Pediatric Cochlear Implant Patient Performance as a Function of Age at Implantation

Ceiling effects for speech perception tests in pediatric cochlear implant users

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.

Quality Standard for Rehabilitation of Young Deaf Children Receiving Cochlear Implants

Background and objectives: More and more children with severe-to-profound hearing loss are receiving cochlear implants (CIs) at an early age to improve their hearing and listening abilities, speech recognition, speech intelligibility, and other aspects of spoken language development. Despite this, the rehabilitation outcomes can be very heterogeneous in this population, not only because of issues related to surgery and fitting or the specific characteristics of the child with his/her additional disabilities but also because of huge differences in the quality of the support and rehabilitation offered by the therapist and the family. These quality standards for the rehabilitation of young deaf children receiving CIs are developed within the European KA202 Erasmus+ project "VOICE"-vocational education and training for speech and language therapists and parents for the rehabilitation of children with CIs, Ref. No.: 2020-1-RO01-KA202-080059. Material and methods: To develop these quality standards, we used the input from the face-to-face interviews of 11 local rehabilitation experts in CIs from the four partner countries of the project and the outcomes of the bibliographic analysis of 848 publications retrieved from six databases: Pub Med, Psych Info, CINAHL, Scopus, Eric, and Cochrane. Based on all this information, we created a first set of 32 quality standards over four domains: general, fitting, rehabilitation, and for professionals. Further on, the Delphi method was used by 18 international rehabilitation experts to discuss and agree on these standards. Results: The results from the literature analysis and the interviews show us that more than 90% of the consulted international experts agreed on 29 quality standards. They focus on different aspects of rehabilitation: the multidisciplinary team, their expertise and knowledge, important rehabilitation topics to focus on, and programming issues related to rehabilitation. Conclusions: These quality standards aim to optimize the activity of speech rehabilitation specialists so that they reach the optimal level of expertise. Also presented is the necessary equipment for the IC team to carry out the rehabilitation sessions in good conditions. This set of quality standards can be useful to ensure the appropriate postoperative care of these children. As a result, the rehabilitation process will be more relaxed, and therapists will have the opportunity to focus more on the specific needs of each child, with the provision of quality services, which will result in better results. This theme is particularly complex and dependent on multifactorial aspects of medicine, education, speech therapy, social work, and psychology that are very intricate and interdependent.

Intraoperative Neural Response Telemetry and Auditory Outcomes in Pediatric Cochlear Implantation

OBJECTIVE

To evaluate the relationship between intraoperative neural response telemetry (NRT) and postoperative auditory testing outcomes in children.

STUDY DESIGN

Retrospective study.

SETTING

Tertiary-care academic center.

METHODS

Children who underwent cochlear implantation using the Cochlear Corporation device between 2010 and 2019 were included. Associations of average NRT and the slope of amplitude with postoperative auditory outcomes including functional auditory measure Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS), and speech perception testing (consonant-nucleus-consonant [CNC], Pediatric AzBio [BABY BIO], Hearing In Noise Test [HINT], and Northwestern University Children's Perception of Speech [NU-CHIPS]), measured between 6 and 57 months after implantation, were assessed using Spearman's rank correlation (ρ).

RESULTS

Thirty-eight patients (19 female, 19 male) and 54 ears were included. The median age of implantation was 20.6 months (range 9.6 months to 10.6 years). Eight (21%) children had neurologic disorders such as stroke, epilepsy, cerebral palsy, and other causes. Thirteen (34%) children had connexin mutations. Average NRT was not significantly correlated with postoperative auditory outcomes (IT-MAIS [ρ = -0.08, p = .74], CNC [ρ = 0.19, p = .32], BABY BIO [ρ = 0.21, p = .29], HINT [ρ = 0.05, p = .83]) and NU-CHIPS (ρ = 0.21, p = .28). The average slopes of amplitude and comfort level were not strongly correlated with any auditory outcomes (p > .05).

CONCLUSIONS

Intraoperative NRT was not correlated with any postoperative functional auditory outcomes. Patient counseling should include discussions that a subpar intraoperative cochlear response does not preclude favorable speech and auditory outcomes.

Efficacy of auditory verbal therapy in children with cochlear implantation based on auditory performance - A systematic review

This systematic review focuses on the efficacy of auditory verbal therapy (AVT) in children with cochlear implants based on their auditory performance. The results presented are based on research findings from 2010 to 2021. The systematic review was designed based on the Popular Reporting Systems for the Systematic Review and Analysis of Meta-Analysts (PRISMA), the 2020 revised version, and the Critical Evidence for Clinical Evidence (CATE) checklist. Specific keywords were chosen based on the formulated research question and searched on the following search engines: Google Scholar, Microsoft Academic, PubMed, Semantic Scholar, Cochrane, Science Direct, and BASE. All the searched articles were analysed based on specific exclusion criteria. The results revealed an important progression based on the auditory performance among children with cochlear implantation who received habilitation. The studies highlight that younger the age at implantation better the auditory performance and this may be necessary to allow at least relatively normal organization of auditory pathways in pre-lingual children with hearing impairment. Therefore, regular revitalization of aural-verbal rehabilitation and speech and language therapy is essential for younger children with hearing impairment to achieve the highest level of hearing function. This systematic review highlights importance of assessment of the auditory performance to be considered in the test battery while evaluating children with CI before and after habilitation along with AVT.

Machine Learning-Based Prediction of the Outcomes of Cochlear Implantation in Patients With Cochlear Nerve Deficiency and Normal Cochlea: A 2-Year Follow-Up of 70 Children

Cochlear nerve deficiency (CND) is often associated with variable outcomes of cochlear implantation (CI). We assessed previous investigations aiming to identify the main factors that determine CI outcomes, which would enable us to develop predictive models. Seventy patients with CND and normal cochlea who underwent CI surgery were retrospectively examined. First, using a data-driven approach, we collected demographic information, radiographic measurements, audiological findings, and audition and speech assessments. Next, CI outcomes were evaluated based on the scores obtained after 2 years of CI from the Categories of Auditory Performance index, Speech Intelligibility Rating, Infant/Toddler Meaningful Auditory Integration Scale or Meaningful Auditory Integration Scale, and Meaningful Use of Speech Scale. Then, we measured and averaged the audiological and radiographic characteristics of the patients to form feature vectors, adopting a multivariate feature selection method, called stability selection, to select the features that were consistent within a certain range of model parameters. Stability selection analysis identified two out of six characteristics, namely the vestibulocochlear nerve (VCN) area and the number of nerve bundles, which played an important role in predicting the hearing and speech rehabilitation results of CND patients. Finally, we used a parameter-optimized support vector machine (SVM) as a classifier to study the postoperative hearing and speech rehabilitation of the patients. For hearing rehabilitation, the accuracy rate was 71% for both the SVM classification and the area under the curve (AUC), whereas for speech rehabilitation, the accuracy rate for SVM classification and AUC was 93% and 94%, respectively. Our results identified that a greater number of nerve bundles and a larger VCN area were associated with better CI outcomes. The number of nerve bundles and VCN area can predict CI outcomes in patients with CND. These findings can help surgeons in selecting the side for CI and provide reasonable expectations for the outcomes of CI surgery.

