Receptive and expressive language skills of 106 children with a minimum of 2 years' experience in hearing with a cochlear implant

Beginner's Intelligibility Test (BIT): translation, cultural adaptation to Brazilian Portuguese and validation

OBJECTIVE

Translate and validate the Beginner's Intelligibility Test (BIT) speech intelligibility assessment instrument into Brazilian Portuguese.

METHOD

Study developed in two stages: 1st translation and cross-cultural adaptation of the Beginner's Intelligibility Test instrument into Brazilian Portuguese; 2nd application of the instrument. The second stage of the study involved 20 children using cochlear implants, aged between 4 and 11 years old, enrolled in the Cochlear Implant Program at Hospital das Clínicas de Ribeirão Preto, Faculty of Medicine of Ribeirão Preto, University of São Paulo. All data collection procedures were video, and audio recorded for analysis by judges. After orthographic transcription of each sentence repeated by the child, the judge was asked to score the participant's speech intelligibility and classify it according to criteria established in the literature.

RESULTS

The translation stage took place for the four lists and 40 sentences of the Beginner's Intelligibility Test (BIT) instrument into Brazilian Portuguese, the semantic, idiomatic, experimental and conceptual equivalences were considered, and it took place without any difficulties identified by the translators. The terms used in the Portuguese language were similar and those that presented differences among the translators did not bring significant divergences to its understanding. In the inter-evaluator analysis, there was reliability between the classification and the score obtained. Different judges evaluated the same children and a concordance was observed in classification and scoring.

CONCLUSIONS

Face validity of the BIT was confirmed through the understanding of each sentence of the four lists by the majority of children using cochlear implants participating in the pre-test phase. The content validity among experts was unanimous for the four lists of sentences. The Brazilian Portuguese adapted version maintained the semantic, idiomatic, conceptual, and cultural equivalence, according to the evaluation of the expert committee.

EVIDENCE LEVEL

02.

Long-term speech perception and morphosyntactic outcomes in adolescents and young adults implanted in childhood

BACKGROUND

Long-term assessments of children with cochlear implants (CI) are important inputs to help guide families and professionals in therapeutic and counselling processes. Based on these premises, the primary aim of the present study was to assess the long-term speech and language outcomes in a sample of prelingually deaf or hard of hearing (DHH) adolescents and young adults with unilateral or bilateral implantation in childhood. The secondary aim was to investigate the correlations of age at implantation with long-term speech and language outcomes.

MATERIALS AND METHODS

Retrospective observational study on 54 long-term CI users, 33 unilateral and 21 bilateral (mean age at CI surgery 38.1 ± 24.6 months; mean age at last follow-up assessment 19.1 ± 4.3 years of age and mean follow-up time 16 ± 3.7 years). Means and standards were used to describe speech perception (in quiet, in fixed noise and in adaptive noise using It-Matrix) and morphosyntactic comprehension (TROG-2) outcomes. A univariate analysis was used to evaluate outcome differences between unilateral and bilateral patients. Bivariate analysis was performed to investigate the relationships between age at CI, audiological variables, and language outcomes. Finally, multivariate analysis was performed to quantify the relationship between It-Matrix, sentence recognition in quiet and at SNR+10 and TROG-2.

RESULTS

The participants showed good speech recognition performance in quiet (94% for words and 89% for sentences) whilst their speech-in-noise scores decreased significantly. For the It-Matrix, only 9.2% of the participants showed scores within the normative range. This value was 60% for TROG-2 performance. For both auditory and language skills, group differences for unilateral versus bilateral CI users were not statistically significant (p > 0.05). Bivariate analysis showed that age at CI correlated significantly with overall results at TROG-2 (r = -0.6; p < 0.001) and with It-Matrix (r = 0.5; p < 0.001). TROG-2 was negatively correlated with results for It-Matrix (r = -0.5; p < 0.001). In the multivariate analysis with It-Matrix as a dependent variable, the model explained 63% of the variance, of which 60% was related to sentence recognition and 3% to morphosyntax.

CONCLUSIONS

These data contribute to the definition of average long-term outcomes expected in subjects implanted during childhood whilst increasing our knowledge of the effects of variables such as age at CI and morphosyntactic comprehension on speech perception. Although the majority of this prelingually DHH cohort did not achieve scores within a normative range, remarkably better It-Matrix scores were observed when compared to those from postlingually deafened adult CI users.

Outcomes of cochlear implantation in children with Usher syndrome: a long-term observation

PURPOSE

To evaluate auditory performance and speech intelligibility of children with Usher syndrome up to 10 years after cochlear implantation.

METHODS

Thirty-five children with USH were compared to 46 non-syndromic patients regarding age at implantation. Auditory performance and speech intelligibility was assessed with standard tools. Genetic counseling, vestibular tests, imaging studies, and ophthalmological findings were evaluated, depending on the availability.

RESULTS

The mean age of implantation in USH children was 6.3 years (SD 4.6, range 0.3-17.6 years). Post-implantation values of the studied parameters were compared between USH and NS children and presented as follows: PTA = 25.0 dB HL vs. 28.4, CAP = 5.3 vs. 5.1, SIR = 4.1 vs. 3.9, MAIS = 82.3% vs. 80.5%, MUSS = 81.8% vs. 76.6%. There were no statistically significant differences between the USH and NS groups (p > 0.005). USH patients reached a higher score ceiling earlier compared to NS patients. Children implanted before 3 years of age achieved significantly higher results than older children in USH and NS groups (p < 0.005). In all patients with USH, the electroretinogram was abnormal. Vestibular examination was abnormal in 29 of 31 patients with USH1. Imaging studies revealed no inner ear or auditory nerve anomalies in patients with USH.

CONCLUSION

Cochlear implantation successfully improves auditory performance and speech intelligibility in patients with USH, especially those implanted under 3 years of age. The electroretinogram is the only reliable test to establish a diagnosis of USH. Logopedic outcomes are associated with early implantation, and early diagnosis of USH contributes to optimizing speech therapy.

The development of auditory temporal processing during the first year of life

OBJECTIVES

The processing of auditory temporal information is important for the extraction of voice pitch, linguistic information, as well as the overall temporal structure of speech. However, many aspects of its early development remain poorly understood. This paper reviews the development of auditory temporal processing during the first year of life when infants are acquiring their native language.

METHODS

First, potential mechanisms of neural immaturity are discussed in the context of neurophysiological studies. Next, what is known about infant auditory capabilities is considered with a focus on psychophysical studies involving non-speech stimuli to investigate the perception of temporal fine structure and envelope cues. This is followed by a review of studies involving speech stimuli, including those that present vocoded signals as a method of degrading the spectro-temporal information available to infant listeners.

