Auditory perception and speech identification in children with cochlear implants tested with the EARS protocol

Efficacy of auditory verbal therapy in children with cochlear implantation based on auditory performance - A systematic review

This systematic review focuses on the efficacy of auditory verbal therapy (AVT) in children with cochlear implants based on their auditory performance. The results presented are based on research findings from 2010 to 2021. The systematic review was designed based on the Popular Reporting Systems for the Systematic Review and Analysis of Meta-Analysts (PRISMA), the 2020 revised version, and the Critical Evidence for Clinical Evidence (CATE) checklist. Specific keywords were chosen based on the formulated research question and searched on the following search engines: Google Scholar, Microsoft Academic, PubMed, Semantic Scholar, Cochrane, Science Direct, and BASE. All the searched articles were analysed based on specific exclusion criteria. The results revealed an important progression based on the auditory performance among children with cochlear implantation who received habilitation. The studies highlight that younger the age at implantation better the auditory performance and this may be necessary to allow at least relatively normal organization of auditory pathways in pre-lingual children with hearing impairment. Therefore, regular revitalization of aural-verbal rehabilitation and speech and language therapy is essential for younger children with hearing impairment to achieve the highest level of hearing function. This systematic review highlights importance of assessment of the auditory performance to be considered in the test battery while evaluating children with CI before and after habilitation along with AVT.

The role of age on speech development in subjects with cochlear implants

The cochlear implant has been approved as a method of treating bilateral deep deafness since the 1980s, and since then candidate selection methods have changed several times. Initially, the candidates were only adult patients, and in 1990 the cochlear implant was approved for the first time in children under 2 years of age by the US Food and Drug Administration. In 2000, the same US Administration reduced the limit to one year. The aim of this study was to determine the effect of age at cochlear implantation on speech recognition abilities. Concerning the age groups in which the subjects were assigned to, the best results on the tests were achieved by the group who underwent cochlear implantation at the youngest age. In conclusion, the benefit from cochlear implant in subjects with pre-lingual hearing impairment of the most severe degree has to be stressed and it is much bigger in comparison to individual amplifying hearing aids. If cochlear implant is placed at the youngest age, the results might lead to even 100% of active involvement in the social life of individuals with this kind of impairment.

Development of Mandarin Chinese Vowel Perception in Young Children With Normal Hearing and Cochlear Implants

Purpose Depicting the development pattern of vowel perception for children with normal hearing (NH) and cochlear implants (CIs) would be useful for clinicians and school teachers to monitor children's auditory rehabilitation. The study was to investigate the development of Mandarin Chinese vowel perception for Mandarin Chinese native-speaking children with the ages of 4-6 years. Method Vowel identification of children with NH and CIs were tested. All children with CIs received CIs before the age of 4 years. In a picture identification task with Mandarin Chinese speech stimuli, listeners identified the target consonant-vowel word among two to four contrastive words that differed only in vowels. Each target word represented a concrete object and was spoken by a young female native Mandarin Chinese talker. The target words included 16 monophthongs, 22 diphthongs, and nine triphthongs. Results Children with NH showed significantly better identification of monophthongs and diphthongs than children with CIs at the age of 6 years, whereas the two groups had comparable performance at age of 4 and 5 years. Children with NH significantly outperformed children with CIs for triphthong identification across all three age groups. For children with NH, a rapid development of perception of all three types of vowels occurred between age 4 and 5 years with a rapid development only for monophthong perception between age 5 and 6 years. For children with CIs, a rapid development of both diphthong and triphthong perception occurred between 4 and 5 years old, but not monophthong, with no significant development between 5 and 6 years old for all three types of vowels. Overall, Mandarin-speaking children with NH achieved their ceiling performance in vowel perception before or at the age of 6 years, whereas children with CIs may need more time to reach the typical level of their peers with NH. Conclusions The development of Mandarin vowel perception for Mandarin-native children differed between preschool-age children with NH and CIs, likely due to the deficits of spectral processing for children with CIs. The results would be a supplement to the development of speech recognition in Mandarin-native children with NH and CIs.

Does size of the cochlear nerve affect postoperative auditory performance in pediatric cochlear implant patients with normal cochlear nerves?

Introduction

Cochlear implantation is an effective treatment method for severe to profound hearing loss. Many factors that may influence cochlear implantation success have been explained in previous studies. Apart from those, minor differences in size of normal cochlear nerves may affect postoperative performance.

Objective

To investigate whether the minor differences in cochlear nerve size in normal cochlear nerves affect postoperative cochlear implant performance.

