Associations between Auditory Capacity, Speech and Language, Level of Communication and Parental Assessment of Children with Cochlear Implant

The timeline of non-vocal and vocal communicative skills in infants with hearing loss

Objective

The study investigates what is the link between early verbal and non-vocal abilities, when does predominantly verbal communicative style occur after the intervention with cochlear implants (CI) or hearing aids (HA), and how predictive it is of later linguistic development in deaf and hard of hearing (DHH) infants and children.

Methods

Cohort: children with moderate-to-profound hearing impairment (N = 49, 20 girls, mean age at HA or CI intervention = 15 months, range: 4-35 months).

Measures

Receptive and productive vocabulary at 24 and 36 months and video analysis at 12 months post-intervention. Analysis: Predictive values of total and verbal responses to communicative turns for later vocabulary development were assessed, as well as the relative time course of the development of vocal/verbal communication in DHH children.

Results

Vocabulary at 24 months is predicted by auditory responses at 12 months, as well as by overall responsiveness before intervention. Non-vocal responses decline and overall verbal responses increase significantly between 6 and 12 months after intervention. The trend is delayed in children with delayed (>12 months of age) treatment with CI or HA.

Conclusions

Age of intervention affects the development of vocal/verbal communicative style. Language development, in particular, vocabulary growth, can be further stimulated by the enhancement of preverbal (both vocal and non-vocal) communicative skills.

Cochlear Implantation Outcomes in Pediatrics with Inner Ear Malformations in a Tertiary Care Hospital in Ahvaz

Cochlear implantation (CI) has been successful in individuals with sensorineural hearing loss (SNHL) over the last few years. This study assessed the auditory and speech performance results of pediatrics with inner ear malformations (IEMs) following cochlear implantation at the Ahvaz cochlear implantation center and compared the outcomes of various malformations. All pediatrics with IEMs undergoing CI were included in the study. This retrospective study was performed on pediatrics with congenital IEMs who underwent cochlear implantation in Ahvaz cochlear implantation center between 2014 and 2019. The Category of Auditory Performance (CAP) and the Speech Intelligibility Rating (SIR) scores are two of the most frequently administered tests. The CAP with ranging from 0 (displays no awareness of environmental sounds) to 7 (can use the telephone with a familiar talker), was used to measure the speech perception performance of the implanted children. Furthermore, SIR consists of five performance categories ranging from "prerecognizable words in spoken language" to "connected speech is intelligible to all listeners". Finally, the study included 22 patients. The evaluation of the CT-Scan revealed three types of inner ear malformation: Incomplete Partition (IP)-I in 2 (9.1%), IP-II in 12 (54.5%), and common cavity in 8 (36.4%) individuals. The results were shown that the median CAP score preoperative was 0.5 (interquartile range (IQR): 0-2) and postoperative was 3.5 (IQR: 3-7). There were statistically significant differences in CAP scores between preoperative and second-year follow-up postoperative (p value = 0.036). The results were shown that the median SIR score preoperative was 1 (IQR: 1-5) and postoperative was 2 (IQR: 1-5). There were statistically significant differences in SIR scores between preoperative and second-year follow-up postoperative (p value = 0.001). Following a thorough preoperative screening, patients with specific IEMs can be candidates for CI and not a contraindication. There were statistically significant differences in CAP and SIR scores between preoperative and second-year follow-up postoperative in the common cavity and IP-II groups.

Brain MRI findings of prelingually deaf children and cochlear implant outcome: Preliminary results

OBJECTIVE

To estimate the incidence of brain abnormalities in a cohort of prelingually deaf children and whether these abnormalities can impact the hearing outcomes of patients eligible for cochlear implantation (CI).

METHODS

We performed a retrospective review of consecutive medical charts of prelingually deaf children under 12 years of age who underwent brain magnetic resonance imaging (MRI) during their preoperative workup for CI surgery. We used the category of auditory performance (CAP) test and the speech intelligibility rating (SIR) test to assess the hearing and speech performance of the children, respectively.

