Determinants of speech perception in children after cochlear implantation

Prosodic and Visual Cues Facilitate Irony Comprehension by Mandarin-Speaking Children With Cochlear Implants

PURPOSE

This study investigated irony comprehension by Mandarin-speaking children with cochlear implants, focusing on how prosodic and visual cues contribute to their comprehension, and whether second-order Theory of Mind is required for using these cues.

METHOD

We tested 52 Mandarin-speaking children with cochlear implants (aged 3-7 years) and 52 age- and gender-matched children with normal hearing. All children completed a Theory of Mind test and a story comprehension test. Ironic stories were presented in three conditions, each providing different cues: (a) context-only, (b) context and prosody, and (c) context, prosody, and visual cues. Comparisons were conducted on the accuracy of story understanding across the three conditions to examine the role of prosodic and visual cues.

RESULTS

The results showed that, compared to the context-only condition, the additional prosodic and visual cues both improved the accuracy of irony comprehension for children with cochlear implants, similar to their normal-hearing peers. Furthermore, such improvements were observed for all children, regardless of whether they passed the second-order Theory of Mind test or not.

CONCLUSIONS

This study is the first to demonstrate the benefits of prosodic and visual cues in irony comprehension, without reliance on second-order Theory of Mind, for Mandarin-speaking children with cochlear implants. It implies potential insights for utilizing prosodic and visual cues in intervention strategies to promote irony comprehension.

A systematic review of altered resting-state networks in early deafness and implications for cochlear implantation outcomes

Auditory deprivation following congenital/pre-lingual deafness (C/PD) can drastically affect brain development and its functional organisation. This systematic review intends to extend current knowledge of the impact of C/PD and deafness duration on brain resting-state networks (RSNs), review changes in RSNs and spoken language outcomes post-cochlear implant (CI) and draw conclusions for future research. The systematic literature search followed the PRISMA guideline. Two independent reviewers searched four electronic databases using combined keywords: 'auditory deprivation', 'congenital/prelingual deafness', 'resting-state functional connectivity' (RSFC), 'resting-state fMRI' and 'cochlear implant'. Seventeen studies (16 cross-sectional and one longitudinal) met the inclusion criteria. Using the Crowe Critical Appraisal Tool, the publications' quality was rated between 65.0% and 92.5% (mean: 84.10%), ≥80% in 13 out of 17 studies. A few studies were deficient in sampling and/or ethical considerations. According to the findings, early auditory deprivation results in enhanced RSFC between the auditory network and brain networks involved in non-verbal communication, and high levels of spontaneous neural activity in the auditory cortex before CI are evidence of occupied auditory cortical areas with other sensory modalities (cross-modal plasticity) and sub-optimal CI outcomes. Overall, current evidence supports the idea that moreover intramodal and cross-modal plasticity, the entire brain adaptation following auditory deprivation contributes to spoken language development and compensatory behaviours.

Vestibular function, subjective complaints, perceived disability in daily life, and sports activities in patients with cochlear implants performed during childhood: a prospective cross-section study

BACKGROUND

Vestibular function (VF) in patients with cochlear implantation (CI) performed during childhood is underinvestigated.

OBJECTIVE

To study VF in patients receiving CI during childhood.

MATERIAL & METHODS

Sixty patients (22 females) from 7-34 years old, unilaterally (n = 21) and bilaterally (n = 39) implanted, were included. Deafness was congenital (n = 45), consequential to meningitis (n = 3), skull fracture (n = 1), perinatal CMV infection (n = 1), ototoxic drugs (n = 1), unknown etiology (n = 9). VF was measured between 1 to 22 years after implantation, including calorics, v-HIT, c-VEMPS. Dizziness handicap inventory (DHI), age at independent walking(IW), sport activities were also investigated.

RESULTS

Nine CI-patients (15%) reported dizziness/vertigo either prior or months to years after surgery. Comparison between symptomatic (15%), asymptomatic (85%), uni-bilaterally CI-patients showed no significant difference on VF's impairment for calorics (p = .603) and v-HIT (p = 1). Symptoms were not related to vestibular impairment. Age at implantation (p = 0.956), uni- bilateral (p = .32), simultaneous versus sequential (p = .134) did not influence IW age. DHI showed a tendency for being symptomatic at higher implantation age. Interval between CI, IWage, current age between surgery and vestibular evaluation did not have a significant effect on symptomatology.

CONCLUSION & SIGNIFICANCE

This first middle to long-term evaluation of the VF in CI-patients, implanted in childhood, pointed out that 85% of patients were asymptomatic, with a mean time of >10 years after surgery. Vestibular impairment and symptoms seem to be mainly due to the underlying inner ear's disease rather than surgery.

Speech rehabilitation in children with cochlear implants using a multisensory (French Cued Speech) or a hearing-focused (Auditory Verbal Therapy) approach

Introduction

Early exposure to a rich linguistic environment is essential as soon as the diagnosis of deafness is made. Cochlear implantation (CI) allows children to have access to speech perception in their early years. However, it provides only partial acoustic information, which can lead to difficulties in perceiving some phonetic contrasts. This study investigates the contribution of two spoken speech and language rehabilitation approaches to speech perception in children with CI using a lexicality judgment task from the EULALIES battery. Auditory Verbal Therapy (AVT) is an early intervention program that relies on auditory learning to enhance hearing skills in deaf children with CI. French Cued Speech, also called Cued French (CF), is a multisensory communication tool that disambiguates lip reading by adding a manual gesture.

Methods

In this study, 124 children aged from 60 to 140 months were included: 90 children with typical hearing skills (TH), 9 deaf children with CI who had participated in an AVT program (AVT), 6 deaf children with CI with high Cued French reading skills (CF+), and 19 deaf children with CI with low Cued French reading skills (CF-). Speech perception was assessed using sensitivity (d') using both the hit and false alarm rates, as defined in signal-detection theory.

Results

The results show that children with cochlear implants from the CF- and CF+ groups have significantly lower performance compared to children with typical hearing (TH) (p < 0.001 and p = 0.033, respectively). Additionally, children in the AVT group also tended to have lower scores compared to TH children (p = 0.07). However, exposition to AVT and CF seems to improve speech perception. The scores of the children in the AVT and CF+ groups are closer to typical scores than those of children in the CF- group, as evidenced by a distance measure.

Discussion

Overall, the findings of this study provide evidence for the effectiveness of these two speech and language rehabilitation approaches, and highlight the importance of using a specific approach in addition to a cochlear implant to improve speech perception in children with cochlear implants.

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.

Is Early Cochlear Implantation Leads to Better Speech and Language Outcomes?

