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Objective: Subjects implanted with a Direct Acoustic Cochlear Implant (DACI) show improvements in their bone conduction (BC) thresholds after surgery. We hypothesised that a new pathway for BC sound is created via the DACI. The aim of this study was to investigate the contribution of this pathway to the cochlear response via measurements of the promontory and round window membrane (RWM) velocities while stimulating with a conventional bone conductor. Design: This study was a cadaver head study with a repeated measures study design. Study Sample: Eight ears of five fresh-frozen cadaveric whole heads were investigated in this trial. Results: After DACI implantation the promontory and RWM velocities did not change significantly in the frequency range 0.5–2 kHz when the DACI was switched off. Conclusions: No significant changes in the relative vibration magnitude of the RWM after DACI implantation were observed. The improvements in BC thresholds seen in patients implanted with a DACI very likely have their origin in the changed impedance at the oval window after DACI surgery leading to a more efficient contribution from the inner ear components to BC sound. [ABSTRACT FROM AUTHOR]

Objective: The recent integration of automated real-ear measurements (REM) in the fitting software facilitates the hearing aid fitting process. Such a fitting strategy, TargetMatch (TM), was evaluated. Test-retest reliability and matching accuracy were quantified, and compared to a REM-based fitting with manual adjustment. Also, it was investigated whether TM leads to better perceptual outcomes compared to a FirstFit (FF) approach, using software predictions only. Design and study sample: Ten hearing impaired participants were enrolled in a counterbalanced single-blinded cross-over study comparing TM and FF. Aided audibility, speech intelligibility and real-life benefits were assessed. Repeated measurements of both TM and REMs with manual adjustment were performed. Results: Compared to a REM-based fitting with manual adjustment, TM had higher test-retest reliability. Also, TM outperformed the other fitting strategies in terms of matching accuracy. Compared to a FF, improved aided audibility and real-life benefits were found. Speech intelligibility did not improve. Conclusions: Preliminary data suggest that automated REMs increase the likelihood of meeting amplification targets compared with a FF. REMs integrated in the fitting software provide additional reliability and accuracy compared to traditional REMs. Findings need to be verified in a larger and more varied sample. [ABSTRACT FROM AUTHOR]

The article discusses three court cases which dealt with issues concerning the responsibility of international organizations as well as immunities. In the case Western European Union v. Siedler, the Belgian Court of Cassation rendered judgments regarding jurisdiction immunity of international groups in Belgium. All of the cases covered in this section examined disputes between international groups and individuals such as the General Secretariat of the African, Caribbean and Pacific Group.

The article describes the development of the French Intelligibility Sentence Test (FIST). The procedures include preparation of test materials, estimation of the performance-intensity function, equalization of sentence difficulty, formation of sentence lists and development of norms and reliability. Reference data have been obtained for normal-hearing listeners and the performance of Francophone listeners from France and Belgium was compared.

Importance: Pediatric single-sided deafness (SSD) can seriously affect development, causing impaired spatial hearing skills, speech-language delays, and academic underachievement. Early cochlear implantation likely improves hearing-related outcomes, but its association with language development remains unclear., Objective: To investigate whether early cochlear implantation is associated with language outcomes for children with prelingual SSD., Design, Setting, and Participants: The Cochlear Implant for Children and One Deaf Ear study was initiated in 2015 and recruited participants at 4 academic hospitals in Flanders, Belgium, through 2019. This cohort study included 3 groups of children aged 2 to 5 years: children with SSD and a cochlear implant, children with SSD without a cochlear implant, and a control group with normal hearing. Language and hearing skills were assessed 1 to 2 times per year until the age of 10 years. Study completion rates were high (82%). Data analysis was performed from October to December 2020., Exposure: Unilateral cochlear implant., Main Outcomes and Measures: Longitudinal vocabulary, grammar, and receptive language scores. The implanted group was hypothesized to outperform the nonimplanted group on all language tests., Results: During the recruitment period, 47 children with prelingual SSD without additional disabilities were identified at the participating hospitals. Fifteen of the 34 children with an intact auditory nerve received a cochlear implant (44%, convenience sample). Sixteen of the remaining children were enrolled in the SSD control group (50%). Data from 61 children (mean [SD] age at the time of enrollment, 2.08 [1.34] years; 26 girls [42%]) were included in the analysis: 15 children with SSD and a cochlear implant, 16 children with SSD without a cochlear implant, and 30 children with normal hearing. Children with SSD and a cochlear implant performed in line with their peers with normal hearing with regard to grammar. In contrast, children with SSD without a cochlear implant had worse grammar scores than the group with implants (-0.76; 95% CI, -0.31 to -1.21; P = .004) and the group with normal hearing (-0.53; 95% CI, -0.91 to -0.15; P = .02). The 3 groups had similar vocabulary and receptive language abilities., Conclusions and Relevance: These findings suggest that early cochlear implantation is associated with normal grammar development in young children with prelingual SSD. Although further follow-up will reveal the long-term outcomes of the cochlear implant for other skills, the current results will help clinicians and policy makers identify the best treatment option for these children.

