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Early diagnosis and intervention of deaf and hard-of-hearing (DHH) children leads to improved language and psychosocial outcomes. However, many child, parent and provider related factors can influence access to early intervention services, including hearing devices. This narrative review aims to explore factors that influence health service access in DHH children. A systematic search was conducted to identify articles that explored factors that influenced health service access in DHH children in countries with Universal Newborn Hearing Screening, published between 2010 and 2022. Fifty-nine articles met the inclusion criteria for data extraction. This included 4 systematic reviews, 2 reviews, 39 quantitative and 5 mixed methods studies and 9 qualitative studies. The identified factors were grouped into the following themes: (a) demographic factors, (b) family related factors, (c) child related factors, (d) factors specific to hearing devices, (e) service delivery, f) telehealth and (g) COVID-19. This review provided a comprehensive summary of multiple factors that affect access to health services in DHH children. Psychosocial support, consistent clinical advice, allocation of resources to rural communities and use of telehealth are possible ways to address barriers and improve health service access. [ABSTRACT FROM AUTHOR]

This study investigated differences in functional hearing quality between youth with cochlear implants (CIs) and normal hearing (NH) peers, as well as associations between functional hearing quality and audiological measures, speech perception, language and executive functioning (EF). Youth with CIs and NH peers completed measures of audiological functioning, speech perception, language and EF. Parents completed the Quality of Hearing Scale (QHS), a questionnaire measure of functional hearing quality. Participants were 43 prelingually-deaf, early-implanted, long-term CI users and 43 NH peers aged 7–17 years. Compared to NH peers, youth with CIs showed poorer functional hearing quality on the QHS Speech, Localization, and Sounds subscales and more hearing effort on the QHS Effort subscale. QHS scores did not correlate significantly with audiological/hearing history measures but were significantly correlated with most speech perception, language and EF scores in the CI sample. In the NH sample, QHS scores were uncorrelated with speech perception and language and were inconsistently correlated with EF. The QHS is a valid measure of functional hearing quality that is distinct from office-based audiometric or hearing history measures. Functional hearing outcomes are associated with speech-language and EF outcomes in CI users. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this literature review was to explore parent challenges in caring for children who are deaf or hard of hearing with other disabilities and discuss implications for audiologists related to supporting families. Design: A comprehensive literature review was conducted, and through qualitative analysis, emergent themes were identified, and a narrative summary generated. Study sample: Nine research studies were included in this review. Combined, these studies reflect a sample of 111 children, 23 families and 41 parents. Results: Three broad themes were identified, and include parent-reported challenges related to family, professional and child variables. Sub-themes were identified within each broad theme to further describe parent experiences, such as challenges related to decision-making and planning, interprofessional collaboration, and child communication and behaviours. Conclusions: Parents of children with hearing loss and additional disabilities face unique challenges related to family, professional and child variables that could impact how they manage their child's hearing care. [ABSTRACT FROM AUTHOR]

Objective: Deaf children with cochlear implants (CIs) show poorer verbal working memory compared to normal-hearing (NH) peers, but little is known about their verbal learning and memory (VLM) processes involving multi-trial free recall. Design: Children with CIs were compared to NH peers using the California Verbal Learning Test for Children (CVLT-C). Study sample: Participants were 21 deaf (before age 6 months) children (6-16 years old) implanted prior to age 3 years, and 21 age-IQ matched NH peers. Results: Results revealed no differences between groups in number of words recalled. However, CI users showed a pattern of increasing use of serial clustering strategies across learning trials, whereas NH peers decreased their use of serial clustering strategies. In the CI sample (but not in the NH sample), verbal working memory test scores were related to resistance to the build-up of proactive interference, and sentence recognition was associated with performance on the first exposure to the word list and to the use of recency recall strategies. Conclusions: Children with CIs showed robust evidence of VLM comparable to NH peers. However, their VLM processing (especially recency and proactive interference) was related to speech perception outcomes and verbal WM in different ways from NH peers. [ABSTRACT FROM AUTHOR]

