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: 10451520
• 负责人: VIJAYALAKSHMI EASWAR
• 金额: $ 34.29万
• 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 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10451520
• 关键词: 16 year old; 5 year old; Acoustics; Address; Adoption; Affect; Age; Area; Australia; Bilateral Hearing Loss; Child; Child Development; Clinical; Clinical Services; Cochlear implant procedure; Cohort Studies; Communication; Data; Devices; Diagnosis; Early Diagnosis; Early Intervention; 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

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.

项目摘要/摘要 永久性儿童听力损失发生在千分之一的活产儿中，对 儿童的生活招致了高昂的社会成本。全民新生儿听力筛查(UNHS)能够及早 听力损失的检测和干预，目的是改善人群的长期结果 水平。尽管普遍采用了UNHS，但仍存在严重的证据差距。早期治疗的有效性 改善长期结果的干预措施不确定，成本效益未经证实，以及 设备安装对单侧听力损失儿童预后的影响尚不清楚。 通过利用澳大利亚独特的环境，儿童接受统一的听力服务 来自单一提供者(澳大利亚听证会，AH)，但在狭窄的 时间窗，研究小组开始对听力障碍儿童的纵向结果 2005年的减损(LOCHI)研究。通过NIH的支持，以人口为基础的450名儿童队列 已登记双侧听力损失(53%在6个月前配戴助听器)，他们 结果已经在10年内进行了前瞻性的衡量。五年的数据显示，早些时候 儿童接受助听器试戴或人工耳蜗植入，语言效果越好。优势 对于听力损失更严重的人来说，这一比例更高。这些早期的好处会延续到以后吗？ 教育程度、心理社会幸福感和生活质量？早期干预的成本是- 从长远来看是否有效？此外，早期干预是否能改善先天感染儿童的结局？ 单侧听力损失？作为通过UNHS检测到的非靶标情况，临床上有关于 管理层，因为缺乏证据。由美国国立卫生研究院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%被随机分配到设备安装后 诊断。此应用程序利用集合的LOCHI和CUHL队列。目标是：(1) 通过评估LOCHI队列的结果来确定早期干预的长期有效性 在16岁时；(2)通过执行经济评估来确定成本效益 将从LOCHI队列收集有关结果和医疗资源使用的数据；以及(3) 确定配戴和使用听力装置如何影响单侧听力障碍儿童的语言结果 通过评估CUHL队列在3岁和5岁时的听力损失。所有数据和一系列预测值 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 对于AH，我们将通过AH服务提供网络保持联系，将后续工作的损失降至最低。 这些目标的实现将a)为指导临床最佳实践提供急需的证据 对包括单侧听力损失在内的所有听力损失儿童进行管理； B)展示卫生保健制度的成本效益和早期干预以指导政策决策。