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Glaubitz C, Beck R, Liebscher T, Aschendorff A, Kreibohm-Strauß K, Kronesser D, Seebens Y, Streicher B, Kröger S. [Early language performance in the ELFRA questionnaire : Analysis of multicentre data from children with bilateral cochlear implants]. HNO 2024:10.1007/s00106-024-01489-w. [PMID: 38861032 DOI: 10.1007/s00106-024-01489-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Very early bilateral cochlear implant (CI) provision is today's established standard for children. Therefore, the assessment of preverbal and verbal performance in very early stages of development is becoming increasingly important. Performance data from cohorts of children were evaluated and presented based on diagnostic assessment using chronological age (CA) and hearing age (HA). METHODS The present study, as part of a retrospective multicentre study, included 4 cohorts (N = 72-233) of children with bilateral CI without additional disabilities. Their results in the German parent questionnaires Elternfragebögen zur Früherkennung von Risikokindern(ELFRA‑1 and ELFRA-2) subdivided for CA and HA were statistically analysed. The data were also analysed in terms of mono-/bilingualism and age at CI provision. RESULTS Overall, verbal performance in relation to CA was lower than in relation to HA. Preverbal skills were largely CA appropriate. Children with bi-/multilingual language acquisition performed significantly lower. Verbal performance in ELFRA‑2 referenced to CA was negatively correlated with age at CI provision. CONCLUSION In the case of early CI provision, CA should be the preferred reference mark in preverbal and verbal assessment in order to obtain exact individual performance levels and avoid bias in results. The percentiles determined are of limited use as generally valid reference values to which the individual performance of bilaterally implanted children could be compared. Further multicentre studies should be initiated.
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Affiliation(s)
- Cynthia Glaubitz
- Hals-Nasen-Ohrenklinik, Kopf- und Halschirurgie, Cochlear-Implant-Centrum CICERO, Uniklinikum Erlangen, FAU Erlangen-Nürnberg, Erlangen, Deutschland.
| | - Rainer Beck
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Sektion Implant Centrum (ICF), Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Tim Liebscher
- Hals-Nasen-Ohrenklinik, Kopf- und Halschirurgie, Cochlear-Implant-Centrum CICERO, Uniklinikum Erlangen, FAU Erlangen-Nürnberg, Erlangen, Deutschland
| | - Antje Aschendorff
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Sektion Implant Centrum (ICF), Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | | | - Dominique Kronesser
- Klinik und Poliklinik für Hals-Nasen- und Ohrenheilkunde, Sächsisches Cochlear Implant Centrum (SCIC), Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland
| | - Yvonne Seebens
- Cochlear Implant Center (CIC) Rhein-Main des HSF gGmbH, Friedberg, Deutschland
| | - Barbara Streicher
- HNO-Klinik, Cochlear Implant Centrum Köln (CIK), Uniklinik Köln, Köln, Deutschland
| | - Stefanie Kröger
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Sektion Implant Centrum (ICF), Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
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Jafari Z, Fitzpatrick EM, Schramm DR, Rouillon I, Koravand A. Predictors of cochlear implant outcomes in pediatric auditory neuropathy: A matched case-control study. PLoS One 2024; 19:e0304316. [PMID: 38809896 PMCID: PMC11135674 DOI: 10.1371/journal.pone.0304316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/10/2024] [Indexed: 05/31/2024] Open
Abstract
OBJECTIVES Current evidence supports the benefits of cochlear implants (CIs) in children with hearing loss, including those with auditory neuropathy spectrum disorder (ANSD). However, there is limited evidence regarding factors that hold predictive value for intervention outcomes. DESIGN This retrospective case-control study consisted of 66 children with CIs, including 22 with ANSD and 44 with sensorineural hearing loss (SNHL) matched on sex, age, age at CI activation, and the length of follow-up with CIs (1:2 ratio). The case and control groups were compared in the results of five open-set speech perception tests, and a Forward Linear Regression Model was used to identify factors that can predict the post-CI outcomes. RESULTS There was no significant difference in average scores between the two groups across five outcome measures, ranging from 88.40% to 95.65%. The correlation matrix revealed that younger ages at hearing aid fitting and CI activation positively influenced improvements in speech perception test scores. Furthermore, among the variables incorporated in the regression model, the duration of follow-up with CIs, age at CI activation, and the utilization of two CIs demonstrated prognostic significance for improved post-CI speech perception outcomes. CONCLUSIONS Children with ANSD can achieve similar open-set speech perception outcomes as children with SNHL. A longer CI follow-up, a lower age at CI activation, and the use of two CIs are predictive for optimal CI outcome.
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Affiliation(s)
- Zahra Jafari
- Audiology and Speech-Language Pathology Program, University of Ottawa, Ottawa, Ontario, Canada
- School of Communication Sciences and Disorders (SCSD), Dalhousie University, Halifax, NS, Canada
| | - Elizabeth M. Fitzpatrick
- Audiology and Speech-Language Pathology Program, University of Ottawa, Ottawa, Ontario, Canada
- Child Hearing Lab, CHEO Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - David R. Schramm
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Isabelle Rouillon
- Speech and Language Pathology, and Otolaryngology Department, Necker Hospital, Paris, France
| | - Amineh Koravand
- Audiology and Speech-Language Pathology Program, University of Ottawa, Ottawa, Ontario, Canada
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Farag HM, Osman DM, Safwat RF. Language profile of children with cochlear implants: comparative study about the effect of age of cochlear implantation and the duration of rehabilitation. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08689-8. [PMID: 38755508 DOI: 10.1007/s00405-024-08689-8] [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: 01/29/2024] [Accepted: 04/15/2024] [Indexed: 05/18/2024]
Abstract
PURPOSE The analysis of different language domains and exploration of variables that affect the outcomes of cochlear implantation would help to document the efficacy of cochlear implantation and intervention programs. The aim of this work was to examine the language profile of children with Cochlear Implants (CI) and to assess the effect of age at the time of cochlear implantation and the impact of duration of rehabilitation on the development of linguistic abilities for cochlear implanted children. METHODS The study was conducted on 46 Arabic speaking children using unilateral CI who are receiving regular post-cochlear auditory and language rehabilitation in the phoniatrics unit, Kasr Alaini hospital. A Proficient Preschooler Language Evaluation (APPEL TOOL) was applied for the assessment of different language domains. RESULTS Children who received post implant rehabilitation for ≥ 2 years showed significant improvement in all subtests' scores of APPEL tool than children who received same rehabilitation for ≤ 1 year. There was no significant difference of language scores between children who have received CI before age of 3 years and those who have been implanted after age of 3 years. CONCLUSION This study showed that the language profile of CI children was beneficially affected by the longer duration of therapy post implantation.
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Affiliation(s)
- Heba Mahmoud Farag
- Phoniatrics, Phoniatric Unit, ENT Department, Faculty of Medicine, Cairo University, King Faisal Street, 300, Giza, 12511, Egypt.
| | - Dalia Mostafa Osman
- Phoniatrics, Phoniatric Unit, ENT Department, Faculty of Medicine, Cairo University, King Faisal Street, 300, Giza, 12511, Egypt
| | - Rasha Farouk Safwat
- Phoniatrics, Phoniatric Unit, ENT Department, Faculty of Medicine, Cairo University, King Faisal Street, 300, Giza, 12511, Egypt
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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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Hung YC, Lim TZ, Chen PH, Tsai YS. Hearing aid wear time and its impact on vocabulary in preschoolers with moderately severe to profound hearing loss. Int J Audiol 2024:1-9. [PMID: 38358124 DOI: 10.1080/14992027.2024.2313017] [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: 11/24/2022] [Accepted: 01/26/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVE This study aimed to explore how the consistency of hearing aid (HA) use impacts vocabulary performance in children with moderately severe to profound hearing loss and determine the amount of HA use time associated with better vocabulary outcomes. DESIGN Personal wear time percentage (WTP) was an indicator of HA use consistency, and the information on HA wear time was collected from both parent reports and datalogs. Pearson's correlations were performed to investigate the associations between hearing loss severity, WTP and vocabulary performance. Standard vocabulary scores among children below and above three WTP cutoff values (80%, 85%, and 90%) were examined to determine the WTP amount that yielded significantly better vocabulary outcomes. STUDY SAMPLE Forty-seven children aged 36-79 months and their caregivers. RESULTS Both parent reports and datalogs WTP significantly correlated with vocabulary outcomes. Parent-reported WTP were found to be predictive of datalogs WTP. Apart from hearing thresholds, HA fitting age and maternal education level, datalogs WTP was a significant independent predictor of vocabulary performance. Children with ≥ 90% WTP were more likely to perform better on vocabulary tests than those with < 90% WTP. CONCLUSION The findings support the potential benefits of consistent HA use for vocabulary development.
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Affiliation(s)
- Yu-Chen Hung
- Speech and Hearing Science Research Institute, Children's Hearing Foundation, Taipei City, Taiwan
- Department of Special Education, Chung Yuan Christian University, Taipei City, Taiwan
| | - Tang Zhi Lim
- Speech and Hearing Science Research Institute, Children's Hearing Foundation, Taipei City, Taiwan
| | - Pei-Hua Chen
- Speech and Hearing Science Research Institute, Children's Hearing Foundation, Taipei City, Taiwan
| | - Yi-Shin Tsai
- Speech and Hearing Science Research Institute, Children's Hearing Foundation, Taipei City, Taiwan
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Complications and outcomes of cochlear implantation in children younger than 12 months: A multicenter study. Int J Pediatr Otorhinolaryngol 2023; 167:111495. [PMID: 36868146 DOI: 10.1016/j.ijporl.2023.111495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 02/06/2023] [Accepted: 02/19/2023] [Indexed: 02/27/2023]
Abstract
OBJECTIVES Evidence suggests that Cochlear Implantation (CI) is a beneficial approach for auditory and speech skills improvement in children with severe to profound hearing loss. However, it remains controversial if implantation in children <12 months is safe and effective compared to older children. The present study aimed to determine whether children's ages affect surgical complications and auditory and speech development. METHODS The current multicenter study enrolled 86 children who underwent CI surgery at <12 months of age (group A) and 362 children who underwent implantation between 12 and 24 months of age (group B). The Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) scores were determined pre-impanation, and "one-year" and "two-year" post-implantation. RESULTS All children had full insertions of the electrode array. Four complications (overall rate: 4.65%; three minor) occurred in group A and 12 complications (overall rate: 4.41%; nine minor) occurred in group B. We found no statistically significant difference in the complication rates between the groups (p > 0.05). The mean SIR and CAP scores improved over time following CI activation in both groups. However, we did not find significant differences in CAP and SIR scores between the groups across different time points. CONCLUSION Cochlear implantation in children younger than 12 months is a safe and efficient procedure, providing substantial auditory and speech benefits. Furthermore, rates and nature of minor and major complications in infants are similar to those of children undergoing the CI at an older age.
