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Hearing Disorders: HELP
Articles from Toronto
Based on 260 articles published since 2010
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These are the 260 published articles about Hearing Disorders that originated from Toronto during 2010-2020.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10 · 11
176 Article A detailed clinical and molecular survey of subjects with nonsyndromic USH2A retinopathy reveals an allelic hierarchy of disease-causing variants. 2015

Lenassi, Eva / Vincent, Ajoy / Li, Zheng / Saihan, Zubin / Coffey, Alison J / Steele-Stallard, Heather B / Moore, Anthony T / Steel, Karen P / Luxon, Linda M / Héon, Elise / Bitner-Glindzicz, Maria / Webster, Andrew R. ·UCL Institute of Ophthalmology and Moorfields Eye Hospital, University College of London, London, UK. · Eye Hospital, University Medical Centre, Ljubljana, Slovenia. · The Hospital for Sick Children, Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada. · Ocular Genetics, Singapore Eye Research Institute, Singapore, Singapore. · Wellcome Trust Sanger Institute, Hinxton, UK. · UCL Institute of Child Health, London, UK. · UCL Ear Institute, London, UK. · National Hospital for Neurology and Neurosurgery, London, UK. ·Eur J Hum Genet · Pubmed #25649381.

ABSTRACT: Defects in USH2A cause both isolated retinal disease and Usher syndrome (ie, retinal disease and deafness). To gain insights into isolated/nonsyndromic USH2A retinopathy, we screened USH2A in 186 probands with recessive retinal disease and no hearing complaint in childhood (discovery cohort) and in 84 probands with recessive retinal disease (replication cohort). Detailed phenotyping, including retinal imaging and audiological assessment, was performed in individuals with two likely disease-causing USH2A variants. Further genetic testing, including screening for a deep-intronic disease-causing variant and large deletions/duplications, was performed in those with one likely disease-causing change. Overall, 23 of 186 probands (discovery cohort) were found to harbour two likely disease-causing variants in USH2A. Some of these variants were predominantly associated with nonsyndromic retinal degeneration ('retinal disease-specific'); these included the common c.2276 G>T, p.(Cys759Phe) mutation and five additional variants: c.2802 T>G, p.(Cys934Trp); c.10073 G>A, p.(Cys3358Tyr); c.11156 G>A, p.(Arg3719His); c.12295-3 T>A; and c.12575 G>A, p.(Arg4192His). An allelic hierarchy was observed in the discovery cohort and confirmed in the replication cohort. In nonsyndromic USH2A disease, retinopathy was consistent with retinitis pigmentosa and the audiological phenotype was variable. USH2A retinopathy is a common cause of nonsyndromic recessive retinal degeneration and has a different mutational spectrum to that observed in Usher syndrome. The following model is proposed: the presence of at least one 'retinal disease-specific' USH2A allele in a patient with USH2A-related disease results in the preservation of normal hearing. Careful genotype-phenotype studies such as this will become increasingly important, especially now that high-throughput sequencing is widely used in the clinical setting.

177 Article Development of the adaptive music perception test. 2015

Kirchberger, Martin J / Russo, Frank A. ·1Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland; 2Phonak AG, Stäfa, Switzerland; 3Department of Psychology, Ryerson University, Toronto, Ontario, Canada; and 4Communication Team, Toronto Rehabilitation Institute, Toronto, Ontario, Canada. ·Ear Hear · Pubmed #25350404.

ABSTRACT: OBJECTIVES: Despite vast amounts of research examining the influence of hearing loss on speech perception, comparatively little is known about its influence on music perception. No standardized test exists to quantify music perception of hearing-impaired (HI) persons in a clinically practical manner. This study presents the Adaptive Music Perception (AMP) test as a tool to assess important aspects of music perception with hearing loss. DESIGN: A computer-driven test was developed to determine the discrimination thresholds of 10 low-level physical dimensions (e.g., duration, level) in the context of perceptual judgments about musical dimensions: meter, harmony, melody, and timbre. In the meter test, the listener is asked to judge whether a tone sequence is duple or triple in meter. The harmony test requires that the listener make judgments about the stability of the chord sequences. In the melody test, the listener must judge whether a comparison melody is the same as a standard melody when presented in transposition and in the context of a chordal accompaniment that serves as a mask. The timbre test requires that the listener determines which of two comparison tones is different in timbre from a standard tone (ABX design). Twenty-one HI participants and 19 normal-hearing (NH) participants were recruited to carry out the music tests. Participants were tested twice on separate occasions to evaluate test-retest reliability. RESULTS: The HI group had significantly higher discrimination thresholds than the NH group in 7 of the 10 low-level physical dimensions: frequency discrimination in the meter test, dissonance and intonation perception in the harmony test, melody-to-chord ratio for both melody types in the melody test, and the perception of brightness and spectral irregularity in the timbre test. Small but significant improvement between test and retest was observed in three dimensions: frequency discrimination (meter test), dissonance (harmony test), and attack length (timbre test). All other dimensions did not show a session effect. Test-retest reliability was poor (<0.6) for spectral irregularity (timbre test); acceptable (>0.6) for pitch and duration (meter test), dissonance and intonation (harmony test), and melody-to-chord ratio I and II (melody test); and excellent (>0.8) for level (meter test) and attack (timbre test). CONCLUSION: The AMP test revealed differences in a wide range of music perceptual abilities between NH and HI listeners. The recognition of meter was more difficult for HI listeners when the listening task was based on frequency discrimination. The HI group was less sensitive to changes in harmony and had more difficulties with distinguishing melodies in a background of music. In addition, the thresholds to discriminate timbre were significantly higher for the HI group in brightness and spectral irregularity dimensions. The AMP test can be used as a research tool to further investigate music perception with hearing aids and compare the benefit of different music processing strategies for the HI listener. Future testing will involve larger samples with the inclusion of hearing aided conditions allowing for the establishment of norms so that the test might be appropriate for use in clinical practice.

