Language development and hearing impairment: literature review

ABSTRACT:

The purpose of this study is to review the scientific production about the relationship between language performance and hearing impairment, as well as analyze the observational studies on the subject. It is a literature review, in which it was used the descriptors "Hearing Loss", "Child Language", "Language", "Phonology" and "Vocabulary" in the databases Capes Portal , Bireme, SciELO and Pubmed during the period of July-December 2012. Inclusion criteria were articles available in journals published between 2007-2012. Criterion for exclusion was not having as main focus the acquisition / development of language in children and / or adolescents with hearing impairment. The analytical observational studies were checked by means of 22 items related to information that should be present in the title and abstract, introduction, methods, results and discussion, recommended by the STROBE initiative (Strengthening the Reporting of Observational Studies in Epidemiology). 26 articles were found, which were separated into the following themes: oral language, written language and reading and literature review. It was found that many articles mention the benefits of shorter time of sensory deprivation as well as the longest speech therapy and increased use of Individual hearing aids or cochlear implant. The data analysis through the STROBE initiative points out that most of the analyzed papers presented necessary information, especially in the items title and abstract and introduction. The scientific works studied in the literature review revealed that there are no protocols with specific normal standards for individuals with hearing impairment.

KEYWORDS:
Speech, Language and Hearing Sciences; Hearing Loss; Child Language; Child

RESUMO:

Este estudo tem como objetivo revisar as produções científicas acerca das relações entre desempenho da linguagem e deficiência auditiva, assim como analisar os estudos observacionais sobre a temática. Trata-se de revisão de literatura, no qual foram utilizados os descritores "Hearing Loss", "Child Language", "Perda Auditiva", "Linguagem", "Fonologia" e "Vocabulário" nas bases de dados do Portal Capes, Bireme, Scielo e Pubmed no período de julho a dezembro de 2012. Os critérios de inclusão foram artigos disponíveis em periódicos publicados no período de 2007 a 2012. Foi critério de exclusão não ter como foco principal a aquisição/desenvolvimento da linguagem de crianças e/ou adolescentes portadores de deficiência auditiva. Os estudos analíticos observacionais foram verificados por meio de 22 itens relacionados a informações que deveriam estar presentes no título, resumo, introdução, metodologia, resultados e discussão, recomendados pela iniciativa STROBE (Strengthening the Reporting of Observational Studies in Epidemiology). Foram encontrados 26 artigos, que foram separados em eixos temáticos, sendo linguagem oral, linguagem escrita e leitura e revisão de literatura. Verificou-se que muitos artigos mencionam os benefícios do menor tempo de privação sensorial, bem como do maior tempo de terapia fonoaudiológica e maior uso do Aparelho de Amplificação Sonora Individual ou Implante Coclear). A análise dos dados por meio da iniciativa STROBE aponta que a maioria dos artigos analisados apresentou informações necessárias, principalmente nos itens título e resumo e introdução. As produções científicas estudadas revelam que ainda não há protocolos com padrões de normalidade específicos para indivíduos com deficiência auditiva.

DESCRITORES:
Fonoaudiologia; Perda Auditiva; Linguagem Infantil; Criança

Introduction

The hearing plays an essential role in acquisition and development of language. Thus, considering the communication field, the hearing loss can be held as an important biological factor causing significant delay in child development¹.

Thereby, it is important that there be an early diagnostic and language intervention, in order to bring the hearing development of these individuals to the normality. The language development in child with hearing impairment happens in a heterogeneous manner. However, it is necessary to improve the knowledge about the development process. There are a few standard protocols in Brazil for language assessment of child with hearing impairment, being often used standard protocols for hearing children.

The use of individual hearing aids has favored a greater exploitation of hearing, minimizing the impact of hearing impairment in the process of acquisition and development of language, and consequently, of the orality of child with hearing loss².

It is known that language is a social tool that is used in social interactions with the purpose of communication³. The difficulties in language are concern to alterations in the expression development and verbal reception and writing. Thus the necessity of early identification of these alterations in the normal development avoids subsequent educational and socials unfavorable effects³.

The study of language development in child with hearing impairment using individual hearing aids assess the oral and writing skills, as well as its alterations. It has been used various protocols to assess these development, regarding vocabulary, phonology, pragmatic, speech recognition, auditory discrimination, among others. These assessments make it possible to know the performance of individuals with hearing impairment and compare them with the patterns of normality, providing an assessment of the effectiveness of the speech therapy intervention.

