Elizabeth M Fitzpatrick1, Candyce Hamel2, Adrienne Stevens3, Misty Pratt2, David Moher4, Suzanne P Doucet5, Deirdre Neuss6, Anita Bernstein7, Eunjung Na8. 1. Faculty of Health Sciences and Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; elizabeth.fitzpatrick@uottawa.ca. 2. Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; 3. Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Translational Research in Biomedicine Graduate Program, University of Split School of Medicine, Split, Croatia; 4. Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Epidemiology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; 5. Consultant, Moncton, New Brunswick; 6. Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; Audiology Clinic, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; and. 7. Voice for Hearing-Impaired Children, Toronto, Ontario, Canada. 8. Faculty of Health Sciences and Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada;
Abstract
CONTEXT: Permanent hearing loss affects 1 to 3 per 1000 children and interferes with typical communication development. Early detection through newborn hearing screening and hearing technology provide most children with the option of spoken language acquisition. However, no consensus exists on optimal interventions for spoken language development. OBJECTIVE: To conduct a systematic review of the effectiveness of early sign and oral language intervention compared with oral language intervention only for children with permanent hearing loss. DATA SOURCES: An a priori protocol was developed. Electronic databases (eg, Medline, Embase, CINAHL) from 1995 to June 2013 and gray literature sources were searched. Studies in English and French were included. STUDY SELECTION: Two reviewers screened potentially relevant articles. DATA EXTRACTION: Outcomes of interest were measures of auditory, vocabulary, language, and speech production skills. All data collection and risk of bias assessments were completed and then verified by a second person. Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) was used to judge the strength of evidence. RESULTS: Eleven cohort studies met inclusion criteria, of which 8 included only children with severe to profound hearing loss with cochlear implants. Language development was the most frequently reported outcome. Other reported outcomes included speech and speech perception. LIMITATIONS: Several measures and metrics were reported across studies, and descriptions of interventions were sometimes unclear. CONCLUSIONS: Very limited, and hence insufficient, high-quality evidence exists to determine whether sign language in combination with oral language is more effective than oral language therapy alone. More research is needed to supplement the evidence base.
CONTEXT: Permanent hearing loss affects 1 to 3 per 1000 children and interferes with typical communication development. Early detection through newborn hearing screening and hearing technology provide most children with the option of spoken language acquisition. However, no consensus exists on optimal interventions for spoken language development. OBJECTIVE: To conduct a systematic review of the effectiveness of early sign and oral language intervention compared with oral language intervention only for children with permanent hearing loss. DATA SOURCES: An a priori protocol was developed. Electronic databases (eg, Medline, Embase, CINAHL) from 1995 to June 2013 and gray literature sources were searched. Studies in English and French were included. STUDY SELECTION: Two reviewers screened potentially relevant articles. DATA EXTRACTION: Outcomes of interest were measures of auditory, vocabulary, language, and speech production skills. All data collection and risk of bias assessments were completed and then verified by a second person. Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) was used to judge the strength of evidence. RESULTS: Eleven cohort studies met inclusion criteria, of which 8 included only children with severe to profound hearing loss with cochlear implants. Language development was the most frequently reported outcome. Other reported outcomes included speech and speech perception. LIMITATIONS: Several measures and metrics were reported across studies, and descriptions of interventions were sometimes unclear. CONCLUSIONS: Very limited, and hence insufficient, high-quality evidence exists to determine whether sign language in combination with oral language is more effective than oral language therapy alone. More research is needed to supplement the evidence base.
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