178 Article Effects of hearing and vision impairments on the Montreal Cognitive Assessment. 2015

Dupuis, Kate / Pichora-Fuller, M Kathleen / Chasteen, Alison L / Marchuk, Veronica / Singh, Gurjit / Smith, Sherri L. ·a Department of Psychology , University of Toronto , Toronto , ON , Canada. ·Neuropsychol Dev Cogn B Aging Neuropsychol Cogn · Pubmed #25325767.

ABSTRACT: Many standardized measures of cognition include items that must be seen or heard. Nevertheless, it is not uncommon to overlook the possible effects of sensory impairment(s) on test scores. In the current study, we investigated whether sensory impairments could affect performance on a widely used screening tool, the Montreal Cognitive Assessment (MoCA). Three hundred and one older adults (mean age = 71 years) completed the MoCA and also hearing and vision tests. Half of the participants had normal hearing and vision, 38% impaired hearing, 5% impaired vision, and 7% had dual-sensory impairment. More participants with normal sensory acuity passed the MoCA compared to those with sensory loss, even after modifying scores to adjust for sensory factors. The results suggest that cognitive abilities may be underestimated if sensory problems are not considered and that people with sensory loss are at greater risk of cognitive decline.

179 Article The role of a new contralateral routing of signal microphone in established unilateral cochlear implant recipients. 2015

Grewal, Amandeep S / Kuthubutheen, Jafri / Smilsky, Kari / Nedzelski, Julian M / Chen, Joseph M / Friesen, Lendra / Lin, Vincent Y W. ·Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Sunnybrook Cochlear Implant Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. ·Laryngoscope · Pubmed #25224587.

ABSTRACT: OBJECTIVES/HYPOTHESIS: To investigate whether a contralateral routing of signal (CROS) microphone combined with a unilateral cochlear implant (CI) results in hearing improvement after a prolonged trial period. STUDY DESIGN: A prospective experimental trial was undertaken on a group of 10 postlingually deafened adults who are experienced CI users. METHODS: Participants completed audiometric testing and validated questionnaires with their unilateral CI alone, followed by addition of a CROS microphone (CI-CROS). This was worn daily for the 2-week trial, after which hearing performance was reevaluated using the same measures. Objective tests included AzBio sentences in quiet and noise and consonant-vowel nucleus-consonant (CNC) words. Subjective measures included the Abbreviated Profile of Hearing Aid Benefit (APHAB); Speech, Spatial, Qualities of Hearing Index (SSQ); Hearing Implant Sound Quality Index; an institutional questionnaire; and a daily log sheet. RESULTS: There is statistically significant enhanced speech discrimination with the CI-CROS when speech is presented on the CROS side. However, scores are markedly diminished when background noise is introduced, particularly to the CROS side. Subjective results indicate lower satisfaction scores for the global and ease of communication subdomains of the APHAB with the CI-CROS, but increased scores on the spatial hearing subdomain of the SSQ (P < 0.05). CONCLUSION: The CI-CROS provides significant benefit in certain situations, particularly speech recognition in quiet. CI-CROS performance with background noise is poor, leading to low satisfaction scores. Further refinement of the device may yield a useful tool for unilateral CI users in the future.

180 Article The effect of different utility measures on the cost-effectiveness of bilateral cochlear implantation. 2015

Kuthubutheen, Jafri / Mittmann, Nicole / Amoodi, Hosam / Qian, Wei / Chen, Joseph M. ·Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; School of Surgery, University of Western Australia, Perth, Western Australia, Australia. ·Laryngoscope · Pubmed #25169819.

ABSTRACT: OBJECTIVES/HYPOTHESIS: To determine if the choice of health utility measure affects the incremental cost-utility ratio (ICUR) when assessing the cost-effectiveness of bilateral cochlear implantation (CI). STUDY DESIGN: A scenario-based estimate with three scenarios: 1) a patient with severe to profound sensorineural hearing loss with no intervention, 2) the same patient with a unilateral CI with average or better performance, and 3) the same patient with bilateral CIs with average or better performance. METHODS: One hundred and forty-two subjects comprising preimplantees (n = 30), unilateral cochlear implantees (n = 30), bilateral implantees (n = 30), and healthcare professionals (n = 52). The four health utility instruments applied were the Health Utility Index Mark 3 (HUI3), European Quality of Life Questionnaire in 5 Domains (EQ5D), visual analog scale (VAS), and time trade-off (TTO). Cost for each implant was based on a 25-year time horizon, 50% discount for the second implant, and a 15% failure rate. RESULTS: Using the HUI3, the utility gain from unilateral to bilateral implantation was 0.035 or 11.5% of the total utility gain. This ratio was higher using the other instruments: EQ5D (22.2%), VAS (35.0%), and TTO (41.4%). For the scenario of bilateral CI compared to no intervention, HUI3 ICUR estimates were the lowest, and for bilateral CI compared to unilateral CI, HUI3 ICUR estimates were the highest. CONCLUSIONS: The choice of utility instrument in cost-utility analysis of bilateral CI heavily influences whether the second implant is deemed cost-effective. The HUI3 is the utility of choice in CI studies and is the most conservative. LEVEL OF EVIDENCE: 4.

181 Article De novo large genomic deletions involving POU3F4 in incomplete partition type III inner ear anomaly in East Asian populations and implications for genetic counseling. 2015

Choi, Jin Woong / Min, ByungJoo / Kim, AhReum / Koo, Ja-Won / Kim, Chong-Sun / Park, Woong-Yang / Chung, Juyong / Kim, Veronica / Ryu, Yoon-Jong / Kim, Shin Hye / Chang, Sun-O / Oh, Seung-Ha / Choi, Byung Yoon. ·*Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University Hospital, Daejeon; †Laboratory of Molecular and Genomic Medicine, Department of Biomedical Sciences, ‡Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul; §Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital; ∥Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul; ¶Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon; #Translational Genomics Laboratory, Samsung Institute, Samsung Medical Center, Seoul, Republic of Korea; and**Department of Cell and System Biology, University of Toronto, Toronto, Canada. ·Otol Neurotol · Pubmed #24608376.

