Assessment of outcomes of hearing and speech rehabilitation in children with cochlear implantation

Clinical experience with the Nurotron™ cochlear implant in a Spanish-speaking postlingual population: Clinical safety and audiological results

OBJECTIVE

to assess clinical safety and postoperative audiological outcomes in postlingual deafness Spanish speaking patients, who underwent surgery with Nurotron™ cochlear implant.

MATERIAL AND METHODS

Retrospective descriptive case series study. We performed follow-up of complications and audiological measurements before and after cochlear implantation. Patients with bilateral severe to profound sensorineural hearing loss or patients with unilateral deafness with/without tinnitus were included. Repeated-measures within-subjects for assess pure tone thresholds and speech performance (bilingual test) with a detailed monitoring to establish security or adverse effects were performed. Analysis of variance tests, repetitive measures, were used for statistical analysis.

RESULTS

31 patients were included, 17 (54.8%) men and 14 (45.2%) women. Mean age at the time of surgery was 49.82 ± 18.8 years. The mean follow-up of the group was 31.56 ± 9.57 months (minimum = 19.6 months and maximum = 52.50 months). As major complication one patient (3.23%) had a hard failure that required removal and re-implantation. 25.8% of the patients presented minor complications, the most frequent being vertigo/unsteadiness in 22.6%. The mean of language discrimination (free field at 65 dB SPL) was 62.19% ± 16.66; being 69.82% ± 7.35 in the group of severe to profound bilateral sensorineural hearing loss. A statistically significant reduction was observed in patients with tinnitus, assessed using the visual analogue scale, preoperative = 7.2 ± 1,6 vs postoperative (18months postoperative) = 1.7 ± 1.3 (p < .001).

CONCLUSIONS

The Nurotron™ cochlear implant shows satisfactory audiological results, in accordance with what has been reported in the literature. Minor complications were similar to previous studies, but the percentage of hard failure should continue to be observed, which was higher than other reports with comparable follow-up.

Preoperative factors influencing the rate and speed of available communication ability in prelingual paediatric cochlear implantation recipients

BACKGROUND

Few studies have assessed factors influencing the rate and speed of good outcomes in cochlear implantation (CI) children.

OBJECTIVE

To analyse the factors influencing the rate and speed of available communication in CI children.

MATERIAL AND METHODS

The study involved 316 children. The categories of auditory performance (CAP) and speech intelligibility rating (SIR) were used to evaluate outcomes. Multivariable proportional Cox regression models were established to analyse the effect of preoperative factors.

RESULTS

Five variables were entered into the three multivariable models of CAP ≥6, SIR ≥4 and concurrent CAP ≥6 and SIR ≥4. Older age at implantation was a significant poor factor in the three models with estimated hazard ratios (HRs) of .541, .629, and .554, respectively. Another negative factor was poor parental literacy for the three outcomes (HR .639, .638, and .542, respectively). More than 3 months of rehabilitation from institutes had a positive effect on CAP ≥6 and concurrent CAP ≥6 and SIR ≥4 (HR 1.626 and 1.667, respectively).

CONCLUSIONS AND SIGNIFICANCE

Older age at implantation and poor parental literacy were negative factors. Receiving regular rehabilitation from institutes pre-CI could help the children gain available communication ability earlier on.

[Cochlear implantation in Senegal: challenges, limits and perspectives]

A cochlear implant is an electronic prosthesis used in the rehabilitation of profound bilateral hearing loss. It directly stimulates cochlear nerve fibers by bypassing the hair cells. This high-performance technology, which appeared 60 years ago, has spread widely throughout the world and is regularly used in hearing rehabilitation. In developing countries, the adoption and development of this tool are still lagging behind. The authors analyze factors delaying the penetration of cochlear implants in Senegal.