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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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Noble AR, Resnick J, Broncheau M, Klotz S, Rubinstein JT, Werner LA, Horn DL. Spectrotemporal Modulation Discrimination in Infants With Normal Hearing. Ear Hear 2023; 44:109-117. [PMID: 36218270 PMCID: PMC9780152 DOI: 10.1097/aud.0000000000001277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Spectral resolution correlates with speech understanding in post-lingually deafened adults with cochlear implants (CIs) and is proposed as a non-linguistic measure of device efficacy in implanted infants. However, spectral resolution develops gradually through adolescence regardless of hearing status. Spectral resolution relies on two different factors that mature at markedly different rates: Resolution of ripple peaks (frequency resolution) matures during infancy whereas sensitivity to across-spectrum intensity modulation (spectral modulation sensitivity) matures by age 12. Investigation of spectral resolution as a clinical measure for implanted infants requires understanding how each factor develops and constrains speech understanding with a CI. This study addresses the limitations of the present literature. First, the paucity of relevant data requires replication and generalization across measures of spectral resolution. Second, criticism that previously used measures of spectral resolution may reflect non-spectral cues needs to be addressed. Third, rigorous behavioral measurement of spectral resolution in individual infants is limited by attrition. To address these limitations, we measured discrimination of spectrally modulated, or rippled, sounds at two modulation depths in normal hearing (NH) infants and adults. Non-spectral cues were limited by constructing stimuli with spectral envelopes that change in phase across time. Pilot testing suggested that dynamic spectral envelope stimuli appeared to hold infants' attention and lengthen habituation time relative to previously used static ripple stimuli. A post-hoc condition was added to ensure that the stimulus noise carrier was not obscuring age differences in spectral resolution. The degree of improvement in discrimination at higher ripple depth represents spectral frequency resolution independent of the overall threshold. It was hypothesized that adults would have better thresholds than infants but both groups would show similar effects of modulation depth. DESIGN Participants were 53 6- to 7-month-old infants and 23 adults with NH with no risk factors for hearing loss who passed bilateral otoacoustic emissions screening. Stimuli were created from complexes with 33- or 100-tones per octave, amplitude-modulated across frequency and time with constant 5 Hz envelope phase-drift and spectral ripple density from 1 to 20 ripples per octave (RPO). An observer-based, single-interval procedure measured the highest RPO (1 to 19) a listener could discriminate from a 20 RPO stimulus. Age-group and stimulus pure-tone complex were between-subjects variables whereas modulation depth (10 or 20 dB) was within-subjects. Linear-mixed model analysis was used to test for the significance of the main effects and interactions. RESULTS All adults and 94% of infants provided ripple density thresholds at both modulation depths. The upper range of threshold approached 17 RPO with the 100-tones/octave carrier and 20 dB depth condition. As expected, mean threshold was significantly better with the 100-tones/octave compared with the 33-tones/octave complex, better in adults than in infants, and better at 20 dB than 10 dB modulation depth. None of the interactions reached significance, suggesting that the effect of modulation depth on the threshold was not different for infants or adults. CONCLUSIONS Spectral ripple discrimination can be measured in infants with minimal listener attrition using dynamic ripple stimuli. Results are consistent with previous findings that spectral resolution is immature in infancy due to immature spectral modulation sensitivity rather than frequency resolution.
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Affiliation(s)
- Anisha R. Noble
- Department of Otolaryngology – Head and Neck Surgery, University of Washington, Seattle, WA
| | - Jesse Resnick
- Department of Otolaryngology – Head and Neck Surgery, University of Washington, Seattle, WA
| | - Mariette Broncheau
- Department of Otolaryngology – Head and Neck Surgery, University of Washington, Seattle, WA
| | - Stephanie Klotz
- Department of Speech and Hearing Sciences, University of Washington, Seattle, WA
| | - Jay T. Rubinstein
- Department of Otolaryngology – Head and Neck Surgery, University of Washington, Seattle, WA
| | - Lynne A. Werner
- Department of Otolaryngology – Head and Neck Surgery, University of Washington, Seattle, WA
- Department of Speech and Hearing Sciences, University of Washington, Seattle, WA
| | - David L. Horn
- Department of Otolaryngology – Head and Neck Surgery, University of Washington, Seattle, WA
- Department of Speech and Hearing Sciences, University of Washington, Seattle, WA
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Boonen N, Kloots H, Nurzia P, Gillis S. Spontaneous speech intelligibility: early cochlear implanted children versus their normally hearing peers at seven years of age. JOURNAL OF CHILD LANGUAGE 2023; 50:78-103. [PMID: 36503545 DOI: 10.1017/s0305000921000714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Speaking intelligibly is an important achievement in children's language development. How far do congenitally severe-to-profound hearing-impaired children who received a cochlear implant (CI) in the first two years of their life advance on the path to intelligibility in comparison to children with typical hearing (NH)? Spontaneous speech samples of children with CI and children with NH were orthographically transcribed by naïve transcribers. The entropy of the transcriptions was computed to analyze their degree of uniformity. The same samples were also rated on a continuous rating scale by another group of adult listeners. The transcriptions of the NH children's speech were more uniform, i.e., had significantly lower entropy, than those of the CI children, suggesting that the latter group displayed lower intelligibility. This was confirmed by the ratings on the continuous scale. Despite the relatively restricted age ranges, older children reached better intelligibility scores in both groups.
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Affiliation(s)
- Nathalie Boonen
- Computational Linguistics, & Psycholinguistics Research Centre, University of Antwerp, Antwerp, Belgium E-mail:
| | - Hanne Kloots
- Computational Linguistics, & Psycholinguistics Research Centre, University of Antwerp, Antwerp, Belgium E-mail:
| | - Pietro Nurzia
- Computational Linguistics, & Psycholinguistics Research Centre, University of Antwerp, Antwerp, Belgium E-mail:
| | - Steven Gillis
- Computational Linguistics, & Psycholinguistics Research Centre, University of Antwerp, Antwerp, Belgium E-mail:
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Malcolm KA, Suen JJ, Nieman CL. Socioeconomic position and hearing loss: current understanding and recent advances. Curr Opin Otolaryngol Head Neck Surg 2022; 30:351-357. [PMID: 36004788 PMCID: PMC10155234 DOI: 10.1097/moo.0000000000000831] [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] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to describe recent literature examining the relationship between socioeconomic position (SEP) and hearing loss, including the impact of hearing loss on several socioeconomic outcomes over the life course. Additionally, we highlight current policy advances in recent years and review alternative models of hearing care that aim to address disparities related to SEP and hearing healthcare. RECENT FINDINGS Applying a social epidemiologic lens to hearing health gives insight into the role of material and social contexts in understanding and improving hearing health outcomes. Recent studies investigating the intersection of SEP and hearing health highlight the disparities that exist for individuals with low SEP as well as the influence of hearing loss on SEP. Individuals with hearing loss are more likely to be unemployed, have lower educational attainment, lower income, and are less likely to use hearing aids and access hearing care. Legislation addressing cost and access to hearing care as well as transforming the current landscape of hearing care, is essential to creating equitable care for individuals, especially older adults, with low SEP. SUMMARY With the expected rise in prevalence of hearing loss over the next 40 years, hearing care that is affordable and accessible is a public health priority. As hearing loss is associated with negative outcomes for individuals with low SEP, advances in legislation and care delivery models are necessary in order to include populations traditionally unserved by current hearing healthcare.
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Affiliation(s)
- Kelly A. Malcolm
- Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health
| | - Jonathan J. Suen
- Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health
- Johns Hopkins School of Nursing
| | - Carrie L. Nieman
- Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health
- Johns Hopkins School of Nursing
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Glaubitz C, Geiss KT, Hoppe U. [Word production in children with cochlear implant based on chronological age and hearing age]. Laryngorhinootologie 2022; 101:886-895. [PMID: 36055256 DOI: 10.1055/a-1925-7757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
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.
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Affiliation(s)
- Cynthia Glaubitz
- Cochlear-Implant-Centrum CICERO, Universitätsklinikum Erlangen Hals-Nasen-Ohrenklinik Kopf- und Halschirurgie, Erlangen, Germany
| | - Katrin T Geiss
- Cochlear-Implant-Centrum CICERO, Universitätsklinikum Erlangen Hals-Nasen-Ohrenklinik Kopf- und Halschirurgie, Erlangen, Germany
| | - Ulrich Hoppe
- Cochlear-Implant-Centrum CICERO, Universitätsklinikum Erlangen Hals-Nasen-Ohrenklinik Kopf- und Halschirurgie, Erlangen, Germany
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Lu HP, Lin CS, Wu CM, Peng SC, Feng IJ, Lin YS. The effect of lexical tone experience on English intonation perception in Mandarin-speaking cochlear-implanted children. Medicine (Baltimore) 2022; 101:e29567. [PMID: 35839064 PMCID: PMC11132337 DOI: 10.1097/md.0000000000029567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/26/2022] [Indexed: 11/25/2022] Open
Abstract
To examine the effect of lexical tone experience on English intonation perception in Mandarin-speaking cochlear-implanted children during second language acquisition in Taiwan. A retrospective cohort study. A tertiary referred center. Fourteen children with cochlear implant (CI) in the experimental group, and 9 normal hearing children in the control group were enrolled in this study. Cochlear implantation and hearing rehabilitation. Two speech recognition accuracies were examined: (1) Lexical tone recognition (4-alternative forced choice, AFC), (2) English Sentence Intonation (2AFC). The overall accuracies for tone perception are 61.13% (standard deviation, SD = 10.84%) for CI group and 93.82% (SD = 1.80%) for normal hearing group. Tone 4 and Tone 1 were more easily to be recognized than tone 2 and tone 3 in the pediatric CI recipients (cCI) group. In English intonation perception, the overall accuracies are 61.82% (SD = 16.85%) for CI group, and 97.59% (SD = 4.73%) for normal hearing group. Significant high correlation (R = .919, P ≦ .000) between lexical tone perception and English intonation perception is noted. There is no significant difference for English intonation perception accuracies between Mandarin-speaking cCI (61.82%) and English-speaking cCI (70.13%, P = .11). Mandarin-speaking cochlear-implanted children showed significant deficits in perception of lexical tone and English intonation relative to normal hearing children. There was no tonal language benefit in Mandarin-speaking cochlear-implanted children's English intonation perception, compared to the English-speaking cochlear-implanted peers. For cochlear-implanted children, better lexical tone perception comes with better English intonation perception. Enhancing Mandarin prosodic perception for cochlear-implanted children may benefit their command of intonation in English.
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Affiliation(s)
- Hui-Ping Lu
- Center of Speech and Hearing, Department of Otolaryngology, Chi Mei Medical Center, Tainan, Taiwan
| | - Chih-Shin Lin
- Center of Speech and Hearing, Department of Otolaryngology, Chi Mei Medical Center, Tainan, Taiwan
- Department of Speech and Language Therapy, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Che-Ming Wu
- Department of Otorhinolaryngology, New Taipei municipal TuCheng Hospital (built and operated by Chang Gung Medical Foundation), TuCheng, New Taipei City, Taiwan
- Department of Otorhinolaryngology, Chang Gung Memorial Hospital, Linkou, School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shu-Chen Peng
- Center for Devices and Radiological Health, United States Food and Drug Administration, Silver Spring, MD
| | - I. Jung Feng
- Institute of Precision Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Yung-Song Lin
- Center of Speech and Hearing, Department of Otolaryngology, Chi Mei Medical Center, Tainan, Taiwan
- Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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13
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Busch T, Brinchmann EI, Braeken J, Wie OB. Receptive Vocabulary of Children With Bilateral Cochlear Implants From 3 to 16 Years of Age. Ear Hear 2022; 43:1866-1880. [PMID: 35426854 PMCID: PMC9592181 DOI: 10.1097/aud.0000000000001220] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
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.