A cochlear implant is an electronic sensory system that converts mechanical energy into coded electrical signals that directly activate the auditory nerve fibers. Present review article investigates the findings of previous research papers which have assessed speech and language outcome in children who underwent early cochlear implantation. Several databases, including PubMed, Google, Google Scholar, and Medline, were investigated for research papers on the speech and language outcomes of children who had early-life implants. According to previous research, early detection and intervention of hearing loss are critical for the growth of speech and language skills. The effect of early detection of hearing loss and early cochlear implantation on a child's overall speech-language and auditory growth is highlighted in this article.

A Modified Pediatric Ranked Order Speech Perception Score to Assess Speech Recognition Development in Children With Cochlear Implants

PURPOSE

Characterizing and comparing speech recognition development in children with cochlear implants (CIs) is challenging because of variations in test type. This retrospective cohort study modified the Pediatric Ranked Order Speech Perception (PROSPER) scoring system to (a) longitudinally analyze the speech perception of children with CIs and (b) examine the role of age at CI activation, listening mode (i.e., unilateral or bilateral implantation), and interimplant interval.

METHOD

Postimplantation speech recognition scores from 31 children with prelingual, severe-to-profound hearing loss who received CIs were analyzed (12 with unilateral CI [UniCI], 13 with sequential bilateral CIs [SEQ BiCIs], and six with simultaneous BiCIs). Data were extracted from the Massachusetts Eye and Ear Audiology database. A version of the PROSPER score was modified to integrate the varying test types by mapping raw scores from different tests into a single score. The PROSPER scores were used to construct speech recognition growth curves of the implanted ears, which were characterized by the slope of the growth phase, the time from activation to the plateau onset, and the score at the plateau.

RESULTS

While speech recognition improved considerably for children following implantation, the growth rates and scores at the plateau were highly variable. In first implanted ears, later implantation was associated with poorer scores at the plateau (β = -0.15, p = .01), but not growth rate. The first implanted ears of children with BiCIs had better scores at the plateau than those with UniCI (β = 0.59, p = .02). Shorter interimplant intervals in children with SEQ BiCIs promoted faster speech recognition growth of the first implanted ears.

CONCLUSION

The modified PROSPER score could be used clinically to track speech recognition development in children with CIs, to assess influencing factors, and to assist in developing and evaluating patient-specific intervention strategies.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.20113538.

Relationship between Behavioral and Objective Measures of Sound Intensity in Normal-Hearing Listeners and Hearing-Aid Users: A Pilot Study

Background: For hearing-impaired individuals, hearing aids are clinically fit according to subjective measures of threshold and loudness. The goal of this study was to evaluate objective measures of loudness perception that might benefit hearing aid fitting. Method: Seventeen adult hearing aid users and 17 normal-hearing adults participated in the study. Outcome measures including categorical loudness scaling, cortical auditory evoked potentials (CAEPs), and pupillometry. Stimuli were 1-kHz tone bursts presented at 40, 60, and 80 dBA. Results: Categorical loudness scaling showed that loudness significantly increased with intensity for all participants (p < 0.05). For CAEPs, high intensity was associated with greater P1, N1, and P2 peak amplitude for all listeners (p < 0.05); a significant but small effect of hearing aid amplification was observed. For all participants, pupillometry showed significant effects of high intensity on pupil dilation (p < 0.05); there was no significant effect of hearing aid amplification. A Focused Principal Component analysis revealed significant correlations between subjective loudness and some of the objective measures. Conclusion: The present data suggest that intensity had a significant impact on loudness perception, CAEPs, and pupil response. The correlations suggest that pupillometry and/or CAEPs may be useful in determining comfortable amplification for hearing aids.

Language and Audiological Outcomes Among Infants Implanted Before 9 and 12 Months of Age Versus Older Children: A Continuum of Benefit Associated With Cochlear Implantation at Successively Younger Ages

OBJECTIVE

To compare language and audiological outcomes among infants (<9 and <12 mo) and older children receiving cochlear implantation (CI).

STUDY DESIGN

Retrospective chart review.

SETTING

Tertiary academic referral center.

PATIENTS

Pediatric patients receiving CI between October 1995 and October 2019.

INTERVENTION

Cochlear implantation.

MAIN OUTCOME MEASURES

Most recent language and audiological assessment scores were evaluated by age group.

RESULTS

A total of 118 children were studied, including 19 who were implanted <9 months of age, 19 implanted 9 to <12 months of age, and 80 implanted 12 to <36 months of age. The mean duration of follow-up was 7.4 ± 5.0 years. Most recent REEL-3 receptive (88 ± 12 vs. 73 ± 15; p = 0.020) and expressive (95 ± 13 vs. 79 ± 12; p = 0.013) communication scores were significantly higher in the <9 months group compared to the 9 to <12 months group. PLS and OWLS auditory comprehension and oral expression scores were significantly higher in the <12 months group compared to the 12 to <36 months group. The difference in NU-CHIPS scores between <12 and 12 to <36 months was statistically significant (89% ± 6 vs. 83% ± 12; p = 0.009). LNT scores differed significantly between <9 and 9 to <12 months (94% ± 4 vs. 86% ± 10; p = 0.028).

CONCLUSIONS

The recent FDA expansion of pediatric CI eligibility criteria to include infants as young as 9 months of age should not serve as a strict clinical cutoff. Rather, CI can be pursued in appropriately selected younger infants to optimize language and audiological outcomes.

Does early cochlear implantation promote better reading comprehension skills?

OBJECTIVE

to investigate the effect of age at CI activation and to explore the role of other variables such as linguistic skills, stimulation modality and gender on reading comprehension.

STUDY DESIGN

Prospective observational nonrandomized study.

METHODS

89 children with profound congenital sensorineural hearing loss were included in the study. The mean age at CI activation was 21 months (DS ± 11; range 7-50). The Italian reading standardized test, "Prove di lettura MT", was used to assess reading comprehension. The individual raw data MT score were converted into z scores (expected values: means = 0 and SD = 1). The positive values indicated better performance and negative values indicated worse performance.

RESULTS

Early implanted children achieved significantly better reading comprehension skills, 55 out of 89 children are within 1 SD from the overall mean. 34 children (38.2%) attainted MT z-scores less than 1 SD below the mean. Children with unilateral CI performed somewhat worse if compared to bilateral CI and bimodal stimulation mode, although the differences were weakly significant from a statistical point of view. A strong and positive correlation (rho .69, p < .001) was found with the lexical and morphosyntactic comprehension (rho .70, p < .001). Not significantly different values were observed for gender and parental education level.

