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Mammen L, Zlatopolsky A, Tu N. Cochlear implantation in children with single-sided deafness under the age of 5 years: a review of current literature. Curr Opin Otolaryngol Head Neck Surg 2024:00020840-990000000-00135. [PMID: 39146020 DOI: 10.1097/moo.0000000000000992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
PURPOSE OF REVIEW Here we explore the current literature on cochlear implantation of pediatric patients under the age of 5 years with single-sided deafness (SSD). RECENT FINDINGS Single-sided deafness has been noted to cause developmental delays in speech, language, and cognition because of loss of binaural hearing. Currently, cochlear implantation is the only intervention capable of restoring binaural hearing for pediatric patients with SSD. Young children have been shown to have the greatest neuroplasticity of the auditory cortex before 4 years of age. Currently, only children over the age of 5 years are approved by the United States Food and Drug Administration (FDA) to undergo cochlear implantation for SSD. Cochlear implantation for SSD in patients under the age of 5 years has been performed on a limited basis and has been shown to have excellent results. SUMMARY Cochlear implantation is a well tolerated and effective treatment for pediatric patients under the age of 5 years with SSD. Receiving cochlear implantation under the age of 5 years is critical for child development as neuroplasticity decreases after this age.
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Affiliation(s)
- Luke Mammen
- Department of Otolaryngology - Head and Neck Surgery, Albany Medical Center, New York, USA
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Micaletti F, Boullaud L, Amelot A, Schleich M, Pondaven-Letourmy S, Lescanne E. Day-case otology: Special attention to the pediatric cochlear implantation procedure. Int J Pediatr Otorhinolaryngol 2024; 179:111932. [PMID: 38537448 DOI: 10.1016/j.ijporl.2024.111932] [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: 01/10/2024] [Revised: 03/04/2024] [Accepted: 03/23/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE Assess the feasibility of cochlear implantation as day-surgery in children and identify variables influencing admission, readmission, and unplanned postoperative consultation. METHODS This retrospective observational monocentric study was conducted according to the STROBE recommendations. Between January 2017 and July 2022, all medical records of children who underwent cochlear implantation were analyzed. Eligible children were admitted for the first time to the pediatric day-surgery unit. Exclusion criteria were children planned for inpatient procedure, bilateralization or explantation-reimplantation. Sex assigned at birth, analgesic medication, anesthesia and complications were related to categorical variables. Age, duration of anesthesia, length of stay and ASA score were related to continuous variables. RESULTS We included 66 children from a total of 106. Mean age was 53 months [SD: 46 months, range 8-184 months]. Successful day-surgery management was observed in 86% of cases. In 14% of cases, children were admitted to the pediatric ENT unit for the following reasons: late awakening in 6%, non-controlled pain in 4.5%, postoperative nausea and vomiting in 3.5% of cases. Univariate analysis did not observe any factor promoting success of day-surgery regarding anesthetic agents. Age was not statistically significant as a factor of ambulatory failure. Time spent in the operating room was not a determining factor (p = 0.559). None of the children were rehospitalized. Early unplanned consultations were observed in 3% of cases for vertex edema in 1 case and uncomplicated otorrhea in 1 case. CONCLUSION This study adds to the knowledge on pediatric cochlear implantation and suggests that this procedure is suitable for day-surgery at any age.
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Affiliation(s)
- Fabrice Micaletti
- ENT and Cervico-Facial Surgery Department, University Hospital Center of Tours, 2 Boulevard Tonnellé, 37044, Tours, France.
| | - Luc Boullaud
- ENT and Cervico-Facial Surgery Department, University Hospital Center of Tours, 2 Boulevard Tonnellé, 37044, Tours, France
| | - Aymeric Amelot
- Neurosurgery Department, University Hospital Center of Tours, 2 Boulevard Tonnellé, 37044, Tours, France; INSERM U1253, IBrain, University of Tours, Tours, France
| | - Marianne Schleich
- ENT and Cervico-Facial Surgery Department, University Hospital Center of Tours, 2 Boulevard Tonnellé, 37044, Tours, France
| | - Soizick Pondaven-Letourmy
- ENT and Cervico-Facial Surgery Department, University Hospital Center of Tours, 2 Boulevard Tonnellé, 37044, Tours, France; Pediatric Head and Neck Surgery Department, University Hospital Center of Tours, 49 Boulevard Béranger, 37000, Tours, France
| | - Emmanuel Lescanne
- ENT and Cervico-Facial Surgery Department, University Hospital Center of Tours, 2 Boulevard Tonnellé, 37044, Tours, France; Pediatric Head and Neck Surgery Department, University Hospital Center of Tours, 49 Boulevard Béranger, 37000, Tours, France; Faculty of Medicine, Université de Tours, 10 Boulevard Tonnellé, 37044, Tours, France
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Franchella S, Concheri S, Di Pasquale Fiasca VM, Brotto D, Sorrentino F, Ortolani C, Agostinelli A, Montino S, Gregori D, Lorenzoni G, Borghini C, Trevisi P, Marioni G, Zanoletti E. Bilateral simultaneous cochlear implants in children: Best timing of surgery and long-term auditory outcomes. Am J Otolaryngol 2024; 45:104124. [PMID: 38035465 DOI: 10.1016/j.amjoto.2023.104124] [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: 10/11/2023] [Accepted: 11/19/2023] [Indexed: 12/02/2023]
Abstract
PURPOSE Evaluate the hearing outcomes of bilateral deaf children implanted simultaneously and define the most appropriate timing for surgery. MATERIALS AND METHODS Audiological CI results were retrieved in both the short-term and long-term period and compared by stratifying the patients into different subcohorts according to their age at surgery. Additional data collected were age at implant activation, etiology and timing of onset of deafness, presence of psychomotor delay. RESULTS fifty-six bilaterally implanted children were included. The short-term outcomes differed significantly when comparing groups of different ages at implantation: younger patients achieved better aided pure tone audiometry results. Considering long-term follow-up, a significant correlation was identified between an early age at implantation and the hearing outcome at ages 2 to 5 years. Perceptive levels were better at 4 years of age in the younger group. No significant differences were found between children implanted at before 12 months and between 12 and 16 months of age. CONCLUSIONS The results of the analyzed follow-up data support the hypothesis that children implanted at before 24 months are expected to have better hearing performances. Nevertheless, these results are referred to a widely heterogeneous group of patients and the duration of auditory deprivation should be considered.
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Affiliation(s)
- Sebastiano Franchella
- Section of Otorhinolaryngology, Department of Neuroscience, University of Padova, Padova, Italy
| | - Stefano Concheri
- Section of Otorhinolaryngology, Department of Neuroscience, University of Padova, Padova, Italy
| | | | - Davide Brotto
- Section of Otorhinolaryngology, Department of Neuroscience, University of Padova, Padova, Italy
| | - Flavia Sorrentino
- Section of Otorhinolaryngology, Department of Neuroscience, University of Padova, Padova, Italy
| | - Caterina Ortolani
- Section of Otorhinolaryngology, Department of Neuroscience, University of Padova, Padova, Italy
| | - Anna Agostinelli
- Section of Otorhinolaryngology, Department of Neuroscience, University of Padova, Padova, Italy
| | - Silvia Montino
- Section of Otorhinolaryngology, Department of Neuroscience, University of Padova, Padova, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, via Loredan, 18, 35121 Padova, Italy
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, via Loredan, 18, 35121 Padova, Italy
| | - Carlotta Borghini
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, via Loredan, 18, 35121 Padova, Italy
| | - Patrizia Trevisi
- Section of Otorhinolaryngology, Department of Neuroscience, University of Padova, Padova, Italy
| | - Gino Marioni
- Phoniatrics and Audiology Unit, Department of Neuroscience, University of Padova, Treviso, Italy.
| | - Elisabetta Zanoletti
- Section of Otorhinolaryngology, Department of Neuroscience, University of Padova, Padova, Italy
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Illg A, Adams D, Lesinski-Schiedat A, Lenarz T, Kral A. Variability in Receptive Language Development Following Bilateral Cochlear Implantation. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:618-632. [PMID: 38198368 DOI: 10.1044/2023_jslhr-23-00297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
OBJECTIVES The primary aim was to investigate the variability in language development in children aged 5-7.5 years after bilateral cochlear implantation (CI) up to the age of 2 years, and any impact of the age at implantation and additional noncognitive or anatomical disorders at implantation. DESIGN Data of 84 congenitally deaf children that had received simultaneous bilateral CI at the age of ≤ 24 months were included in this retrospective study. The results of language comprehension acquisition were evaluated using a standardized German language acquisition test for normal hearing preschoolers and first graders. Data on speech perception of monosyllables and sentences in quiet and noise were added. RESULTS In a monosyllabic test, the children achieved a median performance of 75.0 ± 12.88%. In the sentence test in quiet, the median performance was 89 ± 12.69%, but dropped to 54 ± 18.92% in noise. A simple analysis showed a significant main effect of age at implantation on monosyllabic word comprehension (p < .001), but no significant effect of comorbidities that lacked cognitive effects (p = .24). Language acquisition values correspond to the normal range of children with normal hearing. Approximately 25% of the variability in the language acquisition tests is due to the outcome of the monosyllabic speech perception test. CONCLUSIONS Congenitally deaf children who were fitted bilaterally in the 1st year of life can develop age-appropriate language skills by the time they start school. The high variability in the data is partly due to the age of implantation, but additional factors such as cognitive factors (e.g., working memory) are likely to influence the variability.
