Language development after cochlear implantation: an epigenetic model

The Impact of Gamified Auditory-Verbal Training for Hearing-Challenged Children at Intermediate and Advanced Rehabilitation Stages

Background: Auditory-verbal training is essential for children with hearing challenges, and the gamification approach has become a promising direction for improving the rehabilitation experience and effect. However, the specific influence of the gamified training approach on participants at different rehabilitation stages has not been empirically studied, especially in the practical training effect caused by gamified interventions and the varying influence on children with different rehabilitation status. Objective: This article is thus intended to investigate the following research questions: (1) do the training performances of children at advanced rehabilitation stage differ before and after using the gamified training system? (2) Do the training performances of children at intermediate rehabilitation stage differ before and after using the gamified training system? (3) Do children enjoy the gamified training approach? Methods: For the purpose, a digital gamified auditory-verbal training system was originally developed, and a series of user experiments were organized. The training performance of 31 hearing-challenged children was assessed, and interviews with six professional therapists were conducted.  Results: It can be found that generally the gamified training approach can effectively facilitate the training experience and help with the basic auditory memory and expression capabilities. Moreover, it is feasible to be applied in practical training due to the high customization of digital training contents, multimodal interactive training means, and highly enjoyable training experience. Conclusions: Regarding the specific influence, the gamified way can better improve the basic auditory-verbal performance of children at the intermediate stage since the focus is more on the ease of learning and adaption to the training system. While for children at the advanced rehabilitation stage, the precise training and professional training contents are more in demand, it is not easy to achieve quick improvements. These findings and conclusions can provide insights for further explorations and applications of the gamification approach in children's auditory-verbal rehabilitation. This study was approved by the Institutional Review Board (IRB) of Shanghai Jiao Tong University with the approval number H2022213P.

Geographic, Sociodemographic, and Clinical Factors Associated With Parental Self-Efficacy in Pediatric Patients With Hearing Loss

OBJECTIVE

To identify geographic, sociodemographic, and clinical factors associated with parental self-efficacy in a diverse cohort of deaf or hard-of-hearing (DHH) children.

STUDY DESIGN

Cross-sectional study.

SETTING

Tertiary children's hospital.

METHODS

Four hundred forty parents of DHH children aged 0 to 17 completed the 25-item Scale of Parental Involvement and Self-Efficacy (SPISE) survey from 2014 to 2022. Residential addresses were geocoded and assigned Area Deprivation Index and Social Vulnerability Index rankings, and univariable and multivariable analyses were conducted using sociodemographic and clinical variables, including sex, race/ethnicity, insurance type, survey language, age at the survey, comorbidities, newborn hearing screening results, and hearing loss laterality and severity.

RESULTS

Compared to English and Spanish-speaking parents, Chinese-speaking parents were associated with overall lower parental self-efficacy and involvement (regression coefficient = -0.518, [-0.929, -0.106]), Cohen's d = 0.606) and lower scores on items related to their ability to affect multiple aspects of their child's development and expression of thoughts as well as competency in checking and putting on their child's sensory device. Across univariable and multivariable analyses, besides Chinese language, all other sociodemographic, clinical, and geographic variables were not associated with SPISE score.

CONCLUSION

To achieve the best patient outcomes, care teams can use the SPISE to evaluate parental self-efficacy and provide targeted support to parents at risk for having lower knowledge and confidence scores about critical skills necessary to facilitate their child's auditory access and language development. Notably, this study found similar reports of parental efficacy across various sociodemographic, clinical, and geographic variables but significantly lower SPISE scores in Chinese-speaking families.

Language development in children from a public cochlear implant program

OBJECTIVE

To evaluate the rate of loss to follow-up in a cochlear implant program from the public health system in Southern Brazil as well as the characteristics of hearing loss, sociodemographic, sociocultural and the development of oral language in children with prelingual deafness.

METHODS

Retrospective cohort study with children who underwent CI surgery between 2010 and 2020. Data was collected through of interviews and review of medical records. The language development assessment was performed using the MUSS, MAIS and IT-MAIS scales. For the classification of language development, we used as parameters the values (mean ± SD) found in a previous national study. From those values, the Z-score for each patient at each hearing age (time of experience with the cochlear implant) was calculated.

RESULTS

Of the 225 children implanted between 2010-2020, 129 were included in this study. The rate of loss to follow-up in the program was 42.6%. The mean age at first surgery was 40.5 (±16.9) months, with 77.5% of patients having received a unilateral implant. Language results below the expected for hearing age (

CONCLUSIONS

Most patients had an elevated mean age at cochlear implantation and there was a high rate of loss to follow-up and low attendance to speech and programming sessions. An overall poor language performance was found for this pediatric cochlear implant program from the public health system in Southern Brazil.

LEVEL OF EVIDENCE

Level 3 (Non-randomized cohort study).

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Key Words

• Cochlear implant
• Language development disorders
• Prelingual deafness

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MESH Headings

• Humans
• Retrospective Studies
• Child, Preschool
• Male
• Female
• Brazil
• Language Development
• Cochlear Implants
• Cochlear Implantation
• Infant
• Deafness/surgery
• Child
• Socioeconomic Factors

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Affiliation(s)

Alice Lang Silva Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil.
Isadora Martins da Silva Stumpf Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Otorrinolaringologia, Porto Alegre, RS, Brazil
Laura Prolla Lacroix Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Porto Alegre, RS, Brazil
Debora Milena Ferreira Alves Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Porto Alegre, RS, Brazil
Adriana Laybauer da Silveira Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Fonoaudiologia, Porto Alegre, RS, Brazil
Sady Selaimen da Costa Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Otorrinolaringologia, Porto Alegre, RS, Brazil
Letícia Petersen Schmidt Rosito Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Otorrinolaringologia, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Porto Alegre, RS, Brazil

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Impact of Sociodemographic Disparities on Language Outcomes After Cochlear Implantation in a Diverse Pediatric Cohort

OBJECTIVE

We examined how sociodemographic and audiologic factors affect receptive and expressive language outcomes in children with cochlear implantation.

STUDY DESIGN

Retrospective cohort study.

SETTING

A hearing loss (HL) clinic at a tertiary center.

METHODS

Sociodemographic variables, HL characteristics, age at implantation, and receptive language scores (Preschool Language Scale and the Clinical Evaluation of Language Fundamentals) were collected from patients with congenital HL who received their first implant by 4 years old after January 1, 2007. t Tests, linear regression, Mann-Whitney, Cohen's d, and mediation analysis were used for descriptive statistics and hypothesis testing.

RESULTS

Among 79 patients, 42 (53%) were females, 44 (56%) under-represented minorities, and 56 (71%) had public insurance. At least 1 year after implantation, the median receptive language score was 69 (range 50-117). Females (p = .005), having private insurance (p = .00001), having a Cochlear Implant Profile score below 4 (p = .0001), and receiving their implant at or before 12 months of age (p = .0009) were significantly associated with improved receptive language outcomes. Insurance type had a significant effect on receptive language outcomes, independent from age at first implantation (total effect: coef = -13.00, p = .02; direct effect: coef = -12.26, p = .03; indirect effect: coef = -0.75, p = .47). Sociodemographic variables had large effect sizes, with the Cochlear Implant Profile score having the largest effect size (d = 1.3).

CONCLUSION

Sociodemographic factors have a large impact on receptive language outcomes. Public insurance is associated with worse receptive language, not mediated by later age at implantation, suggesting that other factors primarily impact language outcomes in publicly insured children with cochlear implants.