Efficacy of auditory verbal therapy in children with cochlear implantation based on auditory performance - A systematic review

This systematic review focuses on the efficacy of auditory verbal therapy (AVT) in children with cochlear implants based on their auditory performance. The results presented are based on research findings from 2010 to 2021. The systematic review was designed based on the Popular Reporting Systems for the Systematic Review and Analysis of Meta-Analysts (PRISMA), the 2020 revised version, and the Critical Evidence for Clinical Evidence (CATE) checklist. Specific keywords were chosen based on the formulated research question and searched on the following search engines: Google Scholar, Microsoft Academic, PubMed, Semantic Scholar, Cochrane, Science Direct, and BASE. All the searched articles were analysed based on specific exclusion criteria. The results revealed an important progression based on the auditory performance among children with cochlear implantation who received habilitation. The studies highlight that younger the age at implantation better the auditory performance and this may be necessary to allow at least relatively normal organization of auditory pathways in pre-lingual children with hearing impairment. Therefore, regular revitalization of aural-verbal rehabilitation and speech and language therapy is essential for younger children with hearing impairment to achieve the highest level of hearing function. This systematic review highlights importance of assessment of the auditory performance to be considered in the test battery while evaluating children with CI before and after habilitation along with AVT.

Tone evaluation of Ling sound test in Mandarin tone version

BACKGROUND

The Ling sound test cannot provide the test of Chinese tone for preschool children with hearing aid and cochlear implants.

OBJECTIVE

The paper tries to design a new tone test method composed of the Ling sound test and four Chinese tones to evaluate the hearing level of Chinese hearing-impaired children.

METHODS

The tone identification rates of 20 cochlear implant children were statistically analyzed to verify the validity of the Ling sound test in the Chinese tone version. In addition, this paper analyzed the pronunciation characteristics of the Ling sound test in the Chongqing-accented Mandarin version of 20 subjects.

RESULTS

The identification rate of Ling six sounds was more than 97.0%, the identification rate of tone was more than 81.0%, and the identification rate of vowels was 83.1%, which was higher than that of consonants 79.0%. The Ling sound test n the Chongqing-accented Mandarin version has a narrower frequency range.

CONCLUSION

The results verify the effectiveness and feasibility of the Ling sound test in the Chinese tone version in the assessment of frequency range and tone identification for cochlear implant users.

Effect of the vertical facial canal to round window distance concerning neural response telemetry during cochlear implantation in children

OBJECTIVE

To assess the correlation of the distance from the round window (RW) to the vertical facial canal (VFC) with neural response telemetry thresholds (T-NRT), which may have an influence on the insertion trajectory and aid in preoperative surgical planning and electrode selection.

METHODS

An observational study was conducted on 30 prelingually deaf children under five years diagnosed with bilateral severe to profound hearing loss and received a cochlear implant. The preoperative high resolution computed tomography (HRCT) images in the axial cut bone window setting at the round window level was used to calculate the distance from the RW to the VFC on the RadiAnt DICOM Viewer. The intraoperative distance was measured with ScopyDoc version 8.2.4 software. In Auto-NRT mode, software-based recordings (Cochlear's Custom Sound EP 6.0) were used to measure and evaluate the T-NRT current level.

RESULTS

A statistically significant positive correlation of the RW to VFC distance with the average T-NRT p = 0.02, r = -0.4 and with the mid-frequency, T-NRT p = 0.003, r = -0.5 was found.

CONCLUSION

The insertion trajectory can be ascertained by a statistically significant correlation between average T-NRT and mid-frequency T-NRT with RW and VFC distance, and this reliable factor can be taken into account in future surgical technique modulation, electrode selection, and electrode design.

A Review of Speech Perception of Mandarin-Speaking Children With Cochlear Implantation

Objective: This paper reviewed the literature on the development of and factors affecting speech perception of Mandarin-speaking children with cochlear implantation (CI). We also summarized speech outcome measures in standard Mandarin for evaluating auditory and speech perception of children with CI.