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Affiliation(s)
- Angelika Illg
- Department of Otolaryngology, Medical University Hannover, Germany
| | - Doris Adams
- Department of Otolaryngology, Medical University Hannover, Germany
| | | | - Thomas Lenarz
- Department of Otolaryngology, Medical University Hannover, Germany
| | - Andrej Kral
- Department of Otolaryngology, Medical University Hannover, Germany
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Lee SJ, Oh H, Shin KH, Park SM, Kim YK, Jung DH, Yang J, Chun Y, Kim MY, Han JH, Kim JA, Tran NT, Kim BJ, Choi BY. Early Postoperative Benefits in Receptive and Expressive Language Development After Cochlear Implantation Under 9 Months of Age in Comparison to Implantation at Later Ages. Clin Exp Otorhinolaryngol 2024; 17:46-55. [PMID: 38326998 PMCID: PMC10933813 DOI: 10.21053/ceo.2024.00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/04/2024] [Accepted: 02/07/2024] [Indexed: 02/09/2024] Open
Abstract
OBJECTIVES The recent expansion of eligibility for cochlear implantation (CI) by the U.S. Food and Drug Administration (FDA) to include infants as young as 9 months has reignited debates concerning the clinically appropriate cut-off age for pediatric CI. Our study compared the early postoperative trajectories of receptive and expressive language development in children who received CI before 9 months of age with those who received it between 9 and 12 months. This study involved a unique pediatric cohort with documented etiology, where the timing of CI was based on objective criteria and efforts were made to minimize the influence of parental socioeconomic status. METHODS A retrospective review of 98 pediatric implantees recruited at a tertiary referral center was conducted. The timing of CI was based on auditory and language criteria focused on the extent of delay corresponding to the bottom 1st percentile of language development among age-matched controls, with patients categorized into very early (CI at <9 months), early (CI at 9-12 months) and delayed (CI at 12-18 months) CI groups. Postoperative receptive/expressive language development was assessed using the Sequenced Language Scale for Infants receptive and expressive standardized scores and percentiles. RESULTS Only the very early CI group showed significant improvements in receptive language starting at 3 months post-CI, aligning with normal-hearing peers by 9 months and maintaining this level until age 2 years. During this period (<2 years), all improvements were more pronounced in receptive language than in expressive language. CONCLUSION CI before 9 months of age significantly improved receptive language development compared to later CI, with improvements sustained at least up to the age of 2. This study supports the consideration of earlier CI, beyond pediatric Food and Drug Administration labeling criteria (>9 months), in children with profound deafness who have a clear deafness etiology and language development delays (<1st percentile).
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Affiliation(s)
- Seung Jae Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Heonjeong Oh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyu Ha Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung-Min Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yun Kyeong Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Do Hyun Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jiyeon Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yejun Chun
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Min Young Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin Hee Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ju Ang Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ngoc-Trinh Tran
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Bong Jik Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, Korea
| | - Byung Yoon Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
- Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul, Korea
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Cottrell J, Spitzer E, Friedmann D, Jethanamest D, McMenomey S, Thomas Roland J, Waltzman S. Cochlear Implantation in Children Under 9 Months of Age: Safety and Efficacy. Otol Neurotol 2024; 45:121-127. [PMID: 38082466 DOI: 10.1097/mao.0000000000004071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
OBJECTIVE To assess the safety of cochlear implants (CIs) in children under 9 months of age to better understand expected postoperative complication rates, and to provide a preliminary look at efficacy. STUDY DESIGN Single-center retrospective review. SETTING Tertiary referral center. PATIENTS Children 5 to 8 months of age who received a CI between 2011 and 2021. INTERVENTIONS Therapeutic-CI. MAIN OUTCOME MEASURES The primary outcome was 6-month postoperative complication rate. Secondary outcomes included length of stay, device explantation/reimplantation, rehabilitation supports, and hearing and language outcomes. Complications of children implanted under than 9 months of age was compared with a cohort of children implanted 9 to 18 months of age between the years 2011 and 2016 using a chi-squared test ( p < 0.05). RESULTS One hundred six children under 9 months of age were implanted (204 CIs) at a mean age of 6.6 months (range: 5-8). Postoperative complications occurred in 28 patients (26%) and were often minor. There were no mortalities. There was no statistically significant difference in complications, including reimplantation rates, between patients implanted under 9 months of age and those implanted 9 to 18 months of age. Speech discrimination outcomes were excellent, and mean spoken language outcomes were near normative for typically developing children. CONCLUSIONS Cochlear implantation can be a safe and effective treatment option for children 5 to 8 months of age. Early hearing screening and referral for infants to receive appropriate intervention will continue to play a critical role in optimizing speech and language outcomes.
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Affiliation(s)
- Justin Cottrell
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone, New York, NY
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Patro A, Holder JT, Brown CL, DeFreese A, Virgin F, Perkins EL. Cochlear Implantation in Very Young Children With Single-Sided Deafness. Otolaryngol Head Neck Surg 2023; 169:1615-1623. [PMID: 37232481 DOI: 10.1002/ohn.375] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 04/17/2023] [Accepted: 04/29/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Cochlear implants (CIs) for single-sided deafness (SSD) have only been approved for patients 5 years and older despite data supporting that younger children can also benefit from implantation. This study describes our institution's experience with CI for SSD in children 5 years and younger. STUDY DESIGN Case series with chart review. SETTING Tertiary referral center. METHODS A case series with chart review identified 19 patients up to age 5 years who underwent CI for SSD between 2014 and 2022. Baseline characteristics, perioperative complications, device usage, and speech outcomes were collected. RESULTS The median age at CI was 2.8 (range, 1.0-5.4) years, with 15 (79%) patients being below age 5 at implantation. Etiologies of hearing loss were idiopathic (n = 8), cytomegalovirus (n = 4), enlarged vestibular aqueduct (n = 3), hypoplastic cochlear nerve (n = 3), and meningitis (n = 1). The median preoperative pure-tone average was 90 (range, 75-120) and 20 (range, 5-35) dB eHL in the poor and better hearing ears, respectively. No patients had postoperative complications. Twelve patients achieved consistent device use (average, 9 h/d). Three of the seven who were not consistent users had hypoplastic cochlear nerves and/or developmental delays. The three patients with available preoperative and postoperative speech testing showed significant benefits, and five patients with available postoperative testing demonstrated speech recognition in the implanted ear when isolated from the better ear. CONCLUSION CI can safely be performed in younger children with SSD. Patients and families accept early implantation, as evidenced by consistent device use, and derive notable benefits in speech recognition. Candidacy can be broadened to include SSD patients under age five years, particularly individuals without hypoplastic cochlear nerves or developmental delay.
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Affiliation(s)
- Ankita Patro
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jourdan T Holder
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Hearing and Speech Science, Vanderbilt Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christine L Brown
- Department of Hearing and Speech Science, Vanderbilt Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Andrea DeFreese
- Department of Hearing and Speech Science, Vanderbilt Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Frank Virgin
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elizabeth L Perkins
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, 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 parents. Cochlear Implants Int 2023; 24:301-310. [PMID: 37434512 DOI: 10.1080/14670100.2023.2233191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
PURPOSE Cochlear implant (CI) decision-making is particularly challenging for families of children who have residual hearing. Parents of these children may be uncertain about whether the potential benefits of CIs outweigh the risks. This study aimed to understand parents' decisional needs during the decision-making process for children with residual hearing. METHOD Semi-structured interviews were conducted with parents of 11 children who had received CIs. Open-ended questions were asked to encourage parents to share their experiences about the decision-making process, their values/preferences, and their needs. The interviews were transcribed verbatim and analyzed using thematic analysis. RESULTS Data were organized according to three key themes: (1) Parents' decisional conflict, (2) values and preferences, (3) decision support and parents' needs. We found that overall parents were satisfied with their decision-making process and the decision support from practitioners. However, parents stressed the importance of receiving more personalized information that considers their specific concerns, values and preferences related to family's circumstances. CONCLUSIONS Our research provides additional evidence to guide the CI decision-making process for children with residual hearing. Additional collaborative research with audiology and decision-making experts specifically on facilitating shared decision-making is needed to provide better decision coaching for these families.