RESULTS/CONCLUSION

This review suggests that temporal resolution may be well developed in the first postnatal months, but that the ability to use and process the temporal information in an efficient way along the entire auditory pathway is longer to develop. Those findings have crucial implications for the development of language abilities, especially for infants with hearing impairment who are using cochlear implants.

Safety and Effectiveness of Cochlear Implantation of Young Children, Including Those With Complicating Conditions

OBJECTIVE

Determine safety and effectiveness of cochlear implantation of children under age 37 months, including below age 12 months.

STUDY DESIGN

Retrospective review.

SETTING

Tertiary care children's medical center.

PATIENTS

219 children implanted before age 37 mos; 39 implanted below age 12 mos and 180 ages 12-36 mos. Mean age CI = 20.9 mos overall; 9.4 mos (5.9-11.8) and 23.4 mos (12.1-36.8) for the two age groups, respectively. All but two ≤12 mos (94.9%) received bilateral implants as did 70.5% of older group. Mean follow-up = 5.8 yrs; age last follow-up = 7.5 yrs, with no difference between groups.

INTERVENTIONS

Cochlear implantation.

MAIN OUTCOME MEASURES

Surgical and anesthesia complications, measurable open-set speech discrimination, primary communication mode(s).

RESULTS

Few surgical complications occurred, with no difference by age group. No major anesthetic morbidity occurred, with no critical events requiring intervention in the younger group while 4 older children experienced desaturations or bradycardia/hypotension. Children implanted under 12 mos developed open-set earlier (3.3 yrs vs 4.3 yrs, p ≤ 0.001) and were more likely to develop oral-only communication (88.2% vs 48.8%, p ≤ 0.001). A significant decline in rate of oral-only communication was present if implanted over 24 months, especially when comparing children with and without additional conditions associated with language delay (8.3% and 35%, respectively).

CONCLUSIONS

Implantation of children under 37 months of age can be done safely, including those below age 12 mos. Implantation below 12 mos is positively associated with earlier open-set ability and oral-only communication. Children implanted after age 24 months were much less likely to use oral communication exclusively, especially those with complex medical history or additional conditions associated with language delay.

The Effect of Age at Cochlear Implantation on Speech and Auditory Performances in Prelingually Deaf Children

To understand the effect of age at implantation on speech and auditory performances of 74 prelingually deaf Indian children after using cochlear implants for 3, 6 and 12 months. We also evaluate the causes of late implantation in this population. Seventy four children who underwent cochlear implantation from December 2013 to December 2015 in the Department of Otorhinolaryngology and Head Neck Cancer in SMS Medical College, Jaipur were participated in this study. To compare the efficacy of cochlear implant, candidates are classified into 2 groups according to the age at the time of implantation: 1-4 years and 4.1-7 years. The sample size is 37 in both age groups. Their auditory performance and speech intelligibility were rated using the Revised Categories of Auditory Perception scales, Speech Intelligibility Rating scales and Meaningful Auditory Integration Scale. The evaluations were made before implantation and 3, 6 and 12 months after implantation. The scores when compared in both the groups revealed that the results were comparable and significant after 12 months of follow up while the scores were not significant after 3 and 6 months. The results were statistically significant when baseline is compared with different postoperative stages. The children implanted before the age of 4 years had significantly better auditory and linguistic performances. At least 12 months of audio-verbal rehabilitation and speech and language therapy are required to compare the effects of cochlear implant in any set of children. Our study shows that hearing impaired children who receive cochlear implantation below 4 years of age acquires better auditory ability for developing language skills.

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.

Academic Performance, Communication, and Psychosocial Development of Prelingual Deaf Children with Cochlear Implants in Mainstream Schools

BACKGROUND AND OBJECTIVES

To assess the academic performance, communication skills, and psychosocial development of prelingual deaf children with cochlear implants (CIs) attending mainstream schools, and to evaluate the impact of auditory speech perception on their classroom performance. Subjects and.

METHODS

As participant, 67 children with CI attending mainstream schools were included. A survey was conducted using a structured questionnaire on academic performance in the native language, second language, mathematics, social studies, science, art, communication skills, self-esteem, and social relations. Additionally, auditory and speech performances on the last follow-up were reviewed retrospectively.

RESULTS

Most implanted children attending mainstream school appeared to have positive self-esteem and confidence, and had little difficulty in conversing in a quiet classroom. Also, half of the implanted children (38/67) scored above average in general academic achievement. However, academic achievement in the second language (English), social studies, and science were usually poorer than general academic achievement. Furthermore, half of the implanted children had difficulty in understanding the class content (30/67) or conversing with peers in a noisy classroom (32/67). These difficulties were significantly associated with poor speech perception.

CONCLUSIONS

Improving the listening environment for implanted children attending mainstream schools is necessary.

Adaptation of Functioning After Pediatric Cochlear Implantation (FAPCI) into Hindi Language

FAPCI is a parent/caregiver reporting questionnaire, which evaluates the communication performance of pre-school children with cochlear implants in the age range of 2-5 years, using behavioral examples of children's daily activities. Tools for the objective and effective measurement of communication for cochlear implanted Indian children in Hindi language are lacking. The primary aim of the study was to adapt American English version of FAPCI into the Hindi language. With a secondary aim to find out the communication functioning of Cochlear implanted children by administering FAPCI (HN) and comparing the findings with children with normal hearing. The FAPCI was translated to Hindi using the forward-backward procedure. The FAPCI (HN) was then administered to the parents of children with NH (n = 35) and CI (n = 44), 2-9 years of age. Internal consistency was checked using Cronbach's alpha. Other statistical analysis included Bartlett's test of sphericity, factor loading, Wilcoxon test and t test. During adaptation few items were modified and one item was removed which contained "inversion question" not used in Hindi language. The Hindi version of FAPCI showed excellent internal consistency (Cronbach's alpha > 0.90). The split-half coefficient for the first half of the data was equal to 0.96 and for the second half was equal to 0.95. The CI group had significantly lower FAPCI scores (61.14 ± 21.49) than the NH group (101.43 ± 9.24) (p < 0.05, Wilcoxon test). FAPCI-Hindi can be used to measure the communicative functioning of cochlear implanted children in Indian population and results may be used as a guideline to revise the speech and language therapy plans to maximize the cochlear implant benefits.