Phoneme Categorization in Prelingually Deaf Adult Cochlear Implant Users

PURPOSE

Phoneme categorization (PC) for voice onset time and second formant transition was studied in adult cochlear implant (CI) users with early-onset deafness and hearing controls.

METHOD

Identification and discrimination tasks were administered to 30 participants implanted before 4 years of age, 21 participants implanted after 7 years of age, and 21 hearing individuals.

RESULTS

Distinctive identification and discrimination functions confirmed PC within all groups. Compared to hearing participants, the CI groups generally displayed longer/higher category boundaries, shallower identification function slopes, reduced identification consistency, and reduced discrimination performance. A principal component analysis revealed that identification consistency, discrimination accuracy, and identification function slope, but not boundary location, loaded on a single factor, reflecting general PC performance. Earlier implantation was associated with better PC performance within the early CI group, but not the late CI group. Within the early CI group, earlier implantation age but not PC performance was associated with better speech recognition. Conversely, within the late CI group, better PC performance but not earlier implantation age was associated with better speech recognition.

CONCLUSIONS

Results suggest that implantation timing within the sensitive period before 4 years of age partly determines the level of PC performance. They also suggest that early implantation may promote development of higher level processes that can compensate for relatively poor PC performance, as can occur in challenging listening conditions.

The Outcome of Cochlear Implantations in Deaf-Blind Patients: A Multicenter Observational Study

OBJECTIVE

This multicenter study aimed to evaluate the auditory and speech outcomes of cochlear implantation (CI) in deaf-blind patients compared with deaf-only patients.

STUDY DESIGN

Retrospective cohort study.

SETTING

Multiple cochlear implant centers.

PATIENTS

The current study was conducted on 17 prelingual deaf-blind children and 12 postlingual deaf-blind adults who underwent CI surgery. As a control group, 17 prelingual deaf children and 12 postlingual deaf adults were selected.

INTERVENTION

Cochlear implantation.

MAIN OUTCOME MEASURES

Auditory and linguistic performances in children were assessed using the categories of auditory performance (CAP) and Speech Intelligibility Rating (SIR) scales, respectively. The word recognition score (WRS) was also used to measure speech perception ability in adults. The mean CAP, SIR, and WRS cores were compared between the deaf-only and deaf-blind groups before CI surgery and at "12 months" and "24 months" after device activation. Cohen's d was used for effect size estimation.

RESULTS

We found no significant differences in the mean CAP and SIR scores between the deaf-blind and deaf-only children before the CI surgery. For both groups, SIR and CAP scores improved with increasing time after the device activation. The mean CAP scores in the deaf-only children were either equivalent or slightly higher than those of the deaf-blind children at "12 months post-CI" (3.94 ± 0.74 vs 3.24 ± 1.25; mean difference score, 0.706) and "24 months post-CI" (6.01 ± 0.79 vs 5.47 ± 1.06; mean difference score, 0.529) time intervals, but these differences were not statistically significant. The SIR scores in deaf-only implanted children were, on average, 0.870 scores greater than the deaf-blind children at "12 months post-CI" (2.94 ± 0.55 vs 2.07 ± 1.4; p = 0.01, d = 0.97) and, on average, 1.067 scores greater than deaf-blind children at "24 months post-CI" (4.35 ± 0.49 vs 3.29 ± 1.20; p = 0.002; d = 1.15) time intervals. We also found an improvement in WRS scores from the "preimplantation" to the "12-month post-CI" and "24-month post-CI" time intervals in both groups. Pairwise comparisons indicated that the mean WRS in the deaf-only adults was, on average, 10.61% better than deaf-blind implanted adults at "12 months post-CI" (62.33 ± 9.09% vs 51.71 ± 10.73%, p = 0.034, d = 1.06) and, on average, 15.81% better than deaf-blind adults at "24-months post-CI" (72.67 ± 8.66% vs 56.8 ± 9.78%, p = 0.002, d = 1.61) follow-ups.

CONCLUSION

Cochlear implantation is a beneficial method for the rehabilitation of deaf-blind patients. Both deaf-blind and deaf-only implanted children revealed similar auditory performances. However, speech perception ability in deaf-blind patients was slightly lower than the deaf-only patients in both children and adults.

Assessment of outcome measures after audiological computer-based auditory training in cochlear implant children

OBJECTIVE

To validate the clinical use of acoustic change complex (ACC) as an objective outcome measure of auditory training in Egyptian cochlear implant (CI) children and explore how far electrophysiological measures could be correlated to behavioral measures in assessing training outcome. Also to explore the efficacy of computer-based auditory training programs (CBATP) in the rehabilitation process of CI children.

METHODS

Sixty Arabic speaking children participated in the present study. Forty children using monaural CI device served as study group (20 children in subgroup A and 20 children in subgroup B). Both subgroups received traditional speech therapy sessions, additionally subgroup (A) children received computer-based auditory training program (CBATP) at home for three months. Their age ranged from 8 to 17 years. 20 age and sex-matched normal hearing children served as control group as a standardization for the stimuli used to elicit ACC. The study group children were subjected to detailed history taking, parent reported questionnaire (MAIS, Arabic version), aided sound field evaluation, psychophysical evaluation using auditory fusion test (AFT), speech perception testing according to language age, ACC in response to gaps in 1000 Hz tones and language evaluation. This work-up was repeated after 3&6 months for both study subgroups.

RESULTS

Children of study subgroup (A) showed improvement of auditory fusion test (AFT) thresholds at 3 & 6 months post-training follow up. As regards acoustic change complex (ACC), it can be detected in 85% of subgroup (A) children, 85% of subgroup (B) children and 100% of control group children. Lower ACC gap detection thresholds were obtained only after 3 months in subgroup (A), while after 6 months in subgroup (B). There were statistically significant differences between initial assessment and 3 & 6 months follow up as regards ACC P1 and N2 latencies and amplitudes in both study subgroups, however in subgroup (A), ACC P1 amplitude at 6 months post-training was significantly larger than values of 3 months follow up. There was highly significant correlation between thresholds of AFT and ACC gap detection threshold.

CONCLUSIONS

ACC can be used as a reliable tool for evaluating auditory training outcome in CI children. ACC gap detection threshold can predict psychophysical temporal resolution after auditory training in difficult to test population. CBATP is an easy and accessible method which may be effective in improving CI outcome.

Delayed cochlear implantation in congenitally deaf children-identifying barriers for targeted interventions

OBJECTIVES

Age of cochlear implantation (CI) is an important predictor of language development in those with congenital sensorineural hearing loss. Despite universal newborn hearing screening initiatives and the known benefits of early CI, a subset of congenitally deaf children continue to be evaluated for cochlear implants later in childhood. This study aims to identify the barriers to early cochlear implantation in these children.

METHODS

A retrospective review was conducted for all pediatric cochlear implants aged 3 years or older performed at a single academic institution between 2013 and 2017. Children implanted before the age three, those with a prior unilateral cochlear implant, and those with progressive or sudden hearing loss were excluded. Variables included newborn hearing screen results, age at hearing loss diagnosis, time of initiation and documented benefit of hearing aids, age of implantation, pre/post-implantation evaluation scores, and reason for delayed referral for cochlear implantation.

