Complications of cochlear implants with MRI scans in different body regions: type, frequency and impact

OBJECTIVES

The aim was to assess the type, frequency and impact of MRI-related complications in patients with cochlear implants (CI) and MRI indications in different body regions.

METHODS

For that purpose, the institutional radiology database of a single tertiary hospital was searched for patients with a CI who underwent MRI between 2001 and 2018. The number of MRI examinations and complications were retrieved from the patient record. Examinations were categorized into five distinct body regions or combinations thereof. Records of CI artifacts in the head also included basic information on diagnostic image quality.

RESULTS

Out of 1017 MRI database entries (examinations) of patients with a CI, 91 records were after implantation (71 patients) and 66 were attempted (no contraindications, 49 patients). In four cases (4/66, 6.1%), the magnet was dislocated and had to be replaced surgically. Three out of four severe complications occurred for examination regions outside the head. Thirteen MRI examinations were aborted due to pain (19.7%) and one because of artifacts-resulting in 48 scans (72.7%) completed successfully (36 patients). All cranial scans featured device artifacts in all sequences, but the majority of them did not affect proper imaging diagnostics in the respective region.

CONCLUSION

This retrospective, single-center analysis of patients with MRI-conditional cochlear implants shows that MRI-related complications were common, at least in models with a fixed magnet, despite appropriate precautions and compliance with the manufacturers' guidelines. MRI examinations of CI patients should therefore be indicated strictly until the exact causes have been clarified.

Listening Difficulties of Children With Cochlear Implants in Mainstream Secondary Education

OBJECTIVES

Previous research has shown that children with cochlear implants (CIs) encounter more communication difficulties than their normal-hearing (NH) peers in kindergarten and elementary schools. Yet, little is known about the potential listening difficulties that children with CIs may experience during secondary education. The aim of this study was to investigate the listening difficulties of children with a CI in mainstream secondary education and to compare these results to the difficulties of their NH peers and the difficulties observed by their teachers.

DESIGN

The Dutch version of the Listening Inventory for Education Revised (LIFE-R) was administered to 19 children (mean age = 13 years 9 months; SD = 9 months) who received a CI early in life, to their NH classmates (n = 239), and to their teachers (n = 18). All participants were enrolled in mainstream secondary education in Flanders (first to fourth grades). The Listening Inventory for Secondary Education consists of 15 typical listening situations as experienced by students (LIFEstudent) during class activities (LIFEclass) and during social activities at school (LIFEsocial). The teachers completed a separate version of the Listening Inventory for Secondary Education (LIFEteacher) and Screening Instrument for Targeting Educational Risk.

RESULTS

Participants with CIs reported significantly more listening difficulties than their NH peers. A regression model estimated that 75% of the participants with CIs were at risk of experiencing listening difficulties. The chances of experiencing listening difficulties were significantly higher in participants with CIs for 7 out of 15 listening situations. The 3 listening situations that had the highest chance of resulting in listening difficulties were (1) listening during group work, (2) listening to multimedia, and (3) listening in large-sized classrooms. Results of the teacher's questionnaires (LIFEteacher and Screening Instrument for Targeting Educational Risk) did not show a similar significant difference in listening difficulties between participants with a CI and their NH peers. According to teachers, NH participants even obtained significantly lower scores for staying on task and for participation in class than participants with a CI.

CONCLUSIONS

Although children with a CI seemingly fit in well in mainstream schools, they still experience significantly more listening difficulties than their NH peers. Low signal to noise ratios (SNRs), distortions of the speech signal (multimedia, reverberation), distance, lack of visual support, and directivity effects of the microphones were identified as difficulties for children with a CI in the classroom. As teachers may not always notice these listening difficulties, a list of practical recommendations was provided in this study, to raise awareness among teachers and to minimize the difficulties.

Impact of Universal Newborn Hearing Screening on cochlear implanted children in Ireland

OBJECTIVES

Cochlear Implant (CI) is an established treatment for severe to profound hearing loss (HL). Early diagnosis and intervention in HL are crucial in order to provide access to sound and increase the likelihood of spoken language development in pre-lingually deaf children. In April 2011, the Health Service Executive (HSE) implemented the Universal Newborn Hearing Screening (UNHS) in a phased regional basis in Ireland. This study aimed to investigate the general clinical pathway for UNHS referrals to the CI service and to evaluate the impact of earlier referrals via UNHS on functional outcomes in children.