Altered Functional Network in Infants With Profound Bilateral Congenital Sensorineural Hearing Loss: A Graph Theory Analysis

Functional magnetic resonance imaging (fMRI) studies have suggested that there is a functional reorganization of brain areas in patients with sensorineural hearing loss (SNHL). Recently, graph theory analysis has brought a new understanding of the functional connectome and topological features in central neural system diseases. However, little is known about the functional network topology changes in SNHL patients, especially in infants. In this study, 34 infants with profound bilateral congenital SNHL and 28 infants with normal hearing aged 11–36 months were recruited. No difference was found in small-world parameters and network efficiency parameters. Differences in global and nodal topologic organization, hub distribution, and whole-brain functional connectivity were explored using graph theory analysis. Both normal-hearing infants and SNHL infants exhibited small-world topology. Furthermore, the SNHL group showed a decreased nodal degree in the bilateral thalamus. Six hubs in the SNHL group and seven hubs in the normal-hearing group were identified. The left middle temporal gyrus was a hub only in the SNHL group, while the right parahippocampal gyrus and bilateral temporal pole were hubs only in the normal-hearing group. Functional connectivity between auditory regions and motor regions, between auditory regions and default-mode-network (DMN) regions, and within DMN regions was found to be decreased in the SNHL group. These results indicate a functional reorganization of brain functional networks as a result of hearing loss. This study provides evidence that functional reorganization occurs in the early stage of life in infants with profound bilateral congenital SNHL from the perspective of complex networks.

Early pediatric Cochlear implantation: An update

The criteria and candidacy for pediatric cochlear implantation (CI) has significantly transformed over the past few decades and continues to evolve with technological advancements, and recognition of benefit in more diverse populations. Prolonged auditory deprivation among patients with profound sensorineural hearing loss has been shown to cause widespread degeneration in the central auditory system. Thus, there is increasing evidence advocating for earlier implantation within a critical neuroplastic window. However, there is a lack of consensus on this optimal age of implantation. Historically, there were concerns regarding surgical feasibility and safety, anesthesia risk, and logistical considerations in very young infants <12 months. Recent literature has investigated surgical safety and anesthesia risk as well speech and language outcomes with early implantation, resulting in the long-awaited reduction in approved age by the FDA (<9 months for certain devices). This article reviews logistical considerations, surgical safety, anesthesia risk, and language developmental outcomes associated with early CI (<12 months).

Early pediatric Cochlear implantation: An update

The criteria and candidacy for pediatric cochlear implantation (CI) has significantly transformed over the past few decades and continues to evolve with technological advancements, and recognition of benefit in more diverse populations. Prolonged auditory deprivation among patients with profound sensorineural hearing loss has been shown to cause widespread degeneration in the central auditory system. Thus, there is increasing evidence advocating for earlier implantation within a critical neuroplastic window. However, there is a lack of consensus on this optimal age of implantation. Historically, there were concerns regarding surgical feasibility and safety, anesthesia risk, and logistical considerations in very young infants <12 months. Recent literature has investigated surgical safety and anesthesia risk as well speech and language outcomes with early implantation, resulting in the long-awaited reduction in approved age by the FDA (<9 months for certain devices). This article reviews logistical considerations, surgical safety, anesthesia risk, and language developmental outcomes associated with early CI (<12 months).

Treating the Individual Ear in Children: Results of Cochlear Implantation in Children With Asymmetric Sensory Hearing Loss

OBJECTIVE

Determine speech outcomes of children undergoing cochlear implantation with severe-to-profound hearing loss in the implanted ear and moderate or better hearing loss in nonimplanted ear.

STUDY DESIGN

Retrospective chart review.

SETTING

Tertiary referral center.

PATIENTS

Forty-nine children with severe-to-profound hearing loss in the ear to be implanted (pure-tone average), and no worse than moderate hearing loss in the nonimplant ear.

INTERVENTION

Subjects underwent cochlear implantation from 2007 and 2017 in the ear with severe-to-profound hearing loss.

MAIN OUTCOME MEASURES

Consonant Nucleus Consonant or Phonetically Balanced Kindergarten word scores pre- and postoperatively were compared in both the implanted ear and binaural setting. Comparisons were made between Phonetically Balanced Kindergarten scores pre- and postoperatively or Consonant Nucleus Consonant scores pre- and postoperatively.

RESULTS

The average pure-tone average for the implant ear was 92 ± 13 dB HL and 55 ± 12 dB HL in the nonimplant ear. Word scores for the implant ear increased an average of 58 (±27) % following cochlear implantation at 12 months and 62 (±20) % at 24 months. Binaural best-aided word scores increased an average of 36 (±29) % at 12 months and 49 (±24) % at 24 months.

CONCLUSION

Children with asymmetric sensory hearing loss should have each ear treated individually as significant benefits can be gained not only in the implanted ear, but also in binaural hearing.

Communication Mode and Speech and Language Outcomes of Young Cochlear Implant Recipients: A Comparison of Auditory-Verbal, Oral Communication, and Total Communication

OBJECTIVE

To evaluate the effect of communication mode on the spoken language outcomes of children who received a cochlear implant.

STUDY DESIGN

Retrospective analysis of postoperative speech and language and reading scores for children who received a cochlear implant and used three different modes of communication: auditory-verbal (AV) (n = 39), oral communication (OC) (n = 107), and total communication (TC) (n = 57).

SETTING

A single tertiary cochlear implant clinic.

PATIENTS

All children received their cochlear implant before the age of 5 years, had no known cochlear anomaly or cognitive delay that would affect their outcome with the CI, and had established consistent use of their respective communication methodology.

INTERVENTION

Rehabilitation varied depending on the selected communication methodology. Data were collected during routine postoperative speech and language evaluations.