RESULTS

The MRIs of 285 patients, 174 boys and 111 girls with a mean age of 36.4 (±16) months, were evaluated for this study. We identified 31 patients with abnormal findings (10.88%): (17/31) (54.8%) had MRI brain abnormalities, (9/31) (29%) had inner ear anomalies, and (5/31) (16.1%) had both inner ear and brain abnormalities. The most frequent inner ear anomaly was an enlarged vestibular aqueduct, while white matter lesions were the most common brain abnormality. The CAP and SIR mean score of patients with inner ear anomalies was slightly, but not significantly, higher than those of patients with brain abnormalities.

CONCLUSION

CAP and SIR scores were not significantly different in children with brain abnormalities than inner ear anomalies. These patients can still benefit from CI to improve their overall hearing and speech performance.

Assessment of Communication Abilities in Four Children with Early Bilateral CIs in Clinical and Home Environments with LENA System: A Case Report

Children’s language acquisition is underpinned by the quantity and quality of linguistic stimulation. Early diagnosis and cochlear implantation (CI), along with a family-centered intervention, are regarded as critical factors in providing appropriate language stimulation and thus supporting successful language outcomes in children with sensory neural hearing loss (SNHL). Considering the lack of tools to assess early language skills and open issues regarding the early predictors of CI outcomes, our goal was to evaluate the potential usability of the Language ENvironment Analysis (LENA) system as an early assessment and/or predictive tool. Clinical video recordings, LENA home recordings, and vocabulary scores were used to assess the progression of communication abilities of four children with CIs (6–35 m.o.). The data revealed a positive correlation between the estimated mean length of utterance (EMLU), vocal conversational turns (CT) in clinical video recordings, and receptive vocabulary, as well as the CT count in LENA being a significant predictor of productive vocabulary. These findings lead us to conclude that the LENA system has the potential to be used as an additional (tele-)measure in the early assessment of communication abilities of children with CI, as well as as a tool in the research of early predictors of CI outcomes.

A study of self-perception and communication success as perceived by adolescents with cochlear implants and their significant others

OBJECTIVES

The objectives of this prospective, cross-sectional study were to compare self-perception and communication-success ratings of adolescents with cochlear implant (AWCI) and their caregivers (C-AWCI) and to explore associations with age at CI, implant age, and chronological age.

METHOD

Fourteen CI centers across India participated. The Think About it Quiz (TAIQ), Self Assessment of Communication-Adolescent (SAC-A), and Significant Other Assessment of Communication-Adolescent (SOAC-A) were translated into five languages. Data were collected from 173 AWCI aged 10;0-19;6 years and an associated caregiver for each participant.

RESULTS

On the TAIQ, self-ratings by AWCI were significantly lower than the ratings by C-AWCI. Peer acceptance correlated with athletic competence for both groups. For the SAC-A versus SOAC-A, there was no significant difference between AWCI and C-AWCI ratings. Except for a negative correlation between peer-acceptance and chronological age for caregiver ratings, no other associations were found between any other ratings and age at CI, implant age, and chronological age.

CONCLUSIONS

Caregiver judgments of their adolescents with CI were not in equal agreement with self-ratings by the adolescents across various aspects of performance. Caregivers appeared to underestimate the self-perception issues faced by adolescents with CI but had excellent agreement with their adolescents' self-rating of communication success. The inclusion of activities to improve children's participation in sports could possibly improve peer acceptance.

Cochlear implantation in children with white matter lesions: Prediction of hearing outcomes by multiple regression analysis