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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
| | - Dorie Noll
- 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
| | - 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
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Delaney DS, Liew LJ, Lye J, Atlas MD, Wong EYM. Overcoming barriers: a review on innovations in drug delivery to the middle and inner ear. Front Pharmacol 2023; 14:1207141. [PMID: 37927600 PMCID: PMC10620978 DOI: 10.3389/fphar.2023.1207141] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 10/02/2023] [Indexed: 11/07/2023] Open
Abstract
Despite significant advances in the development of therapeutics for hearing loss, drug delivery to the middle and inner ear remains a challenge. As conventional oral or intravascular administration are ineffective due to poor bioavailability and impermeability of the blood-labyrinth-barrier, localized delivery is becoming a preferable approach for certain drugs. Even then, localized delivery to the ear precludes continual drug delivery due to the invasive and potentially traumatic procedures required to access the middle and inner ear. To address this, the preclinical development of controlled release therapeutics and drug delivery devices have greatly advanced, with some now showing promise clinically. This review will discuss the existing challenges in drug development for treating the most prevalent and damaging hearing disorders, in particular otitis media, perforation of the tympanic membrane, cholesteatoma and sensorineural hearing loss. We will then address novel developments in drug delivery that address these including novel controlled release therapeutics such as hydrogel and nanotechnology and finally, novel device delivery approaches such as microfluidic systems and cochlear prosthesis-mediated delivery. The aim of this review is to investigate how drugs can reach the middle and inner ear more efficiently and how recent innovations could be applied in aiding drug delivery in certain pathologic contexts.
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Affiliation(s)
- Derek S. Delaney
- Hearing Therapeutics, Ear Science Institute Australia, Nedlands, WA, Australia
- Faculty of Health Sciences, Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia
| | - Lawrence J. Liew
- Hearing Therapeutics, Ear Science Institute Australia, Nedlands, WA, Australia
- Centre for Ear Sciences, Medical School, The University of Western Australia, Nedlands, WA, Australia
| | - Joey Lye
- Hearing Therapeutics, Ear Science Institute Australia, Nedlands, WA, Australia
| | - Marcus D. Atlas
- Hearing Therapeutics, Ear Science Institute Australia, Nedlands, WA, Australia
- Centre for Ear Sciences, Medical School, The University of Western Australia, Nedlands, WA, Australia
- Faculty of Health Sciences, Curtin Medical School, Curtin University, Bentley, WA, Australia
| | - Elaine Y. M. Wong
- Hearing Therapeutics, Ear Science Institute Australia, Nedlands, WA, Australia
- Centre for Ear Sciences, Medical School, The University of Western Australia, Nedlands, WA, Australia
- Faculty of Health Sciences, Curtin Medical School, Curtin University, Bentley, WA, Australia
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Bekele Okuba T, Lystad RP, Boisvert I, McMaugh A, Moore RC, Walsan R, Mitchell RJ. Cochlear implantation impact on health service utilisation and social outcomes: a systematic review. BMC Health Serv Res 2023; 23:929. [PMID: 37649056 PMCID: PMC10468908 DOI: 10.1186/s12913-023-09900-y] [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: 06/05/2023] [Accepted: 08/10/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Hearing loss can have a negative impact on individuals' health and engagement with social activities. Integrated approaches that tackle barriers and social outcomes could mitigate some of these effects for cochlear implants (CI) users. This review aims to synthesise the evidence of the impact of a CI on adults' health service utilisation and social outcomes. METHODS Five databases (MEDLINE, Scopus, ERIC, CINAHL and PsychINFO) were searched from 1st January 2000 to 16 January 2023 and May 2023. Articles that reported on health service utilisation or social outcomes post-CI in adults aged ≥ 18 years were included. Health service utilisation includes hospital admissions, emergency department (ED) presentations, general practitioner (GP) visits, CI revision surgery and pharmaceutical use. Social outcomes include education, autonomy, social participation, training, disability, social housing, social welfare benefits, occupation, employment, income level, anxiety, depression, quality of life (QoL), communication and cognition. Searched articles were screened in two stages ̶̶̶ by going through the title and abstract then full text. Information extracted from the included studies was narratively synthesised. RESULTS There were 44 studies included in this review, with 20 (45.5%) cohort studies, 18 (40.9%) cross-sectional and six (13.6%) qualitative studies. Nine studies (20.5%) reported on health service utilisation and 35 (79.5%) on social outcomes. Five out of nine studies showed benefits of CI in improving adults' health service utilisation including reduced use of prescription medication, reduced number of surgical and audiological visits. Most of the studies 27 (77.1%) revealed improvements for at least one social outcome, such as work or employment 18 (85.7%), social participation 14 (93.3%), autonomy 8 (88.9%), education (all nine studies), perceived hearing disability (five out of six studies) and income (all three studies) post-CI. None of the included studies had a low risk of bias. CONCLUSIONS This review identified beneficial impacts of CI in improving adults' health service utilisation and social outcomes. Improvement in hearing enhanced social interactions and working lives. There is a need for large scale, well-designed epidemiological studies examining health and social outcomes post-CI.
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Affiliation(s)
- Tolesa Bekele Okuba
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
| | - Reidar P Lystad
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Isabelle Boisvert
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Anne McMaugh
- Macquarie School of Education, Faculty of Arts, Macquarie University, Sydney, Australia
| | | | - Ramya Walsan
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Rebecca J Mitchell
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Wu SS, Sbeih F, Anne S, Cohen MS, Schwartz S, Liu YCC, Appachi S. Auditory Outcomes in Children Who Undergo Cochlear Implantation Before 12 Months of Age: A Systematic Review. Otolaryngol Head Neck Surg 2023; 169:210-220. [PMID: 36939587 DOI: 10.1002/ohn.284] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 12/20/2022] [Accepted: 01/16/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE To systematically review the literature to determine auditory outcomes of cochlear implantation in children ≤12 months old. DATA SOURCE PubMed, EMBASE, Medline, CINAHL, Cochrane, Scopus, and Web of Science databases were searched from inception to 9/1/2021 using PRISMA guidelines. REVIEW METHODS Studies analyzing auditory outcomes after cochlear implantation (CI) in children ≤12 months of age were included. Non-English studies and case reports were excluded. Outcome measures included functional and objective auditory results. Two independent reviewers evaluated each abstract and article. Heterogeneity and bias across studies were evaluated. RESULTS Of 305 articles identified, 17 met inclusion criteria. There were 642 children ages 2 to 12 months at CI. The most common etiologies of hearing loss were congenital CMV, meningitis, idiopathic hearing loss, and GJB2 mutations and other genetic causes. All studies concluded that early CI was safe. Overall, outcomes improved following early CI: IT-MAIS (9 studies), LittlEARS (4 studies), PTA (3 studies), CAP (3 studies), GASP (3 studies), and LNT (3 studies). Nine studies compared outcomes to an older implantation group (>12 months); of these (n = 450 early CI, n = 1189 late CI), 8 studies showed earlier CI achieved comparable or better auditory outcomes than later implantation, whereas 1 study (n = 120) concluded no differences in speech perception improvement. CONCLUSION Auditory outcomes were overall improved in children ≤12 months old undergoing CI. Studies that compared early to late CI demonstrated similar or better auditory outcomes in early implantation group. Given the comparable safety profile and critical time period of speech and language acquisition, earlier CI should be considered for infants with hearing loss.
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Affiliation(s)
- Shannon S Wu
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | - Firas Sbeih
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Samantha Anne
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael S Cohen
- Department of Otolaryngology, Head and Neck Surgery, Mass Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Seth Schwartz
- Department of Pediatric Otolaryngology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Yi-Chun C Liu
- Division of Pediatric Otolaryngology, Texas Children's Hospital, Houston, Texas, USA
| | - Swathi Appachi
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
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12
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Mukherjee D, Xue B, Chen CT, Chang M, Kao JPY, Kanold PO. Early retinal deprivation crossmodally alters nascent subplate circuits and activity in the auditory cortex during the precritical period. Cereb Cortex 2023; 33:9038-9053. [PMID: 37259176 PMCID: PMC10350824 DOI: 10.1093/cercor/bhad180] [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: 02/24/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 06/02/2023] Open
Abstract
Sensory perturbation in one modality results in the adaptive reorganization of neural pathways within the spared modalities, a phenomenon known as "crossmodal plasticity," which has been examined during or after the classic "critical period." Because peripheral perturbations can alter the auditory cortex (ACX) activity and functional connectivity of the ACX subplate neurons (SPNs) even before the critical period, called the precritical period, we investigated if retinal deprivation at birth crossmodally alters the ACX activity and SPN circuits during the precritical period. We deprived newborn mice of visual inputs after birth by performing bilateral enucleation. We performed in vivo widefield imaging in the ACX of awake pups during the first two postnatal weeks to investigate cortical activity. We found that enucleation alters spontaneous and sound-evoked activities in the ACX in an age-dependent manner. Next, we performed whole-cell patch clamp recording combined with laser scanning photostimulation in ACX slices to investigate circuit changes in SPNs. We found that enucleation alters the intracortical inhibitory circuits impinging on SPNs, shifting the excitation-inhibition balance toward excitation and this shift persists after ear opening. Together, our results indicate that crossmodal functional changes exist in the developing sensory cortices at early ages before the onset of the classic critical period.