The purposes of this study were to systematically review the literature about the relationship between language development and hearing impairment and analyze the observational researches published about it with reference on the STROBE initiative.

Methods

It is a systematically review of literature that had the following guide question: How is it the acquisition and development of language in a person with hearing impairment?

After the guide question definition, it was realized two stages for the construction of this review. In the first stage, it were realized the following steps: identification of the topic, definition of the keywords, literature search, categorization of the studies, assessment of the studies included in the review, interpretation of the results and synthesis of the knowledge highlighted in the analyzed articles, as proposed in literature^4),(5.

It were performed searches in the databases LILACS and PubMed for access to indexed journals in MEDLINE, and search in the database SciELO about the subject of interest during the period of 2007 to 2012. The search was carried out in the period of July-December 2012. It were used the descriptors in health science created by bireme: "hearing", "Child Language", "hearing loss", "Language", "Phonology" and "Vocabulary" in Portuguese, English and Spanish.

The inclusion criteria were: researches realized with children and / or adolescents with hearing impairment or that has the main focus in the language development of these population; articles in English, Spanish or Portuguese; complete original articles.

The exclusion criteria were: not has as main focus the language development of children and/or adolescents with hearing impairment; opinion articles, letter to the editor and dissertation and thesis.

The initial search appointed 4.069 articles, which 355 were selected for analysis following the inclusion criteria. After reading the title and abstract, 33 articles remained and were read in their entirely. In the first stage (application of the first evidence matrix), 26 articles were selected.

In the second stage, it were applied the second evidence matrix (inclusion of observational articles for methodological analysis, 22 observational and analytical studies were included; it were excluded two cases reports, one analytical and experimental study and one literature review.

The data analysis was realized in two stages. The selects articles in the first evidence matrix were critically analyzed in the following thematic bases oral language, writing and reading language and literature review.

In order to optimize the study of the selected articles after the stages above, it was chosen to analyze the observational articles according to STROBE initiative (Strengthening the Reporting of Observational Studies in Epidemiology)⁵. This methodology is made by 22 items related to the information that should be present in the title and abstract, introduction, methods, results and discussion. The STROBE initiative was developed by researchers in epidemiology, statistics, scientific methodology and editors of scientific journal and the main purpose of it is to disseminate the principle that should guide the description of observational studies.

The data collected in the articles analysis by means of STROBE initiative were stored in electronic formats and it was used for data processing and analysis Epi Info 7.1.0.6. It was realized the descriptive analysis of the frequency distribution of the variables and the Fisher Exact Test was used in order to investigate the associations. The significance level adopted was 5%.

Literature review

In the present review, 26 articles were found^2),(6)-(30, being eighteen analytical observational transversal studies^{2),(6)-(9),(12)-(14),(17)-(21),(23),(24),(27)-(29}, four analytical observational longitudinal studies^{10),(11),(16),(22}, two reported case^15),(25) , one experimental study²⁶ and one literature review³⁰, consisting of nineteen national and seven international researches. The articles were separated in thematic bases and distributed in frames to results presentation.

In Figure 1, the methodology and the main conclusions of the articles that had as focus the oral language are presented. In Figure 2, it was discussed the methodology and main conclusion of the articles that studied the elements of writing and reading language.

Figure 1:
synthesis of the studies concerning the researches in oral language of the individual with hearing impairment

Figure 2:
sinthesys of the studies concerning the researchs in writing and reading language of the individual with hearing impairment

The 20 articles that approached oral language^2),(6)-(24 referred to children with diagnosis of hearing loss, but differed on the protocols used to assessment. It is important to highlight that 4 studies of them assessed the communicative abilities^{12),(14),(16),(21} , by means of pragmatic protocols (Pragmatic Tasks of ABFW - Teste de Linguagem Infantil , Communicative Abilities Pragmatic Profiles e MAASE linguistic test) or verbal interactions; others four described the language expression and understanding^{9),(11),(13),(22} using the Reynell Development Language Scales (RDLS) and there were others four articles that have analyzed the vocabulary^{7),(18),(20),(24} by means of different protocols (Vocabulary Tasks of ABFW - Teste de Linguagem Infantil , Peabody Picture Vocabulary Test - PPVT e British Picture Vocabulary Scale -BPVS).

