Factors that affect the social well-being of children with cochlear implants

Identifying Listeners Whose Speech Intelligibility Depends on a Quiet Extra Moment After a Sentence

PURPOSE

An extra moment after a sentence is spoken may be important for listeners with hearing loss to mentally repair misperceptions during listening. The current audiologic test battery cannot distinguish between a listener who repaired a misperception versus a listener who heard the speech accurately with no need for repair. This study aims to develop a behavioral method to identify individuals who are at risk for relying on a quiet moment after a sentence.

METHOD

Forty-three individuals with hearing loss (32 cochlear implant users, 11 hearing aid users) heard sentences that were followed by either 2 s of silence or 2 s of babble noise. Both high- and low-context sentences were used in the task.

RESULTS

Some individuals showed notable benefit in accuracy scores (particularly for high-context sentences) when given an extra moment of silent time following the sentence. This benefit was highly variable across individuals and sometimes absent altogether. However, the group-level patterns of results were mainly explained by the use of context and successful perception of the words preceding sentence-final words.

CONCLUSIONS

These results suggest that some but not all individuals improve their speech recognition score by relying on a quiet moment after a sentence, and that this fragility of speech recognition cannot be assessed using one isolated utterance at a time. Reliance on a quiet moment to repair perceptions would potentially impede the perception of an upcoming utterance, making continuous communication in real-world scenarios difficult especially for individuals with hearing loss. The methods used in this study-along with some simple modifications if necessary-could potentially identify patients with hearing loss who retroactively repair mistakes by using clinically feasible methods that can ultimately lead to better patient-centered hearing health care.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21644801.

Quality of Life and Cochlear Implant: Results in Saudi Children

Objective To assess the quality of life (QoL) in Saudi children with cochlear implants (CI) and determine sociodemographic and clinical factors that have an impact on the perceived QoL. Methods A cross-sectional study is performed by comparing the QoL of Saudi toddlers and young CI recipients with normal children, using the Paediatric Quality of Life Inventory 4.0 - Generic core scale (PedsQLTM 4.0 - GCS). A self-administered questionnaire was sent to parents of paediatric patients, who had cochlear implantation at King Abdulaziz University Hospital (KAUH), from March 2016 to March 2018. Mothers of age-matched normal children who attended the obstetrics and gynaecology clinics at King Khalid University Hospital (KKUH), in November 2019 were considered as a control group. Results When children with CI and normal children PedsQLTM 4.0 - GCS subscales (physical, emotional, social, and school) and total functioning scores were compared, no single significant difference was noted between the groups. The sociodemographic and clinical factors that have an impact on the perceived QoL were: gender, birth order, and distance from the CI center. Emotional, social, psychosocial, and total functioning were the main dimensions affected. Conclusion The QoL of Saudi children with CI is comparable to those of normal children. However, among children with CI, gender, birth order, and distance from the CI center were found to have different effects on the QoL dimensions.

Academic Performance, Communication, and Psychosocial Development of Prelingual Deaf Children with Cochlear Implants in Mainstream Schools

BACKGROUND AND OBJECTIVES

To assess the academic performance, communication skills, and psychosocial development of prelingual deaf children with cochlear implants (CIs) attending mainstream schools, and to evaluate the impact of auditory speech perception on their classroom performance. Subjects and.

METHODS

As participant, 67 children with CI attending mainstream schools were included. A survey was conducted using a structured questionnaire on academic performance in the native language, second language, mathematics, social studies, science, art, communication skills, self-esteem, and social relations. Additionally, auditory and speech performances on the last follow-up were reviewed retrospectively.

RESULTS

Most implanted children attending mainstream school appeared to have positive self-esteem and confidence, and had little difficulty in conversing in a quiet classroom. Also, half of the implanted children (38/67) scored above average in general academic achievement. However, academic achievement in the second language (English), social studies, and science were usually poorer than general academic achievement. Furthermore, half of the implanted children had difficulty in understanding the class content (30/67) or conversing with peers in a noisy classroom (32/67). These difficulties were significantly associated with poor speech perception.

CONCLUSIONS

Improving the listening environment for implanted children attending mainstream schools is necessary.

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.

