Programming characteristics of cochlear implants in children: effects of aetiology and age at implantation

A new objective method to estimate the charge integration efficiency in cochlear implant users

OBJECTIVE

The present study aimed to objectively assess the charge integration efficiency (CIE) of the auditory nerve using electrically-evoked stapedial reflex threshold (eSRT) measurements in paediatric cochlear implant users.

DESIGN

The eSRT was estimated in two ways: by keeping pulse width constant while increasing pulse amplitude and vice versa. The electrical dynamic range (EDR) obtained for eSRT was measured with increasing pulse amplitude (EDRPA) and pulse width (EDRPW) by calculating the difference in charge units between eSRT and behavioural thresholds; further, CIE was estimated.

STUDY SAMPLE

Fifteen paediatric cochlear implant users.

RESULTS

EDRPW was 1.4 to 1.7 times larger than EDRPA. The EDRPW was significantly greater than the EDRPA. A significant correlation was observed between both EDR measures. However, the CIE measure did not significantly correlate with the behavioural threshold. Further, there was no significant effect of electrode location on the CIE.

CONCLUSIONS

The CIE estimated with objective measures such as eSRT is comparable to those estimated using behavioural loudness judgments. eSRT can serve as a quick method to estimate the CIE, which can be easily implemented in the paediatric population. The CIE could be a valuable tool for differentiating electrodes with excellent and poor charge integration efficiency.

Significant influence of prelingual deafness but less impact of elderly age at implantation on long-term psychoacoustic CI programming parameters

OBJECTIVE

This study aimed to elucidate the long-term impact of prelingual deafness and elderly age at cochlear implantation on cochlear implant (CI) programming parameters and CI thresholds METHODS: We retrospectively reviewed patients who underwent cochlear implantation less than 5 years (Prelingual group) and equal and more than 18 years in our institute. The latter group was further divided into Adult and Elderly groups according to whether the patient was younger or older than 65 at implantation. From 152, 69, and 55 patients in the Prelingual, Adult, and Elderly groups, 242, 92, and 58 ears were included. We compared CI thresholds and CI programming parameters, including impedances, T/C levels, and dynamic ranges for 8 years after implantation between the Prelingual, Adult, and Elderly groups.

RESULTS

The Prelingual group showed consistently lower CI thresholds than the Adult and Elderly groups during the postoperative 2-8 years, but no difference was detected between the Elderly and Adult groups, except at the postoperative 4 years. The elderly group's CI thresholds did not deteriorate until postoperative 8 years. The Prelingual group showed consistently larger T/C levels (minimum/maximum current strength from CI), especially C levels, than the other two groups. At the same time, there was no significant difference between the Elderly and Adult groups except for smaller dynamic ranges in the Elderly group until postoperative 2 years. These results in the CI programming parameters might explain the lower CI thresholds in the Prelingual group than in the other groups. Focusing on CI maps 1 and 3 years after implantation, the strength of the T/C levels was similar for all channels in the Prelingual group, but the Adult and Elderly groups showed larger electrical stimuli in channels responsible for the middle frequencies than those for the lower or higher frequencies.

CONCLUSIONS

Our results suggest a significant influence of prelingual deafness but less impact of elderly age at implantation on long-term CI programming parameters and CI thresholds. The larger C levels and lower CI thresholds in the Prelingual group than in the Adult and Elderly groups implied that CI children with prelingual deafness tolerate and prefer larger CI stimuli, which may reflect the CI-dependent development of their auditory system before the critical period. No age-related reduction in hearing thresholds was observed in the Elderly group, probably because the CI compensates for age-related dysfunction of the peripheral auditory system.

Development of Custom Sound® Pro software utilising big data and its clinical evaluation

OBJECTIVES

To inform and optimise a cochlear implant (CI) fitting software design through an analysis of big data to define array-specific comfort (C) level profiles, frequently-used MAP parameters, and the minimum number of Neural Response Telemetry thresholds (tNRT) needed to create an accurate profile. To evaluate the software's ease of use and completion time for AutoNRT®s.

DESIGN

MAPs analysis. Clinical study evaluating software use in creating MAPs, addressing sound-quality issues and setting patient goals.

STUDY SAMPLE

MAPs (N = 39,885); CI recipients (N = 47) and clinicians (N = 19).