Methods

30 pediatric prelingually deaf patients who were treated with cochlear implantation were included in this study. From the reconstructed parasagittal magnetic resonance images, the diameter and cross-sectional area of the cochlear nerve on the ipsilateral and contralateral side were measured. Auditory evaluations were performed 1, 3, 6 and 12 months following the first fitting. All the analysis was performed by using EARS®, evaluation of auditory responses to speech tool. Correlation between cochlear nerve diameter, cross-sectional area and postoperative auditory perception was analyzed to determine whether variation in cochlear nerve size contributes to postoperative auditory performance.

Results

The mean diameter of the cochlear nerve on the ipsilateral side was 718.4 μm (504.5 − 904.3 μm) and mean cross sectional area was 0.015 cm² (0.012 − 0.018 cm²). On the contralateral side the mean cochlear nerve diameter was 714.4 μm (502.6 − 951.4 μm) and mean cross sectional area was 0.014 cm² (0.011 − 0.019 cm²). The correlation between the diameter and cross-sectional area of the ipsilateral and contralateral cochlear nerve revealed no significance. Mean score at first month monosyllable-trochee-polysyllable test, MTP1, was 0.17 (0.08 − 0.33), at 6th month with 6 words test, 6th month MTP6 was 0.72 (0.39 − 1.0), at 6th month with 12 words, 6th month MTP 12 was 0.46 (0.17 − 0.75) and at 12th month with 12 words, 12th month MTP12 was 0.73 (0.25 − 1.0). There was no correlation between the monosyllable-trochee-polysyllable test, values at any time with the diameter of the ipsilateral cochlear nerve. However, the first month MTP, 6th month MTP6 and 12th month MTP12 correlated with the cross-sectional area of the ipsilateral cochlear nerve.

Conclusion

Measuring the cross sectional area of the normal- appearing cochlear nerve may give important prognostic knowledge on cochlear implant outcomes. In patients with a larger cross sectional area the auditory performance was better and faster. Although normal appearing, slight differences on cross sectional area of the cochlear nerve may affect performance. Measuring the size of the cochlear nerve on parasagittal magnetic resonance images may provide beneficial information on the postoperative rehabilitation process.

Auditory Skills following Cochlear Implantation in Children with the Charge Syndrome

OBJECTIVES

To assess the auditory outcomes and skills of pediatric cochlear implant (CI) users with the CHARGE syndrome. To determine the influence of inner ear malformations on the surgical procedure and speech understanding outcomes in this population.

STUDY DESIGN

Observational, retrospective study.

MATERIALS AND METHODS

Imaging, auditory testing, intraoperative findings, complications, and postoperative auditory skills and outcomes of pediatric CI users with CHARGE syndrome were recorded.

RESULTS

6 children (8 ears) were included, 5 of whom had prelingual deafness. Their mean age at implantation was 37 months. Six of the 8 ears presented cochlear malformation; the most frequent was hypoplasia type III. Intraoperatively, the transmastoid facial recess approach was used in 5 ears, and abnormalities of facial nerve anatomy were found in 5 ears. All electrode insertions were complete. All children were, to a varying degree, able to detect and identify sound. Verbalization skills were developed by 2 children, 1 of whom used oral language as his primary mode of communication.

CONCLUSIONS

Cochlear implantation performed by an experienced surgeon in patients with the CHARGE syndrome is a safe procedure with adequate treatment planning. All children had improved auditory skills although the improvement was variable.

Cochlear implant: Speech and language development in deaf and hard of hearing children following implantation

Bacground/Aim. Almost 200 cochlear implantations were done in the four centers (two in Belgrade, per one in Novi Sad and Nis) in Serbia from 2002 to 2009. Less than 10% of implantees were postlingually deaf adults. The vast majority, i.e. 90% were pre- and perilingually profoundly deaf children. The aim of this study was to assess the influence of improved auditory perception due to cochlear implantation on comprehension of abstract words in children as compared with hearing impaired children with conventional hearing aids and normal hearing children. Methods. Thirty children were enrolled in this study: 20 hearing impaired and 10 normal hearing. The vocabulary test was used. Results. The overall results for the whole test (100 words) showed a significant difference in favor of the normal hearing as compared with hearing impaired children. The normal hearing children successfully described or defined 77.93% of a total of 100 words. Success rate for the cochlear implanted children was 26.87% and for the hearing impaired children with conventional hearing aids 20.32%. Conclusion. Testing for abstract words showed a statistically significant difference between the cochlear implanted and the hearing impaired children with hearing aids (Mann- Whitney U-test, p = 0.019) implying considerable advantage of cochlear implants over hearing aids regarding successful speech development in prelingually deaf children.