The estimated incidence of sensorineural hearing impairment (>40 dB HL) at birth is 1.86 per 1000 newborns in developed countries and 30-40% of these are unilateral. Profound sensorineural unilateral hearing impairment or single sided deafness (SSD) can be treated with a cochlear implant. However, this treatment is costly and invasive and unnecessary in the eyes of many. Very young children with SSD often do not exhibit language and cognitive delays and it is hard to imagine that neurocognitive skills will present difficulties with one good ear. In the current paper we review the most recent evidence on the consequences of unilateral hearing impairment for auditory and neurocognitive factors. While data of both adults and children are discussed, we focus on developmental factors, congenital deafness and a window of opportunity for intervention. We discuss which etiologies qualify for a cochlear implant and present our multi-center prospective study on cochlear implants in infants with one deaf ear. The large, state-of-the art body of research allows for evidence-based decisions regarding management of unilateral hearing loss in children., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objectives: This study aims to investigate the large-scale applicability of the Digit Triplet test (DTT) for school-age hearing screening in fifth grade elementary (5E) (9 to 12 years old) and third grade secondary (3S) (13 to 16 years old) school children. The reliability of the test is investigated as well as whether pass/fail criteria need to be corrected for training and/or age, and whether these criteria have to be refined with respect to referral rates and pure-tone audiometry results., Design: Eleven school health service centers participated in the region of Flanders (the Northern part of Belgium). Pure-tone screening tests, which are commonly used for hearing screening in school children, were replaced by the DTT. Initial pass/fail criteria were determined. Children with speech reception thresholds (SRT) of -7.2 dB signal to noise ratio (SNR) (5E) and -8.3 dB SNR (3S) or worse were referred for an audiogram and follow-up. In total, n = 3412 (5E) and n = 3617 (3S) children participated., Results: Population SRTs (±2 SD) were -9.8 (±1.8) dB SNR (5E) and -10.5 (±1.6) dB SNR (3S), and do not need correction for training and/or age. Whereas grade-specific pass/fail criteria are more appropriate, a linear regression analysis showed an improvement of 0.2 dB per year of the SRT until late adolescence. SRTs could be estimated with a within-measurement reliability of 0.6 dB. Test duration was also grade-dependent, and was 6 min 50 sec (SD = 61 sec) (5E) and 5 min 45 sec (SD = 49 sec) (3S) on average for both ears. The SRT, test reliability, and test duration were comparable across centers. With initial cut-off values, 2.9% (5E) and 3.5% (3S) of children were referred. Based on audiograms of n = 39 (5E) and n = 59 (3S) children, the diagnostic accuracy of the DTT was assessed. A peripheral hearing loss was detected in 31% (5E) and 53% (3S) of the referred children. Hearing losses found were mild. Less strict pass/fail criteria increased the diagnostic accuracy. Optimal pass/fail criteria were determined at -6.5 dB SNR (5E) and -8.1 dB SNR (3S). With these criteria, referral rates dropped to 1.3% (5E) and 2.4% (3S)., Conclusions: The DTT has been implemented as the new hearing screening methodology in the Flemish school-age hearing screening program. Based on the results of this study, pass/fail criteria were determined and optimized to be used for systematic hearing screening of 5E and 3S school children. Furthermore, this study provides reference values for the DTT in children 9 to 16 years of age. Reliable SRTs can be obtained with the test, allowing accurate monitoring of hearing over time. This is important in the context of a screening guideline, which aims to identify children with noise-induced hearing loss. Validation of the screening result should go beyond taking an audiogram, as a peripheral hearing impairment cannot always be found in children with a failed test.