ABSTRACT: OBJECTIVE: The aim of this study was to understand the prevalence and molecular genetic etiology of incomplete partition type III (IP type III) anomaly in Koreans. We also attempted to verify the prevalence of genomic deletions in the DFNX2 locus and to look for association between inheritance patterns and mutation type in East Asian IP type III subjects. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: Subjects with IP type III anomaly and their biological mothers. INTERVENTIONS: Sanger sequencing, array-comparative genomic hybridization (aCGH), and PCR were performed. We also analyzed the type and inheritance of the causative genetic abnormality in East Asian DFNX2 patients. MAIN OUTCOME MEASURE: Mutation type and occurrence. RESULTS: We identified IP type III in 10 (4.8%) of 206 patients with an inner ear abnormality. We confirmed an etiologic homogeneity, DFNX2, of the IP type III in this Korean population. Two (20%) of the 10 DFNX2 carried a large genomic deletion affecting POU3F4, as proved by aCGH. PCR confirmed that the 2 deletions occurred de novo. Genetic alteration occurred de novo in 29.4% (5/17) of all reported Korean IP type III cases. From this study and literature review, we observed a striking difference of de novo occurrence rate (75% versus 12.5%, p = 0.032) between large genomic deletions and point mutations in East Asian population. CONCLUSIONS: Our data suggest that different POU3F4 mutations might show different recurrence rate in siblings of the IP type III families, especially in East Asian population. Genetic counseling should be provided accordingly.

182 Article Perception of binaural cues develops in children who are deaf through bilateral cochlear implantation. 2014

Gordon, Karen A / Deighton, Michael R / Abbasalipour, Parvaneh / Papsin, Blake C. ·Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Ontario, Canada. · Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario, Canada. ·PLoS One · Pubmed #25531107.

ABSTRACT: There are significant challenges to restoring binaural hearing to children who have been deaf from an early age. The uncoordinated and poor temporal information available from cochlear implants distorts perception of interaural timing differences normally important for sound localization and listening in noise. Moreover, binaural development can be compromised by bilateral and unilateral auditory deprivation. Here, we studied perception of both interaural level and timing differences in 79 children/adolescents using bilateral cochlear implants and 16 peers with normal hearing. They were asked on which side of their head they heard unilaterally or bilaterally presented click- or electrical pulse- trains. Interaural level cues were identified by most participants including adolescents with long periods of unilateral cochlear implant use and little bilateral implant experience. Interaural timing cues were not detected by new bilateral adolescent users, consistent with previous evidence. Evidence of binaural timing detection was, for the first time, found in children who had much longer implant experience but it was marked by poorer than normal sensitivity and abnormally strong dependence on current level differences between implants. In addition, children with prior unilateral implant use showed a higher proportion of responses to their first implanted sides than children implanted simultaneously. These data indicate that there are functional repercussions of developing binaural hearing through bilateral cochlear implants, particularly when provided sequentially; nonetheless, children have an opportunity to use these devices to hear better in noise and gain spatial hearing.

183 Article The role of stimulus complexity, spectral overlap, and pitch for gap-detection thresholds in young and old listeners. 2014

Heinrich, A / de la Rosa, S / Schneider, B A. ·Human Communication Laboratory, Department of Psychology, University of Toronto Mississauga, 3359 Mississauga Road North, Mississauga, Ontario L5L 1C6, Canada. ·J Acoust Soc Am · Pubmed #25324081.

ABSTRACT: Thresholds for detecting a gap between two complex tones were determined for young listeners with normal hearing and old listeners with mild age-related hearing loss. The leading tonal marker was always a 20-ms, 250-Hz complex tone with energy at 250, 500, 750, and 1000 Hz. The lagging marker, also tonal, could differ from the leading marker with respect to fundamental frequency (f0), the presence versus absence of energy at f0, and the degree to which it overlapped spectrally with the leading marker. All stimuli were presented with steeper (1 ms) and less steep (4 ms) envelope rise and fall times. F0 differences, decreases in the degree of spectral overlap between the markers, and shallower envelope shape all contributed to increases in gap-detection thresholds. Age differences for gap detection of complex sounds were generally small and constant when gap-detection thresholds were measured on a log scale. When comparing the results for complex sounds to thresholds obtained for pure-tones in a previous study by Heinrich and Schneider [(2006). J. Acoust. Soc. Am. 119, 2316-2326], thresholds increased in an orderly fashion from markers with identical (within-channel) pure tones to different (between-channel) pure tones to complex sounds. This pattern of results was true for listeners of both ages although younger listeners had smaller thresholds overall.

184 Article Can you hear me? Sudden sensorineural hearing loss in the emergency department. 2014

Cheng, Alex Won-Pang / Mitchell, Zoë / Foote, John. ·Resident in the CCFP-EM Program in the Department of Family and Community Medicine at the University of Toronto in Ontario. · Emergency physician at Mount Sinai Hospital in Toronto and Assistant Professor in the Department of Family and Community Medicine at the University of Toronto. ·Can Fam Physician · Pubmed #25316743.

ABSTRACT: -- No abstract --

185 Article Normal-like motor speech parameters measured in children with long-term cochlear implant experience using a novel objective analytic technique. 2014

Eskander, Antoine / Gordon, Karen A / Tirado, Yamilet / Hopyan, Talar / Russell, Laurie / Allegro, Jennifer / Papsin, Blake C / Campisi, Paolo. ·Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada. · Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada. · Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada2Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada. · Centre for Paediatric Voice and Laryngeal Function, Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada4Department of Communication Disorders, Hospital for Sick Children, Toronto, Ontario, Canada. · Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada3Centre for Paediatric Voice and Laryngeal Function, Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canad. ·JAMA Otolaryngol Head Neck Surg · Pubmed #25170778.