Parents' Perception of Health-Related Quality of Life in Children With Cochlear Implants: The Impact of Language Skills and Hearing

PURPOSE

The study compared how parents of children with cochlear implants (CIs) and parents of children with normal hearing perceive their children's health-related quality of life (HR-QOL).

METHOD

The sample consisted of 186 Norwegian-speaking children in the age span of 5;0-12;11 (years;months): 106 children with CIs (53% boys, 47% girls) and 80 children with normal hearing (44% boys, 56% girls). No children had known additional disabilities affecting language, cognitive development, or HR-QOL. Parents completed the generic questionnaire Pediatric Quality of Life Inventory (Varni, Seid, & Kurtin, 2001), whereas children completed a test battery measuring different aspects of language and hearing.

RESULTS

Parents of children with CIs reported statistically significantly poorer HR-QOL in their children, on Pediatric Quality of Life Inventory total score and the subdomains social functioning and school functioning. Roughly 50% of parents of children with CIs reported HR-QOL levels (total score) within normal limits. No significant differences between groups emerged on the physical health and emotional functioning subscales. For the children in the group with CIs, better speech perception in everyday situations was associated with higher proxy-ratings of HR-QOL. Better spoken language skills were weakly to moderately associated with higher HR-QOL.

CONCLUSIONS

The findings suggest that the social and school situation is not yet resolved satisfactorily for children with CIs. Habilitation focusing on spoken language skills and better sound environment may improve social interactions with peers and overall school functioning.

Psychosocial development of 5-year-old children with hearing loss: Risks and protective factors

OBJECTIVE

The aims of this paper were to report on the global psychosocial functioning of 5-year-old DHH children and examine the risk and protective factors that predict outcomes.

DESIGN

A cross-sectional analysis of data collected from a prospective, population-based longitudinal study.

STUDY SAMPLE

Parents/caregivers of 356 children completed questionnaires on psychosocial development (CDI, SDQ), functional communication (PEACH) and demographic information. Children completed standardized assessments of non-verbal cognitive ability (WNV) and language (PLS-4).

RESULTS

On average, global psychosocial functioning was within the range of typically developing children; however, variability was high and 12% of children had scores that were more than 2 SDs below the norm. Non-verbal cognitive ability, presence of additional disabilities, language and functional communication significantly predicted outcomes. In contrast, type of hearing device, severity of hearing loss and age at intervention did not.

CONCLUSION

The global psychosocial functioning of this cohort of 5-year-old DHH children fell within the range of typically developing children. The findings suggest that spoken language ability and functional communication skills are vital for healthy psychosocial development.

Psychosocial Development in 5-Year-Old Children With Hearing Loss Using Hearing Aids or Cochlear Implants

This article reports on the psychosocial development and factors influencing outcomes of 5-year-old children with cochlear implants (CIs) or hearing aids (HAs). It further examines differences between children with CIs and HAs with similar levels of hearing loss. Data were collected as part of the Longitudinal Outcomes of Children with Hearing Impairment study-a prospective, population-based study. Parents/caregivers of children completed the Strengths and Difficulties Questionnaire ( n = 333), the Social Skills subscale from the Child Development Inventory ( n = 317), and questionnaires on functional auditory behavior (Parents' Evaluation of Aural/oral performance of Children), and demographics. Children completed assessments of nonverbal cognitive ability (Wechsler Non-verbal Scale of Ability) and language (Preschool Language Scale - fourth edition). On average, parent-rated Strengths and Difficulties Questionnaire scores on emotional or behavioral difficulties were within 1 SD of the normative mean; however, Child Development Inventory scores on social skills were more than 1 SD below the norm. Children with severe-to-profound hearing losses using HAs had significantly more behavioral problems than children with CIs. Regression analyses showed that non-verbal cognitive ability, language, and functional auditory behavior were significantly associated with psychosocial outcomes for children with HAs, whereas outcomes for children with CIs were associated with functional auditory behavior and the presence of additional disabilities. Age at hearing intervention, severity of hearing loss, and communication mode were not associated with outcomes. The results suggest that even children who develop good language ability with the help of a HA or CI may have psychosocial problems if they exhibit difficulties with listening and communicating in everyday environments. The findings have implications for developing interventions for young children with hearing loss.

