The estimated incidence of sensorineural hearing impairment (>40 dB HL) at birth is 1.86 per 1000 newborns in developed countries and 30-40% of these are unilateral. Profound sensorineural unilateral hearing impairment or single sided deafness (SSD) can be treated with a cochlear implant. However, this treatment is costly and invasive and unnecessary in the eyes of many. Very young children with SSD often do not exhibit language and cognitive delays and it is hard to imagine that neurocognitive skills will present difficulties with one good ear. In the current paper we review the most recent evidence on the consequences of unilateral hearing impairment for auditory and neurocognitive factors. While data of both adults and children are discussed, we focus on developmental factors, congenital deafness and a window of opportunity for intervention. We discuss which etiologies qualify for a cochlear implant and present our multi-center prospective study on cochlear implants in infants with one deaf ear. The large, state-of-the art body of research allows for evidence-based decisions regarding management of unilateral hearing loss in children.

The Language ENvironment Analysis system (LENA™) automatically analyzes the natural sound environments of children. Among other things, it estimates the amounts of adult words (AWC), child vocalizations (CV), conversational turns (CT), and electronic media (TV) that a child is exposed to. To assess LENA's reliability, we compared it to manual transcription. Specifically, we calculated the correlation and agreement between the LENA estimates and manual counts for 48 five-min audio samples. These samples were selected from eight day-long recordings of six Dutch-speaking children (ages 2-5). The correlations were strong for AWC, r =  . 87, and CV, r =  . 77, and comparatively low for CT, r =  . 52, and TV, r =  . 50. However, the agreement analysis revealed a constant bias in AWC counts, and proportional biases for CV and CT (i.e., the bias varied with the values for CV and CT). Agreement for detecting electronic media was poor. Moreover, the limits of agreement were wide for all four metrics. That is, the differences between LENA and the manual transcriptions for individual audio samples varied widely around the mean difference. This variation could indicate that LENA was affected by differences between the samples that did not equally affect the human transcribers. The disagreements and biases cast doubt on the comparability of LENA measurements across families and time, which is crucial for using LENA in research. Our sample is too small to conclude within which limits LENA's measurements are comparable, but it seems advisable to be cautious of factors that could systematically bias LENA's performance and thereby create confounds.

This study showed differences between children with SSD and NH children on several language skills and on auditory behaviour. Possibly, early intervention could prevent such language difficulties and minimise problems with spatial hearing and speech understanding.

ERPEvent-related potentials HLJ Hand laterality judgement RRN Rotation-related negativity AIM Motor imagery refers to the mental simulation of a motor action without producing an overt movement. Implicit motor imagery can be regarded as a first-person kinesthetic perceptual judgement, and addresses the capacity to engage into the manipulation of one's body schema. In this study, we examined whether children with unilateral cerebral palsy (CP) are able to engage in implicit motor imagery.METHOD A modified version of the hand laterality judgment task was employed. Erroneous responses, reaction times, and event-related potentials from the electroencephalograph were analysed.RESULTS In 13 children with typical development (mean age 10y 7mo, SD 1y 2mo; seven male, six female), we observed the classic rotation direction effect. Specifically, when comparing outward rotated with inward rotated hand pictures, decreased accuracy and increased response times were observed. Event-related potentials analyses of the electroencephalogram revealed a more marked N1 and an enhanced rotation-related negativity.INTERPRETATION These findings suggest that an implicit motor imagery strategy was used to solve the task. However, in 10 children with unilateral CP (mean age 10y 7mo, SD 2y 5mo; five male, five female), these effects were observed only when the less-affected hand was involved. This observation suggests that children with CP could benefit from visual training strategies.Cerebral palsy (CP) describes a group of permanent disorders of movement and posture that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain.

Acknowledgements:We would like to thank the children and their parents for participation in the study. Cochlear Ltd is gratefully acknowledged for providing for the cochlear implants and the clinical mapping. Marie Gerits, Liesbeth Lecleir, Caroline Mahy and Tinne Scheldeman are gratefully acknowledged for their help in collecting the data.