The Effect of Cochlear Implant Interval on Spoken Language Skills of Pediatric Bilateral Cochlear Implant Users

Simultaneous versus Sequential Cochlear Implantation in Adults: Quantitative and Qualitative Outcomes

OBJECTIVE

To compare speech recognition and quality of life outcomes between bilateral sequentially and simultaneously implanted adult cochlear implant (CI) recipients who initially qualify for a CI in both ears.

STUDY DESIGN

Retrospective chart review.

SETTING

Tertiary referral center.

METHODS

Retrospective chart review identified adults who underwent bilateral CI, either simultaneously or sequentially, at a high-volume center between 2012 and 2022. Sequentially implanted patients were only included if the second ear qualified for CI in quiet (defined as best-aided AzBio quiet testing <60%), at time of initial CI evaluation.

RESULTS

Of 112 bilateral CI patients who qualified in both ears at initial evaluation, 95 underwent sequential implantation and 17 simultaneous. Age, duration, and etiology of hearing loss, and CI usage were similar between groups. Preoperatively, the sequential group had lower pure-tone average (PTA) in the 1st ear than the simultaneously implanted group (P = <.001) but, no difference in 2nd ear PTA (P = .657). Preoperative speech recognition scores were significantly higher for the sequential group; however, this was not true for postoperative scores. There was no difference in the proportion of patients showing significant CI-only or bilateral performance improvement between the groups. Both groups demonstrated similar benefit in quality of life measures.

CONCLUSION

Our findings indicate both simultaneous and sequential cochlear implantation are effective in improving hearing performance and quality of life. Thus, bilateral versus simultaneous implantation should be discussed and tailored for each individual patient.

Sequential bilateral cochlear implant: long-term speech perception results in children first implanted at an early age

PURPOSE

The study aims to assess the benefit of sequential bilateral cochlear implantation in children with congenital bilateral profound hearing loss, submitted to the first implant at an early age.

METHODS

We enrolled all the bilateral sequential cochlear implanted children who received the first implant within 48 months and the second within 12 years of age at our Institution. The children were submitted to disyllabic word recognition tests and Speech Reception Threshold (SRT) assessment using the OLSA matrix sentence test with the first implanted device (CI1), with the second implanted device (CI2), and with both devices (CIbil). Furthermore, we measured the datalogging of both devices. Then we calculated the binaural SRT gain (b-SRTgain) and checked the correlations between speech perception results and the b-SRTgain with the child's age at CI1 and CI2, DELTA and the datalogging reports.

RESULTS

With the bilateral electric stimulation, we found a significant improvement in disyllabic word recognition scores and in SRT. Moreover, the datalogging showed no significant differences in the time of use of CI1 and CI2. We found significant negative correlations between speech perception abilities with CI2 and age at CI2 and DELTA, and between the SRT with CI1 and the b-SRTgain.

CONCLUSIONS

From this study we can conclude that in a sequential CI procedure, even if a short inter-implant delay and lower ages at the second surgery can lead to better speech perception with CI2, children can benefit from bilateral stimulation independently of age at the second surgery and the DELTA.

Predictive Ability of First-Side Cochlear Implant Performance in Adult Sequential Bilateral Cochlear Implantation

OBJECTIVE

Predictors of second-side cochlear implant performance have not been well studied. We sought to assess whether speech recognition scores from first-side cochlear implant (CI1) could predict second-side cochlear implant (CI2) scores in sequential bilaterally implanted adults.

STUDY DESIGN

Retrospective review using a prospectively collected database.

SETTING

Academic tertiary care hospital.

PATIENTS

Fifty-seven adults with postimplantation speech recognition testing performed at least 12 months after CI2.

INTERVENTION

Sequential bilateral CI.

MAIN OUTCOME MEASURES

CI2 performance at ≥12 months as measured using consonant-nucleus-consonant (CNC) words and AzBio sentences in quiet and +10 dB signal-to-noise ratio (S/N).