Long-term Outcomes in Down Syndrome Children After Cochlear Implantation: Particular Issues and Considerations

OBJECTIVE

The aim of the study was to analyze the long-term outcomes after cochlear implantation in deaf children with Down syndrome (DS) regarding age at the first implantation and refer the results to preoperative radiological findings as well as postoperative auditory and speech performance. Additionally, the influence of the age at implantation and duration of CI use on postoperative hearing and language skills were closely analyzed in children with DS.

STUDY DESIGN

Retrospective analysis.

SETTING

Referral center (Cochlear Implant Center).

MATERIALS AND METHODS

Nine children with Down syndrome were compared with 220 pediatric patients without additional mental disorders or genetic mutations. Patients were divided into four categories depending on the age of the first implantation: CAT1 (0-3 yr), CAT2 (4-5 yr), CAT3 (6-7 yr), and CAT4 (8-17 yr). The auditory performance was assessed with the meaningful auditory integration scales (MAIS) and categories of auditory performance (CAP) scales. The speech and language development were further evaluated with meaningful use of speech scale (MUSS) and speech intelligibility rating (SIR). The postoperative speech skills were analyzed and compared between the study group and the reference group by using nonparametric statistical tests. Anatomic abnormalities of the inner ear were examined using magnetic resonance imaging (MRI) and high-resolution computed tomography of the temporal bones (HRCT).

RESULTS

The mean follow-up time was 14.9 years (range, 13.1-18.3 yr). Patients with DS received a multichannel implant at a mean age of 75.3 months (SD 27.9; ranging from 21 to 127 mo) and 220 non-syndromic children from reference group at a mean age of 51.4 months (SD 34.2; ranging from 9 to 167 mo). The intraoperative neural response was present in all cases. The auditory and speech performance improved in each DS child. The postoperative mean CAP and SIR scores were 4.4 (SD 0.8) and 3.2 (SD 0.6), respectively. The average of scores in MUSS and MAIS/IT-MAIS scales was 59.8% (SD 0.1) and 76.9% (SD 0.1), respectively. Gathered data indicates that children with DS implanted with CI at a younger age (<6 years of age) benefited from the CI more than children implanted later in life, similarly in a control group. There were additional anomalies of the temporal bone, external, middle, or inner ear observed in 90% of DS children, basing on MRI or HRCT.

CONCLUSIONS

The early cochlear implantation in children with DS is a similarly useful method in treating severe to profound sensorineural hearing loss (SNHL) as in non-syndromic patients, although the development of speech skills present differently. Due to a higher prevalence of ear and temporal bone malformations, detailed diagnostic imaging should be taken into account before the CI qualification. Better postoperative outcomes may be achieved through comprehensive care from parents/guardians and speech therapists thanks to intensive and systematic rehabilitation.

Alterations of structural and functional connectivity in profound sensorineural hearing loss infants within an early sensitive period: A combined DTI and fMRI study

Due to heightened level of neuroplasticity, there is a sensitive period (2–4 years after birth) that exists for optimal central auditory development. Using diffusion tensor imaging combined with resting-state functional connectivity (rsFC) analysis, this study directly investigates the structural connectivity alterations of the whole brain white matter (WM) and the functional reorganization of the auditory network in infants with sensorineural hearing loss (SNHL) during the early sensitive period. 46 bilateral profound SNHL infants prior to cochlear implantation (mean age, 17.59 months) and 33 healthy controls (mean age, 18.55 months) were included in the analysis. Compared with controls, SNHL infants showed widespread WM alterations, including bilateral superior longitudinal fasciculus, inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, right corticospinal tract, posterior thalamic radiation and left uncinate fasciculus. Moreover, SNHL infants demonstrated increased rsFC between left/right primary auditory cortex seeds and right insula and superior temporal gyrus. In conclusion, this study suggests that SNHL in the early sensitive period is associated with diffuse WM alterations that mainly affect the auditory and language pathways. Furthermore, increased rsFC in areas mainly associated with auditory and language networks may potentially reflect reorganization and compensatory activation in response to auditory deprivation during the early sensitive period.

A comparison of morpho-syntactic abilities in deaf children with cochlear implant and 5-year-old normal-hearing children

INTRODUCTION

Children with cochlear implants (CIs) have problems in morpho-syntactic abilities more than other language skills. The current study was aimed to evaluate the language samples of children with CIs by using a numerical measurement tool, Persian developmental sentence scoring (PDSS).

METHOD

In this cross-sectional, descriptive, analytical study, 33 children (22 children with CIs and 11 with normal hearing) were recruited. Language samples of the children were recorded during the description of pictures. The PDSS was used as a reliable numerical measurement tool for analyzing the first 100 consecutive intelligible utterances.

RESULTS

We found a significant difference in the mean PDSS total scores (p = 0.0001) between the normal-hearing children and deaf children using CIs for 5 years. Similarly, the results revealed a significant difference in the mean PDSS total scores (p = 0.0001) between the normal-hearing children and 5-year-old deaf children with CIs. There was no significant difference in the mean PDSS total scores between the two groups of children with CIs.

CONCLUSION

Children with CIs can form simple sentences but probably exhibit poor abilities for using complex sentences and essential morphology items.

Comparative evaluation of the white matter fiber integrity in patients with prelingual and postlingual deafness

The aim of this study was to perform a comparative investigation of white matter integrity in patients with prelingual and postlingual deafness; we carried out a tract-based statistical analysis of diffusion tensor anisotropy in eight and ten adults with prelingual and postlingual deafness, respectively. Patients with deafness showed significant decreases in diffusion anisotropy at the right internal capsule, the right thalamus, and the splenium of the corpus callosum as well as within the bilateral superior temporal gyrus (including Heschl gyrus) and right temporal white matter. Furthermore, relative to patients with postlingual deafness, those with prelingual deafness showed lower anisotropy in the right superior temporal gyrus, bilateral temporal white matter, and the genu and anterior body of the corpus callosum. We believe that, in patients with deafness, reception of early auditory stimuli before language acquisition might be more critical to white matter maturation and brain reorganization than the nature of auditory stimuli itself or the duration of disuse. These findings provide the theoretical background for early auditory rehabilitation.

Communication dynamics between mothers and their children with cochlear implants: Effects of maternal support for language production

This study examined (a) the functions and modalities of maternal and child communication during interaction between mothers and children with cochlear implants (CIs), comparing them with mothers and normally hearing (NH) children, and (b) the effectiveness of maternal support strategies in eliciting adequate answers in children with CI. Twenty preschoolers with CIs (M = 40 months) and 40 NH children - 20 matched by chronological age (CANH, M = 40 months) and 20 matched by hearing age (HANH, M = 25 months) - were videotaped during shared book reading and toy play with their mothers. Child and maternal utterances were coded for communicative functions and modalities (vocal, gestural, bimodal), including gesture types; maternal repairs were examined for type of support provided, and child answers for adequacy. Mothers in the CI group and in the CANH group displayed higher proportions of Informative Repairs than mothers of HANH children. However, unlike the mothers of NH children, mothers of children with CIs used bimodal utterances significantly more than vocal utterances. Sequential analysis revealed that maternal Informative Repairs elicited the production of Adequate Answers in both children with CIs and CANH. Interestingly, in the CI group this association was found only when Informative Repairs were accompanied by gestures. These findings offer suggestions for intervention programs focused on parent-child conversation.

