Comparison of reading skills between children with cochlear implants and children with typical hearing in Iran

Developing a programme for training phonological awareness and assessment of its effectiveness on reading skills of elementary first graders with cochlear implant

Background

The current study aimed to develop a comprehensive phonological awareness intervention to train all levels of phonological awareness skills and to investigate its effect on the reading abilities of cochlear implanted children.

Materials and Methods

This study was the single-subject intervention. Phonological awareness intervention programme was developed and validated by experts' opinions. Six elementary first graders with cochlear implants and weak or delayed reading development, in 5-7-year-old range, were trained in phonological awareness skills. 'Auditory test of phonological awareness skills' was used to evaluate the subjects' phonological awareness skills. Nama reading test was also used to determine the level of reading performance.

Results

The results showed that all six subjects with cochlear implants had improvements of both phonological awareness skills and reading skills after participating in the phonological awareness intervention programme. This improvement was not only observed immediately after intervention but was also preserved in follow-up.

Conclusion

The findings of this study demonstrated the importance of planning an intervention programme about phonological awareness skills for elementary first graders with cochlear implant, and the important role of such an intervention programme in improving their performance in phonological awareness tasks, and then in reading tasks consequently. The importance of improvement in these skills could considerably affect these children's linguistic and psychological abilities, which may facilitate their education at higher grades.

Meta-Analytic Findings on Reading in Children With Cochlear Implants

This meta-analysis study aims to quantify the group differences in reading skills between children with cochlear implants and their hearing peers and between children with cochlear implants and children with hearing aids (aged between 3 and 18 years old). Of the 5,642 articles screened, 47 articles met predetermined inclusion criteria (published between 2002 and 2019). The robust variance estimation based meta-analysis models were used to synthesize all the effect sizes. Children with cochlear implants scored significantly lower than their hearing peers in phonological awareness (g = -1.62, p < 0.001), vocabulary (g = -1.50, p < 0.001), decoding (g = -1.24, p < 0.001), and reading comprehension (g = -1.39, p < 0.001), but not for fluency (g = -0.67, p = 0.054). Compared to children with hearing aids, children with cochlear implants scored significantly lower in phonological awareness (g = -0.30, p = 0.028). The percentage of unilateral cochlear implant negatively impacts the group difference between children with cochlear implants and their hearing peers. Findings from this study confirm a positive shift in reading outcomes for profoundly deaf children due to cochlear implantation. Some children with cochlear implants may need additional supports in educational settings.

Effect of cochlear implantation on language development and assessment of the quality of studies in this field: A systematic review

Background: Cochlear implantation (CI) is an achievement that facilitates the acquisition of language skills in deaf children throughout the world. The use of this technology has a positive effect on all components of language acquisition (syntax, semantic, pragmatic, etc.). However, this positive impact is influenced by various factors. Understanding the strengths and weaknesses of studies on the development of language abilities can help improve these studies. Consequently, in the future, it will lead to the improvement of language rehabilitation in these children. Limited studies on children with CI in have been done so far. This article summarized the outcomes of scientific articles on the clinical efficacy of CI on Persian speaking children. This study also provided a clear picture of these studies by examining the quality of their methodologies and tools.

Methods: Articles indexed in Google Scholar, Web of Science, Medline, Scopus and Iranian databases (Danesh Gostar, Magiran, and SID) were searched using keywords "language," "Cochlear implant", "Persian/ Farsi" in English and Persian languages with "and/or". Original articles investigated on children younger than 13 years old with hearing impairment and CI were included.

Results: Five hundred and twenty-three articles were found based on the keywords. Among all of these, 485 were excluded due to the title and the abstract; we selected 38, of which 24 were repeated. Finally, 14 articles remained. We reviewed the articles based on the preferred reporting items for systematic review and meta-analysis (PRISMA) and checklist and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE).

Conclusion: Similar to international studies, Persian speaking children with CI have slower language development than their peers with normal hearing, but they are better than their peers who use hearing aids. The results of reviewing on quality of the articles showed that the studies could not meet reasonable quality because of the lack of a standard test in different aspects of Persian language and the absence of patients’ databanks. These results also can be used by other nationalities that recently have started surveys on children with CIs.

Spelling in Children With Cochlear Implants: Evidence of Underlying Processing Differences

This study compared the spelling skills and sub-skills of young children with cochlear implants (CIs) who use spoken language only (n = 14) with those of a same-aged typically hearing (TH) control group (n = 30). Spelling accuracy was assessed using irregular and nonsense word stimuli. Error and regression analyses were conducted to provide insight into the phonological and orthographic spelling strategies used by each group. Results indicated that children with CIs were as accurate as the TH group. However, misspellings made by the CI group were less phonologically plausible, and while nonword spelling accuracy was related to letter-sound knowledge for the TH group, the same relationship was non-significant for the CI group. Hence, despite demonstrating a similar degree of overall spelling success to TH children, children with CIs appeared to apply phonics skills less effectively.