ABSTRACT: IMPORTANCE: Although voice has been studied extensively in children who use cochlear implants (CIs), speech production has not been studied in this population using the Motor Speech Profile. Whether children who receive CIs gain normal speech production abilities is unknown. OBJECTIVE: To assess speech and articulation in deaf, long-term CI users who had undergone early unilateral cochlear implantation, compared with their normal-hearing peers. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study at a tertiary pediatric hospital of 16 children aged 8 to 17 years who had undergone early implantation, are longstanding users, and had excellent audiogram and speech perception scores. Results were compared with a historical pediatric normal-hearing group. INTERVENTION: Unilateral cochlear implantation. MAIN OUTCOMES AND MEASURES: The Motor Speech Profile, an objective method for assessing motor speech in children. RESULTS: The CI users had normal articulation and timing but poorer than normal intonation stimulability, particularly frequency variability. Diadochokinesis rates were within the 95% confidence interval of age-matched pediatric norms for 11 of 16 (69%) and 11 of 15 (73%) children with CI when they were performing /pa/ and /pataka/ tasks, respectively. The magnitude and rate of the second formant transitions were within normal limits for 9 of 16 (56%) and 10 of 12 (83%) children, respectively. The variability in frequency and amplitude of intonation stimulability domains were within normal limits for 7 of 16 (44%) and 16 of 16 (100%) children, respectively. The syllabic rate and duration were both within normal limits for 14 of 16 children (88%). CONCLUSIONS AND RELEVANCE: Despite significant improvements in speech after cochlear implantation, abnormalities remain, particularly in frequency variability. Such deviations can present as a decreased expression of emotion in speech and likely reflects decreased auditory frequency resolution provided by the CI. These deficits have been the focus of ongoing work to advance CI technologies and speech-processing strategies.

186 Article Unilateral cochlear implant use promotes normal-like loudness perception in adolescents with childhood deafness. 2014

Steel, Morrison Mansour / Abbasalipour, Parvaneh / Salloum, Claire A M / Hasek, David / Papsin, Blake C / Gordon, Karen A. ·1Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; 2Department of Otolaryngology, The Hospital for Sick Children, Toronto, Ontario, Canada; 3Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada; 4Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada; and 5Department of Communication Disorders, The Hospital for Sick Children, Toronto, Ontario, Canada. ·Ear Hear · Pubmed #25072236.

ABSTRACT: OBJECTIVES: Behavioral measures of cochlear implant (CI) device stimulation levels can be difficult to obtain in individuals with limited or no hearing experience. Loudness measures are particularly challenging. It would therefore be useful to have a battery of objective and behavioral measures to determine CI stimulation levels in listeners with childhood deafness. In the present study, the authors characterized loudness growth in 20 adolescents: 8 with normal hearing and 12 CI participants with pre/perilingual bilateral sensorineural hearing loss. They asked (1) do adolescent CI users with childhood deafness experience similar increases in loudness as their peers with normal hearing? and (2) can loudness be predicted by objective measures of auditory activity? The authors hypothesized that loudness perception would be significantly different between CI and normal-hearing groups and that it would correlate with objective measures. DESIGN: CI users were recruited from the Cochlear Implant Program at The Hospital for Sick Children and all had used unilateral Nucleus CIs for at least 2 years. The dynamic range for each participant was defined as the difference between the behavioral threshold and the electrically evoked stapedius reflex (ESR) threshold. Loudness growth was assessed within this range behaviorally on a continuous visual scale and objectively with physiological measures. Auditory brainstem responses (ABRs) and ESRs were recorded in both groups and electrically evoked compound action potentials (ECAPs) of the auditory nerve were recorded in addition in CI listeners. The regression line slopes of ECAP and ABR amplitude growth functions were then calculated and compared with behavioral loudness growth slopes in the upper portion (40-100%) and lower portion (0-40%) of the dynamic range. Electrical pulse stimuli (in CI users) and acoustic clicks (in normal-hearing participants) were presented within each participant's dynamic range. RESULTS: The mean dynamic range in CI listeners was more variable than in normal-hearing individuals. Despite this difference, loudness at the ESR threshold was not significantly different in CI adolescents from their normal-hearing peers, and CI users exhibited normal-like loudness growth. There was a significantly positive correlation between ECAP amplitude growth and loudness growth in CI users in the upper portion of the dynamic range, while ABR wave V amplitude growth was not related to loudness growth in either group. CONCLUSIONS: We confirmed that the ESR threshold is a good measure of comfortably loud levels in adolescents with cochlear implants and their normal-hearing peers. Adolescents using CIs show normal-like rates of loudness growth on average, despite having highly variable dynamic ranges of hearing. Individual rates of loudness growth in the upper dynamic range in CI users can be predicted by the rate of amplitude growth of the ECAP. Thus, the rate of neural recruitment with increasing CI current is important for loudness perception in pre/perilingually deaf listeners and should be considered when programming their CIs.

187 Article A 54-year-old man with hallucinations and hearing loss. 2014

Steriade, Claude / Shumak, Steven L / Feinstein, Anthony. ·Division of Neurology (Steriade), Department of Medicine (Shumak), Department of Psychiatry (Feinstein), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont. claude.steriade@mail.utoronto.ca. · Division of Neurology (Steriade), Department of Medicine (Shumak), Department of Psychiatry (Feinstein), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont. ·CMAJ · Pubmed #24982298.

ABSTRACT: -- No abstract --

188 Article Screening infants for hearing impairment in Canada. 2014

Eskander, Antoine / Papsin, Blake C. ·Department of Otolaryngology - Head and Neck Surgery (Eskander), University of Toronto, Toronto, Ont. · Archie's Cochlear Implant Lab (Papsin), and Department of Otolaryngology - Head and Neck Surgery (Papsin), The Hospital for Sick Children, Toronto, Ont. ·CMAJ · Pubmed #24847140.

ABSTRACT: -- No abstract --

189 Article Cochlear implantation in patients with chronic suppurative otitis media. 2014

Wong, Matthew C / Shipp, David B / Nedzelski, Julian M / Chen, Joseph M / Lin, Vincent Y W. ·Department of Otolaryngology-Head and Neck Surgery, University of Toronto; and Cochlear Implant Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. ·Otol Neurotol · Pubmed #24569796.

