Language Outcomes in Young Children with Mild to Severe Hearing Loss.
Language Outcomes in Young Children with Mild to Severe Hearing Loss.
复制标题
DOI：
10.1097/aud.0000000000000219
复制
发表时间：
2015-11
期刊：
影响因子：
3.7
通讯作者：
Moeller MP
中科院分区：
文献类型：
--
作者：
Tomblin JB;Harrison M;Ambrose SE;Walker EA;Oleson JJ;Moeller MP
这项研究考察了轻度到重度听力损失儿童在学龄前几年的语言结果。采用纵向设计来检验语言发育轨迹是否与听力损失程度相关，以及助听是否以系统的方式影响语言发育。研究还探讨了助听器的佩戴时机和使用程度对儿童语言发育的影响。最后，本研究验证了这一假设，即形态句法可能存在特别的风险，因为它对语言输入中的细微细节的处理提出了要求。本研究的全部儿童队列包括290名34岁听力障碍儿童(CHH)和112名听力正常儿童(CNH)，他们参加了2至6岁听力损失儿童结局35(OCHL)研究。CHH组的平均纯音听力为47.66dBHL(SD=13.35)。所有儿童每年都会接受一系列全面的语言测试，包括标准化测试、家长报告测试、自发的和诱发性的语言样本。主成分分析支持对每个年龄层次(2、3、4、5、6岁)使用单一的综合语言分数。收集未辅助者(较好的耳纯音平均、言语清晰度指数)和辅助者(剩余言语清晰度指数)听力，以及家长报告的日常助听器使用时间。使用混合建模程序检查语言能力随时间的变化率(227CHH；94CNH)与1)听力损失程度、2)辅助听力、3)助听器适配年龄和使用时间以及4)日常助听器使用之间的关系。主成分分析也被用来检验自发语言样本中的因素负荷，并检验它们与标准化测量的一致性。使用多元回归分析来检验听力损失对词形合成和词汇发展的不同影响。平均而言，与年龄和社会经济地位相匹配的听力正常的同龄人相比，轻度到重度听力损失的儿童表现出语言水平低下。CHH的落后程度随着听力损失的严重程度而增加。佩戴助听器的听力改善程度与语言发育速度的不同有关；在学龄前几年，听力较好的儿童语言发育速度较快。早期配戴助听器的儿童比配戴较晚的儿童有更好的早期语言成绩。然而，18个月后身体健康的儿童的语言能力随着助听器使用量的增加而提高。这些结果表明，通过改善获得语言经验的途径，语言学习系统仍然对经验持开放态度。研究发现，CHH在形态合成领域的表现比其语义能力延迟更多。这项研究中获得的数据在很大程度上支持了预测，表明轻度到严重的听力损失会使儿童面临语言发育迟缓的风险。通过提供及早和持续的机会获得适配的助听器来降低风险，这些助听器可以提供最佳的听力。
This study examined the language outcomes of children with mild to severe hearing loss during the preschool years. The longitudinal design was leveraged to test whether language growth trajectories were associated with degree of hearing loss and whether aided hearing influenced language growth in a systematic manner. The study also explored the influence of the timing of hearing aid fitting and extent of use on children’s language growth. Finally, the study tested the hypothesis that morphosyntax may be at particular risk due to the demands it places on the processing of fine details in the linguistic input. The full cohort of children in this study was comprised of 290 children were hard of 34 hearing (CHH) and 112 children with normal hearing (CNH) who participated in the Outcomes 35 of Children with Hearing Loss (OCHL) study between the ages of 2 and 6 years. CHH had a mean better ear pure tone average of 47.66 dB HL (SD = 13.35). All children received a comprehensive battery of language measures at annual intervals, including standardized tests, parent report measures, and spontaneous and elicited language samples. Principal components analysis supported the use of a single composite language score for each of the age levels (2, 3, 4, 5, 6 years). Measures of unaided (better ear pure tone average, Speech Intelligibility Index) and aided (residualized Speech Intelligibility Index) hearing were collected, along with parent report measures of daily hearing aid use time. Mixed modeling procedures were applied to examine the rate of change (227 CHH; 94 CNH) in language ability over time in relation to 1) degree of hearing loss, 2) aided hearing, 3) age of hearing aid fit and duration of use, and 4) daily hearing aid use. Principal components analysis was also employed to examine factor loadings from spontaneous language samples and to test their correspondence with standardized measures. Multiple regression analysis was used to test for differential effects of hearing loss on morphosyntax and lexical development. Children with mild to severe hearing loss, on average, showed depressed language levels compared to peers with normal hearing who were matched on age and socioeconomic status. The degree to which CHH fell behind increased with greater severity of hearing loss. The amount of improved audibility with hearing aids was associated with differential rates of language growth; better audibility was associated with faster rates of language growth in the preschool years. Children fit early with hearing aids had better early language achievement than children fit later. However, children who were fit after 18 months of age improved in their language abilities as a function of the amount of hearing aid use. These results suggest that the language learning system remains open to experience provided by improved access to linguistic experience. Performance in the domain of morphosyntax was found to be more delayed in CHH than their semantic abilities. The data obtained in this study largely support the predictions, suggesting that mild to severe hearing loss places children at risk for delays in language development. Risks are moderated by the provision of early and consistent access to well-fit hearing aids that provide optimized audibility.