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Hall AJ, Dillon B, Pryce H, Ambler M, Hanvey K. A qualitative exploration of the assessment process to cochlear implantation for children with hearing loss. Int J Audiol 2024:1-9. [PMID: 39373479 DOI: 10.1080/14992027.2024.2400328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 08/19/2024] [Accepted: 08/28/2024] [Indexed: 10/08/2024]
Abstract
OBJECTIVE To explore the process of paediatric cochlear implant assessment, from referral to implantation, from the perspective of parents, cochlear implant professionals, and through observations of clinics. DESIGN Qualitative approach, using grounded theory methodology. STUDY SAMPLE Twelve families with children under 5 years with permanent hearing loss referred for a cochlear implant or received an implant in the past year, and six professionals who refer or assess children for cochlear implants. Data collection involved interviews and ethnographic observations of assessment clinics. RESULTS The core theme derived from interview and observation data related to the work of the cochlear implant assessment for families. The relationship between the work generated by the assessment process and capacity of parents to do the work provides a model to examine access to early implantation, consistent with the Burden of Treatment theory. We identified variation in terms of workload, relating to factors such as a child's additional needs or number of appointments required, and in terms of capacity, relating to factors such as social circumstances or health literacy. Social, peer and professional support and information helped families manage the workload. CONCLUSIONS Findings have implications for delivery of paediatric cochlear implant services.
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Affiliation(s)
- Amanda J Hall
- Department of Audiology, College of Health and Life Sciences, Aston University, Birmingham, United Kingdom
| | - Briony Dillon
- Department of Audiology, College of Health and Life Sciences, Aston University, Birmingham, United Kingdom
| | - Helen Pryce
- Department of Audiology, College of Health and Life Sciences, Aston University, Birmingham, United Kingdom
| | - Marette Ambler
- The Midlands Hearing Implant Programme, Aston University Day Hospital, Aston University, Birmingham, United Kingdom
| | - Kate Hanvey
- The Midlands Hearing Implant Programme, Aston University Day Hospital, Aston University, Birmingham, United Kingdom
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Silva AL, Stumpf IMDS, Lacroix LP, Alves DMF, Silveira ALD, Costa SSD, Rosito LPS. Language development in children from a public cochlear implant program. Braz J Otorhinolaryngol 2024; 90:101458. [PMID: 39032465 PMCID: PMC11315129 DOI: 10.1016/j.bjorl.2024.101458] [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] [Received: 11/06/2023] [Revised: 05/16/2024] [Accepted: 06/03/2024] [Indexed: 07/23/2024] Open
Abstract
OBJECTIVE To evaluate the rate of loss to follow-up in a cochlear implant program from the public health system in Southern Brazil as well as the characteristics of hearing loss, sociodemographic, sociocultural and the development of oral language in children with prelingual deafness. METHODS Retrospective cohort study with children who underwent CI surgery between 2010 and 2020. Data was collected through of interviews and review of medical records. The language development assessment was performed using the MUSS, MAIS and IT-MAIS scales. For the classification of language development, we used as parameters the values (mean ± SD) found in a previous national study. From those values, the Z-score for each patient at each hearing age (time of experience with the cochlear implant) was calculated. RESULTS Of the 225 children implanted between 2010-2020, 129 were included in this study. The rate of loss to follow-up in the program was 42.6%. The mean age at first surgery was 40.5 (±16.9) months, with 77.5% of patients having received a unilateral implant. Language results below the expected for hearing age ( CONCLUSIONS Most patients had an elevated mean age at cochlear implantation and there was a high rate of loss to follow-up and low attendance to speech and programming sessions. An overall poor language performance was found for this pediatric cochlear implant program from the public health system in Southern Brazil. LEVEL OF EVIDENCE Level 3 (Non-randomized cohort study).
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Affiliation(s)
- Alice Lang Silva
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil.
| | | | - Laura Prolla Lacroix
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Porto Alegre, RS, Brazil
| | | | | | - Sady Selaimen da Costa
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Otorrinolaringologia, Porto Alegre, RS, Brazil
| | - Letícia Petersen Schmidt Rosito
- Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Otorrinolaringologia, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Porto Alegre, RS, Brazil
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Silva AL, Roberto AC, Ramos MA, Alves DMF, Stumpf IMS, Lacroix LP, Rosito LPS. Functional Language in Children from a Public Cochlear Implant Program in a Developing Country. Int Arch Otorhinolaryngol 2024; 28:e517-e522. [PMID: 38974642 PMCID: PMC11226275 DOI: 10.1055/s-0044-1785205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 01/30/2024] [Indexed: 07/09/2024] Open
Abstract
Introduction The World Health Organization (WHO) estimates that ∼ 32 million children worldwide are affected by hearing loss (HL). Cochlear implant is the first-line treatment for severe to profound sensorineural HL. It is considered one of the most successful prostheses developed to date. Objective To evaluate the oral language development of pediatric patients with prelingual deafness implanted in a reference hospital for the treatment of HL in southern Brazil. Methods We conducted a retrospective cohort study with a review of medical records of patients undergoing cochlear implant surgery between January 2009 and December 2018. Language development was assessed by reviewing consultations with speech therapy professionals from the cochlear implant group. Results A total of 152 children were included in the study. The mean age at cochlear implant surgery was of 41 months (standard deviation [SD]: ± 15). The patients were divided into six groups considering the type of language most used in their daily lives. We found that 36% of children use oral language as their primary form of communication. In a subanalysis, we observed that patients with developed or developing oral language had undergone cochlear implant surgery earlier than patients using Brazilian Sign Language (Língua Brasileira de Sinais, LIBRAS, in Portuguese) or those without developed language. Conclusion The cochlear implant is a state-of-the-art technology that enables the re-establishment of the sense of hearing and the development of oral language. However, language development is a complex process known to present a critical period to properly occur. We still see many patients receiving late diagnosis and treatment, which implies a delay and, often, the impossibility of developing oral communication. Level of Evidence Level 3 (cohort study).
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Affiliation(s)
- Alice Lang Silva
- School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Division of Otorhinolaryngology and Head and Neck Surgery, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | | | | | - Isadora Martins Silva Stumpf
- Division of Otorhinolaryngology and Head and Neck Surgery, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Laura Prolla Lacroix
- School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Letícia Petersen Schmidt Rosito
- School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Division of Otorhinolaryngology and Head and Neck Surgery, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Meral Çetinkaya M, Konukseven Ö, İralı AE. World of sounds (Seslerin Dünyası): A mobile auditory training game for children with cochlear implants. Int J Pediatr Otorhinolaryngol 2024; 179:111908. [PMID: 38461681 DOI: 10.1016/j.ijporl.2024.111908] [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: 12/21/2023] [Revised: 02/24/2024] [Accepted: 03/04/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVES The aim of this study is to develop a mobile auditory training application based on gaming for children aged 3-5 years using cochlear implants and to evaluate its usability. METHODS 4 games were developed in the scope of the application World of Sounds; the crucible sound for auditory awareness, mole hunting for auditory discrimination, find the sound for auditory recognition, and choo-choo for auditory comprehension. The prototype was applied to 20 children with normal hearing and 20 children with cochlear implants, all of whom were aged 3-5. The participants were asked to fill out the Game Evaluation Form for Children. Moreover, 40 parents were included in the study, and the Evaluation Form for the Application was applied. RESULTS According to the form, at least 80% of children using cochlear implants, and all children in the healthy group, responded well to the usability factors. All factors were obtained as highly useable by parents of the children using cochlear implants. The results indicated that in the healthy group, the usefulness and motivation factors were above moderate, and the other factors were highly useable. In the mole-hunting game, there was no significant difference between the groups in the easy level of the first sub-section (p > 0.05). There was a significant difference between the groups in terms of the other sub-sections of the mole-hunting game and all sub-sections of the crucible sound, find the sound, and the choo-choo games (p < 0.05). While there was no correlation between duration of cochlear implant use and ADSI scores and the third sub-section of the crucible sound game (p > 0.05); a correlation was found in the other sub-sections of crucible sound and all sub-sections of the mole hunting, find the sound, and Choo-Choo games (p < 0.05). CONCLUSION It is thought that the application World of Sounds can serve as an accessible option to support traditional auditory rehabilitation for children with cochlear implants.