ABSTRACT: OBJECTIVE: To determine the safety, efficacy, and outcomes of cochlear implantation in patients with chronic suppurative otitis media (CSOM). STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center with large cochlear implant program. PATIENTS: Nineteen patients with CSOM who underwent cochlear implantation were identified. Case history, timing of surgical procedures, complications, infections, and postimplant audiometric scores (Hearing in Noise Test [HINT], City University of New York Sentences [CUNY], and Central Institute for the Deaf Sentences [CID]) were evaluated. MAIN OUTCOME MEASURES: Rates of postoperative infections and complications as well as postimplant auditory performance. RESULTS: Twelve patients underwent a staged procedure involving canal wall down mastoidectomy or radical revision mastoidectomy with middle ear and mastoid obliteration and closure of the external auditory canal followed by cochlear implantation approximately 5 months later. Seven patients were implanted in a single procedure. There were no infections or medical complications after implantation. On average, patients had excellent audiometric scores at 1 year postimplantation (mean sentence test, 79%; SD, 14), and these scores were comparable to our general population (mean sentence test, 71%; SD, 32). CONCLUSION: Cochlear implant patients with CSOM have no increased risk of postoperative infections or complications. These patients have excellent outcomes with audiometric scores comparable to the general cochlear implant population. Cochlear implantation is a safe and effective treatment for patients with profound hearing loss secondary to CSOM.

190 Article Quality of life in cochlear implantees: comparing utility values obtained through the Medical Outcome Study Short-Form Survey-6D and the Health Utility Index Mark 3. 2014

Arnoldner, Christoph / Lin, Vincent Y / Bresler, Richard / Kaider, Alexandra / Kuthubutheen, Jafri / Shipp, David / Chen, Joseph M. ·Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. ·Laryngoscope · Pubmed #24536018.

ABSTRACT: OBJECTIVES/HYPOTHESIS: To evaluate the changes in health-related quality of life in unilateral adult cochlear implant patients using the Medical Outcome Study Short-Form Survey-36 (SF-36) and the Health Utility Index Mark 3 (HUI-3). To do so, a health utility index was obtained by converting the SF-36 to the Medical Outcome Study Short-Form Survey-6D (SF-6D) to permit comparison with HUI-3 scores in the context of health preference as measured by quality-adjusted life years. STUDY DESIGN: Prospective cohort study. METHODS: Eighty-one postlingually deaf adult patients undergoing cochlear implantation completed the SF-36 and HUI-3 preoperatively and at a median of 1.4 years (range, 11 months-5 years) after cochlear implantation. RESULTS: The SF-36 improvement was statistically significant in two domains. The SF-36 data were converted to SF-6D. Preoperatively, the mean SF-6D utility score was 0.575 ± 0.056. One year postoperatively this score increased to 0.590 ± 0.064. The improvement of 0.015 ± 0.082 was not statistically significant (P = .1118). Of the HUI-3 attributes, two showed improvement between preoperative and postoperative evaluations. The overall HUI-3 score increased from 0.464 ± 0.207 preoperatively to 0.611 ± 0.190 postoperatively. The gain of 0.146 ± 0.19 was statistically significant (P < .0001). The intraclass correlation coefficient between the SF-6D and HUI-3 showed a very small correlation, both pre- and postoperatively. CONCLUSIONS: Against the backdrop of diminishing resources for healthcare, cost-effective analysis is fast becoming an important tool. There remains a strong need for health-related quality-of-life instruments that can truly reflect the benefit of cochlear implantation, in which utility estimates are fundamentally important. The SF-36 scores, when converted to SF-6D, do not correlate well with HUI-3 scores in a cohort of adult cochlear implant recipients. The HUI-3 remains the most appropriate tool for this patient group. LEVEL OF EVIDENCE: 4

191 Article Examination of risk factors for intellectual and academic outcomes following treatment for pediatric medulloblastoma. 2014

Schreiber, Jane E / Gurney, James G / Palmer, Shawna L / Bass, Johnnie K / Wang, Mingjuan / Chen, Si / Zhang, Hui / Swain, Michelle / Chapieski, Mary L / Bonner, Melanie J / Mabbott, Donald J / Knight, Sarah J / Armstrong, Carol L / Boyle, Robyn / Gajjar, Amar. ·Department of Psychology St. Jude Children's Research Hospital, Memphis, Tennessee (J.E.S., S.L.P.) · Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee (J.G.G.) · School of Public Health, University of Memphis, Memphis, Tennessee (J.G.G.) · Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, Tennessee (J.K.B) · Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee (M.W., S.C., H.Z.) · Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee (A.G.) · Royal Children's Hospital Brisbane, Herston, Australia (M.S.) · Department of Pediatric Medicine, Texas Children's Hospital, Houston, Texas (M.L.C.) · Department of Psychiatry, Duke University Medical Center, Durham, North Carolina (M.J.B.) · Department of Psychology, The Hospital for Sick Children, Toronto, Canada (D.J.M.) · Department of Psychology, The Royal Children's Hospital Melbourne, Victoria Australia (S.J.K.) · Neuro-Oncology Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (C.L.A) · Psychology Service, Sydney Children's Hospital, Randwick, Australia (R.B.). ·Neuro Oncol · Pubmed #24497405.

ABSTRACT: BACKGROUND: The aim of this study was to prospectively examine the effects of hearing loss and posterior fossa syndrome (PFS), in addition to age at diagnosis and disease risk status, on change in intellectual and academic outcomes following diagnosis and treatment in a large sample of medulloblastoma patients. METHODS: Data from at least 2 cognitive and academic assessments were available from 165 patients (ages 3-21 years) treated with surgery, risk-adapted craniospinal irradiation, and 4 courses of chemotherapy with stem cell support. Patients underwent serial evaluation of cognitive and academic functioning from baseline up to 5 years post diagnosis. RESULTS: Serious hearing loss, PFS, younger age at diagnosis, and high-risk status were all significant risk factors for decline in intellectual and academic skills. Serious hearing loss and PFS independently predicted below-average estimated mean intellectual ability at 5 years post diagnosis. Patients with high-risk medulloblastoma and young age at diagnosis (<7 years) exhibited the largest drop in mean scores for intellectual and academic outcomes. CONCLUSIONS: Despite a significant decline over time, intellectual and academic outcomes remained within the average range at 5 years post diagnosis for the majority of patients. Future studies should determine if scores remain within the average range at time points further out from treatment. Patients at heightened risk should be closely monitored and provided with recommendations for appropriate interventions.

