A Structural Equation Modeling Approach to Examining Factors Influencing Outcomes with Cochlear Implant in Mandarin-Speaking Children

Relationship between self-reported hearing and vision problems, cognitive decline, depressive symptoms, and life satisfaction in older adults: a retrospective observational study

BACKGROUND

Sensory impairment in older adults is associated with cognitive decline, elevated depressive symptoms, and low levels of life satisfaction. However, these relationships are usually investigated separately and in pairs. This study examined these relationships comprehensively, for the first time.

METHODS

The analysis included 5,658 community-dwelling older adults from the China Health and Retirement Longitudinal Study (aged 50 to 108 years, 52.1% male) who completed the Jorm Informant Questionnaire Cognitive Decline in the Elderly and the Center for Epidemiological Studies-Depression-short form. A questionnaire was used to collect information on hearing, visual status, and life satisfaction. Structural equation modelling was used to examine the direct and indirect relationships between these variables.

RESULTS

Self-reported hearing and vision problems are directly associated with cognitive decline and elevated depressive symptoms. In addition, hearing and vision problems are indirectly related to cognitive decline through elevated depressive symptoms. Although hearing and vision problems had no direct effect on life satisfaction, they were indirectly associated with life satisfaction through cognitive decline and depressive symptoms.

CONCLUSIONS

This study provides the first epidemiological evidence of the comprehensive relationships between hearing and vision problems, cognitive decline, depressive symptoms, and life satisfaction. When older adults report hearing and/or vision problems, clinicians and caregivers should be aware of the concurrence of declined cognition, elevated depressive symptoms, and compensated life satisfaction. Future studies should examine the causal relationships and potential mechanisms of these relationships.

Predicting 9-Year Language Ability from Preschool Speech Recognition in Noise in Children Using Cochlear Implants

The presence of congenital permanent childhood hearing loss has a negative impact on children’s development and lives. The current literature documents weaknesses in speech perception in noise and language development in many children with hearing loss. However, there is a lack of clear evidence for a longitudinal relationship between early speech perception abilities and later language skills. This study addressed the evidence gap by drawing on data collected as part of the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study. Cross-lagged regression analyses were used to examine the influence of speech perception in noise at age 5 years on language ability at age 9 years and vice versa (i.e. the influence of language ability at age 5 years on speech perception in noise at age 9 years). Data from 56 children using cochlear implants were analysed. We found that preschool speech perception in noise was a significant predictor of language ability at school age, after controlling for the effect of early language. The findings lend support to early intervention that targets the improvement of language skills, but also highlight the need for intervention and technology to enhance young children’s auditory capabilities for perceiving speech in noise in early childhood so that outcomes of children with hearing loss in school can be maximized.

Just-Noticeable Differences of Fundamental Frequency Change in Mandarin-Speaking Children with Cochlear Implants

Fundamental frequency (F0) provides the primary acoustic cue for lexical tone perception in tonal languages but remains poorly represented in cochlear implant (CI) systems. Currently, there is still a lack of understanding of sensitivity to F0 change in CI users who speak tonal languages. In the present study, just-noticeable differences (JNDs) of F0 contour and F0 level changes in Mandarin-speaking children with CIs were measured and compared with those in their age-matched normal-hearing (NH) peers. Results showed that children with CIs demonstrated significantly larger JND of F0 contour (JND-C) change and F0 level (JND-L) change compared to NH children. Further within-group comparison revealed that the JND-C change was significantly smaller than the JND-L change among children with CIs, whereas the opposite pattern was observed among NH children. No significant correlations were seen between JND-C change/JND-L change and age at implantation /duration of CI use. The contrast between children with CIs and NH children in sensitivity to F0 contour and F0 level change suggests different mechanisms of F0 processing in these two groups as a result of different hearing experiences.

A Review of Speech Perception of Mandarin-Speaking Children With Cochlear Implantation

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.