METHODS

The first part of this study constituted a retrospective review of 100 children referred to the National Hearing Implant and Research Centre (NHIRC) via UNHS from November 2011 to December 2016. Implanted children referred via UNHS were categorised into three groups according to their medical status. Their clinical pathway to cochlear implantation was evaluated. Functional outcomes were investigated based on medical and developmental status, respectively. In the second part of this study, developmentally healthy implanted children referred post-UNHS were compared with medically healthy children referred pre-UNHS under the age of four, from January 2005 to June 2011. Current implant status of children, age at referral and functional outcomes were investigated.

RESULTS

Medically healthy children were referred to the NHIRC at an earlier age than the medically complex children (2.8 months vs 5.2 months, p < 0.01) and the children presenting with auditory neuropathy spectrum disorder (ANSD) (2.8 months vs 5.3 months, p < 0.01). On average they attended their first appointment and were implanted at a younger age than the ANSD group (6.1 months vs 10.1 months, p < 0.01; 16.3 months vs 29.4 months, p < 0.001, respectively). Developmentally healthy children had significantly better functional outcomes than children with developmental delays. Children referred via UNHS were referred and implanted at a younger age than those referred pre-UNHS. The former group achieved better Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) scores 2 years post-implantation.

CONCLUSION

UNHS in Ireland is an important platform for earlier diagnosis and management of congenital HL and our results show that early intervention has a positive impact on functional outcomes in children.

[General anesthesia influence on cochlear implant intraoperative testing]

In this article, we consider the influence of combined general anesthesia on the results of electrically-involved stapedial reflex threshold (esrt) registration. We pay a special attention to the anesthesia to exclude its influence on the esrt. This study included 52 patients with bilateral chronic neurosensory hearing impairment. We conducted a retrospective (from 2014 to 2016) and prospective (from 2017 to 2018) analysis of anesthesia protocols. Even though the inhaled anesthesia (sevoflurane in this case) has a depressive effect on esrt registration (the higher the minimal alveolar concentration of anesthetic agent, the higher the reflex threshold), our study shows a possibility of using it in an extended anesthesia monitoring. Inclusion of myorelaxants in cochlear implantation anesthesia protocol not only provides a safe anesthesia, but also does not prevent a timely intraoperative cochlear implant testing.

Translation and validation of the Listen Inventory for Education Revised into Dutch

INTRODUCTION

In Belgium the majority of children with CI's are being educated in mainstream schools. In mainstream schools difficult listening situations occur (e.g. due to background noise) which may result in educational risks for children with CI's. A tool that identifies potential listening difficulties, the English Listen inventory for Education Revised (LIFE-R), was translated and validated into Dutch for elementary and secondary schools (LIFE-NL, LIFE2-NL respectively).

METHODS

Two forward-backward translations were performed followed by a linguistic evaluation and validation by a multidisciplinary committee. The LIFE-NL was further validated on content by pre-testing the questionnaire in 5 students with hearing loss (8-13 years). After minor cross-cultural adaptations normative data were assembled from 187 normal-hearing (NH) students enrolled in mainstream secondary education (1st to 4th grade). The normative data were further analysed based on grade and school type. Additionally, the internal consistency was evaluated by calculating Cronbach's alpha for 3 different scales of the LIFE2-NL: the LIFE total (situation 1-15), LIFE class (situation 1-10: listening situations in classroom) and LIFE social (situation 11-15: social listening situations in school).

RESULTS

NH students scored on average 72.0 (SD = 19.9%) on the LIFE2-NL, indicating they experience some difficulties in secondary mainstream schools. The most difficult listening situations were those where fellow students are noisy or when students have to listen in large classrooms. NH students scored significantly higher on the LIFE class compared to the LIFE social (84.1 ± 14.7% vs. 68.1 ± 19.0%, p < .000). Moreover the LIFE social tend to decrease from the 3rd grade on. The different subscales of the LIFE2-NL showed high internal consistency (Cronbach's alpha of 0.86, 0.89 and 0.75 for LIFE total, LIFE class and LIFE social respectively).