RESULTS

Distinct C-level profiles were observed for lateral-wall, contour, and slim-modiolar electrode arrays. Default settings were used for most MAP parameters (13/16) except for Pulse Width, Rate, and Maxima. Nine tNRT measurements were required for an accurate C-level profile. Measurement-time of nine tNRTs via the new algorithm was comparable to five tNRTs using the previous algorithm. Nearly all (99%) clinical tasks were completed by clinicians with the first use of the software. Most CI recipients (79.5%) rated goal-setting as valuable.

CONCLUSION

Custom Sound Pro fitting software developed based on big data analysis incorporates a guided fitting workflow and expected fitting ranges. It helps to improve clinical efficiency, is easy to use and supports patient-centred care.

Cochlear Implantation and Educational and Quality-of-Life Outcomes in Adolescence

Importance

Cochlear implants (CIs) have been shown to be effective in improving auditory skills and speech and language development. However, less is known about the long-term outcomes of CIs on educational functioning or quality of life.

Objective

To evaluate long-term educational outcomes and quality of life in adolescents over 13 years postimplantation.

Design, Setting, and Participants

This longitudinal cohort study included 188 children with bilateral severe to profound hearing loss with CIs from the Childhood Development After Cochlear Implantation (CDaCI) study from hospital-based CI programs; a cohort of 340 children with severe to profound hearing loss without CIs from a nationally representative survey (National Longitudinal Transition Study-2; NLTS-2), and results from the literature of comparable children without CIs.

Exposure(s)

Cochlear implantation (early and late).

Main Outcomes and Measures

Adolescent performance on measures of academic achievement (Woodcock Johnson), language (Comprehensive Assessment of Spoken Language), and quality of life (Pediatric Quality of Life Inventory, Youth Quality of Life Instrument-Deaf and Hard of Hearing).

Results

The CDaCI cohort included 188 children, 136 of whom completed the wave 3 postimplantation follow-up visits (77 [55%] female) with CIs; mean [SD] age was 11.47 [1.27] years. The NLTS-2 cohort included 340 children (50% female) with severe to profound hearing loss without CIs. Children with CIs had better academic performance compared with children without CIs with similar levels of hearing loss. The largest benefits were seen for children who received implants early (prior to age 18 months), who performed at or above age and gender norms for language and academic achievement. Similarly, adolescents with CIs reported better quality of life on the Pediatric Quality of Life Inventory compared with children without CIs. On a condition-specific measure (Youth Quality of Life Instrument-Deaf and Hard of Hearing), children who received implants early scored higher across all 3 domains than comparisons without CIs.

Conclusions and Relevance

To our knowledge, this is the first study to evaluate long-term educational outcomes and quality of life in adolescents using CIs. This longitudinal cohort study showed better outcomes of CIs in terms of language, academic performance, and quality of life. While the greatest benefits were observed for children who received implants before age 18 months, benefits were also noted for children who received implants later, providing evidence that children with severe to profound hearing loss with CIs can achieve at or above expected levels compared with hearing peers.

Comparisons of electrophysiological and psychophysical fitting methods for cochlear implants

OBJECTIVE

This study compared two different versions of an electrophysiology-based software-guided cochlear implant fitting method with a procedure employing standard clinical software. The two versions used electrically evoked compound action potential (ECAP) thresholds for either five or all twenty-two electrodes to determine sound processor stimulation level profiles. Objective and subjective performance results were compared between software-guided and clinical fittings.

DESIGN

Prospective, double-blind, single-subject repeated-measures with permuted ABCA sequences.

STUDY SAMPLE

48 post linguistically deafened adults with ≤15 years of severe-to-profound deafness who were newly unilaterally implanted with a Nucleus device.

RESULTS

Speech recognition in noise and quiet was not significantly different between software- guided and standard methods, but there was a visit/learning-effect. However, the 5-electrode method gave scores on the SSQ speech subscale 0.5 points lower than the standard method. Clinicians judged usability for all methods as acceptable, as did subjects for comfort. Analysis of stimulation levels and ECAP thresholds suggested that the 5-electrode method could be refined.

CONCLUSIONS

Speech recognition was not inferior using either version of the electrophysiology-based software-guided fitting method compared with the standard method. Subject-reported speech perception was slightly inferior with the five-electrode method. Software-guided methods saved about 10 min of clinician's time versus standard fittings.

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.