CONCLUSION

Early cochlear implantation promoted better development of reading skills in children with cochlear implantation. LEVEL OF EVIDENCES: outcomes research.

Impact of Universal Newborn Hearing Screening on cochlear implanted children in Ireland

OBJECTIVES

Cochlear Implant (CI) is an established treatment for severe to profound hearing loss (HL). Early diagnosis and intervention in HL are crucial in order to provide access to sound and increase the likelihood of spoken language development in pre-lingually deaf children. In April 2011, the Health Service Executive (HSE) implemented the Universal Newborn Hearing Screening (UNHS) in a phased regional basis in Ireland. This study aimed to investigate the general clinical pathway for UNHS referrals to the CI service and to evaluate the impact of earlier referrals via UNHS on functional outcomes in children.

METHODS

The first part of this study constituted a retrospective review of 100 children referred to the National Hearing Implant and Research Centre (NHIRC) via UNHS from November 2011 to December 2016. Implanted children referred via UNHS were categorised into three groups according to their medical status. Their clinical pathway to cochlear implantation was evaluated. Functional outcomes were investigated based on medical and developmental status, respectively. In the second part of this study, developmentally healthy implanted children referred post-UNHS were compared with medically healthy children referred pre-UNHS under the age of four, from January 2005 to June 2011. Current implant status of children, age at referral and functional outcomes were investigated.

RESULTS

Medically healthy children were referred to the NHIRC at an earlier age than the medically complex children (2.8 months vs 5.2 months, p < 0.01) and the children presenting with auditory neuropathy spectrum disorder (ANSD) (2.8 months vs 5.3 months, p < 0.01). On average they attended their first appointment and were implanted at a younger age than the ANSD group (6.1 months vs 10.1 months, p < 0.01; 16.3 months vs 29.4 months, p < 0.001, respectively). Developmentally healthy children had significantly better functional outcomes than children with developmental delays. Children referred via UNHS were referred and implanted at a younger age than those referred pre-UNHS. The former group achieved better Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) scores 2 years post-implantation.

CONCLUSION

UNHS in Ireland is an important platform for earlier diagnosis and management of congenital HL and our results show that early intervention has a positive impact on functional outcomes in children.

Reliability of Measuring Insertion Depth in Cochlear Implanted Infants and Children Using Cochlear View Radiography

OBJECTIVES

Cochlear implant depth of insertion affects audiologic outcomes and can be measured in adults using plain films obtained in the "cochlear view." The objective of this study was to assess interrater and intrarater reliability of measuring depth of insertion using cochlear view radiography.

STUDY DESIGN

Prospective, observational.

SETTING

Tertiary referral pediatric hospital.

SUBJECTS AND METHODS

Patients aged 11 months to 20 years (median, 4 years; interquartile range [IQR], 1-8 years) undergoing cochlear implantation at our institution were studied over 1 year. Children underwent cochlear view imaging on postoperative day 1. Films were deidentified and 1 image per ear was selected. Two cochlear implant surgeons and 2 radiologists evaluated each image and determined angular depth of insertion. Images were re-reviewed 6 weeks later by all raters. Inter- and intrarater reliability were calculated with intraclass correlation coefficients (ICCs).

RESULTS

Fifty-seven ears were imaged from 42 children. Forty-nine ears (86%) had successful cochlear view x-rays. Median angular depth of insertion was 381° (minimum, 272°; maximum, 450°; IQR, 360°-395°) during the first round of measurement. Measurements of the same images reviewed 6 weeks later showed median depth of insertion of 382° (minimum, 272°; maximum, 449°; IQR, 360°-397°). Interrater and intrarater reliability ICCs ranged between 0.81 and 0.96, indicating excellent reliability.

CONCLUSIONS

Postoperative cochlear view radiography is a reliable tool for measurement of cochlear implant depth of insertion in infants and children. Further studies are needed to determine reliability of intraoperatively obtained cochlear view radiographs in this population.

Mechanical Effects of Cochlear Implants on Residual Hearing Loss: A Finite Element Analysis

The effects of cochlear implants on residual hearing loss is investigated through a finite element model of human auditory periphery consisting of the cochlea and middle ear. The simulation results show that a round window stiffness is the dominant factor in residual hearing loss. The increased round window stiffness to five times caused over 4 dB residual hearing loss at low frequencies below 500 Hz. Without considering round window ossification, inserting a cochlear implant can show at most 4 dB difference of residual hearing loss in magnitude from the no-implant case although the cochlear implant's geometry and position has been varied. If the stiffness of the round window is the same, the simulation results suggest to use a thin-straight-cochlear implant inserted into the lateral side in order to preserve residual hearing at frequencies below 700 Hz. In addition, when the distance between the basilar membrane and a cochlear implant is closer, the residual hearing loss becomes severe at high frequencies above 1 kHz. The results would be helpful for choice of a cochlear implant depending on a patient's condition.

Long-term functional outcomes of hearing and speech rehabilitation efficacy among paediatric cochlear implant recipients in Shandong, China

Purpose: To evaluate the auditory performance and speech intelligibility of 100 children with bilateral profound sensorineural hearing loss up to 3 years after cochlear implantation.Methods: A cohort study was established consisting of 100 children who received cochlear implantation at Shandong Ear Nose and Throat Hospital from 2012 to 2015. Children were examined after 1 month, 1, 2, and 3 years of implantation to assess auditory performance and speech intelligibility using standard tools. The paired Wilcoxon signed-rank test was used to assess whether the scores obtained at different testing points differed significantly. The Mann-Whitney test was utilized to examine the between-group differences (e.g., age at implantation).Results: Three years after implantation, 60% out of 100 children reached the maximal category (7) of categorical auditory performance and 37% achieved the highest category (5) of speech intelligibility rating. Significant improvements were found over time in categorical auditory performance category and speech intelligibility rating (from month 1 to year 1, p < 0.001; from year 1 to year 2, p < 0.001; and from year 2 to year 3, p < 0.001). Larger improvements in auditory outcomes and speech intelligibility were observed in children with a younger age at implantation and those who received speech therapy.Conclusions: Cochlear implantation appears to make a significant, positive contribution to the development of communication skills of young congenital and prelingually deaf children in China. These improvements continue for up to 3 years after implantation. Positive outcomes appear to be associated with earlier age at implantation and receipt of speech therapy.Implications for rehabilitationBilateral sensorineural hearing loss.Bilateral sensorineural hearing loss in children can cause delay in speech development, poor language skills and potentially disorders in psychological behaviour and social isolation.Cochlear implantation (CI) is an effective strategy that helps children with bilateral sensorineural hearing loss gain the ability to hear and continue to develop language.This study shows that the auditory performance and speech intelligibility of deaf children who speak Mandarin continued to improve up to 3 years of implantation, when follow-up ceased.