CONCLUSION

The LIFE-NL and LIFE2-NL are valid Dutch translations of the original LIFE-R and are fully comprehensible for students with hearing loss. The normative data of the LIFE2-NL provide a representative framework for interpreting the results of mainstreamed students with hearing loss in secondary schools.

Word initial fricative production in children with cochlear implants and their normally hearing peers matched on lexicon size

Fricative production is affected in children with cochlear implants (CI) as compared to age-matched normally hearing (NH) children. However, the phonological development of children with CI is rarely compared to that of NH peers matched on lexicon size. We compare the early word initial fricative development of 10 children with CI and 30 NH children matched on lexicon size and on chronological age. Children with CI are expected to differ from their NH peers when they are matched on chronological age. But, are lexical development and phonological development commensurate in children with CI as they have been shown to be in NH children? Results show that fricative production in children with CI deviates from that of age-matched NH peers. The differences between both groups disappear when they were matched on lexicon size. Thus, phonological development in children with CI is similar to that of their NH peers with comparable lexicon sizes.

Predictors of pediatric cochlear implantation outcomes in South Africa

OBJECTIVE

To identify and describe predictors of pediatric cochlear implantation outcomes in a South African population.

METHODS

A retrospective study of 301 pediatric cochlear implant (CI) recipients from five CI programs was conducted and cross-sectional outcome data were added at the time of data collection. Twenty potential prognostic factors were identified from the retrospective dataset, including demographical, CI, risk and family factors. Multiple regression analyses were performed to identify predictor variables that influence outcomes in terms of auditory performance (CAP scores), speech production (SIR scores), communication mode and educational placement.

RESULTS

Although implanted children within this sample did not have equal opportunity to access a second implant, bilateral implantation was strongly predictive of better auditory performance and speech production scores, an oral mode of communication and mainstream education. NICU admittance/prematurity were associated with poorer auditory performance and speech production scores, together with a higher probability for non-oral communication and non-mainstream education. The presence of one or more additional developmental condition was predictive of poorer outcomes in terms of speech production and educational placement, while a delay between diagnosis and implantation of more than one year was also related to non-mainstream education. Ethnicities other than Caucasian were predictive of poorer auditory performance scores and a lower probability for mainstream education.

CONCLUSION

An extensive range of prognostic indicators were identified for pediatric CI outcomes in South Africa. These predictive factors of better and poorer outcomes should guide pediatric CI services to promote optimal outcomes and assist professionals in providing evidence-based informational counseling.

Factors influencing speech and language outcomes of children with early identified severe/profound hearing loss: Clinician-identified facilitators and barriers

PURPOSE

Early identification of severe/profound childhood hearing loss (HL) gives these children access to hearing devices and early intervention to facilitate improved speech and language outcomes. Predicting which infants will go on to achieve such outcomes remains difficult. This study describes clinician identified malleable and non-malleable factors that may influence speech and language outcomes for children with severe/profound HL.

METHOD

Semi-structured interviews were conducted with six experienced auditory verbal clinicians. A collective case study design was implemented. The interviews were transcribed and coded into themes using constant comparative analysis.

RESULT

Clinicians identified that, for children with severe/profound HL, early identification, early amplification and commencing auditory-verbal intervention under 6 months of age may facilitate child progress. Possible barriers were living in rural/remote areas, the clinicians' lack of experience and confidence in providing intervention for infants under age 6-months and belonging to a family with a culturally and linguistically diverse (CALD) background.

CONCLUSION

The results indicate that multiple factors need to be considered by clinicians working with children with HL and their families to determine how each child functions within their own environment and personal contexts, consistent with the International Classification of Functioning, Disability and Health (ICF) framework. Such an approach is likely to empower clinicians to carefully balance potential barriers to, and facilitators of, optimal speech and language outcomes for all children with HL.

