Predictors of cochlear implant outcomes in pediatric auditory neuropathy: A matched case-control study

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.

Rehabilitation of children with cochlear implant in Iran: A scoping review

Background: Recovery of children does not appear on its own after cochlear implantation. Coherent, thoughtful, and comprehensive rehabilitation is needed to achieve complete success. The purpose of this study was to identify the types of rehabilitation interventions for children with cochlear implants that have been performed in Iran.

Methods: A scoping review study was conducted. An electronic search was carried out both in English and Persian. In English, the following keywords were used: cochlear implantation, child, cochlear implants, auditory rehabilitation, deaf, hearing loss, comprehensive, interventions, rehabilitation, and telerehabilitation and a combination of them in ProQuest, PubMed, Science Direct, and Scopus databases, Web of Sciences, Medline and Embase. Persian electronic search was conducted in the Scientific Information Database (SID) of Jihad Daneshgahi, Iran Journals Database (MagIran), and Islamic World Science Citation Database (ISC). Searches were done using articles published until September 25, 2020, and a total of 902 articles were found, of which 14 were directly related to the purpose of the study. Interventional studies were included in the study, and the quality of studies was measured using the Structured Effectiveness Quality Evaluation Scale.

Results: The results showed that using music and rehabilitation equipment, different methods of speech therapy and auditory training, story-based instruction, creative play, family-centered instruction, and occupational therapy are interventions in cochlear implant rehabilitation. Speech therapy accounts for 54% of the rehabilitation share. The mean number of rehabilitation sessions was 26. These interventions were all somehow effective in children with cochlear implantation; the longer the training duration, the better the results.

Conclusion: The process of cochlear implant rehabilitation in children is multi-professional; auditory training and speech therapy possesses the highest share of rehabilitation. Therefore, it is recommended to develop speech therapy centers in Iran.

Psychomotor development of 4-year-old deaf children with cochlear implants: Three case studies

OBJECTIVES

Hearing is one of our most important senses, and hearing ability has an enormous impact on a child's psychomotor development. Children with auditory perception disorders may show abnormal development in terms of speech, language, and communication skills, as well as other disorders involving the cognitive sphere, social-emotional interactions, and motor development. This paper describes different paths of psychomotor development in three 4-year-old children. All were born with bilateral profound sensorineural hearing loss and were implanted early on with a cochlear implant. A longitudinal study of the children's psychomotor development was done for 3 years from the time of cochlear implantation.

METHODS

We present three children with congenital, profound bilateral sensorineural hearing loss. Psychomotor development was evaluated using the Children Development Scale (CDS) and the Psychomotor Development Evaluation Cards (PDEC). The three children were: Girl A (4 years 2 months 17 days) - a user of one CI, last assessment of psychomotor development (PDEC) was 37 months after CI activation; Boy B (4 years 3 months 21 days) - a user of two CIs, last assessment of psychomotor development (PDEC) was 39 months after activation of first CI; Boy C (4 years 1 month 5 days) - user of two CIs, last assessment of psychomotor development (PDEC) was 36 months after activation of the first CI.

RESULTS

Analysis of the results from Girl A showed very poor dynamics of development from the age of 12 months, when the first CDS evaluation was performed, up to the PDEC evaluation performed at age 4 years. The CDS score of Boy B showed a very high level of psychomotor development. The PDEC evaluation performed after 39 months of using the first CI showed that the psychomotor development of Boy B was consistent with his chronological age. Boy C presented an average level of psychomotor development (compared to typically developing children) in his CDS scores in the perioperative period and then at 4, 9, and 14 months after cochlear implantation. After 24 months, his CDS scores showed a high level of psychomotor development. After 3 years of CI use, the PDEC evaluation showed that Boy C had an average score in five tested areas, a high score in the area of fine motor skills and lateralization, and a low score in knowledge and learning competencies.

CONCLUSIONS

Children with bilateral profound hearing loss can present different paths of psychomotor development. Children who receive a CI may show an age-appropriate level of psychomotor development compared to typically developing children. However, a hearing, speech, and language rehabilitation specialist responsible for the child still needs to perform regular checkups to monitor all areas of psychomotor development. Also, the effects of the deaf child's environmental determinants on psychomotor development should be studied in detail. These determinants include the parents' emotional state, the parents' involvement in the child's rehabilitation, the family's quality of life, and the presence of deaf siblings. In particular, the difficulties encountered by the mother (or father) in being the parent of a deaf child may hinder the family from receiving adequate support.