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Affiliation(s)
- Merve Meral Çetinkaya
- Department of Audiology, Faculty of Health Sciences, Istanbul Aydin University, Istanbul, Turkey.
| | - Özlem Konukseven
- Department of Audiology, Faculty of Health Sciences, Istanbul Aydin University, Istanbul, Turkey.
| | - Ali Efe İralı
- Department of Cartoon and Animation, Faculty of Fine Arts, Istanbul Aydin University, Istanbul, Turkey.
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Ren AZ, Sung V. Factors that influence health service access in deaf and hard-of-hearing children: a narrative review. Int J Audiol 2024; 63:171-181. [PMID: 37335176 DOI: 10.1080/14992027.2023.2223357] [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] [Received: 12/06/2022] [Revised: 05/31/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVES Early diagnosis and intervention of deaf and hard-of-hearing (DHH) children leads to improved language and psychosocial outcomes. However, many child, parent and provider related factors can influence access to early intervention services, including hearing devices. This narrative review aims to explore factors that influence health service access in DHH children. DESIGN A systematic search was conducted to identify articles that explored factors that influenced health service access in DHH children in countries with Universal Newborn Hearing Screening, published between 2010 and 2022. STUDY SAMPLES Fifty-nine articles met the inclusion criteria for data extraction. This included 4 systematic reviews, 2 reviews, 39 quantitative and 5 mixed methods studies and 9 qualitative studies. RESULTS The identified factors were grouped into the following themes: (a) demographic factors, (b) family related factors, (c) child related factors, (d) factors specific to hearing devices, (e) service delivery, f) telehealth and (g) COVID-19. CONCLUSION This review provided a comprehensive summary of multiple factors that affect access to health services in DHH children. Psychosocial support, consistent clinical advice, allocation of resources to rural communities and use of telehealth are possible ways to address barriers and improve health service access.
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Affiliation(s)
- Angela Z Ren
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Valerie Sung
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Population Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Centre for Community Child Health, Royal Children's Hospital, Parkville, Victoria, Australia
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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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Drake M, Friedland DR, Hamad B, Marfowaa G, Adams JA, Luo J, Flanary V. Factors associated with delayed referral and hearing rehabilitation for congenital sensorineural hearing loss. Int J Pediatr Otorhinolaryngol 2023; 175:111770. [PMID: 37890209 DOI: 10.1016/j.ijporl.2023.111770] [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: 08/22/2023] [Revised: 10/17/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVES To identify the impact of social determinants of health and clinical status on referral and intervention for congenital sensorineural hearing loss. STUDY DESIGN Retrospective chart review of children with confirmed sensorineural or mixed hearing loss between 2013 and 2021 at a single academic medical institution. METHODS Referral rates and timing for hearing rehabilitation, rates and timing of completed evaluation, and rate and timing of amplification were recorded. Patient demographics included gestational age, race, ethnicity, sex, hearing loss severity, and CMV status. RESULTS There were 216 children with confirmed sensorineural or mixed hearing loss, of which 77 had a unilateral hearing loss and 89 a severe or profound hearing loss. Delayed referral for hearing aid evaluation was noted in premature patients (median 375 days premature, median 147 term; p < 0.01) and publicly insured patients (median 215 days, median 123 private; p = 0.04). Delayed time to hearing aid fitting was noted for non-white patients (median 325 days, median 203 white patients; p < 0.01), publicly insured patients (median 309 days, median 212 private insurance; p < 0.02), and premature patients (median 462 days, median 224 term; p = 0.03). White patients were more likely to be referred for cochlear implant (p = 0.03).Privately insured patients and patients with a positive CMV test were more likely to be referred for cochlear implant evaluation, be seen in the cochlear implant clinic, and undergo implantation (p < 0.05). Non-white patients had a delay in cochlear implantation referral (median 928 days, median 398 days white patients; p = 0.05). Prolonged interval between evaluation in cochlear implant clinic to implantation was noted for privately insured patients (median 125 days; median 78 days publicly insured; p = 0.05). CONCLUSIONS Sociodemographic factors were significantly associated with hearing amplification referral rates and time until amplification for children with identified congenital sensorineural hearing loss. For cochlear implantation, insurance type, CMV status were significantly associated with rate and timing of cochlear implant pathway.
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Affiliation(s)
- Marc Drake
- Medical College of Wisconsin, Department of Otolaryngology and Communication Sciences, United States
| | - David R Friedland
- Medical College of Wisconsin, Department of Otolaryngology and Communication Sciences, United States
| | - Bushra Hamad
- Medical College of Wisconsin, Department of Otolaryngology and Communication Sciences, United States
| | - Gifty Marfowaa
- Medical College of Wisconsin, Department of Otolaryngology and Communication Sciences, United States
| | - Jazzmyne A Adams
- Medical College of Wisconsin, Department of Otolaryngology and Communication Sciences, United States
| | - Jake Luo
- Department of Health Informatics and Administration, University of Wisconsin, Milwaukee, United States
| | - Valerie Flanary
- Medical College of Wisconsin, Department of Otolaryngology and Communication Sciences, United States.
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Spitzer ER, Waltzman SB. Cochlear implants: the effects of age on outcomes. Expert Rev Med Devices 2023; 20:1131-1141. [PMID: 37969071 DOI: 10.1080/17434440.2023.2283619] [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] [Received: 07/13/2023] [Accepted: 11/10/2023] [Indexed: 11/17/2023]
Abstract
INTRODUCTION Cochlear implants (CIs) provide access to sound for children and adults who do not receive adequate benefit from hearing aids. Age at implantation is known to affect outcomes across the lifespan. AREAS COVERED The effects of age on CI outcomes are examined for infants, children, adolescents, and older adults. A variety of outcome measures are considered, including speech perception, language, cognition, and quality of life measures. EXPERT OPINION/COMMENTARY For those meeting candidacy criteria, CIs are beneficial at any age. In general, younger age is related to greater benefit when considering pre-lingual deafness. Other factors such as additional disabilities, may mitigate this effect. Post-lingually deafened adults demonstrate similar benefit regardless of age, though the oldest individuals (80+) may see smaller degrees of improvement from preoperative scores. Benefit can be measured in many ways, and the areas of greatest benefit may vary based on age: young children appear to see the greatest effects of age at implantation on language measures, whereas scores on cognitive measures appear to be most impacted for the oldest population. Future research should consider implantation at extreme ages (5-9 months or > 90 years), unconventional measures of CI benefit including qualitative assessments, and longitudinal designs.
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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
| | - 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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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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The feasibility of cochlear implantation in early infancy. Int J Pediatr Otorhinolaryngol 2023; 165:111433. [PMID: 36634570 DOI: 10.1016/j.ijporl.2022.111433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/12/2022] [Accepted: 12/29/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To determine the key image anatomical parameters that are relevant to cochlear implantation (CI) using temporal bone high-resolution computed tomography (HRCT) scans and to identify age group differences in order to provide image anatomical support for early CI. METHODS The data of 346 temporal bone HRCTs of 173 children from 5 months to 18 years of age were retrospectively selected and reviewed. Parameters of the human temporal bone that are relevant to CI key surgical steps include mastoid thickness (MT), the facial recess width (FRW), and an angle representing the round window visibility. All measurements are performed on axial images. RESULTS There was no significant difference in the above morphological values by gender (p > 0,05). Two-sided FRW was not significantly different (p > 0,05), but MT and angle A were significantly different (p < 0,001). FRW and angle were independent of age (p > 0,05). However, MT had been found to exhibit postnatal development. The linear function of MT were calculated as y = 2463 × group(s) + 20,574 (p < 0,001). CONCLUSIONS Based on preoperative imaging analysis at different ages, middle ear development was stable at 5 months of age, allowing early CI in infancy with severe to severe hearing loss at this age. These data must be considered exploratory and more extensive clinical studies are needed.
