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Purpose: Children who are Deaf and Hard of Hearing (DHH), their parents, Teachers of the Deaf, and other community stakeholders were involved in co-designing a web-based resource to support students' social-emotional well-being. The resource was designed to provide families and teachers with strategies to enhance the social and emotional well-being of Grade 4-6 students who are DHH. This study reports outcomes of a pilot study of the web-based resource intervention. Method: A pre-post pilot study was conducted to quantitatively examine reported anxiety, well-being, social relationships, school experience, student-teacher relationship, and parent and teacher self-efficacy. A total of 37 students, their parents (n = 37), and their classroom teachers (n = 40) participated in the intervention program and were provided access to the resource. Results: In total, 19 students, 22 parents, and 17 teachers completed both pre-and post-survey measures. Paired t tests revealed that there was a statistically significant increase in parents' self-efficacy scores from pre- to post-test. Multivariate analysis of covariance revealed a significant association between parent use of the website and student-reported improved peer support and reduced school loneliness. No other statistically significant differences were found. Conclusions: The use of a web-based resource codeveloped with students who are DHH, their parents, and teachers could potentially be beneficial for the well-being of students who are DHH as well as parents' self-efficacy. Further research is needed to confirm the benefits.

Purpose: This study aimed to describe and compare the performance of two screening protocols used for preschool hearing screening in resource-constrained settings. Method: Secondary data analysis was done to determine the performance of two protocols implemented during a preschool hearing screening program using mobile health technology in South Africa. Pure-tone audiometry screening at 25 dB HL for 1000, 2000, and 4000 Hz in each ear was used by both protocols. The fail criterion for the first protocol (2,147 children screened) constituted a no-response on one or more frequencies in either ear. The second protocol required two or more no-responses (5,782 children). Multivariate logistic regression models were used to investigate associations between outcomes and protocol, age, gender, and duration. Results: Fail rates for the one-frequency fail protocol was 8.7% (n = 186) and 4.3% (n = 250) for the two-frequency fail protocol. Children screened with the two-frequency fail protocol were 52.9% less likely to fail (p < 0.001; OR = 0.471; 95% confidence interval [0.385, 0.575]). Gender (p = 0.251) and age (p = 0.570) had no significant effect on screening outcome. A percentage of cases screened (44.7%) exceeded permissible noise levels in at least one ear at 1000 Hz across both protocols. True- and false-positive cases did not differ significantly between protocols. Protocol type (p = 0.204), gender (p = 0.314), and age (p = 0.982) did not affect the odds of being a true-positive result. Average screening time was 72.8 s (78.66 SD) and 64.9 s (55.78 SD) for the one-frequency and two-frequency fail protocols, respectively. Conclusions: A two-frequency fail criterion and immediate rescreen of failed frequencies significantly reduced referral rate for follow-up services that are often overburdened in resourced-constrained settings. Future protocol adaptations can also consider increasing the screening levels at 1000 Hz to minimize the influence of environmental noise.

Purpose: The aim of the study was to examine whether otitis media (OM) in early childhood has an impact on language development in later childhood. Methods: We analyzed data from 1,344 second-generation (Generation 2) participants in the Raine Study, a longitudinal pregnancy cohort established in Perth, Western Australia, between 1989 and 1991. OM was assessed clinically at 6 years of age. Language development was measured using the Peabody Picture Vocabulary Test--Revised (PPVT-R) at 6 and 10 years of age and the Clinical Evaluation of Language Fundamentals--Third Edition at 10 years of age. Logistic regression analysis accounted for a wide range of social and environmental covariates. Results: There was no significant relationship between bilateral OM and language ability at 6 years of age ([beta] = -0.56 [-3.78, 2.66], p = 0.732). However, while scores were within the normal range for the outcome measures at both time points, there was a significant reduction in the rate of receptive vocabulary growth at 10 years of age (PPVT-R) for children with bilateral OM at 6 years of age ([beta] = -3.17 [-6.04, -0.31], p = 0.030), but not for the combined unilateral or bilateral OM group ([beta] = -1.83 [-4.04, 0.39], p = 0.106). Conclusions: Children with OM detected at 6 years of age in this cohort had average language development scores within the normal range at 6 and 10 years of age. However, there was a small but statistically significant reduction in the rate of receptive vocabulary growth at 10 years of age (on the PPVT-R measure only) in children who had bilateral OM at 6 years of age after adjusting for a range of sociodemographic factors.