Diverse Linguistic Development in Prelingually Deaf Children with Cochlear Implants

The advent of cochlear implants has enormously improved the quality of sensory perception in deaf children. Notwithstanding these advantages, the current literature shows a substantial variability in language proficiency among implanted children. This case series explores the variability of language acquisition in congenitally deaf children with cochlear implants. We report 4 prelingually deaf children (mean age = 10.5; SD = 1.08), affected by a genetically determined bilateral deafness, due to GJB2 gene mutation Cx26. Each implanted child underwent a systematic assessment of speech perception and production, as well as of lexical, morphologic, and syntactic skills in both comprehension and production. Notwithstanding similar clinical histories and similarly good postimplant pure-tone audiometry, two of the four children fared very poorly in speech audiometry, whereas the other two children gained very good results. We suggest that the language impairment detected in (some) implanted children may not be fully accounted for by pure auditory thresholds and that may be the outcome of concomitant damage to core components of the child's linguistic brain.

Effectiveness of Rehabilitation Approaches Proposed to Children With Severe-to-Profound Prelinguistic Deafness on the Development of Auditory, Speech, and Language Skills: A Systematic Review

Purpose The purpose of this systematic review is to identify and evaluate the available scientific evidence on the effectiveness of rehabilitation approaches proposed to children with severe-to-profound prelinguistic deafness on the hearing, speech, and language skills development. Method Databases (PubMed, CINHAL, PsycInfo, Cochrane, ERIC, and EMBASE) were searched with relevant key words (children, deafness, rehabilitation approach, auditory, speech, and language). Studies published between 2000 and 2017 were included. The methodological quality of the studies was evaluated with the Quality Assessment Tool for Quantitative Studies, and the level of evidence was evaluated with the Oxford Centre for Evidence-Based Medicine Levels of Evidence. Every step of the selection and analysis was made by 2 independent judges. Results Of 1,739 articles listed in different databases, 38 met the inclusion criteria and were selected for analysis. The majority of included articles present a relatively low level of evidence. Rehabilitation approaches that do not include signs appear more frequently associated with a better auditory, speech, and language development, except for receptive language, than approaches that included any form of signs. Conclusion More robust studies are needed to decide on the approach to prioritize with severe-to-profound deaf children.

What Is the Sensitive Period to Initiate Auditory Stimulation for the Second Ear in Sequential Cochlear Implantation?

OBJECTIVES

Bilateral cochlear implants (CI) are the standard treatment for bilaterally deaf children, but it is unclear how much the second CI can be delayed in sequential bilateral CI. We investigated the performances of sequential CI to answer this question.

STUDY DESIGN

Retrospective case series review.

SETTING

Tertiary referral center.

METHODS

We studied a cohort of congenitally deaf children (n = 73) who underwent sequential CI without any inner ear anomaly or combined disabilities. Hearing threshold levels and speech perception were evaluated by aided pure tone audiometry and Asan-Samsung Korean word recognition test. The scores were analyzed by the ages at surgery and compared among the different age groups.

RESULTS

When the second CI was performed before 3.5 years (the optimal period for the first CI), the second CI scores (96.9%) were comparable to the first CI scores. Although the first CI scores were more than or equal to 80% when the first CI was implanted before the age of 7 years, the second CI scores were more than or equal to 80% when the second CI was implanted before the age of 12 to 13 years. The hearing threshold levels were not different regardless of the ages and between the first and second CIs.

CONCLUSION

Our cohort demonstrated that the second CI showed comparable results to the first CI when implanted before 3.5 years, suggesting that optimal periods for the first CI and the second CI are same. However, the sensitive period (12-13 yr) for the second CI with good scores (≥80%) was much longer than that (7 yr) of the first CI, suggesting that the first CI prolongs the sensitive period for the second CI. The second CI should be implanted early, but considered even at a later age.

Speech Perception Growth Patterns in Prelingual Deaf Children With Bilateral Sequential Cochlear Implantation

OBJECTIVE

To evaluate speech perception following the first (CI-1) and second (CI-2) cochlear implantation (CI) in children with sequential bilateral CI.

STUDY DESIGN

Retrospective.

PATIENTS

Seventy children with follow-up for 60 months post CI-1 and 36 months post CI-2.

MAIN OUTCOME MEASURES

Word recognition score (WRS) was the main outcome. WRSs were compared by age at CI operation (group A ≤ 3.5 yr, B 3.6-8.6, for CI-1; group I ≤ 3.5 yr, II 3.6-7.0, III 7.1-13, IV > 13, for CI-2).

RESULTS

For CI-1, the WRS of group A exceeded 80% at 24 months post procedure, earlier than group B (54 mo). Group A also had a shorter period of CI-1 use up to the WRS plateau than group B. CI-2 showed an initial burst of WRS growth much earlier than CI-1. This initial burst was most robust within 3 months in group II, but modest in group IV. The periods of CI-2 use (11-17 mo) up to the WRS plateau were much shorter than CI-1 (40-64 mo). Group I did not show the best WRS at 1 month post CI but later exceeded the other groups.

CONCLUSION

Children received an immediate benefit by a burst of WRS growth from CI-2 earlier than CI-1, even within 3 months, suggesting that CI-1 gets the auditory cortex ready to foster speech processing from CI-2. The CI-2 performance depends on age at CI-2 implantation and on CI-1 performance. Our current findings will be relevant for clinicians who are counselling parents on CI-2 surgery.

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.

Semantic processing in children with cochlear implants: Evidence from event-related potentials

Introduction: Existing research has shown that children with significant hearing loss who use cochlear implants (CIs) perform worse than their hearing peers on behavioral measures of spoken language. The present study sought to examine how children with CIs process lexical-semantic incongruence, as indexed by electrophysiological evidence of the N400 effect. Method: Twelve children with CIs, aged between 6 and 9 years, participated in a spoken word-picture matching task while event-related potentials (ERPs) were recorded. To determine whether the N400 effect elicited in this group deviated from normal, independent samples t tests and analysis of variance (ANOVA) analyses were used to compare the results of children with CIs against those of a similarly aged typically hearing (TH) group (n = 30). Correlational analyses were also conducted within each group to gauge the degree to which the N400 effect related to behavioral measures of spoken language. Results: An N400 effect was elicited in both groups of CI and TH children. The amplitude and latency of the N400 effect did not differ significantly between groups. Despite the similarity in ERP responses, children with CIs scored significantly lower on behavioral measures of spoken word- and sentence-level comprehension. No significant correlations between ERP and behavioral measures were found, although there was a trending relationship between sentence-level spoken language comprehension and the TH group's N400 effect mean amplitude (p = .060). Conclusions: The results suggest that, at a neural level, children with CIs can process lexical-semantic incongruence, and that other underlying processes not measured by the N400 effect contribute to this population's spoken language difficulties.

