potential evaluations for infants under the age of 6 months were reviewed for this study. Data were only gathered for infants identified with a bilateral hearing loss ( n = 34). The following was recorded: degree of hearing loss, number of diagnostic sessions over time, the percentage of infants who transitioned to hearing aid fittings, and the age at which JCIH benchmarks were accomplished. Results Sixty-two percent of infants were diagnosed with hearing loss by 3 months of age, 48% of infants were fitted with hearing aids by 4 months of age, and the average age of infants enrolled in early intervention was 4.58 months. Seventy percent of infants were fitted within 1 month of the diagnosis of hearing loss. The identified variables that led to the hearing aids being fitted greater than 1 month after the diagnosis are as follows: cancellations/missed appointments, middle ear involvement, and mild hearing loss. Conclusions Results of this internal audit revealed opportunities for growth in better meeting and exceeding JCIH recommendations of diagnosis by 3 months of age and hearing aid fitting within 1 month of diagnosis. Adjustments in the scheduling process and appointment options have been implemented in response to these results. Additional examination of why these recommendations are not being met and what can be done to achieve them is needed.

No abstract