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Hearing Disorders: HELP
Articles by John Kim Niparko
Based on 28 articles published since 2010
(Why 28 articles?)

Between 2010 and 2020, J. Niparko wrote the following 28 articles about Hearing Disorders.
+ Citations + Abstracts
Pages: 1 · 2
1 Review Cochlear implants: clinical and societal outcomes. 2012

Semenov, Yevgeniy R / Martinez-Monedero, Rodrigo / Niparko, John K. ·Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD 21287-0910, USA. ·Otolaryngol Clin North Am · Pubmed #22980678.

ABSTRACT: Over the past 30 years, hearing care clinicians have increasingly relied on cochlear implants to restore auditory sensitivity in selected patients with advanced sensorineural hearing loss. This article examines the impact of intervention with cochlear implantation in children and adults. The authors report a range of clinic-based results and patient-based outcomes reflected in the reported literature on cochlear implants. The authors describe the basic assessment of the physiologic response to auditory nerve stimulation; measures of receptive and productive benefit; and surveys of life effects as reflected measures of quality of life, educational attainment, and economic impact.

2 Review Language outcomes after cochlear implantation. 2012

Ganek, Hillary / McConkey Robbins, Amy / Niparko, John K. ·Department of Otolaryngology-Head and Neck Surgery, The Listening Center at Johns Hopkins, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD 21287, USA. hganek1@jhmi.edu ·Otolaryngol Clin North Am · Pubmed #22115689.

ABSTRACT: This article presents a focused review of language, speech, and comprehension outcomes in children with cochlear implants. Language acquisition with early-age implants and later-age implants are discussed, along with literacy and comprehension skills. A wide range of language outcomes is possible for children with cochlear implants, but many can achieve listening and spoken language skills at the same rate as their hearing peers. Appropriate auditory rehabilitation and parental guidance is vital for the development of listening and spoken language skills.

3 Review Bone-anchored devices in single-sided deafness. 2011

Stewart, C M / Clark, J H / Niparko, J K. · ·Adv Otorhinolaryngol · Pubmed #21389709.

ABSTRACT: Single sided deafness (SSD) implies sensorineural hearing loss in one ear with normal contralateral hearing function. Traditionally, SSD patients have been overlooked due to a belief that the preserved functioning of the contralateral ear compensates for the nonhearing side. SSD patients however experience multiple audiological difficulties, particularly when the sound source is situated on the non-hearing side or in the presence of competing sounds. Through reviewing current literature, we describe the role of bone-anchored devices (Baha) in the management of SSD patients. Recent publications for Baha in SSD have demonstrated consistent objective and subjective improvement in audiologic metrics when compared to unaided conditions. There is also evidence of benefit provided by Baha by the Abbreviated Profile of Hearing Aid Benefit, in global measures of ease of communication, reverberation, and background noise, but not typically in aversiveness to sounds. Interestingly, despite some patients gaining minimal objective or subjective benefits, the majority of these patients still report improved quality of life and would recommend the procedure. Despite increasing evidence for the role of Baha in the management of SSD in the literature, much of these data are based on older technology. Further reports should specify the processor type used and the etiology of the hearing loss to ensure accuracy of future data.

4 Article Symbolic Play and Novel Noun Learning in Deaf and Hearing Children: Longitudinal Effects of Access to Sound on Early Precursors of Language. 2016

Quittner, Alexandra L / Cejas, Ivette / Wang, Nae-Yuh / Niparko, John K / Barker, David H. ·Department of Psychology, University of Miami, Coral Gables, FL, United States of America. · Department of Otolaryngology, University of Miami Miller School of Medicine, Barton G. Kids Hear Now Cochlear Implant Family Resource Center, Miami, FL, United States of America. · School of Medicine, Johns Hopkins University, Baltimore, MD, United States of America. · Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, CA, United States of America. · Department of Child and Adolescent Psychiatry, Brown University, Providence, RI, United States of America. ·PLoS One · Pubmed #27228032.

ABSTRACT: In the largest, longitudinal study of young, deaf children before and three years after cochlear implantation, we compared symbolic play and novel noun learning to age-matched hearing peers. Participants were 180 children from six cochlear implant centers and 96 hearing children. Symbolic play was measured during five minutes of videotaped, structured solitary play. Play was coded as "symbolic" if the child used substitution (e.g., a wooden block as a bed). Novel noun learning was measured in 10 trials using a novel object and a distractor. Cochlear implant vs. normal hearing children were delayed in their use of symbolic play, however, those implanted before vs. after age two performed significantly better. Children with cochlear implants were also delayed in novel noun learning (median delay 1.54 years), with minimal evidence of catch-up growth. Quality of parent-child interactions was positively related to performance on the novel noun learning, but not symbolic play task. Early implantation was beneficial for both achievement of symbolic play and novel noun learning. Further, maternal sensitivity and linguistic stimulation by parents positively affected noun learning skills, although children with cochlear implants still lagged in comparison to hearing peers.

5 Article Should All Deaf Children Learn Sign Language? 2015

Napoli, Donna Jo / Mellon, Nancy K / Niparko, John K / Rathmann, Christian / Mathur, Gaurav / Humphries, Tom / Handley, Theresa / Scambler, Sasha / Lantos, John D. ·Swarthmore College; · The River School, Washington, District of Columbia; · Department of Otolaryngology, University of Southern California; · Institute for German Sign Language and Communication of the Deaf, University of Hamburg; · Graduate School, Gallaudet University; · Department of Education Studies, University of California at San Diego; · King's College London; and. · Children's Mercy Hospital jlantos@cmh.edu. ·Pediatrics · Pubmed #26077481.