MAIN OUTCOME MEASURES

Receptive and expressive language, reading comprehension, and speech intelligibility scores obtained up to 7 years post-activation of a cochlear implant.

RESULTS

All groups showed improvements over time. Linear mixed model analyses indicated scores obtained by children in the AV group were significantly higher than mean scores obtained by children in the other groups on most test measures at most post-implant intervals. Significantly greater numbers of children in the AV group obtained standard scores within normal limits than children in the OC and TC groups.

CONCLUSIONS

These findings support the use of the auditory-verbal communication approach to facilitate development of age-appropriate speech and language and literacy skills in profoundly deaf children.

Age-sensitive associations of segmental and suprasegmental perception with sentence-level language skills in Mandarin-speaking children with cochlear implants

BACKGROUND AND AIM

It remains unclear how recognition of segmental and suprasegmental phonemes contributes to sentence-level language processing skills in Mandarin-speaking children with cochlear implants (CIs). Our study examined the influence of implantation age on the recognition of consonants, lexical tones and sentences respectively, and more importantly, the contribution of phonological skills to sentence repetition accuracy in Mandarin-speaking children with CIs.

METHODS

The participants were three groups of prelingually deaf children who received cochlear implants at various ages and their age-matched controls with normal hearing. Three tasks were administered to assess their consonant perception, lexical tone recognition and language skills in open-set sentence repetition.

RESULTS

Children with CIs lagged behind NH peers in all the three tests, and performances on segmental, suprasegmental and sentence-level processing were differentially modulated by implantation age. Furthermore, performances on recognition of consonants and lexical tones were significant predictors of sentence repetition accuracy in the children with CIs.

CONCLUSION

Overall, segmental and suprasegmental perception as well as sentence-level processing is impaired in Mandarin-speaking children with CIs compared with age-matched children with NH. In children with CIs recognition of segmental and suprasegmental phonemes at the lower level predicts sentence repetition accuracy at the higher level. More importantly, implantation age plays an important role in the development of phonological skills and higher-order language skills, suggesting that age-appropriate aural rehabilitation and speech intervention programs need to be developed in order to better help CI users who receive CIs at different ages.

A Predictive Model for Cochlear Implant Outcome in Children with Cochlear Nerve Deficiency

The outcome of cochlear implantation (CI) in patients with cochlear nerve deficiency (CND) is variable, resulting in a wide range of speech perception performance, from degrees of environmental sound perception to conversation without lip-reading. Twenty-five cochlear implantees with CND were enrolled retrospectively to determine the factors correlated with CI outcome in patients with CND and to develop a predictive model for CI outcome. CI outcome was evaluated using the Categories of Auditory Performance (CAP) score at 2 years after CI. Patients with negative auditory brainstem response (ABR) showed a significantly lower CAP score than those with positive ABR (2.5 ± 1.7, 4.8 ± 0.7; p = 0.001). The area ratio of vestibulocochlear nerve (VCN) to facial nerve (FN) at the cerebellopontine angle on magnetic resonance images was positively correlated with CI outcome (p < 0.001). With multiple regression analysis, a predictive equation accounting for 66% of variance of CAP score at 2 years after CI was \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\bf{deduced}}:{\bf{CAP}}\,{\bf{score}}{\boldsymbol{=}}{\bf{0.7}}{\boldsymbol{+}}{\bf{1.9}}{\boldsymbol{\ast }}{\boldsymbol{(}}{\bf{ABR}}{\boldsymbol{)}}{\boldsymbol{+}}{\bf{1.2}}{\boldsymbol{\ast }}(\frac{{\boldsymbol{V}}{\boldsymbol{C}}{\boldsymbol{N}}}{{\boldsymbol{F}}{\boldsymbol{N}}})$$\end{document}deduced:CAPscore=0.7+1.9∗(ABR)+1.2∗(VCNFN). We found that preoperative ABR and area ratio of VCN to FN at the cerebellopontine angle could predict CI outcome in patients with CND. Preoperative counselling based on our predictive model might be helpful to determine treatment modality for auditory rehabilitation and which ear to implant.

Cochlear Implantation for Children and Adults with Severe-to-Profound Hearing Loss

Cochlear implants (CIs) have proven to be a useful treatment option for individuals with severe-to-profound hearing loss by providing improved access to one's surrounding auditory environment. CIs differ from traditional acoustic amplification by providing information to the auditory system via electrical stimulation. Both postlingually deafened adults and prelingually deafened children can benefit from a CI; however, outcomes with a CI can vary. Numerous factors can impact performance outcomes with a CI. It is important for the audiologist to understand what factors might play a role and impact performance outcomes with a CI so that they can effectively counsel the recipient and their family, as well as establish appropriate and realistic expectations with a CI. This review article will discuss the CI candidacy process, CI programming and postoperative follow-up care, as well as considerations across the lifespan that may affect performance outcomes with a CI.

Preference for Infant-Directed Speech in Infants With Hearing Aids: Effects of Early Auditory Experience

Purpose

It is well established that (a) infants prefer listening to infant-directed speech (IDS) over adult-directed speech (ADS), and (b) IDS facilitates speech, language, and cognitive development, compared with ADS. The main purpose of this study was to determine whether infants with hearing aids (HAs), similar to their peers with normal hearing (NH), show a listening preference for IDS over ADS.

Method

A total of 42 infants participated in the study. In Experiment 1, 9 infants with hearing loss, who had approximately 12 months of experience (mean chronological age of 17.57 months) with HAs, and 9 infants with NH, who had similar chronological age (17.54 months), were tested. In Experiment 2, 10 infants with hearing loss, who had approximately 4 months of experience (mean chronological age of 9.86 months) with HAs, and 14 infants with NH, who had similar chronological age (9.09 months), were tested. Infants were tested on their listening preference in 3 randomized blocks: IDS versus silence, ADS versus silence, and IDS versus ADS blocks, using the central fixation preference procedure.

Results

Experiment 1 showed that infants with HAs, similar to their peers with NH, listened longer to both IDS and ADS relative to silence; however, neither infants with HAs nor infants with NH showed a listening preference for IDS over ADS. In Experiment 2, both infants with HAs and infants with NH showed a listening preference for IDS and ADS relative to silence; in addition, both groups preferred listening to IDS over ADS.

Conclusions

Infants with HAs appear to have sufficient access to the acoustic cues in the speech that allow them to develop an age-equivalent IDS preference. This may be attributed to a combination of being able to use the hearing they do have before receiving HAs and early device fitting. Given previously demonstrated positive associations between IDS preference and language development, this research encourages early interventions focusing on maximizing early auditory experience in infants with hearing loss.