RESULTS

Thirty-one patients were identified meeting these inclusion criteria. Twenty-one children were subject to UNBS in the U.S. Fourteen of those children failed their newborn hearing screening. Average age at implantation was 6.2 years. Four reasons were identified for increased age at cochlear implantation. Two categories represent delays related to (1) Amplification continually prescribed even though the range of hearing loss and speech development assessment suggests CI may have been more appropriate well before referral (N = 13) (2) Patients were not subject to newborn hearing screening and/or timely diagnosis of their hearing loss (N = 8). In other cases, patients were appropriately fit with hearing aids until evidence that they derived limited benefit and then referred for CI (N = 8). Lastly, in a few cases, records were indeterminate with regards to the timing and appropriate diagnosis of their hearing loss (N = 2).

CONCLUSION

Understanding the reasons for delayed cochlear implantation in congenitally deaf children might allow the development of targeted interventions to improve outcomes. Specifically, those children who were not referred before age 3 despite use of amplification with limited benefit offer one potential target population for earlier CI.

Does auditory deprivation impairs statistical learning in the auditory modality?

Early sensory deprivation allows assessing the extent of reorganisation of cognitive functions, well beyond sensory processing. As such, it is a good model to explore the links between sensory experience and cognitive functions. One of these functions, statistical learning - the ability to extract and use regularities present in the environment - is suspected to be impaired in prelingually deaf children with a cochlear implant. However, empirical evidence supporting this claim is very scarce and studies have reported contradictory results. This might be because previous studies have tested statistical learning only in the visual modality and did not make clear distinctions between multiple types of statistical regularities. To overcome these problems, we designed a modified serial reaction time task where cochlear implanted children and normal hearing children had to react to auditory sequences that embed multiple statistical regularities, namely transition probabilities of 0^th, 1^st or 2^nd order. We compared the reaction times of the children with the output of a simple computational model that learns transition probabilities. First, 6-12 years old children were able to learn 0^th and 1^st order transition probabilities but not 2^nd order ones. Second, there were no differences between cochlear implanted children and their normal hearing peers. These results indicate that auditory statistical learning is preserved in congenitally deaf children with cochlear implants. This suggests in turn that early auditory deprivation might not be crucially detrimental for the normal development of statistical learning.

Parenting Stress, Self-Efficacy, and Involvement: Effects on Spoken Language Ability Three Years After Cochlear Implantation

OBJECTIVE

This study evaluated associations among parenting stress, self-efficacy, and involvement in relation to spoken language outcomes in young children 3 years following cochlear implantation.

STUDY DESIGN

Cross-sectional.

SETTING

Six university tertiary medical centers.

PATIENTS

One hundred sixty-four young children with bilateral, severe-to-profound sensorineural hearing loss who had 3 years of experience with a CI; children with substantial cognitive impairments were excluded from the study.

MAIN OUTCOME MEASURESS

Family Stress Scale (FSS), Scale of Parental Involvement and Self-Efficacy (SPISE), Oral and Written Language Scales (OWLS).

RESULTS

Correlations were of moderate strength between FSS scores and SPISE scores (Parental Self-Efficacy, r = -0.45, p < 0.01, Parental Involvement r = -0.32, p < 0.01). As hypothesized, parents reporting higher levels of stress reported lower perceptions of self-efficacy and involvement. In addition, results showed that family stress had a direct, negative effect on spoken language (-4.43 [95% confidence interval: -6.97; -1.89]). After controlling for maternal education and activation age, parental self-efficacy mediated the negative effect between family stress and spoken language (indirect effect = -1.91 [3.45; -0.69]; proportion mediated = 0.43). No mediating effects were found for parental involvement.

CONCLUSIONS

These findings highlight the need for parenting interventions that focus on reducing stressors and increasing parents' perceptions of self-efficacy in families of children using cochlear implants. Integration of mental health screening and tailored parenting interventions in CI clinics may increase parental self-efficacy and involvement, with measurable benefits in the child's use of spoken language.

Prelinguistic Vocal Development in Children With Cochlear Implants: A Systematic Review

OBJECTIVES

This systematic review is designed to (a) describe measures used to quantify vocal development in pediatric cochlear implant (CI) users, (b) synthesize the evidence on prelinguistic vocal development in young children before and after cochlear implantation, and (c) analyze the application of the current evidence for evaluating change in vocal development before and after cochlear implantation for young children. Investigations of prelinguistic vocal development after cochlear implantation are only beginning to uncover the expected course of prelinguistic vocal development in children with CIs and what factors influence that course, which varies substantially across pediatric CI users. A deeper understanding of prelinguistic vocal development will improve professionals' abilities to determine whether a child with a CI is exhibiting sufficient progress soon after implantation and to adjust intervention as needed.

DESIGN

We systematically searched PubMed, ProQuest, and CINAHL databases for primary reports of children who received a CI before 5 years 0 months of age that included at least one measure of nonword, nonvegetative vocalizations. We also completed supplementary searches.

RESULTS

Of the 1916 identified records, 59 met inclusion criteria. The included records included 1125 total participants, which came from 36 unique samples. Records included a median of 8 participants and rarely included children with disabilities other than hearing loss. Nearly all of the records met criteria for level 3 for quality of evidence on a scale of 1 (highest) to 4 (lowest). Records utilized a wide variety of vocalization measures but often incorporated features related to canonical babbling. The limited evidence from pediatric CI candidates before implantation suggests that they are likely to exhibit deficits in canonical syllables, a critical vocal development skill, and phonetic inventory size. Following cochlear implantation, multiple studies report similar patterns of growth, but faster rates producing canonical syllables in children with CIs than peers with comparable durations of robust hearing. However, caution is warranted because these demonstrated vocal development skills still occur at older chronological ages for children with CIs than chronological age peers with typical hearing.

CONCLUSIONS

Despite including a relatively large number of records, the evidence in this review regarding changes in vocal development before and after cochlear implantation in young children remains limited. A deeper understanding of when prelinguistic skills are expected to develop, factors that explain deviation from that course, and the long-term impacts of variations in vocal prelinguistic development is needed. The diverse and dynamic nature of the relatively small population of pediatric CI users as well as relatively new vocal development measures present challenges for documenting and predicting vocal development in pediatric CI users before and after cochlear implantation. Synthesizing results across multiple institutions and completing rigorous studies with theoretically motivated, falsifiable research questions will address a number of challenges for understanding prelinguistic vocal development in children with CIs and its relations with other current and future skills. Clinical implications include the need to measure prelinguistic vocalizations regularly and systematically to inform intervention planning.

Short-Term Pediatric Acclimatization to Adaptive Hearing Aid Technology

Purpose This exploratory study assessed the perceptual, cognitive, and academic learning effects of an adaptive, integrated, directionality, and noise reduction hearing aid program in pediatric users. Method Fifteen pediatric hearing aid users (6-12 years old) received new bilateral, individually fitted Oticon Opn hearing aids programmed with OpenSound Navigator (OSN) processing. Word recognition in noise, sentence repetition in quiet, nonword repetition, vocabulary learning, selective attention, executive function, memory, and reading and mathematical abilities were measured within 1 week of the initial hearing aid fitting and 2 months post fit. Caregivers completed questionnaires assessing their child's listening and communication abilities prior to study enrollment and after 2 months of using the study hearing aids. Results Caregiver reporting indicated significant improvements in speech and sound perception, spatial sound awareness, and the ability to participate in conversations. However, there was no positive change in performance in any of the measured skills. Mathematical scores significantly declined after 2 months. Conclusions OSN provided a perceived improvement in functional benefit, compared to their previous hearing aids, as reported by caregivers. However, there was no positive change in listening skills, cognition, and academic success after 2 months of using OSN. Findings may have been impacted by reporter bias, limited sample size, and a relatively short trial period. This study took place during the summer when participants were out of school, which may have influenced the decline in mathematical scores. The results support further exploration with age- and audiogram-matched controls, larger sample sizes, and longer test-retest intervals that correspond to the academic school year.