Reading Development in Children With Cochlear Implants Who Communicate via Spoken Language: A Psycholinguistic Investigation

Purpose This study sought to comprehensively examine the reading skills and subskills of children with cochlear implants (CIs) and gain insight into the processes underlying their early reading development. Method Fourteen 6- to 9-year-old children with CIs were assessed on a range of reading and spoken language measures. Their performances were compared to a control group of 31 children with normal hearing (NH) of the same chronological and mental age. Group differences were examined using t tests and regression modeling. Results Children with CIs performed significantly worse than children with NH on reading accuracy, phonological processing, and spoken language tasks. The predominant predictor of reading comprehension was word reading accuracy for the CI group and listening comprehension for the NH group. Word reading profiles were similar across groups, with orthographic and phonological processing skills both contributing significant variance. Conclusions Children with CIs demonstrated more early reading difficulties than their peers with NH. As predicted by the Simple View of Reading model, successful reading comprehension for all children related to skills in listening comprehension and word recognition. The CI group's increased reliance on word reading accuracy when comprehending written text may stem from reduced word recognition automaticity. Despite showing reduced reading accuracy, children with CIs appeared to draw on orthographic and phonological skills to a similar degree as children with NH when reading words in isolation.

Effect of age at cochlear implantation and at exposure to Cued Speech on literacy skills in deaf children

The aim of this study was to investigate how age at cochlear implantation (CI) and age at exposure to Cued Speech (CS, Manual system that resolves the ambiguity inherent lipreading) could impact literacy skills in deaf children. Ninety deaf children fitted with CI (early vs late) and exposed to CS (early vs late) from primary schools (from Grade 2 to Grade 5) took part in this study. Five literacy skills were assessed: phonological skills through phoneme deletion, reading (decoding and sentence comprehension), word spelling and vocabulary. The results showed that both age at CI and age at first exposure to CS had some influence on literacy skills but there was no interaction between these factors. This implies that the positive effects of age at CI, especially on all literacy skills in the younger children, were not strengthened by age at exposure to CS.

Teaching language components to deaf/hard-of-hearing and cochlear implant users: a literature review

ABSTRACT Cochlear implants are one of the possible ways for Deaf or Hard-of-Hearing (DHH) individuals to detect sounds and as a mean of insertion in the social, academic and work environments. Nevertheless, in many cases, the cochlear implant alone is not sufficient, demanding hearing and expressive language skills rehabilitation to optimize the device used. This study aimed at reviewing scientific articles that described empirical research with interventions and/or teaching methods of various language repertoires to deaf and hard-of-hearing cochlear implant users. The review was carried out in five scientific databases considering all periods. On the first phase, 156 articles were identified and from these, 24 publications were selected. After being read, these articles were categorized and analyzed as to the participants, teaching targets and procedures adopted. On the last stage of the research, 10 experimental studies were selected and analyzed regarding procedures and results, indicating important factors in teaching this population. The results point to the necessity of an increase of scientific production in the construction and evaluation of effective verbal repertoires teaching programs for cochlear implant users.

Speech Intelligibility in Persian Hearing Impaired Children with Cochlear Implants and Hearing Aids

The aim of present study is to evaluate and compare speech intelligibility in hearing impaired children with cochlear implants (CI) and hearing aid (HA) users and children with normal hearing (NH). The sample consisted of 45 Persian-speaking children aged 3 to 5-years-old. They were divided into three groups, and each group had 15, children, children with CI and children using hearing aids in Hamadan. Participants was evaluated by the test of speech intelligibility level. Results of ANOVA on speech intelligibility test showed that NH children had significantly better reading performance than hearing impaired children with CI and HA. Post-hoc analysis, using Scheffe test, indicated that the mean score of speech intelligibility of normal children was higher than the HA and CI groups; but the difference was not significant between mean of speech intelligibility in children with hearing loss that use cochlear implant and those using HA. It is clear that even with remarkabkle advances in HA technology, many hearing impaired children continue to find speech production a challenging problem. Given that speech intelligibility is a key element in proper communication and social interaction, consequently, educational and rehabilitation programs are essential to improve speech intelligibility of children with hearing loss.

Reading skills in Persian deaf children with cochlear implants and hearing aids

OBJECTIVES

Reading skills are necessary for educational development in children. Many studies have shown that children with hearing loss often experience delays in reading. This study aimed to examine reading skills of Persian deaf children with cochlear implant and hearing aid and compare them with normal hearing counterparts.

METHOD

The sample consisted of 72 s and third grade Persian-speaking children aged 8-12 years. They were divided into three equal groups including 24 children with cochlear implant (CI), 24 children with hearing aid (HA), and 24 children with normal hearing (NH). Reading performance of participants was evaluated by the "Nama" reading test. "Nama" provides normative data for hearing and deaf children and consists of 10 subtests and the sum of the scores is regarded as reading performance score.