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Affiliation(s)
- Didhiti Mukherjee
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21205, United States
| | - Binghan Xue
- Department of Biology, University of Maryland, College Park, MD 20742, United States
| | - Chih-Ting Chen
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21205, United States
| | - Minzi Chang
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21205, United States
| | - Joseph P Y Kao
- Department of Physiology, Center for Biomedical Engineering and Technology, University of Maryland School of Medicine, Baltimore, MD 21201, United States
| | - Patrick O Kanold
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21205, United States
- Department of Biology, University of Maryland, College Park, MD 20742, United States
- Kavli Neuroscience Discovery Institute, Johns Hopkins University, Baltimore, MD 21205, United States
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13
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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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Yiannos JM, Bester CW, Zhao C, Gell B, Jayakody DMP. Speech-in-noise performance in objectively determined cochlear implant maps, including the effect of cognitive state. PLoS One 2023; 18:e0286986. [PMID: 37315077 DOI: 10.1371/journal.pone.0286986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/30/2023] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVE Cochlear Implant (CI) programming based on subjective psychophysical fine-tuning of loudness scaling involves active participation and cognitive skills and thus may not be appropriate for difficult-to-condition populations. The electrically evoked stapedial reflex threshold (eSRT) is an objective measure that is suggested to provide clinical benefit to CI programming. This study aimed to compare speech reception outcomes between subjective and eSRT objectively determined CI maps for adult MED-EL recipients. The effect of cognitive skills on these skills was further assessed. METHODS Twenty-seven post lingually hearing-impaired MED-EL CI recipients were recruited, 6 with mild cognitive impairment (MCI- 4 male, 79 years ± 5), 21 with normal cognitive function (5 male, 63 years ± 12). Two MAPs were generated: a subjective MAP and an objective MAP in which eSRTs determined maximum comfortable levels (M-Levels). Participants were randomly divided into two groups. Group A trialled the objective MAP for two weeks before returning for outcome assessment. During the following two weeks, Group A trialled the subjective MAP before returning for outcome assessment. Group B trialled MAPs in reverse. Outcome measures included the Hearing Implant Sound Quality Index (HISQUI), Consonant-Nucleus-Consonant (CNC) word test, and Bamford-Kowal-Bench Speech-in-Noise (BKB-SIN) test. RESULTS eSRT based MAPS were obtained in 23 of the participants. A strong relationship was demonstrated between global charge between eSRT-based and psychophysical-based M-Levels (r = 0.89, p < .001). The Montreal Cognitive Assessment for the Hearing Impaired (MoCA-HI) testing identified 6 CI recipients with MCI (MoCA-HI total score ≤23). The MCI group was older (63, 79 years), but were not otherwise different in sex, duration of hearing loss or duration of CI use. For all patients, no significant differences were found for sound quality or speech in quiet scores between eSRT-based and psychophysical-based MAPs. However, psychophysically determined MAPs showed significantly better speech-in-noise reception (6.74 vs 8.20-dB SNR, p = .34). MoCA-HI scores showed a significant, moderate negative correlation with BKB SIN for both MAP approaches (Kendall's Tau B, p = .015 and p = .008), with no effect on the difference between MAP approaches. CONCLUSION Results indicate eSRT-based methods provide poorer outcomes than psychophysical-based method. While speech-in-noise reception is correlated with MoCA-HI score, this affected both behaviourally and objectively determined MAPs. The results suggest fair confidence in the eSRT-based method as a guide for setting M-Level for difficult-to-condition CI populations in simple listening conditions.
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Affiliation(s)
- Jessica M Yiannos
- Ear Science Institute Australia, Subiaco, Western Australia, Australia
| | - Christofer W Bester
- Ear Science Institute Australia, Subiaco, Western Australia, Australia
- School of Human Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Christopher Zhao
- School of Human Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Barbara Gell
- MED-EL Australasia, Alexandria, New South Wales, Australia
| | - Dona M P Jayakody
- Ear Science Institute Australia, Subiaco, Western Australia, Australia
- Centre for Ear Sciences, Medical School, University of Western Australia, Crawley, Western Australia, Australia
- Western Australian Centre for Health & Ageing, University of Western Australia, Crawley, Western Australia, Australia
- School of Allied Health, Curtin University, Bentley, Western Australia, Australia
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Allen DZ, Rosamilia GL, Lee KH, Huang Z. Evaluation of cost data associated with pediatric cochlear implantation (CI) throughout 2016-2021. Am J Otolaryngol 2023; 44:103790. [PMID: 36706716 DOI: 10.1016/j.amjoto.2023.103790] [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: 12/23/2022] [Accepted: 01/14/2023] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Cochlear Implants (CI) are a mainstay in the treatment of severe sensorineural hearing loss with proven cost-effectiveness and improved quality of life. However, costs associated with CI are variable. During the Covid-19 pandemic, elective surgeries decreased. The investigation into how the pandemic affected CI procedures, costs, and demographic utilization has not been elucidated. METHODS A retrospective cohort study using the Pediatric Health Information System® (PHIS) database, which consists of 50 children's hospitals, was performed. Regions were defined according to PHIS guidelines. We evaluated number of CIs, total charges and costs, Charge to Cost Ratios (CCR), demographic information, and subgrouped this analysis by region throughout 2016-2021. Charges were adjusted by CMS wage index for hospital location. RESULTS During the years of 2016-2021, there was a rising number of CIs every year except for 2020 which had a decrease, largely driven by the southern and midwestern regions. The median number of cases did not differ between the years. The median adjusted charges increased every year, but not significantly ($103,883-$125,394). The median CCR also did not differ throughout the years (2.7-3.1). Still, there was a larger interquartile range in 2021 (2.3-4.4) for the median CCR compared to all other years (2.1-3.8), particularly in the South. The percentage of white, non-Hispanic/Latino patients who underwent CI was larger in 2020-2021 (78-79.8 %) compared to 2016-2019 (73.3-77.5 %). CONCLUSIONS The number of CIs in 2020 was lower than in 2019 or 2021. The median CCR for CI procedures increased from 2016 to 2021 but not significantly. The range of CCR was larger in 2021 compared to the years prior, suggestive of cost shifting by some hospitals to offset the loss in revenue. There was a small but significant increase in white, non-Hispanic patients receiving CI in 2020 and 2021, suggestive of a socio-economic shift in care post pandemic.
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Affiliation(s)
- David Z Allen
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, Houston, TX, United States of America
| | - Gianna L Rosamilia
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, Houston, TX, United States of America
| | - Kyung Hyun Lee
- Center for Clinical Research & Evidence-Based Medicine, University of Texas Health Science Center, Houston, TX, United States of America
| | - Zhen Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, Houston, TX, United States of America.
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Chen Y, Li Y, Jia H, Gu W, Wang Z, Zhang Z, Xue M, Li J, Shi W, Jiang L, Yang L, Sterkers O, Wu H. Simultaneous Bilateral Cochlear Implantation in Very Young Children Improves Adaptability and Social Skills: A Prospective Cohort Study. Ear Hear 2023; 44:254-263. [PMID: 36126187 DOI: 10.1097/aud.0000000000001276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate the value of using the Gesell Development Diagnosis Scale (GDDS) to predict developmental outcomes in very young children who undergo simultaneous bilateral cochlear implantation. DESIGN In this prospective cohort study, a repeated-measures investigation was conducted in a tertiary referral hospital. A total of 62 children receiving simultaneous bilateral cochlear implantations were enrolled from April 2017 to August 2018. They were divided into 2 groups depending on the operative age: "Infants" group (6 to 12 months, N = 38) or "Children" group (12 to 36 months, N = 24). Data on the surgical outcomes, auditory development, speech production, and developmental indicators were collected until 2 years after the initial fitting. The primary outcome measure was the GDDS, a neuropsychological development examination. Secondary outcomes included the following: complication rate, aided pure-tone average, Infant-Toddler Meaningful Auditory Integration Scale, Categories of Auditory Performance-II, Meaningful Use of Speech Scale, Speech Intelligibility Rating, and the LittlEARS Auditory Questionnaire. RESULTS The mean ages at implantation in infants and children groups were 9.2 ± 1.17 and 16.6 ± 3.60 months, respectively. Significant differences were found in the social skills ( p = 0.001) and adaptability ( p = 0.031) domains of GDDS. The younger the age of bilateral cochlear implants surgery, the higher developmental quotient of language, social skills, and adaptability the child could achieve after 2 years. The complication rates in the infants and children groups were 0% versus 2.1% ( p = 0.57). There was no surgical complication in the infants group. In the children group, 1 case with enlarged vestibular aqueduct and Mondini malformation had a receiver-implant misplacement on the right side (2%, 1/48). In the two groups, auditory performance and speech production had improved similarly. In the infants group, social skills developmental quotient at baseline had a significant positive relationship with Meaningful Use of Speech Scale after 2 years. CONCLUSIONS Simultaneous bilateral cochlear implantation in younger children improves adaptability and social skills. GDDS is a sensitive tool of evaluating short-term effect of bilateral cochlear implants in neuropsychological development and constitutes a reliable predictor of speech production for the very younger pediatric cochlear implant users.
