“Using a cutoff score of greater than or equal to 32, CAS-15 exhibited very good sensitivity and specificity in our referred sample,” Dr. Goldstein said. “Therefore, it may be used for the evaluation of most children. We can save PSG for the evaluation of complicated patients, children with discrepancies between their histories and physical examination, and children who remain symptomatic after [tonsillectomy and adenoidectomy].”
Explore This IssueMay 2012
Children with Unilateral Hearing Loss
In her study, Dr. Lieu set out to determine whether speech-language and educational performance or behavioral problems improved or worsened over time in a group of school-age children with unilateral hearing loss. The aim was to drill down further beyond what is already known about the problems among children with UHL.
“The effects of unilateral hearing loss … in children has been documented since the early 80s, where people have found educational and behavioral problems in multiple studies,” Dr. Lieu said.
Studies have found that between 22 and 59 percent of kids with UHL have such problems, and that 24 to 35 percent fail a grade in school, compared with 3 percent of children without hearing loss (Arch Otolaryngol Head Neck Surg. 2004;130:524-530). Studies have also found that children with UHL have poorer oral speech skills and have a greater risk of needing an individualized education program (IEP) and speech therapy than children without hearing loss (Pediatrics. 2010;125:e1348-1355).
Dr. Lieu’s study followed children ages 6 to 8 at the time of recruitment for more than three years, with researchers looking at standardized test scores on cognition, language and achievement, as well as the Child Behavior Check List, hearing on audiograms and school records on IEPs and speech therapy.
There were improvements across almost all categories. There were statistically significant improvements in full IQ, verbal IQ, oral expression and oral composite scores. Even though the group as a whole showed improvements over the three years, more than 20 percent of the group still scored at the third percentile or lower in competency scales for activities, social skills and school performance. And 24 percent had an academic area of weakness or executive function problems as reported by teachers, while roughly 50 percent continued to participate in IEPs over three years.
The study found that starting IQ scores and participation in an IEP may play a role in the improvement. As an example, Dr. Lieu showed a graph of oral composite scores over time for those with baseline IQs of higher than 90 and for those with IQs of 90 or lower. Those with higher IQ scores showed an upward slope, while those with a lower IQ actually showed a drop-off in score. In another example, those with an IEP showed greater improvements in verbal IQ than those without one. In fact, the IEP group started off with lower scores but had essentially caught up to the other group.