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Chen L, Zhang JG, Zhu HY, Hou XY, Tang ZQ, Sun JW, Sun JQ, Guo XT. Electrically Evoked Auditory Brainstem Responses in Children Fitted with Hearing Aids Prior to Cochlear Implantation. Trends Hear 2023; 27:23312165221148846. [PMID: 36632674 PMCID: PMC9982387 DOI: 10.1177/23312165221148846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
This study investigates the effect of hearing aid use on the peripheral auditory pathways in children with sensorineural hearing loss prior to cochlear implantation, as revealed by the electrically evoked auditory brainstem response (EABR). Forty children with hearing aids were recruited. Half of them had normal inner ear structures and the other half had inner ear malformations (IEMs). The EABR was evoked by electrically stimulating the round window niche (RWN) and round window membrane (RWM) during the cochlear implantation operation. The onset age of hearing aid use was significantly correlated with the peak latencies, but not amplitudes, of the wave III (eIII) and wave V (eV). Higher EABR thresholds were found for RWN stimulation than for RWM stimulation and in the children with IEMs than in those without IEMs. Our study provides neurophysiological evidence that earlier use of hearing aids may ameliorate physiological functions of the peripheral auditory pathway in children with and without IEMs. The EABR evoked by the electrical stimulation at RWM is more sensitive compared with that at RWN for evaluating functions of the auditory conduction pathway.
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Affiliation(s)
- Li Chen
- Department of Otolaryngology-Head and Neck Surgery, The First
Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of
Science and Technology of China, Hefei, Anhui, 230001, China,Wannan Medical College, Anhui Provincial Hospital, Hefei, Anhui,
230001, China
| | - Jun-Ge Zhang
- Department of Otolaryngology-Head and Neck Surgery, The First
Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of
Science and Technology of China, Hefei, Anhui, 230001, China,Wannan Medical College, Anhui Provincial Hospital, Hefei, Anhui,
230001, China
| | - Han-Yu Zhu
- Department of Otolaryngology-Head and Neck Surgery, The First
Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of
Science and Technology of China, Hefei, Anhui, 230001, China
| | - Xiao-Yan Hou
- Department of Otolaryngology-Head and Neck Surgery, The First
Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of
Science and Technology of China, Hefei, Anhui, 230001, China
| | - Zheng-Quan Tang
- School of Life Sciences, Anhui University, Hefei, Anhui, 230601, China
| | - Jing-Wu Sun
- Department of Otolaryngology-Head and Neck Surgery, The First
Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of
Science and Technology of China, Hefei, Anhui, 230001, China
| | - Jia-Qiang Sun
- Department of Otolaryngology-Head and Neck Surgery, The First
Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of
Science and Technology of China, Hefei, Anhui, 230001, China,Jia-Qiang Sun, Department of
Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of USTC,
Division of Life Sciences and Medicine, University of Science and Technology of
China, Hefei, Anhui 230001, China.
| | - Xiao-Tao Guo
- Department of Otolaryngology-Head and Neck Surgery, The First
Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of
Science and Technology of China, Hefei, Anhui, 230001, China,CAS Key Laboratory of Brain Function and Diseases, School of Life
Sciences, University of Science and Technology of China, Hefei, Anhui, 230027,
China,Xiao-Tao Guo, Department of
Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of USTC,
Division of Life Sciences and Medicine, University of Science and Technology of
China, Hefei, Anhui 230001, China.
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Ferguson O, Simões-Franklin C, Walshe P, Glynn F, Viani L. In an era of bilateral funding and changing criteria, when is unilateral cochlear implantation a better option? Eur Arch Otorhinolaryngol 2022; 279:5913-5920. [PMID: 35852651 DOI: 10.1007/s00405-022-07500-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/01/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Funding for paediatric bilateral cochlear implantation became available in Ireland in 2014. Prior to this, children eligible for cochlear implantation received a unilateral implant. OBJECTIVE To examine the cohort of children who received a unilateral cochlear implant in the 4 year period following bilateral cochlear implantation funding becoming available. METHODS A clinical audit of all children implanted for the first time between July 2014 and July 2018. The unilaterally implanted children (n = 105) were divided into 3 groups according to whether they met the audiometric thresholds for implantation in neither ear (Group 1), one ear (Group 2) or both ears (Group 3). One year post operative functional outcomes were examined for all 3 groups. RESULTS All 3 groups showed significant improvements in functional outcomes at 1 year post op. To date, 20% of the unilaterally implanted children have proceeded to get a sequential CI, often where there was no change in audiological status. CONCLUSIONS The number of children in Groups 1 and 2 highlighted how our decision making around cochlear implantation has changed in recent years. Unilateral cochlear implantation in certain circumstances is good practice, independent of the audiological profile when an experienced multi-disciplinary team (MDT) is involved in the decision making process. Decision making using a holistic model approach is key, including involving the parent/carer and, where appropriate, the child/teenager themselves. A staged bilateral cochlear implant is also a good option, where careful monitoring and support for the first implant has resulted in positive outcomes.
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Affiliation(s)
- Olivia Ferguson
- National Hearing Implant and Research Centre (NHIRC), Beaumont Hospital, Dublin 9, Ireland.
| | - Cristina Simões-Franklin
- National Hearing Implant and Research Centre (NHIRC), Beaumont Hospital, Dublin 9, Ireland.,School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Peter Walshe
- National Hearing Implant and Research Centre (NHIRC), Beaumont Hospital, Dublin 9, Ireland.,Royal College of Surgeons Ireland, Dublin 2, Ireland
| | - Fergal Glynn
- National Hearing Implant and Research Centre (NHIRC), Beaumont Hospital, Dublin 9, Ireland.,Royal College of Surgeons Ireland, Dublin 2, Ireland
| | - Laura Viani
- National Hearing Implant and Research Centre (NHIRC), Beaumont Hospital, Dublin 9, Ireland.,School of Medicine, Trinity College Dublin, Dublin 2, Ireland.,Royal College of Surgeons Ireland, Dublin 2, Ireland
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13
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McGregor S, Goldman RD. Les effets sur le langage d’une implantation cochléaire. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:739-741. [PMID: 36241407 PMCID: PMC9833142 DOI: 10.46747/cfp.6810739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Question Un jeune bébé suivi par votre clinique a reçu un diagnostic de perte auditive congénitale profonde. Ses parents envisagent un implant cochléaire pour leur enfant, mais ils s’inquiètent de son acquisition du langage avant et après l’intervention chirurgicale. Que devraient-ils savoir à propos de l’intervention, et comment peuventils améliorer les résultats sur le plan du langage? Réponse La perte auditive congénitale est souvent détectée chez les nouveau-nés lors d’un dépistage par des tests auditifs. Les implants cochléaires peuvent améliorer dans l’ensemble les habiletés en langue parlée chez les enfants souffrant d’une déficience auditive profonde. Certains facteurs associés à la réussite de l’acquisition du langage après l’implantation cochléaire sont l’exécution de la procédure en bas âge et l’engagement de la famille dans des programmes d’intervention précoce. L’apprentissage de la langue des signes avant l’opération peut améliorer les résultats subséquents sur le plan du langage et contribuer au sain développement cognitif et socioémotionnel de l’enfant.
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14
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McGregor S, Goldman RD. Language outcomes after cochlear implant. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:737-738. [PMID: 36241402 PMCID: PMC9833135 DOI: 10.46747/cfp.6810737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
QUESTION A young infant seen in our practice was diagnosed with profound congenital hearing loss. Their parents want to pursue cochlear implant surgery for their child, but they are concerned about language acquisition before and after the surgery. What should they know about the procedure, and how can they improve language outcomes? ANSWER Congenital hearing loss is often identified on newborn screening hearing tests. Cochlear implants may lead to overall improved spoken language skills among children with profound hearing loss. Some factors associated with successful language acquisition in children after cochlear implant surgery include having the procedure at an earlier age and family engagement in early intervention programs. Learning sign language before cochlear implant surgery may improve subsequent language outcomes and support the child's cognitive and socioemotional success.