The impact of unilateral, simultaneous, or sequential cochlear implantation on pediatric language outcomes

OBJECTIVES

The purpose of this study was to determine the impact of unilateral versus bilateral cochlear implantation on receptive and expressive spoken language outcomes. Secondary aims were to investigate factors timing of first and second implant placement and reliance on government funded health plans on language outcome.

METHODS

This was a retrospective chart review of spoken language users with bilateral severe-to-profound hearing loss. A total of 204 children were included, 105 in the bilateral group and 99 in the unilateral group. Multiple regression analyses were completed to investigate factors that influence language outcomes at age 5.

RESULTS

Recipients who received bilateral CIs performed significantly higher on measures of receptive and expressive language than those with unilateral implants.

DISCUSSION

This study demonstrates that bilateral implantation has a significant impact on receptive and expressive aspects of language development, and should be strongly considered as standard practice for children with bilateral severe to profound hearing loss.

CONCLUSION

These results indicate that families should be counseled that language outcomes are better with bilateral cochlear implantation than unilateral implantation. Cochlear implant teams should continue to consider the impact of socioeconomic status on outcomes and explore new methods to reduce the impacts and barriers of poverty to language development.

Developing new scales for assessing parents' aural and oral rehabilitation skills to interact with children with hearing loss

OBJECTIVE

Scales for evaluating the teaching and behavioural skills of parents enrolled in aural and oral rehabilitation programs for children with hearing loss are lacking. This study developed and validated scales for assessing parental teaching and behavioural skills of those parents for use in guiding their child to develop language and communication skills.

DESIGN

Scales were constructed and evaluated using exploratory and confirmatory factor analysis. The performance of parents in teaching and behavioural skills was also explored.

STUDY SAMPLE

The teaching and behavioural skills of 344 parents (179 for scale development and 165 for validation) were rated by their intervention therapists using parental teaching skill (PTS) and parental behavioural skill (PBS) scales.

RESULTS

Good reliability and model fit (validity) were observed for both scales, which ultimately included 13 and 10 items, respectively. Maternal educational level was a significant indicator of their performance ratings.

CONCLUSIONS

The PTS and PBS scales were validated and can be used by early intervention professionals to evaluate the relative interaction and behavioural skills of parents of children with hearing loss, and enrolled in listening and spoken language intervention programs.

"Textual Prosody" Can Change Impressions of Reading in People With Normal Hearing and Hearing Loss

Recently, dynamic text presentation, such as scrolling text, has been widely used. Texts are often presented at constant timing and speed in conventional dynamic text presentation. However, dynamic text presentation enables visually presented texts to indicate timing information, such as prosody, and the texts might influence the impression of reading. In this paper, we examined this possibility by focusing on the temporal features of digital text in which texts are represented sequentially and with varying speed, duration, and timing. We call this "textual prosody." We used three types of textual prosody: "Recorded," "Shuffled," and "Constant." Recorded prosody is the reproduction of a reader's reading with pauses and varying speed that simulates talking. Shuffled prosody randomly shuffles the time course of speed and pauses in the recorded type. Constant prosody has a constant presentation speed and provides no timing information. Experiment 1 examined the effect of textual prosody on people with normal hearing. Participants read dynamic text with textual prosody silently and rated their impressions of texts. The results showed that readers with normal hearing preferred recorded textual prosody and constant prosody at the optimum speed (6 letters/second). Recorded prosody was also preferred at a low presentation speed. Experiment 2 examined the characteristics of textual prosody using an articulatory suppression paradigm. The results showed that some textual prosody was stored in the articulatory loop despite it being presented visually. In Experiment 3, we examined the effect of textual prosody with readers with hearing loss. The results demonstrated that readers with hearing loss had positive impressions at relatively low presentation speeds when the recorded prosody was presented. The results of this study indicate that the temporal structure is processed regardless of whether the input is visual or auditory. Moreover, these results suggest that textual prosody can enrich reading not only in people with normal hearing but also in those with hearing loss, regardless of acoustic experiences.

Evaluating the Efficacy of Taurodeoxycholic Acid in Providing Otoprotection Using an in vitro Model of Electrode Insertion Trauma

Cochlear implants (CIs) are widely used to provide auditory rehabilitation to individuals having severe to profound sensorineural hearing loss (SNHL). However, insertion of electrode leads to inner trauma and activation of inflammatory and apoptotic signaling cascades resulting in loss of residual hearing in implanted individuals. Pharmaceutical interventions that can target these signaling cascades hold great potential for preserving residual hearing by preventing sensory cell damage. Bile salts have shown efficacy in various regions of the body as powerful antioxidants and anti-inflammatory agents. However, their efficacy against inner ear trauma has never been explored. The objective of this study was to determine whether taurodeoxycholic acid (TDCA), a bile salt derivative, can prevent sensory cell damage employing an in vitro model of electrode insertion trauma (EIT). The organ of Corti (OC) explants were dissected from postnatal day 3 (P-3) rats and placed in serum-free media. Explants were divided into control and experimental groups: (1) untreated controls; (2) EIT; (3) EIT+ TDCA (different concentrations). Hair cell (HC) density, analyses of apoptosis pathway (cleaved caspase 3), levels of reactive oxygen species (ROS) as well as inducible nitric oxide synthase (iNOS) activity and Mitochondrial Membrane Potential (MMP) were assayed. Treatment with TDCA provided significant otoprotection against HC loss in a dose-dependent manner. The molecular mechanisms underlying otoprotection involved decreasing oxidative stress, lowering levels of iNOS, and abrogating generation of cleaved caspase 3. The results of the present study suggest that TDCA provides efficient otoprotection against EIT, in vitro and should be explored for developing pharmaceutical interventions to preserve residual hearing post-cochlear implantation.

Lexical Repetition Properties of Caregiver Speech and Language Development in Children With Cochlear Implants

Purpose Early language input plays an important role in child language and cognitive development (e.g., Gilkerson et al., 2018; Hart & Risley, 1995). In this study, we examined the effects of child's hearing status on lexical repetition properties of speech produced by their caregivers with normal hearing (NH). In addition, we investigated the relationship between maternal lexical repetition properties and later language skills in English-learning infants with cochlear implants (CIs). Method In a free-play session, 17 mothers and their prelingually deaf infants who received CIs before 2 years of age (CI group) were recorded at two post-CI intervals: 3 and 6 months postactivation; 18 hearing experience-matched infants with NH and their mothers and 14 chronological age-matched infants with NH group and their mothers were matched to the CI group. Maternal speech was transcribed from the recordings, and measures of maternal lexical repetition were obtained. Standardized language assessments were administered on children with CIs approximately two years after CI activation. Results The findings indicated that measures of lexical repetition were similar among the three groups of mothers, regardless of the hearing status of their infants. In addition, lexical repetition measures were correlated with later language skills in infants with CIs. Conclusions Infants with CIs receive the language input that contains similar lexical repetition properties as that in the speech received by their peers with NH, which is likely to play an important role in child speech processing and language development. These findings provide the knowledge for professionals to coach parents to implement specific language intervention strategies to support language development in infants with hearing loss. Supplemental Material https://doi.org/10.23641/asha.11936322.