Objective: This study evaluated the cost and outcome of a community-based hearing screening programme in which village health workers (VHWs) screened children in their homes using a two-step DPOAE screening protocol. Children referred in a second screening underwent tele diagnostic ABR testing in a mobile tele-van using satellite connectivity or at local centre using broadband internet at the rural location. Design: Economic analysis was carried out to estimate cost incurred and outcome achieved for hearing screening, follow-up diagnostic assessment and identification of hearing loss. Two-way sensitivity analysis determined the most beneficial cost-outcome. Study sample: 1335 children under 5 years of age underwent screening by VHWs. Results: Nineteen of the 22 children referred completed the tele diagnostic evaluation. Five children were identified with hearing loss. The cost-outcomes were better when using broadband internet for tele-diagnostics. The use of least expensive human resources and equipment yielded the lowest cost per child screened (Rs.1526; $23; €21). When follow-up expenses were thus maximised, the cost per child was reduced considerably for diagnostic hearing assessment (Rs.102,065; $1532; €1368) and for the cost per child identified (Rs.388,237; $5826; €5204). Conclusion: Settings with constrained resources can benefit from a community-based programme integrated with tele diagnostics. [ABSTRACT FROM AUTHOR]

Objective: The purpose of the present study was to investigate Mandarin tone recognition in background noise in children with cochlear implants (CIs), and to examine the potential factors contributing to their performance. Design: Tone recognition was tested using a twoalternative forced-choice paradigm in various signal-to-noise ratio (SNR) conditions (i.e. quiet, +12, +6, 0, and -6 dB). Linear correlation analysis was performed to examine possible relationships between the tone-recognition performance of the CI children and the demographic factors. Study sample: Sixty-six prelingually deafened children with CIs and 52 normal-hearing (NH) children as controls participated in the study. Results: Children with CIs showed an overall poorer tone-recognition performance and were more susceptible to noise than their NH peers. Tone confusions between Mandarin tone 2 and tone 3 were most prominent in both CI and NH children except for in the poorest SNR conditions. Age at implantation was significantly correlated with tone-recognition performance of the CI children in noise. Conclusions: There is a marked deficit in tone recognition in prelingually deafened children with CIs, particularly in noise listening conditions. While factors that contribute to the large individual differences are still elusive, early implantation could be beneficial to tone development in pediatric CI users. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the association between maternal infection with Toxoplasma gondii (T. gondii) in pregnancy and subsequent risk of hearing loss in the offspring. The study included 27 727 children born in Norway 1992–1994. Maternal toxoplasma infection during pregnancy was ascertained by serological examination and fetal infection was ascertained by parasite detection in amniotic fluid and/or postnatal serological examination. Hearing loss was defined as mean hearing loss >35 dB HL in the better ear averaged over the pure-tone hearing thresholds at 500, 1000, and 2000 Hz, and the children were identified through linkage to the Norwegian Registry of Hearing Loss in Children. Twenty-two of the 27 727 children (0.08%) were diagnosed with hearing loss. Forty women had primary T. gondii infection in pregnancy. None of their offspring had hearing loss. There was also no association between T. gondii infection prior to pregnancy and hearing loss in the offspring. Hence, we did not find any association between T. gondii infection in pregnancy and hearing loss in the offspring. Sumario El propósito de este estudio fue investigar la asociación entre la infección materna con Toxoplasma gondii (T. Gondii) en el embarazo y el riesgo subsiguiente de pérdida auditiva en el bebé. El estudio incluyó 27.727 niños nacidos en Noruega entre 1992 y 1994. La infección materna por toxoplasma durante el embarazo fue evaluada por examen serológico y la infección fetal fue evaluada por detección del parásito en el líquido amniótico y/o por examen serológico post-natal. La pérdida auditiva fue definida como una hipoacusia media de > 35 dB en el mejor oído, promediado con base en los umbrales auditivos de tonos puros en 500, 1000 y 2000 Hz, y los niños fueron identificados a través de contacto con el Registro Noruego de Hipoacusia en Niños. Veintidós de los 27.727 niños (0.08%) se diagnosticaron con una pérdida auditiva. Cuarenta mujeres tuvi-eron infección primaria por T. Gondii durante el embarazo. Ninguno de sus hijos exhibieron una pérdida auditiva. No existió asociación entre la infección por T. Gondii antes del embarazo y la hipoacusia en el producto. Por tanto, no encontramos ninguna asociación entre la infección por T. Gondii en el embarazo y la aparición de una pérdida auditiva en el producto. [ABSTRACT FROM AUTHOR]