The relationships among verbal ability, executive function, and theory of mind in young children with cochlear implants

This study aims to examine the complex relationships among verbal ability (VA), executive function (EF), and theory of mind (ToM) in young Chinese children with cochlear implants (CCI). All participants were tested using a set of nine measures: one VA, one non-VA, three EF, and four ToM. Our study cohort comprised 82 children aged from 3.8 to 6.9 years, including 36 CCI and 46 children with normal hearing (CNH). CNH outperformed CCI on measures of VA, EF, and ToM. One of the EF tasks, inhibitory control, was significantly associated with ToM after controlling for VA. VA was the primary predictor of EF, while inhibitory control significantly predicted ToM. Our findings suggest that inhibitory control explains the association between EF and ToM, thereby supporting the hypothesis that EF may be a prerequisite for ToM.

Vocabulary development in Mandarin-speaking children with cochlear implants and its relationship with speech perception abilities

BACKGROUND

China has the largest population of children with hearing impairments and cochlear implantation is gaining popularity there. However, the vocabulary development in this population is largely unexplored.

AIMS

This study examined early vocabulary outcomes, factors influencing early vocabulary development and the relationship between speech perception and vocabulary development in Mandarin-speaking children during the first year of cochlear implant use.

METHODS AND PROCEDURES

A battery of vocabulary tests was administered to 80 children before implantation and 3, 6, and 12 months after implantation. Demographic information was obtained to evaluate their relationships with vocabulary outcomes.

OUTCOMES AND RESULTS

The Mandarin-speaking children, who received their cochlear implants before 3 years of age, developed vocabulary at a rate faster than that of their same-aged peers with normal hearing. Better pre-implant hearing levels, younger age at implantation, and higher maternal education level contributed to the early vocabulary development. The trajectories of speech perception development highly correlated with those of vocabulary development during 3 to 12 months of CI use.

CONCLUSIONS

and Implications: These findings imply that the vocabulary development of children implanted before 3 years of age may catch up with that of their hearing peers.

Current trends in outcome studies for children with hearing loss and the need to establish a comprehensive framework of measuring outcomes in children with hearing loss in China

Since the 1970s, outcome studies for children with hearing loss expanded from focusing on assessing auditory awareness and speech perception skills to evaluating language and speech development. Since the early 2000s, the multi-center large scale research systematically studied outcomes in the areas of auditory awareness, speech-perception, language development, speech development, educational achievements, cognitive development, and psychosocial development. These studies advocated the establishment of baseline and regular follow-up evaluations with a comprehensive framework centered on language development. Recent research interests also include understanding the vast differences in outcomes for children with hearing loss, understanding the relationships between neurocognitive development and language acquisition in children with hearing loss, and using outcome studies to guide evidence-based clinical practice. After the establishment of standardized Mandarin language assessments, outcomes research in Mainland China has the potential to expand beyond auditory awareness and speech perception studies.

Early speech perception in Mandarin-speaking children at one-year post cochlear implantation

PURPOSE

The aim in this study was to examine early speech perception outcomes in Mandarin-speaking children during the first year of cochlear implant (CI) use.

METHOD

A hierarchical early speech perception battery was administered to 80 children before and 3, 6, and 12 months after implantation. Demographic information was obtained to evaluate its relationship with these outcomes.

RESULTS

Regardless of dialect exposure and whether a hearing aid was trialed before implantation, implant recipients were able to attain similar pre-lingual auditory skills after 12 months of CI use. Children speaking Mandarin developed early Mandarin speech perception faster than those with greater exposure to other Chinese dialects. In addition, children with better pre-implant hearing levels and younger age at implantation attained significantly better speech perception scores after 12 months of CI use. Better pre-implant hearing levels and higher maternal education level were also associated with a significantly steeper growth in early speech perception ability.

CONCLUSIONS

Mandarin-speaking children with CIs are able to attain early speech perception results comparable to those of their English-speaking counterparts. In addition, consistent single language input via CI probably enhances early speech perception development at least during the first-year of CI use.