Profiling morpho-syntactical development of cochlear implanted children with TR-LARSP

This research aims to describe the grammatical development of Turkish-speaking children with cochlear implants (CI) using the Turkish adaptation of the Language Assessment and Remediation Profile (LARSP). The study was conducted on a total of 15 children with CIs aged 43-87 months with 22-45 months of hearing age. A total of 750 utterances were elicited from the CI group's recorded speech samples and analysed using the methodology of Turkish-Language Assessment and Remediation Profile (TR-LARSP). A cross-sectional descriptive model is used in the study. The results show that there is a significant difference in the acquisition of grammatical structures in children with CIs as compared to typically developing (TD) age-matched children in Turkish. In conclusion, this study suggests that after the implantation of these children, the speech therapist should consider the acquisition time of morpho-syntactical structures before making a language-based therapy plan.

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.

Noun plural production in preschoolers with early cochlear implantation: an experimental study of Dutch and German

OBJECTIVES

Studies investigating language skills of children after cochlear implantation usually present general measures of expressive/receptive vocabulary and grammar and rarely tackle the acquisition of specific language phenomena (word classes, grammatical constructions, word forms, etc.). Furthermore, research is largely restricted to children acquiring English. Cross-linguistic comparisons among children acquiring different languages are almost inexistent. The present study targets the acquisition of noun plurals (e.g., dogs, balls) by Dutch- and German-speaking children implanted before their second birthday. Given its structural complexity and irregularity, noun plural formation is a good indicator of grammatical proficiency in children at risk for a developmental delay.

METHODS

The study sample consisted of 14 cochlear-implanted (CI) children (M=55 months of age), 80 age-matched normally hearing (NH) controls, and 40 normally hearing controls matched by Hearing Age (HA). The children were administered an elicitation task in which they had to provide plural forms to a set of singular nouns. The analysis focussed on the following variables: Hearing status (CI, NH), Language (Dutch, German), and Suffix Predictability/Stem Transparency of the plural words.

RESULTS

There was no significant difference between children with CI and their NH peers in correct plural production. In both child groups, plural responses followed the predicted pattern of Suffix Predictability/Stem Transparency. However, children with CI significantly more frequently replied to the test item with a recast of the singular noun instead of the plural, and the probability of these responses increased with later age of CI implantation. Furthermore, Dutch-speaking children showed an overall better performance than German-speaking children.

CONCLUSIONS

The findings suggest that after 3 years of implant use, preschoolers with early cochlear implantation show age-appropriate patterns of noun plural formation, but still have to catch up with respect to associating a particular singular with its plural form.

Brazilian adaptation of the Functioning after Pediatric Cochlear Implantation (FAPCI): comparison between normal hearing and cochlear implanted children

OBJECTIVE

Enabling development of the ability to communicate effectively is the principal objective of cochlear implantation (CI) in children. However, objective and effective metrics of communication for cochlear-implanted Brazilian children are lacking. The Functioning after Pediatric Cochlear Implantation (FAPCI), a parent/caregiver reporting instrument developed in the United States, is the first communicative performance scale for evaluation of real-world verbal communicative performance of 2-5-year-old children with cochlear implants. The primary aim was to cross-culturally adapt and validate the Brazilian-Portuguese version of the FAPCI. The secondary aim was to conduct a trial of the adapted Brazilian-Portuguese FAPCI (FAPCI-BP) in normal hearing (NH) and CI children.

METHODS

The American-English FAPCI was translated by a rigorous forward-backward process. The FAPCI-BP was then applied to the parents of children with NH (n=131) and CI (n=13), 2-9 years of age. Test-retest reliability was verified.

RESULTS

The FAPCI-BP was confirmed to have excellent internal consistency (Cronbach's alpha > 0.90). The CI group had lower FAPCI scores (58.38 ± 22.6) than the NH group (100.38 ± 15.2; p<0.001, Wilcoxon test).

CONCLUSION

The present results indicate that the FAPCI-BP is a reliable instrument. It can be used to evaluate verbal communicative performance in children with and without CI. The FAPCI is currently the only psychometrically-validated instrument that allows such measures in cochlear-implanted children.

Acquisition of early auditory milestones with a cochlear implant

OBJECTIVE

Speech acquisition after cochlear implant is a long process. Various studies have followed the auditory milestones in the early period after implantation. The aim of the present study was to track the development of hearing skills in the early period after cochlear implantation and evaluate which factors influence the process.

METHODS

195 records of children implanted in the Hadassah Medical Center were examined retrospectively. Data on etiology, age at implantation and type of implant were collected. In addition, information on the rate of progress was measured: the first time that there was detection and identification of Ling sounds, the first time it was possible to obtain SDT (speech detection threshold), SRT (speech reception threshold) and an audiogram, and the first accurate repetition of VCV (vowel consonant vowel) sounds.

RESULTS

Results show a consistent pattern of auditory milestone acquisition similar to that of normal development, from milestones that do not require decoding beginning with SDT, detection of Ling sounds followed by an audiogram which requires cooperation, to tasks that involve decoding starting with SRT and repetition of Ling sounds and finally VCV repetition. The children implanted before 24 months of age achieved the auditory milestones later than children implanted between 2 and 6 years, apparently since these tasks involve cognitive abilities which are not yet developed in the youngest children. Previous hearing experience improved the rate of acquisition of the auditory milestones and progress was faster in the second implanted ear compared to the first implanted ear.

CONCLUSION

More research is needed to address the relationship between acquisition of early auditory milestones and performance with the cochlear implant later on in life.

Academic achievements and classroom performance in Mandarin-speaking prelingually deafened school children with cochlear implants

OBJECTIVES

To document academic achievements and classroom performance in 35 Mandarin-speaking, congenital/pre-lingual, deafened children who used cochlear implants (CIs) for 5-11 years. The possible associated factors were also analyzed.

STUDY DESIGN

Cross-sectional case series.