Hearing loss is referred to as the silent, overlooked epidemic in developing countries, and data reporting the mean age of diagnosis and intervention is virtually non-existent due to limited systematic or routine screening programs. The objective of this paper is to present findings of recent practice in early diagnosis and intervention services in an urban South African context, with specific reference to parental needs for support. Data was collected by means of questionnaire surveys for 54 parents of children with congenital or early-onset hearing loss, followed by focus group discussions conducted with 10 parents. The results of this study indicate the mean age of diagnosis to be 23 months (±18 SD), the mean age of initial hearing-aid fitting to be 28 months (±19 SD), and the mean age of enrollment into an early intervention program to be 31 months (±19 SD). In addition, results signify that this diverse and challenging population of parents of young hearing-impaired children largely depends on the ongoing support, guidance, and commitment of the pediatric audiologist. [ABSTRACT FROM AUTHOR]

Since little information is available on the outcome of early hearing intervention programs in South Africa, this article examines data on infants and families registered with a family-centred, home-based intervention program (HI HOPES) over a 12-month period in order to track the effectiveness of the holistic unbiased support to families of infants and toddlers with a hearing-loss. The aim of HI HOPES, which is based on the SKI-HI model of early intervention in the USA, is to ensure that families are enabled to make informed choices for their unique infant. Data were gathered on 32 infants ages birth to three years and their families using both qualitative and quantitive measures which included analysis of demographic data, quarterly language assessments, and parent satisfaction surveys. The report on the pilot year of this early intervention program shows that, though the sample is small, there is significant improvement in infant receptive and expressive language for infants identified before seven months of age, as well as a high level of satisfaction from families who have received services. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the current status of newborn/infant hearing screening programs in public sector hospitals in South Africa by means of a descriptive survey. Data was gathered using a self-administered postal questionnaire, which included questions on screening resources and protocols, follow-up, diagnostic, and information management procedures as well as timing of intervention. The questionnaire was sent to 86 speech therapy and audiology departments within public sector hospitals throughout South Africa and 44 questionnaires were returned. The findings indicated that 27% (n=12) of respondents were conducting some form of hearing screening. The most frequently reported reasons for the absence of a screening program were a lack of appropriate equipment and a shortage of staff. Institutions with active screening programs face many challenges and programs are mostly unsystematic. Reported findings make a valuable contribution to the field of early hearing detection and intervention by providing a baseline for the development and structuring of early hearing detection and intervention services as a priority in the public healthcare sector of South Africa. [ABSTRACT FROM AUTHOR]

Congenitally deaf infants and children commonly suffer vestibular failure in both ears, and impairment of postural control, locomotion, and gait. The development of gross motor functions, such as head control, sitting, and walking is likely to be delayed, but fine motor function is usually preserved unless disorders of the central nervous system are present. These children can eventually catch up with their normal peers in terms of development and growth as a result of central vestibular compensation. The visual and somatosensory systems, pyramidal and extrapyramidal motor system (cerebellum, basal ganglia, cerebrum) and intellectual development, compensate for vestibular failure in infants and children with congenitally hypoactive or absent function of the semicircular canals and otolith organs. [ABSTRACT FROM AUTHOR]

In 1984 the Bone-Anchored Hearing Aid, or BAHA, system was introduced. Its transducer is coupled directly to the skull percutaneously to form a highly effective bone-conduction hearing device. Clinical studies on adults with conductive hearing loss have shown that the BAHA system outperforms conventional bone-conduction hearing aids. Therefore, the next step was to apply the BAHA system in children with congenital or acquired conductive hearing loss. Reviewed data showed that, on average, such children benefited significantly more from the BAHA than from reconstructive surgery. Thus, BAHA application appears to be the best option to achieve normal communication and speech and language development in children with bilateral conductive hearing loss. However, in children under the age of three to four years, a conventional solution must be applied, e.g. a bone conductor with a transcutaneous coupling, because they are too young to undergo BAHA implant surgery. In the case of unilateral congenital conductive hearing loss, there is no convincing evidence in the clinical literature for early intervention. In summary, the BAHA system can be considered a new, indispensable tool for children with bilateral conductive hearing loss. [ABSTRACT FROM AUTHOR]