Value of Routine Magnetic Resonance Imaging for the Preoperative Assessment of Cochlear Implant Candidates

Background

The selection of an appropriate imaging technique for assessment before cochlear implantation is critical for precise diagnosis and management. While magnetic resonance imaging (MRI) is used for the diagnosis of several conditions, such as labyrinthitis ossificans, cochlear nerve deficiency, and neoplasms, high-resolution computed tomography (HRCT) provides excellent details of the temporal bone. However, it remains unclear whether routine MRI provides any additional benefits over HRCT.

Objectives

To assess the added value of MRI as a screening tool for temporal bone abnormalities in cochlear implant candidates through comparisons of its findings with those of HRCT.

Materials and method

It is a retrospective analysis of preoperative HRCT and MR images in a tertiary referral center. A total of 308 patients who underwent MRI and HRCT examinations before cochlear implantation between 2013 and 2015 were included. Preoperative HRCT and MR images were screened for temporal bone abnormalities by a senior neurotologist and a neuroradiologist.

Results

HRCT detected inner ear deformities in 51 of the 308 (16.6%) subjects, whereas MRI revealed abnormalities in only 18 (5.8%) of subjects. HRCT detected the same inner abnormalities in 16 of the 18 (88.9%) subjects diagnosed by MRI, whereas it showed normal results for the remaining two subjects. MRI detected cochlear nerve aplasia/hypoplasia in 13 subjects, 11 of whom had associated inner ear deformities that were detected by HRCT. The MR images of nine subjects showed cochlear fibrosis, which was confirmed by HRCT in all nine subjects.

Conclusion

In this study, MRI did not exhibit significant additional benefits over HRCT, and its routine use for the preoperative assessment of CI candidates was not justified. However, MRI is warranted for subjects at an increased risk of cochlear nerve aplasia due to an inner ear deformity or a narrow internal auditory canal. The establishment of criteria that facilitate the performance of MRI only when absolutely needed will reduce healthcare costs, prevent unnecessary exposure to the risks associated with general anesthesia, and shorten delays before cochlear implantation.

Effects of Age at Cochlear Implantation on Vocabulary and Grammar: A Review of the Evidence

Purpose The increasing prevalence of pediatric cochlear implantation over the past 25 years has left little doubt that resulting improvements in hearing offer significant benefits to language development for many deaf children. Furthermore, given the documented importance of access to language from birth, there has been strong support for providing congenitally deaf children with implants as early as possible. Earliest implantation, in many ways, has become the "gold standard" in pediatric cochlear implantation, on the assumption that it is the key to language development similar to that of hearing children. Empirical evidence to support this assumption, however, appears more equivocal than generally is believed. This article reviews recent research aimed at assessing the impact of age at implantation on vocabulary and grammatical development among young implant users. Method Articles published between 2003 and 2018 that included age at implantation as a variable of interest and in which it was subjected to statistical analysis were considered. Effect sizes were calculated whenever possible; we conducted a multivariate meta-analysis to compare outcomes in different language domains. Results Taken together, findings from 49 studies suggest that age at implantation is just one of a host of variables that influence vocabulary and grammatical development, its impact varying with several factors including whether age at implantation is treated as a dichotomous or continuous variable. Results from a meta-analysis showed significant differences across language domains. Conclusion The pattern of results obtained indicates the importance of considering various child, family, and environmental characteristics in future research aimed at determining how early "early implantation" needs to be and the extent to which age at implantation, duration of implant use, and other factors influence language and language-related outcomes. Supplemental Material https://doi.org/10.23641/asha.9789041.

Early general development and central auditory system maturation in children with cochlear implants - A case series

OBJECTIVES

A cochlear implant (CI) has the potential to improve the functioning of a deaf child in many aspects. Nevertheless, the dynamics of the general development, beyond the typically measured language abilities, directly after CI, is still unknown, especially if a child is implanted early. In this study we present a methodological framework for assessment of different domains of development, as well as the central auditory nervous system (CANS) maturation in infants and toddlers with a CI.

METHODS

Three children with bilateral congenital hearing loss and a unilateral CI, aged below 2.5 years, participated in a longitudinal study. Children were tested at three time points after cochlear implantation using the Polish Children Development Scale (CDS) consisting of a comprehensive battery of tests, as well as recordings of Cortical Auditory Evoked Potentials (CAEP).

RESULTS

All three children revealed gradual improvement in the overall CDS result as well as most of the CDS subscales. After 9 months of CI experience two younger children showed age-appropriate performance. In CAEP measurements a decrease of latency of the P1 component (an established biomarker of cortical auditory maturation) was observed in the same two children, with one achieving normal ranges of P1 latency after 9 months of CI use.

CONCLUSIONS

Our novel methodological framework can be successfully applied in small children with cochlear implants. It contributes to better understanding of the general development in early implanted children. The preliminary results indicate variability in children's performance in various developmental domains and thus the need to monitor the development of each child individually and holistically.

Systematic Review of Auditory Training in Pediatric Cochlear Implant Recipients

Objective The purpose of this systematic review is to evaluate the published research in auditory training (AT) for pediatric cochlear implant (CI) recipients. This review investigates whether AT in children with CIs leads to improvements in speech and language development, cognition, and/or quality of life and whether improvements, if any, remain over time post AT intervention. Method A systematic search of 7 databases identified 96 review articles published up until January 2017, 9 of which met the inclusion criteria. Data were extracted and independently assessed for risk of bias and quality of study against a PICOS (participants, intervention, control, outcomes, and study) framework. Results All studies reported improvements in trained AT tasks, including speech discrimination/identification and working memory. Retention of improvements over time was found whenever it was assessed. Transfer of learning was measured in 4 of 6 studies, which assessed generalization. Quality of life was not assessed. Overall, evidence for the included studies was deemed to be of low quality. Conclusion Benefits of AT were illustrated through the improvement in trained tasks, and this was observed in all reviewed studies. Transfer of improvement to other domains and also retention of benefits post AT were evident when assessed, although rarely done. However, higher quality evidence to further examine outcomes of AT in pediatric CI recipients is needed.

The Role of Statistical Learning in Understanding and Treating Spoken Language Outcomes in Deaf Children With Cochlear Implants

Purpose

Statistical learning-the ability to learn patterns in environmental input-is increasingly recognized as a foundational mechanism necessary for the successful acquisition of spoken language. Spoken language is a complex, serially presented signal that contains embedded statistical relations among linguistic units, such as phonemes, morphemes, and words, which represent the phonotactic and syntactic rules of language. In this review article, we first review recent work that demonstrates that, in typical language development, individuals who display better nonlinguistic statistical learning abilities also show better performance on different measures of language. We next review research findings that suggest that children who are deaf and use cochlear implants may have difficulties learning sequential input patterns, possibly due to auditory and/or linguistic deprivation early in development, and that the children who show better sequence learning abilities also display improved spoken language outcomes. Finally, we present recent findings suggesting that it may be possible to improve core statistical learning abilities with specialized training and interventions and that such improvements can potentially impact and facilitate the acquisition and processing of spoken language.

