[Impact of CI use and CI fitting on speech production in very early cochlear-implanted infants]

[The LittlEARS® Auditory Questionnaire : An analysis of multicentre data of children after early bilateral cochlear implant placement]

BACKGROUND

In order to optimise the support of children with cochlear implants (CI), it is very important to detect slow developmental processes as early as possible. Data from the LittlEARS® Auditory Questionnaire (LEAQ) from children with early bilateral CI are evaluated and presented in relation to age and hearing age and compared with language development data recorded later.

MATERIALS AND METHODS

This retrospective multicentre study included data from a total of 554 children for whom at least one LEAQ was completed during the course of CI rehabilitation. Children without additional disabilities who received bilateral simultaneous or sequential CI treatment were included.

RESULTS

As expected, there are high correlations between hearing age (HA) and the overall LEAQ total score. When analysed according to chronological age (CA), development runs roughly parallel to the development of children with normal hearing, albeit at a lower level. Children implanted early up to an age of ≤ 12 months consistently achieve approximately 7-8 raw points more. Only the LEAQ results of the later test times (from the age of 18 months) correlate with some areas of the speech development test for children (SETK; areas 3-5).

CONCLUSION

The earliest possible detection of critical developmental processes in children with CI is extremely important. In the case of very early CI fitting, the CA should be used as a reference measure in diagnostics. The LEAQ values determined for the group of children with CI are suitable to a limited extent as generally valid reference values for children with early bilateral CI. Further studies should continue to work out the correlations between early preverbal development and later speech development.

[Early language performance in the ELFRA questionnaire : Analysis of multicentre data from children with bilateral cochlear implants]

BACKGROUND

Very early bilateral cochlear implant (CI) provision is today's established standard for children. Therefore, the assessment of preverbal and verbal performance in very early stages of development is becoming increasingly important. Performance data from cohorts of children were evaluated and presented based on diagnostic assessment using chronological age (CA) and hearing age (HA).

METHODS

The present study, as part of a retrospective multicentre study, included 4 cohorts (N = 72-233) of children with bilateral CI without additional disabilities. Their results in the German parent questionnaires Elternfragebögen zur Früherkennung von Risikokindern(ELFRA‑1 and ELFRA-2) subdivided for CA and HA were statistically analysed. The data were also analysed in terms of mono-/bilingualism and age at CI provision.

RESULTS

Overall, verbal performance in relation to CA was lower than in relation to HA. Preverbal skills were largely CA appropriate. Children with bi-/multilingual language acquisition performed significantly lower. Verbal performance in ELFRA‑2 referenced to CA was negatively correlated with age at CI provision.

CONCLUSION

In the case of early CI provision, CA should be the preferred reference mark in preverbal and verbal assessment in order to obtain exact individual performance levels and avoid bias in results. The percentiles determined are of limited use as generally valid reference values to which the individual performance of bilaterally implanted children could be compared. Further multicentre studies should be initiated.

Validation of a predictive model for speech discrimination after cochlear impIant provision

BACKGROUND

If sufficient speech discrimination is no longer achieved with conventional hearing systems, an audiological indication for a cochlear implant (CI) is given. However, there are no established target criteria for CI aftercare with regard to the level of speech comprehension to be achieved. The aim of this study is to validate an existing predictive model for speech comprehension after CI provision. This is applied to different patient groups.

MATERIALS AND METHODS

The prospective study included 124 postlingually deaf adults. The model is based on preoperative maximum monosyllabic recognition score, aided monosyllabic recognition score at 65 dBSPL, and age the time of implantation. The model was investigated with regard to prediction accuracy for monosyllabic recognition with CI after 6 months.

RESULTS

Mean speech discrimination improved from 10% with hearing aid to 65% with CI after 6 months, with a statistically significant improvement in 93% of cases. Deterioration of aided unilateral speech discrimination was not observed. The mean prediction error was 11.5 percentage points in the cases with preoperative scores better than zero and 23.2 percentage points in all other cases.

CONCLUSION

Cochlear implantation should also be considered in patients with moderately severe to severe hearing loss and insufficient speech discrimination with hearing aids. The model based on preoperatively measured data for predicting speech discrimination with CI can be used in preoperative consultation and in the context of postoperative quality assurance.

[Validation of a predictive model for speech discrimination after cochlear implant provision]

BACKGROUND

If sufficient speech discrimination is no longer achieved with conventional hearing systems, an audiological indication for a cochlear implant (CI) is given. However, there are no established target criteria for CI aftercare with regard to the level of speech comprehension to be achieved. The aim of this study is to validate an existing predictive model for speech comprehension after CI provision. This is applied to different patient groups.

MATERIALS AND METHODS

The prospective study included 124 postlingually deaf adults. The model is based on preoperative maximum monosyllabic recognition score, aided monosyllabic recognition score at 65 dB_SPL, and age the time of implantation. The model was investigated with regard to prediction accuracy for monosyllabic recognition with CI after 6 months.

RESULTS

Mean speech discrimination improved from 10% with hearing aid to 65% with CI after 6 months, with a statistically significant improvement in 93% of cases. Deterioration of aided unilateral speech discrimination was not observed. The mean prediction error was 11.5 percentage points in the cases with preoperative scores better than zero and 23.2 percentage points in all other cases.