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15
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Nassiri AM, Holcomb MA, Perkins EL, Bucker AL, Prentiss SM, Welch CM, Andresen NS, Valenzuela CV, Wick CC, Angeli SI, Sun DQ, Bowditch SP, Brown KD, Zwolan TA, Haynes DS, Saoji AA, Carlson ML. Catchment Profile of Large Cochlear Implant Centers in the United States. Otolaryngol Head Neck Surg 2022; 167:545-551. [PMID: 35041546 PMCID: PMC9289081 DOI: 10.1177/01945998211070993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To characterize the catchment area and patient profile of large cochlear implant (CI) centers in the United States. STUDY DESIGN Multi-institutional retrospective case series. SETTING Tertiary referral CI centers. METHODS Patients who underwent CI surgery at 7 participating CI centers between 2015 and 2020 were identified. Patients' residential zip codes were used to approximate travel distances and urban vs rural residential areas. RESULTS Over the 6-year study period (2015-2020), 6313 unique CI surgical procedures occurred (4529 adult, 1784 pediatric). Between 2015 and 2019, CI procedures increased by 43%. Patients traveled a median 52 miles (interquartile range, 21-110) each way; patients treated at rural CI centers traveled greater distances vs those treated at urban centers (72 vs 46 miles, P < .001). Rural residents represented 61% of the patient population and traveled farther than urban residents (73 vs 24 miles, P < .001). Overall, 91% of patients lived within a 200-mile radius of the institution, while 71% lived within a 100-mile radius. In adults, multiple regression analysis redemonstrated an association between greater travel distances and (1) older age at the time of CI and (2) residential rural setting (both P < .001, r2 = 0.2). CONCLUSIONS While large CI centers serve geographically dispersed populations, most patients reside within a 200-mile radius. Strategies to expand CI utilization may leverage remote programming, telemedicine, and strategic placement of new centers and satellite clinics to ameliorate travel burden.
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Affiliation(s)
- Ashley M. Nassiri
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Meredith A. Holcomb
- Department of Otolaryngology–Head and Neck Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Elizabeth L. Perkins
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Andrea L. Bucker
- Department of Otolaryngology–Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sandra M. Prentiss
- Department of Otolaryngology–Head and Neck Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Christopher M. Welch
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Nick S. Andresen
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Johns Hopkins University Baltimore, MD, USA
| | - Carla V. Valenzuela
- Department of Otolaryngology–Head and Neck Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Cameron C. Wick
- Department of Otolaryngology–Head and Neck Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Simon I. Angeli
- Department of Otolaryngology–Head and Neck Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Daniel Q. Sun
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Johns Hopkins University Baltimore, MD, USA
| | - Stephen P. Bowditch
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Johns Hopkins University Baltimore, MD, USA
| | - Kevin D. Brown
- Department of Otolaryngology–Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Teresa A. Zwolan
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - David S. Haynes
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Aniket A. Saoji
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew L. Carlson
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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16
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Nassiri AM, Saoji AA, DeJong MD, Tombers NM, Driscoll CLW, Neff BA, Haynes DS, Carlson ML. Implementation Strategy for Highly-Coordinated Cochlear Implant Care With Remote Programming: The Complete Cochlear Implant Care Model. Otol Neurotol 2022; 43:e916-e923. [PMID: 35970171 PMCID: PMC9394487 DOI: 10.1097/mao.0000000000003644] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To introduce and discuss implementation strategy for the Complete Cochlear Implant Care (CCIC) model, a highly-coordinated cochlear implant (CI) care delivery model requiring a single on-site visit for preoperative workup, surgery, and postoperative programming. STUDY DESIGN Prospective, nonrandomized, two-arm clinical trial. SETTING Tertiary referral CI center. PATIENTS Adults who meet audiologic criteria for cochlear implantation. INTERVENTIONS Cochlear implantation, coordinated care delivery, including remote programming. MAIN OUTCOME MEASURES Care delivery model feasibility and process implementation. RESULTS Patients determined to be likely CI candidates based on routine audiometry are eligible for enrollment. The CCIC model uses telemedicine and electronic educational materials to prepare patients for same-day on-site consultation with CI surgery, same or next-day activation, and postoperative remote programming for 12 months. Implementation challenges include overcoming inertia related to the implementation of a new clinical workflow, whereas scalability of the CCIC model is limited by current hardware requirements for remote programming technology. A dedicated CCIC process coordinator is critical for overcoming obstacles in implementation and process improvement through feedback and iterative changes. Team and patient-facing materials are included and should be tailored to fit each unique CI program looking to implement CCIC. CONCLUSION The CCIC model has the potential to dramatically streamline hearing healthcare delivery. Implementation requires an adaptive approach, as obstacles may vary according to institutional infrastructure and policies.
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Affiliation(s)
- Ashley M. Nassiri
- Department of Otolaryngology—Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Aniket A. Saoji
- Department of Otolaryngology—Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Melissa D. DeJong
- Department of Otolaryngology—Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Nicole M. Tombers
- Department of Otolaryngology—Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Colin L. W. Driscoll
- Department of Otolaryngology—Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Brian A. Neff
- Department of Otolaryngology—Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - David S. Haynes
- Department of Otolaryngology—Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matthew L. Carlson
- Department of Otolaryngology—Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
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17
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Gordon SA, Waltzman SB, Friedmann DR. Delayed cochlear implantation in congenitally deaf children-identifying barriers for targeted interventions. Int J Pediatr Otorhinolaryngol 2022; 155:111086. [PMID: 35219037 DOI: 10.1016/j.ijporl.2022.111086] [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: 09/29/2021] [Revised: 02/01/2022] [Accepted: 02/15/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Age of cochlear implantation (CI) is an important predictor of language development in those with congenital sensorineural hearing loss. Despite universal newborn hearing screening initiatives and the known benefits of early CI, a subset of congenitally deaf children continue to be evaluated for cochlear implants later in childhood. This study aims to identify the barriers to early cochlear implantation in these children. METHODS A retrospective review was conducted for all pediatric cochlear implants aged 3 years or older performed at a single academic institution between 2013 and 2017. Children implanted before the age three, those with a prior unilateral cochlear implant, and those with progressive or sudden hearing loss were excluded. Variables included newborn hearing screen results, age at hearing loss diagnosis, time of initiation and documented benefit of hearing aids, age of implantation, pre/post-implantation evaluation scores, and reason for delayed referral for cochlear implantation. RESULTS Thirty-one patients were identified meeting these inclusion criteria. Twenty-one children were subject to UNBS in the U.S. Fourteen of those children failed their newborn hearing screening. Average age at implantation was 6.2 years. Four reasons were identified for increased age at cochlear implantation. Two categories represent delays related to (1) Amplification continually prescribed even though the range of hearing loss and speech development assessment suggests CI may have been more appropriate well before referral (N = 13) (2) Patients were not subject to newborn hearing screening and/or timely diagnosis of their hearing loss (N = 8). In other cases, patients were appropriately fit with hearing aids until evidence that they derived limited benefit and then referred for CI (N = 8). Lastly, in a few cases, records were indeterminate with regards to the timing and appropriate diagnosis of their hearing loss (N = 2). CONCLUSION Understanding the reasons for delayed cochlear implantation in congenitally deaf children might allow the development of targeted interventions to improve outcomes. Specifically, those children who were not referred before age 3 despite use of amplification with limited benefit offer one potential target population for earlier CI.
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Affiliation(s)
- Steven A Gordon
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, USA
| | - Susan B Waltzman
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, USA
| | - David R Friedmann
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, USA.
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American Cochlear Implant Alliance Task Force Guidelines for Determining Cochlear Implant Candidacy in Children. Ear Hear 2022; 43:268-282. [PMID: 35213891 PMCID: PMC8862774 DOI: 10.1097/aud.0000000000001087] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article summarizes the available evidence on pediatric cochlear implantation to provide current guidelines for clinical protocols and candidacy recommendations in the United States. Candidacy determination involves specification of audiologic and medical criteria per guidelines of the Food and Drug Administration. However, recommendations for a cochlear implant evaluation also should maintain flexibility and consider a child’s skill progression (i.e., month-for-month progress in speech, language, and auditory development) and quality of life with appropriately fit hearing aids. Moreover, evidence supports medical and clinical decisions based on other factors, including (a) ear-specific performance, which affords inclusion of children with asymmetric hearing loss and single-sided deafness as implant candidates; (b) ear-specific residual hearing, which influences surgical technique and device selection to optimize hearing; and (c) early intervention to minimize negative long-term effects on communication and quality of life related to delayed identification of implant candidacy, later age at implantation, and/or limited commitment to an audiologic rehabilitation program. These evidence-based guidelines for current clinical protocols in determining pediatric cochlear implant candidacy encourage a team-based approach focused on the whole child and the family system.