Purpose: Children who are deaf and hard of hearing (DHH) face a wide array of issues that can impact their mental health and well-being. This study aimed to explore the role of schools and classroom teachers in supporting the mental health and well-being of DHH children. Method: A qualitative study comprising telephone and semistructured interviews with 12 mainstream school classroom teachers who directly support the education and well-being of DHH children was conducted. Thematic analysis was used to analyze the data. Result: Classroom teachers indicated they play an important role in supporting the mental health and well-being of DHH children but identified a range of constraints to providing this support. Four themes were identified: (a) "culture of professional practice," (b) "operationalized practice," (c) "constraints to practice," and (d) "solutions for constraints." Conclusions: Classroom teachers play an important role in supporting the mental health and well-being of DHH children but face several constraints in their practice, including limited training and awareness and access to resources. While further research is needed, this study suggests that classroom resources and teacher professional development are needed to enhance classroom teachers' understanding of how to support the mental health and well-being of DHH children.

Appropriate speech-in noise assessment is challenging in multilingual populations. This study aimed to assess whether first preferred language affected performance on an English Digits-in-noise (DIN) test in the local Asian multilingual population, controlling for hearing threshold, age, sex, English fluency and educational status. A secondary aim was to determine the association between DIN test scores and hearing thresholds. English digit-triplets in noise testing and pure-tone audiometry were conducted. Multiple regression analysis was performed with DIN scores and hearing thresholds as dependent variables. Correlation analysis was performed between DIN-SRT and hearing thresholds. 165 subjects from the Singapore Longitudinal Ageing Study, a population-based longitudinal study of community-dwellers over 55 years of age. Mean DIN speech reception threshold (DIN-SRT) was −5.7 dB SNR (SD 3.6; range 6.7 to −11.2). Better ear pure tone average and English fluency were significantly associated with DIN-SRT. DIN performance was independent of first preferred language in a multilingual ageing Singaporean population after adjusting for age, gender and education. Those with poorer English fluency had a significantly lower DIN-SRT score. The DIN test has the potential to provide a quick, uniform method of testing speech in noise in this multilingual population. [ABSTRACT FROM AUTHOR]