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Affiliation(s)
- Tobias Busch
- Department of Special Needs Education, University of Oslo, Oslo, Norway
| | | | - Johan Braeken
- Centre for Educational Measurement, University of Oslo, Oslo, Norway
| | - Ona Bø Wie
- Department of Special Needs Education, University of Oslo, Oslo, Norway,Department of Otolaryngology, Oslo University Hospital, Oslo, Norway
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14
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Gao Q, Wong LLN, Chen F. A Review of Speech Perception of Mandarin-Speaking Children With Cochlear Implantation. Front Neurosci 2022; 15:773694. [PMID: 34970113 PMCID: PMC8712552 DOI: 10.3389/fnins.2021.773694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/15/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: This paper reviewed the literature on the development of and factors affecting speech perception of Mandarin-speaking children with cochlear implantation (CI). We also summarized speech outcome measures in standard Mandarin for evaluating auditory and speech perception of children with CI. Method: A comprehensive search of Google Scholar and PubMed was conducted from March to June 2021. Search terms used were speech perception/lexical tone recognition/auditory perception AND cochlear implant AND Mandarin/Chinese. Conclusion: Unilateral CI recipients demonstrated continuous improvements in auditory and speech perception for several years post-activation. Younger age at implantation and longer duration of CI use contribute to better speech perception. Having undergone a hearing aid trial before implantation and having caregivers whose educational level is higher may lead to better performance. While the findings that support the use of CI to improve speech perception continue to grow, much research is needed to validate the use of unilateral and bilateral implantation. Evidence to date, however, revealed bimodal benefits over CI-only conditions in lexical tone recognition and sentence perception in noise. Due to scarcity of research, conclusions on the benefits of bilateral CIs compared to unilateral CI or bimodal CI use cannot be drawn. Therefore, future research on bimodal and bilateral CIs is needed to guide evidence-based clinical practice.
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Affiliation(s)
- Qi Gao
- Department of Electrical and Electronic Engineering, Southern University of Science and Technology, Shenzhen, China.,Faculty of Education, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Lena L N Wong
- Faculty of Education, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Fei Chen
- Department of Electrical and Electronic Engineering, Southern University of Science and Technology, Shenzhen, China
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15
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Šikolová S, Urík M, Hošnová D, Kruntorád V, Bartoš M, Motyka O, Jabandžiev P. Two Bonebridge bone conduction hearing implant generations: audiological benefit and quality of hearing in children. Eur Arch Otorhinolaryngol 2021; 279:3387-3398. [PMID: 34495351 PMCID: PMC9130159 DOI: 10.1007/s00405-021-07068-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/31/2021] [Indexed: 12/05/2022]
Abstract
Purpose The study aimed to evaluate audiological benefits, quality of hearing and safety of two Bonebridge generation: BCI601 and BCI602 (MED-EL, Innsbruck, Austria) in children. Methods Twelve children were implanted: five BCI601 and seven BCI602 comprising of ten conductive hearing loss, and two single sided deaf SSD subjects. Audiological outcomes tested were sound field audiometry, functional gain, speech recognition threshold (SRT50), speech recognition in noise (SPRINT) and localisation abilities. Subjective measures were Speech, Spatial and Qualities of Hearing Scale (SSQ12). Results The mean FG with the BCI601 was 25.0 dB and with the BCI602 28.0 dB. The benefit in SRT50 was 23.2 dB and 33.8 dB, respectively. The mean benefit in SPRINT was 15% and 6.7% and the localisation ability improved from 33.3° to 16° and from 26.2° to 17.6°, respectively. The two SSD subjects reported a FG of 17 dB, a benefit in SRT50 of 22.5 and a benefit in SPRINT of 20%. Subjective outcomes improved significantly and even exceeded the values of their age-and sex matched normal hearing peers. One revision was reported: a retroauricular emphysema above the implant occurred 12 months post-OP, it was resolved operatively with the implant still being functional. Conclusion The pediatric cohort reports significant audiological benefit, even exceeding that of the age- and sex matched control. The combination of the high safety and audiological benefit makes the Bonebridge a comfortable and effective option in hearing rehabilitation in children.
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Affiliation(s)
- Soňa Šikolová
- Department of Pediatric Otorhinolaryngology, University Hospital Brno, Černopolní 9, 61300, Brno, Czech Republic.,Faculty of Medicine, Masaryk University Brno, Kamenice 5, 62500, Brno, Czech Republic
| | - Milan Urík
- Department of Pediatric Otorhinolaryngology, University Hospital Brno, Černopolní 9, 61300, Brno, Czech Republic. .,Faculty of Medicine, Masaryk University Brno, Kamenice 5, 62500, Brno, Czech Republic.
| | - Dagmar Hošnová
- Department of Pediatric Otorhinolaryngology, University Hospital Brno, Černopolní 9, 61300, Brno, Czech Republic.,Faculty of Medicine, Masaryk University Brno, Kamenice 5, 62500, Brno, Czech Republic
| | - Vít Kruntorád
- Department of Pediatric Otorhinolaryngology, University Hospital Brno, Černopolní 9, 61300, Brno, Czech Republic.,Faculty of Medicine, Masaryk University Brno, Kamenice 5, 62500, Brno, Czech Republic
| | - Michal Bartoš
- Department of Pediatric Otorhinolaryngology, University Hospital Brno, Černopolní 9, 61300, Brno, Czech Republic.,Faculty of Medicine, Masaryk University Brno, Kamenice 5, 62500, Brno, Czech Republic
| | - Oldřich Motyka
- Nanotechnology Centre, CEET, VSB-Technical University of Ostrava, 708 00, Ostrava-Poruba, Czech Republic.,Centre ENET, CEET, VSB-Technical University of Ostrava, 708 00, Ostrava-Poruba, Czech Republic
| | - Petr Jabandžiev
- Faculty of Medicine, Masaryk University Brno, Kamenice 5, 62500, Brno, Czech Republic.,Department of Pediatrics, University Hospital Brno, 61300, Brno, Czech Republic
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16
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Effect of Age at Cochlear Implantation in Educational Placement and Peer Relationships. Ear Hear 2021; 42:1054-1061. [PMID: 33974787 DOI: 10.1097/aud.0000000000001000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The education and school life of children who have undergone cochlear implantation (CI) is very important and should be monitored continuously. This study assessed auditory performance in children with cochlear implants over time, along with educational placement and peer relationship, and compared the results based on the age at CI and the presence of additional disabilities. DESIGN In total, 77 children who had undergone CI at the Hearing Center in Ajou University Hospital at less than 10 years old and who were presently attending school or had already graduated from school within 3 years were enrolled in this study. All children had congenital bilateral severe or profound hearing loss at the diagnosis. They were classified based on the age at which they received CI: the "early-implanted group," younger than 3.5 years (n = 38), and the "late-implanted group," between 3.5 and 10 years old (n = 39). RESULTS The early-implanted group had worse short-term auditory performance than the late group, but after 2 years of the implant use, auditory performance was similar in both groups. The early and late groups did not differ significantly in terms of the proportions of children who were enrolled in a regular school (94.7% and 89.7%, respectively). However, the early-implanted group had a larger proportion of children who were enrolled in a regular school without additional needs (73.0%), compared with the late group (48.6%) (p = .034). Children with multiple disabilities showed poorer performance (word score of 57.7% and sentence score of 44.7%) than children with hearing disability only (91.8% and 87.2%, respectively), which affected full-time enrollment in regular schools. With regard to peer relationships, 19.0% of children in the early-implanted group required close observation and assistance, and 9.5% even required help and counseling. Children who underwent early CI had a high tendency toward social restraint, apathy, and over-commitment. No correlations were observed between audiological factors and the aspects of peer relationships assessed in this study. CONCLUSIONS Early CI and the absence of other disabilities were the two main factors that increased the likelihood of full-time enrollment in mainstream classes at regular schools. Nevertheless, many children who underwent earlier CI still encountered difficulties in peer relationships.
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17
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Glaubitz C, Liebscher T, Hoppe U. Age-related language performance and device use in children with very early bilateral cochlear implantation. Int J Pediatr Otorhinolaryngol 2021; 147:110780. [PMID: 34052573 DOI: 10.1016/j.ijporl.2021.110780] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/21/2021] [Accepted: 05/17/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Paediatric cochlear implantation within the first year of life results in better outcome in auditory and language skills. Beside individual, audiological and social factors, quantity and quality of daily cochlear implant (CI) use also seem to be an influencing factor. The purpose of this study was to evaluate children's early receptive and expressive language performance considering bilingual language development as well as quantity and quality of daily CI use and intraoperative objective measurements. METHODS The retrospective analysis included data from 35 very early bilaterally cochlear-implanted children (age at CI M = 8.4 ± 1.5 months). Language performance was assessed by the German standardised test SETK-2 (age at testing M = 29.4 ± 4.0 months). The CI system-integrated data-logging was analysed with regard to daily CoilOn-time, CoilOff and exposure to classified listening scenes. Intraoperatively measured thresholds of evoked compound action potentials (T-ECAPs) were analysed to ensure CI functionality. RESULTS The cohort showed language performance within the normal range for word comprehension, sentence comprehension and word production, level of sentence production was reduced. Overall, bilingual children performed less well than monolingual children. Intraoperative T-ECAPs were recorded for the total cohort and no anomalies were detected. Children used their CI for about 8.7 ± 1.4 h per day, most of this time spent in a quiet environment (38%). Word production was significantly correlated with the daily duration of CI use (CoilOn-time) and with exposure to the listening environment Speech. No correlation was found between number of daily coil disconnections (CoilOff) and language performance. CONCLUSION Very early bilateral cochlear implantation may result in age-appropriate language skills already at the age of 2 years. Monolingualism seems to a better condition for early language development with CI than bilingualism. Especially for word production, the daily duration of CI use and exposure time in a speech-characterised environment seem to be additional positive factors. Monitoring the data-logs should be one important focus of professionals during the postoperative rehabilitation process to detect potential benefits and risks. These findings should be integrated into rehabilitative therapy and parent counselling.
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18
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Mathew R, Bajo FR, Hatton N, Buttfield L, Gowrishankar S, Vickers D, Donnelly N, Tysome J, Bance M, Axon P. Assessment of the cochlear implant pathway for newborn hearing screening referrals. Cochlear Implants Int 2021; 22:345-352. [PMID: 34232110 DOI: 10.1080/14670100.2021.1948163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the cochlear implant (CI) assessment pathway for children referred through the newborn hearing screening programme (NHSP) and identify potential reasons for delay in CI surgery at a large UK centre. METHODS Retrospective analysis of electronic notes of children referred through NHSP from 2016 to 2019. Key points in the assessment pathway from referral to switch-on were assessed. RESULTS Of the 46 referrals, 44 went on to have CI surgery. Median age at CI surgery was 15 months (interquartile range (IQR) 13 to 17 months). Only 5% of referrals were implanted before the age of 12 months. Delayed referral and the presence of otitis media with effusion (OME) were associated with delayed implantation. The median period of monitoring for OME was 48 days (IQR 20 to 93 days), with a natural resolution rate of only 11%. The median time from surgery to switch-on was 5 weeks (IQR 4.1 to 5.4 weeks). CONCLUSION Achieving implantation prior to the age of 12 months for NHSP referrals can be challenging for a variety of reasons. The delays in the system and the steps that our implant programme has taken to address these will be highlighted.