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Almishaal AA, Saleh S, Alferaih H, Alhelo O. Prevalence, risk factors, and audiological characteristics of auditory neuropathy. Int J Audiol 2021; 61:1018-1026. [PMID: 34928752 DOI: 10.1080/14992027.2021.2014074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The objective of this study was to determine the prevalence, risk factors, and audiological characteristics of auditory neuropathy spectrum disorder (ANSD) in the pediatric population. DESIGN A retrospective review of medical charts was conducted for children visiting two hospitals in Saudi Arabia. STUDY SAMPLE Medical records of 1025 patients with sensorineural hearing loss (SNHL) were reviewed. We analyzed the databases for results of audiological examinations, risk factors, and outcomes of intervention including hearing aid (HA) and cochlear implantation (CI). RESULTS Out of 1025 children with SNHL, 101 patients (9.85%) were identified to have ANSD. Audiological characteristics of the ANSD group revealed a severe-to-profound degree of hearing loss, all showed type A tympanogram and absent reflexes, absent auditory brainstem response (ABR) findings with present cochlear microphonic while otoacoustic emissions were absent in 54.5% of patients. The most prevalent risk factors for ANSD in this group were family history of hearing loss, consanguinity, hyperbilirubinemia, and low birth weight. Pure tone and speech detection thresholds improved significantly with CI compared to HA use in this sample of patients with ANSD. CONCLUSION This study shows that ANSD is not extremely rare among Saudi children with severe to profound hearing loss, with a prevalence of 9.85%.
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Affiliation(s)
- Ali A Almishaal
- College of Applied Medical Sciences, University of Hail, Hail, Saudi Arabia
| | - Shaza Saleh
- King Abdullah Ear Specialist Center, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Hala Alferaih
- Ear, Nose, and Throat Department, Audiology Clinic, King Fahad General Hospital, Jeddah, Saudi Arabia
| | - Osamah Alhelo
- College of Applied Medical Sciences, University of Hail, Hail, Saudi Arabia
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Na E, Toupin-April K, Olds J, Whittingham J, Fitzpatrick EM. Clinical characteristics and outcomes of children with cochlear implants who had preoperative residual hearing. Int J Audiol 2021; 61:108-118. [PMID: 33761807 DOI: 10.1080/14992027.2021.1893841] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Cochlear implants (CI) candidacy criteria have expanded to include children with more residual hearing. This study explored the clinical profiles and outcomes of children with CIs who had preoperative residual hearing in at least one ear. DESIGN A retrospective chart review was conducted to collect clinical characteristics and speech perception data. Pre- and post-CI auditory and speech perception data were analysed using a modified version of the Pediatric Ranked Order Speech Perception (PROSPER) score. STUDY SAMPLE This study included all children with residual hearing who received CIs in one Canadian paediatric centre from 1992 to 2018. RESULTS A total of 100 of 389 (25.7%) children with CIs had residual hearing (median 77.6 dB HL, better ear). The proportion of children with residual hearing increased from 1992 to 2018. Children who had auditory behaviour and speech perception tests (n = 83) showed higher modified PROSPER scores post-CI compared to pre-CI. Phonologically Balanced Kindergarten (PBK) test scores were available for 71 children post-CI; 81.7% (58/71) of children achieved > 80% on the PBK. CONCLUSIONS One in four children who received CIs had residual hearing, and most of them had severe hearing loss at pre-CI. These children showed a high level of speech perception with CIs.
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Affiliation(s)
- Eunjung Na
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Karine Toupin-April
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Janet Olds
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - JoAnne Whittingham
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Elizabeth M Fitzpatrick
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
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21
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Al-Shawi YA, Alrawaf FK, Al-Gazlan NS, Al-Qahtani MM, Almuhawas FA. Relationship between proximity to a cochlear implant center and early presentation in children with congenital hearing loss. Saudi Med J 2021; 41:314-317. [PMID: 32114606 PMCID: PMC7841559 DOI: 10.15537/smj.2020.3.24918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To determine whether distance from a cochlear implant (CI) center can influences the ages of presentation and intervention for CI, which thus may influence CI outcomes in Saudi Arabia. Methods: This study comprised a retrospective crosssectional analysis of 221 patients who presented to the CI committee between March 2016 and March 2018 at King Abdullah Ear Specialist Center, Riyadh, Saudi Arabia. Through phone interviews and patients’ files, age at suspicion, audiology testing, diagnosis, hearing aid fitting, and CI discussion were recorded for prelingually deaf children; additionally, demographic information were recorded. Patients were divided into 3 groups based on the distance between their place of residence and the nearest CI center (residing within 200 km, 200-500 km, and >500 km). Results: Patients living within 200 km showed the youngest mean age for all tested checkpoints; however, there were no statistically significant differences among the groups. Conclusion: In Saudi Arabia, distance from CI center does not have a significant effect on age of presentation for CI intervention.
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Affiliation(s)
- Yazeed A Al-Shawi
- Department of Otolaryngology and Head and Neck Surgery, King Abdullah Ear Specialist Center, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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22
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Purcell PL, Deep NL, Waltzman SB, Roland JT, Cushing SL, Papsin BC, Gordon KA. Cochlear Implantation in Infants: Why and How. Trends Hear 2021; 25:23312165211031751. [PMID: 34281434 PMCID: PMC8295935 DOI: 10.1177/23312165211031751] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 04/22/2021] [Accepted: 06/23/2021] [Indexed: 11/25/2022] Open
Abstract
In children with congenital deafness, cochlear implantation (CI) prior to 12 months of age offers the opportunity to foster more typical auditory development during late infancy and early childhood. Recent studies have found a positive association between early implantation and expressive and receptive language outcomes, with some children able to achieve normal language skills by the time of school entry. Universal newborn hearing screening improved early detection and diagnosis of congenital hearing loss, allowing for earlier intervention, including decision-making regarding cochlear implant (CI) candidacy. It can be more challenging to confirm CI candidacy in infants; therefore, a multidisciplinary approach, including objective audiometric testing, is recommended to not only confirm the diagnosis but also to counsel families regarding expectations and long-term management. Surgeons performing CI surgery in young children should consider both the anesthetic risks of surgery in infancy and the ways in which mastoid anatomy may differ between infants and older children or adults. Multiple studies have found CI surgery in infants can be performed safely and effectively. This article reviews current evidence regarding indications for implantation in children younger than 12 months of age and discusses perioperative considerations and surgical technique.
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Affiliation(s)
- Patricia L. Purcell
- Department of Otolaryngology, Head & Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nicholas L. Deep
- Department of Otolaryngology, Head & Neck Surgery, New York University Grossman School of Medicine, New York, New York, United States
| | - Susan B. Waltzman
- Department of Otolaryngology, Head & Neck Surgery, New York University Grossman School of Medicine, New York, New York, United States
| | - J. Thomas Roland
- Department of Otolaryngology, Head & Neck Surgery, New York University Grossman School of Medicine, New York, New York, United States
| | - Sharon L. Cushing
- Department of Otolaryngology, Head & Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Blake C. Papsin
- Department of Otolaryngology, Head & Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karen A. Gordon
- Department of Otolaryngology, Head & Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
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23
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Park LR, Perkins EL, Woodard JS, Brown KD. Delaying Cochlear Implantation Impacts Postoperative Speech Perception of Nontraditional Pediatric Candidates. Audiol Neurootol 2020; 26:182-187. [PMID: 33352551 DOI: 10.1159/000510693] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 08/05/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION As pediatric cochlear implant (CI) candidacy expands, children with greater degrees of residual hearing are receiving CIs. These nontraditional candidates have audiometric thresholds that meet adult manufacturer labeling but are better than current pediatric guidelines allow. The purpose of this study was to determine the impact of delayed cochlear implantation on speech perception in nontraditional pediatric CI recipients. METHODS Pediatric CI recipients with a history of progressive hearing loss and a preoperative 4-frequency pure-tone average of ≤75 dB HL at the time of implantation were considered for this retrospective study. Preoperative serial audiograms and word recognition scores were reviewed, and a method was created to establish a date when each individual ear 1st met nontraditional candidacy. The length of time between the date of candidacy and implantation was calculated and defined as the "delay time." A multiple linear regression investigated delay time, age at surgery, surgery type (1st vs. 2nd side), and array type as predictive factors of maximum postoperative Consonant-Nucleus-Consonant (CNC) word scores. A one-way ANCOVA was performed comparing the postoperative CNC scores between subjects grouped by delay time. RESULTS A significant regression was found (F(4, 38) = 5.167, p = 0.002, R2 = 0.353). Both age at implantation (p = 0.023) and delay time (p = 0.002) predicted CNC word scores. Longer delay time was associated with poorer word recognition scores, while older age at implantation correlated with higher CNC word scores in this progressive hearing loss group. A significant difference was noted between subjects implanted with <1 year of delay and those with 3 or more years of delay (p = 0.003). All ears implanted within a year of candidacy achieved word recognition abilities that are generally accepted as above average (M = 84.91). CONCLUSION CI candidacy for adults has evolved to allow for greater degrees of residual hearing, while audiometric guidelines for children have not changed since 2000. Our findings suggest that delay of cochlear implantation, even for children with significant levels of residual hearing, leads to poorer outcomes. Modified candidacy guidelines for children should be established to expedite referral to multidisciplinary CI teams and minimize delays in this population.
