Pediatric Auditory Brainstem Implant Users Compared With Cochlear Implant Users With Additional Disabilities

Auditory performance and language skills in children with auditory brainstem implants and cochlear implants

PURPOSE

This study aims to evaluate school-age language skills and auditory performance in different listening situations in children with cochlear implants and auditory brainstem implants.

METHOD

The study included 60 children between the ages of 5 and 9 years with cochlear implants (CI) and auditory brainstem implants (ABI). The volunteer children were divided into two groups: bimodal CI-ABI and bilateral CI users. Test of Language Development: Primary (TOLD-P:4), which assesses components of language such as phonology, morphology, syntax and semantics, was used to evaluate school-age language skills. Children's Auditory Performance Scale (CHAPS) was used to measure their listening performance in quiet, noisy, multi-stimulus environments and their auditory attention and memory skills in daily life. The correlations between language and auditory performance were analyzed and compared between the two groups.

RESULTS

Children with ABI showed poorer performance in school-age language skills and auditory performance in different listening environments (p < 0.05). Significant correlations were between school-age language skills and auditory performance (p < 0.05).

CONCLUSION

Improved auditory performance is crucial for the development of school-age language skills. To improve auditory performance in children with ABI in different listening environments, assistive listening devices, acoustic environmental arrangements, informative activities, etc., should be used.

Evaluation of language, attention, and memory skills in children with auditory brainstem implants

PURPOSE

This study aimed to evaluate attention, memory, and language skills in children with auditory brainstem implants and cochlear implants.

METHODS

This study included 20 children with auditory brainstem implants (ABI) and 20 cochlear implanted (CI) children between the ages of 6 years and 8 years 11 months and their families. "Test of Language Development: Primary (TOLD-P:4)" was used to assess language skills, "STROOP Test, Visual-Aural Digit Span (VADS) test, and Cancellation Test" were used to evaluate attention and memory skills. In addition, the functional outcomes of hearing skills in daily life were scored by "Auditory Behavior in Everyday Life (ABEL) scale". The significance level was determined as 0.05.

RESULTS

Children with ABI showed lower language skills than children with CI in terms of TOLD-P:4 language test scores, STROOP sub-test completion times, and the VADS and Cancellation test scores (p < 0.05). In addition, statistically significant correlations were found between language, attention, memory skills, and auditory behavior scale.

CONCLUSIONS

This study is one of the limited numbers of studies investigating cognitive processes in children with ABI. Since attention and memory are correlated with language skills, it is recommended that the development of cognition should be considered in follow-up and intervention approaches of children with ABI and/or CI.

Neuroanatomical anomalies due to a defect in the FGF3 gene, associated with the Labyrinthine Aplasia, Microtia and Microdontia syndrome: insights from the placement of auditory brainstem implants in two siblings

Here, we describe two congenitally deaf male siblings with the same compound heterozygotic, likely pathogenic mutations in the FGF3 gene, associated with the labyrinthine aplasia, microtia and microdontia (LAMM) syndrome. Both children had bilateral cochleovestibular aplasia, precluding cochlear implantation. The elder brother received an auditory brainstem implant (ABI) with very limited auditory responses. During the ABI-surgery of the younger subject, it was discovered that excellent auditory responses could be obtained when the electrode array was placed considerably more caudally and more medially than standard. It was observed that the foramen of Luschka, the entrance to the lateral recess of the fourth ventricle was located more caudally. In view of this observation the good auditory development of the latter child, it was decided to give the older child a contralateral ABI. Again, it turned out that the anatomy of the brainstem was abnormal with a more caudal location of the foramen of Luschka and the cochlear nucleus, and this child is showing good progress with his auditory development. It is concluded that one should be aware of the anatomical differences at the level of the brainstem when placing an ABI in children with this genetic disorder (and most likely also in the LAMM syndrome). This also underpins the need of a multidisciplinary approach with closely collaborating team members and good family guidance when diagnosing and treating children with rare deafness.

Evaluation of auditory brainstem implant (ABI) users' auditory behavior in everyday life

PURPOSE

This study aims to evaluate the everyday listening status of pediatric ABI users using the Turkish ABEL questionnaire.

METHODS

The study included 33 parents of children with auditory brainstem implant, and 28 parents of children with cochlear implant were included as a control group. All implant users were between the ages of 4-14. Parents answered the ABEL questionnaire to assess their child's auditory behavior in their daily living environment. In addition, Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) scales were used to evaluate speech perception and production.

RESULTS

Auditory-aural, auditory awareness and ABEL total score of ABI users were statistically significantly lower than the CI group (p < 0.05). There was no statistically significant difference between the groups in the Conversational/Social skills subgroups. It was found that as the duration of ABI use increased, auditory-verbal, social skills and total scores increased significantly. In addition, correlations were obtained between ABEL total and subscale scores and CAP and SIR scores.

CONCLUSIONS

Parents believe that their children adapt nicely to ABI and are aware of environmental sounds. This study reveals the auditory, aural, and social skills of children using ABI through the regards of their parents. This study showed that the ABEL questionnaire, which was used in previous studies to express parental views of children with hearing aids and cochlear implants, can also be used for parents of children using ABI.

