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Editorial: The Outcomes of Children with Hearing Loss Study

Tomblin, J. Bruce; Moeller, Mary Pat

doi: 10.1097/AUD.0000000000000220
Editorial

University of Iowa, Iowa City, Iowa

Boys Town National Research Hospital, Omaha, Nebraska

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and text of this article on the journal’s Web site (www.ear-hearing.com).

Articles contained in this Supplement describe the theoretical motivation, design, methods, and results of a longitudinal, multidisciplinary, multicenter investigation, entitled Outcomes of Children with Hearing Loss (OCHL). A primary goal of this project was to examine the language and auditory outcomes of infants and preschool-age children with permanent, bilateral, mild-to-severe hearing loss and to identify the factors that moderate the relationship between hearing loss and longitudinal outcomes. This project was a collaborative effort of research teams at the University of Iowa, Boys Town National Research Hospital, and the University of North Carolina at Chapel Hill. This OCHL Supplement provides longitudinal and cross-sectional data on factors predicted to influence linguistic access in young children who are hard of hearing (CHH), most of whom had access to contemporary intervention services. Outcomes of CHH are compared with those of children with normal hearing who are matched on age and socioeconomic status.

Several recent lines of research argue that the language input to the child is central to the process of child language development and that variations in the quantity and quality of language input should account for a substantial fraction of individual differences in language development. In the OCHL Supplement, we propose that CHH experience limitations in access to and perception of linguistic input, which leads to a decrease in uptake of language exposure and an overall reduction in language experience. This inconsistent access account is examined in relation to three primary factors that are proposed to influence children’s access to linguistic input: aided audibility, duration and consistency of hearing aid use, and characteristics of caregiver input. We explore the degree to which these factors moderate the relationship between hearing loss and children’s outcomes.

The articles in the OCHL Supplement are based on data collected from 317 CHH and a comparison group of 117 children with normal hearing. The children were recruited from locations surrounding the three collaborating sites and ultimately came from 17 states. The majority of children (76%) were identified subsequent to newborn hearing screening. With a few exceptions (see Tomblin et al. 2015b), these children had permanent, bilateral hearing losses, ranging from 25 to 75 dB HL, and all but a few children were fit with hearing aids. An accelerated longitudinal design was implemented, which meant that children entered the study at various infant–preschool ages and were subsequently followed prospectively for 3 or more years. To support the reader, frequently used acronyms are defined in a Table that is included as an online resource. (For a Table of Acronyms, see Supplemental Digital Content, Appendix A, http://links.lww.com/EANDH/A202.) It should be noted that the acronym HL is used throughout the OCHL Supplement to refer to “hearing loss.” However, when the acronym appears as dB HL, it means “decibels hearing level.”

The overall organizational structure of the OCHL Supplement is summarized in Table 1. As shown, the content is presented in three major sections (1) Introduction and Method, (2) Examination of the three primary factors proposed to influence access and cumulative linguistic experience, and (3) Investigation of the influence of the proposed factors on children’s auditory and language outcomes. The OCHL Supplement concludes with a summary of key research findings, along with implications for research and clinical practice. An afterword summarizes lessons learned by the team while implementing a multisite longitudinal study.

TABLE 1

TABLE 1

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ACKNOWLEDGMENTS

The studies contained in this OCHL Supplement were supported by the National Institute on Deafness and Other Communication Disorders (NIDCD R01DC009560). The authors are especially grateful for the support of multiple colleagues and their respective university clinics, school programs, and/or speech and hearing clinics for allowing the authors to use their excellent facilities and for supporting the authors’ efforts to recruit and assess children in their geographic areas. Their efforts greatly enhanced the size and breadth of the Outcomes of Children with Hearing Loss (OCHL) sample. These valued individuals and programs include Dr. Stephen Boney from the Department of Special Education and Communication Disorders at University of Nebraska-Lincoln, Lincoln, NE; Christine Evans, private speech-language pathologist in Richmond, VA; Dr. Jennifer Gutzwiller, AuD, of Educational Service Unit 10 in Kearney, NE; Drs. Tiffany Johnson and Judith Widen from the Department of Hearing and Speech at the University of Kansas Medical Center, Kansas City, KS; The Moog Center for Deaf Education in St. Louis, MO; Richmond Hearing Doctors in Richmond, VA; Dr. Susie Ternes, AuD; Via Christi Rehabilitation Hospital, Inc., in Wichita, KS; University of Minnesota-Twin Cities Department of Speech, Language, and Hearing Sciences in Minneapolis, MN. Many other professionals referred children and families to the study and provided invaluable documentation and background records. The authors are grateful for their substantive support of this project.

The OCHL team also expresses sincere appreciation to the caregivers and children who served as research volunteers in this project. This project would not have been possible without their enthusiastic and ongoing participation. Their involvement in the study took on many dimensions, and their enduring efforts contributed to the success of the project.

The test batteries were administered by an experienced and highly skilled team of clinical professionals. Their training and oversight was managed by Connie Ferguson, CCC-SLP, of the University of Iowa, whose efforts made a major contribution to fidelity of test administration across sites and to preserving the integrity of scoring rules. The dedication of each examiner to maintaining standardized procedures while engaging children in interesting ways greatly contributed to the integrity of the data. Their impressive work with children and families also contributed to a low rate of attrition. They often travelled over weekends to accommodate the needs of families. The authors appreciate their invaluable input to the team in terms of clinical and scientific insights.