Recent studies show that several audiovestibular pathologies in the paediatric population may be immune-mediated. This is even more probable if the pathology is associated with a coexisting systemic autoimmune disorder. At this time, however, the current literature is limited to a few case reports, and little is known with regard to prevalence, diagnosis, and management of immune-mediated inner-ear disorders in children. This review aims to shed some light on clinical presentation, diagnosis, and treatment of paediatric immune-mediated inner-ear disorders. Sudden and progressive sensorineural hearing loss is discussed, in addition to some of the systemic autoimmune disorders commonly associated with immune-mediated audiovestibular pathology such as Cogan's syndrome, systemic lupus erythematosus, Behcet's disease, Sjogren's syndrome, and juvenile idiopathic arthritis. [ABSTRACT FROM AUTHOR]

This review traces the structural maturation of the human auditory system, and compares the timeline of anatomical development with cotemporaneous physiological and behavioral events. During the embryonic period, there is formation of basic structure at all levels of the system, i.e. the inner ear, the brainstem pathway, and the cortex. The second trimester is a time of rapid growth and development, and by the end of this period, the cochlea has acquired a very adult-like configuration. During the perinatal period, the brainstem reaches a mature state, and brainstem activity is reflected in behavioral responses to sound, including phonetic discrimination, and in evoked brainstem and early middle latency responses. The perinatal period is also the time of peak development of brainstem input to the cortex through the marginal layer, and of the long latency cortical potentials, the N2 and mismatch negativity. In early childhood, from the sixth post-natal month to age five, there is progressive maturation of the thalamic projections to the cortex and of the longer latency Pa and P1 evoked potentials. Later childhood, from six to twelve years, is the time of maturation of the superficial cortical layers and their intracortical connections, accompanied by appearance of the N1 potential and improved linguistic discriminative abilities. Some consideration is given to the potential negative effects of deafness-induced sound deprivation during the perinatal period and childhood. [ABSTRACT FROM AUTHOR]

Newborn hearing screening is the procedure of choice for ensuring optimal outcomes for infants with hearing loss, whether in a developed or developing country. Unfortunately, apart from a small number of recent exceptions, newborn hearing screening has been a practice reserved for the developed world. Despite the prevailing challenges towards implementing hearing screening in developing countries, there are existing structures in these countries that need to be investigated as possible platforms from which programs can be actualized. Immunization clinics, constituting part of a primary healthcare approach characteristic of developing countries, offer one such a platform. A novel service delivery model, based on initial results from a pilot study, was developed for infant hearing screening at immunization clinics in South Africa as an integrated part of primary, secondary, and tertiary levels of healthcare. This type of model is a first step toward ensuring that infants with hearing loss in developing communities are afforded opportunities for optimal development and societal integration through accountable and contextually relevant early hearing detection and intervention services. [ABSTRACT FROM AUTHOR]

Previously, unilateral hearing impairment (UHI) has been considered of little consequence. However, a recent meta-analysis of children with UHI displayed educational and behavioural problems and possible delays of speech and language development. Further, patients with UHI consequently report hearing difficulties. Our study investigated hearing function, possible inner ear protection, and self-assessed hearing problems in 57 subjects aged between 3-80 years with single-sided congenital ear malformations and conductive UHI. Pure-tone thresholds and speech recognition (quiet, noise) were measured, and all patients completed a self-assessment questionnaire. Pure-tone thresholds corresponding to sensorineural function did not significantly differ between the normal (air conduction) and affected ear (bone conduction). However, speech recognition in both quiet and in noise was normal on the non-affected side but significantly worse on the malformed side. A moderate to high degree of self-assessed hearing problems were reported. In conclusion, hearing function in the affected ear was found to be subnormal in terms of supra threshold signal processing. Furthermore, a high degree of hearing difficulty was reported. Therefore, active treatment, surgery, or hearing amplification, might be considered. [ABSTRACT FROM AUTHOR]

In order to develop a sensitive audiometric protocol for identifying ototoxicity in children, a retrospective study of 16 children treated with cisplatin and/or carboplatin was performed. Audiometric testing was done by means of pure-tone threshold audiometry (PTA), high-frequency audiometry (HFA), and distortion product otoacoustic emissions (DPOAEs). Cisplatin caused a sensorineural high-frequency hearing loss in the study group compared to the controls (p < 0.01). Sixty-six percent of the cisplatin patients had a grade 2 or 3 ototoxicity. However, ototoxicity was not found in the patients treated with carboplatin. An excellent correlation was found between DPOAE levels and results obtained by audiometry (r = 0.82). Patients exposed to cisplatin are at significant risk for the development of drug-induced sensorineural hearing loss. Because of the several advantages of DPOAEs (noninvasive, objective, rapid, easy to use, sensitive) this method should be added in the audiological follow-up in infants and toddlers. [ABSTRACT FROM AUTHOR]