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Affiliation(s)
- Lisa R Park
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,
| | - Elizabeth L Perkins
- Department of Otolaryngology/Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, USA
| | - Jennifer S Woodard
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kevin D Brown
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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24
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Cross-modal plasticity and central deficiencies: the case of deafness and the use of cochlear implants. HANDBOOK OF CLINICAL NEUROLOGY 2020. [PMID: 32977890 DOI: 10.1016/b978-0-444-64148-9.00025-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
The primary objective of this chapter is to describe the consequences of central deficiencies on the neurodevelopment of children. We approach this topic from the standpoint of congenital deafness. Thus we first present the current state of knowledge on cortical reorganization following congenital deafness. The allocation of auditory cortices to other sensory systems can enhance sensory processing and therefore the cognitive functions related to them. Second, we explore the linguistic development of deaf children. Given that the English written system is speech-based, its acquisition is complex and atypical for deaf children, usually leading to poorer achievements. Next, we explore the impact of a neural prosthesis named the cochlear implant on the neurocognitive and linguistic development of deaf children. In some cases, it allows the individuals to, at least partially, regain access to the lost sense. We also comment on the specific needs of the deaf population when it comes to neuropsychological assessment. Finally, we touch on the specific context of deaf children born of deaf parents, and therefore naturally exposed to sign language as the only means of communication.
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Gabouer A, Oghalai J, Bortfeld H. Parental use of multimodal cues in the initiation of joint attention as a function of child hearing status. DISCOURSE PROCESSES 2020; 57:491-506. [PMID: 32669749 PMCID: PMC7363029 DOI: 10.1080/0163853x.2020.1759022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In the current study, we examine how hearing parents use multimodal cuing to establish joint attention with their hearing (N=9) or deaf (N=9) children during a free-play session. The deaf children were all candidates for cochlear implantation who had not yet been implanted, and each hearing child was age-matched to a deaf child. We coded parents' use of auditory, visual, and tactile cues, alone and in different combinations, during both successful and failed bids for children's attention. Although our findings revealed no clear quantitative differences in parents' use of multimodal cues as a function of child hearing status, secondary analyses revealed that hearing parents of deaf children used shorter utterances while initiating joint attention than did hearing parents of hearing children. Hearing parents of deaf children also touched their children twice as often throughout the play session than did hearing parents of hearing children. These findings demonstrate that parents differentially accommodate the specific needs of their hearing and deaf children in subtle ways to establish communicative intent.
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Affiliation(s)
| | - John Oghalai
- Otolaryngology - Head and Neck Surgery, Keck School of Medicine, University of Southern California
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Bhamjee A, Roux TL, Schlemmer K, Perold J, Cass N, Schroeder K, Schlesinger D, Ceronio D, Vinck B. Parent-perceived challenges related to the pediatric cochlear implantation process and support services received in South Africa. Int J Pediatr Otorhinolaryngol 2019; 126:109635. [PMID: 31421357 DOI: 10.1016/j.ijporl.2019.109635] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/31/2019] [Accepted: 08/07/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine and describe parent-perceived challenges related to the pediatric cochlear implantation process and support services received. METHOD A multicenter survey study across six cochlear implant (CI) programs in South Africa (SA) was conducted. The study sample included 82 parents of pediatric (≤18 years) CI recipients with at least 12 months CI experience. A self-administered questionnaire was developed for the purpose of this study, exploring parental challenges regarding the CI process, education of their implanted children and the support services received. RESULTS The financial implications of cochlear implantation, including CI device maintenance, were identified by parents as the most prominent challenge. Financing issues were the highest scoring reason that attributed to the delay between diagnosis of hearing loss and cochlear implantation, as well as the greatest barrier to bilateral implantation. Parent-perceived educational challenges included finding adequate educational settings specific to the individual needs of their child and a shortage of trained teachers equipped to support children with CIs. The presence of one/more additional developmental conditions and grade repetition were associated with more pronounced parent-perceived educational challenges. Parents considered speech-language therapy as the most critical support service for their implanted children to achieve optimal outcomes, while parent guidance was indicated to be the most critical support service required for parents of pediatric CI recipients. CONCLUSION A greater understanding of parent-perceived challenges will guide CI professionals to promote optimal outcomes, evidence-based service delivery and on-going support to pediatric CI recipients and their families. Study results imply a call for action regarding financial and educational support for pediatric CI recipients in SA.
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Affiliation(s)
- Aaqilah Bhamjee
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Talita le Roux
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa.
| | - Kurt Schlemmer
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Kwazulu Natal, Durban, South Africa; Durban Cochlear Implant Program, Durban, South Africa
| | - Jenny Perold
- Tygerberg Hospital-Stellenbosch University Cochlear Implant Unit, Cape Town, South Africa
| | - Nicolize Cass
- Pretoria Cochlear Implant Unit, Pretoria, South Africa
| | - Kelly Schroeder
- Port Elizabeth Cochlear Implant Unit, Port Elizabeth, South Africa
| | - Dani Schlesinger
- Chris Hani Baragwanath Academic Hospital Cochlear Implant Program, Soweto, South Africa
| | - Deon Ceronio
- Bloemfontein Cochlear Implant Program, Bloemfontein, South Africa
| | - Bart Vinck
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa; Speech-Language Audiology Department, Ghent University, Gent, Belgium
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Al-Shawi Y, Aldhwaihy LS, Bin Zuair AM, Alfallaj RM, Almuhawas F. After a first prelingually deaf child, does the family learn a lesson? Ann Saudi Med 2019; 39:350-353. [PMID: 31580711 PMCID: PMC6832318 DOI: 10.5144/0256-4947.2019.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Congenital sensorineural hearing loss (SNHL) is a common disability in children. It can affect normal language development and educational achievement. Today, the time to cochlear implant is delayed for many children, which in turn delays intervention and impacts outcomes. Lack of knowledge and experience with congenital SNHL in the family are critical factors that can delay identification and intervention. OBJECTIVES Compare treatment seeking behavior in families for a first and second congenitally deaf child. DESIGN Analytical, cross-sectional using medical record data. SETTING Ear specialist hospital in Riyadh. SUBJECTS AND METHODS All patients who presented to the cochlear implant committee from March 2016 to March 2018 and met criteria were included in the study. Data on when the subjects presented to hospital and were approved for cochlear implant were retrieved from the patient files and through phone calls to the family. The age of first suspicion, audiological testing, diagnosis, hearing aid fitting, and the decision for cochlear implant were compared between the first and second child in families with multiple children with congenital SNHL. MAIN OUTCOME MEASURES The timing difference between the first and second deaf child in seeking treatment. SAMPLE SIZE 116 (58 pairs). RESULTS The second child was suspected to have hearing loss 13.6 months earlier than the first child and presented to the cochlear implant committee for final decision 16.7 months earlier than his\her sibling. Differences in the mean ages at suspicion of hearing loss, presentation to the hospital for audiological evaluation, hearing aid fitting, diagnosis, and decision for cochlear implant by cochlear implant committee were statistically significant ( P<.001). CONCLUSION Experience and knowledge has a major effect on early identification. We need to implement educational programs for the public to increase awareness of how to recognize a deaf child and what steps to take. LIMITATIONS Single-centered. CONFLICT OF INTEREST None.