Therefore, it is concluded that in the literature there is no description of one specific and register evaluation for person with hearing impairment. One of the factors that can collaborate to the diversity of protocols used in the language assessment is the age of the children, as many assessment tools restrict their applications to a certain age limit. In turn, the variability of language development of children with hearing impairment can be influenced by a many factors, such as degree of the hearing loss, speech therapy intervention and use of electronic device.

In considering the 26 articles, only five reported specific studies on language field with emphasis on reading and writing^25)-(29 and the assessment protocols and the analysis of the writing productions were varied. Two articles^25),(28 were concerning on analysis of the writing production of deaf individuals and user of Brazilian Sign Language (LIBRAS). Another study²⁶ described an experimental analysis by means of assessment and intervention performed in a group of individuals with hearing impairment that had the Brazilian Sign Language (LIBRAS) as preferred language. Another study²⁷ also approached a survey performed with person with hearing impairment that was submitted to Cochlear Implant, noting the categories that showed orthographic mistakes.

The last article²⁹ presented a research performed with parents and teachers of a regular school that aims to analyze and discuss the literacy practices in children with hearing impairment. The survey was developed by means of interviews with the parents, open and closed questions, about their vision in relation to school education and literacy of their child, and questionnaire to the teachers about school education in the context of inclusion and the process of reading and writing. This research concluded that the practices of reading are restrict in the familiar environment, while in the school the textbook is used during the reading and writing, and there is no diversification. It is important to highlight that few studies^{25),(26),(28)} discuss the influence of the language used by the individual with hearing impairment, whether it is LIBRAS or oral language, in their writing productions.

In the search conducted, it was find a systematic review³⁰ with 15 articles related to the long-term use of Cochlear Implant, with the purpose of verifying the effectiveness of the electronic device in developing the communicative abilities in individuals who have grown up using it, revealing the efficacy of it for adequacy the levels of language competence.

It is important to highlight that despite of the variety of test performed in the survey, there are no protocols with reference standards specifics for individuals with hearing impairment, in order to analyze the language development of child in your hearing condition. Therefore, it is necessary the development of studies to provide the specific protocols for these individuals.

In Tables 1 to 4, it is presented the analysis of the observational articles according to STROBE initiative checking the association among the subtopics design of the study, variables, size of the study and statistical methods with the topics title and abstract, introduction, results and discussion.

Table 1:
analysis of the association between the articles that described the study design and the others items of Strobe initiative

Table 2:
analysis of the association between the articles that described the variables of the study and others items of Strobe initiative

Table 3:
analysis of the association between the articles that described the sample size and others items of Strobe initiative

Table 4:
analysis of the association between the articles that described the statistical methods and others items of Strobe initiative

The analysis through the Strobe initiative allows us to check the quality of the observational article. The first methodological analysis of the articles referred to the fact of the design of the study present the key elements. In this analysis, there was association between the variables title and abstract and discussion (Table 1). The analysis also showed that 17 articles presented title and abstract incomplete, and 12 of them did not describe completely the design of the study. Although the item result presents more accuracy, it was verify that there are a large number of incomplete designs. It is important highlight that the fussy detail of the study is essential for the reproducibility and understanding of it.

The sub-item variables, contained in the item methodology, it is related to the description of the elements that can confuse and/or modify the finds of the research. It was observed that the most of the study showed the entire description of the variables (Table 2). When comparing the result, it was notice that all researches that presented the full description of the variables, also presented the entire results. However, there is no statistically significant association among the variables and the title and abstract, introduction, results and discussion.

The item size of the study referred to the detail of the criteria and data of calculation the sample size. There was no association between the variable title and abstract and the variables results and discussion (Table 3). However, it is important to highlight that 14 of the 20 studies that had the full results, described the sample size completely. Nevertheless, it was verified that eight articles described the sample size incompletely, setting 36% of the studies approaches in this research. The sample size must be defined according to the aim of the study. The choice and describe of the method according to the literature³¹ enable a qualitative and effectiveness planning of the study, allowing the investigation of researchers.

Noting the association between the articles that describe the statistical methods and the selected variables, it was observed that there was no statistically significant association. All studies that described the statistical methods also describe the results completely (Table 4). However, there were six articles that described the statistical method incompletely, being affected the analysis of the studied population. The use of appropriate methods and techniques enables to find truthful results, and when properly described, provides information for studies with similar methodology³².

