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Objectives: Carers of children with disabilities, especially primary carers, tend to have poorer labor market outcomes than carers of typically developing children. However, the extant literature has been largely silent on whether interventions for children's disabilities spill over to carers' employment outcomes, if at all. We aimed to fill this gap., Design: We analyzed data from the Longitudinal Outcomes of Children with Hearing Impairment study, which is a unique panel dataset of Australian children who are deaf or hard-of-hearing (DHH). The Longitudinal Outcomes of Children with Hearing Impairment dataset includes information about 449 DHH children. We used 3 waves covering the same children at ages 0 to 3, 5 to 7, and 8 to 10 years during 2005 and 2018. We used a panel random-effects model, the use of which was supported by the Hausman specification test to control for time-invariant individual heterogeneity., Results: We found that primary carers (typically mothers) of DHH children with cochlear implants (CI) were more likely to be employed relative to DHH children without a CI. The positive association was stronger among carers from a lower socioeconomic background., Conclusions: The association between childhood CI and carer employment may potentially be due to relaxed primary carers' time constraints to care for the child, increased self-efficacy, and reduced carer stress, enabling them to engage in other activities, including employment. Further research through large-scale, longitudinal studies is warranted to solidify the findings of this research., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Editor's Note: The following article discusses the timely topic Clinical Guidance in the areas of Evidence-Based Early Hearing Detection and Intervention Programs. This article aims to discuss areas of services needed, guidance to countries/organizations attempting to initiate early hearing detection and intervention systems. Expert consensus and systematic/scoping reviews were combined to produce recommendations for evidence-based clinical practice. In Ear and Hearing, our long-term goal for the Point of View article is to stimulate the field's interest in and to enhance the appreciation of the author's area of expertise. Hearing is an important sense for children to develop cognitive, speech, language, and psychosocial skills. The goal of universal newborn hearing screening is to enable the detection of hearing loss in infants so that timely health and educational/therapeutic intervention can be provided as early as possible to improve outcomes. While many countries have implemented universal newborn hearing screening programs, many others are yet to start. As hearing screening is only the first step to identify children with hearing loss, many follow-up services are needed to help them thrive. However, not all of these services are universally available, even in high-income countries. The purposes of this article are (1) to discuss the areas of services needed in an integrated care system to support children with hearing loss and their families; (2) to provide guidance to countries/organizations attempting to initiate early hearing detection and intervention systems with the goal of meeting measurable benchmarks to assure quality; and (3) to help established programs expand and improve their services to support children with hearing loss to develop their full potential. Multiple databases were interrogated including PubMed, Medline (OVIDSP), Cochrane library, Google Scholar, Web of Science and One Search, ERIC, PsychInfo. Expert consensus and systematic/scoping reviews were combined to produce recommendations for evidence-based clinical practice. Eight essential areas were identified to be central to the integrated care: (1) hearing screening, (2) audiologic diagnosis and management, (3) amplification, (4) medical evaluation and management, (5) early intervention services, (6) family-to-family support, (7) D/deaf/hard of hearing leadership, and (8) data management. Checklists are provided to support the assessment of a country/organization's readiness and development in each area as well as to suggest alternative strategies for situations with limited resources. A three-tiered system (i.e., Basic, Intermediate, and Advanced) is proposed to help countries/organizations at all resource levels assess their readiness to provide the needed services and to improve their integrated care system. Future directions and policy implications are also discussed., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 The Authors. Ear & Hearing is published on behalf of the American Auditory Society, by Wolters Kluwer Health, Inc.)

Objectives: The purpose of this study was to (1) develop a Language-independent Test of Auditory Discrimination (LIT-AD) between speech sounds so that people with hearing loss who derive limited speech perception benefits from hearing aids (HAs) may be identified for consideration of cochlear implantation and (2) examine the relationship between the scores for the new discrimination test and those of a standard sentence test for adults wearing either HAs or cochlear implants (CIs)., Design: The test measures the ability of the listener to correctly discriminate pairs of nonsense syllables, presented as sequential triplets in an odd-one-out format, implemented as a game-based software tool for self-administration using a tablet computer. Stage 1 included first a review of phonemic inventories in the 40 most common languages in the world to select the consonants and vowels. Second, discrimination testing of 50 users of CIs at several signal to noise ratios (SNRs) was carried out to generate psychometric functions. These were used to calculate the corrections in SNR for each consonant-pair and vowel combination required to equalize difficulty across items. Third, all items were individually equalized in difficulty and the overall difficulty set. Stage 2 involved the validation of the LIT-AD in English-speaking listeners by comparing discrimination scores with performance in a standard sentence test. Forty-one users of HAs and 40 users of CIs were assessed. Correlation analyses were conducted to examine test-retest reliability and the relationship between performance in the two tests. Multiple regression analyses were used to examine the relationship between demographic characteristics and performance in the LIT-AD. The scores of the CI users were used to estimate the probability of superior performance with CIs for a non-CI user having a given LIT-AD score and duration of hearing loss., Results: The LIT-AD comprises 81 pairs of vowel-consonant-vowel syllables that were equalized in difficulty to discriminate. The test can be self-administered on a tablet computer, and it takes about 10 min to complete. The software automatically scores the responses and gives an overall score and a list of confusable items as output. There was good test-retest reliability. On average, higher LIT-AD discrimination scores were associated with better sentence perception for users of HAs (r = -0.54, p <0.001) and users of CIs (r = -0.73, p <0.001). The probability of superior performance with CIs for a certain LIT-AD score was estimated, after allowing for the effect of duration of hearing loss., Conclusions: The LIT-AD could increase access to CIs by screening for those who obtain limited benefits from HAs to facilitate timely referrals for CI candidacy evaluation. The test results can be used to provide patients and professionals with practical information about the probability of potential benefits for speech perception from cochlear implantation. The test will need to be evaluated for speakers of languages other than English to facilitate adoption in different countries., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 The Authors. Ear & Hearing is published on behalf of the American Auditory Society, by Wolters Kluwer Health, Inc.)