The present status of newborn hearing screening in Japan is reported. According to the survey questionnaire that was sent to all departments of otolaryngology recommended by the Oto-Rhino-Laryngological Society of Japan, 74% of infants referred to the departments of otolaryngology underwent audiologic and medical evaluations before the age of 3 months, and 15.7% of these cases received early intervention. On the other hand, 14.1% of infants who had cleared newborn hearing screening, but were referred to the department of otolaryngology for other reasons? had hearing loss. Thus, the current status in respect of newborn hearing screening and rehabilitation of children with hearing loss in Japan is still problematic, especially in district areas.
A survey was conducted in elementary school students wearing cochlear implants in special-needs classes for the hard-of-hearing, to examine the current status of support provided for them and the problems that they might face in school life. The subjects were six students wearing cochlear implants, their parents, and their teachers in charge of the class for the hard-of-hearing. I interviewed the parents and the teachers to inquire about the children's behavior in school, educational considerations and support, before visiting the classrooms to observe these items. Four students were using FM hearing systems, and the remaining two received support through sign language interpretation. Different types of support were provided for each of the four students using FM hearing systems: “Write-down”, “Sign language interpretation or write-down”, “Verbal support only when the student could not understand”. Even children with a relatively good hearing ability sometimes had difficulty understanding students' conversations. Therefore, consideration should be given to the way one talks to hearing-impaired students, and support needs to be provided to promote communication among them. “Unable to understand what they heard”, “having a limited vocabulary”, and other problems attributed to insufficient language skill were also cited, which suggests that speech therapy should be provided on a continuing basis to these children.
With over 20 years of experience in the use of cochlear implants in Japan, many of the prelingual users have reached school age and are able to be subjected to tests for language development. Language development was compared between 26 prelingually-deafened children who had received cochlear implants at Okayama University and 184 cochlear implant users enrolled in the Research on Sensory and Communicative Disorders (RSCD) project. The demographic background demonstrated a significantly wider prevalence of subjects who had undergone newborn hearing screening and earlier commencement of interventions in our group. Significantly better achievement of Japanese Language skills was observed in our group, although no significant differences were observed in the results of domain-based language tests. Systematic approaches from early identification to cochlear implantation may allow better academic achievement among school-aged cochlear implant users.
In this study, we report on the problems that hearing-impaired children might be expected to face after entering school. Twelve infants with cochlear implants underwent language training based on the Kanazawa method. (1) Seven out of eight children had learned more than 3,000 written words before they entered school: the learning pattern in which children first master written language and successfully move to the stage of auditory-oral language. These seven children had little difficulty in learning at school, which indicated that the written language learned during infancy effectively helped these children using a cochlear implant. (2) Children who had first learned sign or written language and had difficulty moving to auditory-oral language faced several problems in language learning at school. (3) We concluded that children using a cochlear implant are also required to develop sufficient language ability prior to entering school. (4) It is necessary to conduct a proper assessment and provide advice on a regular basis even after children have entered school, to help them continue to develop the language ability and improve articulation.
We examined the speech perception abilities in noisy environments of 5 students wearing cochlear implants (CI), and investigated the acoustic environments in first-year students' classrooms. We examined the effect of the acoustic environment on the speech perception abilities of students wearing CIs in normal classrooms, and our findings were as follows. The speech perception abilities in noisy environments among students wearing CIs were better when the Signal-to-Noise Ratio (SN ratio) exceeded +15dB. Thus, students with CIs had difficulty in perceiving speech in normal classrooms, where the average SN ratio is 7.3dB. It was considered that used tennis balls installed under the legs of desks and chairs effectively reduced the noise level in the classrooms, and this was necessary to reduce the background noise in normal classrooms. We considered it necessary to improve equipments in the classrooms, and practical use of the FM system improved the SN ratio and acoustic environment of classrooms. Thus, comprehensive steps are needed to improve the acoustic environment of normal classrooms for students wearing CIs.
Low birth weight has been reported as a risk factor for congenital hearing loss, however, its effect on the Japanese language development remains unclear. This study was aimed at investigating the prevalence of low birth weight infants among children with pre-lingual severe to profound hearing loss and to investigate the characteristics of their Japanese language development. Of 627 hearing-impaired children recruited for this research, 89 children (14.2%) had a low birth weight of under 2,500g. In regard to the results of the Japanese language development tests in these children, the vocabulary development was the same as that in the normal birth weight hearing loss children, whereas the results of syntax development test and communication ability test were significantly inferior to those in the normal birth weight hearing loss children. Furthermore, the scores on the Pervasive Developmental Disorders Autism Society of Japan rating scale (PARS) in the low birth weight hearing loss children were higher than those in the normal birth weight hearing loss children. These results suggested that low birth weight may be a risk factor for hearing loss with pervasive developmental disorders.
Our methodology was based on the neuropsychological findings on speech perception in children with Landau-Kleffner syndrome who showed pure word deafness. In our home-training program, combined use of residual hearing and sign language, accompanied by finger spelling was recommended to the parents to communicate with their deaf children. We believe that the emotionally stable relationship between the parents and their deaf children which is established through manual communications is indispensable to facilitate language acquisition in the deaf child. Participants of the present study were 27 deaf children who had received cochlear implantation in preschool age. They included 15 children placed in regular primary schools, 10 children in schools for the deaf, one in a special support class attached to a regular school, with approval for postponement of school entry because of physical problems obtained for the remaining one. The follow up studies made in April, 2011 demonstrated that although the children began to acquire language skills through sign language, the manual communication skills gradually changed to auditory-oral communication in 24 of the 27 children after cochlear implantation, while the remaining three continued to use sign language. One of the latter three had auditory neuropathy and the remaining two showed autistic behavioral disorder. These findings suggest that as far as our top-down approach is concerned, manual communication does not interfere with the development of auditory-oral communication in children with cochlear implants.