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Affiliation(s)
- Rajeev Mathew
- Cambridge University Hospitals Foundation trust, Addenbrooke's Hospital, Cambridge, UK
| | | | - Nicola Hatton
- Cambridge University Hospitals Foundation trust, Addenbrooke's Hospital, Cambridge, UK
| | - Louise Buttfield
- Cambridge University Hospitals Foundation trust, Addenbrooke's Hospital, Cambridge, UK
| | | | - Deborah Vickers
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Neil Donnelly
- Cambridge University Hospitals Foundation trust, Addenbrooke's Hospital, Cambridge, UK
| | - James Tysome
- Cambridge University Hospitals Foundation trust, Addenbrooke's Hospital, Cambridge, UK
| | - Manohar Bance
- Cambridge University Hospitals Foundation trust, Addenbrooke's Hospital, Cambridge, UK.,School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Patrick Axon
- Cambridge University Hospitals Foundation trust, Addenbrooke's Hospital, Cambridge, UK
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19
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Krijger S, Coene M, Govaerts PJ, Dhooge I. Listening Difficulties of Children With Cochlear Implants in Mainstream Secondary Education. Ear Hear 2021; 41:1172-1186. [PMID: 32032224 DOI: 10.1097/aud.0000000000000835] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Previous research has shown that children with cochlear implants (CIs) encounter more communication difficulties than their normal-hearing (NH) peers in kindergarten and elementary schools. Yet, little is known about the potential listening difficulties that children with CIs may experience during secondary education. The aim of this study was to investigate the listening difficulties of children with a CI in mainstream secondary education and to compare these results to the difficulties of their NH peers and the difficulties observed by their teachers. DESIGN The Dutch version of the Listening Inventory for Education Revised (LIFE-R) was administered to 19 children (mean age = 13 years 9 months; SD = 9 months) who received a CI early in life, to their NH classmates (n = 239), and to their teachers (n = 18). All participants were enrolled in mainstream secondary education in Flanders (first to fourth grades). The Listening Inventory for Secondary Education consists of 15 typical listening situations as experienced by students (LIFEstudent) during class activities (LIFEclass) and during social activities at school (LIFEsocial). The teachers completed a separate version of the Listening Inventory for Secondary Education (LIFEteacher) and Screening Instrument for Targeting Educational Risk. RESULTS Participants with CIs reported significantly more listening difficulties than their NH peers. A regression model estimated that 75% of the participants with CIs were at risk of experiencing listening difficulties. The chances of experiencing listening difficulties were significantly higher in participants with CIs for 7 out of 15 listening situations. The 3 listening situations that had the highest chance of resulting in listening difficulties were (1) listening during group work, (2) listening to multimedia, and (3) listening in large-sized classrooms. Results of the teacher's questionnaires (LIFEteacher and Screening Instrument for Targeting Educational Risk) did not show a similar significant difference in listening difficulties between participants with a CI and their NH peers. According to teachers, NH participants even obtained significantly lower scores for staying on task and for participation in class than participants with a CI. CONCLUSIONS Although children with a CI seemingly fit in well in mainstream schools, they still experience significantly more listening difficulties than their NH peers. Low signal to noise ratios (SNRs), distortions of the speech signal (multimedia, reverberation), distance, lack of visual support, and directivity effects of the microphones were identified as difficulties for children with a CI in the classroom. As teachers may not always notice these listening difficulties, a list of practical recommendations was provided in this study, to raise awareness among teachers and to minimize the difficulties.
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Affiliation(s)
- Stefanie Krijger
- Department of Head and Skin, Ghent University, Ghent University Hospital, Gent, Belgium
| | - Martine Coene
- Language and Hearing Center Amsterdam, Free University Amsterdam, Amsterdam, The Netherlands.,The Eargroup, Antwerp, Belgium
| | - Paul J Govaerts
- Language and Hearing Center Amsterdam, Free University Amsterdam, Amsterdam, The Netherlands.,The Eargroup, Antwerp, Belgium
| | - Ingeborg Dhooge
- Department of Head and Skin, Ghent University, Ghent University Hospital, Gent, Belgium
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20
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Abstract
Objectives: This longitudinal study followed the language development of children who received the combination of early (5 to 18 months) and simultaneous bilateral cochlear implants (CIs) throughout the first 6 years after implantation. It examined the trajectories of their language development and identified factors associated with language outcomes. Design: Participants were 21 Norwegian children who received bilateral CIs between the ages of 5 and 18 mo and 21 children with normal hearing (NH) who were matched to the children with CIs on age, sex, and maternal education. The language skills of these two groups were compared at 10 time points (3, 6, 9, 12, 18, 24, 36, 48, 60, and 72 months after implantation) using parent reports and standardized measures of general language skills, vocabulary, and grammar. In addition, assessments were made of the effects of age at CI activation, speech recognition abilities, and mothers’ education on language outcomes 6 years after implantation. Results: During the first 4 years after implantation, the gap in general expressive and receptive language abilities between children with CIs and children with NH gradually closed. While at the initial five to six assessments (3 to 36 months after implantation), significant differences between children with CIs and children with NH were observed; at 4 years after implantation, there were no longer any significant group differences in general language skills and most children with CIs achieved scores within 1 SD of the tests’ normative means. From 2 to 3 years after implantation onward, expressive vocabulary and receptive grammar skills of children with CIs were similar to those of the reference group. However, from 4 years after implantation until the end of the observation period, 6 years after implantation, expressive grammar skills of children with CIs were lower than those of children with NH. In addition, a gap in receptive vocabulary appeared and grew increasingly larger from 4 to 6 years postimplantation. At the final assessment, the children with CIs had an average receptive vocabulary score around 1 SD below the normative mean. Regression analysis indicated that the children’s language outcomes at 6 years after implantation were related to their speech recognition skills, age at CI activation, and maternal education. Conclusions: In the first 4 years after implantation, the language performance of children with CIs became increasingly similar to that of their NH peers. However, between 4 and 6 years after implantation, there were indications of challenges with certain aspects of language, specifically receptive vocabulary and expressive grammar. Because these challenges first appeared after the 4-year assessment, the findings underline the importance of long-term language intervention to increase the chances of a continued language development comparable to that of NH peers. They also indicate that there is a need for comprehensive longitudinal studies of the language development of children with CIs beyond 4 years after implantation.
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21
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Hilviu D, Parola A, Vivaldo S, Di Lisi D, Consolino P, Bosco F. Children with hearing impairment and early cochlear implant: A pragmatic assessment. Heliyon 2021; 7:e07428. [PMID: 34286120 PMCID: PMC8273221 DOI: 10.1016/j.heliyon.2021.e07428] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/27/2021] [Accepted: 06/24/2021] [Indexed: 11/30/2022] Open
Abstract
Extensive research has demonstrated the benefits of cochlear implants (CI) in contributing to improve the linguistic skills of children with hearing impairment; however, few studies have focused on the development of pragmatic ability and its relationship with age of implantation. Pragmatics is the ability to use language in different contexts and its development has crucial implications, e.g., social inclusion and professional attainments. In this study, we conducted a comprehensive assessment of pragmatic ability using the Language Pragmatic Abilities (APL Medea), a battery composed by five different tasks: Comprehension of Metaphors, Implicit meaning, Comics, Situations and Colors Game (a perspective taking task). Eighteen children with early CI, belonging to 3 different age groups (6; 11-7; 11, 8; 0-8; 11 and 9; 0-9; 11 years-old), and twenty-four children with typical development (Control Group) participated to the study. We also investigated how the precocity of CI, i.e., age of first implantation, may affect the pragmatic development. Globally, children with CI obtained lower scores in the APL Medea battery than typically hearing children. However, focusing on the Medea tasks separately, children with CIs differed from their hearing peers only in Comics and Colors Game tasks. Finally, age of implantation was a moderate but significant predictor of pragmatic performance.
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Affiliation(s)
- D. Hilviu
- University of Turin, Department of Psychology, Group on Inferential Processes in Social Interaction (GIPSI), Turin, Italy
| | - A. Parola
- University of Turin, Department of Psychology, Group on Inferential Processes in Social Interaction (GIPSI), Turin, Italy
- Aarhus University, Department of Linguistics, Semiotics and Cognitive Science, Aarhus, Denmark
| | - S. Vivaldo
- Martini Hospital, ENT Department, Turin, Italy
| | - D. Di Lisi
- Martini Hospital, ENT Department, Turin, Italy
| | | | - F.M. Bosco
- University of Turin, Department of Psychology, Group on Inferential Processes in Social Interaction (GIPSI), Turin, Italy
- University of Turin, Neuroscience Institute of Turin, Turin, Italy
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22
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Chweya CM, May MM, DeJong MD, Baas BS, Lohse CM, Driscoll CLW, Carlson ML. Language and Audiological Outcomes Among Infants Implanted Before 9 and 12 Months of Age Versus Older Children: A Continuum of Benefit Associated With Cochlear Implantation at Successively Younger Ages. Otol Neurotol 2021; 42:686-693. [PMID: 33710159 DOI: 10.1097/mao.0000000000003011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare language and audiological outcomes among infants (<9 and <12 mo) and older children receiving cochlear implantation (CI). STUDY DESIGN Retrospective chart review. SETTING Tertiary academic referral center. PATIENTS Pediatric patients receiving CI between October 1995 and October 2019. INTERVENTION Cochlear implantation. MAIN OUTCOME MEASURES Most recent language and audiological assessment scores were evaluated by age group. RESULTS A total of 118 children were studied, including 19 who were implanted <9 months of age, 19 implanted 9 to <12 months of age, and 80 implanted 12 to <36 months of age. The mean duration of follow-up was 7.4 ± 5.0 years. Most recent REEL-3 receptive (88 ± 12 vs. 73 ± 15; p = 0.020) and expressive (95 ± 13 vs. 79 ± 12; p = 0.013) communication scores were significantly higher in the <9 months group compared to the 9 to <12 months group. PLS and OWLS auditory comprehension and oral expression scores were significantly higher in the <12 months group compared to the 12 to <36 months group. The difference in NU-CHIPS scores between <12 and 12 to <36 months was statistically significant (89% ± 6 vs. 83% ± 12; p = 0.009). LNT scores differed significantly between <9 and 9 to <12 months (94% ± 4 vs. 86% ± 10; p = 0.028). CONCLUSIONS The recent FDA expansion of pediatric CI eligibility criteria to include infants as young as 9 months of age should not serve as a strict clinical cutoff. Rather, CI can be pursued in appropriately selected younger infants to optimize language and audiological outcomes.