Effects of Cerebral Blood Flow and Vessel Conditions on Speech Recognition in Patients With Postlingual Adult Cochlear Implant: Predictable Factors for the Efficacy of Cochlear Implant

OBJECTIVES

Cochlear implantation (CI) has been the most successful procedure for restoring hearing in a patient with severe and profound hearing loss. However, possibly owing to the variable brain functions of each patient, its performance and the associated patient satisfaction are widely variable. The authors hypothesize that peripheral and cerebral circulation can be assessed by noninvasive and globally available methods, yielding superior presurgical predictive factors of the performance of CI in adult patients with postlingual hearing loss who are scheduled to undergo CI.

DESIGN

Twenty-two adult patients with cochlear implants for postlingual hearing loss were evaluated using Doppler sonography measurement of the cervical arteries (reflecting cerebral blood flow), flow-mediated dilation (FMD; reflecting the condition of cerebral arteries), and their pre-/post-CI best score on a monosyllabic discrimination test (pre-/post-CI best monosyllabic discrimination [BMD] score). Correlations between post-CI BMD score and the other factors were examined using univariate analysis and stepwise multiple linear regression analysis. The prediction factors were calculated by examining the receiver-operating characteristic curve between post-CI BMD score and the significantly positively correlated factors.

RESULTS

Age and duration of deafness had a moderately negative correlation. The mean velocity of the internal carotid arteries and FMD had a moderate-to-strong positive correlation with the post-CI BMD score in univariate analysis. Stepwise multiple linear regression analysis revealed that only FMD was significantly positively correlated with post-CI BMD score. Analysis of the receiver-operating characteristic curve showed that a FMD cutoff score of 1.8 significantly predicted post-CI BMD score.

CONCLUSIONS

These data suggest that FMD is a convenient, noninvasive, and widely available tool for predicting the efficacy of cochlear implants. An FMD cutoff score of 1.8 could be a good index for determining whether patients will hear well with cochlear implants. It could also be used to predict whether cochlear implants will provide good speech recognition benefits to candidates, even if their speech discrimination is poor. This FMD index could become a useful predictive tool for candidates with poor speech discrimination to determine the efficacy of CI before surgery.

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.

A multi-group approach to examining language development in at-risk learners

A battery of standardized language tests and control measures was administered to three groups of at-risk language learners - internationally adopted children, deaf children with cochlear implants, and children with specific language impairment - and to groups of second-language learners and typically developing monolingual children. All children were acquiring French, were matched on age, gender, and socioeconomic status, and were between age 5;0 and 7;3 at the time of testing. Differences between the at-risk and not-at-risk groups were evident in all domains of language testing. The children with SLI or CIs scored significantly lower than the IA children and all three at-risk groups scored lower than the monolingual group; the L2 and IA groups scored similarly. The results suggest that children with limited access to, or ability to process, early language input are at greater risk than children with delayed input to an additional language but otherwise typical or relatively typical early input.

The maxillary nerve block for in-office hybrid balloon sinus dilation procedures: A preliminary study

Transitioning of rhinologic procedures from the operating room to the office setting in selected patients is a rising trend. An effective pain-control, patient-preparation protocol is essential, especially with advanced in-office rhinologic procedures such as hybrid balloon sinus dilation (BSD), in which other procedures such as ethmoidectomy, turbinate reduction, and other procedures are concomitantly performed. A regimen using oral sedation, topical tetracaine gel, topical tetracaine/epinephrine-soaked cottonoid packs, and intranasal local infiltrative anesthesia can vary significantly in effectiveness and be suboptimal at times (as determined by using treated patients as historical controls). A modification of this regimen was subsequently used, incorporating the maxillary nerve block, and qualitative differences were then assessed retrospectively between the two regimens. Twenty-five consecutive patients were retrospectively studied who underwent hybrid BSD procedures in the office setting using the maxillary nerve-block regimen modification. All patients underwent BSD of the sphenoid, frontal, and maxillary sinuses with anterior and partial posterior ethmoidectomies. Five patients also underwent septoplasty, and 18 patients underwent inferior turbinate reduction procedures. Twenty-four patients received oral sedation, and all patients received topical tetracaine/epinephrine-soaked cottonoid packs. The topical tetracaine gel was dropped after 5 patients because it was not felt to be needed anymore. No intranasal local infiltrative anesthesia was used. Several qualitative differences were observed after modifying the patient-preparation regimen incorporating the maxillary nerve block. The most important observation seen with this modification was a consistently reproducible, dense anesthesia coverage over the entire nasal cavity with good paranasal sinus coverage. This modification eliminated intranasal bleeding and swelling associated with intranasal local anesthetic injections. No complications were encountered. This preliminary study provides support for use and further evaluation of the maxillary nerve block for in-office rhinologic procedures. If the trend continues to rise in performing advanced in-office rhinologic procedures in selected patients, the maxillary nerve block may find a place in the patient-preparation protocol.

Auditory and language development in Mandarin-speaking children after cochlear implantation

OBJECTIVE

To evaluate early auditory performance, speech perception and language skills in Mandarin-speaking prelingual deaf children in the first two years after they received a cochlear implant (CI) and analyse the effects of possible associated factors.

METHODS

The Infant-Toddler Meaningful Auditory Integration Scale (ITMAIS)/Meaningful Auditory Integration Scale (MAIS), Mandarin Early Speech Perception (MESP) test and Putonghua Communicative Development Inventory (PCDI) were used to assess auditory and language outcomes in 132 Mandarin-speaking children pre- and post-implantation.

RESULTS

Children with CIs exhibited an ITMAIS/MAIS and PCDI developmental trajectory similar to that of children with normal hearing. The increased number of participants who achieved MESP categories 1-6 at each test interval showed a significant improvement in speech perception by paediatric CI recipients. Age at implantation and socioeconomic status were consistently associated with both auditory and language outcomes in the first two years post-implantation.

CONCLUSION

Mandarin-speaking children with CIs exhibit significant improvements in early auditory and language development. Though these improvements followed the normative developmental trajectories, they still exhibited a gap compared with normative values. Earlier implantation and higher socioeconomic status are consistent predictors of greater auditory and language skills in the early stage.