ABSTRACT: Every year, 10,000 infants are born in the United States with sensorineural deafness. Deaf children of hearing (and nonsigning) parents are unique among all children in the world in that they cannot easily or naturally learn the language that their parents speak. These parents face tough choices. Should they seek a cochlear implant for their child? If so, should they also learn to sign? As pediatricians, we need to help parents understand the risks and benefits of different approaches to parent-child communication when the child is deaf [corrected].

6 Article Development of joint engagement in young deaf and hearing children: effects of chronological age and language skills. 2014

Cejas, Ivette / Barker, David H / Quittner, Alexandra L / Niparko, John K. · ·J Speech Lang Hear Res · Pubmed #24845423.

ABSTRACT: PURPOSE: To evaluate joint engagement (JE) in age-matched children with and without hearing and its relationship to oral language skills. METHOD: Participants were 180 children with severe-to-profound hearing loss prior to cochlear implant surgery, and 96 age-matched children with normal hearing; all parents were hearing. JE was evaluated in a 10-minute videotaped free play task with parents. Engagement states ranged from the lowest (unengaged) to the highest level (symbol-infused coordinated). Standardized language measures were administered. RESULTS: Multivariate analyses were conducted between the groups, stratified by chronological and language age. Children who were deaf (Deaf) spent less time in total symbol-infused JE than children with normal hearing (NH) across all ages. The majority of the Deaf group (83%) fell in the lowest language age group, in comparison to 35% of the NH group, and spent significantly less time in symbol-infused JE than hearing children. These delays were also observed in the Deaf group, who fell into the 18-36 month language age. No children in the Deaf group had achieved a language age of > 36 months. CONCLUSIONS: Young children with and without hearing had different developmental trajectories of JE, which were related to oral language skills.

7 Article Long-term use of cochlear implants in older adults: results from a large consecutive case series. 2014

Choi, Janet S / Contrera, Kevin J / Betz, Joshua F / Blake, Caitlin R / Niparko, John K / Lin, Frank R. ·*Johns Hopkins University School of Medicine; †Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health; ‡Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland; §Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California; and ∥Departments of Otolaryngology-Head & Neck Surgery, Geriatric Medicine, Mental Health and Epidemiology, Johns Hopkins University, Baltimore, Maryland, U.S.A. ·Otol Neurotol · Pubmed #24608374.

ABSTRACT: OBJECTIVE: To investigate rates of long-term use of cochlear implants in a large, consecutive case series of older adults (≥60 yr). STUDY DESIGN: Consecutive case series. SETTING: Tertiary referral center. PATIENTS: Approximately 447 individuals 60 years or older who received their first CI from 1999 to 2011. We successfully contacted 397 individuals (89%) to ascertain data on the individual's daily CI use averaged over the past 4 weeks. INTERVENTION: Cochlear implantation. MAIN OUTCOME MEASURE: Regular CI use was defined as 8 hours or greater of use per day. We investigated the time from implantation to the date when an individual reported discontinuing regular CI use. RESULTS: The overall rate of regular CI use at 13.5 years of follow-up was 82.6% (95% CI, 72.5%-89.3%). Individuals who received a CI at 60 to 74 years had significantly higher rates of regular CI use at 13.5 years of follow-up (91.1% [95% CI, 83.2%-95.4%], n = 251) than individuals who received a CI at 75 years or older (55.7% [95% CI, 24.9%-78.1%], n = 146). The rate of discontinuing regular CI use (<8 hr/d) increased on average by 7.8% (95% CI, 3.0%-12.8%) per year of age at implantation. CONCLUSION: Rates of long-term CI use in older adults at more than 10 years of follow-up exceed 80%. The rate of discontinuing regular CI use was strongly associated with older age at implantation. These results suggest that early implantation of older adults, once critically low levels of speech recognition are present, is associated with greater usage of the device.

8 Article Rates of long-term cochlear implant use in children. 2014

Contrera, Kevin James / Choi, Janet Seolin / Blake, Caitlin Rebecca / Betz, Joshua Francis / Niparko, John Kim / Lin, Frank R. ·*Johns Hopkins University School of Medicine; †Center on Aging and Health, Johns Hopkins Medical Institutions; ‡Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; §Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California; and ∥Departments of Otolaryngology-Head & Neck Surgery, Geriatric Medicine, Mental Health and Epidemiology, Johns Hopkins University, Baltimore, Maryland, U.S.A. ·Otol Neurotol · Pubmed #24518403.