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Affiliation(s)
| | | | | | | | - Christine M Lohse
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
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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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24
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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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Glaubitz C, Liebscher T, Hoppe U. [Impact of CI use and CI fitting on speech production in very early cochlear-implanted infants]. HNO 2021; 69:425-434. [PMID: 32930827 PMCID: PMC8076147 DOI: 10.1007/s00106-020-00942-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Children's age at implantation is an important factor for their outcome in auditory and language skills with a cochlear implant (CI). CI use and frequency of CI fitting may also influence speech performance. Purpose of this study was to evaluate CI use and CI fitting of very early implanted infants and its potential influence on age-related speech production performance. METHODS Data of 34 bilaterally cochlea-implanted infants (age at CI in months: M = 8,8; SD = 1,7) were included. During the third year of life speech production performance was evaluated and related to datalogging-based CI use and number of CI fitting sessions. RESULTS About half of the cohort achieved speech production level within the normal range of hearing peers. Daily time of CI use was approximately 8 h. Analysis of listening environment showed that infants were exposed most of the time to quiet environment and least amount of time to speech in noise. Daily time of CI use seems to be a significant predictor of speech production, speech-exposition particularly predicts word production. Number of daily disconnection between CI-processor and implant as well as the monthly number of CI fitting sessions were not correlated with speech production. CONCLUSION Very early cochlear implanted infants may achieve age-appropriate speech production performance in the third year of life. Time of daily CI use in the study cohort is comparable to results of other studies. Time of daily CI use and exposure to speech seem to be important factors for early speech production. These findings should be integrated in pre- and postoperative parent counselling.
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Affiliation(s)
- C Glaubitz
- Hals-Nasen-Ohrenklinik, Kopf- und Halschirurgie, Cochlear-Implant-Centrum CICERO, Universitätsklinikum Erlangen, Waldstr. 1, 91054, Erlangen, Deutschland.
| | - T Liebscher
- Hals-Nasen-Ohrenklinik, Kopf- und Halschirurgie, Cochlear-Implant-Centrum CICERO, Universitätsklinikum Erlangen, Waldstr. 1, 91054, Erlangen, Deutschland
| | - U Hoppe
- Hals-Nasen-Ohrenklinik, Kopf- und Halschirurgie, Cochlear-Implant-Centrum CICERO, Universitätsklinikum Erlangen, Waldstr. 1, 91054, Erlangen, Deutschland
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Dettman S, Choo D, Au A, Luu A, Dowell R. Speech Perception and Language Outcomes for Infants Receiving Cochlear Implants Before or After 9 Months of Age: Use of Category-Based Aggregation of Data in an Unselected Pediatric Cohort. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:1023-1039. [PMID: 33630667 DOI: 10.1044/2020_jslhr-20-00228] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose This retrospective study aimed to amass large data sets to enable statistical comparisons of communication outcomes for infants receiving cochlear implants (CIs) before 9 months of age compared to groups who received their first CI between 9 months and 3.5 years of age. Method Speech perception scores and experienced clinicians' observations were used to refine the Categories of Auditory Performance Index (CAPI), thus creating its revised version, namely, the CAPI-Revised (CAPI-R). Standardized and criterion-referenced language data were used to create the novel Categories of Linguistic Performance (CLIP). The association between CAPI-R and CLIP data at two time points post implant (at 2 years of device experience and at 5 years of age) was examined in a large unselected cohort stratified for age at first implant: before 9 months (Group 1), between 9 and 12 months (Group 2), between 13 and 18 months (Group 3), between 19 and 24 months (Group 4), between 25 and 30 months (Group 5), between 31 and 36 months (Group 6), and between 37 and 42 months (Group 7). Results CAPI-R medians were 5 at 2 years of device experience, and 6 at 5 years of age. At 2 years of device experience, there was no significant difference in CAPI-R medians for children who received their first CI before 9 months compared to all other age-at-implant groups. At 5 years of age, a significantly better CAPI-R median was demonstrated by Group 1 (CI before 9 months) compared to Groups 4, 5, 6, and 7. CLIP medians were 3 at 2 years of device experience, and at 5 years of age. At 2 years device experience, and at 5 years of age, the Group 1 CLIP medians were significantly better than later age-at-implant groups. Conclusion Median CAPI-R outcomes supported access to CIs before 18 months of age for speech perception, and median CLIP outcomes supported access to CIs before 9 months of age for optimum language development.
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Affiliation(s)
- Shani Dettman
- Department of Audiology and Speech Pathology, The University of Melbourne, Parkville, Victoria, Australia
- The HEARing CRC, Carlton, Victoria, Australia
- Cochlear Implant Clinic, The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Dawn Choo
- Department of Audiology and Speech Pathology, The University of Melbourne, Parkville, Victoria, Australia
- The HEARing CRC, Carlton, Victoria, Australia
- Cochlear Implant Clinic, The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Agnes Au
- Department of Audiology and Speech Pathology, The University of Melbourne, Parkville, Victoria, Australia
| | - Amy Luu
- Department of Audiology and Speech Pathology, The University of Melbourne, Parkville, Victoria, Australia
| | - Richard Dowell
- Department of Audiology and Speech Pathology, The University of Melbourne, Parkville, Victoria, Australia
- The HEARing CRC, Carlton, Victoria, Australia
- Cochlear Implant Clinic, The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
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Holzinger D, Hofer J, Dall M. Frühe Prädiktoren der Sprachentwicklung von Kindern mit permanenter Hörstörung. KINDHEIT UND ENTWICKLUNG 2021. [DOI: 10.1026/0942-5403/a000325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Sprachentwicklungsverläufe bei Kindern mit Hörstörungen zeigen eine hohe und überwiegend ungeklärte Varianz. Fragestellung und Methode: Unsere Übersichtsarbeit präsentiert aktuelle Evidenz zu frühen Prädiktoren der Sprachentwicklung. Ergebnisse und Diskussion: Trotz deutlicher positiver Trends erreicht nur jedes zweite Kind ein Sprachentwicklungsniveau im Normbereich. Der Literaturüberblick ergibt signifikante kindbezogene und familiäre Prädiktoren mit eher geringer Beeinflussbarkeit. Als hoch prädiktiv für sprachliche Ergebnisse und zudem der Intervention zugänglich erweisen sich die frühe Erkennung und technische Versorgung mit Hörgeräten oder -implantaten und Aufnahme in die Frühförderung, konsistente Hörtechnikverwendung und/oder früher Zugang zur Gebärdensprache. Zudem zeigt sich die Qualität der täglichen Eltern-Kind-Interaktion als hocheffektiv für die Sprachentwicklung. Schlussfolgerung: Es bestätigt sich die Wirksamkeit aktueller Best Practice früher Erkennung, Versorgung und familienzentrierter Frühförderung.
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Affiliation(s)
- Daniel Holzinger
- Forschungsinstitut für Entwicklungsmedizin, Johannes Kepler Universität Linz
- Institut für Sinnes- und Sprachneurologie, Konventhospital Barmherzige Brüder, Linz
- Institut für Sprachwissenschaft, Karl-Franzens-Universität Graz
| | - Johannes Hofer
- Forschungsinstitut für Entwicklungsmedizin, Johannes Kepler Universität Linz
- Institut für Sinnes- und Sprachneurologie, Konventhospital Barmherzige Brüder, Linz
- Abteilung für Pädiatrie I, Medizinische Universität Innsbruck
| | - Magdalena Dall
- Forschungsinstitut für Entwicklungsmedizin, Johannes Kepler Universität Linz
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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: 8] [Impact Index Per Article: 2.7] [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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Abstract
IMPORTANCE Hearing loss in children is common and by age 18 years, affects nearly 1 of every 5 children. Without hearing rehabilitation, hearing loss can cause detrimental effects on speech, language, developmental, educational, and cognitive outcomes in children. OBSERVATIONS Consequences of hearing loss in children include worse outcomes in speech, language, education, social functioning, cognitive abilities, and quality of life. Hearing loss can be congenital, delayed onset, or acquired with possible etiologies including congenital infections, genetic causes including syndromic and nonsyndromic etiologies, and trauma, among others. Evaluation of hearing loss must be based on suspected diagnosis, type, laterality and degree of hearing loss, age of onset, and additional variables such as exposure to cranial irradiation. Hearing rehabilitation for children with hearing loss may include use of hearing aids, cochlear implants, bone anchored devices, or use of assistive devices such as frequency modulating systems. CONCLUSIONS AND RELEVANCE Hearing loss in children is common, and there has been substantial progress in diagnosis and management of these cases. Early identification of hearing loss and understanding its etiology can assist with prognosis and counseling of families. In addition, awareness of treatment strategies including the many hearing device options, cochlear implant, and assistive devices can help direct management of the patient to optimize outcomes.
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Affiliation(s)
- Judith E C Lieu
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri
| | - Margaret Kenna
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts
- Department of Otolaryngology, Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | - Samantha Anne
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lisa Davidson
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri
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杨 奉, 郑 芸. [Common tools of auditory function assessment in infants and toddlers]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2020; 34:1045-1048. [PMID: 33254331 PMCID: PMC10133133 DOI: 10.13201/j.issn.2096-7993.2020.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Indexed: 06/12/2023]
Abstract
With the prevalence of early hearing detection and intervention program in China, more and more infants and toddlers with hearing loss can be diagnosed and treated timely. During the process, evaluation of auditory function is of great importance, which can fully reflect the outcomes of auditory intervention. With the variety of auditory function evaluation tools, we should concern the psychometric properties and clinical applications of each tool before application.
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Affiliation(s)
- 奉玲 杨
- 四川大学华西医院耳鼻咽喉头颈外科 听力及言语康复实验室(成都,610041)
| | - 芸 郑
- 四川大学华西医院耳鼻咽喉头颈外科 听力及言语康复实验室(成都,610041)
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31
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Al-Shawi YA, Mesallam TA, Albakheet NM, Alshawi MA, Alfallaj RM, Aldrees TM, Algahtani AA, Alotaibi TO. Validation and inter-rater reliability testing of the Arabic version of speech intelligibility rating among children with cochlear implant. Saudi Med J 2020; 41:1139-1143. [PMID: 33026057 PMCID: PMC7841510 DOI: 10.15537/smj.2020.10.25342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To validate and assess the reliability of the new version of an Arabic speech intelligibility rating among different raters. Methods: This cross-sectional analysis was carried out between December 2018 and January 2019. Thirty cochlear-implant (CI) children (study group) and 30 subjects (control group) were enrolled. Study candidates’ speech skills were evaluated using the translated Arabic SIR by parents and original SIR by professions such as speech-language pathologists (SLPs). Inter-rater agreement, test–retest reliability, pre- and post-intervention score (responsiveness test), patient versus control score comparison (discriminant validity), and cross-validation of Arabic SIR have all been assessed. Results: There was a good sense of agreement between the post-operative SIR parents’ assessments and the professional SLPs’ assessments (r=0.920, p<0.001). The mean of study subjects pre- and post-implantation score of Arabic SIR showed a statistically significant difference (p<0.001). Conclusion: The Arabic SIR demonstrated excellent reliability with strong consistency. It showed its clinical ability in distinguishing healthy subjects from patients along with follow up of speech development skills over time. The Arabic SIR can be used by parents to evaluate post-CI progress of their children.
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Affiliation(s)
- Yazeed A Al-Shawi
- Otolaryngology Department, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia. E-mail.
