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

基本信息

批准号：
10645047
负责人：
VIJAYALAKSHMI EASWAR
金额：
$ 34.07万
依托单位：
AUSTRALIAN HEARING SERVICES
依托单位国家：
美国
项目类别：
财政年份：
2007
资助国家：
美国
起止时间：
2007-08-01 至 2024-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10645047
关键词：
16 year old 5 year old Acoustics Address Adoption Affect Age Area Audiology Australia Bilateral Hearing Loss Child Child Development Clinical Clinical Services Cochlear implant procedure Cohort Studies Communication Data Devices Diagnosis Early Diagnosis Early Intervention Early identification Education Effectiveness Enrollment Environment Equation Equipoise Family Gender Goals Growth Health Policy Healthcare Hearing Hearing Aids Intervention Investments Knowledge Laboratories Language Live Birth Long-Term Effects Measures Mediating Mental Health Modeling Newborn Infant Outcome Outcome Measure Policies Population Practice Management Prospective Studies Provider Quality of life Randomized Regression Analysis Research Resources Service provision Services Socioeconomic Status Speech Perception Testing Time Unilateral Hearing Loss United States National Institutes of Health arm auditory neuropathy base childhood hearing loss cognitive skill cohort cost effectiveness cost-effectiveness ratio disability economic evaluation economic value follow-up hearing impairment hearing screening improved improved outcome incremental cost-effectiveness language outcome population based population health prospective psychosocial psychosocial wellbeing service delivery skills societal costs

项目摘要

PROJECT SUMMARY/ ABSTRACT Permanent childhood hearing loss, which occurs in 1-2/1000 live-births, has negative impacts on children's lives incurring high societal costs. Universal newborn hearing screening (UNHS) enables early detection of hearing loss and intervention, with the goal of improving long-term outcomes at a population level. Despite widespread adoption of UNHS, serious evidence gaps remain. The effectiveness of early intervention for improving long-term outcomes is uncertain, the cost-effectiveness is unproven, and the impact of device fitting on outcomes of children with unilateral hearing loss is unknown. By capitalizing on a unique environment in Australia where children receive uniform hearing services from a single provider (Australian Hearing, AH), but had differential access to UNHS during a narrow time window, the research team commenced the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study in 2005. Through NIH support, a population-based cohort of 450 children with bilateral hearing loss (53% fitted with hearing aids before age 6 months) have been enrolled, and their outcomes have been measured prospectively over 10 years. The 5-year data revealed that the earlier children received hearing-aid fitting or cochlear implantation, the better the language outcomes. Benefits were greater for those with more severe hearing loss. Would these early benefits extend to later educational attainment, psychosocial well-being, and quality of life? Is early intervention cost- effectiveness in the long term? Further, does early intervention improve outcomes of children born with unilateral hearing loss? As a non-target condition detected via UNHS, there is clinical equipoise about management because evidence is lacking. Supported by NIH, the Children with Unilateral Hearing Loss (CUHL) study enrolled 179 children, ~50% of whom were randomly assigned to fitting of devices after diagnosis. This application draws on the assembled LOCHI and CUHL cohorts. The Aims are to: (1) determine the long-term effectiveness of early intervention by measuring outcomes of the LOCHI cohort at 16 years of age; (2) determine the cost-effectiveness by performing an economic evaluation using data on outcomes and healthcare resource use to be collected from the LOCHI cohort; and (3) determine how fitting and use of hearing device influence language outcomes of children with unilateral hearing loss by evaluating the CUHL cohort at 3 and 5 years of age. All data and a range of predictors will be evaluated in multiple regression analyses and structural equation modelling. As the research arm of AH, we will minimise loss to follow-up by maintaining contact via the AH service provision network. Accomplishing the aims will a) provide the much-needed evidence to guide clinical best-practice management of children across the entire spectrum of hearing loss, including unilateral hearing loss; and b) demonstrate the cost-effectiveness of UNHS and early intervention to guide policy decisions.

项目概要/摘要永久性儿童听力损失发生在 1-2/1000 的活产儿中，对儿童有负面影响儿童的生命造成高昂的社会成本。全民新生儿听力筛查 (UNHS) 能够尽早检测听力损失和干预，以改善人群的长期结果等级。尽管 UNHS 被广泛采用，但仍然存在严重的证据差距。早期的有效性改善长期结果的干预措施尚不确定，成本效益尚未得到证实，而且设备安装对单侧听力损失儿童的影响尚不清楚。利用澳大利亚独特的环境，儿童可以获得统一的听力服务来自单一提供商（澳大利亚听证会，AH），但在狭窄的范围内对 UNHS 的访问权限不同时间窗口，研究小组开始了听力儿童的纵向结果研究 2005 年的损伤 (LOCHI) 研究。通过 NIH 的支持，以人群为基础的 450 名儿童队列研究双侧听力损失（53% 在 6 个月前安装了助听器）已被登记，并且他们的情况对 10 年来的结果进行了前瞻性衡量。 5年数据显示，较早前接受助听器验配或人工耳蜗植入的儿童，语言效果越好。好处对于那些听力损失更严重的人来说更大。这些早期的好处会延续到以后吗？教育程度、心理健康和生活质量？早期干预的成本是长期有效吗？此外，早期干预是否可以改善患有先天性心脏病的儿童的结局？单侧听力损失？作为通过 UNHS 检测到的非目标病症，临床上对管理，因为缺乏证据。由 NIH 支持的单侧听力损失儿童 (CUHL) 研究招募了 179 名儿童，其中约 50% 被随机分配到安装设备诊断。该应用程序利用了组装的 LOCHI 和 CUHL 队列。目标是：(1) 通过测量 LOCHI 队列的结果来确定早期干预的长期有效性 16 岁； (2) 通过经济评价确定成本效益从 LOCHI 队列中收集有关结果和医疗保健资源使用的数据；和（3）确定助听器的安装和使用如何影响单侧听力障碍儿童的语言结果通过评估 3 岁和 5 岁的 CUHL 队列来了解听力损失情况。所有数据和一系列预测变量将在多元回归分析和结构方程建模中进行评估。作为研究部门 AH，我们将通过AH服务提供网络保持联系，最大程度地减少后续损失。实现这些目标将 a) 提供急需的证据来指导临床最佳实践对各种听力损失的儿童进行管理，包括单侧听力损失；和 b) 展示 UNHS 的成本效益和早期干预以指导政策决策。