Objective: Investigating the impact of early childhood ventilation tube insertion (VTI) on long‐term language outcomes. Design: Longitudinal cohort study. Setting: A total of 2900 pregnant women participated in the Raine Study between 1989 and 1991 in Western Australia, and 2868 children have been followed up. Participants: Based on parental reports, 314 children had a history of recurrent otitis media but did not undergo VTI (rOM group); another 94 received VTI (VTI group); while 1735 had no history of rOM (reference group) in the first 3 years of childhood. Children with data on outcomes and confounders were included in analyses of PPVT‐R at ages 6 (n = 1567) and 10 years (n = 1313) and CELF‐III at 10 years (n = 1410) (approximately 5% in the VTI group and 15% in the rOM group). Main Outcome Measures: Peabody Picture Vocabulary Test‐Revised edition and Clinical Evaluation of Language Fundamentals® Preschool‐3. Results: At 6 years, mean PPVT‐R scores were significantly lower in the VTI group than the reference group (β = −3.3; 95% CI [−6.5 to −0.04], p =.047). At 10 years, while the difference between the VTI and reference groups was less pronounced for PPVT‐R scores, there was a small but consistent trend of lower measures, on average, across CELF‐III scores (expressive: β = −3.4 [−7.1 to 0.27], p =.069; receptive: β = −4.1 [−7.9 to −0.34], p =.033; total: β = −3.9 [−7.5 to −0.21], p =.038). There was no evidence to suggest that language outcomes in the rOM group differed from the reference group. Conclusion: Lower scores of language outcomes in school‐aged children who received VTI in early childhood may suggest a long‐term risk which should be considered alongside the potential benefits of VTI. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the study was to examine whether otitis media (OM) in early childhood has an impact on language development in later childhood. Methods: We analyzed data from 1,344 second-generation (Generation 2) participants in the Raine Study, a longitudinal pregnancy cohort established in Perth, Western Australia, between 1989 and 1991. OM was assessed clinically at 6 years of age. Language development was measured using the Peabody Picture Vocabulary Test-Revised (PPVT-R) at 6 and 10 years of age and the Clinical Evaluation of Language Fundamentals-Third Edition at 10 years of age. Logistic regression analysis accounted for a wide range of social and environmental covariates. Results: There was no significant relationship between bilateral OM and language ability at 6 years of age (P = -0.56 [-3.78, 2.66], p = .732). However, while scores were within the normal range for the outcome measures at both time points, there was a significant reduction in the rate of receptive vocabulary growth at 10 years of age (PPVT-R) for children with bilateral OM at 6 years of age ([beta] = -3.17 [-6.04, -0.31], p = .030), but not for the combined unilateral or bilateral oM group ([beta] = -1.83 [-4.04, 0.39], p = .106). Conclusions: Children with OM detected at 6 years of age in this cohort had average language development scores within the normal range at 6 and 10 years of age. However, there was a small but statistically significant reduction in the rate of receptive vocabulary growth at 10 years of age (on the PPVT-R measure only) in children who had bilateral OM at 6 years of age after adjusting for a range of sociodemographic factors., Otitis media (OM), a broad term referring to a spectrum of inflammatory conditions involving the middle ear, affects an estimated 80% of children before the age of 3 years (Teele [...]