Method

We conducted a literature search through various online databases including PsychINFO and PubMed, as well as including relevant review articles gleaned from the reference sections of other review articles used in this review. Search terms included various combinations of the following: sequential learning, sequence learning, statistical learning, sequence processing, procedural learning, procedural memory, implicit learning, language, computerized training, working memory training, statistical learning training, deaf, deafness, hearing impairment, hearing impaired, DHH, hard of hearing, cochlear implant(s), hearing aid(s), and auditory deprivation. To keep this review concise and clear, we limited inclusion to the foundational and most recent (2005-2018) relevant studies that explicitly included research or theoretical perspectives on statistical or sequential learning. We here summarize and synthesize the most recent and relevant literature to understanding and treating language delays in children using cochlear implants through the lens of statistical learning.

Conclusions

We suggest that understanding how statistical learning contributes to spoken language development is important for understanding some of the difficulties that children who are deaf and use cochlear implants might face and argue that it may be beneficial to develop novel language interventions that focus specifically on improving core foundational statistical learning skills.

Pediatric Hearing Loss and Speech Recognition in Quiet and in Different Types of Background Noise

Purpose Speech recognition deteriorates with hearing loss, particularly in fluctuating background noise. This study examined how hearing loss affects speech recognition in different types of noise to clarify how characteristics of the noise interact with the benefits listeners receive when listening in fluctuating compared to steady-state noise. Method Speech reception thresholds were measured for a closed set of spondee words in children (ages 5-17 years) in quiet, speech-spectrum noise, 2-talker babble, and instrumental music. Twenty children with normal hearing and 43 children with hearing loss participated; children with hearing loss were subdivided into groups with cochlear implant (18 children) and hearing aid (25 children) groups. A cohort of adults with normal hearing was included for comparison. Results Hearing loss had a large effect on speech recognition for each condition, but the effect of hearing loss was largest in 2-talker babble and smallest in speech-spectrum noise. Children with normal hearing had better speech recognition in 2-talker babble than in speech-spectrum noise, whereas children with hearing loss had worse recognition in 2-talker babble than in speech-spectrum noise. Almost all subjects had better speech recognition in instrumental music compared to speech-spectrum noise, but with less of a difference observed for children with hearing loss. Conclusions Speech recognition is more sensitive to the effects of hearing loss when measured in fluctuating compared to steady-state noise. Speech recognition measured in fluctuating noise depends on an interaction of hearing loss with characteristics of the background noise; specifically, children with hearing loss were able to derive a substantial benefit for listening in fluctuating noise when measured in instrumental music compared to 2-talker babble.

Theoretical Evaluation and Experimental Validation of Localized Therapeutic Hypothermia Application to Preserve Residual Hearing After Cochlear Implantation

OBJECTIVES

Cochlear implantation surgery has been shown to result in trauma to inner ear sensory structures, resulting in loss of residual hearing. Localized therapeutic hypothermia has been shown in clinical care to be a neuroprotective intervention. Previously, we have shown in an experimental model that localized hypothermia protects cochlear hair cells and residual hearing function against surgical and cochlear implantation trauma. Using experimental temperature measurements carried out in human cadaver temporal bones and a finite element model of the inner ear, the present study examined the temperature distribution of a custom-designed hypothermia delivery system in the human inner ear organs.

DESIGN

The efficacy of the hypothermia probe and resulting heat distribution across human cochlea and surrounding tissues were modeled in three-dimensional in COMSOL. The geometry and dimensions of inner ear and temporal bones were derived from computed tomographic and magnetic resonance imaging images. Model predictions were compared with experimental observations from five human temporal bones.

RESULTS

In both the modeling and experimental studies, the cochlear temperature was lowered by 4 to 6 °C on the round window from a baseline of 37 °C within 16 to 18 minutes. The model simulations showed uniformly distributed cooling across the cochlea. This study provides insight for design, operation, and protocols for efficacious delivery of mild therapeutic hypothermia to the human cochlea that may significantly benefit patients undergoing surgical cochlear implantation by preserving residual hearing.

CONCLUSION

There was a close correlation between the results of the numerical simulations and experimental observations in this study. Our custom-designed system is capable of effectively providing mild therapeutic hypothermia locally to the human cochlea. When combined with results from in vivo animal experiments, the present study suggests that the application of localized therapeutic hypothermia may hold potential for patients with an aim to preserve residual hearing after cochlear implantation.

Parent-Implemented Communication Treatment for Infants and Toddlers With Hearing Loss: A Randomized Pilot Trial

Purpose Despite advances in cochlear implant and hearing aid technology, many children with hearing loss continue to exhibit poorer language skills than their hearing peers. This randomized pilot trial tested the effects of a parent-implemented communication treatment targeting prelinguistic communication skills in infants and toddlers with hearing loss. Method Participants included 19 children between 6 and 24 months of age with moderate to profound, bilateral hearing loss. Children were randomly assigned to the parent-implemented communication treatment group or a "usual care" control group. Parents and children participated in 26, hour-long home sessions in which parents were taught to use communication support strategies. The primary outcome measures were the Communication and Symbolic Behavior Scales (Wetherby & Prizant, 2003), a measure of child prelinguistic skills, and parental use of communication support strategies during a naturalistic play session. Results Parents in the treatment group increased their use of communication support strategies by 17%. Children in the treatment group made statistically significant more gains in speech prelinguistic skills ( d = 1.09, p = .03) as compared with the control group. There were no statistically significant differences in social and symbolic prelinguistic skills; however, the effect sizes were large ( d = 0.78, p = .08; d = 0.91, p = .10). Conclusions This study provides modest preliminary support for the short-term effects of a parent-implemented communication treatment for children with hearing loss. Parents learned communication support strategies that subsequently impacted child prelinguistic skills. Although these results appear promising, the sample size is very small. Future research should include a larger clinical trial and child-level predictors of response to treatment.

Predictors of Vocabulary Outcomes in Children Who Are Deaf or Hard of Hearing From Spanish-Speaking Families

Purpose

The goal of this study was to identify predictors of expressive vocabulary in young Spanish-speaking children who are deaf or hard of hearing living in the United States.

Method

This cross-sectional study considered 53 children with bilateral hearing loss between 8 and 34 months of age ( M = 24, SD = 6.9). Demographic variables, variables related to the hearing loss, and intervention variables were included in a hierarchical regression analysis to predict expressive vocabulary quotients from the MacArthur Inventario del Desarrollo de Habilidades Comunicativas (Communicative Development Inventories; Jackson-Maldonado et al., 2003 ).

Results

Chronological age, degree of hearing loss, functional hearing ability ratings, age of enrollment in early intervention, and the interaction between chronological age and age of intervention accounted for 61.5% of the vocabulary variance. Children who received intervention by 6 months of age achieved significantly higher vocabulary outcomes than children who started intervention later.

Conclusion

The children's mean vocabulary outcomes were below average when compared with hearing peers. This was especially true for older children, children with moderately-severe-to-profound hearing loss, and children who began intervention after 6 months of age. This delay in vocabulary outcomes has the potential to interfere with future reading and academic outcomes.