Method: A comprehensive search of Google Scholar and PubMed was conducted from March to June 2021. Search terms used were speech perception/lexical tone recognition/auditory perception AND cochlear implant AND Mandarin/Chinese.

Conclusion: Unilateral CI recipients demonstrated continuous improvements in auditory and speech perception for several years post-activation. Younger age at implantation and longer duration of CI use contribute to better speech perception. Having undergone a hearing aid trial before implantation and having caregivers whose educational level is higher may lead to better performance. While the findings that support the use of CI to improve speech perception continue to grow, much research is needed to validate the use of unilateral and bilateral implantation. Evidence to date, however, revealed bimodal benefits over CI-only conditions in lexical tone recognition and sentence perception in noise. Due to scarcity of research, conclusions on the benefits of bilateral CIs compared to unilateral CI or bimodal CI use cannot be drawn. Therefore, future research on bimodal and bilateral CIs is needed to guide evidence-based clinical practice.

Pediatric Arabic Closed-Set Word-Recognition Test: Development and Evaluation of Psychometric Characteristics

BACKGROUND

 Speech audiometry materials are widely available in many different languages. However, there are no known standardized materials for the assessment of speech recognition in Arabic-speaking children.

PURPOSE

 The aim of the study was to develop and validate phonetically balanced and psychometrically equivalent monosyllabic word recognition lists for children through a picture identification task.

RESEARCH DESIGN

 A prospective repeated-measure design was used. Monosyllabic words were chosen from children's storybooks and were evaluated for familiarity. The selected words were then divided into four phonetically balanced word lists. The final lists were evaluated for homogeneity and equivalency.

STUDY SAMPLE

 Ten adults and 32 children with normal hearing sensitivity were recruited.

DATA COLLECTION AND ANALYSES

 Lists were presented to adult subjects in 5 dB increment from 0 to 60 dB hearing level. Individual data were then fitted using a sigmoid function from which the 50% threshold, slopes at the 50% points, and slopes at the 20 to 80% points were derived to determine list psychometric properties. Lists were next presented to children in two separate sessions to assess their equivalency, validity, and reliability. Data were subjected to a mixed design analysis of variance.

RESULTS

 No statistically significant difference was found among the word lists.

CONCLUSION

 This study provided an evidence that the monosyllabic word lists had comparable psychometric characteristics and reliability. This supports that the constructed speech corpus is a valid tool that can be used in assessing speech recognition in Arabic-speaking children.

Restoration of Deafferentation Reduces Tinnitus, Anxiety, and Depression: A Retrospective Study on Cochlear Implant Patients

Patients with profound bilateral deafness (BD) are prone to suffering from tinnitus, which further leads to psychological comorbidities and makes it more difficult for patients to communicate with people. This study was aimed at investigating the effect of cochlear implants (CIs) on tinnitus distress and psychological comorbidities in patients with profound BD. This multicenter retrospective study reviewed 51 patients with severe postlingual BD who underwent cochlear implantation; 49 patients underwent unilateral cochlear implantation, and 2 patients underwent bilateral cochlear implantation. The patients were asked to complete all the questionnaires, including the tinnitus handicap inventory (THI), the visual analog scale (VAS) score, the Hospital Anxiety and Depression Scale Questionnaire (HADS), the Categories of Auditory Performance (CAP), and the Speech Intelligibility Rating (SIR), at least 4 months after implantation when the CI was on or off, in approximately May-June 2019. In our study, 94% (48/51) of BD patients suffered from tinnitus before CI, and 77% (37/48) of them suffered from bilateral tinnitus. In addition, 50.9% (26/51) of the CI patients were suffering from anxiety, 52.9% (27/51) of them were suffering from depression (score ≥ 8), and 66.7% (34/51) (27/51) of them were suffering from anxiety or depression. Cochlear implantation could reduce tinnitus more obviously when the CI was on than when the CI was off. Cochlear implantation also reduced anxiety/depression severity. There were significantly positive correlations between tinnitus severity and anxiety/depression severity before and after surgery. Moreover, hearing improvement is positively correlated with reduction level of tinnitus, the better hearing, and the lesser severity of tinnitus. Thus, along with effective restoration of deafferentation, cochlear implantation shows positive therapeutic effects on tinnitus and psychological comorbidities, providing a reference for future clinical and research work.