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Affiliation(s)
- Yazeed Al-Shawi
- From the Department of Otolaryngology, King Abdullah Ear Specialist Center, King Saud University, Riyadh, Saudi Arabia
| | | | | | | | - Fida Almuhawas
- From the Department of Otolaryngology, King Abdullah Ear Specialist Center, King Saud University, Riyadh, Saudi Arabia
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Barr M, Dally K, Duncan J. Service accessibility for children with hearing loss in rural areas of the United States and Canada. Int J Pediatr Otorhinolaryngol 2019; 123:15-21. [PMID: 31054536 DOI: 10.1016/j.ijporl.2019.04.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/18/2019] [Accepted: 04/19/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Children in rural areas have difficulty accessing the same services as their urban peers, which is a particular challenge in large countries such as the U.S. and Canada. Despite known problems providing services in rural areas, there is limited research investigating services for children with hearing loss living in rural areas. This scoping review examines the accessibility of services for children with hearing loss in rural U.S. and Canada. METHODS The search strategy included four databases and gray literature from 2008-2018. Eight government documents and 16 articles met the inclusion criteria and the main findings in the literature were themed. RESULTS Children with hearing loss, experienced difficulties accessing specialized services which influenced the timing of diagnosis of hearing loss, receiving hearing technology and accessing ongoing support. Families in rural areas also had access to less information about hearing loss than urban families. Managing funding and health insurance was also a challenge for families in rural areas. CONCLUSION The limited research in this area indicates that children with hearing loss in rural areas can experience barriers when accessing the same services as their urban peers. Limited service provision can negatively influence outcomes for children with hearing loss. Alternate service delivery such as teleintervention and visiting specialists can improve service provision in rural areas. Comprehensive research of the experience of children with hearing loss across states, provinces and territories would guide improvements to services for children with hearing loss in rural areas of the U.S. and Canada.
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Affiliation(s)
- Megan Barr
- The University of Newcastle, Special and Inclusive Education, University Drive, Callaghan, NSW, 2308, Australia.
| | - Kerry Dally
- The University of Newcastle, Special and Inclusive Education, University Drive, Callaghan, NSW, 2308, Australia.
| | - Jill Duncan
- The University of Newcastle, Special and Inclusive Education, University Drive, Callaghan, NSW, 2308, Australia.
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Pitt-Byrne T. Irish School Entry Screening referral trends and cohort comparison with preschool specialist referrals. Int J Audiol 2018; 57:510-518. [PMID: 29504414 DOI: 10.1080/14992027.2018.1437284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To analyse referral cohorts from School Entry Screening, Hearing (SHS) and Vision Screening (SVS) before and after documented changes. To compare referrals to pre-school specialists with subsequent group SHS outcomes. DESIGN Randomized cohort, audit analysis of Community Nursing Developmental and SES records (CHRs), plus Audiology file review for SHS referrals. STUDY SAMPLE Six hundred and sixty-eight mainstream pupils' CHRs were analysed in four birth cohorts, post-SES, using coded anonymized records. RESULTS Significant referral rate differences existed between SHS and SVS. SHS, not SVS, referrals were impacted by nursing staff changes but not by SHS protocol changes. Preschool Audiology referrals outnumbered SHS referrals. All PCHI children with amplification were detected prior to SHS. SHS program yielded conductive hearing loss only. Similar SHS referral rates occurred for pre-school Speech Language Therapy referrals compared to children not referred; just 16% of pre-school Speech Language Therapy primary referrals were referred on to Audiology. CONCLUSIONS SHS referral percentage fell slightly; SVS referral percentage remained unchanged. Low referral rates and low SHS hearing loss yield has modest impact upon Audiology services, but audiometrically screened referrals deserve higher priority. UNHS children born after 2011 create bigger Audiology service impact. International comparisons and European SHS research collaboration are encouraged.
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Affiliation(s)
- Theresa Pitt-Byrne
- a Department of Audiology , HSE Community Audiology Service , Wexford , Ireland
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Abstract
PURPOSE OF REVIEW Children with congenital hearing loss are being identified earlier, leading to earlier intervention. Current US Food and Drug Administration (FDA) criteria states a child must be 12 months or older for cochlear implantation. The purpose of this article is to review recent publications regarding the benefits of implanting infants under 12 months of age. Topics include: safety and efficacy of surgery, speech and language acquisition outcomes, audiologic components, and limitations. RECENT FINDINGS Since the early 1990s, the candidacy criteria evolved drastically. However, the FDA criteria for cochlear implantation in children has remained at 12 months of age or older since 2000. Recent research indicates implanting below 12 months of age a safe and effective procedure. Speech and language outcomes showed better speech and language advantages. In addition, infants implanted earlier showed normal auditory skills as early as 3 months post cochlear implant activation. This article will also address recent findings on the limitations of earlier implantation. SUMMARY Recent research demonstrates positive outcomes in children implanted under 12 months of age. Developing research on earlier implantation could lead to a change in the current FDA criteria allowing infants to reach their speech and hearing potential faster.
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Exploring reasons for late identification of children with early-onset hearing loss. Int J Pediatr Otorhinolaryngol 2017; 100:160-167. [PMID: 28802365 DOI: 10.1016/j.ijporl.2017.06.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/26/2017] [Accepted: 06/30/2017] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Several studies have shown that early identification of childhood hearing loss leads to better language outcomes. However, delays in the confirmation of hearing loss persist even in the presence of well-established universal newborn hearing screening programs (UNHS). The objective of this population-based study was to document the proportion of children who experienced delayed confirmation of congenital and early onset hearing loss in a UNHS program in one region of Canada. The study also sought to determine the reasons for delayed confirmation of hearing loss in children. METHODS Population level data related to age of first assessment, age of identification and clinical characteristics were collected prospectively for all children identified through the UNHS program. We documented the number of children who experienced delay (defined as more than 3 months) from initial audiologic assessment to confirmation of hearing loss. A detailed chart review was subsequently performed to examine the reasons for delay to confirmation. RESULTS Of 418 children identified from 2003 to 2013, 182 (43.5%) presented with congenital or early onset hearing loss, of whom 30 (16.5%) experienced more than 3 months delay from initial audiologic assessment to confirmation of their hearing disorder. The median age of first assessment and confirmation of hearing loss for these 30 children was 3.7 months (IQR: 2.0, 7.6) and 13.8 months (IQR: 9.7, 26.1) respectively. Close examination of the factors related to delay to confirmation revealed that for the overwhelming majority of children, a constellation of factors contributed to late diagnosis. Several children (n = 22; 73.3%) presented with developmental/medical issues, 15 of whom also had middle ear dysfunction at assessment, and 9 of whom had documented family follow-up concerns. For the remaining eight children, additional reasons included ongoing middle ear dysfunction for five children, complicated by family follow-up concerns (n = 3) and mild hearing loss (n = 1) and the remaining three children had isolated reasons related to family follow-up (n = 1) or mild hearing loss (n = 2). CONCLUSION Despite the progress made in the early detection of pediatric hearing loss since UNHS, a substantial number of children referred for early assessment can experience late confirmation and intervention. In particular, infants with developmental and/or medical issues including middle ear disorders are at particular risk for longer time to confirmation of hearing loss.