Prospective Comparison Between Manual and Computer-Assisted (FOX) Cochlear Implant Fitting in Newly Implanted Patients

OBJECTIVE

A prospective, longitudinal, randomized controlled trial with an original crossover design for 1 year was conducted to compare manual fitting to artificial intelligence-based fitting in newly implanted patients.

DESIGN

Twenty-four patients who received their first cochlear implant (CI) were randomly assigned to the manual or Fitting to Outcome eXpert (FOX) arm; they followed the corresponding fitting procedures for 1 year. After 1 year, each patient was switched to another arm. The number of fittings, auditory outcomes (pure-tone thresholds, loudness scaling curves, spectral discrimination scores, bisyllabic word recognition in quiet and noise, and speech tracking), fitting session questionnaire, and CI parameters (T level, C level, Threshold Sound Pressure Level (T-SPL), Comfortable Sound Pressure Level (C-SPL), and loudness growth value) were compared between the two groups. Differences between the two groups were analyzed using the Mann-Whitney test, and Holm corrections were applied for multiple statistical tests. At the end of the crossover session, patients were offered the choice to continue with their old or new map.

RESULTS

As early as 3 mo postactivation, the FOX group showed less variability and significantly better speech intelligibility in quiet conditions at 40 and 55 dB SPL and noise ( p < 0.05) with median phoneme scores of 50%, 70%, and 50% at 55, 70, and 85 dB SPL compared with 45%, 50%, and 40%, respectively. This group showed better results at 12 mo postactivation ( p < 0.05). In the manual group, 100% of the patients decided to keep the new FOX map, and 82% performed better with the FOX map. In the FOX group, 63% of the patients decided to keep the manual map, although the measurable outcome had not improved. In this group, participants reported to prefer the manual map because it felt more comfortable, even if the FOX map gave better measured outcome.

CONCLUSION

Although the study size remains relatively small, the AI-FOX approach was equivalent to or even outperformed the manual approach in hearing performance, comfort, and resources. Furthermore, FOX is a tool capable of continuous improvement by comparing its predictions with observed results and is continuously learning from clinicians' practice, which is why this technology promises major advances in the future.

Cochlear implant outcomes in patients with Meniere's disease: a large case series

OBJECTIVE

To perform a matched cohort study to assess whether patients with Meniere's Disease (MD) require more intensive auditory rehabilitation following cochlear implantation (CI) and identify factors that may affect outcomes in patients with MD.

METHODS

A retrospective case review was performed. MD and control patients were matched for age, biological sex, implant manufacturer and electrode design. Outcomes measured were speech scores, number of visits to audiology department following switch-on, and post-operative active MD.

RESULTS

Forty consecutive implanted MD patients were identified between May 1993 and May 2019. Patients with active MD following CI required significantly more visits to the audiology department compared to controls (P &lt; 0.01) and patients who had inactive MD post-operatively (P &lt; 0.01). However, in MD patients, active MD was less likely following CI (P = 0.03). In patients who continued to experience active MD post-operatively, further medical and surgical ablative intervention was required to control ongoing Meniere's attacks.

CONCLUSION

We present the largest case series of performance outcomes in CI patients with MD. Although speech outcomes in MD patients are comparable to controls, patients with active MD pre-operatively are more likely to experience variation in CI performance requiring a prolonged period of auditory rehabilitation compared to inactive preoperative MD.

Precision Medicine Approach to Cochlear Implantation

In the early days of cochlear implantation (CI) surgery, when the types of electrodes were limited and the etiology of sensorineural hearing loss (SNHL) was not well understood, the one-size-fits-all approach to CI held true, as in all other fields. However, in the era of personalized medicine, there have been attempts to associate CI performance with the etiology of SNHL and to establish customized surgical techniques that can maximize performance according to individual cochlear dimensions. Personalized genomic-driven assessments of CI candidates and a better understanding of genotype-phenotype correlations could provide clinically applicable diagnostic and prognostic information about questions such as who, how, and when to implant. Rigorous and strategic imaging assessments also provide better insights into the anatomic etiology of SNHL and cochlear dimensions, leading to individualized surgical techniques to augment CI outcomes. Furthermore, the precision medicine approach to CI is not necessarily limited to preoperative planning, but can be extended to either intraoperative electrode positioning or even the timing of the initial switch-on. In this review, we discuss the implications of personalized diagnoses (both genetic and nongenetic) on the planning and performance of CI in patients with prelingual and postlingual SNHL.