Supplemental Material

https://doi.org/10.23641/asha.6906365.

Socio-emotional adjustment of adolescents with cochlear implants: Loneliness, emotional autonomy, self-concept, and emotional experience at the hospital

Recent studies have reported contrasting results in the socio-emotional adjustment of Italian adolescents with cochlear implants (CIs). The aim of the present study is to explore the relationship between the socio-emotional adjustment of adolescents with CIs, the quality of their hospital stay, and their age at CI activation. The participants were 29 adolescents with CIs (CI group) and 29 typically developing adolescents (TD group). The Emotional Autonomy Scale, the Loneliness and Aloneness Scale for Children and Adolescents, and the Multidimensional Self-Concept Scale were administered to each participant. The emotional experience reported during the hospital stay was considered for each participant in the CI group. The adolescents with CIs displayed significantly higher levels of loneliness and lower levels of aversion toward aloneness than the TD group participants. Adolescents who had received the CI in preschool displayed a higher level of physical self-concept than adolescents who had received it later. The adolescents' emotional experiences at the hospital were reported to be quite complex and related to their relationships with parents. In summary, the findings point to a specific type of fragility in socio-emotional adjustment-focused on loneliness/aloneness-rather than a general one.

The Advances in Hearing Rehabilitation and Cochlear Implants in China

Hearing loss (HL) is a common sensory impairment in humans, with significant economic and social impacts. With nearly 20% of the world's population, China has focused on economic development and health awareness to improve the care for its hearing-impaired population. Recently, the Chinese government has initiated national programs such as the China Disabled Persons Federation to fund prevention, treatment, and rehabilitation of hearing impairment. Newborn hearing screening and auditory rehabilitation programs in China have expanded exponentially with government support. While facing many challenges and overcoming obstacles, cochlear implantation (CI) programs in China have also experienced considerable growth. This review discusses the implementation of CI programs for HL in China and presents current HL data including epidemiology, newborn hearing screening, and determination of genetic etiologies. Sharing the experience in Chinese auditory rehabilitation and CI programs will shine a light on the developmental pathway of healthcare infrastructure to meet emerging needs of the hearing-impaired population in other developing countries.

Surgical timing for bilateral simultaneous cochlear implants: When is best?

INTRODUCTION

Hearing loss is considered the most common congenital disease and the prevalence of neonatal deafness can be estimated between 1 and 2 cases per 1000 live births. Infant deafness must be diagnosed as early as possible and an effective therapeutic intervention needs to be carried out in order to avoid the serious consequences of hearing deprivation during the evolutionary period: alterations in the development of central auditory pathways and lack of language acquisition. The cochlear implant (CI) has proved to be the best instrument to solve the problem of auditory deprivation. In particular, the bilateral CI gives the patient access to binaural hearing which results in benefits in terms of sound localisation and discrimination. The optimal age of application of the CI is a widely discussed topic in the scientific community and the current guidelines indicate a period between 12 and 24 months of age, even though the supporters of the application before 12 months of age are nowadays increasing.

MATERIALS AND METHODS

The study is observational, retrospective, monocentric. 49 paediatric patients (<18 years) with simultaneous bilateral CIs were included. The audiometric threshold and speech tests were carried out during the follow-up 3, 6 and 12 months after the CIs activation and when the patient reached 2 years of age.

RESULTS

The statistical analysis showed that undergoing bilateral implantation surgery before 2 years of age allows a satisfactory audiometric performance, while there are no particular benefits in performing the surgery before 1 year of age. As far as the speech outcome is concerned, the statistical analysis didn't show significant correlation between the earlier age of implantation and better speech performance if the operation is carried out before 2.5 years of age.

CONCLUSIONS

The results of the study indicate that the optimal age to perform the simultaneous bilateral CIs surgery is between 12 and 24 months, without demonstrating any particular benefit in carrying out the procedure before 1 year of age. This may be clinically relevant in terms of avoiding the risks of diagnostic mistakes and reducing the related surgical risk in children under 1 year of age.

Auditory steady-state response in cochlear implant patients

INTRODUCTION AND OBJECTIVE

Auditory steady state responses to continuous amplitude modulated tones at rates between 70 and 110Hz, have been proposed as a feasible alternative to objective frequency specific audiometry in cochlear implant subjects. The aim of the present study is to obtain physiological thresholds by means of auditory steady-state response in cochlear implant patients (Clarion HiRes 90K), with acoustic stimulation, on free field conditions and to verify its biological origin.

METHODS

11 subjects comprised the sample. Four amplitude modulated tones of 500, 1000, 2000 and 4000Hz were used as stimuli, using the multiple frequency technique. The recording of auditory steady-state response was also recorded at 0dB HL of intensity, non-specific stimulus and using a masking technique.

RESULTS

The study enabled the electrophysiological thresholds to be obtained for each subject of the explored sample. There were no auditory steady-state responses at either 0dB or non-specific stimulus recordings. It was possible to obtain the masking thresholds. A difference was identified between behavioral and electrophysiological thresholds of -6±16, -2±13, 0±22 and -8±18dB at frequencies of 500, 1000, 2000 and 4000Hz respectively.

CONCLUSIONS

The auditory steady state response seems to be a suitable technique to evaluate the hearing threshold in cochlear implant subjects.

Cochlear implantation in infants below 12 months of age

Objectives

To provide safety and efficacy data on infants implanted below 12 months of age.

Methods

With the wide application of newborn hearing screening programs, infants with deafness are being identified at birth. When a hearing aid trial fails, cochlear implantation is the only option to restore hearing. Mounting evidence suggests that age at implantation is a strong predictor of language outcomes. Using the minimally invasive surgical technique we have employed for nearly two decades, a limited clinical trial was initiated in the year 2000 because this age limitation fell outside of FDA guidelines. The infants were initially assessed using the preferential listening paradigm to confirm that they could learn associations between speech sounds and objects. Sufficient time was allowed to pass to administer more traditional language measures.

Results

No surgical or anesthetic complications occurred in this group of infants. The pattern of listening skill development mirrored that seen in normal hearing infants. Long-term language assessments using the Peabody Picture Vocabulary Test (PPVT) and other measures have demonstrated that many of infants achieved age appropriate language skills.

Conclusion

Cochlear implantation in children less than 12 months of age is safe and efficacious as demonstrated by long-term PPVT language data.

Prediction of Cochlear Implant Outcomes in Patients With Prelingual Deafness

Objectives.

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

Methods.

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

Results.

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

Conclusion.