Evaluation of Cerebral White Matter in Prelingually Deaf Children Using Diffusion Tensor Imaging

This study compared white matter development in prelingually deaf and normal-hearing children using a tract-based spatial statistics (TBSS) method. Diffusion tensor imaging (DTI) was performed in 21 prelingually deaf (DEAF group) and 20 normal-hearing (HEAR group) subjects aged from 1.7 to 7.7 years. Using TBSS, we evaluated the regions of significant difference in fractional anisotropy (FA) between the groups. Correlations between FA values and age in each group were also analyzed using voxel-wise correlation analyses on the TBSS skeleton. Lower FA values of the white matter tract of Heschl's gyrus, the inferior frontooccipital fasciculus, the uncinate fasciculus, the superior longitudinal fasciculus, and the forceps major were evident in the DEAF group compared with those in the HEAR group below 4 years of age, while the difference was not significant in older subjects. We also found that age-related development of the white matter tracts may continue until 8 years of age in deaf children. These results imply that development of the cerebral white matter tracts is delayed in prelingually deaf children.

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.

Impact of socioeconomic factors on paediatric cochlear implant outcomes

OBJECTIVES

The study was aimed at evaluating the impact of certain socioeconomic factors such as family income, level of parents' education, distance between the child's home and auditory verbal therapy clinic, and age of the child at implantation on postoperative cochlear implant outcomes.

METHODS

Children suffering from congenital bilateral profound sensorineural hearing loss and a chronologic age of 4 years or younger at the time of implantation were included in the study. Children who were able to complete a prescribed period of a 1-year follow-up were included in the study. These children underwent cochlear implantation surgery, and their postoperative outcomes were measured and documented using categories of auditory perception (CAP), meaningful auditory integration (MAIS), and speech intelligibility rating (SIR) scores. Children were divided into three groups based on the level of parental education, family income, and distance of their home from the rehabilitation-- auditory verbal therapy clinic.

RESULTS

A total of 180 children were studied. The age at implantation had a significant impact on the postoperative outcomes, with an inverse correlation. The younger the child's age at the time of implantation, the better were the postoperative outcomes. However, there were no significant differences among the CAP, MAIS, and SIR scores and each of the three subgroups. Children from families with an annual income of less than $7,500, between $7,500 and $15,000, and more than $15,000 performed equally well, except for significantly higher SIR scores in children with family incomes more than $15,000. Children with of parents who had attended high school or possessed a bachelor's or Master's master's degree had similar scores, with no significant difference. Also, distance from the auditory verbal therapy clinic failed to have any significantimpact on a child's performance.

DISCUSSION

These results have been variable, similar to those of previously published studies. A few of the earlier studies concurred with our results, but most of the studies had suggested that children in families of higher socioeconomic status had have better speech and language acquisition.

CONCLUSIONS

Cochlear implantation significantly improves auditory perception and speech intelligibility of children suffering from profound sensorineural hearing loss. Younger The younger the age at implantation, the better are the results. Hence, early implantation should be promoted and encouraged. Our study suggests that children who followed the designated program of postoperative mapping and auditory verbal therapy for a minimum period of 1 year seemed to do equally well in terms of hearing perception and speech intelligibility, irrespective of the socioeconomic status of the family. Further studies are essential to assess the impact of these factors on long-term speech acquisition andlanguage development.

Breaking the sound barrier: exploring parents' decision-making process of cochlear implants for their children

OBJECTIVE

To understand the dynamic experiences of parents undergoing the decision-making process regarding cochlear implants for their child(ren).

METHODS

Thirty-three parents of d/Deaf children participated in semi-structured interviews. Interviews were digitally recorded, transcribed, and coded using iterative and thematic coding.

RESULTS

The results from this study reveal four salient topics related to parents' decision-making process regarding cochlear implantation: 1) factors parents considered when making the decision to get the cochlear implant for their child (e.g., desire to acculturate child into one community), 2) the extent to which parents' communities influence their decision-making (e.g., norms), 3) information sources parents seek and value when decision-making (e.g., parents value other parent's experiences the most compared to medical or online sources), and 4) personal experiences with stigma affecting their decision to not get the cochlear implant for their child.

CONCLUSION

This study provides insights into values and perspectives that can be utilized to improve informed decision-making, when making risky medical decisions with long-term implications.

PRACTICAL IMPLICATIONS

With thorough information provisions, delineation of addressing parents' concerns and encompassing all aspects of the decision (i.e., medical, social and cultural), health professional teams could reduce the uncertainty and anxiety for parents in this decision-making process for cochlear implantation.

Literacy Outcomes for Primary School Children Who Are Deaf and Hard of Hearing: A Cohort Comparison Study

PURPOSE

In this study, we compared the language and literacy of two cohorts of children with severe-profound hearing loss, recruited 10 years apart, to determine if outcomes had improved in line with the introduction of newborn hearing screening and access to improved hearing aid technology.

METHOD

Forty-two children with deafness, aged 5-7 years with a mean unaided loss of 102 DB, were assessed on language, reading, and phonological skills. Their performance was compared with that of a similar group of 32 children with deafness assessed 10 years earlier and also a group of 40 children with normal hearing of similar single word reading ability.

RESULTS

English vocabulary was significantly higher in the new cohort although it was still below chronological age. Phonological awareness and reading ability had not significantly changed over time. In both cohorts, English vocabulary predicted reading, but phonological awareness was only a significant predictor for the new cohort.

CONCLUSIONS

The current results show that vocabulary knowledge of children with severe-profound hearing loss has improved over time, but there has not been a commensurate improvement in phonological skills or reading. They suggest that children with severe-profound hearing loss will require continued support to develop robust phonological coding skills to underpin reading.

Speechreading in Deaf Adults with Cochlear Implants: Evidence for Perceptual Compensation

Previous research has provided evidence for a speechreading advantage in congenitally deaf adults compared to hearing adults. A 'perceptual compensation' account of this finding proposes that prolonged early onset deafness leads to a greater reliance on visual, as opposed to auditory, information when perceiving speech which in turn results in superior visual speech perception skills in deaf adults. In the current study we tested whether previous demonstrations of a speechreading advantage for profoundly congenitally deaf adults with hearing aids, or no amplificiation, were also apparent in adults with the same deafness profile but who have experienced greater access to the auditory elements of speech via a cochlear implant (CI). We also tested the prediction that, in line with the perceptual compensation account, receiving a CI at a later age is associated with superior speechreading skills due to later implanted individuals having experienced greater dependence on visual speech information. We designed a speechreading task in which participants viewed silent videos of 123 single words spoken by a model and were required to indicate which word they thought had been said via a free text response. We compared congenitally deaf adults who had received CIs in childhood or adolescence (N = 15) with a comparison group of hearing adults (N = 15) matched on age and education level. The adults with CI showed significantly better scores on the speechreading task than the hearing comparison group. Furthermore, within the group of adults with CI, there was a significant positive correlation between age at implantation and speechreading performance; earlier implantation was associated with lower speechreading scores. These results are both consistent with the hypothesis of perceptual compensation in the domain of speech perception, indicating that more prolonged dependence on visual speech information in speech perception may lead to improvements in the perception of visual speech. In addition our study provides metrics of the 'speechreadability' of 123 words produced in British English: one derived from hearing adults (N = 61) and one from deaf adults with CI (N = 15). Evidence for the validity of these 'speechreadability' metrics come from correlations with visual lexical competition data.