Assessment of early auditory development of very young Finnish children with LittlEARS(®) Auditory Questionnaire and McArthur Communicative Developmental Inventories

OBJECTIVES

We analysed the Finnish version of the LittlEARS(®) Auditory Questionnaire as a method for assessing very young children's early auditory, pre-verbal and emerging verbal development. We also examined whether any background factors exist that influence the results and thus the usability of this method. To determine its potential in assessment, the Finnish version of the LittlEARS(®) Auditory Questionnaire was analysed in relation to the Finnish McArthur Communicative Developmental Inventories. The latter is currently the method most commonly used together with parental interviews. However, this method is neither designed for infants younger than 8 months nor is its main emphasis on auditory development. Thus, we investigated whether the Finnish version of LittlEARS(®) Auditory Questionnaire could supplement the Finnish McArthur Communicative Developmental Inventories and thereby help in detecting children with hearing impairments.

METHODS

Normative data were collected for Finnish children with normal hearing (N=318) using the LittlEARS(®) Auditory Questionnaire and an abridged version of the Finnish McArthur Communicative Developmental Inventories. In addition, background information was collected with a questionnaire designed for this study. The results of these questionnaires were analysed in relation to each other.

RESULTS

Statistical analysis showed that the results gained with the Finnish version of LittlEARS(®) Auditory Questionnaire and the abridged version of the Finnish McArthur Communicative Developmental Inventories are closely related. However, the LittlEARS(®) Auditory Questionnaire manages to capture the earlier and subtler changes that occur in infancy, therefore making a good continuum with McArthur Communicative Developmental Inventories. Also, most background factors, such as parents' educational level, did not affect the results significantly, rendering the LittlEARS(®) Auditory Questionnaire a valuable method for assessment of early auditory development in very young children.

CONCLUSIONS

The Finnish version of the LittlEARS(®) Auditory Questionnaire is a reliable assessment tool with no confounding background factors. It enables evaluation of the early auditory development in even the youngest of children.

Perioperative complications of cochlear implant surgery in children

Cochlear implant is a commonly performed surgery for hearing loss in pre-school and school children. However, data on anesthesia management and anesthesia-related complications are sparse. We retrospectively reviewed the data of our institute from January, 2007 to December, 2012. Medical records and anesthesia charts of all the patients who had undergone cochlear implant under general anesthesia between this period were reviewed. Information related to the demographic profile, preoperative evaluation, anesthetic techniques, and perioperative complications were collected and analyzed. A total of 190 patients underwent cochlear implant surgery for pre-lingual (175) and post-lingual (15) deafness. General endotracheal anesthesia with inhalational agents was used in all the cases. Difficult intubation was encountered in three patients. Anesthesia-related complications were laryngospasm at extubation (4.73 %), emergence agitation (2.63 %), and postoperative nausea and vomiting (1.05 %). Major surgical complications were CSF leak without meningitis (3.15 %), device migration/failure (1.05 %), and flap infection (1.57 %). Cochlear implant under general anesthesia in small children is safe and anesthesia-related complications were minimal. Surgical complications, although more frequent, were predominantly minor and self-limiting.

Narrative spoken language skills in severely hearing impaired school-aged children with cochlear implants

Cochlear implants have a significant positive effect on spoken language development in severely hearing impaired children. Previous work in this population has focused mostly on the emergence of early-developing language skills, such as vocabulary. The current study aims at comparing narratives, which are more complex and later-developing spoken language skills, of a contemporary group of profoundly deaf school-aged children using cochlear implants (n=66, median age=8 years 3 months) with matched normal hearing peers. Results show that children with cochlear implants demonstrate good results on quantity and coherence of the utterances, but problematic outcomes on quality, content and efficiency of retold stories. However, for a subgroup (n=20, median age=8 years 1 month) of deaf children without additional disabilities who receive cochlear implantation before the age of 2 years, use two implants, and are raised with one spoken language, age-adequate spoken narrative skills at school-age are feasible. This is the first study to set the goals regarding spoken narrative skills for deaf children using cochlear implants.

New expectations: pediatric cochlear implantation in Japan

Funding for cochlear implants

The Japanese health-care system provides universal health coverage for the entire 127 million population of Japan. This includes all aspects of cochlear implantation, from diagnosis to implantation to mapping and habilitation aftercare. Japan has the third largest developed economy; however, the uptake rate for cochlear implants is lower than that of countries with similar economic status. Japan has an uptake rate of approximately 1% of potentially suitable subjects of all ages, compared with 5.6% in the USA.