Long-Term Auditory and Speech Outcomes of Cochlear Implantation in Children With Cochlear Nerve Aplasia

OBJECTIVES

In this study, we aimed to (1) review the long-term outcomes of cochlear implantation in children with cochlear nerve aplasia and (2) compare the development of their auditory and speech abilities to children with normal-sized cochlear nerves.

DESIGN

This is a retrospective case-control study. Patients who underwent unilateral cochlear implant (CI) surgery in a tertiary referral center from September 2012 to December 2018 were reviewed. The study group included 55 children with cochlear nerve aplasia diagnosed using preoperative images. The control group included 35 children with normal-sized cochlear nerves. The control group did not differ from the study group in terms of age at implantation, pre-implantation auditory and speech abilities, or the electrode array type. Cochlear implantation outcomes were assessed using a test battery, including the Categories of Auditory Performance (CAP) score, the Speech Intelligibility Rating (SIR) score, behavioral audiometry, and closed- or open-set speech recognition tests. The development of auditory and speech abilities was compared between the two groups using Generalized Linear Mixed-effect Models.

RESULTS

The mean duration of CI usage was 4.5 years (SD = 1.5, range = 2.0 to 9.5) in the study group. The CAP scores, SIR scores, and aided hearing thresholds improved significantly post-implantation in the study group, but were significantly poorer than those in the control group. Generalized Linear Mixed-effect Models showed that the development of CAP and SIR scores was significantly slower in the study group than in the control group. Overall, 27 (49%) children with cochlear nerve aplasia had some degree of open-set speech perception skills, but the monosyllabic and bisyllabic word recognition rates were significantly lower than those in the control group.

CONCLUSION

For children with cochlear nerve aplasia, auditory perception and speech intelligibility continued to improve in the long-term follow-up, but this progress was significantly slower than in children with normal-sized cochlear nerves. Most children with cochlear nerve aplasia could obtain the ability of common phrase perception and understanding simple spoken language with consistent CI usage and auditory rehabilitation.

Speech intelligibility of children with an auditory brainstem implant: a triple-case study

Auditory brainstem implantation (ABI) is a relative recent development in paediatric hearing restoration. Consequently, young-implanted children's productive language has not received much attention. This study investigated speech intelligibility of children with ABI (N = 3) in comparison to children with cochlear implants (CI) and children with typical hearing (TH). Spontaneous speech samples were recorded from children representing the three groups matched on cumulative vocabulary level. Untrained listeners (N = 101) rated the intelligibility of one-word utterances on a continuous scale and transcribed each utterance. The rating task yielded a numerical score between 0 and 100, and similarities and differences between the listeners' transcriptions were captured by a relative entropy score. The speech intelligibility of children with CI and children with TH was similar. Speech intelligibility of children with ABI was well below that of the children with CI and TH. But whereas one child with ABI's intelligibility approached that of the control groups with increasing lexicon size, the intelligibility of the two other children with ABI did not develop in a similar direction. Overall, speech intelligibility was only moderate in the three groups of children, with quite low ratings and considerable differences in the listeners' transcriptions, resulting in high relative entropy scores.

Hearing and language development in children with brainstem implants: a systematic review

OBJECTIVE

To present scientific evidence, based on a systematic review of the literature, on the benefit of brainstem implants in auditory rehabilitation and language development in children.

METHODS

A systematic search was used to identify studies that contain information about the benefit of brainstem implants in the auditory rehabilitation and language development of children. The review was conducted based on a structured literature search, following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) checklist. The search was carried out in the PubMed, Web of Science and Scopus databases, using the combination "Auditory brainstem implants" AND "Pediatric", without restriction of language, period, and location. The quality assessment of the articles was performed using the Study Quality Assessment Tools.

RESULTS

Regarding hearing, children with brainstem implants showed sound detection, access to most speech sounds, basic auditory perception skills, recognition of ambient sounds, recognition of some frequently used words and phrases, in addition to some closed-set word discrimination capability. Expressive and comprehensive language were identified in children using auditory brainstem implants, increasing significantly in the short and long terms in most cases; however, in some of the children, such skills remained stable.

CONCLUSION

The auditory brainstem implant can be considered an effective alternative for children with cochlear malformation and/or auditory nerve deficiency and for those who cannot benefit from cochlear implant surgery.

Intraword Variability in Children With Auditory Brainstem Implants: A Longitudinal Comparison With Children With Cochlear Implants

PURPOSE

Intraword variability designates the phenomenon that a particular target word is produced variably by a child at one point in the child's development. In this study, the amount of intraword variability is studied longitudinally in children with auditory brainstem implants (ABIs). Auditory brainstem implantation is a relative recent technique in pediatric hearing restoration. Therefore, little is known about the phonological development of these children's speech.

METHOD

The intraword variability is investigated in three children with ABI, in comparison to children with cochlear implants, matched on lexical development. Intraword variability is measured using relative entropy in order to take into account the frequency distribution in children's productions.

RESULT

Results showed considerable variation between the three children with ABI. Still, all children had higher levels of intraword variability in their spontaneous speech productions as compared to children with cochlear implants.