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Amundsen VV, Wie OB, Myhrum M, Bunne M. The impact of ethnicity on cochlear implantation in Norwegian children. Int J Pediatr Otorhinolaryngol 2017; 93:30-36. [PMID: 28109494 DOI: 10.1016/j.ijporl.2016.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/28/2016] [Accepted: 12/01/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To explore the impact of parental ethnicity on cochlear implantation in children in Norway with regard to incidence rates of cochlear implants (CIs), comorbidies, age at onset of profound deafness (AOD), age at first implantation, uni- or bilateral CI, and speech recognition. METHOD This retrospective cohort study included all children (N = 278) aged <18 years in Norway who received their first CI during the years 2004-2010. RESULTS 86 children (30.9%) in our study sample had parents of non-Nordic ethnicity, of whom 46 were born in Nordic countries with two non-Nordic parents. Compared with the background population, children with non-Nordic parents were 1.9 times more likely to have received CI than Nordic children (i.e., born in Nordic countries with Nordic parents). When looking at AOD, uni-vs. bilateral CIs, and comorbidities, no significant differences were found between Nordic children and children with a non-Nordic ethnicity. Among children with AOD <1 year (n = 153), those born in non-Nordic countries with two non-Nordic parents (n = 6) and adopted non-Nordic children (n = 6) received their first CI on average 14.9 and 21.1 months later than Nordic children (n = 104), respectively (p = 0.006 and 0.005). Among children with AOD <1 year, those born in Nordic countries with two non-Nordic parents (n = 31) received their CI at an older age than Nordic children, but this difference was not significant after adjusting for calendar year of implantation and excluding comorbidity as a potential cause of delayed implantation. The mean age at implantation for children with AOD <1 year dropped 2.3 months/year over the study period. The mean monosyllable speech recognition score was 84.7% for Nordic children and 76.3% for children born in Norway with two non-Nordic parents (p = 0.002). CONCLUSIONS The incidence of CI was significantly higher in children with a non-Nordic vs. a Nordic ethnicity, reflecting a higher incidence of profound deafness. Children born in Norway have equal access to CIs regardless of their ethnicity, but despite being born and receiving care in Norway, prelingually deaf children with non-Nordic parents are at risk of receiving CI later than Nordic children. Moreover, prelingually deaf children who arrive in Norway at an older age may be at risk for a worse prognosis after receiving a CI due to lack of auditory stimulation in early childhood, which is critical for language development and late implantation; this is a serious issue with regard to deafness among refugees.
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Affiliation(s)
- Viktoria Vedeler Amundsen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. Box 1078 Blindern, N-0316 Oslo, Norway.
| | - Ona Bø Wie
- Department of Special Needs Education, Faculty of Education, University of Oslo, P.O. Box 1140 Blindern, N-0318 Oslo, Norway; Department of Otorhinolaryngology, Division of Head and Neck Surgery, Oslo University Hospital Rikshospitalet, P.O. Box 4950, N-0424 Oslo, Norway.
| | - Marte Myhrum
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. Box 1078 Blindern, N-0316 Oslo, Norway; Department of Otorhinolaryngology, Division of Head and Neck Surgery, Oslo University Hospital Rikshospitalet, P.O. Box 4950, N-0424 Oslo, Norway.
| | - Marie Bunne
- Department of Otorhinolaryngology, Division of Head and Neck Surgery, Oslo University Hospital Rikshospitalet, P.O. Box 4950, N-0424 Oslo, Norway.
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Korver AMH, Smith RJH, Van Camp G, Schleiss MR, Bitner-Glindzicz MAK, Lustig LR, Usami SI, Boudewyns AN. Congenital hearing loss. Nat Rev Dis Primers 2017; 3:16094. [PMID: 28079113 PMCID: PMC5675031 DOI: 10.1038/nrdp.2016.94] [Citation(s) in RCA: 287] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Congenital hearing loss (hearing loss that is present at birth) is one of the most prevalent chronic conditions in children. In the majority of developed countries, neonatal hearing screening programmes enable early detection; early intervention will prevent delays in speech and language development and has long-lasting beneficial effects on social and emotional development and quality of life. A diagnosis of hearing loss is usually followed by a search for an underlying aetiology. Congenital hearing loss might be attributed to environmental and prenatal factors, which prevail in low-income settings; congenital infections, particularly cytomegalovirus infection, are also a common risk factor for hearing loss. Genetic causes probably account for the majority of cases in developed countries; mutations can affect any component of the hearing pathway, in particular, inner ear homeostasis (endolymph production and maintenance) and mechano-electrical transduction (the conversion of a mechanical stimulus into electrochemical activity). Once the underlying cause of hearing loss is established, it might direct therapeutic decision making and guide prevention and (genetic) counselling. Management options include specific antimicrobial therapies, surgical treatment of craniofacial abnormalities and implantable or non-implantable hearing devices. An improved understanding of the pathophysiology and molecular mechanisms that underlie hearing loss and increased awareness of recent advances in genetic testing will promote the development of new treatment and screening strategies.
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Affiliation(s)
- Anna M H Korver
- Department of Pediatrics, St Antonius Hospital, PO BOX 2500, 3430 EM Nieuwegein, The Netherlands
| | - Richard J H Smith
- Molecular Otolaryngology and Renal Research Laboratories and the Genetics PhD Program, University of Iowa, Iowa City, Iowa, USA
| | - Guy Van Camp
- Department of Medical Genetics, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Mark R Schleiss
- Division of Pediatric Infectious Diseases and Immunology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Maria A K Bitner-Glindzicz
- Genetics and Genomic Medicine Programme, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Lawrence R Lustig
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Medical Center, New York, New York, USA
| | - Shin-Ichi Usami
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto, Japan
| | - An N Boudewyns
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
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Abstract
OBJECTIVE Identify variables associated with paediatric access to cochlear implants (CIs). DESIGN Part 1. Trends over time for age at CI surgery (N = 802) and age at hearing aid (HA) fitting (n = 487) were examined with regard to periods before, during, and after newborn hearing screening (NHS). Part 2. Demographic factors were explored for 417 children implanted under 3 years of age. Part 3. Pre-implant steps for the first 20 children to receive CIs under 12 months were examined. RESULTS Part 1. Age at HA fitting and CI surgery reduced over time, and were associated with NHS implementation. Part 2. For children implanted under 3 years, earlier age at HA fitting and higher family socio-economic status were associated with earlier CI. Progressive hearing loss was associated with later CIs. Children with a Connexin 26 diagnosis received CIs earlier than children with a premature / low birth weight history. Part 3. The longest pre-CI steps were Step 1: Birth to diagnosis/identification of hearing loss (mean 16.43 weeks), and Step 11: MRI scans to implant surgery (mean 15.05 weeks) for the first 20 infants with CIs under 12 months. CONCLUSION NHS implementation was associated with reductions in age at device intervention in this cohort.
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Affiliation(s)
- Shani Dettman
- a The University of Melbourne, Department of Audiology and Speech Pathology , Parkville, Victoria , Australia ;,b The Royal Victorian Eye and Ear Hospital , East Melbourne, Victoria , Australia ;,c The HEARing CRC , Carlton, Victoria , Australia
| | - Dawn Choo
- a The University of Melbourne, Department of Audiology and Speech Pathology , Parkville, Victoria , Australia ;,b The Royal Victorian Eye and Ear Hospital , East Melbourne, Victoria , Australia ;,c The HEARing CRC , Carlton, Victoria , Australia
| | - Richard Dowell
- a The University of Melbourne, Department of Audiology and Speech Pathology , Parkville, Victoria , Australia ;,b The Royal Victorian Eye and Ear Hospital , East Melbourne, Victoria , Australia ;,c The HEARing CRC , Carlton, Victoria , Australia
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le Roux T, Vinck B, Butler I, Cass N, Louw L, Nauta L, Schlesinger D, Soer M, Tshifularo M, Swanepoel DW. Predictors of pediatric cochlear implantation outcomes in South Africa. Int J Pediatr Otorhinolaryngol 2016; 84:61-70. [PMID: 27063755 DOI: 10.1016/j.ijporl.2016.02.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/27/2016] [Accepted: 02/25/2016] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Talita le Roux
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa.
| | - Bart Vinck
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa; Speech-Language Audiology Department, Ghent University, Belgium
| | - Iain Butler
- Department of Otorhinolaryngology, University of the Free State, Bloemfontein, South Africa
| | | | - Liebie Louw
- Department of Statistics, University of Pretoria, South Africa
| | - Leone Nauta
- Johannesburg Cochlear Implant Program, South Africa
| | - Dani Schlesinger
- Department of Speech Therapy and Audiology, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | - Maggi Soer
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
| | - Mashudu Tshifularo
- Department of Otorhinolaryngology, Steve Biko Academic Hospital, University of Pretoria, South Africa
| | - De Wet Swanepoel
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa; Ear Sciences Centre, School of Surgery, University of Western Australia, Nedlands, Australia; Ear Science Institute Australia, Subiaco, Australia
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