ABSTRACT: OBJECTIVE: To determine the rate of long-term cochlear implant (CI) use in children. STUDY DESIGN: Consecutive case series. SETTING: Tertiary referral center. PATIENTS: Approximately 474 patients younger than 18 years who received a first CI from 1999 to 2011. INTERVENTIONS: Cochlear implantation. MAIN OUTCOME MEASURE(S): Regular CI use, defined as using the CI for 8 hours or greater per day. RESULTS: We successfully contacted and obtained follow-up data on 402 patients (85%) via email, telephone, and postal survey. The rate of regular CI use was 93.2% (95% CI, 90.0-95.4) at 5 years postimplantation and 87.7% (95% CI, 82.9-91.3) at 10 years postimplantation. The mean number of hours of use per day was 12.0 hours (SD, 4.1 h). Cox proportional hazard regression analysis demonstrated a linear association between the age at implantation and the risk of discontinuing regular CI use. Rates of CI discontinuation increased by 18.2% per year of age at implantation (95% CI, 7.2%-30.4%). Reported reasons for CI use less than 8 hours per day include poor hearing benefit (53.2%), social pressure (21.3%), and recurrent displacement of the transmitter coil (17.0%). CONCLUSION: High rates of regular CI use are sustained after childhood implantation, and younger age at implantation is associated with a higher rate of continued device usage.

9 Article Mitigation of informational masking in individuals with single-sided deafness by integrated bone conduction hearing aids. 2014

May, Bradford J / Bowditch, Stephen / Liu, Yinda / Eisen, Marc / Niparko, John K. ·1Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA; and 2Department of Otorhinolaryngology, Hartford Hospital, Hartford, Connecticut, USA. ·Ear Hear · Pubmed #24067501.

ABSTRACT: OBJECTIVES: To confirm an increased susceptibility to informational masking among individuals with single-sided deafness (SSD). To demonstrate a reduction in informational masking when SSD is treated with an integrated bone conduction hearing aid (IBC). To identify the acoustic cues that contribute to IBC-aided masking release. To determine the effects of device experience on the IBC advantage. DESIGN: Informational masking was evaluated with the coordinate-response measure. Participants performed the task by reporting color and number coordinates that changed randomly within target sentences. The target sentences were presented in free field accompanied by zero to three distracting sentences. Target and distracting sentences were spoken by different talkers and originated from different source locations, creating two sources of information for auditory streaming. Susceptibility to informational masking was inferred from the error rates of unaided SSD patients relative to normal controls. These baseline measures were derived by testing inexperienced IBC users without the device on the day of their initial fitting. The benefits of IBC-aided listening were assessed by measuring the aided performance of users who had at least 3 months' device experience. The acoustic basis of the listening advantage was isolated by correlating response errors with the voice pitch and location of distracting sentences. The effects of learning on cue effectiveness were evaluated by comparing the error rates of experienced and inexperienced users. RESULTS: Unaided SSD participants (inexperienced users) performed as well as normal controls when tested without distracting sentences but produced significantly higher error rates when tested with distracting sentences. Most errors involved responding with coordinates that were contained in distracting sentences. This increased susceptibility to informational masking was significantly reduced when experienced IBC users were tested with the device. The listening advantage was most strongly correlated with the availability of voice pitch cues, although performance was also influenced by the location of distracting sentences. Directional asymmetries appear to be dictated by location-dependent cues that are derived from the distinctive transmission characteristics of IBC stimulation. Experienced users made better use of these cues than inexperienced users. CONCLUSIONS: These results suggest that informational masking is a significant source of communication impairment among individuals with SSD. Despite the lateralization of auditory function, unaided SSD subjects experience informational masking when distractors occur in either the deaf or normal spatial hemifield. Restoration of aural sensitivity in the deaf hemifield with an IBC enhances speech intelligibility under complex listening conditions, presumably by providing additional sound-segregation cues that are derived from voice pitch and spatial location. The optimal use of these cues is not immediate, but a significant listening advantage is observed after 3 months of unstructured use.

10 Article Cochlear implantation in older adults: long-term analysis of complications and device survival in a consecutive series. 2013

Chen, David S / Clarrett, Danisa M / Li, Lingsheng / Bowditch, Steve P / Niparko, John K / Lin, Frank R. ·Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. ·Otol Neurotol · Pubmed #23921942.

ABSTRACT: OBJECTIVES: To analyze the postoperative complications associated with cochlear implant (CI) surgery in a large consecutive case series of older adults (≥ 60 yr). STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: Approximately 445 individuals aged 60 years and older who received a first CI between 1999 and 2011. INTERVENTIONS: Cochlear implantation. MAIN OUTCOME MEASURE(S): Postoperative complications classified as major (meningitis, immediate postoperative facial weakness, device failure, flap dehiscence, and surgical removal) and minor (surgical site infection, balance problems, delayed postoperative facial weakness, and facial nerve stimulation). RESULTS: The mean age at implantation was 72.7 years (60-94.9 yr), and the median duration of follow-up was 4.8 years (0.1-12.5 yr). There were 42 minor complications in 41 patients (9.2%) and 36 major complications in 21 patients (4.7%). Seventeen patients (3.8%) required surgical device removal, 15 of whom underwent reimplantation. A Kaplan-Meier analysis of rates of device explantation demonstrated that at 5 and 10 years after CI, respectively, 95.4% and 93.1% of patients retained their original CI. When comparing complications between patients aged 60 to 74 years and those aged 75 years and older, there was a higher prevalence of balance problems lasting more than 1 month in the older group (9.5% versus 4.9%, p = 0.05). CONCLUSION: Our results indicate that the safety profile of cochlear implantation in an older population is comparable to that of younger adults and children. We suggest that concerns for increased postoperative complications in patients of advanced age do not need to be a primary consideration when determining CI candidacy.