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

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

BACKGROUND

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

PURPOSE

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

RESEARCH DESIGN

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

STUDY SAMPLE

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

DATA COLLECTION AND ANALYSIS

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

RESULTS

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

CONCLUSIONS

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

Mandarin Tone and Vowel Recognition in Cochlear Implant Users: Effects of Talker Variability and Bimodal Hearing

OBJECTIVES

For cochlear implant (CI) users with residual low-frequency acoustic hearing in the nonimplanted ear, bimodal hearing combining the use of a CI and a contralateral hearing aid (HA) may provide more salient talker voice cues than CI alone to handle the variability of talker identity across trials. This study tested the effects of talker variability, bimodal hearing, and their interaction on response accuracy and time of CI users' Mandarin tone, vowel, and syllable recognition (i.e., combined Mandarin tone and vowel recognition in this study).

DESIGN

Fifteen prelingually deafened native Mandarin-speaking CI users (at age 20 or lower) participated in this study. Four talkers each produced six Mandarin single-vowel syllables in four lexical tones. The stimuli were presented in quiet via a single loudspeaker. To study the effects of talker variability, Mandarin tone, vowel, and syllable recognition was tested in two presentation conditions: with stimuli blocked according to talker (blocked-talker condition) or mixed across talkers from trial to trial (mixed-talker condition). To explore the effects of bimodal hearing, two processor conditions were tested: CI alone or CI + HA. The cumulative response time was recorded as an indirect indicator of the cognitive load or listening effort in each condition. The correlations were computed between demographic/hearing factors (e.g., hearing thresholds in the nonimplanted ear) and bimodal performance/benefits (where bimodal benefits refer to the performance differences between CI alone and CI + HA).

RESULTS

Mandarin tone recognition with both CI alone and CI + HA was significantly poorer in the mixed-talker condition than in the blocked-talker condition, while vowel recognition was comparable in the two presentation conditions. Bimodal hearing significantly improved Mandarin tone recognition but not vowel recognition. Mandarin syllable recognition was significantly affected by both talker variability and bimodal hearing. The cumulative response time significantly reduced with CI + HA compared with CI alone, but remained invariant with respect to talker variability. There was no interaction between talker variability and bimodal hearing for any performance measure adopted in this study. Correlation analyses revealed that the bimodal performance and benefits in Mandarin tone, vowel, and syllable recognition could not be predicted by the hearing thresholds in the nonimplanted ear or by the demographic factors of the participants.

CONCLUSIONS

Talker variability from trial to trial significantly degraded Mandarin tone and syllable recognition performance in both the CI alone and CI + HA conditions. While bimodal hearing did not reduce the talker variability effects on Mandarin tone and syllable recognition, generally better Mandarin tone and syllable recognition performance with shorter response time (an indicator of less listening effort) was observed when a contralateral HA was used in conjunction with the CI. On the other hand, vowel recognition was not significantly affected by either talker variability or bimodal hearing, because ceiling effects could not be counted out of the vowel recognition results.

Predictors of pediatric cochlear implantation outcomes in South Africa

OBJECTIVE

To identify and describe predictors of pediatric cochlear implantation outcomes in a South African population.

METHODS

A retrospective study of 301 pediatric cochlear implant (CI) recipients from five CI programs was conducted and cross-sectional outcome data were added at the time of data collection. Twenty potential prognostic factors were identified from the retrospective dataset, including demographical, CI, risk and family factors. Multiple regression analyses were performed to identify predictor variables that influence outcomes in terms of auditory performance (CAP scores), speech production (SIR scores), communication mode and educational placement.

RESULTS

Although implanted children within this sample did not have equal opportunity to access a second implant, bilateral implantation was strongly predictive of better auditory performance and speech production scores, an oral mode of communication and mainstream education. NICU admittance/prematurity were associated with poorer auditory performance and speech production scores, together with a higher probability for non-oral communication and non-mainstream education. The presence of one or more additional developmental condition was predictive of poorer outcomes in terms of speech production and educational placement, while a delay between diagnosis and implantation of more than one year was also related to non-mainstream education. Ethnicities other than Caucasian were predictive of poorer auditory performance scores and a lower probability for mainstream education.

CONCLUSION

An extensive range of prognostic indicators were identified for pediatric CI outcomes in South Africa. These predictive factors of better and poorer outcomes should guide pediatric CI services to promote optimal outcomes and assist professionals in providing evidence-based informational counseling.

A Systematic Review to Define the Speech and Language Benefit of Early (<12 Months) Pediatric Cochlear Implantation

Objective: This review aimed to evaluate the additional benefit of pediatric cochlear implantation before 12 months of age considering improved speech and language development and auditory performance. Materials and Methods: We conducted a search in PubMed, EMBASE and CINAHL databases and included studies comparing groups with different ages at implantation and assessing speech perception and speech production, receptive language and/or auditory performance. We included studies with a high directness of evidence (DoE). Results: We retrieved 3,360 articles. Ten studies with a high DoE were included. Four articles with medium DoE were discussed in addition. Six studies compared infants implanted before 12 months with children implanted between 12 and 24 months. Follow-up ranged from 6 months to 9 years. Cochlear implantation before the age of 2 years is beneficial according to one speech perception score (phonetically balanced kindergarten combined with consonant-nucleus-consonant) but not on Glendonald auditory screening procedure scores. Implantation before 12 months resulted in better speech production (diagnostic evaluation of articulation and phonology and infant-toddler meaningful auditory integration scale), auditory performance (Categories of Auditory Performance-II score) and receptive language scores (2 out of 5; Preschool Language Scale combined with oral and written language skills and Peabody Picture Vocabulary Test). Conclusions: The current best evidence lacks level 1 evidence studies and consists mainly of cohort studies with a moderate to high risk of bias. Included studies showed consistent evidence that cochlear implantation should be performed early in life, but evidence is inconsistent on all speech and language outcome measures regarding the additional benefit of implantation before the age of 12 months. Long-term follow-up studies are necessary to provide insight on additional benefits of early pediatric cochlear implantation.