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Affiliation(s)
- Ying Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases (14DZ2260300), Shanghai, China
- The authors contributed equally to this work
| | - Yun Li
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases (14DZ2260300), Shanghai, China
- The authors contributed equally to this work
| | - Huan Jia
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases (14DZ2260300), Shanghai, China
- The authors contributed equally to this work
| | - Wenxi Gu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases (14DZ2260300), Shanghai, China
| | - Zhaoyan Wang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases (14DZ2260300), Shanghai, China
| | - Zhihua Zhang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases (14DZ2260300), Shanghai, China
| | - Minbo Xue
- Child Healthcare Department, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jingjie Li
- Department of Anesthesiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wentao Shi
- Clinical Research Center, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Linlin Jiang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases (14DZ2260300), Shanghai, China
| | - Lu Yang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases (14DZ2260300), Shanghai, China
| | - Olivier Sterkers
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases (14DZ2260300), Shanghai, China
| | - Hao Wu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases (14DZ2260300), Shanghai, China
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Hou V, Tellez P, Fandiño M, Ospina J, Chia R, Bergstrom R, Riding K, Kozak J, Kozak E, Pauwels J, Kozak F. Pediatric cochlear implant explantation and reimplantation over a 32-year period. Int J Pediatr Otorhinolaryngol 2023; 166:111460. [PMID: 36764079 DOI: 10.1016/j.ijporl.2023.111460] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 01/09/2023] [Accepted: 01/21/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Cochlear implantation is indicated for pediatric patients with bilateral severe to profound sensorineural hearing loss. The literature reports large variability in cochlear implant (CI) device survival and rates of explantation and reimplantation. This retrospective chart review summarizes CI survival and rates of explantation and reimplantation in pediatric CI recipients at a Canadian tertiary pediatric hospital over 32 years. METHODS A retrospective chart review of all pediatric patients who received a Cochlear Corporation® CI between April 1988 and June 2020 was undertaken. Rates of explantation/reimplantation were collected and categorized based on device type and reason for failure (medical, device, and inconclusive failure). Device survival analysis based on implant model was also completed utilizing Kaplan-Meier curves. RESULTS 512 CIs were implanted over the 32-year period by four surgeons (77.1%, 18.16%, 4.49%, and 0.20%, respectively). Patient age ranged from seven months to 20.4 years. The overall explantation and reimplantation rate was 3.32% (17/512 implants), with seven as a result of device failure (1.37%), nine events of medical failure (1.76%), and one inconclusive failure (0.20%). Cumulative CI survival rates at 5, 10, 15, and 20 years were 98.15%, 96.33%, 95.53%, and 94.39%. CONCLUSION The overall institutional CI failure, explantation, and reimplantation rates are lower than the average reported rates in the literature.
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Affiliation(s)
- Vincent Hou
- BC Children's Hospital, 4500 Oak St, Vancouver, BC, V6H 3N1, Canada
| | - Paula Tellez
- Pontificia Universidad Xaveriana, Carrera 7 No. 40 - 62, Bogotá D.C, Colombia
| | - Marcela Fandiño
- Fundacion Cardiovasuclar de Colombia, Calle 155A No.23-58, Floridablanca, Santander, Colombia
| | - Juan Ospina
- Pontificia Universidad Xaveriana, Carrera 7 No. 40 - 62, Bogotá D.C, Colombia
| | - Ruth Chia
- BC Children's Hospital, 4500 Oak St, Vancouver, BC, V6H 3N1, Canada
| | - Raegan Bergstrom
- BC Children's Hospital, 4500 Oak St, Vancouver, BC, V6H 3N1, Canada
| | - Keith Riding
- BC Children's Hospital, 4500 Oak St, Vancouver, BC, V6H 3N1, Canada
| | - Jessica Kozak
- BC Children's Hospital, 4500 Oak St, Vancouver, BC, V6H 3N1, Canada
| | - Emelie Kozak
- University of Calgary Health Sciences Centre, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
| | - Julie Pauwels
- BC Children's Hospital, 4500 Oak St, Vancouver, BC, V6H 3N1, Canada
| | - Frederick Kozak
- BC Children's Hospital, 4500 Oak St, Vancouver, BC, V6H 3N1, Canada.
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18
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Mukherjee D, Xue B, Chen CT, Chang M, Kao JPY, Kanold PO. Early retinal deprivation crossmodally alters nascent subplate circuits and activity in the auditory cortex during the precritical period. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.02.21.529453. [PMID: 36865142 PMCID: PMC9980129 DOI: 10.1101/2023.02.21.529453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Sensory perturbation in one modality results in adaptive reorganization of neural pathways within the spared modalities, a phenomenon known as "crossmodal plasticity", which has been examined during or after the classic 'critical period'. Because peripheral perturbations can alter auditory cortex (ACX) activity and functional connectivity of the ACX subplate neurons (SPNs) even before the classic critical period, called the precritical period, we investigated if retinal deprivation at birth crossmodally alters ACX activity and SPN circuits during the precritical period. We deprived newborn mice of visual inputs after birth by performing bilateral enucleation. We performed in vivo imaging in the ACX of awake pups during the first two postnatal weeks to investigate cortical activity. We found that enucleation alters spontaneous and sound-evoked activity in the ACX in an age-dependent manner. Next, we performed whole-cell patch clamp recording combined with laser scanning photostimulation in ACX slices to investigate circuit changes in SPNs. We found that enucleation alters the intracortical inhibitory circuits impinging on SPNs shifting the excitation-inhibition balance towards excitation and this shift persists after ear opening. Together, our results indicate that crossmodal functional changes exist in the developing sensory cortices at early ages before the onset of the classic critical period.
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19
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Alkhamra R, Alkhamra H. Assessing school readiness in children with cochlear implants using an Arabic language-based test. SPEECH, LANGUAGE AND HEARING 2023. [DOI: 10.1080/2050571x.2023.2178760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- Rana Alkhamra
- Department of Hearing and Speech Sciences, University of Jordan, Amman, Jordan
| | - Hatem Alkhamra
- Department of Special Education, University of Jordan, Amman, Jordan
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20
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Sbeih F, Bouzaher MH, Appachi S, Schwartz S, Cohen MS, Carvalho D, Yoon P, Liu YCC, Anne S. Safety of Cochlear Implantation in Children 12 Months or Younger: Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2022; 167:912-922. [PMID: 34982600 DOI: 10.1177/01945998211067741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To systematically review the literature to determine safety of cochlear implantation in pediatric patients 12 months and younger. DATA SOURCE Ovid MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched from inception to March 20, 2021. REVIEW METHODS Studies that involved patients 12 months and younger with report of intraoperative or postoperative complication outcomes were included. Studies selected were reviewed for complications, explants, readmissions, and prolonged hospitalizations. Two independent reviewers screened all studies that were selected for the systematic review and meta-analysis. All studies included were assessed for quality and risk of bias. RESULTS The literature search yielded 269 studies, of which 53 studies underwent full-text screening, and 18 studies were selected for the systematic review and meta-analysis. A total of 449 patients and 625 cochlear implants were assessed. Across all included studies, major complications were noted in 3.1% of patients (95% CI, 0.8-7.1) and 2.3% of cochlear implantations (95% CI, 0.6-5.2), whereas minor complications were noted in 2.4% of patients (95% CI, 0.4-6.0) and 1.8% of cochlear implantations (95% CI, 0.4-4.3). There were no anesthetic complications reported across all included studies. CONCLUSION The results of this systematic review and meta-analysis suggest that cochlear implantation in patients 12 months and younger is safe with similar rates of complications to older cohorts.
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Affiliation(s)
- Firas Sbeih
- Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Malek H Bouzaher
- Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Swathi Appachi
- Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Seth Schwartz
- Department of Otolaryngology-Head and Neck Surgery, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Michael S Cohen
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Daniela Carvalho
- Department of Otolaryngology-Head and Neck Surgery, Rady Children's Hospital, San Diego, California, USA
| | - Patricia Yoon
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, The Children's Hospital, Denver, Colorado, USA
| | - Yi-Chun Carol Liu
- Texas Children's Hospital, Division of Pediatric Otolaryngology, Houston, Texas, USA
| | - Samantha Anne
- Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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21
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Sawaf T, Vovos R, Hadford S, Woodson E, Anne S. Utility of intraoperative neural response telemetry in pediatric cochlear implants. Int J Pediatr Otorhinolaryngol 2022; 162:111298. [PMID: 36088734 DOI: 10.1016/j.ijporl.2022.111298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 06/19/2022] [Accepted: 08/27/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this study is to evaluate the relationship between intraoperative neural response telemetry (NRT) and postoperative Threshold (T) and Comfort (C) levels and their correlation over time after cochlear implantation (CI). METHODS A retrospective chart review was conducted of patients less than 18 years of age who had CI with a Cochlear™ device and NRT at an academic center from 2010 to 2019. Data collected included demographics, extrapolated NRT threshold (tNRT) and slope of amplitude for electrodes 1, 6/7, 11/12, 16, and 22, and postoperative T and C levels at initial activation and 1 month, 3 months, and 1 year post-activation. Associations between T and C levels and slope of amplitude or tNRT were assessed using Spearman's rank correlation. RESULTS 39 patients (65 CIs) were included. Intraoperative tNRT correlated strongly with T and C levels at 1 month, 3 months, and 1 year post-activation on nearly all electrodes. Electrodes 6/7 and 11/12 at 3 months and electrodes 6/7 at 1 year did not correlate with T and C levels. There was no significant relationship between the slope of amplitude for nearly all electrodes and the T or C levels post-activation. CONCLUSION NRT is invaluable in children, with significant correlation found between tNRT and T and C levels over time on nearly all electrodes. There are changes in T and C levels in electrodes 6/7 and 11/12 over time, and close surveillance is beneficial to tailor programming as needed.