New approach in programming sequentially implanted children: Towards balanced dynamic ranges (DR)

There is a tendency for children undergoing sequential cochlear implant after a long period of unilateral implant use to have a smaller dynamic range in their second implant compared to their first implant. This study aimed to investigate if balancing the dynamic ranges between the two implants influenced functional outcomes in sequentially implanted children. Nineteen participants with long inter-implant time delays were randomly assigned to a study group or a control group. Children in the study group received progressive minimal changes to both first and second implants over a period of nine months to achieve balanced dynamic ranges, while the children in the control group received only changes to their sequential implant. Functional outcomes were collected 24-months after sequential implantation and consisted of speech discrimination scores, spatial localisation, device use and quality of life measures. Results show that spatial discrimination skills improved over time for both groups of children; however children in the study group had smaller localisation errors compared with the children in the control group. No other differences between the two groups were observed. Balanced dynamic ranges in sequentially implanted children can contribute to better performance, particularly in spatial discrimination tasks that rely in inter-aural level differences.

Cochlear implantation in children with Autism Spectrum Disorder (ASD): Outcomes and implant fitting characteristics

BACKGROUND

Little is known regarding fitting parameters and receptive and expressive language development in cochlear-implanted children (CCI) with profound sensorineural hearing loss (SHL) who are diagnosed with Autism Spectrum Disorder (ASD). The aim of the study was to evaluate a group of ASD CCI users in order to describe their ASD clinical features and CCI outcomes; report on the average electrical charge requirements; and evaluate the possible correlations between electrical and psychophysical outcomes with ASD characteristics.

MATERIALS AND METHODS

A multicentre observational study of 22 ASD children implanted in four cochlear implant (CI) centers. Data concerning profound SHL diagnosis, ASD diagnosis, CI timing and CI compliance were collected. Sound Field (SF) was assessed through repeated behavioural measurements. Categories of Auditory Perception (CAP) and Categories of Language (CL) were used to evaluate speech perception and language skills at short (≤2 yrs), medium (5 yrs) and long term (>10 yrs) follow-up. Fitting parameters such as comfortable thresholds, pulse-width (pw, μsec) and clinical units converted into units of charge/phase were collected. The diagnosis of ASD was acquired by the referral neuropsychiatric department and severity was assessed through the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) and the Childhood Autism Rating Scale (CARS).

RESULTS

At the final follow-up session the median SF threshold for CI outcomes was 30 dB HL (min 15 - max 60). CAP score was extremely variable: 45.5% showed no improvement over time and only 22% of children reached CAP scores of 5-7. CL 45.5% showed no improvement over time and score was 1-2 in the majority of ASD children (72.7%), while only 18.2% reached the highest level of language skills. There were no statistically significant differences at each follow-up between subjects with or without comorbidities. CAP and CL were inversely correlated with DSM-V A and B domains, corresponding to lower speech and language scores in children with more severe ASD symptoms, and maintained their correlation at mid and long follow-ups whilst controlling for age at CI. Electrical charge requirements did not correlate with SF or age at implant but did inversely correlate with ASD severity. With regards to CI compliance: only 13.6% children (3) with severe DSM-V A/B levels and CARS score were partial/intermittent users.

CONCLUSION

The present study is a targeted contribution to the current literature to support clinical procedures for CI fitting and audiological follow-up in children with ASD. The findings indicate that the outcomes of CI use and the fitting procedures are both influenced by the severity of the ASD symptoms rather than the demographic variables or associated disorders.

Remote check test battery for cochlear implant recipients: proof of concept study

OBJECTIVES

(1) To investigate the remote check test battery, designed for self-administration by cochlear implant (CI) recipients, parents/caregivers, to determine if the results give adequate information for clinicians to decide the necessity of an appointment and to capture suggestions for improvement. (2) To gauge acceptance of remote monitoring by CI-recipients and their parents/caregivers.

DESIGN

Prospective, multicentre, un-blinded, non-randomized, single-subject, repeated-measures evaluation. The test battery includes an implant-site photograph, impedance measurements, datalogs, questionnaires, speech perception and aided threshold tests. Clinicians reviewed test battery results, followed by a clinical appointment with each CI-recipient, and reported if the battery identified all the issues. Study sample: n = 93 CI-recipients (73 adults, 20 children) and 28 clinicians.