Diffusion Tensor Imaging of the Auditory Neural Pathway for Clinical Outcome of Cochlear Implantation in Pediatric Congenital Sensorineural Hearing Loss Patients

Although conventional structural MRI provides vital information in the evaluation of congenital sensorineural hearing loss (SNHL), it is relatively insensitive to white matter microstructure. Our objective was to evaluate possible changes in microstructure of the auditory pathway in children with congenital sensorineural hearing loss (SNHL), and the possible distinction between good and poor outcome of cochlear implantation (CI) patients by using diffusion tensor imaging (DTI). Twenty-four patients with congenital SNHL and 20 healthy controls underwent conventional MRI and DTI examination using a 1.5T MR scanner. The DTI metrics of fractional anisotropy (FA) and mean diffusivity (MD) of six regions of interest (ROIs) positioned along the auditory pathway—the trapezoid body, superior olivary nucleus, inferior colliculus, medial geniculate body, auditory radiation and white matter of Heschl's gyrus—was measured in all subjects. Among the 24 patients, 8 patients with a categorie of auditory performance (CAP) score over 6 were classified into the good outcome group, and 16 patients with a CAP score below 6 were classified into the poor outcome group. A significant decrease was observed in FA values while MD values remained unchanged at the six ROIs of SNHL patients compared with healthy controls. Compared to good outcome subjects, poor outcome subjects displayed decreased FA values at all of the ROIs. No changes were observed in MD values. Correlation analyses only revealed strong correlations between FA values and CAP scores, and strong correlations between CAP scores and age at implant were also found. No correlations of FA values with age at implant were observed. Our results show that preoperative DTI can be used to evaluate microstructural alterations in the auditory pathway that are not detectable by conventional MR imaging, and may play an important role in evaluating the outcome of CI. Early cochlear implantation might be more effectively to restore hearing in SNHL patients.

Prevalence of various etiologies of hearing loss among cochlear implant recipients: Systematic review and meta-analysis

OBJECTIVE

To investigate the etiology of deafness in cochlear implanted children and to address the question whether there is a need for more thorough diagnostics, especially concerning genetics.

DESIGN

Systematic review. Four databases were searched for studies (year 2000-2014) on cochlear implanted children (n > 100). Studies were excluded if etiology had influenced their inclusion criteria. Eligibility and methodological quality were assessed independently by three authors. The studies' description of diagnostic evaluation was categorized in three groups.

STUDY SAMPLE

Sixteen studies were included (5069 children).

RESULTS

The most common etiological categories were 'Unknown' 40.3% (95% CI 32.8 to 48.0), 'Non-syndromic' 22.4% (95% CI 17.1 to 28.2), and 'Postnatal' 11.3% (95% CI 7.2 to 16.2). Studies published after 2006 had a lower proportion of 'Unknown' etiology 35.3% (95% CI 28.0 to 42.8) than older 45.5% (95% CI 31.0 to 60.4). Important information was missing from several studies: 11 (69%) studies did not provide detailed description on diagnostic evaluation of the etiology of deafness and had a higher proportion of 'Unknown' etiology.

CONCLUSIONS

In order to ensure a higher level of comparability in future studies, we recommend agreement upon an international standard of diagnostics and the introduction of an international standard for reporting etiology.

Diffusion tensor imaging and MR spectroscopy of microstructural alterations and metabolite concentration changes in the auditory neural pathway of pediatric congenital sensorineural hearing loss patients

PURPOSE

Our objective was to evaluate age-dependent changes in microstructure and metabolism in the auditory neural pathway, of children with profound sensorineural hearing loss (SNHL), and to differentiate between good and poor surgical outcome cochlear implantation (CI) patients by using diffusion tensor imaging (DTI) and magnetic resonance spectroscopy (MRS).

MATERIALS AND METHODS

Ninety-two SNHL children (49 males, 43 females; mean age, 4.9 years) were studied by conventional MR imaging, DTI and MRS. Patients were divided into three groups: Group A consisted of children≤1 years old (n=20), Group B consisted of children 1-3 years old (n=31), and group C consisted of children 3-14 years old (n=41). Among the 31 patients (19 males and 12 females, 12m- 14y ) with CI, 18 patients (mean age 4.8±0.7 years) with a categories of auditory performance (CAP) score over five were classified into the good outcome group and 13 patients (mean age, 4.4±0.7 years) with a CAP score below five were classified into the poor outcome group. Two DTI parameters, fractional anisotropy (FA) and apparent diffusion coefficient (ADC), were measured in the superior temporal gyrus (STG) and auditory radiation. Regions of interest for metabolic change measurements were located inside the STG. DTI values were measured based on region-of-interest analysis and MRS values for correlation analysis with CAP scores.

RESULTS

Compared with healthy individuals, 92 SNHL patients displayed decreased FA values in the auditory radiation and STG (p<0.05). Only decreased FA values in the auditory radiation was observed in Group A. Decreased FA values in the auditory radiation and STG were both observed in B and C groups. However, in Group C, the N-acetyl aspartate/creatinine ratio in the STG was also significantly decreased (p<0.05). Correlation analyses at 12 months post-operation revealed strong correlations between the FA, in the auditory radiation, and CAP scores (r=0.793, p<0.01).

CONCLUSIONS

DTI and MRS can be used to evaluate microstructural alterations and metabolite concentration changes in the auditory neural pathway that are not detectable by conventional MR imaging. The observed changes in FA suggest that children with SNHL have a developmental delay in myelination in the auditory neural pathway, and it also display greater metabolite concentration changes in the auditory cortex in older children, suggest that early cochlear implantation might be more effective in restoring hearing in children with SNHL. This article is part of a Special Issue entitled SI: Brain and Memory.

Longitudinal speech perception and language performance in pediatric cochlear implant users: the effect of age at implantation

OBJECTIVES

Few studies have examined the long-term effect of age at implantation on outcomes using multiple data points in children with cochlear implants. The goal of this study was to determine whether age at implantation has a significant, lasting impact on speech perception, language, and reading performance for children with prelingual hearing loss.

DESIGN

A linear mixed-model framework was used to determine the effect of age at implantation on speech perception, language, and reading abilities in 83 children with prelingual hearing loss who received cochlear implants by the age of 4 years. The children were divided into two groups based on their age at implantation: (1) under 2 years of age and (2) between 2 and 3.9 years of age. Differences in model-specified mean scores between groups were compared at annual intervals from 5 to 13 years of age for speech perception, and 7 to 11 years of age for language and reading.

RESULTS

After controlling for communication mode, device configuration, and preoperative pure-tone average, there was no significant effect of age at implantation for receptive language by 8 years of age, expressive language by 10 years of age, reading by 7 years of age. In terms of speech-perception outcomes, significance varied between 7 and 13 years of age, with no significant difference in speech-perception scores between groups at ages 7, 11, and 13 years. Children who used oral communication (OC) demonstrated significantly higher speech-perception scores than children who used total communication (TC). OC users tended to have higher expressive language scores than TC users, although this did not reach significance. There was no significant difference between OC and TC users for receptive language or reading scores.

