UHL IMPact: Examining the

effect of unilateral hearing loss

on infant vocal development

Robyn Cantle Moore, PhD

Precis

UHL pilot study – infant vocal progress

relative to IMP hearing norms <12 mths.

a) Which UHL infants ‘at greater risk’ for speech

and language delay, relative to peers?

b) Any factors associated with ‘at risk’ potential?

Study in context– Working definition of Unilateral Hearing Loss

– UHL prevalence at birth

– Perspectives in the literature

Working definition of UHL

UHL = hearing loss in one ear only.

National Workshop on Mild and Unilateral Hearing Loss:

Workshop Proceedings, (2005). Breckenridge (CO):

Centres for Disease Control and Prevention.

PTA >20 dB HL in the affected ear

or

>25 dB HL at 2 or more frequencies above 2 kHz

Prevalence of congenital UHL

A unilateral hearing loss (UHL) is reported

in approx.15-30% of infants diagnosed with

HL through newborn hearing screening.

(De Capua et al., 2007; Fitzpatrick et al., 2014; Johnson et al., 2005;

Vohr et al., 2002; SWISH, 2010).

Healthy Hearing Q’land (2010)

UHL: 0.52/1000 births

SWISH (NSW) (2010)

UHL: 0.65/1000 births

Perspectives in the literature

Some young children with UHL experience

delays in speech & language development

(Lieu et al., 2010) while others do not (Briggs et al., 2011).

“…59% of the infants with UHL were within or

above ±2SE of normal preverbal vocalizations”

(p. 1132) however, “delayed auditory behaviour

and preverbal vocalizations were approximately

four and nine times more common in infants

with UHL compared to BNH respectively” (p. 1134).

Kishon-Rabin et al., 2015.

UHL IMPact pilot study

Infants identified with UHL through

state-wide newborn screening.

Diagnosis & follow-up at RIDBC Jim Patrick

Audiology Centre (JPAC), Sydney.

IMP assessment completed in conversation

with parents during infant ear & hearing

health appointments at 5 mths, 8 mths, and

12 mths of age.

Materials and Method

Infant Monitor of vocal Production (IMP) is a

normed assessment tool (Cantle Moore & Colyvas, in prep.)

IMP guides parent understanding as to nature &

pace of their infant’s progress toward speech.

IMP systematically monitors & documents

audition-led features of production in the

pre-linguistic vocalizations of infants <12 mths.

IMP supports informed parent-professional

decision making in early intervention.

IMP: Typical infant vocal development

(Kuhl, 2004; Lewkowicz & Hansen-Tift, 2012 *).

Production

1 2 3 4 5 6 7 8 9 10 11 12 MONTHS

Universal speech production

Language specific speech production

First words

Non-speech sounds

Vowel-like sounds

‘Canonical babbling’

* Visual attention shift to mouth seeks

redundant audio-visual speech cues Social attention

shift back to eyesVisual-social attention to eyes

BaselineIMP Transition Integrity

IMP assessment procedure

months

months

Chronological Age

(corrected)

Hearing Age

(HA) (CI)

Question ceiling

Innate … Transition to Audition-Production … Integrity of A-P Loop

Loop

Subject ages

Range 1: Baseline 4-5 months

2: Transition 8-10 months

3: Integrity 11-18 months

Mean 1: Baseline 4.3 months

2: Transition 8.4 months

3: Integrity 12.4 months

Mode 1: Baseline 4 months

2: Transition 8 months

3: Integrity 11 months

Subject characteristics

Case

No.#

Gender Birth

history

Birth order Aetiology Degree HL Ear (L/R)

1 Female WB Sibling ANSD (ABR) L

2 Male WB Sibling ANSD (ABR) R

3 Female WB Sibling ANSD (ABR) R

4 Female WB Sibling Sensorineural Mild-Mod R

5 Male WB Singleton Sensorineural Sev-Prof L

6 Female CMV Sibling Sensorineural Sev-Prof R

7 Male Intervene Sibling Conductive Mild-Mod L

8 Female WB Singleton Sensorineural Mild-Mod R

9 Female WB Sibling ANSD (ABR) R

10 Male WB Sibling ANSD (ABR) L

11 Female WB Singleton ANSD (ABR) R

12 Female WB Singleton Conductive Sev-Prof R

13 Male Premature Singleton Sensorineural Sev-Prof L

Individual subject results, IMP trend plots

Perception? Processing? Production?