RESULTS

The test battery identified 94% (615/656) of all issues. The test battery and clinician observations agreed in 99% (92/93) of cases on the need for a clinic visit. For 68% (63/93) of cases, the test battery identified all clinician observed issues. The majority (77%, 72/93) of recipients would be satisfied if clinic visits were based on their test battery results. A significantly high proportion agreed that remote monitoring was more convenient than clinic visits and could result in travel, time and cost reductions.

CONCLUSION

This is the first comprehensive test battery designed for CI-recipient remote monitoring.

Effect of Age at Cochlear Implantation in Educational Placement and Peer Relationships

OBJECTIVES

The education and school life of children who have undergone cochlear implantation (CI) is very important and should be monitored continuously. This study assessed auditory performance in children with cochlear implants over time, along with educational placement and peer relationship, and compared the results based on the age at CI and the presence of additional disabilities.

DESIGN

In total, 77 children who had undergone CI at the Hearing Center in Ajou University Hospital at less than 10 years old and who were presently attending school or had already graduated from school within 3 years were enrolled in this study. All children had congenital bilateral severe or profound hearing loss at the diagnosis. They were classified based on the age at which they received CI: the "early-implanted group," younger than 3.5 years (n = 38), and the "late-implanted group," between 3.5 and 10 years old (n = 39).

RESULTS

The early-implanted group had worse short-term auditory performance than the late group, but after 2 years of the implant use, auditory performance was similar in both groups. The early and late groups did not differ significantly in terms of the proportions of children who were enrolled in a regular school (94.7% and 89.7%, respectively). However, the early-implanted group had a larger proportion of children who were enrolled in a regular school without additional needs (73.0%), compared with the late group (48.6%) (p = .034). Children with multiple disabilities showed poorer performance (word score of 57.7% and sentence score of 44.7%) than children with hearing disability only (91.8% and 87.2%, respectively), which affected full-time enrollment in regular schools. With regard to peer relationships, 19.0% of children in the early-implanted group required close observation and assistance, and 9.5% even required help and counseling. Children who underwent early CI had a high tendency toward social restraint, apathy, and over-commitment. No correlations were observed between audiological factors and the aspects of peer relationships assessed in this study.

CONCLUSIONS

Early CI and the absence of other disabilities were the two main factors that increased the likelihood of full-time enrollment in mainstream classes at regular schools. Nevertheless, many children who underwent earlier CI still encountered difficulties in peer relationships.

Cochlear Implantation in NF2 Patients Without Intracochlear Schwannoma Removal

OBJECTIVE

To determine if cochlear implantation without removal of inner ear schwannomas (IES) is an effective treatment option for Neurofibromatosis 2 (NF2) patients. To determine how the presence of an intracochlear schwannoma might impact cochlear implant (CI) outcomes and programming parameters.

STUDY DESIGN

Retrospective chart review.

SETTING

Tertiary center for cochlear and auditory brainstem implantation.

PATIENTS

Of 10 NF2 patients with IES, 8 are reported with no previous tumor removal on the implanted ear.

INTERVENTIONS

Cochlear implant without tumor removal.

MAIN OUTCOME MEASURES

Performance outcomes with CI at least 1-year post intervention. Programming parameters, including impedances, for patients with IES.

RESULTS

All patients had full insertion of the electrode arrays with round window approaches. Performance outcomes ranged from 0 to 100% for Bamford-Kowal-Bench sentences. Impedance measurements for active electrodes for patients with IES were comparable to those measured in patients without vestibular schwannoma (VS). Only patients who had radiation treatment before receiving their implant had elevated threshold requirements for CI programming compared with CI recipients without VS.

CONCLUSION

Cochlear implantation without tumor removal is an effective option for treating NF2 patients with IES. The presence of an intracochlear tumor did not have an impact on CI performance or programming requirements compared with patients without VS; however, previous treatment with radiation may be related to elevated current requirements in the CI settings.