According to the literature³³, the scientific methodology specifies the appropriate path to the knowledge construction and cooperates to the reproducibility of the study, when adequately described. The STROBE initiative provides the list to verification of the items that should be present in the observation studies, contributing to the more accuracy of the researches and reproducibility of the studies. Furthermore, it also propitiates the critical analysis and the state-of-the-art of the production and knowledge.

Conclusion

The article analysis showed that language development is related to the development of auditory skills. Hearing impairment results in losses for language development and the greater is the degree of the hearing loss, the greater is the difficulty of speech perception and discrimination and language deficits.

The scientific documents analyzed also revealed a great variety of tests used on language assessment. However, it is observed that there are no protocols with patterns of normality specific to a person with hearing impairment, in order to analyze the language development of child in your hearing condition.

In relation to methodological analysis, it was observed that the majority of the articles presented the essentials information, especially in title and abstract and introduction.

Referências

• ¹
  Carvalho LS, Carvalheiro LG. Detecção precoce e intervenção em crianças surdas congênitas inseridas em escolas especiais da cidade de Salvador/ BA. Arq Int Otorrinolaringol. 2009;13:189-94.
• ²
  Moret ALM, Bevilacqua MC, Costa AO. Implante Coclear: audição e linguagem em crianças deficientes auditivas pré-linguais. Pró-Fono R Atual Cient. 2007;19:295-304.
• ³
  Shirmer CR, Fontoura DR, Nunes ML. Distúrbios da aquisição da linguagem e da aprendizagem. J Pediatr. 2004;80:95-103.
• ⁴
  Pompeo DA, Rossi LA, Galvão CM. Revisão integrativa: etapa inicial do processo de validação de diagnóstico de enfermagem. Acta Paul Enferm. 2009;22(4):434-8.
• ⁵
  Malta M, Cardoso LO, Bastos FI, Magnanini MMF, Silva CMFP. Iniciativa STROBE: subsídios para a comunicação de estudos observacionais. Rev Saúde Pública. 2010;44(3): 559-65.
• ⁶
  Zanichelli L, Gil D. Porcentagem de Consoantes Corretas (PCC) em crianças com e sem deficiência auditiva. J Soc Bras Fonoaudiol. 2011;23(2):107-13.
• ⁷
  Ferreira MIO, Dornelas AS, Teófilo MMM, Alves LM. Avaliação do vocabulário expressivo em crianças surdas usuárias da língua brasileira de sinais. Rev CEFAC. 2012;14(1):9-17.
• ⁸
  Angelo TCS, Bevilacqua MC, Moret ALM. Percepção da fala em deficientes auditivos pré-linguais usuários de implante coclear. Pró-Fono R Atual Cient. 2010;22(3):275-80.
• ⁹
  Stuchi R F, Nascimento LT, Bevilacqua MC, Brito Neto RV. Linguagem oral de crianças com cinco anos de uso do implante coclear. Pró-Fono R Atual Cient .2007;19:167-76.
• ¹⁰
  Fernandes DMZ, Lima MCMP, Gonçalves VMG, Françozo MFC. Acompanhamento do desenvolvimento da linguagem de lactentes de risco para surdez. Rev Soc Bras Fonoaudiol. 2011;16(1):30-6.
• ¹¹
  Queiroz CAUF, Bevilacqua MC, Costa MPR. Estudo longitudinal da compreensão verbal de crianças usuárias de implante coclear. Rev CEFAC. 2010;12(2):210-5.
• ¹²
  Curti L, Quintas TA, Goulart BNG, Chiari BM. Habilidades pragmáticas em crianças deficientes auditivas: estudo de casos e controles. Rev Soc Bras Fonoaudiol. 2010;15(3):390-4.
• ¹³
  Fortunato CAU, Bevilacqua MC, Costa MPR. Análise comparativa da linguagem oral de crianças ouvintes e surdas usuárias de implante coclear. Rev CEFAC. 2009;11(4):662-72.
• ¹⁴