11 Article The significance of cochlear implant history. 2013

Niparko, John K. ·Department of Otolaryngology–Head & Neck Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA. ·JAMA Otolaryngol Head Neck Surg · Pubmed #23681027.

ABSTRACT: -- No abstract --

12 Article Quality of life in youth with severe to profound sensorineural hearing loss. 2013

Meyer, Abby / Sie, Kathleen / Skalicky, Anne / Edwards, Todd C / Schick, Brenda / Niparko, John / Patrick, Donald L. ·Department of Otolaryngology, University of Minnesota, Minneapolis, USA. ·JAMA Otolaryngol Head Neck Surg · Pubmed #23657441.

ABSTRACT: IMPORTANCE: Adolescence is a life stage with rapid and major developmental changes, yet little is known about how these changes influence the quality of life of young people who are deaf or hard of hearing (DHH). OBJECTIVE: To determine differences in the 3 domains of a hearing-specific quality-of-life instrument between youth who had severe to profound sensorineural hearing loss based on whether they used no technology, hearing aids, or cochlear implants. DESIGN AND SETTING: A multi-institutional prospective cohort study. PARTICIPANTS: A convenience sample of 11- to 18-year-old youths with severe to profound sensorineural hearing loss recruited between January 1 and December 31, 2008. MAIN OUTCOME MEASURES: Youth Quality of Life-Research Instrument and Youth Quality of Life Instrument-Deaf and Hard of Hearing (YQoL-DHH) scores. The YQoL-DHH was composed of 3 domains: participation, self-acceptance/advocacy, and stigma-related quality of life. RESULTS: A total of 157 individuals participated. Overall mean (SD) age was 14.1 (2.3) years, and the female-male ratio was 82:75. Forty-nine individuals (31.2%) were not using any technology, 45 (28.7%) were using hearing aids, and 63 (40.1%) were using cochlear implants. Mean age of unilateral or first cochlear implant was 62.9 months. Thirty-eight individuals (24.2%) attended schools with DHH programs, 55 (35.0%) attended schools without DHH programs, and 58 (36.9%) attended schools for the deaf. Statistically significant differences were noted in YQoL-DHH participation and perceived stigma scores between the groups when stratified by technology used and school setting. CONCLUSIONS: These data suggest that the domains of quality of life as measured by our instrument differ significantly among youth based on technology used and school setting. Youth using no technology or cochlear implants tended to score higher than those using hearing aids in mainstream schools with or without DHH programs and in schools for the deaf. The YQoL-DHH instrument is able to detect differences in quality of life within a group of youth with severe to profound hearing loss.

13 Article Age-dependent cost-utility of pediatric cochlear implantation. 2013

Semenov, Yevgeniy R / Yeh, Susan T / Seshamani, Meena / Wang, Nae-Yuh / Tobey, Emily A / Eisenberg, Laurie S / Quittner, Alexandra L / Frick, Kevin D / Niparko, John K / Anonymous6250754. ·Department of Otolaryngology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. ·Ear Hear · Pubmed #23558665.

ABSTRACT: OBJECTIVES: Cochlear implantation (CI) has become the mainstay of treatment for children with severe-to-profound sensorineural hearing loss (SNHL). Yet, despite mounting evidence of the clinical benefits of early implantation, little data are available on the long-term societal benefits and comparative effectiveness of this procedure across various ages of implantation-a choice parameter for parents and clinicians with high prognostic value for clinical outcome. As such, the aim of the present study is to evaluate a model of the consequences of the timing of this intervention from a societal economic perspective. Average cost utility of pediatric CI by age at intervention will be analyzed. DESIGN: Prospective, longitudinal assessment of health utility and educational placement outcomes in 175 children recruited from six U.S. centers between November 2002 and December 2004, who had severe-to-profound SNHL onset within 1 year of age, underwent CI before 5 years of age, and had up to 6 years of postimplant follow-up that ended in November 2008 to December 2011. Costs of care were collected retrospectively and stratified by preoperative, operative, and postoperative expenditures. Incremental costs and benefits of implantation were compared among the three age groups and relative to a nonimplantation baseline. RESULTS: Children implanted at <18 months of age gained an average of 10.7 quality-adjusted life years (QALYs) over their projected lifetime as compared with 9.0 and 8.4 QALYs for those implanted between 18 and 36 months and at >36 months of age, respectively. Medical and surgical complication rates were not significantly different among the three age groups. In addition, mean lifetime costs of implantation were similar among the three groups, at approximately $2000/child/year (77.5-year life expectancy), yielding costs of $14,996, $17,849, and $19,173 per QALY for the youngest, middle, and oldest implant age groups, respectively. Full mainstream classroom integration rate was significantly higher in the youngest group at 81% as compared with 57 and 63% for the middle and oldest groups, respectively (p < 0.05) after 6 years of follow-up. After incorporating lifetime educational cost savings, CI led to net societal savings of $31,252, $10,217, and $6,680 for the youngest, middle, and oldest groups at CI, respectively, over the child's projected lifetime. CONCLUSIONS: Even without considering improvements in lifetime earnings, the overall cost-utility results indicate highly favorable ratios. Early (<18 months) intervention with CI was associated with greater and longer quality-of-life improvements, similar direct costs of implantation, and economically valuable improved classroom placement, without a greater incidence of medical and surgical complications when compared to CI at older ages.