High homogeneity in auditory outcome of pediatric CI-patients with mutations in Gap-Junction-Protein Beta2

OBJECTIVES

A controversy exists in the literature regarding better auditory performance of cochlear implanted children with mutations in the Gap-Junction-Protein Beta2 (GJB2) gene. This is partially due to insufficient numbers, lack of proper statistics, etc. As this represents a very important issue for the counselling clinician, the aim of the study was to analyze auditive outcome in GJB2-related hearing loss in relation to other causes and review the literature.

METHODS

Retrospective study. 44 children with unilateral cochlea implants were assigned into 3 groups according to their cause of deafness: group A contained 13 patients with GJB2-related deafness, group B 15 with hereditary hearing loss and negative GJB2-screening, and group C 16 with a nonhereditary cause. The auditory outcome performance was evaluated by pure-tone audiograms (PTA), the Monosyllabic-Trochee-Polysyllabic-Word Test (MTP) and the Listening Progress Profile (LiP) according to the EARS-protocol (Evaluation of Auditory Response to Speech) pre- and postoperatively up to 6.5 years. Additionally the educational setting was considered. Statistical analysis included direct comparison by using mixed models and computing the variance to test for homogeneity.

RESULTS

A trend towards better performance for the GJB2 group (vs. the other groups combined) was observed regarding PTA, even more pronounced for LiP/MTP. However, a significant p-value was not reached. A high homogeneity, expressed by a significant difference in the variance of MTP and LiP was observed in the GJB2 group. Differences in educational setting were not significant.

CONCLUSIONS

The results of the study seem to support a better auditory performance of GJB2-patients with cochlea implants due to a cochlear origin of the defect. The significant homogeneity for this group is of paramount issue for the counselling clinician and a very important observation.

Three-year follow-up of children with open-set speech recognition who use the MED-EL cochlear implant system

Improvement in implant technology and the fact that children with cochlear implants have surpassed all expectations have led the field to believe that open-set speech understanding is a common and expected outcome. The available literature suggests this to be the case in open-set word understanding. This study shows the results of 41 pre-lingually deafened children with a minimum of 3 years' cochlear implant experience assessed on the EARS test battery, which includes open-set phoneme, word and sentence tests. Results show that some open-set skills emerge by 6 months after implantation. There was significant improvement over time, even after 3 years of cochlear implant experience. A significant effect of age at implantation was also demonstrated. Results suggest that cochlear-implanted children develop open-set speech recognition soon after implantation, and these skills develop over a long period of time, highlighting the need for continued therapy to maximize listening and learning.

Greek adaptation of EARS test battery

Evaluation of Auditory Responses to Speech (EARS) is a test battery that was developed to measure the progress in the performance of children with cochlear implant. EARS was compiled in 1996 and is designed to assess hearing and speech perception skills in cochlear-implanted children. To date, the test battery has been adapted in 17 languages and is in use in various clinics worldwide. The aim of this study was to validate and determine the usability of a Greek EARS version in children with normal hearing. It was necessary to investigate whether the test items are appropriate for the language development in Greek children because of temporal and structural differences in language acquisition between Greek and English. Seventeen monolingual Greek children with normal hearing have been tested, aged 4 to 6 years, with the revised Greek version of EARS. The results pointed out the usability of EARS as an auditory test instrument for Greek children. Some materials and tasks had to be revised. The children had no difficulties with most of the subtests. In two of the seven subtests, children had some problems, perhaps due to their higher cognitive demand.

Comparison between the IT-MAIS and MUSS questionnaires with video-recording for evaluation of children who may receive a cochlear implantation

There is a great difficulty in determining earlier on which children would benefit or not from cochlear implants, especially because of their young age, the responses they give are very subtle.

AIM

To compare results obtained through video-recording of the interactions of children who may receive a cochlear implant with the results obtained through evaluation protocols.

METHOD

Seven children, with an average age of 39.7 months, with profound hearing loss were selected for the study. IT-MAIS and MUSS questionnaires were given to their parents/guardians of these children and the results were compared with the observation of the video-recordings.

RESULTS

It was possible to observe that the data is compatible with the auditory stages. However, the MUSS questionnaire data gathered during playful activities is very different . The questionnaire only takes into consideration the use of verbal language and therefore the majority of the evaluated children inevitably score low.