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Affiliation(s)
- Tuleen Sawaf
- Case Western Reserve University School of Medicine, 9501 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Rachel Vovos
- Cleveland Clinic, Head and Neck Institute, 9500 Euclid Avenue, Cleveland, OH, 44995, USA
| | - Stephen Hadford
- Cleveland Clinic, Head and Neck Institute, 9500 Euclid Avenue, Cleveland, OH, 44995, USA
| | - Erika Woodson
- Cleveland Clinic, Head and Neck Institute, 9500 Euclid Avenue, Cleveland, OH, 44995, USA
| | - Samantha Anne
- Cleveland Clinic, Head and Neck Institute, 9500 Euclid Avenue, Cleveland, OH, 44995, USA.
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22
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Lovin BD, Sweeney AD, Chapel AC, Alfonso K, Govil N, Liu YCC. Effects of Age on Delayed Facial Palsy After Otologic Surgery: A Systematic Review and Meta-Analysis. Ann Otol Rhinol Laryngol 2022; 131:1092-1101. [PMID: 34706584 DOI: 10.1177/00034894211053966] [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: 12/31/2022]
Abstract
OBJECTIVES To report 4 cases of delayed facial palsy (DFP) after pediatric middle ear (ME) surgery and systematically review and analyze the associated literature to evaluate the effects of age on DFP etiology, management, and prognosis. METHODS Systematic review of PubMed, Cochrane Library, and Embase for articles related to DFP after cochlear implantation (CI) was performed. These articles were assessed for level of evidence, methodological limitations, and number of cases. Meta-analysis was performed to assess the effects of age on DFP incidence. Furthermore, a comprehensive list of all pediatric DFP cases after otologic surgery was assembled through a multi-institutional retrospective review and systematic review of the literature. RESULTS Twenty-nine articles fit the criteria for inclusion in the meta-analysis. The incidence of DFP after CI was 0.23% and 1.01% for pediatric and adult cases, respectively. This difference was statistically significant (P < .001, odds ratio 4.36). Twenty-three cases, adding to the 4 presented herein, were suitable for a comprehensive list. The mean age was 6.9 years. Average postoperative day of paresis onset was 5.4, with an average maximum House-Brackmann grade of 3.5. All patients obtained full facial recovery after an average of 23.5 days. CONCLUSIONS The systematic review demonstrates that DFP after pediatric CI is rare and occurs at a significantly lower rate than in adults, further supporting the viral reactivation hypothesis of DFP. The prognosis for pediatric DFP after otologic surgery is excellent, with a high rate of full recovery in a short time frame. However, steroid administration can be considered. LEVEL OF EVIDENCE IIa.
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Affiliation(s)
- Benjamin D Lovin
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Alex D Sweeney
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA.,Division of Otolaryngology, Department of Surgery-Head and Neck Surgery, Texas Children's Hospital, Houston, TX, USA.,Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | | | - Kristan Alfonso
- Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Nandini Govil
- Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA.,Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Yi-Chun Carol Liu
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA.,Division of Otolaryngology, Department of Surgery-Head and Neck Surgery, Texas Children's Hospital, Houston, TX, USA
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23
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Culbertson SR, Dillon MT, Richter ME, Brown KD, Anderson MR, Hancock SL, Park LR. Younger Age at Cochlear Implant Activation Results in Improved Auditory Skill Development for Children With Congenital Deafness. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:3539-3547. [PMID: 36001854 PMCID: PMC9913281 DOI: 10.1044/2022_jslhr-22-00039] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/27/2022] [Accepted: 06/04/2022] [Indexed: 06/01/2023]
Abstract
PURPOSE The U.S. Food and Drug Administration indications for cochlear implantation in children is currently 9 months of age and older for children with bilateral profound sensorineural hearing loss (SNHL). Studies have shown that earlier activation of a cochlear implant (CI) can lead to better spoken language outcomes. As auditory skills are a precursor to the development of spoken language, this study was developed to investigate the influence of age at CI activation on auditory skill acquisition in young children. A secondary aim was to describe the auditory skills of children implanted prior to 9 months of age as compared to children with older ages of activation. METHOD Functional Listening Index (FLI) scores obtained during routine clinical visits were reviewed for 78 pediatric CI recipients with congenital bilateral profound hearing loss who were activated before 2 years of age. A linear mixed-effects model assessed the effect of age at CI activation on cumulative FLI scores over time. RESULTS There was a significant interaction between age at activation and chronological age at the time of evaluation, indicating that children with earlier access to sound achieved a greater number of auditory skills than those with later CI activations when measured at the same chronological age. Children activated before the age of 9 months approximated scores expected of children with typical hearing, whereas children activated between 9 and 24 months of age did not. CONCLUSIONS Younger age at CI activation is associated with increased auditory skills over time. Children who undergo cochlear implantation and CI activation before 9 months achieve more auditory skills by 4 years of age than children who are activated at later ages. These data suggest that reducing the approved age at cochlear implantation for children with congenital bilateral profound SNHL may support optimal auditory skill acquisition.
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Affiliation(s)
- Shannon R. Culbertson
- Division of Speech and Hearing Sciences, Department of Allied Health Sciences, University of North Carolina at Chapel Hill
| | - Margaret T. Dillon
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill
| | - Margaret E. Richter
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill
| | - Kevin D. Brown
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill
| | - Melissa R. Anderson
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill
| | - Sandra L. Hancock
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill
| | - Lisa R. Park
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill
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24
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AlKhtoum N, AlTamimi S, Alalwan O, Alrfooh A, AlKrymeen M. Cochlear implantations in Jordan: Retrospective analysis of post-operative complications. Niger Postgrad Med J 2022; 29:244-248. [PMID: 35900461 DOI: 10.4103/npmj.npmj_141_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
AIMS This study aims to carry out a retrospective analysis of demographic information and post-operative complications with special emphasis on complications related to the soft tissue over the implanted device in patients who underwent cochlear implantation. SETTINGS AND DESIGN Retrospective study. PATIENTS AND METHODS We conducted a retrospective review of 840 patients who had cochlear implants at our centre during the period between March 2010 and November 2020. The patients' demographic details and complications related to the soft tissue over the implanted device were analysed. STATISTICAL ANALYSIS USED SPSS software version 12. RESULTS In total, 380 (45.2%) patients were male and 460 (54.8%) were female. The age of patients at the time of surgery ranged between 7 months and 68 years and the mean age was 4.64 ± 2.91 years. The majority of patients underwent unilateral cochlear implantation (837 patients), with only three patients receiving a bilateral implant. There were a total of 19 implanted patients who developed complications related to the soft tissue around the implanted device, with an incidence rate of 2.3%. Haematoma was the most commonly encountered complication and other complications were: seroma, wound infection, abscess formation and flap necrosis. CONCLUSIONS Cochlear implantation is considered to be a reliable and safe surgical procedure for the rehabilitation of deaf patients. Complications can be avoided by proper patient preparation, appropriate incision and flap design, rigorous surgical techniques and periodic post-operative follow-up to detect and manage any complications early.