METHODS

Standardized Chinese literacy ability and mathematics tests were administered to evaluate the academic achievement of these children. Raw scores derived from both literacy ability and mathematics tests were compared with normative data from children with normal hearing (NH). A modified Mandarin edition of the Screening Instrument for Targeting Educational Risk (SIFTER) and a Regular School Adjustment Scale (RSAS) for students with hearing impairments filled out by regular classroom teachers were used to assess the children's classroom performances.

RESULTS

The mean standard T-scores for Chinese literacy ability and mathematics ability were 48.6 and 50.3 (NORM=50 ± 10), respectively. A total of 85.7% of children with CIs scored within or above the normal range of their age-matched hearing peers in Chinese literacy ability, and 82.9% were within normal ranges in mathematics ability. The SIFTER results showed that 45.7% failure was noted on the communication subscale, and the RSAS also indicated 40% of CI students to have communication problems. The academic subscale scores on the SIFTER were associated with the children's Chinese literacy abilities. The Verbal Comprehension Index (VCI) of the Wechsler IQ test IV was related to the children's mathematics abilities.

CONCLUSIONS

The academic achievements of Mandarin-speaking children who receive CIs from a young age and are integrated into mainstream elementary school system appear to fall within the normal range of their age-matched hearing counterparts after 5-11 years of use. This study strongly suggests the need for future ongoing support for these children in communication field.

Effectiveness of cochlear implants in children: long term results

OBJECTIVES

This study aimed to evaluate the effectiveness, according to the hearing threshold and language performance, of cochlear implants through a period of 10 or more years of follow-up.

METHODS

A retrospective chart review was conducted. 132 patients were selected from the children's population that underwent cochlear implantation at the Department of Otorhinolaryngology, Centro Hospitalar e Universitário de Coimbra, from 1992 to 2001, with a minimum follow-up period of 10 years. A comparison of the pure-tone and speech audiometric thresholds between two periods (T0 and T1) was performed. T0 refers to the initial evaluation, immediately after the rehabilitation programme, within the first year after cochlear implantation. T1 refers to the most recent annual assessment, carried out in 2010 and 2011. Speech understanding was also evaluated through word and sentence recognition tests.

RESULTS

No statistically significant differences were found between early and late assessments, in paediatric cochlear implants users, after a 10 years period of cochlear implantation. Both speech and pure-tone audiometry seem to stabilize except for 2000 Hz where the results were even better after 10 years. Factors such as age at time of implantation, duration of deafness, aetiology and exchange of the speech processor do not seem to have a role in auditory performance after a long rehabilitation period. In tests of verbal discrimination rates of words and phrases recognition were of 84.6% and 65.1%, respectively.

CONCLUSIONS

Cochlear implant is an effective treatment for severe to profound hearing loss in children, contributing to a hearing performance and an appropriate language acquisition, currently comparable to normal hearing children. These benefits appear to keep stable over the years. No deterioration was identified.

Infrequent word classes in the speech of two- to seven-year-old children with cochlear implants and their normally hearing peers: a longitudinal study of adjective use

OBJECTIVE

Studies investigating language skills of children after cochlear implantation usually use global language proficiency scores and rarely tackle the acquisition of specific language phenomena (word classes, grammatical constructions, etc.). Furthermore, research is largely restricted to frequent word classes (nouns, verbs). The present study targets the acquisition of adjectives (e.g. big, intelligent) by children implanted before their second birthday. Adjectives constitute a relatively infrequent, but functionally important word class and were shown to be good indicators of language delays and impairments.

METHOD

Nine cochlear-implanted (CI) children and 60 age-matched normally hearing (NH) controls participated in the study. The CI children were followed longitudinally from ages 2 to 7; control data were collected in a cross-sectional manner (10 children per age group). Samples of children's spontaneous interactions with their caregivers were transcribed and analyzed for adjective use (frequency, lexical diversity, complexity of syntactic constructions, and morphological correctness).

RESULTS

The performance of the CI subjects was not significantly different from that of NH peers on adjective frequency and lexical diversity. On these measures, both groups reached adult levels by age 3. However, the CI group had a significant delay in the acquisition of complex syntactic constructions. The NH subjects produced adjectives in adult-like grammatical constructions from age 3 onwards, whereas their CI peers lagged behind until age 5. The speech of the CI participants also featured morphological errors that are not characteristic of typical development (inflection of predicative adjectives). However, the overall error rate was low.

CONCLUSIONS

The findings suggest that CI children have particular difficulty with grammatical items (bound morphemes, copulas) that are less salient in the flow of speech than content words. Nevertheless, children implanted before their second birthday are able to catch up with their hearing peers by age 5, even in the use of relatively infrequent word classes.

A case study assessing the auditory and speech development of four children implanted with cochlear implants by the chronological age of 12 months

Children with severe hearing loss most likely receive the greatest benefit from a cochlear implant (CI) when implanted at less than 2 years of age. Children with a hearing loss may also benefit greater from binaural sensory stimulation. Four children who received their first CI under 12 months of age were included in this study. Effects on auditory development were determined using the German LittlEARS Auditory Questionnaire, closed- and open-set monosyllabic word tests, aided free-field, the Mainzer and Göttinger speech discrimination tests, Monosyllabic-Trochee-Polysyllabic (MTP), and Listening Progress Profile (LiP). Speech production and grammar development were evaluated using a German language speech development test (SETK), reception of grammar test (TROG-D) and active vocabulary test (AWST-R). The data showed that children implanted under 12 months of age reached open-set monosyllabic word discrimination at an age of 24 months. LiP results improved over time, and children recognized 100% of words in the MTP test after 12 months. All children performed as well as or better than their hearing peers in speech production and grammar development. SETK showed that the speech development of these children was in general age appropriate. The data suggests that early hearing loss intervention benefits speech and language development and supports the trend towards early cochlear implantation. Furthermore, the data emphasizes the potential benefits associated with bilateral implantation.

Quantification of LLAEP interhemispheric symmetry by the intraclass correlation coefficient as a measure of cortical reorganization after cochlear implantation

OBJECTIVE

Electrical stimulation by a cochlear implant (CI) induces maturation of the auditory system and reorganization of the auditory cortex in deaf children. Cortical reorganization produces an interhemispheric asymmetry in auditory evoked brain potentials associated with sound stimulation after unilateral implantation. To objectively determine the onset of this phenomenon and follow this process over time, the interhemispheric symmetry needs to be quantified. In this paper, the intraclass correlation coefficient (ICC) between mean global field powers (MGFPs) of each hemisphere is proposed to quantify long latency auditory evoked potential (LLAEP) interhemispheric symmetries as a measure of auditory cortex reorganization in CI recipients.