CONCLUSION

Cochlear implantation should also be considered in patients with moderately severe to severe hearing loss and insufficient speech discrimination with hearing aids. The model based on preoperatively measured data for predicting speech discrimination with CI can be used in preoperative consultation and in the context of postoperative quality assurance.

Children with cochlear implant and additional disabilities benefit from consistent device use

OBJECTIVES

Although the prevalence of additional disabilities (AD) in children with a cochlear implant (CI) is high, children with such disabilities are often excluded from clinical studies, or their specific characteristics are only partially included. The literature shows that several factors need to be considered in evaluating auditory and language development in CI children with AD, including demographic variables as well as the severity and type of disability. Current findings on device use in children show correlations with auditory and language outcome, but little is known about device use specifically in children with AD. The purpose of this study was to determine the auditory and language outcome of CI children with AD and to analyse their datalogging-based daily device use, both 1 year and 2 years after implantation. In addition, any potential correlations between outcome and device use were to be identified.

METHODS

A cohort of 32 CI children with 5 different types of AD were included in this retrospective analysis. The children's auditory and language outcome was assessed by the parental questionnaires LittlEARS and ELFRA and by the professional observation tool CAP (Categories of Auditory Performance) 1 and 2 years after implantation. Longitudinal device use was analysed by using the CI system-integrated data-logging; daily duration of CI use, number of coil disconnections and exposure to different listening scenes were recorded.

RESULTS

Overall, the cohort's auditory and language performance showed significant progress over time, while reduced abilities became more obvious after 2 years of CI experience. The mean daily duration of CI use increased significantly from 7.8 ± 2.8 to 8.2 ± 2.7 h after 2 years. High numbers of daily coil disconnections were detected, with a significant mean decrease from 83.4 ± 73.1 to 66.3 ± 54.6 whereas the percentage exposure to different listening environments was widely stable over time. Significant rank correlations were identified between outcomes measured by ELFRA and CAP with daily duration of CI use, numbers of coil disconnections and percentage of exposure to speech-characterised listening scenes.

CONCLUSION

The auditory and language outcome in CI children with AD is variable, but it progresses over time. Children benefit from a consistent daily device use as well as from a high exposure to speech-characterised environments. Device use should be monitored constantly, with particular focus on daily duration of CI use and, in particular, on the number of coil disconnections if children have a severe motor impairment. Objective data-logging is an important addition to outcome assessment by testing, observations and parental questionnaires. Although assessment in children with AD is a major challenge for professionals, comprehensive assessment is needed to improve cochlear implant services with special adaption to children with AD, and this should include audiological, development-related and psychosocial information. A unified system to classify types of disabilities could help to improve procedures for analysing different outcomes.

[Word production in children with cochlear implant based on chronological age and hearing age]

BACKGROUND

For congenitally deaf children, an early bilateral provision with cochlear implant (CI) is a favourable condition for language acquisition. The objective of the present study was to determine the word production in CI children. The focus was on a comparison of chronological age and hearing age performance and on the evaluation of potential effects of multilingualism, additional disabilities and age at provision.

METHODS

The data of 62 children with bilateral CI (age at provision in months M=12,1; SD=6,2) were retrospectively analysed. Vocabulary was assessed by the test Aktiver Wortschatztest für 3- bis 5-jährige Kinder - Revision and compared for chronological age and hearing age. Group comparisons and correlation analysis was conducted regarding multilingualism, additional disabilities and age at provision.

RESULTS

The cohort performed significantly better when referenced to hearing age: level were within or above the norm in more than 50%; referenced to chronological age in around 37%. The descriptive performance differences for multilingualism and additional disabilities were only significant for children with both characteristics. Performance of monolingual children without additional disabilities was not significantly associated with age at provision.

CONCLUSION

CI children may achieve an adequate expressive vocabulary at the age of 3 to 5 years. Multilingualism and additional disabilities seem to be particular challenges for CI children and need a more precise definition in further studies. The use of both chronological and hearing age as reference marks allows a differentiated assessment of the language status. This may lead to benefits in therapeutic interventions and parent councelling.

The Cochlear Implant Use Questionnaire: Assessing Habits and Barriers to Use

OBJECTIVE

The objective was to design a questionnaire to identify daily cochlear implant (CI) use habits and barriers to daily CI use and to administer this questionnaire to adult CI users. We hypothesized that recipients who reported a greater number of barriers to daily CI use would show lower daily CI use.

STUDY DESIGN

Questionnaire.

SETTING

Academic medical center.

PATIENTS

Hundred adult CI recipients.

MAIN OUTCOME MEASURES

Questionnaire responses and amount of CI use per day as measured from the CI software.

RESULTS

The cochlear implant use questionnaire (CIUQ) was created and responses were obtained from 100 participants. The CIUQ yielded an average overall score of 23 (range, 3-54) out of 100; responses were variable, and CI recipients experienced different barriers to using their CI processor. The CIUQ overall score was significantly correlated with recipients' daily CI use (h/d) (rs = -0.561, p < 0.0001, 95% confidence interval [-0.694, -0.391]), which provides evidence of construct validity. Responses were immediately useful for identifying and overcoming barriers to consistent CI use with our study participants.

CONCLUSIONS

Increasing evidence suggests that daily CI use is correlated with speech recognition outcomes. To optimize outcomes, clinicians should consider implementing this questionnaire to identify and overcome barriers to consistent, full-time CI processor use.