Conductive Hearing Loss (CHL) 

Does CHL during early development cause long-term measurable problems?

Ventry (1980) questioned the validity of studies suggesting a cause and effect relationship between OME and developmental problems

- did not question cause and effect, but rather the validity of the studies

1. Studies were retrospective

2. Lack of diagnostic standard

3. Lack of comparable study groups

4. Lack of data on hearing level

5. Use of non-standard or inappropriate measures

6. Lack of examination of mediating factors

7. Biased investigators

Five

1. Association between OME early in life and abnormal speech language development in children younger than age 4

2. Association between OME early in life and delay in expressive language development

3. Association between OME early in life and behavior (attention) in children over age 4

4. Most important parameter is hearing status in terms of: 

- frequency, severity, and duration loss

- frequency and duration of periods of normal hearing

- age of onset

5. Language use by parents may overcome the deleterious effect of OME (quality/quantity of linguistic input to child)

1. Auditory Perceptual Problems

2. Attention Problems

3. Expressive Language Problems

4. Phonological Development

5. Scholastic Problems

What is included in Auditory Perceptual Problems? 

(list six)

1. Higher order listening skills are affected

2. Auditory attention/auditory discrimination

3. Problems hearing in noise

4. Poorer listening skills

5. Poorer attention to language tasks

6. Poorer receptive language skills

Attention Problems 

(list three criteria)

1. Sustained attention problems

2. Less task oriented

3. Less able to work independently

Expressive Language Problems

(list five characteristics)

1. Higher order language skills are affected

2. Score poorer on expressive language tests

3. Delayed expressive language

4. Less diverse vocabulary

5. Use less complex syntax even though MLUs are similar to children without a history of OME

Phonological Development

(list three characteristics)

1. Effect may not be drastic and may be overlooked unless tested formally 

2. Problems with velars and post-vocalic obstruents

3. Problem is less obvious on liquids

Scholastic Problems

(list three characteristics)

1. Poorer scholastic performance

2. Especially in reading which will affect performance in other areas

3. Poor spelling and math solving problems

1. Differences between normal and OME decrease with age

2. Development is delayed rather than disordered

3. Those with OME during early development never fully caught up,, but the difference did decrease with age

Other mediating factors to blame for developmental problems due to OME during early development

(three)

1. Higher prevalence of problems in low SES children

2. Unfavorable environmental conditions that may cause children to "tune-out" language

3. Quality and quantity of linguistic input

1. Degree/duration of the loss

2. Hearing loss present during early development

3. Intensity and quality of caregiver speech (linguistic deprivation)

4. SES

1) Scholastic Amplitude

2) Life Experiences 

1. Greater stress

2. Less social support

3. Poorer self-esteem

4. Less energy - increased energy needed for listening

1. Tend to be more introverted

2. Tend to be more submissive

3. Have a tendency for aggression

4. Are less emotionally stable

5. Not as well adjusted

6. Not accepted as well by their classmates

7. More likely to be bullied

8. Can handle their frustration more constructively

9. Are named less often as friends and perceived as less popular

10. Have lower self esteen

11. Have a harder time making friends

12. Felt unimportant within families

1. Not as well adjusted emotionally and socially

2. Higher incidence of immaturity

3. More egocentric, rigid and neurotic

4. Negative personality traits may be improved through educational and character forming procedures 

-Negative personality traits "associated" with deafness may be the result of training and/or the environment where it occurred 

- Reason for normalization; education in least restrictive environment

The incidence of maltreatment, including neglect and physical/sexual abuse, is more than 25% higher among deaf and hard-of-hearing children than among hearing youths

- Introverted                      - Suspicious

- Despondent                     - Apathetic

- Hopelessness                   - Listless

- Sense of Inferiority           - Cruel

- Fear                               - Egocentric

- Bitter                              - Selfish

- Brooding                         - Unsympathetic

- Persecution Complex

- increase stress of everyday life

- patience required when having family members handle phone messages

- problems obtaining employment

- anxiety about keeping employment

- maintaining friends

- social isolation

- despondency (loss of confidence and hope)

- need to identify with other hard of hearing individuals

- inability to hear warning sounds

- absence of ordinary social minglings

- limitation of educational opportunities

- slowness in learning problems related to work

- feelings of inadequacy and frustration

- inability to enjoy music and recreation dependent upon hearing

1. degree of hearing loss

2. age of onset

3. gender

The earlier the age of onset and/or more severe the hearing loss, the greater the effect on emotional adjustment

Language Acquisition and Use

- ability to communicate overall -

They studied normal hearing (NH) and hearing impaired (HI) children prospectively and compared 1) size of consonantal repertoire and 2) proportional occurrence of multi-sullabic CV utterances over time 

They found four main findings

1. NH demonstrated an increase in the size of their consonantal repertoire with age

2. HI in the same range had a smaller repertoire that decreased with time

3. HI produced fewer multi-syllabic utterances containing consonants

4. Some HI produced a high proportion of vocalizations with glides and glottal stops

Findings suggest both QUALITATIVE and QUANTITATIVE differences in vocalizations between NH and HI children 

- the differences were apparent as early as 6-8 months 

Child receives auditory information/feed back about his/her vocalizations both internally from self and externally from others 

Child only receives auditory feedback from him/herself, but receives auditory and visual input from the care giver

They will not continue to develop speech and language, but they may continue to vocalize based on tactile/visual information.

Their vocalizations, however, will never approximate adult form.

1. Child does not make connection between speech sound generation and speech movement

2. Connection between production and perception

3. Child does not experience normal phonetic play

4. Does not discover the possibility of their phonology and articulatory mechanisms

1. Will not be able to take in language from environment

2. Will result a delay or deviancy in the ability to produce speech and to receive/acquire language

3. Does not develop phonological awareness (the ability to hear sounds of a spoken language, think about them, and manipulate or "play" with them.

4. Does not develop phonemic awareness - the ability to think about and manipulate (play with) individual speech sounds within words

- less diverse vocabulary

- have difficulty with word meaning and content words

- have difficulty with synonyms, antonyms, and words with multiple meanings

- overuse nouns and verbs

- rarely use adverbs, prepositions, or pronouns

- use simple syntactic structures

- Poor pragmatics

 - initiating conversations

 - topic maintenance

 - turn-taking

 - changing topics

 - repair of conversational breakdowns

- May have an effect on social interactions with peers