Children with hearing loss who happen to reside in Africa deserve the chance to develop according to their potential as much as their peers living in more affluent regions. This leaves a moral obligation to pursue ways of initiating, developing,and growing early hearing detection and intervention services in Africa. For these reasons, the first EHDI Africa international conference was held in Johannesburg, South Africa, in 2007 (13-14 August). The theme was 'Building bridges in Africa: Early childhood development for children with hearing loss'. This special issue contains several reports from the EHDI Africa conference. [ABSTRACT FROM AUTHOR]

Abstract The relative effectiveness of the NAL-NL1 and the DSL4.1 prescriptions for 48 children with mild to moderately severe hearing loss was studied using a double-blind, four-period, two-treatment cross-over design in Australia and in Canada. Evaluations included speech perception tests, loudness ratings, reports from parents and teachers on functional performance in real life, children's self-reports, paired-comparison judgements of intelligibility, and children's preferences in real-world environments. Electroacoustic measures of hearing aids revealed that gain differences dominated the comparison. Across trials and measures, individual Australian children consistently preferred either the NAL-NL1 or the DSL v.4.1 prescription. An overall figure of merit (FOM), calculated by averaging the standardized difference scores between prescriptions for all measures, revealed that the strongest prescription-related differences were found in Australia. On average, an advantage and preference for the NAL-NL1 prescription was associated with lesser degrees of hearing loss. This research provides evidence on the effectiveness of the NAL-NL1 and DSL v.4.1 prescriptions, and highlights the need for evaluating and fine-tuning amplification to meet the diverse needs of individual children in real life. Sumario Se estudió la relativa efectividad de las prescripciones NAL-NL1 y DSL 4.1 en 48 niños con pérdidas auditivas de leves a moderadamente severas, usando un estudio doble ciego, en cuatro períodos y con un diseño cruzado de dos tratamientos en Australia y en Canadá. Las evaluaciones incluyeron pruebas de percepción de la palabra, tasas de reclutamiento, auto-reportes de los niños, juicios de inteligibilidad comparados por pares y preferencias de los niños en ambientes de mundo real. Las mediciones electroacústicas de los auxiliares auditivos revelaron que las diferencias en ganancia dominaron la comparación. En todas las pruebas y mediciones, los niños Australianos individualmente prefirieron de manera consistente tanto la prescripción NAL-NL1 como la DSL v.4.1. Una figura global de mérito (FOM), calculada al promediar las puntuaciones de diferencias estandarizadas entre prescripciones de todas las medidas, revelaron que las diferencias más fuertemente relacionadas con la prescripción, se encontraron en Australia. En promedio, la ventaja y preferencias hacia la prescripción NAL-NL1 se asoció con grados menores de pérdida auditiva. Esta investigación proporciona evidencia de la efectividad de las prescripciones NAL-NL1 y DSL v.4.1 y pone de relieve la necesidad de evaluar y de afinar la amplificación para alcanzar las diversas necesi-dades individuales de los niños en la vida real. [ABSTRACT FROM AUTHOR]

