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Na E, Toupin-April K, Olds J, Chen J, Fitzpatrick EM. Benefits and risks related to cochlear implantation for children with residual hearing: a systematic review. Int J Audiol 2024; 63:75-86. [PMID: 36524877 DOI: 10.1080/14992027.2022.2155879] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 11/24/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Abstract
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.
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Affiliation(s)
- Eunjung Na
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Karine Toupin-April
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Janet Olds
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Jianyong Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Elizabeth M Fitzpatrick
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
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Pignac S, Sygal N, Biglari M, Olds J, Fitzpatrick EM. Determining cochlear implant candidacy in children with residual hearing: A scoping review. Int J Pediatr Otorhinolaryngol 2024; 177:111855. [PMID: 38190764 DOI: 10.1016/j.ijporl.2024.111855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/20/2023] [Accepted: 01/02/2024] [Indexed: 01/10/2024]
Abstract
OBJECTIVES The purpose of this review was to summarize what is known about criteria, assessments, and recommendations for evaluating cochlear implant (CI) candidacy in children with residual hearing. METHODS Peer-reviewed studies were identified through a systematic search in five electronic databases. Articles were screened and assessed for eligibility. From the eligible studies, data were extracted to summarize and present a narrative synthesis of the findings. RESULTS A total of seven articles (two reviews and five primary studies) were included in the final analysis. Hearing levels better than the moderately severe to severe range (65-90 dB HL) tend to be supported as audiological candidacy criteria for pediatric CI. Recommendations for candidacy consideration based on audiologic thresholds range from 65 to 80 dB Hl pure-tone average as the lower boundary. Our review did not identify any specific assessment protocols. However, additional decision-making considerations related to borderline hearing loss configurations and assessment tools (the Speech Intelligibility Index and the Pediatric Minimum Speech Test Battery) were identified. Supplementary assessment considerations were also reported. CONCLUSION There is limited information regarding specific assessment protocols for children with residual hearing. The literature is primarily focused on guidelines related to audiologic criteria, although it is widely recommended that other areas of functioning should also be considered. Most recommendations appear to be based on expert opinion, clinical expertise, and evidence from overall pediatric CI outcomes rather than empirical evidence targeting children with residual hearing. There is an ongoing need for research to further develop protocols and tools that can assist clinicians and families in making cochlear implantation decisions for children with residual hearing.
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Affiliation(s)
- Sarah Pignac
- Faculty of Health Sciences, University of Ottawa, 200 Lees Avenue, Ottawa, Ontario, K1N 6N5, Canada
| | - Ninell Sygal
- Faculty of Health Sciences, University of Ottawa, 200 Lees Avenue, Ottawa, Ontario, K1N 6N5, Canada
| | - Maryam Biglari
- Faculty of Health Sciences, University of Ottawa, 200 Lees Avenue, Ottawa, Ontario, K1N 6N5, Canada
| | - Janet Olds
- Child Hearing Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa, Ontario, K1N 8L1, Canada
| | - Elizabeth M Fitzpatrick
- Faculty of Health Sciences, University of Ottawa, 200 Lees Avenue, Ottawa, Ontario, K1N 6N5, Canada; Child Hearing Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa, Ontario, K1N 8L1, Canada.
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Spitzer ER, Landsberger DM, Lichtl AJ, Waltzman SB. Ceiling effects for speech perception tests in pediatric cochlear implant users. Cochlear Implants Int 2024; 25:69-80. [PMID: 37875157 DOI: 10.1080/14670100.2023.2271219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
OBJECTIVES The purpose of this study was to determine the prevalence of ceiling effects for commonly used speech perception tests in a large population of children who received a cochlear implant (CI) before the age of four. A secondary goal was to determine the demographic factors that were relevant for predicting which children were more likely to reach ceiling level performance. We hypothesize that ceiling effects are highly prevalent for most tests. DESIGN Retrospective chart review of children receiving a CI between 2002 and 2014. RESULTS 165 children were included. Median scores were above ceiling levels (≥90% correct) for the majority of speech perception tests and all distributions of scores were highly skewed. Children who were implanted earlier, received two implants, and were oral communicators were more likely to reach ceiling-level performance. Age and years of CI listening experience at time of test were negatively correlated with performance, suggesting a non-random assignment of tests. Many children were re-tested on tests for which they had already scored at ceiling. CONCLUSIONS Commonly used speech perception tests for children with CIs are prone to ceiling effects and may not accurately reflect how a child performs in everyday listening situations.