  Lichtig I, Couto MIV, Leme VN. Perfil pragmático de crianças surdas em diferentes fases linguísticas. Rev Soc Bras Fonoaudiol. 2008;13(3):251-7.
• ¹⁵
  Bastos FN, Fleig R, Nascimento IB. Análise das habilidades auditivas em uma criança deficiente auditiva oralizada e portadora de hiv: estudo de caso. Rev CEFAC. 2010;12(4):700-8.
• ¹⁶
  Sousa NA, Quadros RM. Uma análise do fenômeno "alternância de línguas" na fala de bilíngues intermodais (Libras e Português). ReVEL. 2012;19(10):327-46.
• ¹⁷
  Quadros RM, Cruz CR, Pizzio AL. Memória fonológica em crianças bilíngues bimodais e crianças com implante coclear. ReVEL. 2012;19(10):185-212.
• ¹⁸
  Geers AE, Sedey AL. Language and Verbal Reasoning Skills in Adolescents with 10 or More Years of Cochlear Implant Experience. 2011;32(1 Suppl):39S-48S.
• ¹⁹
  Fagan MK, Pisoni DB. Hearing Experience and Receptive Vocabulary Development in Deaf Children With Cochlear Implants. JDSDE. 2010;15(2):149-61.
• ²⁰
  Edwards L, Figueras B, Mellanby J, Langdon D. Verbal and Spatial Analogical Reasoning in Deaf and Hearing Children: The Role of Grammar and Vocabulary. JDSDE. 2011;16(2):189-97.
• ²¹
  Most T, Shina-August E, Meilijson S. Pragmatic Abilities of Children With Hearing Loss Using Cochlear Implants or Hearing Aids Compared to Hearing Children. JDSDE. 2010;15(4):422-37.
• ²²
  Niparko JK, Tobey EA, Thal DJ, Eisenberg LS, Wang NY, Quittner AL et al. Spoken Language Development in Children Following Cochlear Implantation. JAMA. 2010;303(15):1498-506.
• ²³
  Sarant JZ, Holt CM, Dowell RC, Rickards FW, Blamey PJ. Spoken Language Development in Preschool Children With Permanent Childhood Hearing Loss. JDSDE. 2009;14(2):205-17.
• ²⁴
  Houston DM, Miyamoto RT. Effects of Early Auditory Experience on Word Learning and Speech Perception in Deaf Children With Cochlear Implants: Implications for Sensitive Periods of Language Development. Otology & Neurotology. 2010;31(8):1248-53.
• ²⁵
  Guarinello AC, Massi G, Berberian AP. Surdez e linguagem escrita: um estudo de caso. Rev Bras Ed. Esp 2007;13(2):205-18.
• ²⁶
  Cárnio MS, Csipai ES, Couto MIV. Relação entre níveis de compreensão e estratégias de leitura utilizadas por surdos sinalizadores em um programa terapêutico. Rev Soc Bras Fonoaudiol. 2010;15(2):206-12.
• ²⁷
  Lemes JP, Goldfeld M. Análise da ortografia de crianças usuárias de implante coclear. Rev Soc Bras Fonoaudiol. 2008;13(3):79-89.
• ²⁸
  Crato NA, Cárnio MS. Análise da flexão verbal de tempo na escrita de surdos sinalizadores. Rev Bras Ed. Esp. 2009;15(2):233-50.
• ²⁹
  Schemberg S, Guarinello AC, Santana APO. As práticas de letramento na escola e na família no contexto da surdez: reflexões a partir do discurso dos pais e professores. Rev Bras. Ed Esp. 2009;15(2):251-68.
• ³⁰
  Tanamati LF, Orizombo AC, Bevilacqua MC. Resultados a longo prazo com o uso do implante coclear em crianças: Revisão sistemática. Arq. Int. Otorrinolaringol. / Intl Arch Otorhinolaryngol. 2011;15(3):365-75.
• ³¹
  Trindade DB, Esquivel RM, Amorim LDAF. Tamanho amostral para análise de medidas repetidas em estudos longitudinais. Simpósio Nacional de Probabilidade e Estatística; jul-26-30; São Pedro, São Paulo: Associação Brasileira de Estatística (ABE), 2011.
• ³²
  Silva EL, Menezes EM. Metodologia da pesquisa e elaboração de dissertação. 4. ed. Rev. Atual. Florianópolis: UFSC; 2005.
• ³³
  Amatuzzi MLL, Amatuzzi MM, Leme LEG. Metodologia científica: o desenho da pesquisa. Acta Ortop Bras. 2003;11(1):58-61.

Publication Dates

• Publication in this collection
  Nov-Dec 2015

History

• Received
  01 July 2014
• Accepted
  14 Sept 2014