Study design: Systematic literature review and meta-analysis.
Explore This IssueSeptember 2012
Setting: Department of Otorhinolaryngology, Hospital Sao Sebastiao, Santa Maria da Feira; Center for Research in Health Technologies and Information Systems, University of Porto; Department of Pulmonology, Department of Pediatrics and Department of Biostatistics and Medical Informatics, Faculty of Medicine, University of Porto, Portugal.
Synopsis: Ten studies (1,525 patients) comparing the clinical assessment with polysomnography were included. Summary estimates of diagnostic accuracy used the sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratio, and hierarchical summary receiver operating characteristic (HSROC) model. Substantial variation was found in the sensitivity and specificity among different symptoms and signs, as well as across studies. For example, tonsillar size and snoring reported by parents or caregivers had relatively high sensitivity but low specificity. In contrast, excessive daytime somnolence, observed apnea and difficulty breathing during sleep had relatively high specificity but low sensitivity.
Bottom line: Both single symptoms and combinations of symptoms and signs have poor diagnostic accuracy in predicting pediatric OSA.
Reference: Certal V, Catumbela E, Winck JC, Azevedo I, Teixeira-Pinto A, Costa-Pereira A. Clinical assessment of pediatric obstructive sleep apnea: a systemic review and meta-analysis. Laryngoscope. 2012;122(9):2105-2114.
—Reviewed by Sue Pondrom
Individualized Education Improves Language Skills in UHL
Do language skills and education performance improve or worsen over time in children?
Background: Unilateral hearing loss (UHL) affects an increasing number of children as they grow older, from one in 1,000 newborns to one in five adolescents. Given the overall dearth of knowledge about the longitudinal effects of UHL in children, this study sought to determine whether speech-language and educational performance increased or decreased over a three-year period in 46 children ages 6 to 12 years.
Study design: Prospective longitudinal cohort.
Setting: Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis; and St. Louis University School of Public Health, Mo.
Synopsis: The children were studied using standardized cognitive, achievement and language testing at yearly intervals for three years. Secondary outcomes included behavioral issues, individualized education plans (IEPs), receipt of speech therapy and teacher report of problems at school. Out of the 46 children, 39 percent had received speech therapy, 54 percent had an IEP, and 36 percent had additional educational assistance. About half had tried some form of amplification, but none wore a bone-anchored hearing aid.
Although there was no change in the achievement test mean scores, verbal and full IQ, oral expression scale and oral composite scale mean scores increased significantly. The authors said improvement in language scores and verbal IQ may be attributable to catch-up, regression to the mean or practice effects. Vocabulary T scores showed a trend toward increase, while rates of IEPs, speech therapy and behavioral issues did not decrease over time. The authors said increases in language scores did not appear sufficient to improve academic performance. Limitations to the study included lack of a control group of normal hearing children and the short period of time children were followed.