The project was greatly supported by the behind-the-scenes administrative team. The authors are especially grateful for the extraordinary project management contributions of Marlea O’Brien at the University of Iowa. Her capable direction and ability to foster teamwork and accountability kept the project on track and running smoothly. The authors are thankful for the major contributions of Rick Arenas, who created and managed the project database with support from Wendy Fick. The authors also recognize the efforts of Barbara Peterson, who conducted annual phone interviews with parents. The authors recognize the numerous contributions of research assistants at each site. They are acknowledged by name in the OCHL team list below.

The authors received outstanding direction and feedback from Brenda Ryals, Laurie Eisenberg, Ben Hornsby, and Susan Jerger, and the authors are grateful for their support. Their input and that of multiple anonymous reviewers resulted in strengthening the manuscripts in the OCHL Supplement. The authors appreciate their investment of time and expertise in this work.

The members of the OCHL collaboration are listed as follows: Child language—Sophie Ambrose, Boys Town National Research Hospital, Omaha, NE; Lauren Unflat Berry, Boys Town National Research Hospital, Omaha, NE; Connie Ferguson, University of Iowa, Department of Communication Sciences and Disorders, Iowa City, IA; Colleen Fitzgerald, Boys Town National Research Hospital, Omaha, NE; Melody Harrison, Speech & Hearing Sciences, University of North Carolina, Chapel Hill, NC; Keegan Koehlinger, Boys Town National Research Hospital, Omaha, NE, and University of Iowa, Department of Communication Sciences and Disorders, Iowa City, IA; Mary Pat Moeller (Co-PI), Boys Town National Research Hospital, Omaha, NE; Thomas Page, Speech & Hearing Sciences, University of North Carolina, Chapel Hill, NC; Marcia St. Clair, University of Iowa, Department of Communication Sciences and Disorders, Iowa City, IA; Emilie Sweet, Boys Town National Research Hospital, Omaha, NE; and J. Bruce Tomblin (Co-PI), University of Iowa, Department of Communication Sciences and Disorders, Iowa City, IA. Audiology—Sandie Bass-Ringdahl, University of Iowa, Department of Communication Sciences and Disorders, Iowa City, IA; Ruth Bentler, University of Iowa, Department of Communication Sciences and Disorders, Iowa City, IA; Lenore Holte, University of Iowa, Department of Communication Sciences and Disorders, Iowa City, IA; Shana Jacobs, Department of Otolayrngology, University of North Carolina, Chapel Hill, NC; Ryan McCreery, Boys Town National Research Hospital, Omaha, NE; Pat Roush, Department of Otolaryngology, University of North Carolina, Chapel Hill, NC; Meredith Spratford, Boys Town National Research Hospital, Omaha, NE; Pat Stelmachowicz, Boys Town National Research Hospital, Omaha, NE; and Elizabeth Walker, University of Iowa, Department of Communication Sciences and Disorders, Iowa City, IA. Biostatistics, Linguistics, Psychology—Rick Arenas, University of Iowa, Department of Communication Sciences and Disorders, Iowa City, IA; John Knutson, University of Iowa, Department of Psychology, Iowa City, IA; Jake Oleson, University of Iowa, Department of Biostatistics, Iowa City, IA; Hua Ou, University of Iowa, Department of Biostatistics, Iowa City, IA; Mark VanDam, Boys Town National Research Hospital, Omaha, NE; and Anne Welhaven, University of Iowa, Department of Biostatistics, Iowa City, IA. Project management—Wendy Fick, University of Iowa, Department of Communication Sciences and Disorders, Iowa City, IA; Sue Nutty, Boys Town National Research Hospital, Omaha, NE; Marlea O’Brien, University of Iowa, Department of Communication Sciences and Disorders, Iowa City, IA; Barbara Peterson, Boys Town National Research Hospital, Omaha, NE, and University of Iowa, Department of Communication Sciences and Disorders, Iowa City, IA. Project consultant–Amy R. Lederberg, Georgia State University, Atlanta, GA.

J. Bruce Tomblin

University of Iowa

Iowa City, Iowa

Mary Pat Moeller

Boys Town National Research Hospital

Omaha, Nebraska

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REFERENCES

Ambrose S. E., Walker E. A., Unflat-Berry L. M., et al. Quantity and quality of caregivers’ linguistic input to 18-month and 3-year-old children who are hard of hearing. Ear Hear. (2015);36:48S–59S
    McCreery R. W., Walker E. A., Spratford M., et al. Longitudinal predictors of aided speech audibility in infants and children. Ear Hear. (2015);36:24S–37S
      McCreery R. W., Walker E. A., Spratford M., et al. Speech recognition and parent ratings from auditory development questionnaires in children who are hard of hearing. Ear Hear. (2015);36:60S–75S
        Moeller M. P., Tomblin J. B.. An introduction to the outcomes of children with hearing loss study. Ear Hear. (2015);36:4S–13S
          Moeller M. P., Tomblin J. B.the OCHL Collaboration. . Epilogue: Conclusions and implications for research and practice. Ear Hear. (2015);36:92S–98S
            Moeller M. P., Tomblin J. B.the OCHL Collaboration. . Afterword. Ear Hear. (2015);36:99S–101S
              Tomblin J. B., Harrison M., Ambrose S. E., et al. Language outcomes in young children with mild to severe hearing loss. Ear Hear. (2015a);36:76S–91S
                Tomblin J. B., Walker E. A., McCreery R. W., et al. Outcomes of children with hearing loss: Data collection and methods. Ear Hear. (2015b);36:14S–23S
                Walker E. A., McCreery R. W., Spratford M., et al. Trends and predictors of longitudinal hearing aid use for children who are hard of hearing. Ear Hear. (2015);36:38S–47S

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