DESIGN

An LLAEP, in response to a simple tone, was recorded in 5 juvenile unilateral CI recipients at less and at more than two years post-implantation and the ICC between MGFPs was calculated for both recordings. The cross correlation coefficients (CC) between MGFPs of each hemisphere were also calculated and compared with the ICC.

RESULTS

The experience-related visually observed increases in amplitude and shape asymmetries of the LLAEP topographic map (around the LLAEP P(1) peak), were reflected in a considerable reduction of ICC values (on average 41.4%), at more than two years post-implantation surgery. In contrast, CC values only showed much smaller decreases (on average 20.0%), at more than two years post-implantation.

CONCLUSIONS

The ICC is a better descriptor of symmetry than the CC because it reflects both shape and amplitude similarity between left and right LLAEP MGFPs instead of only shape similarity. The decrease in ICC values at more than two years post-implantation is likely associated with a lateralization of the auditory response as a result of cortical reorganization. Our results show that the ICC between the MGFPs for each hemisphere can be useful to objectively determine the auditory cortex reorganization process and also to evaluate the performance of cochlear implant users without the necessity to use expensive technologies such as high density EEG recordings and/or fMRI scans.

Cochlear implants: our experience and literature review

Introduction: Cochlear Implants are important for individuals with severe to profound bilateral sensorineural hearing loss.

Objective: Evaluate the experience of cochlear implant center of Otorhinolaryngology through the analysis of records of 9 patients who underwent cochlear implant surgery.

Methods: This is a retrospective study performed with the patients records. Number 0191.0.107.000-11 ethics committee approval. We evaluated gender, etiology, age at surgery, duration of deafness, classification of deafness, unilateral or bilateral surgery, intraoperative and postoperative neural response and impedance of the electrodes in intraoperative and preoperative tests and found those that counter-indicated surgery.

Results: There were 6 pediatric and 3 adult patients. Four male and 5 female. Etiologies: maternal rubella, cytomegalovirus, ototoxicity, meningitis, and sudden deafness. The age at surgery and duration of deafness ranged from 2–46 years and 2–18 years, respectively. Seven patients were pre-lingual. All had profound bilateral PA. There were 7 bilateral implants. Intraoperative complications: hemorrhage. Complications after surgery: vertigo and internal device failure. In 7 patients the electrodes were implanted through. Telemetry showed satisfactory neural response and impedance. CT and MRI was performed in all patients. We found enlargement of the vestibular aqueduct in a patient and incudomalleolar malformation.

Conclusion: The cochlear implant as a form of auditory rehabilitation is well established and spreading to different centers specialized in otoaudiology. Thus, the need for structured services and trained professionals in this type of procedure is clear.

Reduced visual discrimination in cochlear implant users

The aim of the study was to investigate low-level visual function in cochlear implant users. Spatial frequency discrimination was assessed in 16 adults with normal hearing and 18 adults with profound deafness who had a cochlear implant. Thresholds were measured with sinusoidal gratings using a two-alternative temporal forced-choice procedure combined with an adaptive staircase. Cochlear implant users had significantly poorer spatial frequency discrimination compared with normal hearing participants. Therefore, auditory privation leads to substantial changes in this particular visual function and these changes remain even after the restoration of hearing with a cochlear implant.

The effect of cochlear implantation in development of intelligence quotient of 6-9 deaf children in comparison with normal hearing children (Iran, 2009-2011)

OBJECTIVE

Before the introduction of cochlear implant (CI) in 1980, hearing aids were the only means by which profoundly deaf children had access to auditory stimuli. Nowadays, CI is firmly established as effective option in speech and language rehabilitation of deaf children, but much of the literature regarding outcomes for children after CI are focused on development of speech and less is known about language acquisition. So, the main aim of this study is the evaluation of verbal intelligence quotient (IQ) of cochlear implanted children in comparison with normal children.

METHODS AND MATERIALS

30 cochlear implanted and 30 normal hearing children with similar socio-economic level at the same age were compared by a revised version (in Persian) of WISC test (Wechsler, 1991). Then the data were analyzed through SPSS software 16.

RESULTS

In spite of the fact that cochlear implanted children did well in different parameters of WISC test, the average scores of this group was less than normal hearing children. But in similarities (one of the parameters of WISC test) 2 group's performance was approximately the same.

CONCLUSION

CI plays an important role in development of verbal IQ and language acquisition of deaf children. Different researches indicate that most of the cochlear implanted children show less language delay during the time.

Preoperative voice parameters affect the postoperative speech intelligibility in patients with cochlear implantation

OBJECTIVES

Verbal communication depends on a good function of voice and speech organs. Some of the voice characteristics of deaf people differ considerably from those of speakers with normal hearing. After cochlear implantation (CI), auditory control of voice production is possible and the quality of the voice is improved. CI improves quality of voice, speech and hearing with deafness. The aim of our study was to investigate the relationship between acoustic analysis before CI and the speech intelligibility before and after CI.

METHODS

Twelve prelingually deafened children implanted unilaterally at the age of 3.4-9 years were included in the study. For all of the children an acoustic analysis of the Slovene vowel 'a' was performed before CI. The fundamental frequency (F0), jitter, shimmer and noise-to-harmonic ratio (NHR) were studied before the implantation. For all of the children the speech intelligibility was performed before and 12 months after CI. Preoperative hearing was divided on existing residual hearing. The results of the acoustic analyses and speech intelligibility before and after CI were compared for preoperative hearing. The results of the speech intelligibility were compared for the age of operation and preoperative acoustic analysis (F0, jitter, shimmer, NHR).

RESULTS

Preoperative hearing had no influence on preoperative voice analysis. The children with residual hearing had a high grade of speech intelligibility before and after CI. The preoperative shimmer had positive correlation with postoperative 12 month speech intelligibility (r=0.618, P=0.032). The preoperative jitter had positive correlation with postoperative 12 month speech intelligibility, but was not statistically significant (r=0.479, P=0.116).

CONCLUSION

Shimmer on preoperative voice analyses had influence on speech intelligibility after CI.

Cochlear implant in the second year of life: lexical and grammatical outcomes

PURPOSE

The authors studied the effect of the cochlear implant (CI) on language comprehension and production in deaf children who had received a CI in the 2nd year of life.

METHOD

The authors evaluated lexical and morphosyntactic skills in comprehension and production in 17 Italian children who are deaf (M = 54 months of age) with a CI and in 2 control groups of children with normal hearing (NH; 1 matched for chronological age and the other whose chronological age corresponded to the duration of CI activation). The authors also compared children with unilateral CI to children with bilateral CI.