Communication Assessment and Intervention: Implications for Pediatric Hearing Loss

Historically, children with hearing loss have fallen well behind their hearing peers in the areas of speech and language development, which has often limited their participation in a range of social, educational, and vocational activities. However, with early identification and appropriate intervention coupled with current hearing technology, children with hearing loss can achieve speech and language milestones at rates commensurate with hearing peers. To attain the best outcomes for these children, an early intervention system that provides thorough and unbiased information to families and allows for the efficient and coordinated efforts of qualified professionals must be present.

Symptoms of Psychopathology in Hearing-Impaired Children

OBJECTIVES

Children with hearing loss are at risk of developing psychopathology, which has detrimental consequences for academic and psychosocial functioning later in life. Yet, the causes of the extensive variability in outcomes are not fully understood. Therefore, the authors wanted to objectify symptoms of psychopathology in children with cochlear implants or hearing aids, and in normally hearing peers, and to identify various risk and protective factors.

DESIGN

The large sample (mean age = 11.8 years) included three subgroups with comparable age, gender, socioeconomic status, and nonverbal intelligence: 57 with cochlear implants, 75 with conventional hearing aids, and 129 children who were normally hearing. Psychopathology was assessed by means of self- and parent-report measures.

RESULTS

Children with cochlear implants showed similar levels of symptoms of psychopathology when compared with their normally hearing peers, but children with hearing aids had significantly higher levels of psychopathological symptoms, while their hearing losses were approximately 43 dB lower than those of children with implants. Type of device was related with internalizing symptoms but not with externalizing symptoms. Furthermore, lower age and sufficient language and communication skills predicted less psychopathological symptoms.

CONCLUSIONS

Children who are deaf or profoundly hearing impaired and have cochlear implants have lower levels of psychopathological symptoms than children with moderate or severe hearing loss who have hearing aids. Most likely, it is not the type of hearing device but rather the intensity of the rehabilitation program that can account for this difference. This outcome has major consequences for the next generation of children with hearing loss because children with profound hearing impairment still have the potential to have levels of psychopathology that are comparable to children who are normally hearing.

School performance and wellbeing of children with CI in different communicative-educational environments

OBJECTIVES

This study aimed to evaluate the long term effects of CI on auditory, language, educational and social-emotional development of deaf children in different educational-communicative settings.

METHODS

The outcomes of 58 children with profound hearing loss and normal non-verbal cognition, after 60 months of CI use have been analyzed. At testing the children were enrolled in three different educational settings; in mainstream education, where spoken language is used or in hard-of-hearing education where sign supported spoken language is used and in bilingual deaf education, with Sign Language of the Netherlands and Sign Supported Dutch. Children were assessed on auditory speech perception, receptive language, educational attainment and wellbeing.

RESULTS

Auditory speech perception of children with CI in mainstream education enable them to acquire language and educational levels that are comparable to those of their normal hearing peers. Although the children in mainstream and hard-of-hearing settings show similar speech perception abilities, language development in children in hard-of-hearing settings lags significantly behind. Speech perception, language and educational attainments of children in deaf education remained extremely poor. Furthermore more children in mainstream and hard-of-hearing environments are resilient than in deaf educational settings. Regression analyses showed an important influence of educational setting.

CONCLUSIONS

Children with CI who are placed in early intervention environments that facilitate auditory development are able to achieve good auditory speech perception, language and educational levels on the long term. Most parents of these children report no social-emotional concerns.

Bilateral versus unilateral cochlear implants in children: a study of spoken language outcomes

Objectives:

Although it has been established that bilateral cochlear implants (CIs) offer additional speech perception and localization benefits to many children with severe to profound hearing loss, whether these improved perceptual abilities facilitate significantly better language development has not yet been clearly established. The aims of this study were to compare language abilities of children having unilateral and bilateral CIs to quantify the rate of any improvement in language attributable to bilateral CIs and to document other predictors of language development in children with CIs.

Design:

The receptive vocabulary and language development of 91 children was assessed when they were aged either 5 or 8 years old by using the Peabody Picture Vocabulary Test (fourth edition), and either the Preschool Language Scales (fourth edition) or the Clinical Evaluation of Language Fundamentals (fourth edition), respectively. Cognitive ability, parent involvement in children’s intervention or education programs, and family reading habits were also evaluated. Language outcomes were examined by using linear regression analyses. The influence of elements of parenting style, child characteristics, and family background as predictors of outcomes were examined.