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Affiliation(s)
- Emily R Spitzer
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - David M Landsberger
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Alexandra J Lichtl
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Susan B Waltzman
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
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Wiseman KB, McCreery RW, Walker EA. Hearing Thresholds, Speech Recognition, and Audibility as Indicators for Modifying Intervention in Children With Hearing Aids. Ear Hear 2023; 44:787-802. [PMID: 36627755 PMCID: PMC10271969 DOI: 10.1097/aud.0000000000001328] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES The purpose of this study was to determine if traditional audiologic measures (e.g., pure-tone average, speech recognition) and audibility-based measures predict risk for spoken language delay in children who are hard of hearing (CHH) who use hearing aids (HAs). Audibility-based measures included the Speech Intelligibility Index (SII), HA use, and auditory dosage, a measure of auditory access that weighs each child's unaided and aided audibility by the average hours of HA use per day. The authors also sought to estimate values of these measures at which CHH would be at greater risk for delayed outcomes compared with a group of children with typical hearing (CTH) matched for age and socioeconomic status, potentially signaling a need to make changes to a child's hearing technology or intervention plan. DESIGN The authors compared spoken language outcomes of 182 CHH and 78 CTH and evaluated relationships between language and audiologic measures (e.g., aided SII) in CHH using generalized additive models. They used these models to identify values associated with falling below CTH (by > 1.5 SDs from the mean) on language assessments, putting CHH at risk for language delay. RESULTS Risk for language delay was associated with aided speech recognition in noise performance (<59% phonemes correct, 95% confidence interval [55%, 62%]), aided Speech Intelligibility Index (SII < 0.61, 95% confidence internal [.53,.68]), and auditory dosage (dosage < 6.0, 95% confidence internal [5.3, 6.7]) in CHH. The level of speech recognition in quiet, unaided pure-tone average, and unaided SII that placed children at risk for language delay could not be determined due to imprecise estimates with broad confidence intervals. CONCLUSIONS Results support using aided SII, aided speech recognition in noise measures, and auditory dosage as tools to facilitate clinical decision-making, such as deciding whether changes to a child's hearing technology are warranted. Values identified in this article can complement other metrics (e.g., unaided hearing thresholds, aided speech recognition testing, language assessment) when considering changes to intervention, such as adding language supports, making HA adjustments, or referring for cochlear implant candidacy evaluation.
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Affiliation(s)
| | | | - Elizabeth A. Walker
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA
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Na E, Toupin-April K, Olds J, Noll D, Fitzpatrick EM. Cochlear Implant Decision Making for Children With Residual Hearing: Perspectives of Practitioners. Am J Audiol 2023:1-13. [PMID: 36989158 DOI: 10.1044/2023_aja-22-00091] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
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.
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Affiliation(s)
- Eunjung Na
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Karine Toupin-April
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Janet Olds
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Dorie Noll
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Elizabeth M Fitzpatrick
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, University of Ottawa, Ontario, Canada
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Brown C, Gifford RH. Expansion of Audiologic Criteria for Pediatric Cochlear Implantation. Otolaryngol Clin North Am 2021; 54:1181-1191. [PMID: 34774230 DOI: 10.1016/j.otc.2021.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In 2020, the lower age limit for pediatric cochlear implant candidacy was lowered from 12 to 9 months of age. However, audiometric-based criteria for pediatric cochlear implant candidacy have remained unchanged for more than 20 years, requiring bilateral profound sensorineural hearing loss for children less than 2 years and bilateral severe-to-profound sensorineural hearing loss for children 2 years and older. Despite the static audiometric criteria, there is an increasing literature base demonstrating significant benefits for pediatric cochlear implant recipients who exceed current Food and Drug Administration-labeled indications for cochlear implantation.
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Affiliation(s)
- Christine Brown
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, 1215 21st Avenue South, 9302 MCE South Tower, Nashville, TN 37232, USA
| | - René H Gifford
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, 1215 21st Avenue South, 9302 MCE South Tower, Nashville, TN 37232, USA.
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