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32
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Cochlear implantation in different socioeconomic groups - bursting the myth. Int J Pediatr Otorhinolaryngol 2020; 136:110156. [PMID: 32544640 DOI: 10.1016/j.ijporl.2020.110156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 05/14/2020] [Accepted: 05/27/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Cochlear implantation does wonders for children suffering from severe to profound hearing loss, especially when the child is less than 12 months of age. However, most studies indicate that detection and implantation are done well beyond that age, owing to poor socioeconomic status, parental education, and income. Taking into account The Chief Minister's Comprehensive Health Insurance Scheme in Tamil Nadu, which provides cochlear implantation free of cost, this study aims to describe ages at presentation and nutritional factors among different socioeconomic classes. METHODS A randomized retrospective comparative study was done between two groups of children based on the socioeconomic status of the family. Group A included children with a parental income of less than Rs. 72,000 and the cost of surgery covered by the Tamil Nadu Chief Minister's Comprehensive Health Insurance Scheme and group B included children with a parental income of more than 72,000 and the cost of surgery covered by the family. Three parameters were considered and compared-the age at presentation to the hospital for diagnosis and management and the weight and hemoglobin. The results were computed, and statistical analysis done. RESULTS There was a negligible difference between the age at presentation between the two groups with the mean age for children belonging to group A being 2.906563 and the mean age for children belonging to group B being 3.540625. Weight among the two groups showed a significant difference with a p-value of 0.023664 at p < 0.05. The difference in hemoglobin values was found to be insignificant, with mean values being 11.0375 g/dl and 11.7375 g/dl for groups A and B respectively. CONCLUSION This study has concluded sufficient awareness among different strata of society, despite economical differences, over cochlear implant programs owing to government initiatives of educating people and supporting them with necessary health benefits. Tamil Nadu, as a responsible state of a developing nation, has been proactive in ensuring the accessibility and reach of the health care system in this regard.
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Bruijnzeel H, Wammes E, Stokroos RJ, Topsakal V, de Graaff JC. A retrospective cohort study of adverse event assessment during anesthesia-related procedures for cochlear implant candidacy assessment and cochlear implantation in infants and toddlers. Paediatr Anaesth 2020; 30:1033-1040. [PMID: 32506586 PMCID: PMC7590089 DOI: 10.1111/pan.13944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 05/26/2020] [Accepted: 05/30/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cochlear implantation in children with sensorineural hearing loss is preferably performed at youngest age because early auditory input is essential to prevent neural plasticity decline. In contrast, the rate of anesthetic adverse events is increased during infancy. Therefore, to provide recommendations regarding an optimal pediatric implantation age, these possible anesthetic risks in infants need to be taken into account. AIMS This study aimed at assessing the relation between the age at cochlear implant surgery and anesthetic and surgical adverse events. Secondary aims were to evaluate anesthetic and surgical adverse events in relation to (a) the number of preoperative anesthesia-related procedures for cochlear implant candidacy assessment and (b) the anesthetic maintenance agent (total intravenous anesthesia versus inhalation anesthesia) during implantation. METHODS We executed a retrospective cohort study to evaluate cochlear implantation performed in infants and toddlers between January 2008 and July 2015 in a tertiary pediatric center. We compared anesthetic and surgical adverse events between age-at-implantation (0-12 and 12-24 months of age) groups. Furthermore, we assessed whether anesthetic adverse events occurred during preoperative anesthesia-related procedures for cochlear implant candidacy assessment. RESULTS Forty-six cochlear implantations were performed in 43 patients requiring 42 preoperative anesthesia-related procedures. Nineteen cochlear implantations (41.3%) were performed during infancy. During implantation, the maintenance agent was either sevoflurane (n = 22) or propofol (n = 24). None of the patients encountered major anesthetic adverse events, whereas minor adverse events occurred during 34 cochlear implantations. Those attributed to surgery occurred following six implantations. Neither the age at implantation nor the anesthetic maintenance agent was significantly related to the occurrence of both types of adverse events. CONCLUSIONS Adverse events occur independent of the age at implantation, the number of anesthetic preoperative procedures, and the type of anesthetic maintenance agent in patients who received a cochlear implant before 24 months of age.
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Affiliation(s)
- Hanneke Bruijnzeel
- Department of Otolaryngology and Head & Neck SurgeryUniversity Medical Centre UtrechtUtrechtThe Netherlands,Brain Center Rudolf MagnusUtrecht UniversityUtrechtThe Netherlands
| | - Emily Wammes
- Department of Otolaryngology and Head & Neck SurgeryUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - Robert J. Stokroos
- Department of Otolaryngology and Head & Neck SurgeryUniversity Medical Centre UtrechtUtrechtThe Netherlands,Brain Center Rudolf MagnusUtrecht UniversityUtrechtThe Netherlands
| | - Vedat Topsakal
- Brain Center Rudolf MagnusUtrecht UniversityUtrechtThe Netherlands,Department of Otolaryngology and Head & Neck SurgeryUniversity Hospital AntwerpAntwerpBelgium
| | - Jurgen C. de Graaff
- Department of Anesthesiology, Erasmus MCSophia Children's HospitalRotterdamThe Netherlands
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34
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Varadarajan VV, Sydlowski SA, Li MM, Anne S, Adunka OF. Evolving Criteria for Adult and Pediatric Cochlear Implantation. EAR, NOSE & THROAT JOURNAL 2020; 100:31-37. [PMID: 32804575 DOI: 10.1177/0145561320947258] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The indications for cochlear implantation have gradually expanded as advancements in technology have evolved, resulting in improved audiologic outcomes for both adult and children. There remains a significant underutilization of cochlear implant technology in the United States, and recognition of the potential benefits of cochlear implantation for non-traditional indications is critical for encouraging the evolution of candidacy criteria. Adult cochlear implantation candidacy has progressed from patients with bilateral profound sensorineural hearing loss (SNHL) to include patients with greater degrees of residual hearing, single-sided deafness and asymmetric hearing, and atypical etiologies of hearing loss (eg, vestibular schwannoma, Ménière's disease, and otosclerosis). Indications for pediatric cochlear implantation have similarly evolved from children with bilateral severe to profound SNHL to implanting children at a younger age, including those with residual hearing, asymmetric hearing loss, inner ear malformations, as well as cochlear nerve deficiency. In this editorial, the literature investigating cochlear implantation for nontraditional indications is reviewed with an aim to use the best available evidence to encourage the evolution of candidacy criteria.
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Affiliation(s)
- Varun V Varadarajan
- Department of Otolaryngology-Head and Neck Surgery, 2647The Ohio State University, Columbus, OH, USA
| | | | - Michael M Li
- Department of Otolaryngology-Head and Neck Surgery, 2647The Ohio State University, Columbus, OH, USA
| | - Samantha Anne
- Head and Neck Institute, 443553Cleveland Clinic, Cleveland, OH, USA
| | - Oliver F Adunka
- Department of Otolaryngology-Head and Neck Surgery, 2647The Ohio State University, Columbus, OH, USA
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35
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Sharma SD, Cushing SL, Papsin BC, Gordon KA. Hearing and speech benefits of cochlear implantation in children: A review of the literature. Int J Pediatr Otorhinolaryngol 2020; 133:109984. [PMID: 32203759 DOI: 10.1016/j.ijporl.2020.109984] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 11/30/2022]
Abstract
Cochlear implantation is a safe and reliable treatment for children with severe to profound hearing loss. The primary benefit of these medical devices in children is the acquisition of hearing, which promotes development of spoken language. The present paper reviews published literature demonstrating predictive effects of a number of factors on acquisition of hearing development and speech recognition. Of the many variables that contribute to an individual child's development after implantation, age at implantation, the presence of medical comorbidities, social determinants of health, and the provision of bilateral versus unilateral hearing are those that can vary widely and have consistently shown clear impacts. Specifically, age of implantation is crucial to reduce effects of deafness on the developing auditory system and capture the remarkable plasticity of early development. Language development after cochlear implantation requires therapy emphasizing hearing and oral communication, education, and other support which can be influenced by known social determinants of health; specifically, outcomes in children decline with reductions in socioeconomic status and levels of parental education. Medical co-morbidities also slow rates of progress after cochlear implantation. On the other hand, benefits of implantation increase in children who are provided with access to hearing from both ears. In sum, cochlear implants promote development of hearing in children and the best outcomes are achieved by providing early access to sound in both ears. These benefits can be limited by known social determinants of health which restrict access to needed support and medical comorbidities which add further complexity in care and outcome.
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Affiliation(s)
- Sunil D Sharma
- Department of Otolaryngology: Head & Neck Surgery, Hospital for Sick Children, Toronto, ON, Canada; Department of Otolaryngology: Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Sharon L Cushing
- Department of Otolaryngology: Head & Neck Surgery, Hospital for Sick Children, Toronto, ON, Canada; Department of Otolaryngology: Head & Neck Surgery, University of Toronto, Toronto, ON, Canada; Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
| | - Blake C Papsin
- Department of Otolaryngology: Head & Neck Surgery, Hospital for Sick Children, Toronto, ON, Canada; Department of Otolaryngology: Head & Neck Surgery, University of Toronto, Toronto, ON, Canada; Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Karen A Gordon
- Department of Otolaryngology: Head & Neck Surgery, Hospital for Sick Children, Toronto, ON, Canada; Department of Otolaryngology: Head & Neck Surgery, University of Toronto, Toronto, ON, Canada; Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Communication Disorders, Hospital for Sick Children, Toronto, ON, Canada
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Hajr EA, Alotaibi T, Alobida NW, Alsanosi AA. Surgical considerations and speech outcomes in infants who undergo cochlear implantation. Experience of the King Abdullah Ear Specialist Center. Saudi Med J 2020; 40:1123-1128. [PMID: 31707409 PMCID: PMC6901779 DOI: 10.15537/smj.2019.11.24061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objectives: To evaluate the feasibility and outcomes of cochlear implantation (CI) in infancy. Methods: All infants who underwent CI from January 2011 to October 2018 at a tertiary referral center in the Kingdom of Saudi Arabia were retrospectively reviewed. Demographic data, factors associated with early detection, and any surgical difficulties or postoperative complications were extracted from the medical records. The outcome of CI was determined by a speech pathologist. Results: Fifteen patients underwent CI during the study period (9 bilateral and performed simultaneously, 6 unilateral). The round window was difficult to identify in 5 cases. Incomplete electrode insertion because of cochlear ossification secondary to meningitis was documented in one patient. No major postoperative complications were encountered. The average auditory performance score was 7 and the speech intelligibility rating was 5. Conclusions: This study represents the largest national cohort of pediatric patients undergoing CI in infancy. In this series, the surgery was safe and the speech outcome was good. With implementation of the neonatal screening program in the Kingdom of Saudi Arabia, the number of infants undergoing CI is likely to increase in the near future, paving the way for more research in infant CI.
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Affiliation(s)
- Eman A Hajr
- Department of ENT, King Abdullah Ear Specialist Centre, Imam Muhammad Ibn Saud Islamic University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Long-term Change in the Speech Perception Ability in Pediatric Cochlear Implants and the Effect of the Age at Implantation. Otol Neurotol 2020; 41:758-766. [PMID: 32229759 DOI: 10.1097/mao.0000000000002640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We analyzed the long-term changes in speech perception ability of pediatric cochlear implants (CIs) to evaluate the effect of the age at the time of surgery. STUDY DESIGN Retrospective. SETTING Tertiary care academic center. PATIENTS One hundred fourteen prelingually deaf children with CI use duration >10 years. MAIN OUTCOME MEASURES Categories of auditory performance (CAP) scores and monosyllabic word recognition scores using the Asan-Samsung Korean word list (ASK-WRS) and a conventional word list (KS-WRS) were the main outcomes. Outcomes were compared according to the age at surgery (group I, 1-2 yr; II, 2.1-3 yr; III, 3.1-7 yr; IV, 7.1-13 yr). RESULTS CAP scores reached plateaus at 2.6 to 3.3 years post-CI; groups I to III showed better scores than group IV. The maximum CAP score was obtained in all children of groups I to III and in 65% of group IV. ASK-WRSs reached plateaus at 3.2 to 4.8 years post-CI. Younger patients at CI operation showed better ASK-WRSs (97, 93, 90, and 54% in groups I-IV, respectively), but the differences were not significant (I versus II and II versus III). Ceiling effect (perfect score) was observed in early groups (67, 44, 30, and 0% in groups I-IV). KS-WRSs, which is a challenging test, reached plateaus at 7.2 to 8.4 years postsurgery with no ceiling effect. Early implantees showed significantly better scores (88, 82, 73, and 46% in groups I-IV). CONCLUSIONS Speech perception ability after CI showed audiological age-specific improvement evaluated by various test methods. The most challenging test demonstrated long-term performance differences by the age at CI operation.