Developmental outcomes of young deaf children and the self-perceived parental role of their hearing mothers

BACKGROUND

There is little research into the relationship between a deaf child's developmental outcomes and their mother's self-perceived parental role. The aim of this study was to find out whether the different levels of global psychomotor development in young deaf children who had a cochlear implant (CI), or were candidates for a CI, were related to particular family factors: the self-perceived parental role and the family quality of life (FQoL) as gauged by their hearing mothers, as well as the child's sociodemographic and deafness-related factors and the sociodemographic characteristics of the mothers.

METHODS

The study was conducted on a group of 64 children with bilateral severe or profound sensorineural hearing loss (SNHL) who were CI users (36 children) or qualified for cochlear implantation (28 children) and their hearing mothers. The age of the children ranged from 6.5 to 47 months (M = 23.6; SD = 10.1), among whom 55% were girls (n = 35). The mothers of the children were aged 24-48 years (M = 32.7; SD = 5.3). Information was collected via the Children Development Scale (CDS), the Self-Perception of Parental Role (S-PPR), the Family Quality of Life Survey (FQOLS-2006), and an additional information questionnaire which included questions about sociodemographic variables of the child and the mother, as well as questions related to deafness, the CI, and the child's rehabilitation.

RESULTS

Based on results of the CDS, the deaf children were divided into two groups: those who had a low level of global psychomotor development (Low global psychomotor development subgroup - LGPD) and others with medium or high scores (Medium/high global psychomotor development subgroup - MHGPD). The mothers of deaf children in the LGPD group assessed their investment in motherhood lower than did mothers from the MHGPD group. The mothers of the LGPD group rated their satisfaction with the child's rehabilitation lower than did mothers from the MHGPD group. The two subgroups did not differ in FQOLS-2006 domains except for community interactions, which were significantly higher in the MHGPD families.

CONCLUSIONS

Among the determinants of the global psychomotor development of a young deaf child, the most important ones relate to the use of a CI, but maternal investment in parenting is also important. Community interactions of the family with a deaf child are also crucial, as they create a framework for social network and support for the deaf child's optimal development. Any psychological diagnosis should include, apart from psychomotor development of the deaf child, an assessment of how the mother is coping with their parenting. Mothers of deaf children, especially those with LPGD, need additional support in parenting.

Postural control characterization according to age and auditory input in cochlear implant users

Aims/Objectives: Understand the relationship between auditory input and balance motor control. Material and Methods: Twelve prelingual adolescent cochlear implant users (CIU) and 12 adult postlingual CIU were tested by posturography on a force platform with eyes open in two conditions, with the cochlear implant (CI) on and off. Energy consumption (EC) of the body center of pressure sway signal was measured, calculating total EC and divided into three bands of frequencies; low (B1) 0-0.1 Hz, medium (B2) 0.1-1 Hz, and high (B3)1-2 Hz. Wilcoxon and Mann-Whitney tests were used for statistical analysis and the significance level was P ≤ 0.05. Results: Prelingual CIU decrease the EC in low and high frequencies throughout the adolescence (P < 0.05) assessed with the CI turned on, while it did not show any modification with the CI off. Postlingual CIU showed a deterioration of PR related to aging when evaluated with the CIU turned off, P < 0.05 in band 1. However, with the CI turned on they had no significant increase in this age range. Conclusions and Significance: The acoustic input improved EC of postural responses in higher and lower frequencies in adolescence and with aging which suggests a relationship with gross and fine movements involved in postural control.

Early general development and central auditory system maturation in children with cochlear implants - A case series

OBJECTIVES

A cochlear implant (CI) has the potential to improve the functioning of a deaf child in many aspects. Nevertheless, the dynamics of the general development, beyond the typically measured language abilities, directly after CI, is still unknown, especially if a child is implanted early. In this study we present a methodological framework for assessment of different domains of development, as well as the central auditory nervous system (CANS) maturation in infants and toddlers with a CI.

METHODS

Three children with bilateral congenital hearing loss and a unilateral CI, aged below 2.5 years, participated in a longitudinal study. Children were tested at three time points after cochlear implantation using the Polish Children Development Scale (CDS) consisting of a comprehensive battery of tests, as well as recordings of Cortical Auditory Evoked Potentials (CAEP).