Objective: To compare results on the everyday sentence test 'FIST', the new closed-set sentence test 'FrMatrix', and the digit triplet screening test 'FrDigit3'., Design: First, the FrMatrix was developed and normative values were obtained. Subsequently, speech reception thresholds (SRTs) for the three types of tests were gathered at four study centers representing different geographic regions in Belgium and France., Study Sample: Fifty-seven normal-hearing listeners took part in the normative study of the FrMatrix, and 118 subjects, with a wide range of hearing thresholds, participated in the comparative study., Results: Homogenizing the individual words of the FrMatrix with regard to their intelligibility resulted in a reference SRT of -6.0 (±0.6) dB SNR and slope at the SRT of 14.0 %/dB. The within-subject variability was only 0.4 dB. Comparison of the three tests showed high correlations between the SRTs mutually (>0.81). The FrMatrix had the highest discriminative power, both in stationary and in fluctuating noise. For all three tests, differences across the participating study centers were small and not significant., Conclusions: The FIST, the FrMatrix, and the FrDigit3 provide similar results and reliably evaluate speech recognition performance in noise both in normal-hearing and hearing-impaired listeners.

Objective: To examine spoken language outcomes in children undergoing bilateral cochlear implantation compared with matched peers undergoing unilateral implantation., Design: Case-control, frequency-matched, retrospective cross-sectional multicenter study., Setting: Two Belgian and 3 Dutch cochlear implantation centers., Participants: Twenty-five children with 1 cochlear implant matched with 25 children with 2 cochlear implants selected from a retrospective sample of 288 children who underwent cochlear implantation before 5 years of age., Intervention: Cochlear implantation., Main Outcome Measures: Performance on measures of spoken language comprehension and expression (Reynell Developmental Language Scales and Schlichting Expressive Language Test)., Results: On the receptive language tests (mean difference [95% CI], 9.4 [0.3-18.6]) and expressive language tests (15.7 [5.9-25.4] and 9.7 [1.5-17.9]), children undergoing bilateral implantation performed significantly better than those undergoing unilateral implantation. Because the 2 groups were matched with great care on 10 auditory, child, and environmental factors, the difference in performance can be mainly attributed to the bilateral implantation. A shorter interval between both implantations was related to higher standard scores. Children undergoing 2 simultaneous cochlear implantations performed better on the expressive Word Development Test than did children undergoing 2 sequential cochlear implantations., Conclusions: The use of bilateral cochlear implants is associated with better spoken language learning. The interval between the first and second implantation correlates negatively with language scores. On expressive language development, we find an advantage for simultaneous compared with sequential implantation.

This longitudinal study examined the development of phonology and literacy in Dutch-speaking children at family risk of dyslexia and in matched controls. Measures were administered in kindergarten (before the start of formal reading instruction), in first and in third grade. Children, diagnosed with dyslexia in third grade, showed impaired phonological awareness (PA), verbal short-term memory, and rapid automatic naming ability (RAN) at all time points, with the deficit in PA aggravating over time. These children also performed more poorly in letter knowledge, word and nonword reading accuracy and speed, and spelling at each time point. Children at family risk of dyslexia who did not fulfil criteria for dyslexia, scored more poorly than low-risk controls on the literacy and phonological measures that required the most fine-grained phonological representations. This suggests that the family risk of dyslexia is continuous rather than discrete. Hierarchical regression analyses demonstrated that PA and RAN were initially the most important instigators of reading accuracy and reading speed, respectively. After 2 years of reading instruction, only RAN predicted reading speed and accuracy. Letter knowledge, reading accuracy, and reading speed also contributed to the development of PA.