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Ismail FY, Ljubisavljevic MR, Johnston MV. A conceptual framework for plasticity in the developing brain. HANDBOOK OF CLINICAL NEUROLOGY 2020; 173:57-66. [PMID: 32958193 DOI: 10.1016/b978-0-444-64150-2.00007-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In this chapter, we highlight the various definitions of early brain plasticity commonly used in the scientific literature. We then present a conceptual framework of early brain plasticity that focuses on plasticity at the level of the synapse (synaptic plasticity) and the level of the network (connectivity). The proposed framework is organized around three main domains through which current theories and principles of early brain plasticity can be integrated: (1) the mechanisms of plasticity and constraints at the synaptic level and network connectivity, (2) the importance of temporal considerations related to the development of the immature brain, and (3) the functions early brain plasticity serve. We then apply this framework to discuss some clinical disorders caused by and/or associated with impaired plasticity mechanisms. We propose that a careful examination of the relationship between mechanisms, constraints, and functions of early brain plasticity in health and disease may provide an integrative understanding of the current theories and principles generated by experimental and observational studies.
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Affiliation(s)
- Fatima Y Ismail
- Department of Pediatrics, United Arab Emirates University, Al-Ain, United Arab Emirates; Department of Neurology (adjunct), Johns Hopkins School of Medicine, Baltimore, MD, United States.
| | | | - Michael V Johnston
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, United States
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Duchesne L, Marschark M. Effects of Age at Cochlear Implantation on Vocabulary and Grammar: A Review of the Evidence. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:1673-1691. [PMID: 31513745 DOI: 10.1044/2019_ajslp-18-0161] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose The increasing prevalence of pediatric cochlear implantation over the past 25 years has left little doubt that resulting improvements in hearing offer significant benefits to language development for many deaf children. Furthermore, given the documented importance of access to language from birth, there has been strong support for providing congenitally deaf children with implants as early as possible. Earliest implantation, in many ways, has become the "gold standard" in pediatric cochlear implantation, on the assumption that it is the key to language development similar to that of hearing children. Empirical evidence to support this assumption, however, appears more equivocal than generally is believed. This article reviews recent research aimed at assessing the impact of age at implantation on vocabulary and grammatical development among young implant users. Method Articles published between 2003 and 2018 that included age at implantation as a variable of interest and in which it was subjected to statistical analysis were considered. Effect sizes were calculated whenever possible; we conducted a multivariate meta-analysis to compare outcomes in different language domains. Results Taken together, findings from 49 studies suggest that age at implantation is just one of a host of variables that influence vocabulary and grammatical development, its impact varying with several factors including whether age at implantation is treated as a dichotomous or continuous variable. Results from a meta-analysis showed significant differences across language domains. Conclusion The pattern of results obtained indicates the importance of considering various child, family, and environmental characteristics in future research aimed at determining how early "early implantation" needs to be and the extent to which age at implantation, duration of implant use, and other factors influence language and language-related outcomes. Supplemental Material https://doi.org/10.23641/asha.9789041.
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Affiliation(s)
- Louise Duchesne
- Département d'Orthophonie, Université du Québec à Trois-Rivières, Canada
| | - Marc Marschark
- National Technical Institute for the Deaf, Rochester Institute of Technology, NY
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Sirirattawan J, Khuancharee K. Measures of Comparative Behavior in Hearing Loss Patients with Cochlear Implant: Caretaker Assessment. Indian J Otolaryngol Head Neck Surg 2019; 71:1147-1152. [DOI: 10.1007/s12070-018-01574-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 12/24/2018] [Indexed: 11/24/2022] Open
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Rødvik AK, Tvete O, Torkildsen JVK, Wie OB, Skaug I, Silvola JT. Consonant and Vowel Confusions in Well-Performing Children and Adolescents With Cochlear Implants, Measured by a Nonsense Syllable Repetition Test. Front Psychol 2019; 10:1813. [PMID: 31474900 PMCID: PMC6702790 DOI: 10.3389/fpsyg.2019.01813] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 07/22/2019] [Indexed: 12/31/2022] Open
Abstract
Although the majority of early implanted, profoundly deaf children with cochlear implants (CIs), will develop correct pronunciation if they receive adequate oral language stimulation, many of them have difficulties with perceiving minute details of speech. The main aim of this study is to measure the confusion of consonants and vowels in well-performing children and adolescents with CIs. The study also aims to investigate how age at onset of severe to profound deafness influences perception. The participants are 36 children and adolescents with CIs (18 girls), with a mean (SD) age of 11.6 (3.0) years (range: 5.9-16.0 years). Twenty-nine of them are prelingually deaf and seven are postlingually deaf. Two reference groups of normal-hearing (NH) 6- and 13-year-olds are included. Consonant and vowel perception is measured by repetition of 16 bisyllabic vowel-consonant-vowel nonsense words and nine monosyllabic consonant-vowel-consonant nonsense words in an open-set design. For the participants with CIs, consonants were mostly confused with consonants with the same voicing and manner, and the mean (SD) voiced consonant repetition score, 63.9 (10.6)%, was considerably lower than the mean (SD) unvoiced consonant score, 76.9 (9.3)%. There was a devoicing bias for the stops; unvoiced stops were confused with other unvoiced stops and not with voiced stops, and voiced stops were confused with both unvoiced stops and other voiced stops. The mean (SD) vowel repetition score was 85.2 (10.6)% and there was a bias in the confusions of [i:] and [y:]; [y:] was perceived as [i:] twice as often as [y:] was repeated correctly. Subgroup analyses showed no statistically significant differences between the consonant scores for pre- and postlingually deaf participants. For the NH participants, the consonant repetition scores were substantially higher and the difference between voiced and unvoiced consonant repetition scores considerably lower than for the participants with CIs. The participants with CIs obtained scores close to ceiling on vowels and real-word monosyllables, but their perception was substantially lower for voiced consonants. This may partly be related to limitations in the CI technology for the transmission of low-frequency sounds, such as insertion depth of the electrode and ability to convey temporal information.
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Affiliation(s)
- Arne Kirkhorn Rødvik
- Department of Special Needs Education, Institute of Educational Sciences, University of Oslo, Oslo, Norway.,Cochlear Implant Unit, Department of Otorhinolaryngology, Division of Surgery and Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Ole Tvete
- Cochlear Implant Unit, Department of Otorhinolaryngology, Division of Surgery and Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Janne von Koss Torkildsen
- Department of Special Needs Education, Institute of Educational Sciences, University of Oslo, Oslo, Norway
| | - Ona Bø Wie
- Department of Special Needs Education, Institute of Educational Sciences, University of Oslo, Oslo, Norway.,Cochlear Implant Unit, Department of Otorhinolaryngology, Division of Surgery and Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | | | - Juha Tapio Silvola
- Department of Special Needs Education, Institute of Educational Sciences, University of Oslo, Oslo, Norway.,Cochlear Implant Unit, Department of Otorhinolaryngology, Division of Surgery and Clinical Neuroscience, Oslo University Hospital, Oslo, Norway.,Ear, Nose, and Throat Department, Division of Surgery, Akershus University Hospital, Lørenskog, Norway
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Bae SH, Kwak SH, Nam GS, Choi JY. Educational Status in Bilateral Prelingual Deaf Children with Cochlear Implantation. J Audiol Otol 2019; 23:135-139. [PMID: 31234247 PMCID: PMC6646890 DOI: 10.7874/jao.2018.00521] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 01/24/2019] [Indexed: 11/29/2022] Open
Abstract
Background and Objectives This study was undertaken to investigate the educational status in bilateral prelingual deaf children with a cochlear implant (CI), also known as early cochlear implantees (CIs). Type of schooling and enrollment rate of tertiary education were analyzed as primary results. Subjects and Methods Participants in this study comprised a highly homogeneous group of deaf patients who underwent cochlear implantation at a similar age. Sixty-four Korean patients were enrolled. Statistical data for disabled populations and the general population were obtained from the National Statistics Korea. Results Among 64 patients, 46, 8, and 10 attended mainstream, integrated, and special schools, respectively. Notably, there was a significant difference in the type of school between hearing-impaired and CI groups (p=0.007). Ten of 13 patients enrolled in tertiary education. Conclusions CI users were more likely than hearing impaired students to attend mainstream school. The enrollment rate of CI users in tertiary education was the same as that of the general population.
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Affiliation(s)
- Seong Hoon Bae
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hyun Kwak
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Gi-Sung Nam
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Young Choi
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
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Pierce K, Gazestani VH, Bacon E, Barnes CC, Cha D, Nalabolu S, Lopez L, Moore A, Pence-Stophaeros S, Courchesne E. Evaluation of the Diagnostic Stability of the Early Autism Spectrum Disorder Phenotype in the General Population Starting at 12 Months. JAMA Pediatr 2019; 173:578-587. [PMID: 31034004 PMCID: PMC6547081 DOI: 10.1001/jamapediatrics.2019.0624] [Citation(s) in RCA: 160] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Universal early screening for autism spectrum disorder (ASD) in primary care is becoming increasingly common and is believed to be a pivotal step toward early treatment. However, the diagnostic stability of ASD in large cohorts from the general population, particularly in those younger than 18 months, is unknown. Changes in the phenotypic expression of ASD across early development compared with toddlers with other delays are also unknown. OBJECTIVES To examine the diagnostic stability of ASD in a large cohort of toddlers starting at 12 months of age and to compare this stability with that of toddlers with other disorders, such as developmental delay. DESIGN, SETTING, AND PARTICIPANTS In this prospective cohort study performed from January 1, 2006, to December 31, 2018, a total of 2241 toddlers were referred from the general population through a universal screening program in primary care or community referral. Eligible toddlers received their first diagnostic evaluation between 12 and 36 months of age and had at least 1 subsequent evaluation. EXPOSURES Diagnosis was denoted after each evaluation visit as ASD, ASD features, language delay, developmental delay, other developmental issue, typical sibling of an ASD proband, or typical development. MAIN OUTCOMES AND MEASURES Diagnostic stability coefficients were calculated within 2-month age bands, and logistic regression models were used to explore the associations of sex, age, diagnosis at first visit, and interval between first and last diagnosis with stability. Toddlers with a non-ASD diagnosis at their first visit diagnosed with ASD at their last were designated as having late-identified ASD. RESULTS Among the 1269 toddlers included in the study (918 [72.3%] male; median age at first evaluation, 17.6 months [interquartile range, 14.0-24.4 months]; median age at final evaluation, 36.2 months [interquartile range, 33.4-40.9 months]), the overall diagnostic stability for ASD was 0.84 (95% CI, 0.80-0.87), which was higher than any other diagnostic group. Only 7 toddlers (1.8%) initially considered to have ASD transitioned into a final diagnosis of typical development. Diagnostic stability of ASD within the youngest age band (12-13 months) was lowest at 0.50 (95% CI, 0.32-0.69) but increased to 0.79 by 14 months and 0.83 by 16 months (age bands of 12 vs 14 and 16 months; odds ratio, 4.25; 95% CI, 1.59-11.74). A total of 105 toddlers (23.8%) were not designated as having ASD at their first visit but were identified at a later visit. CONCLUSIONS AND RELEVANCE The findings suggest that an ASD diagnosis becomes stable starting at 14 months of age and overall is more stable than other diagnostic categories, including language or developmental delay. After a toddler is identified as having ASD, there may be a low chance that he or she will test within typical levels at 3 years of age. This finding opens the opportunity to test the impact of very early-age treatment of ASD.
