The effect of age at cochlear implantation outcomes in Saudi children

Efficacy of Bilateral Cochlear Implantation in Pediatric and Adult Patients with Profound Sensorineural Hearing Loss: A Retrospective Analysis in a Developing European Country

This retrospective study aimed to evaluate the outcomes of bilateral cochlear implantation in patients with severe-to-profound sensorineural hearing loss at the Timisoara Municipal Emergency Clinical Hospital ENT Clinic. The study involved 77 participants, divided into four groups based on their hearing loss characteristics and implantation history. Assessments were conducted pre- and post-implantation, focusing on speech perception, speech production, and reading achievement. Standard surgical procedures were performed, and participants were provided with a comprehensive rehabilitation program involving auditory training and communication therapy. The variables considered for analysis included demographic factors, implantation period, and quality of life assessment, with no statistically significant differences pre-implantation between the four study groups. Results revealed significant improvements in speech perception, speech production, and reading achievement after cochlear implantation. In adult patients, speech perception scores increased from 21.3% to 73.4% for WIPI and from 22.7% to 68.4% for HINT after 12 months of rehabilitation. Speech production scores improved from 33.5% to 76.8% and reading achievement scores increased from 76.2 to 106.3. Moreover, there was a significant improvement in patients' quality of life following cochlear implantation, with mean scores increasing from 2.0 to 4.2. Although it is known that bilateral cochlear implantation significantly improves speech perception, speech production, reading achievement, and quality of life in patients with severe-to-profound sensorineural hearing loss, this is the first study of its kind from Romania. Further research is warranted to optimize patient selection and rehabilitation strategies to maximize outcomes and determine better policies towards funding and access of cochlear implants for a wider range of patients in need.

Spontaneous speech intelligibility: early cochlear implanted children versus their normally hearing peers at seven years of age

Speaking intelligibly is an important achievement in children's language development. How far do congenitally severe-to-profound hearing-impaired children who received a cochlear implant (CI) in the first two years of their life advance on the path to intelligibility in comparison to children with typical hearing (NH)? Spontaneous speech samples of children with CI and children with NH were orthographically transcribed by naïve transcribers. The entropy of the transcriptions was computed to analyze their degree of uniformity. The same samples were also rated on a continuous rating scale by another group of adult listeners. The transcriptions of the NH children's speech were more uniform, i.e., had significantly lower entropy, than those of the CI children, suggesting that the latter group displayed lower intelligibility. This was confirmed by the ratings on the continuous scale. Despite the relatively restricted age ranges, older children reached better intelligibility scores in both groups.

Speech intelligibility of children with an auditory brainstem implant: a triple-case study

Auditory brainstem implantation (ABI) is a relative recent development in paediatric hearing restoration. Consequently, young-implanted children's productive language has not received much attention. This study investigated speech intelligibility of children with ABI (N = 3) in comparison to children with cochlear implants (CI) and children with typical hearing (TH). Spontaneous speech samples were recorded from children representing the three groups matched on cumulative vocabulary level. Untrained listeners (N = 101) rated the intelligibility of one-word utterances on a continuous scale and transcribed each utterance. The rating task yielded a numerical score between 0 and 100, and similarities and differences between the listeners' transcriptions were captured by a relative entropy score. The speech intelligibility of children with CI and children with TH was similar. Speech intelligibility of children with ABI was well below that of the children with CI and TH. But whereas one child with ABI's intelligibility approached that of the control groups with increasing lexicon size, the intelligibility of the two other children with ABI did not develop in a similar direction. Overall, speech intelligibility was only moderate in the three groups of children, with quite low ratings and considerable differences in the listeners' transcriptions, resulting in high relative entropy scores.

Correlation of quality of life with speech and hearing performance after pediatric cochlear implantation

OBJECTIVES

This study aimed to determine the correlation of the quality of life (QOL) with the Categories of Auditory Performance (CAP) and the Speech Intelligibility Rating (SIR) scales in children after cochlear implantation.

METHODS

This cross-sectional study was conducted from November 2018 to February 2020 at the otolaryngology department at a tertiary referral center. Patients aged ≤16 years who had received cochlear implants (CIs) at our center were consecutively included in this study. Parents were asked to complete the Glasgow Children's Benefit Inventory questionnaire, and auditory and speech assessments were performed by the speech therapists at our center. The correlations of Glasgow Children's Benefit Inventory results with the objective data from the CAP and SIR assessment tools were analyzed.

