title: Narrative skills following early confirmation of permanent childhood hearing impairment.
abstract: OBJECTIVE
  the aim of this study was to compare spoken language production in children with permanent childhood hearing impairment (PCHI) whose PCHI was confirmed either early or late.
  
  
  METHODS
  audio-taped spoken narrative was assessed for syntax, phonology, morphology, and narrative in transcripts from a population-based sample of 89 children (49 males, 40 females; age mean age 7y 7mo, SD1y 1mo, range 6y 6mo-10y 9mo) with bilateral PCHI (≥ 40dB hearing loss) and a comparison group of 63 children (37 males, 26 females; mean age 8y 1mo; SD 1y) with normal hearing. Of the 89 children with PCHI, 41 (21 males, 20 females) had their hearing impairment confirmed by the age of 9 months. All children with PCHI were tested with hearing aids in place, including 16 with cochlear implants. The group of children whose PCHI had been confirmed by age 9 months was compared with the group with later confirmation of PCHI using regression models on the outcome measures.
  
  
  RESULTS
  compared with those with late-confirmed PCHI, children with early-confirmed PCHI used significantly more sentences (mean difference 2.7; 95% confidence interval [CI] 0.49-5.24; p=0.019) and categories of high-pitched morphological markers (mean difference 6.64; 95% CI 1.96-11.31; p=0.006). The number of categories of low-pitched morphological markers, phonological simplifications, and sentences with multiple clauses did not differ between groups. The odds ratios (95% CI) of superior narrative structure and narrative content in children whose PCHI was confirmed early were 3.03 (1.09-8.46; p=0.034) and 4.43 (1.52-12.89; p=0.006) respectively.
  
  
  CONCLUSIONS
  early confirmation compared with late confirmation of PCHI was associated with benefit to narrative skills and to certain expressive aspects of syntax and morphology, but not expressive phonology.
authors.affiliation: Clinical Neurosciences, School of Medicine, University of Southampton, Southampton, UK. smw3@soton.ac.uk
authors.forename: Sarah
authors.initials: S
authors.lastname: Worsfold
authors.forename: Merle
authors.initials: M
authors.lastname: Mahon
authors.forename: Ho Ming
authors.initials: HM
authors.lastname: Yuen
authors.forename: Colin
authors.initials: C
authors.lastname: Kennedy
mesh_terms: D000367:Age Factors; D002648:Child; D004739:England; D005260:Female; D034381:Hearing Loss / Q000175:diagnosis / Q000523:psychology; D006801:Humans; D007231:Infant, Newborn; D007802:Language; D008037:Linguistics; D008297:Male; D033262:Narration; D015997:Neonatal Screening; D012720:Severity of Illness Index; D012813:Sign Language; D013060:Speech