Objective To implement and evaluate a community-based hearing and vision screening programme for preschool children in the Western Cape, South Africa, supported by mobile health technology (mHealth) and delivered by community health workers (CHWs). Methods We trained four CHWs to provide dual sensory screening in preschool centres of Khayelitsha and Mitchells Plain during September 2017-December 2018. CHWs screened children aged 4-7 years using mHealth software applications on smartphones. We used logistic regression analysis to evaluate the association between screening results and age, sex and test duration, and, for hearing, excessive background noise levels. Results CHWs screened 94.4% (8023/10 362) of eligible children at 271 centres at a cost of 5.63 United States dollars per child. The number of children who failed an initial hearing and visual test was 435 (5.4%) and 170 (2.1%), respectively. Hearing test failure was associated with longer test times (odds ratio, OR: 1.022; 95% confidence interval, CI: 1.021-1.024) and excessive background noise levels at 1 kilohertz (kHz) (e.g. OR for left ear: 1.688; 95% CI: 1.198-2.377). Visual screening failure was associated with longer test duration (OR: 1.003; 95% CI: 1.002-1.005) and younger age (OR: 0.629; 95% CI: 0.520-0.761). Of the total screened, 111 (1.4%) children were diagnosed with a hearing and/or visual impairment. Conclusion mHealth-supported CHW-delivered hearing and vision screening in preschool centres provided a low-cost, acceptable and accessible service, contributing to lower referral numbers to resource-constrained public health institutions. Objectif Mettre en place et evaluer un programme de depistage communautaire des troubles auditifs et visuels chez les enfants d'age prescolaire dans la province du Cap-Occidental, en Afrique du Sud, effectue a l aide de technologies medicales mobiles par des agents de sante communautaires. Methodes Nous avons forme quatre agents de sante communautaires a realiser des doubles depistages sensoriels dans des centres prescolaires de Khayelitsha et de Mitchells Plain de septembre 2017 a decembre 2018. Ces agents de sante ont examine des enfants ages de 4 a 7 ans a l'aide d'applications specifiques sur smartphones. Nous avons realise une analyse de regression logistique pour evaluer l'association entre les resultats du depistage et l'age, le sexe et la duree du test ainsi que, pour le depistage auditif, les niveaux de bruit de fond excessifs. Resultats Les agents de sante communautaires ont examine 94,4% (8023/10 362) des enfants eligibles dans 271 centres, pour un cout de 5,63 dollars des Etats-Unis par enfant. Le nombre d'enfants qui n'ont pu beneficier d'un test initial de depistage auditif et visuel etait respectivement de 435 (5,4%) et 170 (2,1%). Lechec du test auditif etait associe a une duree de test plus longue (rapport des cotes, RC: 1,022; intervalle de confiance de 95%, IC: 1,021-1,024) et a des niveaux de bruit de fond excessifs a 1 kHz (par ex., RC pour l'oreille gauche: 1,688; IC 95%: 1,198-2,377). Lechec du depistage visuel etait associe a une duree de test plus longue (RC: 1,003; IC 95%: 1,002-1,005) et a un plus jeune age (RC: 0,629; IC 95%: 0,520-0,761). Sur le nombre total d'enfants examines, 111 (1,4%) presentaient une deficience auditive et/ou visuelle. Conclusion Le depistage auditif et visuel sur mobile par des agents de sante communautaires dans des centres prescolaires a permis de proposer un service accessible, acceptable et a faible cout, qui a contribue a reduire le nombre de consultations dans les etablissements de sante publics disposant de peu de ressources. Objetivo Implementar y evaluar un programa comunitario para examinar la audicion y la vision de los ninos en edad preescolar en el Cabo Occidental, Sudafrica, apoyado por la tecnologia de salud movil (mHealth) e impartido por los trabajadores de la salud de la comunidad (CHW, por sus siglas en ingles). Metodos Capacitamos a cuatro CHW para que realizaran examenes sensoriales duales en centros preescolares de Khayelitsha y Mitchells Plain entre septiembre de 2017 y diciembre de 2018. Los CHW examinaron a ninos de 4 a 7 anos de edad utilizando las aplicaciones de software mHealth en telefonos inteligentes. Se utilizo el analisis de regresion logistica para evaluar la asociacion entre los resultados del examen y la edad, el sexo y la duracion del mismo, y, en el caso de la audicion, los niveles excesivos de ruido de fondo. Resultados Los CHW examinaron al 94,4 % (8 023/10 362) de los ninos que reunian los requisitos en 271 centros, a un coste de 5,63 dolares estadounidenses por nino. El numero de ninos que no pasaron una prueba inicial de audicion y vision fue de 435 (5,4 %) y 170 (2,1 %), respectivamente. El fallo de la prueba de audicion se asocio con tiempos de prueba mas largos (razon de momios, RM: 1,022; intervalo de confianza del 95 %, IC: 1,021-1,024) y niveles excesivos de ruido de fondo a 1 kHz (p.ej. RM para el oido izquierdo: 1,688; IC del 95 %: 1,198-2,377). El fallo del examen visual se asocio con una mayor duracion de la prueba (RM: 1,003; IC del 95 %: 1,002-1,005) y una edad mas temprana (RM: 0,629; IC del 95 %: 0,520-0,761). Del total de ninos examinados, 111 (1,4 %) fueron diagnosticados con un impedimento auditivo y/o visual. Conclusion mHealth, con apoyo de los CHW, realizo examenes de audicion y vision en los centros preescolares y proporciono un servicio de bajo coste, aceptable y accesible, lo que contribuyo a reducir el numero de remisiones a las instituciones de salud publica con recursos limitados., Introduction Sensory inputs of hearing and vision during early childhood development support the achievement of optimal language, speech and educational outcomes. (1, 2) Early detection of sensory impairments is essential [...]