Cochlear implant provision for children

In Japan, about 55% of cochlear implant recipients are children of less than 18 years of age. This represents an increase of 20% in the last 10 years, with a relative increase in the numbers of children receiving implants compared with the numbers of adults. However, only 3–4% of children under the age of 3 years are being implanted at less than 18 months of age. This is in accordance with the Japanese ENT Academy's guidelines, which currently puts the minimum age limit for implants in children at 18 months.

Neonatal screening

For hearing loss was first piloted nationally in Japan in 2000. Funding for screening subsequently stopped in 2005, though the national treasury provided a further 2 years' funding. Since 2007 local government organizations have been given responsibility to support these screening programs, but there remains considerable variation in funding between different prefectures. In one prefecture, Okayama, 95% of babies were screened and followed up for 2 years. However, the support system for children who need further diagnostic testing after screening remains insufficient.

Referral

When diagnosed, children with hearing loss are referred for counselling, hearing aids and habilitation. The responsibility for these is divided between the Ministry of Health and Welfare (including surgery, device programming, and therapy) and the Ministry of Education. Schools for the deaf and preschool hearing impaired education centers have had most of the responsibility for early intervention, educational choices and referral for cochlear implantation. In the past 98% of schools for children with hearing loss have used communication methods relying mostly on visual cues. In recent years, however, there has been a shift toward ‘inclusive’ mainstream education. Between 2008 and 2011 the number of children with cochlear implants in special needs schools increased to 16%. It is now estimated that 67% of children with cochlear implants may now be in mainstream schools.

There is still the need for support services for these implanted children attending mainstream schools, with adequate provision of resources.

Conclusion

Cochlear Implantation has had a significant role in changing the medical management and education of children in Japan with hearing loss. Much remains to be done, though the situation has greatly improved in recent years and continues to do so.

Accessibility to cochlear implants in Belgium: state of the art on selection, reimbursement, habilitation, and outcomes in children and adults

Belgium, and especially the northern region called Flanders, has been a center of expertise in cochlear implants and early hearing screening for many years. Some of their surgeons and engineers were pioneers in the development of cochlear implants and in 1998 Flanders was the first region in Europe to implement a universal hearing screening program for all neonates. The Belgian National Institute for Health and Disability Insurance has reimbursed cochlear implants in children and adults since 1994 and bilateral implantation in children under the age of 12 years since February 2010. These deaf children, screened and implanted early, achieve higher auditory, speech and language outcomes and increasing numbers are going to regular schools using fewer interpreters. In 2010, 93% of severe-to-profound deaf preschool children in Flanders had received cochlear implants and 25% had bilateral implants. Although on average twice as many adults as children are implanted a year in Belgium, we have less research data available from this adult population. Also very little is published about the growth curves and minimal rehabilitation requirements (intensity, duration etc.) after implantation for both children and adults. So, there still remain many challenges for the future.

Listen up: children with early identified hearing loss achieve age-appropriate speech/language outcomes by 3 years-of-age

OBJECTIVES

Age-appropriate speech/language outcomes for children with early identified hearing loss are a possibility but not a certainty. Identification of children most likely to achieve optimal outcomes is complicated by the heterogeneity of the children involved in outcome research, who present with a range of malleable (e.g. age of identification and cochlear implantation, type of intervention, communication mode) and non-malleable (e.g. degree of hearing loss) factors. This study considered whether a homogenous cohort of early identified children (≤ 12 months), with all severities of hearing loss and no other concomitant diagnoses could not only significantly outperform a similarly homogenous cohort of children who were later identified (>12 months to <5 years), but also achieve and maintain age-appropriate speech/language outcomes by 3, 4 and 5 years of age.

METHODS

A mixed prospective/retrospective comparative study of a homogenous cohort of 45 early identified (≤ 12 months) and 49 late identified (> 12 months to < 5 years) children with hearing loss was conducted. The children all attended the same oral auditory-verbal early intervention programme. Speech/language assessments standardized on typically developing hearing children were conducted at 3, 4 and 5 years of age.

RESULTS

The early identified children significantly outperformed the late identified at all ages and for all severities of HL. By 3 years of age, 93% of all early identified participants scored within normal limits (WNL) for speech; 90% were WNL for understanding vocabulary; and 95% were WNL for receptive and expressive language. Progress was maintained and improved so that by 5 years of age, 96% were WNL for speech, with 100% WNL for language.