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Affiliation(s)
- Karen Pierce
- Department of Neurosciences, University of California, San Diego, La Jolla
| | - Vahid H. Gazestani
- Department of Neurosciences, University of California, San Diego, La Jolla,Department of Pediatrics, University of California, San Diego, La Jolla
| | - Elizabeth Bacon
- Department of Neurosciences, University of California, San Diego, La Jolla
| | | | - Debra Cha
- Department of Neurosciences, University of California, San Diego, La Jolla
| | - Srinivasa Nalabolu
- Department of Neurosciences, University of California, San Diego, La Jolla
| | - Linda Lopez
- Department of Neurosciences, University of California, San Diego, La Jolla
| | - Adrienne Moore
- Department of Neurosciences, University of California, San Diego, La Jolla
| | | | - Eric Courchesne
- Department of Neurosciences, University of California, San Diego, La Jolla
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de Kleijn JL, van Kalmthout LWM, van der Vossen MJB, Vonck BMD, Topsakal V, Bruijnzeel H. Identification of Pure-Tone Audiologic Thresholds for Pediatric Cochlear Implant Candidacy. JAMA Otolaryngol Head Neck Surg 2018; 144:630-638. [DOI: 10.1001/jamaoto.2018.0652] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jasper L. de Kleijn
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ludwike W. M. van Kalmthout
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Martijn J. B. van der Vossen
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Bernard M. D. Vonck
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Brain Center Rudolf Magnus, University of Utrecht, Utrecht, the Netherlands
| | - Vedat Topsakal
- Brain Center Rudolf Magnus, University of Utrecht, Utrecht, the Netherlands
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Hanneke Bruijnzeel
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Brain Center Rudolf Magnus, University of Utrecht, Utrecht, the Netherlands
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Surgical timing for bilateral simultaneous cochlear implants: When is best? Int J Pediatr Otorhinolaryngol 2018; 109:54-59. [PMID: 29728185 DOI: 10.1016/j.ijporl.2018.03.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 03/18/2018] [Accepted: 03/21/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Hearing loss is considered the most common congenital disease and the prevalence of neonatal deafness can be estimated between 1 and 2 cases per 1000 live births. Infant deafness must be diagnosed as early as possible and an effective therapeutic intervention needs to be carried out in order to avoid the serious consequences of hearing deprivation during the evolutionary period: alterations in the development of central auditory pathways and lack of language acquisition. The cochlear implant (CI) has proved to be the best instrument to solve the problem of auditory deprivation. In particular, the bilateral CI gives the patient access to binaural hearing which results in benefits in terms of sound localisation and discrimination. The optimal age of application of the CI is a widely discussed topic in the scientific community and the current guidelines indicate a period between 12 and 24 months of age, even though the supporters of the application before 12 months of age are nowadays increasing. MATERIALS AND METHODS The study is observational, retrospective, monocentric. 49 paediatric patients (<18 years) with simultaneous bilateral CIs were included. The audiometric threshold and speech tests were carried out during the follow-up 3, 6 and 12 months after the CIs activation and when the patient reached 2 years of age. RESULTS The statistical analysis showed that undergoing bilateral implantation surgery before 2 years of age allows a satisfactory audiometric performance, while there are no particular benefits in performing the surgery before 1 year of age. As far as the speech outcome is concerned, the statistical analysis didn't show significant correlation between the earlier age of implantation and better speech performance if the operation is carried out before 2.5 years of age. CONCLUSIONS The results of the study indicate that the optimal age to perform the simultaneous bilateral CIs surgery is between 12 and 24 months, without demonstrating any particular benefit in carrying out the procedure before 1 year of age. This may be clinically relevant in terms of avoiding the risks of diagnostic mistakes and reducing the related surgical risk in children under 1 year of age.
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Keilmann A, Friese B, Lässig A, Hoffmann V. Validation of the second version of the LittlEARS ® Early Speech Production Questionnaire (LEESPQ) in German-speaking children with normal hearing. Eur Arch Otorhinolaryngol 2018; 275:883-888. [PMID: 29417278 DOI: 10.1007/s00405-018-4889-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 01/24/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The introduction of neonatal hearing screening and the increasingly early age at which children can receive a cochlear implant has intensified the need for a validated questionnaire to assess the speech production of children aged 0‒18. Such a questionnaire has been created, the LittlEARS® Early Speech Production Questionnaire (LEESPQ). This study aimed to validate a second, revised edition of the LEESPQ. METHODS AND MATERIALS Questionnaires were returned for 362 children with normal hearing. Completed questionnaires were analysed to determine if the LEESPQ is reliable, prognostically accurate, internally consistent, and if gender or multilingualism affects total scores. RESULTS Total scores correlated positively with age. The LEESPQ is reliable, accurate, and consistent, and independent of gender or lingual status. A norm curve was created. DISCUSSION This second version of the LEESPQ is a valid tool to assess the speech production development of children with normal hearing, aged 0‒18, regardless of their gender. As such, the LEESPQ may be a useful tool to monitor the development of paediatric hearing device users. CONCLUSION The second version of the LEESPQ is a valid instrument for assessing early speech production of children aged 0‒18 months.
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Affiliation(s)
| | - Barbara Friese
- Department for Communication Disorders, University Medical Center, Mainz, Germany
| | - Anne Lässig
- Department for Communication Disorders, University Medical Center, Mainz, Germany
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Abstract
PURPOSE OF REVIEW Children with congenital hearing loss are being identified earlier, leading to earlier intervention. Current US Food and Drug Administration (FDA) criteria states a child must be 12 months or older for cochlear implantation. The purpose of this article is to review recent publications regarding the benefits of implanting infants under 12 months of age. Topics include: safety and efficacy of surgery, speech and language acquisition outcomes, audiologic components, and limitations. RECENT FINDINGS Since the early 1990s, the candidacy criteria evolved drastically. However, the FDA criteria for cochlear implantation in children has remained at 12 months of age or older since 2000. Recent research indicates implanting below 12 months of age a safe and effective procedure. Speech and language outcomes showed better speech and language advantages. In addition, infants implanted earlier showed normal auditory skills as early as 3 months post cochlear implant activation. This article will also address recent findings on the limitations of earlier implantation. SUMMARY Recent research demonstrates positive outcomes in children implanted under 12 months of age. Developing research on earlier implantation could lead to a change in the current FDA criteria allowing infants to reach their speech and hearing potential faster.
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Nicholas JG, Geers AE. Sensitivity of expressive linguistic domains to surgery age and audibility of speech in preschoolers with cochlear implants. Cochlear Implants Int 2017; 19:26-37. [PMID: 28992767 DOI: 10.1080/14670100.2017.1380114] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To determine whether relative delays among domains exist in the conversational use of vocabulary, syntax, and morphology by children with cochlear implants (CIs) and whether these were differentially affected by age of implantation (AOI) and the audibility of speech. METHODS Participants in this short-term longitudinal study were 126 children with AOI of 6-38 months and a matched group of 30 children without hearing loss. Language samples of the same children at ages 3.5 and 4.5 were analyzed for the breadth of vocabulary and bound morphemes used, and sentence length. RESULTS At both test ages, expressive language domains were delayed equally. Higher performance across domains was independently associated with younger AOI and better pre-implant-aided thresholds. No domain was affected differently by very early implantation, but bound morpheme breadth was associated with better CI-aided thresholds. Between 63 and 78% of children with AOI of 6-11 months scored close to hearing age-mates by 4.5, a level achieved by fewer than 25% of those with AOI of 19-24 months or later ages. DISCUSSION Previous studies indicated greater language delays in the areas of morphology and syntax than those of vocabulary, with the earliest ages of implantation conferring the greatest benefit to those domains. The current design addressed inconsistency across studies in modes of communication used, presence/absence of other disabilities, and differences in language domains chosen as outcome measures. CONCLUSIONS Linguistic domains benefitted equally from early implantation, regardless of the duration of auditory stimulation. Better pre-CI-aided hearing often compensated for later AOI. Bound morpheme use was greater with better CI-aided thresholds.
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Affiliation(s)
- Johanna G Nicholas
- a Department of Otolaryngology , Washington University School of Medicine , Box 8115, 660 S. Euclid Ave., St. Louis , MO 63130 , USA
| | - Ann E Geers
- b School of Behavioral and Brain Sciences , The University of Texas at Dallas , GR41, 800 West Campbell Rd., Richardson , TX 75080 , USA
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Crowson MG, Chen JM, Tucci D. Provincial Variation of Cochlear Implantation Surgical Volumes and Cost in Canada. Otolaryngol Head Neck Surg 2016; 156:137-143. [PMID: 27650806 DOI: 10.1177/0194599816668325] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives To investigate provincial cochlear implantation (CI) annual volume and cost trends. Study Design Database analysis. Setting National surgical volume and cost database. Subjects and Methods Aggregate-level provincial CI volumes and cost data for adult and pediatric CI surgery from 2005 to 2014 were obtained from the Canadian Institute for Health Information. Population-level aging forecast estimates were obtained from the Ontario Ministry of Finance and Statistics Canada. Linear fit, analysis of variance, and Tukey's analyses were utilized to compare variances and means. Results The national volume of annual CI procedures is forecasted to increase by <30 per year ( R2 = 0.88). Ontario has the highest mean annual CI volume (282; 95% confidence interval, 258-308), followed by Alberta (92.0; 95% confidence interval, 66.3-118), which are significantly higher than all other provinces ( P < .05 for each). Ontario's annual CI procedure volume is forecasted to increase by <11 per year ( R2 = 0.62). Newfoundland and Nova Scotia have the highest CI procedures per 100,000 residents as compared with all other provinces ( P < .05). Alberta, Newfoundland, and Manitoba have the highest estimated implantation cost of all provinces ( P < .05). Conclusions Historical trends of CI forecast modest national volume growth. Potential bottlenecks include provincial funding and access to surgical expertise. The proportion of older adult patients who may benefit from a CI will rise, and there may be insufficient capacity to meet this need. Delayed access to CI for pediatric patients is also a concern, given recent reports of long wait times for CI surgery.
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Affiliation(s)
- Matthew G Crowson
- 1 Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Joseph M Chen
- 2 Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Center, Toronto, Canada
| | - Debara Tucci
- 1 Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina, USA
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