Purpose: This review examined (a) the current evidence from studies on teleaudiology applications for rehabilitation of adults with hearing impairment with hearing aids and (b) whether it is sufficient to support the translation into routine clinical practice. Method: A search strategy and eligibility criteria were utilized to include articles specifically related to hearing aid fitting and follow-up procedures that are involved in consultations for the rehabilitation of adults, where the service was provided by the clinician by teleaudiology. A search using key words and Medical Subject Headings (MeSH) was conducted on the main electronic databases that index health-related studies. The included studies were assessed using validated evaluation tools for methodological quality, level of evidence, and grade recommendations for application into practice. Results: Fourteen studies were identified as being within the scope of this review. The evaluation tools showed that none of these studies demonstrated either a strong methodological quality or high level of evidence. Analysis of evidence identified 19 activities, which were classified into service outcomes categories of feasibility, barriers, efficiency, quality, and effectiveness. Recommendations could be made regarding the (a) feasibility, (b) barriers, and (c) efficiency of teleaudiology for the rehabilitation of hearing loss with hearing aids. Conclusion: This review provides up-to-date evidence for teleaudiology hearing aid services in new and experienced hearing aid users in different practice settings. Findings direct future research priorities to strengthen evidence-based practice. There is a need for further studies of many aspects of teleaudiology services for rehabilitation with hearing aids to support their implementation into clinical practice.

Background: Chronic tinnitus during childhood/adolescence can be associated with impaired quality of life. Guidelines for managing paediatric tinnitus recommend assessment and interventions are often based upon the experiences and opinions of guideline committee members. Objective: To examine patient response tools used for the assessment and management of childhood tinnitus and how interventions had been evaluated. Design: A structured scoping review (i) identifying and critically appraising patient response measures (PRMs) assessing tinnitus in children/adolescents, and (ii) critically appraising evidence supporting reported interventions. Original papers written in English, involving paediatric participants ≤19 years, reporting (i) application of established PRMs to assess the experience of chronic tinnitus or (ii) application and evaluation of tinnitus interventions were included. Study sample: Papers written in English, identifying, or assessing the experience of chronic tinnitus (>3 months) as a primary complaint during childhood/adolescence in participants ≤19 years of age using a PRM and studies evaluating the application of non-pharmaceutical interventions for tinnitus in children/adolescents. Results: Six studies involving the assessment of tinnitus during childhood/adolescence using a PRM were identified and evaluated. Three established (previously named, described, and published) PRMs were applied of which none were developed specifically for children/adolescents. Three behavioural tinnitus interventions and three combination intervention strategies (coupling of psychological intervention with sound enrichment) had been applied to and evaluated within paediatric populations. Conclusions: Although clinicians are seeing children/adolescents with tinnitus, they are evaluating and managing children’s distress without appropriate PRMs, and little evidence exists to support clinical interventions. [ABSTRACT FROM AUTHOR]

Purpose: This review examined (a) the current evidence from studies on teleaudiology applications for rehabilitation of adults with hearing impairment with hearing aids and (b) whether it is sufficient to support the translation into routine clinical practice. Method: A search strategy and eligibility criteria were utilized to include articles specifically related to hearing aid fitting and follow-up procedures that are involved in consultations for the rehabilitation of adults, where the service was provided by the clinician by teleaudiology. A search using key words and Medical Subject Headings (MeSH) was conducted on the main electronic databases that index health-related studies. The included studies were assessed using validated evaluation tools for methodological quality, level of evidence, and grade recommendations for application into practice. Results: Fourteen studies were identified as being within the scope of this review. The evaluation tools showed that none of these studies demonstrated either a strong methodological quality or high level of evidence. Analysis of evidence identified 19 activities, which were classified into service outcomes categories of feasibility, barriers, efficiency, quality, and effectiveness. Recommendations could be made regarding the (a) feasibility, (b) barriers, and (c) efficiency of teleaudiology for the rehabilitation of hearing loss with hearing aids. Conclusion: This review provides up-to-date evidence for teleaudiology hearing aid services in new and experienced hearing aid users in different practice settings. Findings direct future research priorities to strengthen evidencebased practice. There is a need for further studies of many aspects of teleaudiology services for rehabilitation with hearing aids to support their implementation into clinical practice. Supplemental Material: https://doi.org/10.23641/asha. 6534473, The high prevalence of hearing loss is a major global public health challenge. Over 5.3% of the world's population has disabling hearing loss, and a further 10% has a nondisabling [...]