RESULTS

CI1 performance scores at ≥12 months were independently associated with CI2 performance scores at ≥12 months for CNC words (β = 0.371 [0.136-0.606], p = 0.003), AzBio sentences in quiet (β = 0.614 [0.429-0.80], p < 0.0001), and AzBio +10 dB S/N (β = 0.712 [0.459-0.964], p < 0.0001). CI1 scores on AzBio in quiet at 0 to 6 months were also independently associated with CI2 AzBio in quiet scores at ≥12 months (β = 0.389 [0.004-0.774], p = 0.048). Hearing loss etiology and duration, age at implantation, interval between CI1 and CI2, duration of hearing aid use, and preimplantation speech recognition testing scores were not consistently associated with CI2 scores at ≥12 months.

CONCLUSIONS

CI1 performance is an independent predictor of second-side performance as measured ≥12 months postimplantation. This may be a clinically useful metric when considering adult sequential bilateral implantation.

[Word production in children with cochlear implant based on chronological age and hearing age]

BACKGROUND

For congenitally deaf children, an early bilateral provision with cochlear implant (CI) is a favourable condition for language acquisition. The objective of the present study was to determine the word production in CI children. The focus was on a comparison of chronological age and hearing age performance and on the evaluation of potential effects of multilingualism, additional disabilities and age at provision.

METHODS

The data of 62 children with bilateral CI (age at provision in months M=12,1; SD=6,2) were retrospectively analysed. Vocabulary was assessed by the test Aktiver Wortschatztest für 3- bis 5-jährige Kinder - Revision and compared for chronological age and hearing age. Group comparisons and correlation analysis was conducted regarding multilingualism, additional disabilities and age at provision.

RESULTS

The cohort performed significantly better when referenced to hearing age: level were within or above the norm in more than 50%; referenced to chronological age in around 37%. The descriptive performance differences for multilingualism and additional disabilities were only significant for children with both characteristics. Performance of monolingual children without additional disabilities was not significantly associated with age at provision.

CONCLUSION

CI children may achieve an adequate expressive vocabulary at the age of 3 to 5 years. Multilingualism and additional disabilities seem to be particular challenges for CI children and need a more precise definition in further studies. The use of both chronological and hearing age as reference marks allows a differentiated assessment of the language status. This may lead to benefits in therapeutic interventions and parent councelling.

Benefit of sequential bilateral cochlear implantation in children between 5 to 18 years old: A prospective cohort study

Objective

To determine the benefit of sequential cochlear implantation after a long inter-implantation interval in children with bilateral deafness receiving their second implant between 5 and 18 years of age.

Study design

Prospective cohort-study.

Setting

Tertiary multicenter.

Patients

85 children with bilateral deafness and unilateral implantation receiving a contralateral cochlear implant at the age of 5 to 18 years.

Method

The primary outcomes were speech recognition in quiet and noise (CVC) scores. The secondary outcomes were language outcomes and subjective hearing abilities, all measured before and 12 months after sequential bilateral cochlear implantation. Medians of the paired data were compared using the Wilcoxon signed-rank test. Univariable linear regression analyses was used to analyze associations between variables and performance outcomes.

Results

A significant benefit was found for speech recognition in quiet (96% [89–98] vs 91% [85–96]; p < 0.01) and noise (65% [57–75] vs 54% [47–71]; p = 0.01) in the bilateral CI condition compared to unilateral (n = 75, excluded 10 non-users). No benefit was seen for language outcomes. The subjective sound quality score was statistically significant higher in bilateral compared to the unilateral CI condition. Pre-operative residual hearing level in the ear of the second implant, the inter-implant interval and age at time of second implantation was not significantly associated with performance scores.

Conclusion

After 12 months of use, sequential bilateral cochlear implantation showed improved speech perception in quiet and noise and improved subjective sound quality outcomes in children despite a great inter-implantation interval (median of 8 years [range 1–16 years]).