14 Article Influence of implantation age on school-age language performance in pediatric cochlear implant users. 2013

Tobey, Emily A / Thal, Donna / Niparko, John K / Eisenberg, Laurie S / Quittner, Alexandra L / Wang, Nae-Yuh / Anonymous4710751. ·Dallas Cochlear Implant Program, University of Texas at Dallas, Dallas, Texas, USA. etobey@utdallas.edu ·Int J Audiol · Pubmed #23448124.

ABSTRACT: OBJECTIVE: This study examined specific spoken language abilities of 160 children with severe-to-profound sensorineural hearing loss followed prospectively 4, 5, or 6 years after cochlear implantation. STUDY SAMPLE: Ninety-eight children received implants before 2.5 years, and 62 children received implants between 2.5 and 5 years of age. DESIGN: Language was assessed using four subtests of the Comprehensive Assessment of Spoken Language (CASL). Standard scores were evaluated by contrasting age of implantation and follow-up test time. RESULTS: Children implanted under 2.5 years of age achieved higher standard scores than children with older ages of implantation for expressive vocabulary, expressive syntax, and pragmatic judgments. However, in both groups, some children performed more than two standard deviations below the standardization group mean, while some scored at or well above the mean. CONCLUSIONS: Younger ages of implantation are associated with higher levels of performance, while later ages of implantation are associated with higher probabilities of continued language delays, particularly within subdomains of grammar and pragmatics. Longitudinal data from this cohort study demonstrate that after 6 years of implant experience, there is large variability in language outcomes associated with modifiers of rates of language learning that differ as children with implants age.

15 Article Effects of maternal sensitivity and cognitive and linguistic stimulation on cochlear implant users' language development over four years. 2013

Quittner, Alexandra L / Cruz, Ivette / Barker, David H / Tobey, Emily / Eisenberg, Laurie S / Niparko, John K / Anonymous870737. ·Department of Psychology, University of Miami, Miami, FL, USA. aquittner@miami.edu ·J Pediatr · Pubmed #22985723.

ABSTRACT: OBJECTIVES: To examine the effects of observed maternal sensitivity (MS), cognitive stimulation (CS), and linguistic stimulation on the 4-year growth of oral language in young, deaf children receiving a cochlear implant. Previous studies of cochlear implants have not considered the effects of parental behaviors on language outcomes. STUDY DESIGN: In this prospective, multisite study, we evaluated parent-child interactions during structured and unstructured play tasks and their effects on oral language development in 188 deaf children receiving a cochlear implant and 97 normal-hearing children as controls. Parent-child interactions were rated on a 7-point scale using the National Institute of Child Health and Human Development's Early Childcare Study codes, which have well-established psychometric properties. Language was assessed using the MacArthur Bates Communicative Development Inventories, the Reynell Developmental Language Scales, and the Comprehensive Assessment of Spoken Language. RESULTS: We used mixed longitudinal modeling to test our hypotheses. After accounting for early hearing experience and child and family demographics, MS and CS predicted significant increases in the growth of oral language. Linguistic stimulation was related to language growth only in the context of high MS. CONCLUSION: The magnitude of effects of MS and CS on the growth of language was similar to that found for age at cochlear implantation, suggesting that addressing parenting behaviors is a critical target for early language learning after implantation.

16 Article Sex and age associations with vestibular schwannoma size and presenting symptoms. 2012

Harun, Aisha / Agrawal, Yuri / Tan, Marietta / Niparko, John K / Francis, Howard W. ·Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. ·Otol Neurotol · Pubmed #22996162.

ABSTRACT: OBJECTIVE: To assess the association of sex and age with presenting symptoms and size of vestibular schwannoma at clinical presentation to our clinics. STUDY DESIGN: Retrospective chart review. SETTING: Academic medical center. PATIENTS: Approximately 1,269 subjects diagnosed with unilateral vestibular schwannoma between 1997 and 2010. INTERVENTION: Demographic information, tumor characteristics, and treatment strategy were recorded. MAIN OUTCOME MEASURE: Tumor size, patient-reported presence of hearing loss or dizziness at presentation. RESULTS: Male subjects had significantly larger tumors than female subjects at presentation (18.23 versus 16.81 mm, p = 0.031); this difference was particularly pronounced in patients younger than 40 years. Patient-reported symptoms at baseline also differed by sex: the prevalence of hearing loss was 95.1% in male subjects versus 90.3% in female subjects (p = 0.001), and the frequency of dizziness was 74.3% in female subjects versus 59.0% in male subjects (p<0.0001). In multivariate analyses, male subjects continued to have a borderline significant positive association with tumor size (p = 0.066) and were 2-fold more likely to have hearing loss (odds ratio [OR], 2.082; 95% confidence interval [CI], 1.300-3.336) but half as likely to have dizziness (OR, 0.501; 95% CI, 0.387-0.649) than female subjects. Additionally, for every 1-mm increase in tumor size, patients were more likely to report hearing loss by 14.7% (OR, 1.147; 95% CI, 1.106-1.191) and dizziness by 2.8% (OR, 1.028; 95% CI, 1.016-1.041). CONCLUSION: We observed significant sex differences in the presentation and size of unilateral vestibular schwannomas. As management and treatment strategies are predicated on presenting symptoms and patient factors, these observations merit further study to further understand tumor biology, improve risk stratification, and optimize tumor management.