RESULTS

Seventy patients were included in this study. The mean age at implantation was 3 years and 9 months. The mean Glasgow Children's Benefit Inventory score was 52.23 (standard deviation = 23.99), indicating a positive benefit in QOL. There was a statistically significant correlation of the QOL questionnaire score with the CAP score (r = 0.40, p = 0.008), but no correlation was found between the QOL questionnaire score and the SIR score.

CONCLUSION

We recommend that cochlear implant patients should undergo an evaluation that incorporates auditory, language, and QOL assessment tools to gain a more comprehensive understanding of their progress.

Native and non-native listeners' judgements on the overall speech quality of hearing-impaired children

This study focuses on the influence of listeners' native language on their judgement of the overall speech quality of normally hearing (NH) and hearing-impaired (HI) children. Studies have shown that listeners' native language influences their judgements on linguistic aspects of a foreign language. Since judging speech quality does in principle not require any knowledge of the language, the question arose if the native language influences listeners' judgements. For this purpose, the overall speech quality of seven-year-old Dutch speaking children (n = 21) with an acoustic hearing aid (HA), a cochlear implant (CI) and normal hearing (NH) was judged by four listener groups (native speakers of Italian, German, French and Dutch). Listeners completed a comparative judgement task in which stimuli were presented in pairs. For each pair, they selected the better sounding stimulus. This procedure ultimately led to a ranking of the stimuli according to their speech quality. The ranking showed that NH children had a significantly higher speech quality than HI children. Interestingly, there was no significant effect of language background. Both native and non-native listeners perceived a significant difference in speech quality. Also, within the group of HI children, all listener groups preferred the speech of CI children when comparing them to HA children. These results indicated that the differences were purely speech related since the non-native listeners had no linguistic knowledge of Dutch. Considering that all listeners perceived a similar qualitative difference, we conclude that there was no transfer of native language in this type of judgement.

Influence of family environment on the development of speech and language in pre-lingually deaf children after cochlear implantation

OBJECTIVE

To investigate the influence of family environment on the development of speech and language in pre-school children after cochlear implantation.

METHODS

A total of 88 pre-lingually deaf children, aged 2-5 years, who received cochlear implantation, were included in this study. All families completed a self-report family environment questionnaire (FES). The deaf children's linguistic progress was assessed by Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) at 0, 3, 6 and 12 months after implantation.

RESULTS

The family environment was the significant factor associated with CAP and SIR at 6 months post-implantation. The children in families with higher levels of Cohesion, Intellectual-Cultural Orientation and the ability to express emotion effectively had better auditory and speech abilities, while children in families with low intimacy and high incompatibility exhibited a delay in the development of auditory speech (P < .05).

CONCLUSIONS

The development of speech and language in pre-lingually deaf children after cochlear implantation can be influenced by family environment and parents' roles.

Rating the overall speech quality of hearing-impaired children by means of comparative judgements

OBJECTIVE

Acoustic measurements have shown that the speech of hearing-impaired (HI) children deviates from the speech of normally hearing (NH) peers. The aim of the present study is to examine whether listeners with varying degrees of experience with (HI) children's speech perceive a difference in the overall speech quality of seven-year-old NH children and their HI peers who received a device before the age of two.

METHOD

Short speech samples of seven children with NH, seven children with an acoustic hearing aid (HA) and seven children with a cochlear implant (CI) were judged by three groups of listeners (audiologists, primary school teachers and inexperienced listeners) in a comparative judgement task. In this task, listeners compared stimuli in pairs and decided which stimulus sounded better, leading to a ranking of the stimuli according to their overall speech quality.

RESULTS

The ranking showed that the overall speech quality differed considerably for HI and NH children. The latter group had a significantly higher overall speech quality than HI children. In the group of HI children, children with CI were ranked higher than children with HA. Moreover, length of device use was found to have a significant effect in the group of children with CI: longer device experience led to better ratings. This effect was significantly less strong in HA children. No significant differences were found between the three groups of listeners.