RESULTS

Results of ANOVA on reading test showed that NH children had significantly better reading performance than deaf children with CI and HA in both grades (P < 0.001). Post-hoc analysis, using Tukey test, indicated that there was no significant difference between HA and CI groups in terms of non-word reading, word reading, and word comprehension skills (respectively, P = 0.976, P = 0.988, P = 0.998).

CONCLUSION

Considering the findings, cochlear implantation is not significantly more effective than hearing aid for improvement of reading abilities. It is clear that even with considerable advances in hearing aid technology, many deaf children continue to find literacy a challenging struggle.

Cost Effectiveness of Childhood Cochlear Implantation and Deaf Education in Nicaragua: A Disability Adjusted Life Year Model

INTRODUCTION

Cochlear implantation (CI) is a common intervention for severe-to-profound hearing loss in high-income countries, but is not commonly available to children in low resource environments. Owing in part to the device costs, CI has been assumed to be less economical than deaf education for low resource countries. The purpose of this study is to compare the cost effectiveness of the two interventions for children with severe-to-profound sensorineural hearing loss (SNHL) in a model using disability adjusted life years (DALYs).

METHODS

Cost estimates were derived from published data, expert opinion, and known costs of services in Nicaragua. Individual costs and lifetime DALY estimates with a 3% discounting rate were applied to both two interventions. Sensitivity analysis was implemented to evaluate the effect on the discounted cost of five key components: implant cost, audiology salary, speech therapy salary, number of children implanted per year, and device failure probability.

RESULTS

The costs per DALY averted are $5,898 and $5,529 for CI and deaf education, respectively. Using standards set by the WHO, both interventions are cost effective. Sensitivity analysis shows that when all costs set to maximum estimates, CI is still cost effective.

CONCLUSION

Using a conservative DALY analysis, both CI and deaf education are cost-effective treatment alternatives for severe-to-profound SNHL. CI intervention costs are not only influenced by the initial surgery and device costs but also by rehabilitation costs and the lifetime maintenance, device replacement, and battery costs. The major CI cost differences in this low resource setting were increased initial training and infrastructure costs, but lower medical personnel and surgery costs.

Paragraph-reading comprehension ability in Mandarin-speaking children with cochlear implants

OBJECTIVES

1) To investigate different aspects of paragraph reading in Mandarin-speaking students with cochlear implants (CIs) and the factors associated with unfavorable outcomes, and 2) to understand the replaceability of a paragraph-reading test with a sentence-reading test.

STUDY DESIGN

Cross-sectional, case-controlled study.

METHODS

Fifty-three students with CIs (aged 11.0 ± 1.4 years) and 53 grade- and gender-matched children with normal hearing (NH) participated in the study. A paragraph-reading comprehension test was conducted. Sentence and word reading, speech perception, language skills, and child/family characteristics were examined. An unfavorable paragraph-reading outcome was defined as a score lower than one standard deviation below the NH mean.

RESULTS

The CI subjects had significantly worse paragraph-reading comprehension than did the NH controls (P = 0.017, d = 0.54). Their performance in grades 5 to 6 was not significantly higher than of those with NH in grades 2 to 4. The CI children's abilities to understand semantics (P = 0.012) and syntax (P = 0.020) significantly fell behind the NH controls in grades 2 to 4, and the lag continued in grades 5 to 6 (P = 0.039, P = 0.002, respectively). Grade and sentence reading were independently associated with unfavorable paragraph-reading outcomes (R(2)  = 0.453). The optimal sensitivity and specificity of the sentence-reading test in identifying unfavorable paragraph-reading outcomes were 90.9% and 90.0%, respectively (area under the curve = 0.923).

CONCLUSIONS

Specialists should pay attention to CI students' development of different reading skills. Paragraph-reading tests enable a multidimensional evaluation of reading competence. Use of sentence-reading tests is suggested only as a tool for preliminary screening for basic reading capacities.

LEVEL OF EVIDENCE

3b.

Vowel Production in Persian Deaf Children with Cochlear Implant: is the Age of Implantation an Important Factor?

Proper production of vowels has great significance in speech intelligibility. Evidence shows that cochlear implantation has a significant impact on language and reading abilities in some children immediately after the surgery. The aim of the present study is comparing the quality of 6 simple Persian vowels between two groups of cochlear-implanted children under and over 2 years old. This was a cross-sectional analytic study conducted on 70 children who were implanted under the age of 2, 70 children who were implanted over the age of 2 and 238 normal children as control group. For data analysis, the SFS win acoustic analysis was used. Result of this study showed that F2/i/, f1/e/, f2/e/, f2/∞/, f1/a/, F2/a/, f1/o/, F2/o/and F2/u/means had significant difference between three groups (P < 0.05). Children implanted under the age of 2 showed similar performance as normal children in vowel production. Early cochlear implantation (under the age of 2) affects the quality of simple Persian vowel production significantly as well as the increase of speech intelligibility.