Trajectories of receptive and expressive vocabulary in Mandarin speaking children under 4 years of age fitted with cochlear implants: a 12-month longitudinal study

OBJECTIVE

To explore trajectories of receptive and expressive vocabulary in Mandarin-speaking children under the age of 4 years, fitted with cochlear implants (CIs).

DESIGN

Vocabulary trajectories were measured at baseline, 3, 6, and 12 months after implantation using the Chinese version of the MacArthur-Bates Communicative Development Inventory.

STUDY SAMPLE

There were 216 children with CIs in West China Hospital who took part and were divided into three groups based on age at first CI.

RESULTS

Receptive and expressive vocabulary scores of the younger implantation group were significantly different from the older groups at baseline. After 12 months of implant use, there were no significant differences between all groups. Furthermore receptive vocabulary trajectories for all children with CIs were not significantly different from those of children with normal hearing. However, expressive vocabulary trajectories were poorer when compared to children with normal hearing. Significant differences were seen between receptive and expressive vocabulary in all age groups.

CONCLUSIONS

This study suggests no differences in vocabulary trajectories in Mandarin-speaking children whether they received their first CI at 1, 2, or 3 years of age. It is important that clinicians convey realistic expectations about potential differences in receptive vs. expressive trajectories for Mandarin-speaking children fitted with CIs.

Receptive Vocabulary of Children With Bilateral Cochlear Implants From 3 to 16 Years of Age

OBJECTIVES

The vocabulary of children with cochlear implants is often smaller than that of their peers with typical hearing, but there is uncertainty regarding the extent of the differences and potential risks and protective factors. Some studies indicate that their receptive vocabulary develops well at first, but that they fail to keep up with their typical hearing peers, causing many CI users to enter school with a receptive vocabulary that is not age-appropriate. To better understand the receptive vocabulary abilities of children with cochlear implants this study explored age-related differences to matched children with typical hearing and associations between vocabulary skills and child-level characteristics.

DESIGN

A retrospective cross-sectional study with matched controls was conducted at the Norwegian national cochlear implant center at Oslo University Hospital. Eighty-eight children (mean age 8.7 years; range 3.2 to 15.9; 43 girls, 45 boys) who had received bilateral cochlear implants before 3 years of age were compared with two groups of children with typical hearing. One group was matched for maternal education, sex, and chronological age, the other group was matched for maternal education, sex, and hearing age. Receptive vocabulary performance was measured with the British Picture Vocabulary Scale.

RESULTS

Cochlear implant users' receptive vocabulary was poorer than that of age-matched children with typical hearing ( M = 84.6 standard points, SD = 21.1; children with typical hearing: M = 102.1 standard points, SD = 15.8; mean difference -17.5 standard points, 95% CI [-23.0 to -12.0], p < 0.001; Hedges's g = -0.94, 95% CI [-1.24 to -0.62]), and children with cochlear implants were significantly more likely to perform below the normative range (risk ratio = 2.2, 95% CI [1.42 to 3.83]). However, there was a significant nonlinear U-shaped effect of age on the scores of cochlear implant users, with the difference to the matched typical hearing children being largest (23.9 standard points, on average) around 8.7 years of age and smaller toward the beginning and end of the age range. There was no significant difference compared with children with typical hearing when differences in auditory experience were accounted for. Variability was not significantly different between the groups. Further analysis with a random forest revealed that, in addition to chronological age and hearing age, simultaneous versus sequential implantation, communication mode at school, and social integration were predictors of cochlear implant users' receptive vocabulary.

CONCLUSIONS

On average, the receptive vocabulary of children with cochlear implants was smaller than that of their typical hearing peers. The magnitude of the difference was changing with age and was the largest for children in early primary school. The nonlinear effect of age might explain some of the ambiguity in previous research findings and could indicate that better intervention is required around school entry. The results emphasize that continuous monitoring and support are crucial to avoid far-reaching negative effects on the children's development and well-being.