Introduction: Video otoscopy plays an important role in improving access to ear health services. This study investigated the clinician-rated quality of video otoscopy recordings and still images, and compared their suitability for asynchronous diagnosis of middle-ear disease. Methods: Two hundred and eighty video otoscopy image–recording pairs were collected from 150 children (aged six months to 15 years) by an ear, nose, and throat (ENT) specialist, audiologists, and trained research assistants, and independently rated by an audiologist and ENT surgeon. On a five-point scale, clinicians rated the cerumen amount, field of view, quality, focus, light, and gave an overall rating, and asked whether they could make an accurate diagnosis for both still images and recordings. Results: More video otoscopy recordings were rated as 'good' or 'excellent' compared to still images across all domains. The mean difference between the two otoscopic procedures ratings was significant across almost all domains (p < 0.05), except 'cerumen amount'. The suitability to make a diagnosis significantly improved when using recordings (p<0.05). Younger participant age was found to have a significant, negative impact on the ratings across all domains (p < 0.03). The role of the tester conducting video otoscopy did not have a significant impact on the ratings. Discussion: Video otoscopy recordings were found to provide clearer views of the tympanic membrane and increase the ability to make diagnoses, compared to still images, for both audiologists and ENT surgeons. Research assistants with limited practice were able to obtain video otoscopy images and recordings that were comparable to the ones obtained by clinicians. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to explore whether self-reported mental wellbeing (anxiety, depression and loneliness) in audiologists has changed over the course of the COVID-19 pandemic and to examine possible factors contributing to audiologists' current state of mental wellbeing. Design: Two cross-sectional surveys were distributed at two different time points during the COVID-19 pandemic screening for psychological distress (PHQ-4: anxiety and depression) and loneliness (UCLA-3). Study sample: 117 audiologists from around the world. Results: Findings demonstrated that over the course of the COVID-19 pandemic audiologists' levels of depression decreased, levels of anxiety were low and stable, whilst levels of loneliness were stable and high. Younger age was associated with lower levels of mental well-being. Responses to open text questions suggests that audiologists could be supported through development of clear and consistent guidelines on COVID-19 workplace restrictions, allowing for more workplace flexibility and providing mental health support through employee assistance programs. Conclusions: The rates of anxiety, depression and loneliness observed highlight the continued need for mental health and workplace interventions to support audiologists throughout the COVID-19 pandemic and the subsequent recovery period. [ABSTRACT FROM AUTHOR]

To explore the barriers and facilitators faced by hearing healthcare clinicians (HHCs) with respect to asking adults with hearing loss (HL) about their emotional well-being. This qualitative study was conducted using semi-structured individual interviews and focus groups. The interview topic guide was developed based on the COM-B model. Fifteen HHCs of a single hearing services organisation in Western Australia across 13 clinic locations participated. Barriers and facilitators that may influence HHCs' behaviour of routinely asking adults about their emotional well-being include having the knowledge and skills to ask about emotional well-being, forgetting to ask, awareness of the emotional impacts of HL, time and tools for asking, clients' reactions to being asked, supportive peers, normalisation of discussions relating to emotional well-being, presence of significant others, emotions associated with asking, being in the habit of asking, reminders, beliefs about consequences and confidence or capabilities, and scope of audiology practice. Application of the COM-B model identified barriers in capabilities (e.g. knowledge), opportunities (e.g. tools), and motivation (e.g. beliefs about benefits of asking about emotions) that need to be addressed for HHCs to ask their clients about their emotional well-being. [ABSTRACT FROM AUTHOR]