192 Article Remodelling at the calyx of Held-MNTB synapse in mice developing with unilateral conductive hearing loss. 2014

Grande, Giovanbattista / Negandhi, Jaina / Harrison, Robert V / Wang, Lu-Yang. ·Corresponding Author L.-Y. Wang, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1X8.  luyang.wang@utoronto.ca. ·J Physiol · Pubmed #24469075.

ABSTRACT: Structure and function of central synapses are profoundly influenced by experience during developmental sensitive periods. Sensory synapses, which are the indispensable interface for the developing brain to interact with its environment, are particularly plastic. In the auditory system, moderate forms of unilateral hearing loss during development are prevalent but the pre- and postsynaptic modifications that occur when hearing symmetry is perturbed are not well understood. We investigated this issue by performing experiments at the large calyx of Held synapse. Principal neurons of the medial nucleus of the trapezoid body (MNTB) are innervated by calyx of Held terminals that originate from the axons of globular bushy cells located in the contralateral ventral cochlear nucleus. We compared populations of synapses in the same animal that were either sound deprived (SD) or sound experienced (SE) after unilateral conductive hearing loss (CHL). Middle ear ossicles were removed 1 week prior to hearing onset (approx. postnatal day (P) 12) and morphological and electrophysiological approaches were applied to auditory brainstem slices taken from these mice at P17-19. Calyces in the SD and SE MNTB acquired their mature digitated morphology but these were structurally more complex than those in normal hearing mice. This was accompanied by bilateral decreases in initial EPSC amplitude and synaptic conductance despite the CHL being unilateral. During high-frequency stimulation, some SD synapses displayed short-term depression whereas others displayed short-term facilitation followed by slow depression similar to the heterogeneities observed in normal hearing mice. However SE synapses predominantly displayed short-term facilitation followed by slow depression which could be explained in part by the decrease in release probability. Furthermore, the excitability of principal cells in the SD MNTB had increased significantly. Despite these unilateral changes in short-term plasticity and excitability, heterogeneities in the spiking fidelity among the population of both SD and SE synapses showed similar continuums to those in normal hearing mice. Our study suggests that preservations in the heterogeneity in spiking fidelity via synaptic remodelling ensures symmetric functional stability which is probably important for retaining the capability to maximally code sound localization cues despite moderate asymmetries in hearing experience.

193 Article Cost-utility analysis of bilateral cochlear implantation in adults: a health economic assessment from the perspective of a publicly funded program. 2014

Chen, Joseph M / Amoodi, Hossam / Mittmann, Nicole. ·Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. ·Laryngoscope · Pubmed #24431194.

ABSTRACT: OBJECTIVES/HYPOTHESIS: To determine the cost-effectiveness of bilateral cochlear implantation (CI) in deaf adults. STUDY DESIGN: Cost-utility analysis. METHODS: Ninety patients and 52 health professionals served as proxies to estimate the benefit of bilateral cochlear implantation, utilizing the Health Utility Index. Three scenarios were created to reflect 1) deafness without intervention, 2) unilateral CI, and 3) bilateral CI. Cost evaluation reflected the burden on a publicly funded healthcare system. The base case included 25 years of service provision, processor upgrades every 5 years, 50% price reduction for second side, and 15% failure rate. Discounting and sensitivity analyses were applied. RESULTS: Costs were $63,632 (unilateral CI), $111,764 (bilateral CI), and $48,132 (incremental cost of second CI). The health preference gained from no intervention to unilateral CI, and to bilateral CI were 0.270 and 0.305. Incremental utility gained by the second implant was 11.5% of total. The incremental cost-utility ratio (ICUR) was $14,658/quality-adjusted life year (QALY) for bilateral CI compared to no intervention. It was stable regardless of discounting or sensitivity analyses. ICUR was $55,020/QALY from unilateral to bilateral CI with higher uncertainties. It improved with differential discounting, further second-side price reduction, and reduced frequency of processor upgrades. ICUR worsened with reduced length of use and higher failure rates. CONCLUSIONS: Sequential bilateral CI was cost-effective when compared to no intervention, although gains were made mostly by the first implant. Cost-effectiveness compared to unilateral implantation was borderline but improved through base case variations to reflect long-term gains or cost-saving measures. LEVEL OF EVIDENCE: 2C.

194 Article Cochlear implantation in patients with advanced Ménière's disease. 2014

Mick, Paul / Amoodi, Hosam / Arnoldner, Christoph / Shipp, David / Friesen, Lendra / Lin, Vincent / Nedzelski, Julian / Chen, Joseph. ·*Harvard School of Public Health, Boston, Massachusetts, U.S.A.; and †Department of Otolaryngology - Head & Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. ·Otol Neurotol · Pubmed #24366468.

ABSTRACT: BACKGROUND/OBJECTIVES: Ménière's disease (MD) that results in bilateral severe to profound sensorineural hearing loss is a rare indication for cochlear implantation; only a few studies exist documenting performance in these patients. The primary objective was to compare the difference in preoperative to 12-month postoperative speech perception scores among subjects with MD and controls. Groupwise comparisons of secondary postoperative outcomes (Tinnitus Handicap Inventory [THI] scores, 36-Item Short Form [SF-36] scores, and postoperative dizziness) were also performed. METHODS: A retrospective cohort study was conducted. Subjects with MD and controls matched by age, device manufacturer and model, preoperative sentence score, and sentence test used for preimplantation and postimplantation performance assessments were identified from 1,130 patients in the prospectively maintained cochlear implant database at our center. Speech perception, THI, and SF-36 scores and demographic variables were obtained from the database. Vestibular outcomes were obtained by retrospective chart review. Statistical comparisons were performed to compare preoperative to postoperative change between groups. RESULTS: Twenty patients with MD were identified. At 1 year after CI, improvements in sentence and word understanding did not differ in magnitude from the controls. Tinnitus was reduced significantly in patients with MD, whereas there was a trend for improvement in the controls. Quality of life as measured by the SF-36 improved in both groups. Patients with MD had significant improvements in 1 domain compared with 5 domains for the controls. Subjects with MD had significantly more chronic dizziness in the postoperative period than did controls. CONCLUSIONS: Patients with MD who have bilateral severe to profound sensorineural hearing loss benefit significantly from CI. Ongoing dizziness in some patients with MD may result in quality of life improvements that are slightly less than seen for the average adult patient with CI. Larger studies are needed to corroborate the results.