17 Article Cochlear implantation in older adults. 2012

Lin, Frank R / Chien, Wade W / Li, Lingsheng / Clarrett, Danisa M / Niparko, John K / Francis, Howard W. ·Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA. flin1@jhmi.edu ·Medicine (Baltimore) · Pubmed #22932787.

ABSTRACT: Cochlear implants allow individuals with severe to profound hearing loss access to sound and spoken language. The number of older adults in the United States who are potential candidates for cochlear implantation (CI) is approximately 150,000 and will continue to increase with the aging of the population. Should CI be routinely recommended for these older adults, and do these individuals benefit from CI? We reviewed our 12-year experience with CI in adults aged ≥60 years (n = 445) at Johns Hopkins Medical Institutions to investigate the impact of CI on speech understanding and to identify factors associated with speech performance. Complete data on speech outcomes at baseline and 1 year post-CI were available for 83 individuals. Our results demonstrate that CI in adults aged ≥60 years consistently improved speech understanding scores, with a mean increase of 60.0% (SD 24.1) on HINT (Hearing in Noise Test) sentences in quiet. The magnitude of the gain in speech scores was negatively associated with age at implantation, such that for every increasing year of age at CI the gain in speech scores was 1.3 percentage points less (95% confidence interval [95% CI], 0.6-1.9) after adjusting for age at hearing loss onset. Conversely, individuals with higher pre-CI speech scores (HINT scores between 40% and 60%) had significantly greater post-CI speech scores by a mean of 10.0 percentage points (95% CI, 0.4-19.6) than those with lower pre-CI speech scores (HINT <40%) after adjusting for age at CI and age at hearing loss onset. These results suggest that older adult CI candidates who are younger at implantation and with higher preoperative speech scores obtain the highest speech understanding scores after CI, with possible implications for current United States Medicare policy. Finally, we provide an extended discussion of the epidemiology and impact of hearing loss in older adults. Future research of CI in older adults should expand beyond simple speech outcomes to take into account the broad cognitive, social, and physical functioning outcomes that are likely detrimentally affected by hearing loss and may be mitigated by CI.

18 Article Language and behavioral outcomes in children with developmental disabilities using cochlear implants. 2012

Cruz, Ivette / Vicaria, Ishabel / Wang, Nae-Yuh / Niparko, John / Quittner, Alexandra L / Anonymous9510728. ·Department of Otolaryngology, University of Miami, Miami, Florida 33136, USA. icruz@med.miami.edu ·Otol Neurotol · Pubmed #22699986.

ABSTRACT: OBJECTIVE: Over the past decade, the number of deaf children with developmental disabilities receiving cochlear implants has increased dramatically. However, little is known about the developmental outcomes of these children post-implantation. The current study evaluated oral language and behavioral outcomes over 3 years after implantation in a sample of typically developing deaf children and children with developmental disabilities. STUDY DESIGN: A three year longitudinal study of the effects of cochlear implantation on language and behavioral outcomes in children with and without additional disabilities. SETTING: Six cochlear implant centers in the United States. PATIENTS: The study cohort consisted of 188 deaf children. Eighty-five percent of the sample (n = 157) had a single diagnosis of severe to profound hearing loss and 15% (n = 31) had an additional disability. MAIN OUTCOME MEASURES: Oral language was assessed using the Reynell Developmental Language Scales, and behavioral outcomes were assessed using the Child Behavior Checklist. RESULTS: Results using multilevel modeling indicated that deaf children with and without additional disabilities improved significantly in oral language skills post-implantation. However, children with additional disabilities made slower progress. In terms of specific diagnoses, children with developmental disorders, such as autism, made the slowest progress over time. In addition, behavior problems increased significantly in this group, whereas behavior problems decreased over 3 years in the typically developing deaf sample. CONCLUSION: Overall, given the improvements in expressive and receptive language skills documented over 3 years, these findings support the use of cochlear implants for deaf children with developmental disabilities.

19 Article Timing of cochlear implantation and parents' global ratings of children's health and development. 2012

Clark, James H / Wang, Nae-Yuh / Riley, Anne W / Carson, Christine M / Meserole, Rachel L / Lin, Frank R / Eisenberg, Laurie S / Tobey, Emily A / Quittner, Alexandra L / Francis, Howard W / Anonymous1690726 / Niparko, John K. ·Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. ·Otol Neurotol · Pubmed #22588232.

ABSTRACT: OBJECTIVE: To assess children's health-related quality of life (HRQL) and development after cochlear implant (CI) surgery and compare improvements between different age of implantation categories. STUDY DESIGN: Prospective, longitudinal study comparing outcomes of deaf children post-CI with hearing controls. SETTING: Six US CI centers. PATIENTS: Deaf children who received CI (n = 188) and hearing children of comparable ages (n = 97). INTERVENTION: CI before 5 years of age. MAIN OUTCOME MEASURE: Parental ratings of global HRQL and development, as assessed over the first 4 years of follow-up using visual analog scales. Development scores assess parental views of children's growth and development, motor skills, ability to express themselves and communicate with others, and learning abilities. Associations of baseline child and family characteristics with post-CI HRQL and development were investigated using multivariable analysis, controlling for factors that influence post-CI language learning. RESULTS: Baseline deficits of CI candidates relative to hearing controls were larger in development than HRQL. Development scores improved significantly by 4 years after CI, particularly in the youngest CI recipients. Developmental deficits of older CI recipients with early, extended hearing aid use were only partially remediated by CI. Overall, no significant health deficits were observed in CI children after 4 years. Cognition and speech recognition were positively associated with both HRQL and development. CONCLUSION: Parental perspectives on quality of their child's life and development provide practical insight into the optimal timing of interventions for early-onset deafness. Validity of parental global assessments is supported by clinical measures of speech perception and language learning and comparison with a well-validated health status instrument.