[The results of cochlear implantation in the patient with hereditary and non-hereditary hearing loss]

The objective of the present study was to evaluate the effectiveness of rehabilitation of the patients after cochlear implantation in the early and late periods after operation taking into consideration the etiology of congenital deafness. The comprehensive clinico-audiological examination performed during the period from 2010 to 2015 involved 246 children who had undergone cochlear implantation (CI). All children were operated at the National Research Center for Audiology and Hearing Rehabilitation in the period from 2003 to 2013. 83 (56%) patients were aged 1 to 3 years at the time of surgery. Their age varied from 3 to 18 years when they underwent the clinico-audiological examination. Thus, the study is based on the experience with cochlear implantation varying from 3 to 12 years. The genetic analysis revealed mutations in the GJB2 gene in 49% of the children, in agreement with the data of earlier studies. 85% of all the children with GJB2 deafness surgically treated at the age under 4 years attend ordinary institutions of learning. Within 24 months after the onset of the observations the majority of the children with hereditary deafness (63%) were referred to the groups with good and excellent results of the rehabilitation and only 6 (12%) patients presented with unsatisfactory results. It was shown that the acquired causes of the loss of hearing including severe prenatal pathology have a negative influence on the long-term outcomes of rehabilitation. The results of the genetic analysis for the elucidation of the cause of impaired hearing can be employed as a prognostic criteria not only for the prediction but also for the guarantee of the success of cochlear implantation provided the rehabilitative process was initiated in a proper time.

Current trends in outcome studies for children with hearing loss and the need to establish a comprehensive framework of measuring outcomes in children with hearing loss in China

Since the 1970s, outcome studies for children with hearing loss expanded from focusing on assessing auditory awareness and speech perception skills to evaluating language and speech development. Since the early 2000s, the multi-center large scale research systematically studied outcomes in the areas of auditory awareness, speech-perception, language development, speech development, educational achievements, cognitive development, and psychosocial development. These studies advocated the establishment of baseline and regular follow-up evaluations with a comprehensive framework centered on language development. Recent research interests also include understanding the vast differences in outcomes for children with hearing loss, understanding the relationships between neurocognitive development and language acquisition in children with hearing loss, and using outcome studies to guide evidence-based clinical practice. After the establishment of standardized Mandarin language assessments, outcomes research in Mainland China has the potential to expand beyond auditory awareness and speech perception studies.

Barriers to early cochlear implantation

OBJECTIVE

Identify variables associated with paediatric access to cochlear implants (CIs).

DESIGN

Part 1. Trends over time for age at CI surgery (N = 802) and age at hearing aid (HA) fitting (n = 487) were examined with regard to periods before, during, and after newborn hearing screening (NHS). Part 2. Demographic factors were explored for 417 children implanted under 3 years of age. Part 3. Pre-implant steps for the first 20 children to receive CIs under 12 months were examined.

RESULTS

Part 1. Age at HA fitting and CI surgery reduced over time, and were associated with NHS implementation. Part 2. For children implanted under 3 years, earlier age at HA fitting and higher family socio-economic status were associated with earlier CI. Progressive hearing loss was associated with later CIs. Children with a Connexin 26 diagnosis received CIs earlier than children with a premature / low birth weight history. Part 3. The longest pre-CI steps were Step 1: Birth to diagnosis/identification of hearing loss (mean 16.43 weeks), and Step 11: MRI scans to implant surgery (mean 15.05 weeks) for the first 20 infants with CIs under 12 months.

CONCLUSION

NHS implementation was associated with reductions in age at device intervention in this cohort.

Sensitive periods and language in cochlear implant users

This study explores the hypothesis that the existence of a short sensitive period for lower-level speech perception/articulation skills, and a long one for higher-level language skills, may partly explain the language outcomes of children with cochlear implants (CIs). The participants were fourteen children fitted with a CI before their second birthday. Data about their language skills and the environmental conditions (e.g. Family Involvement in rehabilitation) were obtained over a period of three years. Age at implantation correlated exclusively with the ratio of errors of place of articulation, a phonological feature for which CIs provide insufficient information. The degree of Family Involvement was significantly correlated with the remaining language measures. We conclude that small plasticity reductions affecting lower-level skills may partly explain the difficulties of some CI users in developing language.

New language outcome measures for Mandarin speaking children with hearing loss

Objective

The paper discusses recent evidence on the assessment of language outcomes in children with hearing loss acquiring oral language.

Methods

Research emphasizes that language tests must be specific enough to capture subtle deficits in vocabulary and grammar learning at different developmental ages. The Diagnostic Receptive and Expressive Assessment of Mandarin (DREAM) was carefully designed to be a comprehensive standardized Mandarin assessment normed in Mainland China.

Results

This paper summarizes the evidence-based item design process and validity and reliability results of DREAM. A pilot study reported here shows that DREAM provided detailed information about hearing impaired children's language abilities and can be used to aid intervention planning to maximize progress.

Conclusion

DREAM represents an example of translational science, transferring methods from empirical studies of language acquisition in research environments into applied domains such as assessment and intervention. Research on outcomes in China will advance significantly with the availability of evidence-based comprehensive language tests that measure a sufficient age range of skills, are normed on Mandarin speaking children in mainland China, and are designed to capture features central to Mandarin language acquisition.

Semantic and syntactic reading comprehension strategies used by deaf children with early and late cochlear implantation

Deaf students have traditionally exhibited reading comprehension difficulties. In recent years, these comprehension problems have been partially offset through cochlear implantation (CI), and the subsequent improvement in spoken language skills. However, the use of cochlear implants has not managed to fully bridge the gap in language and reading between normally hearing (NH) and deaf children, as its efficacy depends on variables such as the age at implant. This study compared the reading comprehension of sentences in 19 children who received a cochlear implant before 24 months of age (early-CI) and 19 who received it after 24 months (late-CI) with a control group of 19 NH children. The task involved completing sentences in which the last word had been omitted. To complete each sentence children had to choose a word from among several alternatives that included one syntactic and two semantic foils in addition to the target word. The results showed that deaf children with late-CI performed this task significantly worse than NH children, while those with early-CI exhibited no significant differences with NH children, except under more demanding processing conditions (long sentences with infrequent target words). Further, the error analysis revealed a preference of deaf students with early-CI for selecting the syntactic foil over a semantic one, which suggests that they draw upon syntactic cues during sentence processing in the same way as NH children do. In contrast, deaf children with late-CI do not appear to use a syntactic strategy, but neither a semantic strategy based on the use of key words, as the literature suggests. Rather, the numerous errors of both kinds that the late-CI group made seem to indicate an inconsistent and erratic response when faced with a lack of comprehension. These findings are discussed in relation to differences in receptive vocabulary and short-term memory and their implications for sentence reading comprehension.

The impact of universal newborn hearing screening on long-term literacy outcomes: a prospective cohort study

OBJECTIVE

To determine whether the benefits of universal newborn hearing screening (UNHS) seen at age 8 years persist through the second decade.

DESIGN

Prospective cohort study of a population sample of children with permanent childhood hearing impairment (PCHI) followed up for 17 years since birth in periods with (or without) UNHS.

SETTING

Birth cohort of 100 000 in southern England.

PARTICIPANTS

114 teenagers aged 13-19 years, 76 with PCHI and 38 with normal hearing. All had previously their reading assessed aged 6-10 years.

INTERVENTIONS

Birth in periods with and without UNHS; confirmation of PCHI before and after age 9 months.

MAIN OUTCOME MEASURE

Reading comprehension ability. Regression modelling took account of severity of hearing loss, non-verbal ability, maternal education and main language.

RESULTS

Confirmation of PCHI by age 9 months was associated with significantly higher mean z-scores for reading comprehension (adjusted mean difference 1.17, 95% CI 0.36 to 1.97) although birth during periods with UNHS was not (adjusted mean difference 0.15, 95% CI -0.75 to 1.06). The gap between the reading comprehension z-scores of teenagers with early compared with late confirmed PCHI had widened at an adjusted mean rate of 0.06 per year (95% CI -0.02 to 0.13) during the 9.2-year mean interval since the previous assessment.