Abstract This document describes the national protocol for the selection, fitting, verification, and evaluation of amplification for hearing-impaired children in Australia. It also outlines the approach to management of children who have auditory neuropathy spectrum disorder, children who have mild and unilateral hearing loss, and children who require cochlear implantation. Audiological management of all Australian citizens and permanent residents under twenty-one years of age who have a hearing loss is carried out by the national hearing service provider, Australian Hearing. It is funded by the Australian Government's Hearing Services Program to provide fully subsidised hearing aids, frequency modulated (FM) systems and ongoing audiological management. All hearing aids for children are multi-channel devices that offer wide dynamic range compression, directional microphone technology and feedback cancellation as well as access to multiple listening programs, telecoil and audio-input facilities. Hearing aid gain, frequency response and maximum power output are derived according to the NAL-NL1 prescription procedure and verified using real ear measurements. Amplification benefit is evaluated using a range of speech perception tests and functional assessment questionnaires. Sumario Este documento describe el protocolo nacional para la selección, la adaptación, la verificación y la evaluación de la amplificación en niños hipoacúsicos en Australia. También esboza el acercamiento para el tratamiento de niños con el espectro de desórdenes de neuropatía auditiva, niños con hipoacusia moderada y unilateral y niños que requieren implante coclear. El tratamiento audiológico de todos los ciudadanos australianos y residentes permanentes menores de veintiún años de edad con hipoacusia se lleva a cabo por el proveedor nacional de servicios auditivos: Australian Hearing. Es financiado por el Programa del Gobierno Australiano de Servicios Auditivos para otorgar auxiliares auditivos, sistemas de frecuencia modulada (FM) y tratamiento audiológico subsidiados. Todos los auxiliares auditivos para niños son de tipo multicanal que ofrecen un amplio rango de compresión, tecnología de micrófono direccional y de cancelación de la retroalimentación, así como acceso a múltiples programas, telecoil y múltiples propiedades de ingreso de la señal. La ganancia del auxiliar auditivo, la frecuencia de respuesta y la máxima salida derivan de acuerdo a los procedimientos de las prescripciones NAL-NL1 y se verifican utilizando las mediciones de oído real. El beneficio de la amplificación se evalúa utilizando un rango de pruebas de habla y cuestionarios prescripción de la prueba de rango de habla y cuestionarios de desempeño funcional. [ABSTRACT FROM AUTHOR]

Abstract This paper reports speech and loudness measures on a group of children in a double-blind cross-over trial comparing the NAL-NL1 and DSL[i/o] prescriptions. Twenty-four children with hearing impairment were fitted with digital WDRC hearing aids at each site (Australia, Canada). Speech recognition was measured for nonsense syllables and for the 50% correct threshold for sentence recognition in noise. Loudness ratings for sentences were made on a 7-point scale. Measures were made at fitting and repeated following 8-week trials. Fitting orders were randomized and counterbalanced. Significant differences in consonant recognition occurred for individual children. On average, scores at the 80 dB SPL presentation level were better with the NAL-NL1 fitting. Loudness ratings differed at baseline but did not differ following home trials. Speech recognition scores revealed a small but significant interaction of prescription with level in quiet but not in noise. Individual children had significant performance differences. Loudness ratings showed significant acclimatization effects for children at both sites. Sumario Este trabajo reporta las mediciones de lenguaje y de intensidad subjetiva en un grupo de niños sometidos a un estudio cruzado doble ciego, que comparó las prescripciones NAL-NL1 y DSL. A 24 niños con problemas auditivos se les adaptaron auxiliares auditivos digitales con WDRC en cada sede (Australia, Canadá). El reconocimiento del lenguaje se midió con sílabas sin sentido y con el umbral correcto del 50% de reconoci-miento de oraciones en ruido. Los índices de intensidad subjetiva con oraciones se obtuvieron con base en una escala de 7 grados. Las mediciones se tomaron al hacer la adaptación y de manera repetida con pruebas cada 8 semanas. Las instrucciones de adaptación se manejaron con bases aleatorias y de contrapeso. Se encontraron diferencias significativas en el reconocimiento de consonantes en algunos niños. En promedio, las puntuaciones en el nivel de presentación de 80 dB SPL fueron mejores con la adaptación NAL-NL1. Los índices de intensidad subjetiva difirieron en el basal, pero no en las siguientes pruebas en el hogar. Las puntuaciones de reconocimiento del lenguaje revelaron una pequeña pero significativa interacción de la prescripción con el nivel sin ruido pero no con ruido. Los niños en lo individual tuvieron diferencias de rendimiento significativas. Los índices de intensidad subjetiva mostraron efectos de aclimatación en los niños, en las dos sedes. [ABSTRACT FROM AUTHOR]