RESULTS

Children with CI appeared to keep pace with NH children matched for time since CI activation in terms of language acquisition, and they were similar to same-age NH children in lexical production. However, children with CI showed difficulties in lexical comprehension when a task required phonological discrimination as well as in grammar comprehension and production. Children with bilateral CI showed better comprehension than did children with unilateral CI; the 2 groups were similar for production.

CONCLUSIONS

Activation of CI in the 2nd year of life may provide children who are deaf with a good opportunity to develop language skills, although some limitations in phonological and morphological skills are still present 3 years after auditory reafferentation.

Soft tissue complications after pediatric cochlear implantation in children younger than 12 months

OBJECTIVES

Children are undergoing cochlear implantation younger than ever before. There has been some concern that young children may have an increased risk of soft tissue complications than older age groups. We aim to review the major and minor soft tissue complications after pediatric cochlear implantation in the age group of younger than 12 months.

STUDY DESIGN

Retrospective case review.

METHODS

Patients were identified from the cochlear implant program database of more than 1,000 children at the Hospital for Sick Children, Toronto, Canada. Demographic data, cause of hearing loss, and time of the onset of hearing loss were recorded.

RESULTS

A total of 66 patients were identified (94 implants) in the age group of younger than 12 months. Of these, there was 1 minor complication (implanted at 8 mo)-skin infection around implant 14 days later treated with antibiotics. There were no major complications.

CONCLUSION

Cochlear implantation in children younger than 12 months does not increase the risk of soft tissue complications.

Effects of early auditory experience on word learning and speech perception in deaf children with cochlear implants: implications for sensitive periods of language development

HYPOTHESIS

That early word learning and speech perception skills have different sensitive periods and that very early implantation may affect later vocabulary outcomes more than speech perception outcomes.

BACKGROUND

Several studies have found that deaf children who receive cochlear implants before 3 years of age tend to have better speech perception outcomes than children implanted later. Recent studies have not found age-at-implantation effects on speech perception or central auditory processing among children implanted younger than 2 years, suggesting that there may be a sensitive period for speech perception skills that closes by around 3 years of age. There has been very little work investigating possible sensitive periods for other language skills, such as the ability to learn words. Recent work suggests the possibility that the development of word-learning skills may have an earlier sensitive period than the development of speech perception skills.

METHODS

Assess speech perception and vocabulary outcomes in children implanted before 13 months of age and in children implanted between 16 and 23 months of age.

RESULTS

Children implanted during the first year of life had better vocabulary outcomes than children implanted during the second year of life. However, earlier implanted children did not show better speech perception outcomes than later implanted children.

CONCLUSION

There may be an earlier sensitive period for developing the ability to associate the sound patterns of words to their referents than for developing speech perception and central auditory processing skills.

Long-term language levels and reading skills in mandarin-speaking prelingually deaf children with cochlear implants

The aim of this study was to document receptive and expressive language levels and reading skills achieved by Mandarin-speaking children who had received cochlear implants (CIs) and used them for 4.75-7.42 years. The effects of possible associated factors were also analyzed. Standardized Mandarin language and reading tests were administered to 39 prelingually deaf children with Nucleus 24 devices. The Mandarin Chinese version of the Peabody Picture Vocabulary Test was used to assess their receptive vocabulary knowledge and the Revised Primary School Language Assessment Test for their receptive and expressive language skills. The Graded Chinese Character Recognition Test was used to test their written word recognition ability and the Reading Comprehension Test for their reading comprehension ability. Raw scores from both language and reading measurements were compared to normative data of nor- mal-hearing children to obtain standard scores. The results showed that the mean standard score for receptive vocabulary measurement and the mean T scores for the receptive language, expressive language and total language measurement were all in the low-average range in comparison to the normative sample. In contrast, the mean T scores for word and text reading comprehension were almost the same as for their age-matched hearing counterparts. Among all children with CIs, 75.7% scored within or above the normal range of their age-matched hearing peers on receptive vocabulary measurement. For total language, Chinese word recognition and reading scores, 71.8, 77 and 82% of children with CIs were age appropriate, respectively. A strong correlation was found between language and reading skills. Age at implantation and sentence perception scores account for 37% of variance for total language outcome. Sentence perception scores and preimplantation residual hearing were revealed to be associated with the outcome of reading comprehension. We concluded that by using standard tests, the language development and reading skill of Mandarin-speaking children who use CIs from a young age appear to fall within the normal range of their hearing age mates, at least after 4.8-7.4 years of experience. However, to fully evaluate the fine linguistic skills of these subjects, a more detailed study and longer follow-up period are needed.

Choosing for the child with cochlear implants: a note of precaution

Recent contributions to discussions on paediatric cochlear implantation in Norway indicate two mutually exclusive doctrines prescribing the best course of post-operative support for a child with cochlear implants; bilingually with sign language and spoken language simultaneously or primarily monolingually with speech only. This conflict constitutes an ethical problem for parents responsible for choosing between one of the two alternatives. This article puts forth the precautionary principle as a possible solution to this problem. Although scientific uncertainty exists in the case of both doctrines, there exists a scenario of possible irreversible harm to some of the children habilitated monolingually. An application of the precautionary principle may hence suggest that it is rational to agree on the bilingual approach, at least for the time-being.

Estudo longitudinal da compreensão verbal de crianças usuárias de implante coclear

OBJETIVO: analisar a compreensão verbal de crianças surdas usuárias de implante coclear (IC) por meio de um estudo longitudinal. MÉTODOS: os participantes foram nove crianças surdas usuárias de IC. A idade cronológica das crianças variou entre quatro e oito anos e o tempo de uso do IC foi, em média, 1 ano e 6 meses na 1ª avaliação, 3 anos e 7 meses na 2ª avaliação e 4 anos e 9 meses na 3ª avaliação. As crianças foram avaliadas longitudinalmente por meio da Escala de Compreensão Verbal da RDLS. Os materiais usados foram brinquedos, objetos e figuras. Os dados foram analisados qualitativa e quantitativamente. RESULTADOS: os resultados mostraram que as crianças implantadas obtiveram uma evolução estatisticamente significante em relação às habilidades de linguagem receptiva. CONCLUSÃO: o estudo comprova a efetividade do IC para o desenvolvimento da compreensão verbal.

Phonological awareness, vocabulary, and reading in deaf children with cochlear implants

PURPOSE

To explore the phonological awareness skills of deaf children with cochlear implants (CIs) and relationships with vocabulary and reading development.

