Criteria versus guidelines: Are we doing the best for our paediatric patients?

Benefits and risks related to cochlear implantation for children with residual hearing: a systematic review

OBJECTIVE

This study aimed to synthesise information concerning the potential benefits and risks related to cochlear implants (CIs) versus hearing aids (HAs) in children with residual hearing.

DESIGN

A systematic review of articles published from January 2003 to January 2019 was conducted.

STUDY SAMPLE

Our review included studies that compared the benefits and risks of CIs versus HAs in children (≤18 years old) with residual hearing. A total of 3265 citations were identified; 8 studies met inclusion criteria.

RESULTS

Children with CIs showed significantly better speech perception scores post-CI than pre-CI. There was limited evidence related to improvement in everyday auditory performance, and the results showed non-significant improvement in speech intelligibility. One study on social-emotional functioning suggested benefits from CIs. In four studies, 37.2% (16/43) of children showed loss of residual hearing and 14.0% (8/57) had discontinued or limited use of their device.

CONCLUSIONS

Children with CIs showed improvement in speech perception outcomes compared to those with HAs. However, due to the limited number of studies and information to guide decision-making related to other areas of development, it will be important to conduct further research of both benefits and risks of CIs in this specific population to facilitate decision-making.

Cochlear Implant Decision Making for Children With Residual Hearing: Perspectives of Practitioners

PURPOSE

Cochlear implants (CIs) are increasingly considered for children with residual hearing who benefit from hearing aids (HAs). However, the decision-making process for families of these children and for practitioners is particularly challenging because there is no clear audiological cut point for CI candidacy. This study aimed to understand Canadian practitioners' perspectives of the CI decision-making process and how they guide families of children with residual hearing.

METHOD

Semistructured interviews were conducted with a total of 17 practitioners through four focus groups and one individual interview. Interviews were transcribed verbatim, and a thematic analysis was carried out.

RESULTS

Data were organized into five broad domains: candidacy issues for children with residual hearing, practitioners' roles in decision support, additional considerations affecting decision making, factors facilitating decision making, and practitioners' needs.

CONCLUSIONS

This study found that practitioners' confidence in determining candidacy and supporting parents has increased due to their experiences with positive outcomes for these children. Practitioners indicated that there was a need for more research to guide the decision-making process.

A Modelling Study on the Comparison of Predicted Auditory Nerve Firing Rates for the Personalized Indication of Cochlear Implantation

The decision of whether to perform cochlear implantation is crucial because implantation cannot be reversed without harm. The aim of the study was to compare model-predicted time–place representations of auditory nerve (AN) firing rates for normal hearing and impaired hearing with a view towards personalized indication of cochlear implantation. AN firing rates of 1024 virtual subjects with a wide variety of different types and degrees of hearing impairment were predicted. A normal hearing reference was compared to four hearing prosthesis options, which were unaided hearing, sole acoustic amplification, sole electrical stimulation, and a combination of the latter two. The comparisons and the fitting of the prostheses were based on a ‘loss of action potentials’ (LAP) score. Single-parameter threshold analysis suggested that cochlear implantation is indicated when more than approximately two-thirds of the inner hair cells (IHCs) are damaged. Second, cochlear implantation is also indicated when more than an average of approximately 12 synapses per IHC are damaged due to cochlear synaptopathy (CS). Cochlear gain loss (CGL) appeared to shift these thresholds only slightly. Finally, a support vector machine predicted the indication of a cochlear implantation from hearing loss parameters with a 10-fold cross-validated accuracy of 99.2%.

Communication Skills and Communicative Autonomy of Prelinguistic Deaf and Hard-of-Hearing Children: Application of a Video Feedback Intervention

Background and Aim

Evidence on the efficacy of parenting interventions to support communication development in deaf and hard-of-hearing children is emerging. In previous research, we showed that parental participation in a video feedback-based intervention enhanced parental self-esteem and emotional availability to their deaf and hard-of-hearing children. This paper investigates the impact of the intervention on the development of the children's prelingual communication skills and autonomy. Evidence on the efficacy of parenting interventions to support communication development is warranted.

Methods

Sixteen hearing parents with a prelingual deaf and hard-of-hearing child (Mage = 2.05 years, SD = 1.77) were recruited by self-selection from pediatric audiological services and randomly stratified into intervention-first and waiting-list groups. Families completed three sessions of Video Interaction Guidance in their homes. Designed for maximal inclusion, the sample comprised children with complex developmental and social needs. The primary inclusion criterion was the child's prelingual status (<50 signed/spoken words), which was established using speech and language therapy reports. Child communicative autonomy was assessed from a 20 min free-play video recording using a gold standard measure for deaf and hard-of-hearing children (Tait) before and after the intervention.

Results

A Mann-Whitney U test indicated no significant difference between the two groups. The groups were collated, and a Wilcoxon signed-rank test with time (pre-/post-intervention) as a repeating variable was run. A significant increase in children's communicative autonomy (Z = -3.517, p < 0.0001, d = 0.62) and decrease in children's no-responses (Z = -3.111, p < 0.005, d = 0.55) were seen. There was no significant difference in the overall number of turn-taking between the parent and child, indicating differences in the quality of the parent-child interactions, not the quantity.

Conclusion

This study adds to the emerging evidence for parenting interventions with deaf and hard-of-hearing children. We hypothesize that the video feedback intervention with its focus on emotional availability created space for the children to show increased communicative autonomy during parent-child interactions. Communicative autonomy is a long-term predictor of communication and linguistic development in deaf and hard-of-hearing children, and its conceptual underpinning makes it a good early measure of relational agency. Results can inform wider interventions that focus on the quantity of the parent-child communication.

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

Objectives

This study aimed to assess the effect of hearing and speech rehabilitation in patients with Nurotron^® cochlear implants.

Design

Ninety-eight paediatric patients with bilateral severe-to-profound sensorineural deafness who received cochlear implantation were divided into three groups according to age: group A (≤3 years), group B (4–7 years), and group C (8–16 years). All patients were followed up for one year for hearing and speech performance after the surgery. The comprehensive Auditory Perception Assessment, MAIS, CAP and SIR hearing and speech assessments and rating materials were used for assessment before the surgery and at 3, 6, and 12 months after implant activation.

Results

The scores of patients in the open-set speech assessment, Chinese Auditory Perception Assessment, MAIS, CAP and SIR significantly improved after cochlear implantation in all age groups. The younger the age at implantation, the better the results. Moreover, the hearing and speech performance of cochlear implant recipients gradually improved with the extension of rehabilitation time.

Conclusions

Nurotron^® Venus™ cochlear implantation can improve the hearing and speech performance of patients with bilateral severe-to-profound sensorineural deafness.