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Affiliation(s)
- Nemer AlKhtoum
- Department of Otolaryngology, Royal Medical Services, Amman, Jordan
| | - Shawkat AlTamimi
- Department of Otolaryngology, Balqa' Applied University, Balqa, Jordan
| | - Osama Alalwan
- Department of Otolaryngology, Royal Medical Services, Amman, Jordan
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25
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Kral A. Cochlear implantation in children born preterm. Dev Med Child Neurol 2022; 64:408. [PMID: 34693524 DOI: 10.1111/dmcn.15095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 10/27/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Andrej Kral
- Department of Experimental Otology, Hannover Medical School, Hannover, Germany
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26
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Robertson J, Simoes-Franklin C, Ferguson O, Hussey A, Costello P, Walshe P, Glynn F, Viani L, Gill I. Listening and spoken language outcomes after 5 years of cochlear implant use for children born preterm and at term. Dev Med Child Neurol 2022; 64:481-487. [PMID: 34553369 DOI: 10.1111/dmcn.15063] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 11/30/2022]
Abstract
AIM To compare listening and spoken language outcomes after cochlear implantation for children born preterm and at term, and to examine patterns associated with additional disabilities or gestational age. METHOD Children were included if they underwent cochlear implantation in 2013 or 2014 and had complete 5-year follow-up data available. An analysis of assessment data recorded annually was conducted, including outcomes as measured by the Category of Auditory Performance (CAP), the Speech Intelligibility Rating, Second Edition (SIR 2) scale, and the British Picture Vocabulary Scales, Third Edition (BPVS-3). Analyses were conducted to measure the impact of preterm birth and of additional causes of disability on these outcomes. RESULTS Eighty-two children (39 males, 43 females; median corrected age at first cochlear implantation 28.5mo [interquartile range 16.3-48.5]) were included in the study. Children who underwent cochlear implantation experienced significant improvements as measured by the CAP, SIR 2, and BPVS-3. Comparable improvements were seen in the groups born at term and preterm. Children with additional disabilities experienced significant improvement in all measures but performed less well than children without additional disabilities. INTERPRETATION Infants born preterm benefit from cochlear implantation to a degree comparable to their peers born at term. Additional disabilities may limit improvements in speech intelligibility, listening performance, and receptive vocabulary. Children with additional disabilities, nonetheless, derived significant benefit from cochlear implantation; additional benefits of cochlear implantation for this subgroup may go unmeasured by the outcome tools used in this study.
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Affiliation(s)
- Jennifer Robertson
- National Hearing Implant and Research Centre, Beaumont Hospital, Dublin, Ireland
| | - Cristina Simoes-Franklin
- National Hearing Implant and Research Centre, Beaumont Hospital, Dublin, Ireland.,School of Medicine, Trinity College, University of Dublin, Dublin, Ireland
| | - Olivia Ferguson
- National Hearing Implant and Research Centre, Beaumont Hospital, Dublin, Ireland
| | - Antonia Hussey
- National Hearing Implant and Research Centre, Beaumont Hospital, Dublin, Ireland
| | - Patsy Costello
- National Hearing Implant and Research Centre, Beaumont Hospital, Dublin, Ireland
| | - Peter Walshe
- National Hearing Implant and Research Centre, Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons, Dublin, Ireland
| | - Fergal Glynn
- National Hearing Implant and Research Centre, Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons, Dublin, Ireland
| | - Laura Viani
- National Hearing Implant and Research Centre, Beaumont Hospital, Dublin, Ireland.,School of Medicine, Trinity College, University of Dublin, Dublin, Ireland.,Royal College of Surgeons, Dublin, Ireland
| | - Irwin Gill
- National Hearing Implant and Research Centre, Beaumont Hospital, Dublin, Ireland.,Department of Neurodisability, Children's Health Ireland at Temple Street, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
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27
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Jenks CM, Hoff SR, Haney J, Tournis E, Thomas D, Young NM. Cochlear Implantation Can Improve Auditory Skills, Language and Social Engagement of Children With Autism Spectrum Disorder. Otol Neurotol 2022; 43:313-319. [PMID: 34935761 PMCID: PMC8843363 DOI: 10.1097/mao.0000000000003463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To review outcomes of cochlear implantation (CI) in children diagnosed with autism spectrum disorder (ASD). STUDY DESIGN Retrospective case review and parent survey. SETTING Tertiary care children's hospital. PATIENTS Thirty children with ASD who underwent CI between 1991 and 2018. Mean age at CI = 3.5 years (0.8-11.8), mean age at diagnosis of ASD = 5.1 years (2.0-15.0) (22/30 diagnosed after CI), mean follow-up = 10.5 years (1.4-21.6). Parents of 7 children returned a survey. INTERVENTION Unilateral or bilateral cochlear implantation. MAIN OUTCOME MEASURES Speech perception; expressive communication mode; educational placement; social engagement; consistency of CI use; parent survey of child behavior change. RESULTS Thirty-three percent of all and 45% of the 22 consistent device users developed measurable open-set speech perception by an average of 4.5 years of device use. Educational placement at last follow-up included 13% mainstreamed without interpreter, 50% Special Education programs, 10% therapeutic residential or day programs, 23% total communication programs, and one home schooled. Spoken language alone was used by 31% and spoken plus sign by 14%, with the remainder using sign alone, augmentative communication devices or no mode of communication. By parent report, 86% showed improvement in social engagement compared to pre-CI. Survey results showed the behaviors most frequently ranked as most affected by CI were communication and attention, while awareness of environment had the lowest (most affected) mean ranking. CONCLUSIONS Findings support a growing body of literature that cochlear implantation has the potential to improve auditory skills, language, and enhance social engagement in some deaf children with autism spectrum disorder.
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Affiliation(s)
- Carolyn M. Jenks
- Department Otolaryngology – Head and Neck Surgery, Johns Hopkins Medicine, Northwestern University Feinberg School of Medicine
- Division of Otolaryngology – Head and Neck Surgery, Section of Otology and Ann & Robert H Lurie Children's Hospital of Chicago
| | - Stephen R. Hoff
- Department Otolaryngology – Head and Neck Surgery, Johns Hopkins Medicine, Northwestern University Feinberg School of Medicine
- Division of Otolaryngology – Head and Neck Surgery, Section of Otology and Ann & Robert H Lurie Children's Hospital of Chicago
| | - Jennifer Haney
- Department of Children's Services, Ann & Robert H Lurie Children's Hospital of Chicago
| | - Elizabeth Tournis
- Department of Audiology, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Denise Thomas
- Department of Audiology, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Nancy M. Young
- Department Otolaryngology – Head and Neck Surgery, Johns Hopkins Medicine, Northwestern University Feinberg School of Medicine
- Division of Otolaryngology – Head and Neck Surgery, Section of Otology and Ann & Robert H Lurie Children's Hospital of Chicago
- Knowles Hearing Center, Northwestern University School of Communication, Evanston, Illinois
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28
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American Cochlear Implant Alliance Task Force Guidelines for Clinical Assessment and Management of Cochlear Implantation in Children With Single-Sided Deafness. Ear Hear 2022; 43:255-267. [PMID: 35213890 PMCID: PMC8862768 DOI: 10.1097/aud.0000000000001204] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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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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30
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Park LR, Gagnon EB, Brown KD. The Limitations of FDA Criteria: Inconsistencies with Clinical Practice, Findings, and Adult Criteria as a Barrier to Pediatric Implantation. Semin Hear 2021; 42:373-380. [PMID: 34912165 PMCID: PMC8660172 DOI: 10.1055/s-0041-1739370] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Children require greater access to sound than adults as they are learning to communicate using hearing and spoken language. Yet when it comes to cochlear implant candidacy, currently approved Food and Drug Administration (FDA) criteria for adults are much less restrictive than those for children, allowing for greater levels of residual hearing and aided speech recognition in adults. Cochlear implant guidelines for children have changed very little in the 30 years since cochlear implants have been approved for pediatrics, and this lack of change has proven to be a barrier to implantation. Using evidence-based practice, centers have been providing off-label implantation for children who fall outside of current FDA criteria, including children with more residual hearing, children with single-side deafness younger than 5 years, and infants with bilateral profound loss younger than 9 months. The purpose of this article is to outline how these restrictions impede access to implants for children and describe the evidence supporting cochlear implantation in children who fall outside of current criteria.
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Affiliation(s)
- Lisa R Park
- Department of Otolaryngology/Head and Neck Surgery, The University of North Carolina at Chapel Hill, Durham, North Carolina
| | - Erika B Gagnon
- Department of Otolaryngology/Head and Neck Surgery, The University of North Carolina at Chapel Hill, Durham, North Carolina
| | - Kevin D Brown
- Department of Otolaryngology/Head and Neck Surgery, The University of North Carolina at Chapel Hill, Durham, North Carolina
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31
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Jenks CM, Mithal LB, Hoff SR. Early Identification and Management of Congenital Cytomegalovirus. Otolaryngol Clin North Am 2021; 54:1117-1127. [PMID: 34535282 DOI: 10.1016/j.otc.2021.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Congenital cytomegalovirus (cCMV) is the most common nongenetic cause of sensorineural hearing loss. Despite its prevalence, universal screening for cCMV is not currently performed. Hearing loss caused by cCMV is most often severe to profound, often bilateral, and may be fluctuating or progressive. Infants with hearing loss at birth and confirmed cCMV might benefit from antiviral therapy. Roughly half of hearing loss cases owing to cCMV are delayed in onset, and consequently, these children pass newborn hearing screening. Children with cCMV require close audiologic monitoring, require appropriate management with hearing aids, and should be monitored for cochlear implant candidacy.
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Affiliation(s)
- Carolyn M Jenks
- Department Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street 6th Floor, Baltimore, MD 21287, USA
| | - Leena B Mithal
- Department of Pediatrics, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box #20, Chicago, IL 60611, USA
| | - Stephen R Hoff
- Department Otolaryngology-Head & Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Division of Otolaryngology-Head & Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Chicago, IL 60611, USA.