CONCLUSION

Observing children play allows us to trace a better profile of linguistic behavior and aspects relative to language, that may presented differences in the questionnaire.

Comparação entre os questionários IT-MAIS e MUSS com vídeo-gravação para avaliação de crianças candidatas ao implante coclear

Existe uma grande dificuldade para determinar precocemente crianças que se beneficiariam ou não com o implante coclear, até porque devido à pouca idade são muito sutis as respostas apresentadas. OBJETIVO: Comparar os resultados obtidos através da vídeo-gravação de situações de interação de crianças candidatas ao implante coclear com os resultados obtidos através de protocolos de avaliação. MÉTODO: Fizeram parte da amostra 7 crianças com idade média de 39,7 meses, portadores de perda auditiva neurossensorial profunda. Foram aplicados os questionários IT-MAIS e MUSS aos pais e os resultados foram comparados com a observação da vídeo-gravação destas crianças. RESULTADOS: Foi possível observar que os dados são compatíveis no que se refere às etapas auditivas. No entanto, no que se refere ao questionário MUSS, os dados obtidos na observação lúdica são bastante diferentes. O questionário leva em consideração apenas a uso da linguagem oral e, portanto, a maioria das crianças apresentou um escore muito baixo. CONCLUSÃO: A observação lúdica permitiu traçar um perfil mais amplo do comportamento lingüístico e de aspectos relativos à linguagem apresentando diferenças do questionário.

Effects of Stimulus Level on the Speech Perception Abilities of Children Using Cochlear Implants or Digital Hearing Aids

OBJECTIVE

The present investigation was designed to provide information to facilitate the decision of whether a child should continue using digital signal processing (DSP) hearing aids with wide dynamic range compression (WDRC) or be recommended for a cochlear implant, based on the unaided pure-tone average (PTA at 500, 1000, and 2000 Hz).

DESIGN

Fifty-two children (ages 5 to 15 yr) with unaided PTAs in the moderately severe to profound range, wearing (DSP) hearing aids with (WDRC) or a Nucleus 24, Clarion 1.2, or CII cochlear implant system, participated: 26 with unaided PTAs from 60 to 98 dB HL using DSP hearing aids and 26 with pre-implant unaided PTAs from 93 to 120 dB HL, using cochlear implants. An open-set speech perception test, the Lexical Neighborhood Test (LNT; ), was administered at intensity levels representative of raised (70 dB SPL) and soft (50 dB SPL) speech at two different times approximately 1 mo apart. Minimum audibility of soft sounds was determined for the children with implants and with DSP hearing aids using warble-tone thresholds at octave intervals between 250 and 4000 Hz.

RESULT

Regression analyses and significance testing were used to determine the unaided PTA values at which the performance of the DSP Hearing Aid group (DSP HA group) and Cochlear Implant group on the LNT test were statistically different at the 0.05 significance level. For the 70 dB SPL presentation level, the statistically different PTAs were 113 and 97 dB HL at Time 1 and Time 2, respectively, and 96 and 88 dB HL at 50 dB SPL for Time 1 and Time 2, respectively.

CONCLUSIONS

The Unaided PTA at which children in the cochlear implant group would be expected to score significantly better than the children in the DSP HA group was lowest (96 and 88 dB HL) for the lower signal level (50 dB SPL). Assuming that LNT scores at 50 dB SPL are representative of long-term hearing of soft incidental speech that is essential for language learning and fluent communication, the children with PTA values greater than the range from 88 to 96 dB HL would be expected to have significantly better LNT scores with a cochlear implant. These results should be further examined with research efforts focusing on early intervention with optimally fitted DSP hearing aids and cochlear implants.

Implantes cocleares em crianças portadoras de deficiência auditiva decorrente de meningite