20 Article Consumer preferences for hearing aid attributes: a comparison of rating and conjoint analysis methods. 2012

Bridges, John F P / Lataille, Angela T / Buttorff, Christine / White, Sharon / Niparko, John K. ·Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Rm 689, Baltimore, MD 21205, USA. jbridges@jhsph.edu ·Trends Amplif · Pubmed #22514094.

ABSTRACT: Low utilization of hearing aids has drawn increased attention to the study of consumer preferences using both simple ratings (e.g., Likert scale) and conjoint analyses, but these two approaches often produce inconsistent results. The study aims to directly compare Likert scales and conjoint analysis in identifying important attributes associated with hearing aids among those with hearing loss. Seven attributes of hearing aids were identified through qualitative research: performance in quiet settings, comfort, feedback, frequency of battery replacement, purchase price, water and sweat resistance, and performance in noisy settings. The preferences of 75 outpatients with hearing loss were measured with both a 5-point Likert scale and with 8 paired-comparison conjoint tasks (the latter being analyzed using OLS [ordinary least squares] and logistic regression). Results were compared by examining implied willingness-to-pay and Pearson's Rho. A total of 56 respondents (75%) provided complete responses. Two thirds of respondents were male, most had sensorineural hearing loss, and most were older than 50; 44% of respondents had never used a hearing aid. Both methods identified improved performance in noisy settings as the most valued attribute. Respondents were twice as likely to buy a hearing aid with better functionality in noisy environments (p < .001), and willingness to pay for this attribute ranged from US$2674 on the Likert to US$9000 in the conjoint analysis. The authors find a high level of concordance between the methods-a result that is in stark contrast with previous research. The authors conclude that their result stems from constraining the levels on the Likert scale.

21 Article Cochlear coiling pattern and orientation differences in cochlear implant candidates. 2011

Martinez-Monedero, Rodrigo / Niparko, John K / Aygun, Nafi. ·Department of Otolaryngology & Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland, USA. rmarti72@jhmi.edu ·Otol Neurotol · Pubmed #21817935.

ABSTRACT: BACKGROUND: Detailed studies of cochlear morphology can guide our approach to cochleostomy and electrode insertion to optimize neuronal and hair cell preservation and ultimate electrode location. METHODS: Normal developed cochleae from 124 cochlear implant candidates were studied. We performed morphometric analysis of the right cochleae in all subjects based on computed tomographic data. The length and width of the cochlear base, the angle between the first and second turn of the cochlea, and the cochlear orientation within the cranial base were measured and compared across age groups. In cochlear implant candidates with underdeveloped cochleae (n = 7), we performed similar measurements and assessed the modiolar inlet area on 3D volume rendered images. RESULTS: The birth to 1 year and 1- to 2-year age groups showed insignificant differences in the lengths and widths of the cochlear base, although variability was considerable, and a significantly wider angle (from the midsagittal line) than that of the older age groupings (p < 0.05). For underdeveloped cochleae, the length and width of the cochlear base were significantly smaller and angled between the first and second turn differed from the normal developed group. The modiolar inlet also was significantly smaller in the underdeveloped cochleae compared with normal cochleae. CONCLUSION: We observed that perspective 3D-volume rendering of the cochlea enables the determination of key features of cochlear morphology and orientation that may escape detection with routine computed tomographic scanning. Infants and young toddler candidates demonstrate greater variability in the dimensions of the cochlear base and in the orientation of the cochlea within the cranium. As evolving surgical techniques and device design enhance the ability of the surgeon to avoid cochlear damage and optimize electrode location, refined morphometric information may assist the surgeon in tailoring strategies of scala tympani implantation.

22 Article Measuring communicative performance with the FAPCI instrument: preliminary results from normal hearing and cochlear implanted children. 2011

Clark, James H / Aggarwal, Pooja / Wang, Nae-Yuh / Robinson, Raymond / Niparko, John K / Lin, Frank R. ·Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA. ·Int J Pediatr Otorhinolaryngol · Pubmed #21296432.

ABSTRACT: OBJECTIVE: To develop preliminary "growth curves" of Functioning after Pediatric Cochlear Implantation (FAPCI) scores using a cross-sectional sample of normal hearing children and to compare these curves to trajectories of FAPCI scores in children receiving cochlear implants. METHODS: Quantile regression was used to develop growth curves from the FAPCI scores of a cross-sectional sample of 82 normal hearing children (age range 7 months-5 years). Trajectories of FAPCI scores from a longitudinal cohort of 75 children with cochlear implants (age range 1-5 years) were compared to these growth curves. RESULTS: FAPCI scores were positively associated with increasing age in normal hearing children with a rapid increase in scores observed at earlier ages followed by a plateau at age 3 years. FAPCI trajectories for cochlear-implanted children varied with age at implantation and did not reach a plateau until age 5-6 years. CONCLUSION: Normal hearing children demonstrated increasing FAPCI scores with age, and these preliminary growth curves allow for the interpretation of a cochlear-implanted child's FAPCI scores in comparison to normal hearing children. Additional research using a larger, longitudinal cohort of normal hearing children will be needed to develop definitive normative FAPCI trajectories.