CONCLUSIONS

This study found that most children with all severities of hearing loss and no other concomitant diagnosed condition, who were early diagnosed; received amplification by 3 months; enrolled into AV intervention by 6 months and received a cochlear implant by 18 months if required, were able to "keep up with" rather than "catch up to" their typically hearing peers by 3 years of age on measures of speech and language, including children with profound hearing loss. By 5 years, all children achieved typical language development and 96% typical speech.

Addressing Qualified Personnel Shortages for Children Who Are Deaf or Hard of Hearing With an Interdisciplinary Service Learning Program

Purpose

To describe the student training benefits for speech-language pathology graduate students involved in an interdisciplinary, community-based intervention program at a Midwestern university for families of preschool children who were deaf or hard of hearing (DHH) and auditory-based spoken language users.

Method

The Auditory and Language Enriched Program was developed to provide graduate students with a clinically relevant service learning opportunity that also met some unique community needs of families in the community. Specifically, students learned to provide families with imaginative ways to expose their children who were DHH to language and literacy and nurture their natural curiosity and zest for learning.

Results

Statistically significant improvement was noted between pre- and postintervention questionnaires of knowledge and skill related to intervention for this population by a single group of students.

Conclusions

An interdisciplinary service learning approach to intervention might provide opportunities for university graduate programs to address the immediate and long-term needs of families who have chosen a spoken language outcome for their young children who are DHH while simultaneously providing invaluable experience with low-incidence populations for their preservice graduate students.

Anesthetic complications in pediatric patients undergoing cochlear implantation

OBJECTIVES/HYPOTHESIS

Cochlear implantation (CI) is effective in the treatment of childhood sensorineural hearing loss and is associated with minimal surgical complications. We investigated the incidence of anesthetic complications in young patients undergoing general anesthesia for CI.

STUDY DESIGN

Retrospective chart review.

METHODS

A retrospective chart review of 123 patients younger than 18 years, who underwent CI between 2007 and 2008, was conducted for identification of intra- and postoperative anesthesia-related complications. The relation of collected variable to the complication events was analyzed using logistic regression.

RESULTS

Of the 123 CI procedures, eight patients had nine anesthesia-related complications, yielding a complication rate of 6.5% and included the following: postoperative wheezing/stridor (5 cases), laryngospasm (3 cases), and emesis during inhalational induction (1 case). Divided by age group, 12 patients were <12 months with one complication (8%), 18 patients were between 1 and 2 years with one complication (5.6%), 35 patients were between 2 and 5 years with one complication (3%), 39 patients were between 5 and 12 years with five complications (13%), and 19 patients were older than 12 years with no complication (0%). Logistic regression failed to identify a significant association of any collected variable(s) with the observed complications. The incidence of complications is similar to that previously reported in elderly patients (4.3%) (Pearson χ(2) , P = .523).

CONCLUSIONS

General anesthesia is well tolerated by pediatric patients undergoing CI, even under 1 year of age. Significant perioperative complications are primarily respiratory, are usually free of long-term sequelae, and occur with an incidence similar to other reported age groups.

A longitudinal study on auditory perception and speech intelligibility in deaf children implanted younger than 18 months in comparison to those implanted at later ages

OBJECTIVE

The objective of this study was to measure longitudinally the progress in the auditory performance and speech intelligibility of young deaf children implanted under the age of 18 months in comparison to those implanted after 18 months and to create normative data on these children implanted under 18 months.

STUDY DESIGN

: This is a retrospective longitudinal study based on data available at our centre 'KIDS-Hasselt-Belgium'.

PATIENTS

52 deaf children who received a cochlear implant under the age of 18 months.

METHODS

LiP (Listening Progress profile) and CAP (Categories of Auditory Performance) were administered to measure auditory perception and SIR (Speech Intelligibility Rating) was used to measure speech intelligibility. Over a 4 year period, six assessments were made to monitor the auditory and speech development of the children: a pre-test before implantation and five post-tests at 6, 12, 24, 36 and 48 months after implantation.

RESULTS

Deaf children receiving cochlear implants before the age of 18 months show more rapid progress in auditory performance and speech intelligibility in comparison to children implanted at an older age. Their auditory performance and speech intelligibility also reach a higher level 4 years after implantation compared with children implanted later in life.