Changes in electrically evoked auditory brainstem responses in children with sequential bilateral cochlear implants

OBJECTIVES

The primary aim of this study is to investigate whether the electrical stimulation of the second ear causes a difference in electrically evoked auditory brainstem responses (eABR) between two ears over time.

METHODS

The study included thirteen subjects under the age of five who used cochlear implants for at least six months in the first ear prior to the sequential cochlear implantation. Postoperative eABRs were conducted on the 1st (first fitting of the second speech processor), 3rd, and 6th months of the second implantation in the basal, medial, and apical electrode positions. The recording was started with the second cochlear implant (CI2), and then the first cochlear implant (CI1) was tested. Sound field audiometry and receptive/expressive language assessments were also performed at 1 and 6 months after the second cochlear implantation.

RESULTS

eABR results indicate that when eV wave latencies are examined for all electrodes, CI2 is significantly longer than CI1 (p < 0.05). When eV wave amplitudes are examined for all electrodes, CI1 is significantly higher than the CI2 (p < 0.05). eV latency and amplitude changes between both implants were examined up to six months after implantation. Statistically significant changes were observed in the basal, medial, apical electrode for eV wave latencies, and only in the medial electrode for eV wave amplitudes (p < 0.05). Average sound field thresholds and receptive/expressive language scores improved statistically significantly for all subjects at the end of the study (p < 0.05).

CONCLUSION

The postoperative eABR test is a valuable test battery that provides the clinician with important ideas about the estimated threshold, comfortable and audible sound level, CI performance, and auditory pathways up to the brainstem. Since the maturation is still ongoing, an extended period longer than six months is needed to evaluate interaural differences.

The impact of unilateral, simultaneous, or sequential cochlear implantation on pediatric language outcomes

OBJECTIVES

The purpose of this study was to determine the impact of unilateral versus bilateral cochlear implantation on receptive and expressive spoken language outcomes. Secondary aims were to investigate factors timing of first and second implant placement and reliance on government funded health plans on language outcome.

METHODS

This was a retrospective chart review of spoken language users with bilateral severe-to-profound hearing loss. A total of 204 children were included, 105 in the bilateral group and 99 in the unilateral group. Multiple regression analyses were completed to investigate factors that influence language outcomes at age 5.

RESULTS

Recipients who received bilateral CIs performed significantly higher on measures of receptive and expressive language than those with unilateral implants.

DISCUSSION

This study demonstrates that bilateral implantation has a significant impact on receptive and expressive aspects of language development, and should be strongly considered as standard practice for children with bilateral severe to profound hearing loss.

CONCLUSION

These results indicate that families should be counseled that language outcomes are better with bilateral cochlear implantation than unilateral implantation. Cochlear implant teams should continue to consider the impact of socioeconomic status on outcomes and explore new methods to reduce the impacts and barriers of poverty to language development.

Analysis of the developmental trajectory and influencing factors of auditory and speech functions after cochlear implantation in Mandarin Chinese speaking children

Background: The auditory and speech development of the children with cochlear implants (CIs) are influenced by many factors.Objective: To study the developmental trajectory and influencing factors of auditory and speech functions for the Mandarin Chinese speaking children with CIs.Material and methods: The children with CIs undergoing rehabilitation in the same institution from June 2016 to June 2019 were followed up. Their closed monosyllables and disyllables recognition rate, closed average language age, categories of auditory performance (CAP) and speech intelligibility rating (SIR) were evaluated at 0, 1, 3, 6, 12 and 24 months of rehabilitation. The results were analyzed by SPSS 23.0.Results: 49 children were followed up for 1 year, 29 children for 2 years. The evaluated indicators of auditory and speech functions were improved with the prolongation of rehabilitation and influenced by the age of cochlear implantation, the use of hearing aids before surgery, guardian's educational degree, the relationship between guardian and child.Conclusions and significance: The auditory and speech functions of the children with CIs were improved significantly with the prolongation of rehabilitation and influenced by many factors, which can help us to predict the effect of CI more accurately and develop an individualized rehabilitation program.