195 Article Children's recognition of spectrally degraded cartoon voices. 2014

van Heugten, Marieke / Volkova, Anna / Trehub, Sandra E / Schellenberg, E Glenn. ·1Laboratoire de Sciences Cognitives et Psycholinguistique, CNRS/EHESS/DEC-ENS, Paris, France; and 2Department of Psychology, University of Toronto, Mississauga, ON, Canada. ·Ear Hear · Pubmed #24213020.

ABSTRACT: OBJECTIVES: Although the spectrally degraded input provided by cochlear implants (CIs) is sufficient for speech perception in quiet, it poses problems for talker identification. The present study examined the ability of normally hearing (NH) children and child CI users to recognize cartoon voices while listening to spectrally degraded speech. DESIGN: In Experiment 1, 5- to 6-year-old NH children were required to identify familiar cartoon characters in a three-alternative, forced-choice task without feedback. Children heard sentence-length utterances at six levels of spectral degradation (noise-vocoded utterances with 4, 8, 12, 16, and 24 frequency bands and the original or unprocessed stimuli). In Experiment 2, child CI users 4 to 7 years of age and a control sample of 4- to 5-year-old NH children were required to identify the unprocessed stimuli from Experiment 1. RESULTS: NH children in Experiment 1 identified the voices significantly above chance levels, and they performed more accurately with increasing spectral information. Practice with stimuli that had greater spectral information facilitated performance on subsequent stimuli with lesser spectral information. In Experiment 2, child CI users successfully recognized the cartoon voices with slightly lower accuracy (0.90 proportion correct) than NH peers who listened to unprocessed utterances (0.97 proportion correct). CONCLUSIONS: The findings indicate that both NH children and child CI users can identify cartoon voices under conditions of severe spectral degradation. In such circumstances, children may rely on talker-specific phonetic detail to distinguish one talker from another.

196 Article Antioxidant vitamins and magnesium and the risk of hearing loss in the US general population. 2014

Choi, Yoon-Hyeong / Miller, Josef M / Tucker, Katherine L / Hu, Howard / Park, Sung Kyun. ·Department of Preventive Medicine and Institute of Environmental Medicine, Seoul National University College of Medicine, Seoul, Korea (Y-HC) · the Department of Otolaryngology, School of Medicine and Kresge Hearing Research Institute, University of Michigan, Ann Arbor, MI (JMM) · the Department of Health Sciences, Bouve College of Health Sciences, Northeastern University, Boston, MA (KLT) · the Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (HH) · and the Departments of Epidemiology and Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI (SKP). ·Am J Clin Nutr · Pubmed #24196403.

ABSTRACT: BACKGROUND: The protective effects of antioxidant vitamins on hearing loss are well established in animal studies but in few human studies. Recent animal studies suggest that magnesium intake along with antioxidants may act in synergy to prevent hearing loss. OBJECTIVE: We examined associations between intake of antioxidant vitamins (daily β-carotene and vitamins C and E) and magnesium and hearing thresholds and explored their joint effects in US adults. DESIGN: We analyzed cross-sectional data from 2592 participants aged 20-69 y from NHANES 2001-2004. Hearing thresholds as pure tone averages (PTAs) at speech (0.5, 1, 2, and 4 kHz) and high frequencies (3, 4, and 6 kHz) were computed. RESULTS: When examined individually, modeled as quartiles, and after adjustment for potential confounders, higher intakes of β-carotene, vitamin C, and magnesium were associated with lower (better) PTAs at both speech and high frequencies. High intakes of β-carotene or vitamin C combined with high magnesium compared with low intakes of both nutrients were significantly associated with lower (better) PTAs at high frequencies (-14.82%; 95% CI: -20.50% to -8.74% for β-carotene + magnesium and -10.72%; 95% CI: -16.57% to -4.45% for vitamin C + magnesium). The estimated joint effects were borderline significantly larger than the sums of the individual effects [high β-carotene/low magnesium (-4.98%) and low β-carotene/high magnesium (-0.80%), P-interaction = 0.08; high vitamin C/low magnesium (-1.33%) and low vitamin C/high magnesium (2.13%), P-interaction = 0.09]. CONCLUSION: Dietary intakes of antioxidants and magnesium are associated with lower risks of hearing loss.

197 Article The management of acute mastoiditis in children with cochlear implants: saving the device. 2013

Osborn, Heather A / Cushing, Sharon L / Gordon, Karen A / James, Adrian L / Papsin, Blake C. ·University of Toronto, Toronto, Canada. ·Cochlear Implants Int · Pubmed #23998418.

ABSTRACT: OBJECTIVE: Early treatment of profound bilateral sensorineural hearing loss with cochlear implantation has become routine, resulting in an increased proportion of children implanted at younger ages. These children are at a relatively high risk for acute otitis media (AOM), and are more likely to develop mastoiditis in the implanted ear. Despite the significant risks associated with mastoiditis, including compromise of the implant, there are no specific guidelines on the management of this population. We propose a treatment algorithm emphasizing early but conservative operative intervention. METHODS: A retrospective chart review included eight patients, who experienced mastoiditis, in the context of cochlear implantation at our center from August 2005 to November 2012. During this period 806 implant surgeries were completed. RESULTS: The median age at which mastoiditis occurred was 37 months, and the mean time from implantation to mastoiditis was 9.56 months. All patients underwent drainage of the middle ear in conjunction with intravenous antibiotics, and two additionally underwent post-auricular incision and drainage. DISCUSSION: Recent mastoidectomy may be a risk factor for the development of a post-auricular abscess in children, who develop AOM following cochlear implantation. A treatment algorithm was developed, which emphasizes early operative drainage in conjunction with aggressive antibiotic therapy. Conclusions A consistent approach to the management of mastoiditis in children with cochlear implants has not been established. Rapid initiation of aggressive antibiotic therapy and a low threshold for conservative operative intervention results in effective resolution of infection while allowing preservation of the implant.