Results:

Children using bilateral CIs achieved significantly better vocabulary outcomes and significantly higher scores on the Core and Expressive Language subscales of the Clinical Evaluation of Language Fundamentals (fourth edition) than did comparable children with unilateral CIs. Scores on the Preschool Language Scales (fourth edition) did not differ significantly between children with unilateral and bilateral CIs. Bilateral CI use was found to predict significantly faster rates of vocabulary and language development than unilateral CI use; the magnitude of this effect was moderated by child age at activation of the bilateral CI. In terms of parenting style, high levels of parental involvement, low amounts of screen time, and more time spent by adults reading to children facilitated significantly better vocabulary and language outcomes. In terms of child characteristics, higher cognitive ability and female sex were predictive of significantly better language outcomes. When family background factors were examined, having tertiary-educated primary caregivers and a family history of hearing loss were significantly predictive of better outcomes. Birth order was also found to have a significant negative effect on both vocabulary and language outcomes, with each older sibling predicting a 5 to 10% decrease in scores.

Conclusions:

Children with bilateral CIs achieved significantly better vocabulary outcomes, and 8-year-old children with bilateral CIs had significantly better language outcomes than did children with unilateral CIs. These improvements were moderated by children’s ages at both first and second CIs. The outcomes were also significantly predicted by a number of factors related to parenting, child characteristics, and family background. Fifty-one percent of the variance in vocabulary outcomes and between 59 to 69% of the variance in language outcomes was predicted by the regression models.

The study compared language abilities of children with unilateral and bilateral cochlear implants (CIs), quantified the rate of language development attributable to bilateral CIs and documented predictors of language development. Children with bilateral CIs achieved significantly better vocabulary outcomes, and 8-year-old children with bilateral CIs had significantly better language outcomes. Improvements were moderated by children’s ages at both first and second CIs. Outcomes were significantly predicted by a number of factors related to parenting, child characteristics, and family background. Fifty-one percent of the variance in vocabulary outcomes and between 59 to 69% of the variance in language outcomes was predicted by the regression models.

Supplemental Digital Content is available in the text.

Outcomes of early- and late-identified children at 3 years of age: findings from a prospective population-based study

OBJECTIVE

To address the question of whether, on a population level, early detection and amplification improve outcomes of children with hearing impairment.

DESIGN

All families of children who were born between 2002 and 2007, and who presented for hearing services below 3 years of age at Australian Hearing pediatric centers in New South Wales, Victoria, and Southern Queensland were invited to participate in a prospective study on outcomes. Children's speech, language, functional, and social outcomes were assessed at 3 years of age, using a battery of age-appropriate tests. Demographic information relating to the child, family, and educational intervention was solicited through the use of custom-designed questionnaires. Audiological data were collected from the national database of Australian Hearing and records held at educational intervention agencies for children. Regression analysis was used to investigate the effects of each of 15 predictor variables, including age of amplification, on outcomes.

RESULTS

Four hundred and fifty-one children enrolled in the study, 56% of whom received their first hearing aid fitting before 6 months of age. On the basis of clinical records, 44 children (10%) were diagnosed with auditory neuropathy spectrum disorder. There were 107 children (24%) reported to have additional disabilities. At 3 years of age, 317 children (70%) were hearing aid users and 134 children (30%) used cochlear implants. On the basis of parent reports, about 71% used an aural/oral mode of communication, and about 79% used English as the spoken language at home. Children's performance scores on standardized tests administered at 3 years of age were used in a factor analysis to derive a global development factor score. On average, the global score of hearing-impaired children was more than 1 SD below the mean of normal-hearing children at the same age. Regression analysis revealed that five factors, including female gender, absence of additional disabilities, less severe hearing loss, higher maternal education, and (for children with cochlear implants) earlier age of switch-on were associated with better outcomes at the 5% significance level. Whereas the effect of age of hearing aid fitting on child outcomes was weak, a younger age at cochlear implant switch-on was significantly associated with better outcomes for children with cochlear implants at 3 years of age.