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32
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Jenks CM, Hoff SR, Mithal LB. Congenital Cytomegalovirus Infection: Epidemiology, Timely Diagnosis, and Management. Neoreviews 2021; 22:e606-e613. [PMID: 34470762 DOI: 10.1542/neo.22-9-e606] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Congenital cytomegalovirus (cCMV) infection is common because of the ubiquitous nature of the virus and the lack of an effective prevention strategy during pregnancy. Most infants with cCMV are asymptomatic, although a notable subset can have sequelae including, most commonly, sensorineural hearing loss and neurodevelopmental disability, which may not be present at birth. Timely screening for cytomegalovirus in the first weeks after birth is critical to appropriately diagnose congenital infection, evaluate affected infants, and determine the treatment course. Antiviral therapy with valganciclovir can optimize end hearing and neurodevelopmental outcomes in symptomatic infants. This review discusses the epidemiology and clinical manifestations of cCMV, targeted and universal screening approaches, and treatment and monitoring of infants with cCMV.
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Affiliation(s)
- Carolyn M Jenks
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Stephen R Hoff
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Leena B Mithal
- Division of Infectious Diseases, Department of Pediatrics, Northwestern University Feinberg School of Medicine; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
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33
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Naik AN, Varadarajan VV, Malhotra PS. Early pediatric Cochlear implantation: An update. Laryngoscope Investig Otolaryngol 2021. [PMID: 34195373 DOI: 10.1002/lio2.574/format/pdf] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
The criteria and candidacy for pediatric cochlear implantation (CI) has significantly transformed over the past few decades and continues to evolve with technological advancements, and recognition of benefit in more diverse populations. Prolonged auditory deprivation among patients with profound sensorineural hearing loss has been shown to cause widespread degeneration in the central auditory system. Thus, there is increasing evidence advocating for earlier implantation within a critical neuroplastic window. However, there is a lack of consensus on this optimal age of implantation. Historically, there were concerns regarding surgical feasibility and safety, anesthesia risk, and logistical considerations in very young infants <12 months. Recent literature has investigated surgical safety and anesthesia risk as well speech and language outcomes with early implantation, resulting in the long-awaited reduction in approved age by the FDA (<9 months for certain devices). This article reviews logistical considerations, surgical safety, anesthesia risk, and language developmental outcomes associated with early CI (<12 months).
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Affiliation(s)
- Akash N Naik
- Department of Otolaryngology - Head and Neck Surgery The Ohio State University Columbus Ohio USA
| | - Varun V Varadarajan
- Department of Otolaryngology - Head and Neck Surgery The Ohio State University Columbus Ohio USA
| | - Prashant S Malhotra
- Division of Pediatric Otolaryngology Nationwide Children's Hospital Columbus Ohio USA
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34
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Naik AN, Varadarajan VV, Malhotra PS. Early pediatric Cochlear implantation: An update. Laryngoscope Investig Otolaryngol 2021; 6:512-521. [PMID: 34195373 PMCID: PMC8223461 DOI: 10.1002/lio2.574] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/27/2021] [Accepted: 04/11/2021] [Indexed: 11/17/2022] Open
Abstract
The criteria and candidacy for pediatric cochlear implantation (CI) has significantly transformed over the past few decades and continues to evolve with technological advancements, and recognition of benefit in more diverse populations. Prolonged auditory deprivation among patients with profound sensorineural hearing loss has been shown to cause widespread degeneration in the central auditory system. Thus, there is increasing evidence advocating for earlier implantation within a critical neuroplastic window. However, there is a lack of consensus on this optimal age of implantation. Historically, there were concerns regarding surgical feasibility and safety, anesthesia risk, and logistical considerations in very young infants <12 months. Recent literature has investigated surgical safety and anesthesia risk as well speech and language outcomes with early implantation, resulting in the long-awaited reduction in approved age by the FDA (<9 months for certain devices). This article reviews logistical considerations, surgical safety, anesthesia risk, and language developmental outcomes associated with early CI (<12 months).
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Affiliation(s)
- Akash N. Naik
- Department of Otolaryngology – Head and Neck SurgeryThe Ohio State UniversityColumbusOhioUSA
| | - Varun V. Varadarajan
- Department of Otolaryngology – Head and Neck SurgeryThe Ohio State UniversityColumbusOhioUSA
| | - Prashant S. Malhotra
- Division of Pediatric OtolaryngologyNationwide Children's HospitalColumbusOhioUSA
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35
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Dazert S, Thomas JP, Loth A, Zahnert T, Stöver T. Cochlear Implantation. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 117:690-700. [PMID: 33357341 DOI: 10.3238/arztebl.2020.0690] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 03/12/2020] [Accepted: 07/20/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Hearing impairment that is too severe to be adequately treated with conventional hearing aids can lead, in children, to severe developmental disturbances of hearing and language, and, in adults, to communicative and social deprivation. Recent advances in medical device technology and in microsurgical techniques have led to an expansion of the indications for cochlear implantation (CI) for adults with progressive hearing loss in older age, and to a restructuring of the process of care for these patients in Germany. METHODS This review is based on pertinent publications retrieved by a selective search in PubMed, as well as on the CI guidelines and CI "white book" of the German Society of Otolaryngology and Head and Neck Surgery. RESULTS Early and accurate diagnosis is crucial for the successful auditory rehabilitation of high-grade hearing impairment. In children, a key role is played by newborn auditory screening, which is mandatory in Germany and enables the provision of a CI in the first year of life when necessary. 86% of the children receiving a CI achieve linguistic comprehension of fluently spoken sentences. For adults, positive prognostic factors for hearing after the provision of a CI include a highly motivated patient, "postlingual" onset of the hearing impairment (i.e., after the acquisition of language), and a brief duration of deafness. Auditory rehabilitation is associated with significant improvement, not just of hearing and of the comprehension of spoken language, but also of quality of life, particularly in elderly patients. For patients of any age with bilateral hearing loss, CIs should be provided on both sides, if possible. The more common complications of the procedure, with a probability of 2-4% each, are technical implant defects, dizziness, and wound-healing disturbances. CONCLUSION Cochlear implantation, performed in specialized centers, is a safe and reliable technique and regularly enables the successful rehabilitation of hearing in both children and adults.
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Affiliation(s)
- Stefan Dazert
- Rhino-Laryngology, Head and Neck Surgery, St. Elisabeth Hospital, Ruhr University Bochum; Department of Oto-Rhino-Laryngology, University Hospital Frankfurt; Department of Oto- Rhino-Laryngology, University Hospital Carl Gustav Carus Dresden
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Deep NL, Purcell PL, Gordon KA, Papsin BC, Roland Jr. JT, Waltzman SB. Cochlear Implantation in Infants: Evidence of Safety. Trends Hear 2021; 25:23312165211014695. [PMID: 34028328 PMCID: PMC8150451 DOI: 10.1177/23312165211014695] [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: 04/08/2021] [Accepted: 04/14/2021] [Indexed: 11/15/2022] Open
Abstract
The aim of this study was to investigate surgical, anesthetic, and device-related complications associated with cochlear implantation (CI) in children younger than 1 year of age. This was a multicenter, retrospective chart review of all children with severe-to-profound sensorineural hearing loss who underwent cochlear implantation with a Cochlear Nucleus Implant System before 1 year of age. Endpoints included perioperative course, major and minor surgical, anesthetic and device-related complications, and 30-day readmission rates. One hundred thirty-six infants (242 ears) met criteria. The mean age at implantation was 9.4 months (standard deviation 1.8). Six-month follow-up was reported in all patients. There were no major anesthetic or device-related complications. Adverse events were reported in 34 of implanted ears (14%; 7 major, 27 minor). Sixteen adverse events occurred ≤30 days of surgery, and 18 occurred >30 days of surgery. The 30-day readmission rate was 1.5%. The rate of adverse events did not correlate with preexisting medical comorbidities or duration under anesthesia. There was no significant difference detected in complication rate for patients younger than 9 months of age versus those 9 to 11 months of age. This study demonstrates the safety of CI surgery in infants and supports reducing the indication for cochlear implantation to younger than 1 year of age for children with bilateral, profound sensorineural hearing loss obtaining a Cochlear Nucleus Implant System.
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Affiliation(s)
- Nicholas L. Deep
- Department of Otolaryngology, Head & Neck Surgery, New York University Grossman School of Medicine, New York City, United States
| | - Patricia L. Purcell
- Department of Otolaryngology, Head & Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karen A. Gordon
- Department of Otolaryngology, Head & Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Blake C. Papsin
- Department of Otolaryngology, Head & Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - J. Thomas Roland Jr.
- Department of Otolaryngology, Head & Neck Surgery, New York University Grossman School of Medicine, New York City, United States
| | - Susan B. Waltzman
- Department of Otolaryngology, Head & Neck Surgery, New York University Grossman School of Medicine, New York City, United States
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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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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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