CONCLUSIONS

The benefit to reading comprehension of confirmation of PCHI by age 9 months increases during the teenage years. This strengthens the case for UNHS programmes that lead to early confirmation of permanent hearing loss.

TRIAL REGISTRATION NUMBER

ISRCTN03307358.

Cochlear implantation (CI) for prelingual deafness: the relevance of studies of brain organization and the role of first language acquisition in considering outcome success

Cochlear implantation (CI) for profound congenital hearing impairment, while often successful in restoring hearing to the deaf child, does not always result in effective speech processing. Exposure to non-auditory signals during the pre-implantation period is widely held to be responsible for such failures. Here, we question the inference that such exposure irreparably distorts the function of auditory cortex, negatively impacting the efficacy of CI. Animal studies suggest that in congenital early deafness there is a disconnection between (disordered) activation in primary auditory cortex (A1) and activation in secondary auditory cortex (A2). In humans, one factor contributing to this functional decoupling is assumed to be abnormal activation of A1 by visual projections-including exposure to sign language. In this paper we show that that this abnormal activation of A1 does not routinely occur, while A2 functions effectively supramodally and multimodally to deliver spoken language irrespective of hearing status. What, then, is responsible for poor outcomes for some individuals with CI and for apparent abnormalities in cortical organization in these people? Since infancy is a critical period for the acquisition of language, deaf children born to hearing parents are at risk of developing inefficient neural structures to support skilled language processing. A sign language, acquired by a deaf child as a first language in a signing environment, is cortically organized like a heard spoken language in terms of specialization of the dominant perisylvian system. However, very few deaf children are exposed to sign language in early infancy. Moreover, no studies to date have examined sign language proficiency in relation to cortical organization in individuals with CI. Given the paucity of such relevant findings, we suggest that the best guarantee of good language outcome after CI is the establishment of a secure first language pre-implant-however that may be achieved, and whatever the success of auditory restoration.

How does visual language affect crossmodal plasticity and cochlear implant success?

Cochlear implants (CI) are the most successful intervention for ameliorating hearing loss in severely or profoundly deaf children. Despite this, educational performance in children with CI continues to lag behind their hearing peers. From animal models and human neuroimaging studies it has been proposed the integrative functions of auditory cortex are compromised by crossmodal plasticity. This has been argued to result partly from the use of a visual language. Here we argue that 'cochlear implant sensitive periods' comprise both auditory and language sensitive periods, and thus cannot be fully described with animal models. Despite prevailing assumptions, there is no evidence to link the use of a visual language to poorer CI outcome. Crossmodal reorganisation of auditory cortex occurs regardless of compensatory strategies, such as sign language, used by the deaf person. In contrast, language deprivation during early sensitive periods has been repeatedly linked to poor language outcomes. Language sensitive periods have largely been ignored when considering variation in CI outcome, leading to ill-founded recommendations concerning visual language in CI habilitation.

Cerebral asymmetry and language development: cause, correlate, or consequence?

In most people, language is processed predominantly by the left hemisphere of the brain, but we do not know how or why. A popular view is that developmental language disorders result from a poorly lateralized brain, but until recently, evidence has been weak and indirect. Modern neuroimaging methods have made it possible to study normal and abnormal development of lateralized function in the developing brain and have confirmed links with language and literacy impairments. However, there is little evidence that weak cerebral lateralization has common genetic origins with language and literacy impairments. Our understanding of the association between atypical language lateralization and developmental disorders may benefit if we reconceptualize the nature of cerebral asymmetry to recognize its multidimensionality and consider variation in lateralization over developmental time. Contrary to popular belief, cerebral lateralization may not be a highly heritable, stable characteristic of individuals; rather, weak lateralization may be a consequence of impaired language learning.

Effects of maternal sensitivity and cognitive and linguistic stimulation on cochlear implant users' language development over four years

OBJECTIVES

To examine the effects of observed maternal sensitivity (MS), cognitive stimulation (CS), and linguistic stimulation on the 4-year growth of oral language in young, deaf children receiving a cochlear implant. Previous studies of cochlear implants have not considered the effects of parental behaviors on language outcomes.

STUDY DESIGN

In this prospective, multisite study, we evaluated parent-child interactions during structured and unstructured play tasks and their effects on oral language development in 188 deaf children receiving a cochlear implant and 97 normal-hearing children as controls. Parent-child interactions were rated on a 7-point scale using the National Institute of Child Health and Human Development's Early Childcare Study codes, which have well-established psychometric properties. Language was assessed using the MacArthur Bates Communicative Development Inventories, the Reynell Developmental Language Scales, and the Comprehensive Assessment of Spoken Language.

RESULTS

We used mixed longitudinal modeling to test our hypotheses. After accounting for early hearing experience and child and family demographics, MS and CS predicted significant increases in the growth of oral language. Linguistic stimulation was related to language growth only in the context of high MS.

CONCLUSION

The magnitude of effects of MS and CS on the growth of language was similar to that found for age at cochlear implantation, suggesting that addressing parenting behaviors is a critical target for early language learning after implantation.

Toward epigenetic and gene regulation models of specific language impairment: looking for links among growth, genes, and impairments

Children with specific language impairment (SLI) are thought to have an inherited form of language impairment that spares other developmental domains. SLI shows strong heritability and recent linkage and association studies have replicated results for candidate genes. Regulatory regions of the genes may be involved. Behavioral growth models of language development of children with SLI reveal that the onset of language is delayed, and the growth trajectories of children with SLI parallel those of younger children without SLI. The rate of language acquisition decelerates in the pre-adolescent period, resulting in immature language levels for the children with SLI that persist into adolescence and beyond. Recent genetic and epigenetic discoveries and models relevant to language impairment are reviewed. T cell regulation of onset, acceleration, and deceleration signaling are described as potential conceptual parallels to the growth timing elements of language acquisition and impairment. A growth signaling disruption (GSD) hypothesis is proposed for SLI, which posits that faulty timing mechanisms at the cellular level, intrinsic to neurocortical functioning essential for language onset and growth regulation, are at the core of the growth outcomes of SLI. The GSD highlights the need to document and account for growth patterns over childhood and suggests needed directions for future investigation.

Neogenomic events challenge current models of heritability, neuronal plasticity dynamics, and machine learning

We address current needs for neogenomics-based theoretical and computational approaches for several neuroscience research fields, from investigations of heritability properties, passing by investigations of spatiotemporal dynamics in the neuromodulatory microcircuits involved in perceptual learning and attentional shifts, to the application of genetic algorithms to create robots exhibiting ongoing emergence.

Cochlear implantation updates: the Dallas Cochlear Implant Program

This report provides an overview of many research projects conducted by the Dallas Cochlear Implant Program, a joint enterprise between the University of Texas at Dallas, the University of Texas Southwestern Medical Center, and Children's Medical Center. The studies extend our knowledge of factors influencing communication outcomes in users of cochlear implants. Multiple designs and statistical techniques are used in the studies described including both cross sectional and longitudinal analyses. Sample sizes vary across the studies, and many of the samples represent large populations of children from North America. Multiple statistical techniques are used by the team to analyze outcomes. The team has provided critical information regarding electrode placement, signal processing, and communication outcomes in users of cochlear implants.