CONCLUSIONS

Speech perception, language, and reading performance continue to improve over time for children implanted before 4 years of age. The present results indicate that the effect of age at implantation diminishes with time, particularly for higher-order skills such as language and reading. Some children who receive cochlear implants after the age of 2 years have the capacity to approximate the language and reading skills of their earlier-implanted peers, suggesting that additional factors may moderate the influence of age at implantation on outcomes over time.

Evaluation of cortical processing of language by use of positron emission tomography in hearing loss children with congenital cytomegalovirus infection

OBJECTIVE

To predict cochlear implant efficacy and investigate the cortical processing of the visual component of language in profoundly deafened patients with asymptomatic congenital cytomegalovirus (CMV) infection.

METHODS AND CASES

The cortical activity of two children with CMV-related hearing loss was evaluated with fluorodeoxyglucose-positron emission tomography (FDG-PET) with a visual language task before cochlear implantation. Total development and auditory perception ability were assessed one year after implantation.

RESULTS

The two children with CMV-related hearing loss showed activation in the auditory association area where no activation was found in the controls, and exhibited nearly identical cortical activation patterns to those seen in patients with profound congenital hearing loss. In contrast, differences in total development in verbal ability and discrimination of sentences between the two cases were revealed one year after implantation.

CONCLUSION

These results might indicate that the differences of cortical activities according to hearing abilities could have been influenced by CMV infection that involves higher function of the brain directly and/or affects the cochlea peripherally. Additionally, if CMV infection might have affected only the cochlea, these cortical activation patterns were influenced secondary by the time course of hearing loss characterized by CMV infection, which had varied manifestations. Accurate diagnosis and cochlear implantation at the appropriate time are important for successful speech development, and each patient needs a personalized habilitation program based on their etiology and brain function.

Vision rehabilitation in the case of blindness

This article examines the various vision rehabilitation procedures that are available for early and late blindness. Depending on the pathology involved, several vision rehabilitation procedures exist, or are in development. Visual aids are available for low vision individuals, as are sensory aids for blind persons. Most noninvasive sensory substitution prostheses as well as implanted visual prostheses in development are reviewed. Issues dealing with vision rehabilitation are also discussed, such as problems of biocompatibility, electrical safety, psychosocial aspects, and ethics. Basic studies devoted to vision rehabilitation such as simulation in mathematical models and simulation of artificial vision are also presented. Finally, the importance of accurate rehabilitation assessment is addressed, and tentative market figures are given.

Hearing versus Listening: Attention to Speech and Its Role in Language Acquisition in Deaf Infants with Cochlear Implants

The advent of cochlear implantation has provided thousands of deaf infants and children access to speech and the opportunity to learn spoken language. Whether or not deaf infants successfully learn spoken language after implantation may depend in part on the extent to which they listen to speech rather than just hear it. We explore this question by examining the role that attention to speech plays in early language development according to a prominent model of infant speech perception - Jusczyk's WRAPSA model - and by reviewing the kinds of speech input that maintains normal-hearing infants' attention. We then review recent findings suggesting that cochlear-implanted infants' attention to speech is reduced compared to normal-hearing infants and that speech input to these infants differs from input to infants with normal hearing. Finally, we discuss possible roles attention to speech may play on deaf children's language acquisition after cochlear implantation in light of these findings and predictions from Jusczyk's WRAPSA model.

Communication development in children who receive a cochlear implant by 12 months of age

OBJECTIVE

Describe the long-term benefits of early cochlear implantation. Provide a comprehensive description of outcomes, including: language, speech production, and speech perception. Compare the communication outcomes for the early implanted children to those of normally hearing children and children who received a cochlear implant at a comparatively older age.

METHOD

Retrospective review of the communication development of 35 children implanted between 6 and 12 months of age and 85 children implanted between 13 and 24 months of age. Audiologic assessments included unaided and aided audiograms, auditory brainstem response (ABR), auditory steady state response (ASSR), and otoacoustic emissons (OAEs). Formal language, speech production, and speech perception measures were administered, preimplant and at 1, 2, 3, and 5 years postimplant.

RESULTS

The children who received their cochlear implant by 12 months of age demonstrated language growth rates equivalent to their normally hearing peers and achieved age appropriate receptive language scores 3 years postimplant. The children who received their cochlear implant between 13 and 24 months demonstrated a significant language delay at 3 years postimplant. Speech production development followed a similar pattern to that of normal-hearing children, although was delayed, for both groups of children. Mean open-set speech perception scores were comparable with previous reports for children and adults who use cochlear implants.

CONCLUSION

Children implanted by 12 months of age demonstrate better language development compared with children who receive their cochlear implant between 13 and 24 months. This supports the provision of a cochlear implant within the first year of life to enhance the likelihood that a child with severe-to-profound hearing impairment will commence elementary school with age-appropriate language skills.

Musicians' enhanced neural differentiation of speech sounds arises early in life: developmental evidence from ages 3 to 30

The perception and neural representation of acoustically similar speech sounds underlie language development. Music training hones the perception of minute acoustic differences that distinguish sounds; this training may generalize to speech processing given that adult musicians have enhanced neural differentiation of similar speech syllables compared with nonmusicians. Here, we asked whether this neural advantage in musicians is present early in life by assessing musically trained and untrained children as young as age 3. We assessed auditory brainstem responses to the speech syllables /ba/ and /ga/ as well as auditory and visual cognitive abilities in musicians and nonmusicians across 3 developmental time-points: preschoolers, school-aged children, and adults. Cross-phase analyses objectively measured the degree to which subcortical responses differed to these speech syllables in musicians and nonmusicians for each age group. Results reveal that musicians exhibit enhanced neural differentiation of stop consonants early in life and with as little as a few years of training. Furthermore, the extent of subcortical stop consonant distinction correlates with auditory-specific cognitive abilities (i.e., auditory working memory and attention). Results are interpreted according to a corticofugal framework for auditory learning in which subcortical processing enhancements are engendered by strengthened cognitive control over auditory function in musicians.

Cochlear implants: clinical and societal outcomes

Over the past 30 years, hearing care clinicians have increasingly relied on cochlear implants to restore auditory sensitivity in selected patients with advanced sensorineural hearing loss. This article examines the impact of intervention with cochlear implantation in children and adults. The authors report a range of clinic-based results and patient-based outcomes reflected in the reported literature on cochlear implants. The authors describe the basic assessment of the physiologic response to auditory nerve stimulation; measures of receptive and productive benefit; and surveys of life effects as reflected measures of quality of life, educational attainment, and economic impact.