CONCLUSIONS

Fifty-six percent of the 451 children were fitted with hearing aids before 6 months of age. At 3 years of age, 134 children used cochlear implants and the remaining children used hearing aids. On average, outcomes were well below population norms. Significant predictors of child outcomes include: presence/absence of additional disabilities, severity of hearing loss, gender, maternal education, together with age of switch-on for children with cochlear implants.

O uso da Classificação Internacional de Funcionalidade, Incapacidade e Saúde para acompanhamento de pacientes usuários de Implante Coclear

OBJETIVO: Caracterizar o perfil dos pacientes usuários de Implante Coclear a partir do proposto pela Classificação Internacional de Funcionalidade, Incapacidade e Saúde para Crianças e Jovens (CIF-CJ). MÉTODOS: Tratou-se de um estudo descritivo, retrospectivo transversal, em que foram analisados 30 prontuários de pacientes usuários de Implante Coclear do Centro de Pesquisas Audiológicas. Para caracterização do perfil dos pacientes, foi utilizada a CIF-CJ. Para avaliação, os pesquisadores basearam-se em procedimentos realizados na rotina clínica, além de informações registradas no prontuário. Após a revisão dessas informações, estas foram relacionadas com o código da CIF-CJ, sendo acrescido posteriormente um qualificador. RESULTADOS: No total, 55 códigos da CIF foram relacionados com os instrumentos para caracterização desta população. Com relação ao domínio Funções do Corpo, a maioria dos participantes não apresentava deficiência quanto aos aspectos relacionados à recepção e expressão da linguagem oral e funções auditivas, sendo apenas encontrada deficiência na linguagem escrita. Esse mesmo achado foi observado no domínio Atividade e Participação. Quanto aos Fatores Ambientais, o ruído e a não disponibilidade de recursos tecnológicos para auxiliar na compreensão auditiva no ruído foram caracterizados como barreira, além da não realização da terapia fonoaudiológica. CONCLUSÃO: Este trabalho permitiu-nos concluir que a maioria das crianças participantes não apresentou deficiência nas Funções do Corpo, sendo observadas apenas dificuldades no desempenho escolar. Os fatores ambientais (ruído, não disponibilidade de recursos tecnológicos, não realização da terapia fonoaudiológica) foram caracterizados como barreira. Notou-se também a necessidade de ampliar as avaliações na rotina clínica.

Exploring perspectives on cochlear implants and language acquisition within the deaf community

Cochlear implants generated intense debate almost immediately following their introduction in the 1980s. Today, with a vast number of deaf individuals with cochlear implants, the debate about the cochlear implant device and mode of communication continues. Q-methodology was used in this study to explore cochlear implants and language acquisition perspectives within the deaf community. Thirty respondents sorted 33 statements, which were collected from professional literature and mainstream media, into a forced-choice, quasi-normal template. A by-person factor analysis of the Q-sorts revealed 5 model viewpoints: (a) American Sign Language advocate, (b) bilingual advocate, (c) cochlear implant advocate, (d) diverse options advocate, and (e) English visually advocate. Even though the results indicate 5 distinct perspectives, the Q-method also revealed similarities among them. The results also show that there seems to be some agreement on using a bilingual approach, although the perspectives seem to disagree on which language should be acquired first.

Actor vocal training for the habilitation of speech in adolescent users of cochlear implants

This study examined changes to speech production in adolescents with hearing impairment following a period of actor vocal training. In addition to vocal parameters, the study also investigated changes to psychosocial factors such as confidence, self-esteem, and anxiety. The group were adolescent users of cochlear implants (mean age at commencement of training 15.9 years), with approximately half of the group wearing a hearing aid in the contralateral ear. The mean age of implantation of the group was 7.6 years and the participants displayed a range of speech production abilities. Evaluation of posttraining outcomes was performed via a combination of perceptual and acoustic analyses. Significant posttraining changes to vocal parameters included increased pitch range and variability and decreased speaking rate. From a psychosocial perspective, posttraining stress levels were significantly lowered. This study suggested that actor vocal training may benefit young people with hearing impairment, both in the way in which they use their voices and in the way in which they view themselves.