Audiovisual sentence repetition as a clinical criterion for auditory development in Persian-language children with hearing loss

OBJECTIVES

It is important for clinician such as speech-language pathologists and audiologists to develop more efficient procedures to assess the development of auditory, speech and language skills in children using hearing aid and/or cochlear implant compared to their peers with normal hearing. So, the aim of study was the comparison of the performance of 5-to-7-year-old Persian-language children with and without hearing loss in visual-only, auditory-only, and audiovisual presentation of sentence repetition task.

METHODS

The research was administered as a cross-sectional study. The sample size was 92 Persian 5-7 year old children including: 60 with normal hearing and 32 with hearing loss. The children with hearing loss were recruited from Soroush rehabilitation center for Persian-language children with hearing loss in Shiraz, Iran, through consecutive sampling method. All the children had unilateral cochlear implant or bilateral hearing aid. The assessment tool was the Sentence Repetition Test. The study included three computer-based experiments including visual-only, auditory-only, and audiovisual. The scores were compared within and among the three groups through statistical tests in α = 0.05.

RESULTS

The score of sentence repetition task between V-only, A-only, and AV presentation was significantly different in the three groups; in other words, the highest to lowest scores belonged respectively to audiovisual, auditory-only, and visual-only format in the children with normal hearing (P < 0.01), cochlear implant (P < 0.01), and hearing aid (P < 0.01). In addition, there was no significant correlationship between the visual-only and audiovisual sentence repetition scores in all the 5-to-7-year-old children (r = 0.179, n = 92, P = 0.088), but audiovisual sentence repetition scores were found to be strongly correlated with auditory-only scores in all the 5-to-7-year-old children (r = 0.943, n = 92, P = 0.000).

CONCLUSIONS

According to the study's findings, audiovisual integration occurs in the 5-to-7-year-old Persian children using hearing aid or cochlear implant during sentence repetition similar to their peers with normal hearing. Therefore, it is recommended that audiovisual sentence repetition should be used as a clinical criterion for auditory development in Persian-language children with hearing loss.

Prediction of Cochlear Implant Outcomes in Patients With Prelingual Deafness

Objectives.

To evaluate the factors that limit post-cochlear implantation (CI) speech perception in prelingually deaf children.

Methods.

Patients with CI were divided into two groups according to Category of Auditory Performance (CAP) scores 3 years post-CI: the poor performance group (poor performance group, CAP scores≤4, n=41) and the good performance group (good performance group, CAP scores≥5, n=85). The distribution and contribution of the potential limiting factors related to post-CI speech perception was compared.

Results.

Perinatal problems, inner ear anomalies, narrow bony cochlear nerve canal (BCNC), and intraoperative problems was significantly higher in the poor performance group than the good performance group (P=0.010, P=0.003, P=0.001, and P=0.045, respectively). The mean number of limiting factors was significantly higher in the poor performance group (1.98±1.04) than the good performance group (1.25±1.11, P=0.001). The odds ratios for perinatal problems and narrow bony cochlear nerve canal in the poor performance group in comparison with the good performance group were 4.878 (95% confidence interval, 0.067 to 0.625; P=0.005) and 4.785 (95% confidence interval, 0.045 to 0.972; P=0.046).

Conclusion.

This study highlights the comprehensive prediction of speech perception after CI and provides otologic surgeons with useful information for individualized preoperative counseling of CI candidates.

Factors Affecting Speech Discrimination in Children with Cochlear Implants: Evidence from Early-Implanted Infants

BACKGROUND

To learn words and acquire language, children must be able to discriminate and correctly perceive phonemes. Although there has been much research on the general language outcomes of children with cochlear implants (CIs), little is known about the development of speech perception with regard to specific speech processes, such as speech discrimination.

PURPOSE

The purpose of this study was to investigate the development of speech discrimination in infants with CIs and identify factors that might correlate with speech discrimination skills.

RESEARCH DESIGN

Using a Hybrid Visual Habituation procedure, we tested infants with CIs on their ability to discriminate the vowel contrast /i/-/u/. We also gathered demographic and audiological information about each infant.

STUDY SAMPLE

Children who had received CIs before 2 yr of age served as participants. We tested the children at two post cochlear implantation intervals: 2-4 weeks post CI stimulation (N = 17) and 6-9 mo post CI stimulation (N = 10).

DATA COLLECTION AND ANALYSIS

The infants' mean looking times during the novel versus old trials of the experiment were measured. A linear regression model was used to evaluate the relationship between the normalized looking time difference and the following variables: chronological age, age at CI stimulation, gender, communication mode, and best unaided pure-tone average.

RESULTS

We found that the best unaided pure-tone average predicted speech discrimination at the early interval. In contrast to some previous speech perception studies that included children implanted before 3 yr of age, age at CI stimulation did not predict speech discrimination performance.

CONCLUSIONS

The results suggest that residual acoustic hearing before implantation might facilitate speech discrimination during the early period post cochlear implantation; with more hearing experience, communication mode might have a greater influence on the ability to discriminate speech. This and other studies on age at cochlear implantation suggest that earlier implantation might not have as large an effect on speech perception as it does on other language skills.

A Prospective Longitudinal Study of U.S. Children Unable to Achieve Open-Set Speech Recognition 5 Years After Cochlear Implantation

OBJECTIVE

To identify characteristics associated with the inability to progress to open-set speech recognition in children 5 years after cochlear implantation.

STUDY DESIGN

Prospective, longitudinal, and multidimensional assessment of auditory development for 5 years.

SETTING

Six tertiary cochlear implant (CI) referral centers in the United States.

PATIENTS

Children with severe-to-profound hearing loss who underwent implantation before age 5 years enrolled in the Childhood Development after Cochlear Implantation study, categorized by level of speech recognition ability.

INTERVENTION(S)

Cochlear implantation before 5 years of age and annual assessment of emergent speech recognition skills.