METHOD

Forty-three deaf children with implants who were between 5 and 15 years of age were tested; 21 had been implanted at around 2.5 years of age (Early CI group), and 22 had been implanted at around 5 years of age (Late CI group). Two control groups-a deaf hearing aided group (16 children) and a typically developing group of hearing children (19 children)-were also tested. All children received a battery of phonological processing tasks along with measures of reading, vocabulary, and speechreading. Analyses focus on deaf children within the normal IQ range (n = 53).

RESULTS

Age at cochlear implantation had a significant effect on vocabulary and reading outcomes when quotient scores were calculated. Individual differences in age at implant, duration of fit, phonological development, vocabulary development, auditory memory, visual memory, and speech intelligibility were all strongly associated with progress in reading for the deaf implanted children. Patterns differed somewhat depending on whether quotient scores or standard scores were used.

CONCLUSIONS

Cochlear implantation is associated with development of the oral language, auditory memory, and phonological awareness skills necessary for developing efficient word recognition skills. There is a benefit of earlier implantation.

The emergence of cognitive hearing science

Cognitive Hearing Science or Auditory Cognitive Science is an emerging field of interdisciplinary research concerning the interactions between hearing and cognition. It follows a trend over the last half century for interdisciplinary fields to develop, beginning with Neuroscience, then Cognitive Science, then Cognitive Neuroscience, and then Cognitive Vision Science. A common theme is that an interdisciplinary approach is necessary to understand complex human behaviors, to develop technologies incorporating knowledge of these behaviors, and to find solutions for individuals with impairments that undermine typical behaviors. Accordingly, researchers in traditional academic disciplines, such as Psychology, Physiology, Linguistics, Philosophy, Anthropology, and Sociology benefit from collaborations with each other, and with researchers in Computer Science and Engineering working on the design of technologies, and with health professionals working with individuals who have impairments. The factors that triggered the emergence of Cognitive Hearing Science include the maturation of the component disciplines of Hearing Science and Cognitive Science, new opportunities to use complex digital signal-processing to design technologies suited to performance in challenging everyday environments, and increasing social imperatives to help people whose communication problems span hearing and cognition. Cognitive Hearing Science is illustrated in research on three general topics: (1) language processing in challenging listening conditions; (2) use of auditory communication technologies or the visual modality to boost performance; (3) changes in performance with development, aging, and rehabilitative training. Future directions for modeling and the translation of research into practice are suggested.

[Present state of cochlear implant treatment in adults and children]

The technique of cochlear implantation was the first method which allowed replacement of a sense organ by a (partially) implantable electronic prosthesis. By this method the cells of the spiral ganglion of the cochlea are directly stimulated by the electrodes introduced into the cochlea, bypassing the functions of the outer and middle ear as well as the cochlea. Treatment with a cochlear implant (CI) has been established over the last 20-30 years as a reliable method for restoring hearing in adults and children with severe hearing disorders and is now a routine method in many centers. For optimal results in understanding speech and for children in the speech development phase, rehabilitation must be an integral part of the total treatment and follow soon after implantation. To achieve this early diagnosis of hearing difficulties or deafness is necessary, which is simplified by a consistent hearing screening of newborns, now a statutory procedure in Germany.

Long-term follow-up of infants (4-11 months) fitted with cochlear implants

CONCLUSION

In this study the outcomes from several indices (Category of Auditory Performance, CAP; Peabody Picture Vocabulary Test (Revised), PPVT-R; Test of Reception of Grammar, TROG; and Speech Intellegibility Rating, SIR) in three groups of children with different ages at implantation (from 4 to 36 months) with a follow-up time from 4 to 9 years demonstrate that very early cochlear implantation (<11 months) provides normalization of audio-phonologic parameters with no complications.

OBJECTIVES

The aim of the present study was to investigate the efficacy of cochlear implants (CIs) in infants who were implanted at < 11 months of age versus children operated at later age (i.e. 12-36 months) and to document whether children who receive a CI below 11 months of age are able to achieve age-appropriate expected spoken language skills, at a follow-up time from 4 to 9 years.

SUBJECTS AND METHODS

From November 1998 to November 2007, 185 children received CIs and 34 received auditory brainstem implants in our department. The present study focuses on 13 children implanted at ages younger than 12 months (4-11 months; mean, 8.2; SD = 2.4) and fitted with CIs between November 1998 and March 2004. To avoid bias these children were selected from a larger longitudinal cohort of pediatric CI recipients fitted with CIs because they all were implanted with the same cochlear device (Nucleus CI 24 M) during the same period. Postoperatively auditory abilities were evaluated at the latest follow-up, from 4 to 9 years after surgery, with CAP, PPVT-R, TROG, and SIR. The results obtained in this group of 13 children were compared with those obtained in two groups of children implanted at later ages (12-23 and 24-36 months, respectively).

RESULTS

No complication has been observed so far. The highest score of CAP function was achieved in all the three groups but at different intervals from CI activation as function of age at CI implantation. The rate of receptive language growth (PPVT-R) provides distinctive evidence that only the scores of the first group overlap the line of normal-hearing children, whereas the second and third group never reached the values of normal peers even after 9 years of CI use. TROG outcomes clearly indicate that only children from the first group (77%) are in the 76-100 percentile at 5 years follow-up. At 9 years follow-up, 100% of children in the first group, 38% in the second group, and 20% in the third group are in the 76-100 percentile. The SIR outcomes at the 5 years follow-up indicate that none of children was identified within the first two categories, only children from the third group (18%) were identified in category 3, all infants of the first group, 80% of group 2, and 63% of the third group were identified in category 5. At the 9 years follow-up, the number of children from the third group identified in category 3 was reduced to 10%, the second and third groups displayed a slightly higher percentage of children in category 5, but the difference from the values observed at the 5-year follow-up is not significant.

Receptive language outcomes in children after cochlear implantation

OBJECTIVES

The objectives of the present study were (1) to assess receptive language scores in children after cochlear implantation and compare them with scores in normal hearing children and children with hearing loss that use hearing aids and (2) to determine how demographic factors, such as age of implantation, impact language outcomes.

STUDY DESIGN

Case series.

SUBJECTS/METHODS

Receptive language scores in children with profound prelingual hearing loss who received cochlear implants between 1996 and 2004 were analyzed.

RESULTS

Standardized language assessments were available for 36 children. The average age at implantation was 33 months. The mean language scores for implanted children were within 1 standard deviation of scores of normal hearing individuals. Children with cochlear implants had significantly higher subtest scores (P < 0.05) than children with hearing aids. Children with additional disabilities had significantly (P < 0.05) poorer language performance.

CONCLUSIONS

Pediatric cochlear implant recipients acquire receptive language skills that approach those of their hearing peers and exceed those of children with hearing aids.