Cochlear Implant Decision Making for Children With Residual Hearing: Perspectives of Practitioners

PURPOSE

Cochlear implants (CIs) are increasingly considered for children with residual hearing who benefit from hearing aids (HAs). However, the decision-making process for families of these children and for practitioners is particularly challenging because there is no clear audiological cut point for CI candidacy. This study aimed to understand Canadian practitioners' perspectives of the CI decision-making process and how they guide families of children with residual hearing.

METHOD

Semistructured interviews were conducted with a total of 17 practitioners through four focus groups and one individual interview. Interviews were transcribed verbatim, and a thematic analysis was carried out.

RESULTS

Data were organized into five broad domains: candidacy issues for children with residual hearing, practitioners' roles in decision support, additional considerations affecting decision making, factors facilitating decision making, and practitioners' needs.

CONCLUSIONS

This study found that practitioners' confidence in determining candidacy and supporting parents has increased due to their experiences with positive outcomes for these children. Practitioners indicated that there was a need for more research to guide the decision-making process.

Prognostic Factors for Communication Improvement in Young Children After Cochlear Implant Surgery

OBJECTIVE

Our objective was to examine the prognostic factors for post-cochlear implant (CI) communication improvement and determine whether the otologist's and speech-language pathologist's (SLP's) recommendations exhibited the same predictive performance regarding children's post-CI verbal expression acquisition.

STUDY DESIGN

Retrospective, diagnostic study.

SETTING

Hospital.

PATIENTS

The study reviewed 339 medical charts of preschool children who underwent CI surgery before the age of 6 years during 1999 to 2016. After these medical charts were assessed, the cohort comprised of 79 preschool children with pre- and post-CI surgery speech-language assessment reports and medical records.

INTERVENTION

A senior SLP and an otologist conducted blind testing of CI candidacy according to the 79 children's pre-CI reports.

MAIN OUTCOME MEASURES

Spoken mean length of utterance (MLU).

RESULTS

Children with superior skills in comprehending facial and gesture expressions or using gestures or sounds for expression were significantly more likely to receive the SLP's recommendation for CI surgery. The SLP's CI candidacy recommendation, based on background information, communication skill assessments, and magnetic resonance imaging (provided by an otologist), had significant predictive effects. Children recommended by the SLP exhibited a 20 times higher probability of benefiting from CI surgery; such a benefit would be a longer MLU after 2 years.

CONCLUSION

CI candidacy testing for young children with prelingual hearing impairment based on a SLP's recommendations provided significant predictive effects.

LEVEL OF EVIDENCE

4 (Evidence from well-designed case-control or cohort studies).

Dual language versus English-only support for bilingual children with hearing loss who use cochlear implants and hearing aids

BACKGROUND

There is a critical need to understand better speech and language development in bilingual children learning two spoken languages who use cochlear implants (CIs) and hearing aids (HAs). The paucity of knowledge in this area poses a significant barrier to providing maximal communicative outcomes to a growing number of children who have a hearing loss (HL) and are learning multiple spoken languages. In fact, the number of bilingual individuals receiving CIs and HAs is rapidly increasing, and Hispanic children display a higher prevalence of HL than the general population of the United States. In order to serve better bilingual children with CIs and HAs, appropriate and effective therapy approaches need to be designed and tested, based on research findings.

AIMS

This study investigated the effects of supporting both the home language (Spanish) and the language of the majority culture (English) on language outcomes in bilingual children with HL who use CIs and HAs as compared to their bilingual peers who receive English-only support.

METHODS & PROCEDURES

Retrospective analyses of language measures were completed for two groups of Spanish- and English-speaking bilingual children with HL who use CIs and HAs matched on a range of demographic and socio-economic variables: those with dual-language support versus their peers with English-only support. Dependent variables included scores from the English version of the Preschool Language Scales, 4th Edition.

OUTCOMES & RESULTS

Bilingual children who received dual-language support outperformed their peers who received English-only support at statistically significant levels as measured by Total Language and Expressive Communication as raw and language age scores. No statistically significant group differences were found on Auditory Comprehension scores.

CONCLUSIONS & IMPLICATIONS

In addition to providing support in English, encouraging home language use and providing treatment support in the first language may help rather than hinder development of both English and the home language in bilingual children with HL who use CIs and HAs. In fact, dual-language support may yield better overall and expressive English language outcomes than English-only support for this population.

Predictors of pediatric cochlear implantation outcomes in South Africa

OBJECTIVE

To identify and describe predictors of pediatric cochlear implantation outcomes in a South African population.

METHODS

A retrospective study of 301 pediatric cochlear implant (CI) recipients from five CI programs was conducted and cross-sectional outcome data were added at the time of data collection. Twenty potential prognostic factors were identified from the retrospective dataset, including demographical, CI, risk and family factors. Multiple regression analyses were performed to identify predictor variables that influence outcomes in terms of auditory performance (CAP scores), speech production (SIR scores), communication mode and educational placement.

RESULTS

Although implanted children within this sample did not have equal opportunity to access a second implant, bilateral implantation was strongly predictive of better auditory performance and speech production scores, an oral mode of communication and mainstream education. NICU admittance/prematurity were associated with poorer auditory performance and speech production scores, together with a higher probability for non-oral communication and non-mainstream education. The presence of one or more additional developmental condition was predictive of poorer outcomes in terms of speech production and educational placement, while a delay between diagnosis and implantation of more than one year was also related to non-mainstream education. Ethnicities other than Caucasian were predictive of poorer auditory performance scores and a lower probability for mainstream education.

CONCLUSION

An extensive range of prognostic indicators were identified for pediatric CI outcomes in South Africa. These predictive factors of better and poorer outcomes should guide pediatric CI services to promote optimal outcomes and assist professionals in providing evidence-based informational counseling.

Persistent Language Delay Versus Late Language Emergence in Children With Early Cochlear Implantation

PURPOSE

The purpose of the present investigation is to differentiate children using cochlear implants (CIs) who did or did not achieve age-appropriate language scores by midelementary grades and to identify risk factors for persistent language delay following early cochlear implantation.

MATERIALS AND METHOD

Children receiving unilateral CIs at young ages (12-38 months) were tested longitudinally and classified with normal language emergence (n = 19), late language emergence (n = 22), or persistent language delay (n = 19) on the basis of their test scores at 4.5 and 10.5 years of age. Relative effects of demographic, audiological, linguistic, and academic characteristics on language emergence were determined.

RESULTS

Age at CI was associated with normal language emergence but did not differentiate late emergence from persistent delay. Children with persistent delay were more likely to use left-ear implants and older speech processor technology. They experienced higher aided thresholds and lower speech perception scores. Persistent delay was foreshadowed by low morphosyntactic and phonological diversity in preschool. Logistic regression analysis predicted normal language emergence with 84% accuracy and persistent language delay with 74% accuracy.

CONCLUSION

CI characteristics had a strong effect on persistent versus resolving language delay, suggesting that right-ear (or bilateral) devices, technology upgrades, and improved audibility may positively influence long-term language outcomes.