198 Article Central auditory development after long-term cochlear implant use. 2013

Jiwani, Salima / Papsin, Blake C / Gordon, Karen A. ·Archie's Cochlear Implant Laboratory, Department of Otolaryngology, The Hospital for Sick Children, Toronto, Ontario, Canada. s.jiwani@mail.utoronto.ca ·Clin Neurophysiol · Pubmed #23680008.

ABSTRACT: OBJECTIVE: We aimed to determine whether long-term cortical auditory development is altered or delayed in children using cochlear implants relative to their normal hearing peers. We hypothesized that cortical development in children using unilateral cochlear implants follows a normal trajectory with long-term auditory input when the duration of bilateral auditory deprivation in childhood is limited. METHODS: Electrically-evoked cortical responses were recorded in 79 children who received one cochlear implant within 2.03 ± 1.36 years of bilateral deafness and had up to ∼16 years of time-in-sound experience, and in 58 peers with normal hearing. Amplitude differences between the responses from children using cochlear implants and with normal hearing were calculated between 0 and 300 ms. RESULTS: Responses from cochlear implant users remain different from those of their normal hearing peers. These differences decreased over time, but were not eliminated even after 10 years of time-in-sound. Specifically, the P(1)-N(1)-P(2)-N(2) complex, typical of a normally mature response, began to emerge by 10 years of time-in-sound experience, but the amplitudes of peaks P(2) and N(2) became abnormally large. CONCLUSION: Mature-like cortical responses emerge in children after long-term unilateral cochlear implant use, however, differences from normal persist. SIGNIFICANCE: Maturation of cortical responses with long-term cochlear implant use potentially underlies functional improvements in hearing. Persistent differences from normal could reflect an increase in attention or multi-sensory processing during listening.

199 Article Bilateral input protects the cortex from unilaterally-driven reorganization in children who are deaf. 2013

Gordon, Karen A / Wong, Daniel D E / Papsin, Blake C. ·Archie's Cochlear Implant Laboratory The Hospital for Sick Children Room 6D08, 555 University Avenue, Toronto, Ontario, Canada. karen.gordon@utoronto.ca ·Brain · Pubmed #23576127.

ABSTRACT: Unilateral hearing in childhood restricts input along the bilateral auditory pathways, possibly causing permanent reorganization. In this study we asked: (i) do the auditory pathways develop abnormally in children who are bilaterally deaf and hear with a unilateral cochlear implant? and (ii) can such differences be reversed by restoring input to the deprived ear? We measured multichannel electroencephalography in 34 children using cochlear implants and seven normal hearing peers. Dipole moments of activity became abnormally high in the auditory cortex contralateral to the first implant as unilateral cochlear implant use exceeded 1.5 years. This resulted in increased lateralization of activity to the auditory cortex contralateral to the stimulated ear and a decline in normal contralateral activity in response to stimulation from the newly implanted ear, corresponding to poorer speech perception. These results reflect an abnormal strengthening of pathways from the stimulated ear in consequence to the loss of contralateral activity including inhibitory processes normally involved in bilateral hearing. Although this reorganization occurred within a fairly short period (∼1.5 years of unilateral hearing), it was not reversed by long-term (3-4 years) bilateral cochlear implant stimulation. In bilateral listeners, effects of side of stimulation were assessed; children with long periods of unilateral cochlear implant use prior to bilateral implantation showed a reduction in normal dominance of contralateral input in the auditory cortex ipsilateral to the stimulated ear, further confirming an abnormal strengthening of pathways from the stimulated ear. By contrast, cortical activity in children using bilateral cochlear implants after limited or no unilateral cochlear implant exposure normally lateralized to the hemisphere contralateral to side of stimulation and retained normal contralateral dominance of auditory input in both hemispheres. Results demonstrate that the immature human auditory cortex reorganizes, potentially permanently, with unilateral stimulation and that bilateral auditory input provided with limited delay can protect the brain from such changes. These results indicate for the first time that there is a sensitive period for bilateral auditory input in human development with implications for functional hearing.

200 Article Validation of the Focus on the Outcomes of Communication under Six outcome measure. 2013

Thomas-Stonell, Nancy / Oddson, Bruce / Robertson, Bernadette / Rosenbaum, Peter. ·Bloorview Research Institute, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada. nthomasstonell@hollandbloorview.ca ·Dev Med Child Neurol · Pubmed #23461266.

ABSTRACT: AIM: The aim of this study was to establish the construct validity of the Focus on the Outcomes of Communication Under Six (FOCUS(©) ),a tool designed to measure changes in communication skills in preschool children. METHOD: Participating families' children (n=97; 68 males, 29 females; mean age 2y 8mo; SD 1.04y, range 10mo-4y 11mo) were recruited through eight Canadian organizations. The children were on a waiting list for speech and language intervention. Parents completed the Ages and Stages Questionnaire - Social/Emotional (ASQ-SE) and the FOCUS three times: at assessment and at the start and end of treatment. A second sample (n=28; 16 males 12 females) was recruited from another organization to correlate the FOCUS scores with speech, intelligibility and language measures. Second sample participants ranged in age from 3 years 1 month to 4 years 9 months (mean 3y 11mo; SD 0.41y). At the start and end of treatment, children were videotaped to obtain speech and language samples. Parents and speech-language pathologists (SLPs) independently completed the FOCUS tool. SLPs who were blind to the pre/post order of the videotapes analysed the samples. RESULTS: The FOCUS measured significantly more change (p<0.01) during treatment than during the waiting list period. It demonstrated both convergent and discriminant validity against the ASQ-SE. The FOCUS change corresponded to change measured by a combination of clinical speech and language measures (κ=0.31, p<0.05). CONCLUSION: The FOCUS shows strong construct validity as a change-detecting instrument.

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