Brain magnetic resonance imaging (MRI) white matter lesions have been reported in some preoperative cochlear implant children. However, the role of white matter lesions in predicting the hearing outcome is yet unclear. The present study investigated the outcomes of cochlear implantation (CI) in 40 children with white matter lesions.The data from children with white matter lesions were reviewed in this retrospective study. Based on brain MRI, the patients were divided into 3 groups: mild, moderate, and severe. The children were treated with unilateral CI and monitored for a follow-up period of at least 3 years. The main outcome measures were category of auditory performance (CAP) and speech intelligibility rating (SIR). MRI white matter lesions, age at implant, gender, physical impairment, and cognitive impairment were obtained from a research database to assess the correlation with long-term CAP and SIR outcome by multiple regression analysis.The data of children with white matter lesions were reviewed (18 females and 23 males). The mean age at implantation was 31.6 months. Strikingly, all children obtained better CAP and SIR scores. The age at implantation, brain white matters lesions on MRI, and cognitive and physical disabilities were associated with CAP and SIR scores. Multiple regression established a weak correlation between the degree of white matter lesions on brain MRI and long-term CAP and SIR, while cognitive impairment strongly accounted for long-term CAP and SIR outcome.The majority of the children with brain white matter lesions obtained a satisfactory postoperative effect. The cognitive impairment before CI is a major factor, and such factor should be considered.

Cochlear implant outcomes in children with attention-deficit/hyperactivity disorder: Comparison with controls

OBJECTIVES

The coincidence of attention-deficit/hyperactivity disorder (ADHD) and hearing loss in the children has adverse effects in speech, cognition, communication and motor development. This can influence cochlear implant (CI) outcomes negatively. The aim of this study was to compare auditory, language, speech, cognition, communication and motor outcomes between CI children with versus without ADHD.

METHODS

Nineteen CI children with ADHD and twenty-three age and gender matched children without ADHD at the Shiraz CI center ranging in age from 37 to 60 months were participated in this cross-sectional study. The developmental quotient in auditory, receptive and expressive language, speech and cognition skills was evaluated through Newsha Developmental Scale. The Persian version of the Ages and Stages Questionnaire (ASQ) was used to assess children's developmental status in fine and gross movements, communication, problem solving, and personal-social domains. A comparison of the results between two groups was made by the Mann-Whitney test.

RESULTS

CI children with ADHD had significantly lower Newsha developmental quotients in cases of auditory, receptive and expressive language, speech and cognition skills compared to the control group (P = 0.027 to <0.001). A significant difference was observed between children with and without ADHD in fine and gross movements, communication, problem solving, and personal-social domains of ASQ at 60 months (P = 0.029 to 0.003).

CONCLUSION

Children with ADHD showed decreased ability in auditory, language, speech, cognition, motor and communication skills following CI compared to children without ADHD. It can guide clinician to provide these children with more specific rehabilitation program to improve their skills.

Tele-intervention for children with hearing loss: A comparative pilot study

Introduction This pilot study compared tele-intervention to conventional intervention for children with hearing loss in terms of communication performance, parental perceptions and clinician perceptions. Methods A within-subject design was employed, including 10 children with hearing loss and their parents who each received a structurally similar tele-intervention and conventional intervention session in a counterbalanced manner. Quality of communication performance was analysed using a modified Tait video analysis method. Parent and clinician perceptions were collected through rating-scale surveys and thematic analysis of qualitative responses. Results No significant difference ( p > 0.05) was found between tele-intervention and conventional intervention in terms of communication performance of children. Parent perceptions were not significantly different ( p > 0.05) between conventional and tele-intervention in terms of facilitating meaningful communication interaction. Significant differences were evident for parents' comfort level during the session, whether they found it to be a beneficial experience and whether they would like to continue receiving intervention through this method.  Clinician perceptions of conventional and tele-intervention were not significantly different ( p > 0.05) and tele-intervention was deemed a valuable method of service delivery for clients. Discussion This study provides preliminary evidence that tele-intervention is effective for communication intervention and can be a valuable solution to typical barriers such as distance and the shortage of trained interventionists.

Hindi language tool for assessing pediatric cochlear implant recipients

INTRODUCTION

Presently, in India, western material is mainly used for the assessment and planning of habilitation activities for paediatric cochlear implant (CI) recipients. There is no assessment material available in Hindi. Therefore, the present study aimed to develop a parental questionnaire to assess auditory, speech and language skills of paediatric CI recipients in Hindi language for the age range of 3-7 years.