CONCLUSION

It seems that children with ABI are lagging behind their phonological development in reference to children with cochlear implants.

Consonant and vowel production in the spontaneous speech productions of children with auditory brainstem implants

Auditory brainstem implantation provides hearing sensations in children and adults with anomalies of the auditory nerves. In children, perceptual benefits have been established, and research already demonstrated (limited) effects on children's speech production. The current study extends the literature by scrutinizing the phonological development of three children with ABI. Spontaneous speech samples were used to establish their phonemic inventories of vowels, word-initial consonants and word-final consonants, both independently of the target phoneme and relative to the target phoneme. The three children produced all vowels with longer device use and larger vocabulary size. Word-initial and word-final consonants appeared in the three children's spontaneous productions. However, the segmental accuracy was only moderate in the children's productions.

Emotions in Deaf and Hard-of-Hearing and Typically Hearing Children

For deaf and hard-of-hearing (DHH) children living in an environment where their access to linguistic input and social interactions is compromised, learning emotions could be difficult, which may further affect social functioning. To understand the role of emotion in DHH children's social life, this study investigated emotional functioning (i.e., emotion recognition, empathy, emotion expression), and its relation with social functioning (i.e., social competence and externalizing behaviors), in 55 DHH children and 74 children with typical hearing (aged 3-10 years; Mage = 6.04). Parental reports on children's emotional and social functioning and factors related to DHH children's hearing were collected. Results showed similar levels of emotional and social functioning in children with and without hearing loss. Use of auditory intervention and speech perception did not correlate with any measures in DHH children. In both groups, higher levels of empathy related to higher social competence and fewer externalizing behaviors; emotion recognition and positive emotion expression were unrelated to either aspect of social functioning. Higher levels of negative emotion expression related to lower social competence in both groups, but to more externalizing behaviors in DHH children only. DHH children in less linguistically accessible environments may not have adequate knowledge for appropriately expressing negative emotions socially.

Word characteristics and speech production accuracy in children with auditory brainstem implants: a longitudinal triple case report

Auditory brainstem implants (ABI) in children in the first years of life is a recent innovation. Analyses of their speech and language development on the basis of spontaneous language samples are still largely lacking. The aim was to investigate the phonological complexity of the words children with ABI use in their spontaneous speech, and to compare their accuracy with that of children with cochlear implants (CI) and children with normal hearing (NH). Longitudinal recordings of spontaneous speech were collected of three children with ABI. Children with ABI target mainly words of low phonological complexity in their spontaneous speech, just as children with NH and children with CI do. The complexity of the words they attempt increases over time, but this development is less outspoken in comparison to children with CI and NH at the same hearing ages. The accuracy of the ABI children's word productions is situated in the lower ranges of the 95% confidence intervals of the NH and the CI groups, and - depending on the specific measure - even fall below the 95% border. The ABI intervention appears to be beneficial in the three cases studied, although their development is slow compared to children with CI and NH.

Evaluation of phoneme recognition skills in pediatric auditory brainstem implant users

OBJECTIVES

This study aims to evaluate the relationship between phoneme recognition skills and language development skills in pediatric auditory brainstem implant (ABI) users. It further intends to identify the delays and problems that may occur in the phoneme recognition skills of children with ABI and shed light on rehabilitation programs.

METHODS

Our study included 20 children using ABI and another 20 using cochlear implants (CI). They were aged between 6 and 8 years 11 months. The participants exhibited homogenous demographic and audiological characteristics. The Turkish version of the Test of Language Development-Primary: Fourth Edition (TOLDP:4) was used to evaluate the language development skills, and the Turkish version of the Phoneme Recognition Test (PRT) was applied to assess the phoneme recognition skills.

RESULTS

There was a statistically significant difference (p < 0.05) in the PRT values as well as in the language development skills between the children with ABI and those with CI. It was observed that the values of the children with CI were significantly higher than those of children with ABI.

CONCLUSION

Although children with ABI were not able to match the skills of their peers with CI, their language development and communication skills improved. It is believed that this study will contribute to the literature by demonstrating that the use of ABI improves phoneme recognition skills in children who are not eligible for CI or who do not adequately benefit from CI.

Clinical and scientific innovations in auditory brainstem implants

The auditory brainstem implant (ABI) was originally developed to provide rehabilitation of retrocochlear deafness caused by neurofibromatosis type 2 (NF2). Recent studies of the ABI have investigated outcomes in non-NF2 cohorts, such as patients with cochlear nerve aplasia or cochlear ossification and more recently, intractable tinnitus. New technologies that improve the ABI-neural tissue interface are being explored as means to improve performance and decrease side effects. Innovative discoveries in optogenetics and bioengineering present opportunities to continually evolve this technology into the future, enhancing spatial selectivity of neuronal activation in the cochlear nucleus and preventing side effects through reduction in activation of non-target neuronal circuitry. These advances will improve surgical planning and ultimately improve patients’ audiological capabilities. ABI research has rapidly increased in the 21st century and applications of this technology are likely to continually evolve. Herein, we aim to characterize ongoing clinical, basic science, and bioengineering advances in ABIs and discuss future directions of this technology.