Abstract This paper examined how hearing aids adjusted for comparing NAL-NL1 with DSLv.4.1 prescription formulas matched prescriptive targets. The real-ear-to-coupler differences (RECD) of 48 children (24 in Australia and 24 in Canada) were measured and used to derive coupler gain targets. Verification of gain and output were carried out in an HA2-2cc coupler. Electroacoustic measurements revealed a minimal difference between NAL-NL1 and DSLv.4.1 frequency-response slopes due to practical limitations of the devices, even though the prescribed differences were large (up to 13 dB/octave). The difference in overall gain was generally achieved in the hearing aids, with DSLv.4.1 prescribing higher overall gain than NAL-NL1. The mean RECD at 4 kHz was 5 dB higher for children in Australia than in Canada. As the same RECDs were used in deriving targets for both prescriptions, this is unlikely to affect the results of the comparison. The impact of a gain difference between prescriptions on children's performance and preferences in real life is reported in separate papers. Sumario Este trabajo examinó cómo los auxiliares auditivos ajustados para comparar las recetas NAL-NL1 y DSLv.4.1 se ajustaron a las metas de prescripción. Se midieron las diferencias de oído-real a acoplador (RECD) de 48 niños (24 de Australia y 24 de Canadá), y se utilizaron para derivar las metas de ganancia por acoplador. La verificación de la ganancia y la salida se realizó en un acoplador HA2-2cc. Las mediciones electroacústicas revelaron una diferencia mínima entre las curvas de respuesta frecuencial de la NAL-NL1 y la SDLv.4.1, debido a limitaciones prácticas de los dispositivos, aunque las diferencias de prescripción eran grandes (hasta de 13 dB/octava). La diferencia en ganancia global fue generalmente lograda en los auxiliares auditivos, con el DSLv-4.1 indicando una ganancia global más alta que la del NAL-NL1. La RECD a 4 kHz fue 5 dB más alta para los niños de Australia que para los de Canadá. Dado que se usaron los mismas RECD para derivar las metas en ambas recetas, es improbable que éstas afecten los resultados de la comparación. El impacto de la diferencia de ganancia entre las recetas, para el desempeño de los niños y sus preferencias en la vida real se reporta en trabajos separados. [ABSTRACT FROM AUTHOR]

Abstract This paper reports real world preferences of children in a double-blind, cross-over trial comparing NAL-NL1 and DSL v.4.1 prescriptions. Twenty-four children wore digital WDRC hearing aids at each site (Australia, Canada). Multi-memory hearing aids provided the NAL and DSL programs in each of two memories. Diaries were completed during two counterbalanced trials, providing overall preference, situational preference, and preference comments. Ratings were reliable, and situational preferences factored into quiet/low level situations versus noisy/reverberant/high level situations. Children at both sites used DSL v4.1 for hearing low level speech, or when they wanted to hear loudly and clearly. Children used NAL-NL1 when they wished to hear sounds at a lower level, or to reduce background noise. Children expressed strong preferences for having the choice of both programs. Canadian children were more likely to prefer DSL than were the Australian children. Factors such as listening environment and prior listening experience are discussed in interpreting these findings. Sumario Este trabajo reporta las preferencias de los niños en el mundo real, en un estudio cruzado, doble-ciego que compara las prescripciones NAL-NL1 y DSL v4.1. Veinticuatro niños de dos sitios (Australia, Canada) utilizaron auxiliares auditivos digitales con WDRC. Los auxiliares auditivos con multi-memoria contaban con los programas NAL y DSL en dos de sus memorias. Se completaron diarios durante dos ensayos balanceados que proporcionaban información sobre la prefer-encia general, la preferencia situacional y comentarios sobre la preferencia. Las puntuaciones fueron confiables y la preferencia situacional se clasificaron en situación silente/nivel bajo versus situación ruidosa/reverberante/nivel alto. Los niños de ambos lugares utilizaron DSL v4.1 para escuchar el habla a intensidad baja o cuando querían escuchar alto y claro. Los niños expresaron una fuerte preferencia por poder tener la opción de ambos programas. Los niños canadienses tendieron a preferir DSL más que los niños australianos. Factores como el ambiente sonoro y las experiencias auditivas previas se discuten y se interpretan los hallazgos. [ABSTRACT FROM AUTHOR]

The author reflects on the impact of unilateral hearing loss identified at birth on communication ability. The author argues that audiologists around the world need to be concerned about and provide the necessary services to those found with unilateral hearing loss. She also cites the emergence of unilateral hearing loss at birth as an urgent problem that must be addressed immediately based on data from universal newborn hearing screening initiatives in the U.S. and throughout the world.