METHOD

Most commonly used assessment material/curricula used in Indian cochlear implant clinics and primary school Hindi language teachers were consulted during the development of the parental questionnaire. The developed questionnaire was then given to the parents of 50 normal hearing, Hindi speaking children in the age range of 3-7 years, five experienced speech and language pathologist working in the field of paediatric CI and to the same primary school Hindi language teachers who were consulted in the beginning to validate the content of the questionnaire. Based on the feedback from parents, personal observations and views from other professionals, the questionnaire was modified to incorporate the suggestions and the questionnaire was finalized. The final questionnaire has three subtests (1, 2 and 3) to assess auditory, language and speech skills of the CI recipients respectively. The final questionnaire was given to the Hindi speaking parents of 50 CI recipients in the age range of 3-7 years who fulfilled the eligibility criteria. Both the parents were asked to fill the final questionnaire together in the clinic at 0 (switch-on), 1, 6 and 12 months post switch-on of the implant.

RESULT AND DISCUSSION

All the cochlear implant recipients could be evaluated by the questionnaire and none of the recipient scored zero on the questionnaire at any time interval. The developed questionnaire had shown high reliability and internal consistency producing alpha values of 0.9201, 0.7425 and 0.9311 for the subtest 1, 2 and the entire questionnaire respectively. The alpha value was not calculated for subtest 3 as it was a rating scale and not much variation was noticed in this section.

Cochlear implant after bacterial meningitis

BACKGROUND

The aim of this retrospective case study at a tertiary referral center was to investigate the outcome of cochlear implantation (CI) in children with sensorineural hearing loss due to meningitis compared to CI in children with deafness due to other reasons.

METHODS

This post-meningial group (PMG) consisted of 22 children undergoing CI due to deafness induced by meningitis, between December 1996 and January 2012. Five children had bilateral simultaneous implantation. None was excluded and the children were followed for at least 3 years. Operations were carried out by one of two surgeons using similar techniques in all cases. Each patient from the PMG was matched 2:1 with children having implantation for other reasons according to age and follow up (control group).

RESULTS

Overall, the median category of auditory performance (CAP) and speech intelligibility rating (SIR) score were not statistically significantly different between the two groups. The presence of additional central nervous system (CNS) disorders (post-meningeal sequelae), however, correlated significantly with poorer outcome

CONCLUSIONS

CI was a safe procedure without surgical complications in the present study. It is possible to restore auditory capacity and speech performance to a degree comparable to children undergoing implantation for other reasons. A statistically important variable is secondary CNS involvement. The rehabilitation program after CI should be adjusted according to these additional handicaps. It is recommended to screen meningitis patients as fast as possible to identify those with hearing loss and initiate treatment with hearing aids or CI.

Factors that influence the participation of parents in the oral rehabilitation process of children with cochlear implants: a systematic review

PURPOSE

To identify and analyze factors that influence the participation of parents in the rehabilitation process of children with cochlear implants (CI).

RESEARCH STRATEGY

Question formulation and articles selection in three databases using the following keywords: cochlear implant (implante coclear) and parents (pais).

SELECTION CRITERIA

Complete original articles published in Brazilian Portuguese or English, with direct participation of parents of children with CI.

DATA ANALYSIS

Articles were fully read. Data regarding characterization of the centers, research methodology and content were analyzed.

RESULTS

Thirteen articles were selected based on the established criteria. The types of studies were cross-sectional and case-control (interview technique). The following influential factors were identified: pre-CI surgery factors (knowledge about CI, quality and quantity of information, specialist's advices, ethical and biomedical aspects, rehabilitation engagement, contact with experienced families, social service support and overall costs); rehabilitation aspects (CI use, oral communication modality, regular school, other disabilities, social and demographic aspects and rehabilitation program's effectiveness); other important influential processes (communication modality, auditory and language development, second oral language learning, as well as parent's behavior and satisfaction).

CONCLUSION

The engagement of parents in the rehabilitation process of children with CI depends on several distinct influential factors which audiologists should understand and consider when elaborating a rehabilitation program.