A meningite é a principal causa de deficiência auditiva neurossensorial adquirida, o paciente pode apresentar ao mesmo tempo déficit motor, distúrbio visual, distúrbio de linguagem, déficit vestibular, déficit de atenção e incapacidade para a aprendizagem. Caracteristicamente a deficiência auditiva pós-meningite é sensorioneural, profunda, bilateral, simétrica e descendente, mais comum no sexo masculino e em crianças abaixo de 5 anos e traz não só graves implicações quanto ao desenvolvimento social e emocional dos sujeitos por ela afetados, como também sérias alterações na linguagem oral já adquirida e/ou em estágio de aquisição. OBJETIVO: O trabalho objetiva realizar um estudo comparativo de um grupo de crianças com deficiência auditiva sensorioneural devido a meningite e um grupo de crianças com deficiência auditiva sensorioneural de etiologias diversas, implantadas no período pré-lingual, na faixa etária de 1 ano e 10 meses a 6 anos. FORMA DE ESTUDO: Coorte transversal. MATERIAL E MÉTODO: Foram avaliadas 63 crianças com deficiência auditiva neurossensorial profunda bilateral pré-lingual, usuárias de implante coclear multicanal, sendo 25 (40%) do sexo masculino 38 (60%) do sexo feminino. Em 12 casos (19%) a deficiência auditiva foi decorrente da meningite e em 51 casos (81%) de outras etiologias. Todos os indivíduos selecionados foram submetidos a avaliações otorrinolaringológicas e audiológicas clínicas e objetivas. CONCLUSÕES: A ocorrência de inserção parcial dos eletrodos foi maior no grupo com deficiência auditiva pós-meningite. Não houve diferenças estatisticamente significantes quanto ao reconhecimento de palavras e fonemas e nos questionários de avaliação das habilidades auditivas (MAIS) e de linguagem (MUSS) entre os grupos estudados.

Scuba diving with cochlear implants

We report on a patient with bilateral cochlear implants (a Med-El Combi40 and a Med-El Combi40+), as well as considerable experience in scuba diving with both of his implants. After having been exposed to 68 and 89 dives, respectively, in depths of up to 43 m, both cochlear implants are in working order and the patient continues to receive excellent speech recognition scores with both cochlear implant systems. The presented data show that scuba diving after cochlear implantation is possible over a considerable number of dives without any major negative impact on the implants.

Intra- and intersubject comparison of cochlear implant systems using the Esprit and the Tempo+ behind-the-ear speech processor

A patient with bilateral profound deafness was implanted with a Nucleus CI24M cochlear implant (CI) and used an Esprit behind-the-ear (BTE) speech processor. Thirteen months later, the implant had to be removed because of a cholesteatoma. As the same electrode could not be reinserted, a Medel combi40s CI was implanted in the same ear, and the patient used a Tempo+ BTE processor. After 1 year of use of the Combi40s/Tempo+ system, speech recognition was better and was rated better subjectively than with the CI24M/Esprit system. Speech recognition and subjective ratings were also assessed for two matched groups of nine CI users each, using either an Esprit or a Tempo+ processor. On average, speech recognition scores were higher for the group of Tempo+ users, but the difference was not statistically significant. Users of the Esprit processors rated their device higher in terms of cosmetic appearance and comfort of wearing.

A parental questionnaire to evaluate children's Auditory Behavior in Everyday Life (ABEL)

The Auditory Behavior in Everyday Life (ABEL) questionnaire was developed to assess parental perceptions of their children's auditory behavior. The original 49-item questionnaire was intended to assess auditory communication, environmental awareness, functional independence, and social/ communication skills. Our goal was to capture some of the changes in children's everyday auditory behavior in a reliable and easily quantifiable manner. Parents of 28 children aged 4 to 14 years with varying degrees of hearing loss (mild-profound) completed the questionnaire. The results were used to examine the reliability and factor structure of the questionnaire. Eleven items had poor item-total correlations. After these items were removed, the questionnaire had an overall reliability of 0.94 (Cronbach's alpha), and three factors accounted for 20.5% of the variance in the data. In a pilot investigation of the ABEL to determine its appropriateness for children with cochlear implants, questionnaires were also given to a separate group of parents of seven children aged 3 to 12 years who were about to receive a cochlear implant. Questionnaire and speech perception results were obtained preimplant and at 6, 12, 18, 24, and 36 months. Complete (6 visits) or near-complete (4 visits) results were obtained for four children. There were significant improvements over time for both speech perception and questionnaire ratings and there was significant agreement between the two measures. Overall the results indicate excellent reliability and validity of the ABEL questionnaire. Our intent was to develop a simple, quick tool for parents to rate children's auditory skills in everyday life. A shorter questionnaire can be achieved by eliminating items with the poorest reliability and factor loadings. The resultant 24-item ABEL questionnaire has an excellent overall reliability of 0.95. The items fall within three factors, "Aural-oral," "Auditory Awareness," and "Social/Conversational Skills." Children's auditory behavior can be assessed using an overall rating or separately for the three factors. Further research is needed to evaluate this short version of the questionnaire in children wearing hearing aids and cochlear implants.