23 Article Predictors of vestibular schwannoma growth and clinical implications. 2010

Agrawal, Yuri / Clark, James H / Limb, Charles J / Niparko, John K / Francis, Howard W. ·Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. ·Otol Neurotol · Pubmed #20502379.

ABSTRACT: OBJECTIVE: Vestibular schwannomas exhibit variable and unpredictable patterns of growth. We evaluated the extent to which tumor growth influences the management of these benign tumors, and we explored symptom markers present at diagnosis that may be predictive of tumor growth. STUDY DESIGN: Retrospective case review. SETTING: Tertiary care hospital center. PATIENTS: One hundred eighty patients with unilateral vestibular schwannomas diagnosed between 1997 and 2007 who were initially managed conservatively by serial observation. INTERVENTION(S): Serial observation versus eventual microsurgical or radiosurgical treatment. MAIN OUTCOME MEASURE(S): Tumor growth, defined as a 1 mm/year or greater increase in tumor size. RESULTS: We observed that tumor growth was the most important predictor of a change in treatment strategy from serial observation to microsurgical or radiosurgical treatment. We further noted in multivariate analyses that larger tumor size at diagnosis was associated with higher odds of tumor growth, such that each 1-mm increment in tumor size at presentation increased the odds of growth by 20%. We also found that the symptom marker of tinnitus at diagnosis significantly increased the odds of tumor growth nearly 3-fold. CONCLUSION: Tumor growth plays a significant role in guiding the management of vestibular schwannomas. Assessment of tumor size at diagnosis and for the presence of tinnitus may allow for risk stratification of patients with newly diagnosed vestibular schwannomas and for a more rational application of the conservative management approach.

24 Article Spoken language development in children following cochlear implantation. 2010

Niparko, John K / Tobey, Emily A / Thal, Donna J / Eisenberg, Laurie S / Wang, Nae-Yuh / Quittner, Alexandra L / Fink, Nancy E / Anonymous5180658. ·Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. jnipark1@jhmi.edu ·JAMA · Pubmed #20407059.

ABSTRACT: CONTEXT: Cochlear implantation is a surgical alternative to traditional amplification (hearing aids) that can facilitate spoken language development in young children with severe to profound sensorineural hearing loss (SNHL). OBJECTIVE: To prospectively assess spoken language acquisition following cochlear implantation in young children. DESIGN, SETTING, AND PARTICIPANTS: Prospective, longitudinal, and multidimensional assessment of spoken language development over a 3-year period in children who underwent cochlear implantation before 5 years of age (n = 188) from 6 US centers and hearing children of similar ages (n = 97) from 2 preschools recruited between November 2002 and December 2004. Follow-up completed between November 2005 and May 2008. MAIN OUTCOME MEASURES: Performance on measures of spoken language comprehension and expression (Reynell Developmental Language Scales). RESULTS: Children undergoing cochlear implantation showed greater improvement in spoken language performance (10.4; 95% confidence interval [CI], 9.6-11.2 points per year in comprehension; 8.4; 95% CI, 7.8-9.0 in expression) than would be predicted by their preimplantation baseline scores (5.4; 95% CI, 4.1-6.7, comprehension; 5.8; 95% CI, 4.6-7.0, expression), although mean scores were not restored to age-appropriate levels after 3 years. Younger age at cochlear implantation was associated with significantly steeper rate increases in comprehension (1.1; 95% CI, 0.5-1.7 points per year younger) and expression (1.0; 95% CI, 0.6-1.5 points per year younger). Similarly, each 1-year shorter history of hearing deficit was associated with steeper rate increases in comprehension (0.8; 95% CI, 0.2-1.2 points per year shorter) and expression (0.6; 95% CI, 0.2-1.0 points per year shorter). In multivariable analyses, greater residual hearing prior to cochlear implantation, higher ratings of parent-child interactions, and higher socioeconomic status were associated with greater rates of improvement in comprehension and expression. CONCLUSION: The use of cochlear implants in young children was associated with better spoken language learning than would be predicted from their preimplantation scores.

25 Article Estimating the effect of occupational noise exposure on hearing thresholds: the importance of adjusting for confounding variables. 2010

Agrawal, Yuri / Niparko, John K / Dobie, Robert A. ·Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. yagrawa1@jhmi.edu ·Ear Hear · Pubmed #20075736.

ABSTRACT: OBJECTIVES: To evaluate whether valid estimation of the effect of occupational noise exposure on hearing thresholds requires adjustment for factors other than age, sex, and race, which also influence hearing function. DESIGN: Multivariate regression analyses were performed in the 1999-2002 National Health and Nutrition Examination Survey (N = 3527). RESULTS: Occupational noise exposure was significantly associated with educational level, leisure time and firearm noise, and smoking. Incomplete adjustment for these factors leads to an overestimation of the effect of occupational noise exposure. CONCLUSIONS: Current methods of estimating the effect of occupational noise exposure (e.g., Annex C of American National Standards Institute S3.44) require better consideration of these confounding factors.