Word learning in deaf children with cochlear implants: effects of early auditory experience

Word-learning skills were tested in normal-hearing 12- to 40-month-olds and in deaf 22- to 40-month-olds 12 to 18 months after cochlear implantation. Using the Intermodal Preferential Looking Paradigm (IPLP), children were tested for their ability to learn two novel-word/novel-object pairings. Normal-hearing children demonstrated learning on this task at approximately 18 months of age and older. For deaf children, performance on this task was significantly correlated with early auditory experience: Children whose cochlear implants were switched on by 14 months of age or who had relatively more hearing before implantation demonstrated learning in this task, but later implanted profoundly deaf children did not. Performance on this task also correlated with later measures of vocabulary size. Taken together, these findings suggest that early auditory experience facilitates word learning and that the IPLP may be useful for identifying children who may be at high risk for poor vocabulary development.

The right not to hear: the ethics of parental refusal of hearing rehabilitation

OBJECTIVE

To explore the ethics of parental refusal of auditory-oral hearing rehabilitation.

STUDY DESIGN

Case study with medical ethical discussion and review.

METHODS

Two young brothers present with severe-to-profound congenital sensorineural hearing loss. The parents, both of whom have normal hearing and work as sign language interpreters, have decided to raise their children with American Sign Language as their only form of communication. They have chosen not to pursue cochlear implantation nor support the use of hearing aids.

DISCUSSION

This case raises significant questions concerning whether hearing rehabilitation should be mandated, and if there are circumstances in which parental preferences should be questioned or overridden with regard to this issue. In addition, legal concerns may be raised regarding the possible need to file a report with Child Protective Services. Although similar cases involving the Deaf community have historically favored parental rights to forego hearing rehabilitation with either cochlear implantation or hearing aids, we explore whether conclusions should be different because the parents in this case are not hearing impaired.

CONCLUSIONS

The ethics of parental rights to refuse hearing rehabilitation are complex and strikingly context-dependent. A comprehensive appreciation of the medical, practical, and legal issues is crucial prior to intervening in such challenging situations.

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.

Lexical tone perception with HiResolution and HiResolution 120 sound-processing strategies in pediatric Mandarin-speaking cochlear implant users

OBJECTIVES

Lexical tone recognition tends to be poor in cochlear implant users. The HiResolution (HiRes) sound-processing strategy is designed to better preserve temporal fine structure, or the detailed envelope information, of an acoustic signal. The newer HiRes 120 strategy builds on HiRes by increasing the amount of potential spectral information delivered to the implant user. The purpose of this study was to examine lexical tone recognition in native Mandarin Chinese-speaking children with cochlear implants using the HiRes and HiRes 120 sound-processing strategies. Tone recognition performance was tested with HiRes at baseline and then after up to 6 mo of HiRes 120 experience in the same subjects.

DESIGN

Twenty prelingually deafened, native Mandarin-speaking children, with ages ranging from 3.5 to 16.5 yr, participated. All children completed a computerized tone contrast test on three occasions: (1) using HiRes immediately before conversion to HiRes 120 (baseline), (2) 1 mo after conversion, and (3) 3 mo after conversion. Twelve of the 20 children also were tested 6 mo after conversion. In addition, the parents of 18 children completed a questionnaire at the 3-mo follow-up visit regarding the preference of sound-processing strategies and the children's experience related to various aspects of auditory perception and speech production using HiRes 120.

RESULTS

As a group, no statistically significant differences were seen between the tone recognition scores using HiRes and HiRes 120. Individual scores showed great variability. Tone recognition performance ranged from chance (50% correct) to nearly perfect. Using the conventional HiRes strategy, 6 of the 20 children achieved high-level tone recognition performance (i.e., >or=90% correct), whereas 7 performed at a level not significantly different from chance (50-60% correct). At the final test, either 3 or 6 mo after conversion, all children achieved tone recognition performance with HiRes 120 that was equal to or better than that with HiRes, although some children's tone recognition performance was worse initially at the 1 or 3 mo follow-up intervals than at baseline. Eight of the 20 children showed statistically significant improvement in tone recognition performance with HiRes 120 on at least one of the follow-up tests. Age at implantation was correlated with tone recognition performance at all four test intervals. Parents of most of the children indicated that the children preferred HiRes 120 more than HiRes.

CONCLUSIONS

As a group, HiRes 120 did not provide significantly improved lexical tone recognition compared to HiRes, at least throughout the length of the study (up to 6 mo). There were large individual differences in lexical tone recognition among the prelingually deafened, native Mandarin-speaking children with cochlear implants using either HiRes or HiRes 120. Six of the 20 children performed at or near ceiling in the baseline HiRes condition. Of the remainder, approximately half showed significantly better tone recognition when subsequently tested with HiRes 120, although the extent to which this improvement may be attributable to factors other than the change in processing strategy (e.g., general development) is unknown. The children who benefited most from HiRes 120 tended to be those who were implanted at younger ages.

Peer relationships of deaf children with cochlear implants: predictors of peer entry and peer interaction success

This study investigated factors that affect the development of positive peer relationships among deaf children with cochlear implants. Ten 5- to 6-year-old deaf children with implants were observed under conditions varying peer context difficulty in a Peer Entry task. Results revealed better outcomes for deaf children interacting in one-on-one situations compared to interactions including two other hearing children and better performance among girls than boys. In addition, longer duration of implant use and higher self-esteem were associated with better performance on the Peer Task, which was in turn related to parental reports of children's social functioning outside the experimental situation. These findings contribute to the growing literature describing the benefits of cochlear implantation in the areas of communication and socialization, while pointing to interventions that may enhance deaf children's social competence.

Family Quality of Life Following Early Identification of Deafness

Purpose

Family members' perceptions of their quality of life were examined following early identification of deafness in children.

Method

A questionnaire was used to solicit ratings of satisfaction from the family members of 207 children who were deaf and younger than 6 years of age.

Results

Results indicated that families were generally satisfied with the areas of family life surveyed. Descriptive analysis suggested lower satisfaction ratings in the area of emotional well-being. Families also reported that their child’s deafness had the largest impact on their emotional well-being. Family members of children using oral communication with a cochlear implant reported higher satisfaction with their child’s speech production and perception outcomes than family members of children using hearing aids alone.

Implications

We recommend that service providers and early hearing detection and intervention program coordinators consider additional supports for family well-being following the early identification of deafness in children.