Longitudinal outcomes of hearing-impaired children: early vs later intervention

听力障碍儿童的纵向结果：早期干预与后期干预

• 批准号: 8995573
• 负责人: TERESA Y CHING
• 金额: $ 29.33万
• 依托单位: AUSTRALIAN HEARING SERVICES
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-08-01 至 2019-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8995573
• 关键词: 5 year old; 9 year old; Acoustics; Activities of Daily Living; Address; Affect; Age; Age-Months; Australia; Bilateral; Bilateral Hearing Loss; Child; Child Development; Child health care; Childhood; Clinical; Clinical Services; Cochlear implant procedure; Data; Development; Diagnosis; Diagnostic; Dimensions; Early Intervention; Early treatment; Effectiveness; Environment; Funding; Future; Growth; Health; Health Services Research; Healthcare; Hearing; Hearing Aids; Individual; Intervention; Investments; Knowledge; Laboratories; Language; Learning; Life; Link; Live Birth; Measurable; Measurement; Measures; Mental Health; Newborn Infant; Outcome; Outcome Measure; Performance; Phase; Population; Positioning Attribute; Provider; Quality of life; Randomized; Randomized Controlled Trials; Reading; Regression Analysis; Research; Resources; Schools; Services; Social Development; Software Tools; Source; Speech; Time; Translating; Treatment Efficacy; Unilateral Hearing Loss; United States National Institutes of Health; age effect; arm; base; cognitive ability; cohort; cost; evidence base; follow-up; hearing impairment; hearing screening; implantation; improved; improved outcome; learning strategy; literacy; population based; population health; programs; prospective; public health research; randomized trial; reading ability; service intervention; standard care; systematic review

DESCRIPTION (provided by applicant): Permanent childhood hearing loss, which occurs in 1-2/1000 live-births, has negative impacts on children's lives, at high societal cost. Universal newborn hearing screening (UNHS) offers hope for early treatment. However, UNHS is costly, and evidence of its effectiveness in improving long-term outcomes, at a population level, was lacking. By capitalizing on a unique service and research environment in Australia - where children access uniform hearing services from a single provider (Australian Hearing, AH) but had differential access to UNHS during a narrow time window - we addressed the evidence gap by conducting the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study. The funding from NIH enabled us to assemble a population-based cohort of 450 children with significant bilateral hearing loss (53% fitted with hearing aids before 6 months of age). We measured their outcomes from diagnosis to 5 years old. We found that early implantation was positively linked to better outcomes for profound loss, but early hearing aid fitting had limited gains for children with less severe loss. As the cohort ages, the effectiveness of UNHS may alter as benefits in additional domains may be measured. In showing the limited gains made by UNHS and early fitting alone, our findings galvanize new research into how to effectively intervene to capitalize on early treatment for improving outcomes. This application is for Phase 2 of the LOCHI study. The objectives are to investigate the efficacy of early intervention for improving long-term population outcomes, across the entire spectrum of hearing loss: children with mild or unilateral hearing loss (MUHL), which occurs in 1-2/1000 live-births, are also identified via UNHS but for whom audiological treatment is controversial. We propose to measure outcomes of the LOCHI cohort at age 9 years in an expanded range of domains; and to include a randomized controlled trial of intervention for a new cohort of children with MUHL. Our specific aims are: 1) describe the speech, language, literacy, mental health and quality of life of children who received early or later intervention; 2) identify modifiable factors that influence performance outcomes and standard score trajectories; 3) determine predictability of early outcomes for later development to identify the critical age at which children with poor outcomes at age 9 years can be reliably detected; and 4) investigate cognitive abilities and learning strategies of children. All outcomes data and a wide range of predictors will be evaluated in multiple regression analyses. The data and results will be incorporated in a software tool that we will develop to facilitate clinical use. As the research arm of AH, we will minimize loss to follow up by maintaining contact via the service provision network. Achieving the aims will provide the evidence base to 1) guide best-practice intervention following diagnosis across the spectrum of hearing loss; and 2) demonstrate outcomes affected by access to early intervention.

描述（由申请人提供）： 永久性儿童听力损失发生在 1-2/1000 的活产儿中，对儿童的生活产生负面影响，造成高昂的社会成本。全民新生儿听力筛查 (UNHS) 为早期治疗带来了希望。然而，UNHS 成本高昂，而且缺乏其在人口层面改善长期结果的有效性证据。通过利用澳大利亚独特的服务和研究环境 - 儿童从单一提供者（澳大利亚听证会，AH）获得统一的听力服务，但在很短的时间窗口内对 UNHS 的访问有差别 - 我们通过进行纵向结果来解决证据差距听力障碍儿童 (LOCHI) 研究。 NIH 的资助使我们能够收集 450 名双侧听力严重受损的儿童（53% 在 6 个月大之前安装了助听器）。我们测量了他们从诊断到 5 岁的结果。我们发现，早期植入与严重听力损失的更好结果呈正相关，但早期助听器验配对于听力损失较轻的儿童来说效果有限。随着队列年龄的增长，UNHS 的有效性可能会发生变化，因为可以衡量其他领域的益处。我们的研究结果显示了 UNHS 和早期拟合取得的成果有限，因此激发了新的研究，探讨如何有效地进行干预，利用早期治疗来改善结果。该申请适用于 LOCHI 研究的第二阶段。目标是调查早期干预对改善整个听力损失范围的长期人口结果的有效性：患有轻度或单侧听力损失 (MUHL) 的儿童，其发生率为 1-2/1000 活产儿，也通过 UNHS 确定，但对其听力学治疗存在争议。我们建议在更广泛的领域衡量 9 岁时 LOCHI 队列的结果；并纳入一项针对新的 MUHL 儿童队列的随机对照干预试验。我们的具体目标是：1）描述接受早期或后期干预的儿童的言语、语言、读写能力、心理健康和生活质量； 2）确定影响绩效结果和标准分数轨迹的可修改因素； 3) 确定早期结果对后期发育的可预测性，以确定可以可靠地检测到 9 岁时结果不佳的儿童的关键年龄； 4）调查儿童的认知能力和学习策略。所有结果数据和广泛的预测因素将在多元回归分析中进行评估。数据和结果将被纳入我们将开发的软件工具中，以促进临床使用。作为AH的研究机构，我们将通过服务提供网络保持联系，最大限度地减少后续损失。实现这些目标将为以下方面提供证据基础：1）在诊断各种听力损失后指导最佳实践干预； 2) 展示受早期干预影响的结果。