MAIN OUTCOME MEASURE(S)

Progression to open-set speech recognition by 5 years after implantation.

RESULTS

Less functional hearing before implantation, older age at onset of amplification, lower maternal sensitivity to communication needs, minority status, and complicated perinatal history were associated with the inability to obtain open-set speech recognition by 5 years.

CONCLUSION

Characteristics of a subpopulation of children with CIs associated with an inability to achieve open-set speech recognition after 5 years of CI experience were investigated. These data distinguish pediatric CI recipients at risk for poor auditory development and highlight areas for future interventions to enhance support of early implantation.

Is There a Need for Performance Measures for Cochlear Implant Centers?

Performance measures (PMs), or quality indicators, are metrics based on objective data that allow one to assess whether a system achieves a prespecified goal. Given the relatively high level of resource utilization and potential morbidity associated with cochlear implantation (CI), PMs could be used to evaluate quality of care provided by implant centers and, ultimately, optimize care delivery. This article discusses PMs currently in use, how PMs are developed, potential downsides of using PMs, and various examples of PMs that could be used in CI centers.

Cochlear implantation in children with unilateral hearing loss: A systematic review

OBJECTIVES

To systematically review the literature on cochlear implantation (CI) for children with unilateral hearing loss (UHL).

DATA SOURCES

PubMed, Cochrane, CINAHL, and Embase databases were searched for articles up to June 29, 2015 for UHL, children and CI, and all of their synonyms.

METHODS

After screening of titles, abstracts, and full texts for eligible articles, directness of evidence (DoE) and risk of bias (RoB) were assessed for the included articles. Study characteristics and data on our outcomes of interest (speech perception in noise, sound localization, quality of life, and speech and language development) were extracted.

RESULTS

In total, 296 unique articles were retrieved, of which five articles satisfied the eligibility criteria. All of these articles were case series or case reports and had a low to moderate DoE and a high RoB. In these studies, heterogeneous findings were reported in small patient samples. Speech perception in noise and localization ability improved in most patients. Although only measured in one study each, quality of life and speech and language development improved. Most of these results were not statistically significant.

CONCLUSIONS

No firm conclusions can be drawn on the effectiveness of CI in children with UHL, due to heterogeneous findings, small sample sizes, and the lack of high Level of Evidence studies. Based on the findings of this systematic review, cochlear implantation may be an effective treatment option in children with UHL. Laryngoscope, 126:713-721, 2016.

Differential activity in Heschl's gyrus between deaf and hearing individuals is due to auditory deprivation rather than language modality

Sensory cortices undergo crossmodal reorganisation as a consequence of sensory deprivation. Congenital deafness in humans represents a particular case with respect to other types of sensory deprivation, because cortical reorganisation is not only a consequence of auditory deprivation, but also of language-driven mechanisms. Visual crossmodal plasticity has been found in secondary auditory cortices of deaf individuals, but it is still unclear if reorganisation also takes place in primary auditory areas, and how this relates to language modality and auditory deprivation. Here, we dissociated the effects of language modality and auditory deprivation on crossmodal plasticity in Heschl's gyrus as a whole, and in cytoarchitectonic region Te1.0 (likely to contain the core auditory cortex). Using fMRI, we measured the BOLD response to viewing sign language in congenitally or early deaf individuals with and without sign language knowledge, and in hearing controls. Results show that differences between hearing and deaf individuals are due to a reduction in activation caused by visual stimulation in the hearing group, which is more significant in Te1.0 than in Heschl's gyrus as a whole. Furthermore, differences between deaf and hearing groups are due to auditory deprivation, and there is no evidence that the modality of language used by deaf individuals contributes to crossmodal plasticity in Heschl's gyrus.

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.

Pediatric cochlear implantation: role of language, income, and ethnicity

OBJECTIVE

To compare post-cochlear implantation (CI) early speech perception (ESP) outcomes between a non-English speaking, ethnic minority study group and an English speaking, ethnic majority control group.

STUDY DESIGN/METHODS

We performed a retrospective case-control study at an academic tertiary care children's hospital. Records were reviewed of 49 children who underwent CI from February 2005 to September 2011. Children with abnormal cognitive function (n=12), post-surgical complications (n=1), or incomplete SP testing (n=24) were excluded. The remaining 12 cases (mean implant age 4.3 y) were reviewed for language, income, ethnicity, and ESP scores. Their scores were compared to a subset of patients (n=18; mean implant age 2.2 y) serving as control from the Childhood Development after Cochlear Implantation (CDaCI) study at 1 year follow up where standard ESP testing was performed. Briefly, CDaCI includes a demographically balanced and multicenter-based pediatric cohort from which publications are beginning to define normative post-CI SP outcomes.

RESULTS

Of our 12 children, 7 were Hispanic, 2 Caucasian, 2 multi-ethnicity and 1 Russian. 4 were non-English speaking, 5 spoke English as a second language, and 7 were bilingual. Three received bilateral CI. Mean early speech perception (ESP) scores (reported on a scale of 1-4) collected at 6 and 12 months in the study group were 1.71 and 1.75, respectively; in the control group, 3.83 and 3.92. At both follow up intervals the study group performed significantly worse than the control group (6 mo P=0.048, 12 mo P=0.01).

CONCLUSIONS

This study suggests that among pediatric CI recipients, those from predominantly non-English speaking, socioeconomically disadvantaged backgrounds develop SP at slower than normal rates. Future interventions should be directed at overcoming these obstacles.

Executive functioning skills in preschool-age children with cochlear implants

PURPOSE

The purpose of this study was to determine whether deficits in executive functioning (EF) in children with cochlear implants (CIs) emerge as early as the preschool years.

METHOD

Two groups of children ages 3 to 6 years participated in this cross-sectional study: 24 preschoolers who had CIs prior to 36 months of age and 21 preschoolers with normal hearing (NH). All were tested on normed measures of working memory, inhibition-concentration, and organization-integration. Parents completed a normed rating scale of problem behaviors related to EF. Comparisons of EF skills of children with CIs were made to peers with NH and to published nationally representative norms.

RESULTS

Preschoolers with CIs showed significantly poorer performance on inhibition-concentration and working memory compared with peers with NH and with national norms. No group differences were found in visual memory or organization-integration. When data were controlled for language, differences in performance measures of EF remained, whereas differences in parent-reported problems with EF were no longer significant. Hearing history was generally unrelated to EF.

CONCLUSIONS

This is the first study to demonstrate that EF deficits found in older children with CIs begin to emerge as early as preschool years. The ability to detect these deficits early has important implications for early intervention and habilitation after cochlear implantation.