A Study to Determine Various Factors Influencing Auditory Outcomes in Paediatric Cochlear Implantation

To evaluate various factors that affects the auditory outcomes in pediatric patients with bilateral profound sensorineural hearing loss who underwent unilateral cochlear implantation. 50 prelingually deaf pediatric patients aged between 1 and 6 years with bilateral profound sensorineural hearing loss who underwent unilateral cochlear implantation between January 2016 and June 2018 at our tertiary centre were included in this study. Auditory performance was measured using revised categories of auditory performance score at 1 year post cochlear implantation. A Statistical analysis of several factors was performed to reveal any significant relation with outcomes of cochlear implantation. The results of the study showed that patients with younger age at implantation, patient who used hearing aid prior to surgery and patients with normal cochlear morphology had better auditory outcomes post cochlear implantation than their counter group and are the factors which have positive effect on the cochlear implantation outcomes, whereas factors which did not showed any significant relation with the auditory outcomes of cochlear implantation are gender, consanguinity and birth hypoxia. Age at implantation, use of hearing aid prior to surgery and cochlear morphology are the factors with direct impact on the outcomes of cochlear implant.

An Eye-Tracking Study on Audiovisual Speech Perception Strategies Adopted by Normal-Hearing and Deaf Adults Under Different Language Familiarities

Purpose The primary purpose of this study was to explore the audiovisual speech perception strategies.80.23.47 adopted by normal-hearing and deaf people in processing familiar and unfamiliar languages. Our primary hypothesis was that they would adopt different perception strategies due to different sensory experiences at an early age, limitations of the physical device, and the developmental gap of language, and others. Method Thirty normal-hearing adults and 33 prelingually deaf adults participated in the study. They were asked to perform judgment and listening tasks while watching videos of a Uygur-Mandarin bilingual speaker in a familiar language (Standard Chinese) or an unfamiliar language (Modern Uygur) while their eye movements were recorded by eye-tracking technology. Results Task had a slight influence on the distribution of selective attention, whereas subject and language had significant influences. To be specific, the normal-hearing and the d10eaf participants mainly gazed at the speaker's eyes and mouth, respectively, in the experiment; moreover, while the normal-hearing participants had to stare longer at the speaker's mouth when they confronted with the unfamiliar language Modern Uygur, the deaf participant did not change their attention allocation pattern when perceiving the two languages. Conclusions Normal-hearing and deaf adults adopt different audiovisual speech perception strategies: Normal-hearing adults mainly look at the eyes, and deaf adults mainly look at the mouth. Additionally, language and task can also modulate the speech perception strategy.

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.

Impact of COVID-19 on the access to hearing health care services for children with cochlear implants: a survey of parents

Background: The COVID-19 pandemic has affected the world in an unprecedented manner. It has aggravated psychological distress in parents of children with cochlear implants. Continuous use of a speech sound processor is critical for auditory stimulation in children with cochlear implants. However, movement restrictions imposed have affected access to hearing healthcare services. The current study explores the impact of the COVID-19 pandemic on hearing healthcare access for children with cochlear implants. Methods: An online questionnaire survey was conducted among parents of children with cochlear implants. Results: A total of 24 parents responded to the questionnaire. All the respondents reported that COVID-19 has a significant impact on access to hearing health services for their children. Speech processor breakdown and disconnection from the auditory mode of communication had a critical influence on behavioral changes in children. Conclusions: The current study highlights the hurdles faced by the parents in order to access hearing health services for their children. The use of innovative methods such as remote tele-audiology will be the way forward to tackle challenges faced by the parents.