Hearing and speech benefits of cochlear implantation in children: A review of the literature

Cochlear implantation is a safe and reliable treatment for children with severe to profound hearing loss. The primary benefit of these medical devices in children is the acquisition of hearing, which promotes development of spoken language. The present paper reviews published literature demonstrating predictive effects of a number of factors on acquisition of hearing development and speech recognition. Of the many variables that contribute to an individual child's development after implantation, age at implantation, the presence of medical comorbidities, social determinants of health, and the provision of bilateral versus unilateral hearing are those that can vary widely and have consistently shown clear impacts. Specifically, age of implantation is crucial to reduce effects of deafness on the developing auditory system and capture the remarkable plasticity of early development. Language development after cochlear implantation requires therapy emphasizing hearing and oral communication, education, and other support which can be influenced by known social determinants of health; specifically, outcomes in children decline with reductions in socioeconomic status and levels of parental education. Medical co-morbidities also slow rates of progress after cochlear implantation. On the other hand, benefits of implantation increase in children who are provided with access to hearing from both ears. In sum, cochlear implants promote development of hearing in children and the best outcomes are achieved by providing early access to sound in both ears. These benefits can be limited by known social determinants of health which restrict access to needed support and medical comorbidities which add further complexity in care and outcome.

Auditory Detection Thresholds and Cochlear Resistivity Differ Between Pediatric Cochlear Implant Listeners With Enlarged Vestibular Aqueduct and Those With Connexin-26 Mutations

Purpose The goal of this study was to evaluate differences in the electrode-neuron interface as a function of hearing loss etiology in pediatric cochlear implant (CI) listeners with enlarged vestibular aqueduct (EVA) syndrome and in those with autosomal recessive connexin-26 mutations (DFNB1). Method Fifteen implanted ears (9 participants, 5 ears with EVA, 10 ears with DFNB1) were assessed. Single-channel auditory detection thresholds were measured using broad and spatially focused electrode configurations (steered quadrupolar; focusing coefficients = 0 and 0.9). Cochlear resistivity estimates were obtained via electrode impedances and electrical field imaging. Between-group differences were evaluated using linear mixed-effects models. Results Children with EVA had significantly higher auditory detection thresholds than children with DFNB1, irrespective of electrode configuration. Between-group differences in thresholds were more pronounced on apical electrodes than on basal electrodes. In the apex, electrode impedances and electrical field imaging values were higher for children with EVA than for those with DFNB1. Conclusions The electrode-neuron interface differs between pediatric CI listeners with DFNB1 and those with EVA. It is possible that optimal clinical interventions may depend, in part, on hearing loss etiology. Future investigations with large samples should investigate individualized CI programming strategies for listeners with EVA and DFNB1.

Educational Status in Bilateral Prelingual Deaf Children with Cochlear Implantation

Background and Objectives

This study was undertaken to investigate the educational status in bilateral prelingual deaf children with a cochlear implant (CI), also known as early cochlear implantees (CIs). Type of schooling and enrollment rate of tertiary education were analyzed as primary results.

Subjects and Methods

Participants in this study comprised a highly homogeneous group of deaf patients who underwent cochlear implantation at a similar age. Sixty-four Korean patients were enrolled. Statistical data for disabled populations and the general population were obtained from the National Statistics Korea.

Results

Among 64 patients, 46, 8, and 10 attended mainstream, integrated, and special schools, respectively. Notably, there was a significant difference in the type of school between hearing-impaired and CI groups (p=0.007). Ten of 13 patients enrolled in tertiary education.

Conclusions

CI users were more likely than hearing impaired students to attend mainstream school. The enrollment rate of CI users in tertiary education was the same as that of the general population.

Learning from the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study: summary of 5-year findings and implications

OBJECTIVE

This article summarises findings of the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study, and discusses implications of the findings for research and clinical practice.

DESIGN

A population-based study on outcomes of children with hearing loss. Evaluations were conducted at five years of age.

STUDY SAMPLE

Participants were 470 children born with hearing loss between 2002 and 2007 in New South Wales, Victoria and Queensland in Australia, and who first received amplification or cochlear implantation by three years of age.

RESULTS

The earlier hearing aids or cochlear implants were fitted, the better the speech, language and functional performance outcomes. Better speech perception was also associated with better language and higher cognitive abilities. Better psychosocial development was associated with better language and functional performance. Higher maternal education level was also associated with better outcomes. Qualitative analyses of parental perspectives revealed the multiple facets of their involvement in intervention.

CONCLUSIONS

The LOCHI study has shown that early fitting of hearing devices is key to achieving better speech, language and functional performance outcomes for children with hearing loss. The findings are discussed in relation to changes in clinical practice and directions for future research.