DISCUSSION AND CONCLUSION

This study shows encouraging results in the cochlear implantation of children under the age of 18 months. As demonstrated, using the LiP, CAP and SIR measures, children who receive a cochlear implant before the age of 18 months show, that at 3 to 4 years after implantation, significantly greater improvement is made in auditory perception and speech intelligibility than their later implanted peers, although there is a considerable variety in the outcomes.

Intelligibility of hearing impaired children as judged by their parents: A comparison between children using cochlear implants and children using hearing aids

OBJECTIVES

The aim of this study was to determine the intelligibility of prelingually deaf children with cochlear implants (CI) as judged by their own parents, and to compare these results with prelingually hearing impaired children using hearing aids (HA) and normally hearing (NH) children. The authors hypothesised that subjects using conventional hearing aids would have poorer intelligibility judgements compared to NH and CI children.

METHODOLOGY

This is a comparative study of 24 prelingually deaf CI children (m.a. 8.3 years), 24 prelingually hearing impaired HA children (m.a. 9.0 years) and 25 NH children. Recorded speech samples at word-, sentence- and story-level were perceptually judged by two speech pathologists and the child's main caregiver (the mother in most cases) using a five-point hierarchical scale. In addition, the sample of each child was transcribed by the child's main caregiver. The investigators counted and determined a percentage of words correctly understood.

RESULTS

The judgements of the speech pathologists and the transcriptions of the mothers were not different between the CI and NH children, although the mothers tended to judge their CI child to be less intelligible. The HA children on the other hand, showed a mean intelligibility inferior to NH and CI children, as demonstrated by the judgements of the mothers and speech pathologists as well as by the percentages of correctly identified words by the mothers.

CONCLUSION

The intelligibility of the prelingually deaf CI children is very close to the intelligibility of NH children, while the HA children still show a decreased mean intelligibility.

A comparison of the consonant production between Dutch children using cochlear implants and children using hearing aids

OBJECTIVES

The main purpose of the present study was to compare the consonant error patterns of Dutch prelingually deaf CI children with prelingually hearing-impaired hearing aid (HA) children. The authors hypothesized that subjects using conventional hearing aids would have poorer consonant production skills. Additionally, the impact of the age at implantation (CI) and the degree of hearing loss (HA) was determined.

METHODOLOGY

This is a comparative study of 29 prelingually deaf CI children (m.a. 9;0 y) and 32 prelingually hearing-impaired HA children (m.a. 9;11 y) who received their first hearing aid before the age of 2 years. Nineteen CI children were implanted before the age of 5 years. Nine HA children had thresholds above 90dB (range: 91-105dB), 15 between 70 and 90dB (range: 72-90dB) and 8 below 70dB (range: 58-68dB). Speech samples of all the children were elicited by means of a picture naming test and were video-recorded for further phonetic and phonological analysis.

RESULTS

Considerably more phonetic and phonologic errors were observed in the HA children with thresholds above 70dB (range: 72-105dB). No notable differences could be found between deaf CI children and HA children with thresholds below 70dB. Even children implanted after the age of 5 years showed significantly fewer phonetic and phonological errors than HA children.

CONCLUSION

The consonant production of implanted children is more adequate than the consonant production of HA children with a hearing loss of 70dB or more. In addition, the results also indicate that even after the age of 5 years, implantation can still have an advantageous effect on a child's consonant production.

[Present state of cochlear implant treatment in adults and children]

The technique of cochlear implantation was the first method which allowed replacement of a sense organ by a (partially) implantable electronic prosthesis. By this method the cells of the spiral ganglion of the cochlea are directly stimulated by the electrodes introduced into the cochlea, bypassing the functions of the outer and middle ear as well as the cochlea. Treatment with a cochlear implant (CI) has been established over the last 20-30 years as a reliable method for restoring hearing in adults and children with severe hearing disorders and is now a routine method in many centers. For optimal results in understanding speech and for children in the speech development phase, rehabilitation must be an integral part of the total treatment and follow soon after implantation. To achieve this early diagnosis of hearing difficulties or deafness is necessary, which is simplified by a consistent hearing screening of newborns, now a statutory procedure in Germany.