CONCLUSION

Listeners agree that the speech of NH children sounds better than the speech of HI children. This result indicates that even after almost seven years of device use, the speech of HI children still differs from the speech of NH children. The overall speech quality of CI children was better than that of HA children, and this effect increased with longer device use. No effect of listeners' experience with (NH and/or HI) children's speech was established.

Cochlear implants in children: A cross-sectional investigation on the influence of geographic location in Saudi Arabia

INTRODUCTION:

The role of the family in detecting a child's hearing difficulty and the age at which an implantation is done have been identified as strong predictors of the outcomes of pediatric cochlear implantation. In the absence of screening programs for hearing loss in Saudi neonates, the family's role is of paramount importance. The aim of this study was to investigate the influence of geographic location on the course of identification, examination, and cochlear implantation in children in Saudi Arabia.

MATERIALS AND METHODS:

Pediatric patients who had received either unilateral or bilateral cochlear implantation at King Abdulaziz University Hospital in Riyadh, Saudi Arabia, between January 1, 2012, and December 31, 2014, were surveyed.

RESULTS:

A total of 156 pediatric patients have had a cochlear implant between January 1, 2012, and December 31, 2014. The one-way analysis of variance test to compare the means of the independent sample groups in various geographic zones showed that with a hundred percent access to primary health care, the geographic location of the population had an influence on the detection of hearing loss but not on the cochlear implantation.

CONCLUSION:

This study found that the geographic location of the population has an influence on the time of detection of hearing loss in children but not on the time of cochlear implantation. Raising parental awareness of the importance of early detection of hearing loss is necessary. Further research is also required to define the role of factors such as the income and the educational level of parents on the early detection of neonatal hearing loss.

Speech performance in pediatric users of Nurotron ® Venus™ cochlear implants

OBJECTIVES

The primary purpose of this study was to investigate the longitudinal speech performance over 3 years in pediatric users of the Nurotron(®) cochlear implant system. The secondary purpose was to compare the speech performances of younger and older children with cochlear implants (CIs).

METHODS

The Mandarin Early Speech Perception (MESP), Meaningful Use of Speech Scale (MUSS), and Putonghua Chinese Communicative Development Inventory (PCDI) were used to evaluate speech performance of 22 Mandarin-speaking pediatric CI users throughout the first 36 months post-implantation. The subjects were grouped according to the age at implantation, i.e., younger CI group (<3 years) and older CI group (>3 years).

RESULTS

All the subjects demonstrated improvement in speech performance throughout the first 3 years of implant use with mean scores reaching the maximum performance at 36 months post-implantation. The median categories of MESP increased from 0.23 pre-implantation to 5.57 three years post-implantation. Likewise, the median percentage of MUSS was 5.57% to 73.75%; the median performance of PCDI was 55 to 400 for PCDI-comprehension and 32 to 384 for PCDI-production at the same interval. At nearly all test intervals, the older group performed better than the younger group except 24 months post-implantation, at which the MUSS score of the younger CI group was higher than that of the older CI group.

CONCLUSION

The children with Nurotron(®) Venus™ CI system showed considerable gains in speech and language development including tone performance which improved with hearing age. Earlier implantations haven't presented significantly positive performances until 24 months post-implantation in all the tests.

Predictive factors and outcomes of cochlear implantation in patients with connexin 26 mutation: a comparative study

PURPOSE

To compare hearing outcomes in patients with connexin 26 (Cx 26) mutations undergoing cochlear implantation to age matched controls and to examine whether age at implantation, gender and type of mutation were correlated with hearing outcome.

MATERIALS AND METHODS

Retrospective chart review of 21 patients with Cx 26 mutations that underwent cochlear implantation compared to 18 age-matched controls. Patients' characteristics, type of mutation and pre- and postoperative short and long-term hearing thresholds, word and sentence scores were analyzed.

RESULTS

There was no statistically significant difference between the Cx 26 and control group in the mean short term and mean long term post-operative pure tone averages (PTA), speech reception thresholds (SRT), word and sentence scores. Gender, age at implantation and type of connexin 26 mutation did not predict hearing outcomes.

CONCLUSIONS

In patients with connexin 26 mutation, cochlear implantation provides an effective mean of auditory habilitation. Mutational status, age and gender do not seem to predict hearing outcomes.