RESULTS

All three children revealed gradual improvement in the overall CDS result as well as most of the CDS subscales. After 9 months of CI experience two younger children showed age-appropriate performance. In CAEP measurements a decrease of latency of the P1 component (an established biomarker of cortical auditory maturation) was observed in the same two children, with one achieving normal ranges of P1 latency after 9 months of CI use.

CONCLUSIONS

Our novel methodological framework can be successfully applied in small children with cochlear implants. It contributes to better understanding of the general development in early implanted children. The preliminary results indicate variability in children's performance in various developmental domains and thus the need to monitor the development of each child individually and holistically.

Cochlear Implantation and Social-Emotional Functioning of Children with Hearing Loss

This study examined the contribution of cochlear implants (CIs) to the social-emotional functioning of children who are deaf or hard of hearing (dhh). Sixty-three parents of children who are dhh participated in the study. Thirty children were CI users and 32 used hearing aids (HAs). They completed the Strengths and Difficulties Questionnaire and a background questionnaire. Parents of children with CIs reported lower levels of hyperactivity/inattention and higher levels of pro-social behavior compared to parents of children with HAs. Additionally, older age when hearing loss was detected was related to more pro-social behavior, and age at implantation among CI users was negatively correlated with children's hyperactivity/inattention and conduct problems. These findings add to the existing knowledge about the many benefits of CIs for individuals with hearing loss and emphasize the possible impact of early implantation to children's social-emotional functioning.

Comparison of aural rehabilitation outcomes in presence and absence of back ground noise in hearing impaired children with and without attention deficit hyperactivity disorder (ADHD)

OBJECTIVE

We sought to understand the extend of improvement in seven major skills to determine the best rehabilitation approach in hearing impaired young children with and without attention deficit and hyperactivity disorder (ADHD).

METHODS

Newsha developmental scale was assessed in 40 hearing impaired children with and without ADHD in two conditions, in which seven major skills (hearing, speech, receptive language, expressive language, cognition, social communication, and motor skills) were evaluated. Two separate analyses were conducted, each after six months of rehabilitation. The first six months rehabilitation was done by controlling background noise level, while the other six months rehabilitation was performed with background multi talker babble noise, and ADHD and non ADHD children performance were compared.

RESULTS

After the first six months of rehabilitation there were no significant difference in improvement in any of the major skills except for motor and cognition skills between hearing impaired ADHD and non ADHD children. After the second six months of rehabilitation the extend of improvement was equal in both groups.

CONCLUSION

The equal improvement of hearing impaired ADHD and non- Children with ADHD support the benefits of rehabilitation program in both groups. In addition, it seems background multi talker babble noise can facilitate the process of rehabilitation in ADHD group. As a result, it is important to understand the specific needs of hearing impaired children with ADHD in rehabilitation program to provide the best services and increase the chance for success.

Medical and bioethical considerations in elective cochlear implant array removal

OBJECTIVE

Cochlear explantation for purely elective (e.g. psychological and emotional) reasons is not well studied. Herein, we aim to provide data and expert commentary about elective cochlear implant (CI) removal that may help to guide clinical decision-making and formulate guidelines related to CI explantation.

DATA SOURCES

We address these objectives via three approaches: case report of a patient who desired elective CI removal; review of literature and expert discussion by surgeon, audiologist, bioethicist, CI user and member of Deaf community.

REVIEW METHODS

A systematic review using three scientific online databases was performed. Included articles addressed the benefits and/or complications of cochlear implantation in young children, CI explantation with or without revision surgery and the ethical debate between the medical and Deaf communities on cochlear implantation and explantation.

CONCLUSIONS

The medical and audiological perspectives identify a host of risks related to implant removal without reimplantation, including risk from surgery, general anaesthesia, cochlear ossification and poor audiometric outcomes. The member of the deaf community and bioethicist argue that physicians need to guide the principles of beneficence, non-maleficence and patient autonomy. Taken together, patient desires should be seen as paramount, if the patient is otherwise fit for surgery and well informed.

IMPLICATIONS FOR PRACTICE

Similar to the case of device implantation, device explantation should be a multidisciplinary and collaborative decision with the patient and the family's desires at the centre. While every case is different, we offer a CI explantation discussion to assist in clinical decision-making, patient counselling and education.