Trend in vocal progress : IMP norms(10/13 infants, UHL pilot study)

4 6 8 10 12 14

68

10

12

14

16

Age - months

Q c

eili

ng

97th 85th

50th

15th

3rd

Transition to A-P Integrity of A-P

Loop Loop

Trend in vocal progress : IMP norms(13/13 infants, UHL pilot study)

4 6 8 10 12 14

68

10

12

14

16

Age - months

Q c

eili

ng

97th 85th

50th

15th

3rd

Transition to A-P Integrity of A-P

Loop Loop

__ Infant #4

__ Infant #6

__ Infant #13

Aetiology

4 6 8 10 12 14

68

10

12

14

16

Age - months

Q c

eili

ng

Transition to A-P Integrity of A-P

Loop Loop

__ Conductive

__ Sensorineural

__ ANSD

p=0.04

Trend plots X trajectory & aetiology

ANSD Conductive

Mild-Moderate SNHL

Severe-Profound SNHL

Gender

4 6 8 10 12 14

68

10

12

14

16

Age - months

Q c

eili

ng

Transition to A-P Integrity of A-P

Loop Loop

__ Male

__ Female

Rate p=0.57

Robustness p=0.44

Matched cases, variable (M/F) Gender

4 6 8 10 12 14

68

10

12

14

16

Age - months

Q c

eili

ng

Transition to A-P Integrity of A-P

Loop Loop

__ M Infant #10

__ F Infant #1

ANSD

Well baby

Left ear UHL

Sibling

Degree of HL < 65 dB HL : > 65 dB HL

4 6 8 10 12 14

68

10

12

14

16

Age - months

Q c

eili

ng

Transition to A-P Integrity of A-P

Loop Loop

__ <65 dB HL

__ >65 dB HL

UHL Ear

4 6 8 10 12 14

68

10

12

14

16

Age - months

Q c

eili

ng

Transition to A-P Integrity of A-P

Loop Loop

__ Left UHL

__ Right UHL

p=0.57

Matched cases, variable (L/R) Ear

4 6 8 10 12 14

68

10

12

14

16

Age - months

Q c

eili

ng

Transition to A-P Integrity of A-P

Loop Loop

__ Left ear (#10)

__ Left ear (#1)

__ Right ear (#2)

__ Right ear (#9)

ANSD

Well baby

Left ear UHL

Sibling

Birth Order

4 6 8 10 12 14

68

10

12

14

16

Age - months

Q c

eili

ng

Transition to A-P Integrity of A-P

Loop Loop

__ Singleton

__ Sibling

Birth History

4 6 8 10 12 14

68

10

12

14

16

Age - months

Q c

eili

ng

Transition to A-P Integrity of A-P

Loop Loop

__ Premature

__ Intervention

__ CMV

__ Well baby

Trend plots X trajectory & birth history

Premature Well baby

Intervention

CMV

‘At greater risk’

WB

Prem.

CMV

Mild-Moderate

Severe-Profound

Severe-Profound

Female

Female

Male

SNHL

SNHL

SNHL

p=0.04

Limitations of study

Small sample size, limited statistical analysis

No controls for socio-economic status,

parent education, language environment;

however… No relationship found in IMP

normative study between trajectory of vocal

progress and:

(a) maternal work status,

(b) maternal education,

(c) language environment.

Acknowledgement

Thanks to:

RIDBC Jim Patrick Audiology Centre

Irma Huiberts, research student Radboud University, Nijmegen, Netherlands.

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