Speech production intelligibility of early implanted pediatric cochlear implant users

Speech production skills of bilingual children using cochlear implants

Evidence is lacking on the impact of bilingualism on the speech skills of children with cochlear implants (CIs). This study described the speech production of children with CIs acquiring French and one or more additional spoken languages. Four groups of children aged 4-11 were included: bilinguals (n = 15) and monolinguals (n = 14) with CIs and bilinguals (n = 14) and monolinguals (n = 20) with typical hearing. Data were collected about the percentage of consonant correct (PCC) and vowel correct (PVC) produced in French and intelligibility in all languages they spoke. Bilingual and monolingual children with CIs had comparable speech accuracy in French, but the pattern differed, impacting PCC for bilinguals and PVC for monolinguals. Most children with CIs had accurate and intelligible speech in French, but few bilingual children with CIs were highly intelligible in their home language. Therefore, bilingualism did not impede the speech production outcomes of bilingual children with CIs in the language of the wider community.

Similar gaze behaviour during dialogue perception in congenitally deaf children with cochlear Implants and normal hearing children

BACKGROUND

Perceptual and speech production abilities of children with cochlear implants (CIs) are usually tested by word and sentence repetition or naming tests. However, these tests are quite far apart from daily life linguistic contexts.

AIM

Here, we describe a way of investigating the link between language comprehension and anticipatory verbal behaviour promoting the use of more complex listening situations.

METHODS AND PROCEDURE

The setup consists in watching the audio-visual dialogue of two actors. Children's gaze switches from one speaker to the other serve as a proxy of their prediction abilities. Moreover, to better understand the basis and the impact of anticipatory behaviour, we also measured children's ability to understand the dialogue content, their speech perception and memory skills as well as their rhythmic skills, that also require temporal predictions. Importantly, we compared children with CI performances with those of an age-matched group of children with normal hearing (NH).

OUTCOMES AND RESULTS

While children with CI revealed poorer speech perception and verbal working memory abilities than NH children, there was no difference in gaze anticipatory behaviour. Interestingly, in children with CI only, we found a significant correlation between dialogue comprehension, perceptual skills and gaze anticipatory behaviour.

CONCLUSION

Our results extend to a dialogue context of previous findings showing an absence of predictive deficits in children with CI. The current design seems an interesting avenue to provide an accurate and objective estimate of anticipatory language behaviour in a more ecological linguistic context also with young children.

WHAT THIS PAPER ADDS

What is already known on the subject Children with cochlear implants seem to have difficulties extracting structure from and learning sequential input patterns, possibly due to signal degradation and auditory deprivation in the first years of life. They also seem to have a reduced use of contextual information and slow language processing among children with hearing loss. What this paper adds to existing knowledge Here we show that when adopting a rather complex linguistic context such as watching a dialogue of two individuals, children with cochlear implants are able to use the speech and language structure to anticipate gaze switches to the upcoming speaker. What are the clinical implications of this work? The present design seems an interesting avenue to provide an accurate and objective estimate of anticipatory behaviour in a more ecological and dynamic linguistic context. Importantly, this measure is implicit and it has been previously used with very young (normal-hearing) children, showing that they spontaneously make anticipatory gaze switches by age two. Thus, this approach may be of interest to refine the speech comprehension assessment at a rather early age after cochlear implantation where explicit behavioural tests are not always reliable and sensitive.

Measuring speech intelligibility with deaf and hard-of-hearing children: A systematic review

There is great variability in the ways in which the speech intelligibility of d/Deaf and hard-of-hearing (DHH) children who use spoken language as part, or all, of their communication system is measured. This systematic review examined the measures and methods that have been used when examining the speech intelligibility of children who are DHH and the characteristics of these measures and methods. A systematic database search was conducted of CENTRAL; CINAHL; Cochrane; ERIC; Joanna Briggs; Linguistics, Language and Behavior Abstracts; Medline; Scopus; and Web of Science databases, as well as supplemental searches. A total of 204 included studies reported the use of many different measures/methods which measured segmental aspects of speech, with the most common being Allen et al.'s (2001, The reliability of a rating scale for measuring speech intelligibility following pediatric cochlear implantation. Otology and Neurotology, 22(5), 631-633. https://doi.org/10.1097/00129492-200109000-00012) Speech Intelligibility Rating scale. Many studies included insufficient details to determine the measure that was used. Future research should utilize methods/measures with known psychometric validity, provide clear descriptions of the methods/measures used, and consider using more than one measure to account for limitations inherent in different methods of measuring the speech intelligibility of children who are DHH, and consider and discuss the rationale for the measure/method chosen.

Cochlear implants: the effects of age on outcomes

INTRODUCTION

Cochlear implants (CIs) provide access to sound for children and adults who do not receive adequate benefit from hearing aids. Age at implantation is known to affect outcomes across the lifespan.

AREAS COVERED

The effects of age on CI outcomes are examined for infants, children, adolescents, and older adults. A variety of outcome measures are considered, including speech perception, language, cognition, and quality of life measures.

EXPERT OPINION/COMMENTARY

For those meeting candidacy criteria, CIs are beneficial at any age. In general, younger age is related to greater benefit when considering pre-lingual deafness. Other factors such as additional disabilities, may mitigate this effect. Post-lingually deafened adults demonstrate similar benefit regardless of age, though the oldest individuals (80+) may see smaller degrees of improvement from preoperative scores. Benefit can be measured in many ways, and the areas of greatest benefit may vary based on age: young children appear to see the greatest effects of age at implantation on language measures, whereas scores on cognitive measures appear to be most impacted for the oldest population. Future research should consider implantation at extreme ages (5-9 months or > 90 years), unconventional measures of CI benefit including qualitative assessments, and longitudinal designs.

The Impact of Bimodal Hearing on Speech Acoustics of Vowel Production in Adult Cochlear Implant Users

PURPOSE

This study aimed to investigate the acoustic changes in vowel production with different forms of auditory feedback via cochlear implant (CI), hearing aid (HA), and bimodal hearing (CI + HA).

METHOD

Ten post-lingually deaf adult bimodal CI users (aged 50-78 years) produced English vowels /i/, /ɛ/, /æ/, /ɑ/, /ʊ/, and /u/ in the context of /hVd/ during short-term use of no device (ND), HA, CI, and CI + HA. Segmental features (first formant frequency [F 1], second formant frequency [F 2], and vowel space area) and suprasegmental features (duration, intensity, and fundamental frequency [f o]) of vowel production were analyzed. Participants also categorized a vowel continuum synthesized from their own productions of /ɛ/ and /æ/ using HA, CI, and CI + HA.

RESULTS

F 1s of all vowels decreased; F 2s of front vowels but not back vowels increased; vowel space areas increased; and vowel durations, intensities, and f os decreased with statistical significance in the HA, CI, and CI + HA conditions relative to the ND condition. Only f os were lower, and vowel space areas were larger with CI and CI + HA than with HA. Average changes in f o, intensity, and F 1 from the ND condition to the HA, CI, and CI + HA conditions were positively correlated. Most participants did not show a typical psychometric function for vowel categorization, and thus, the relationship between vowel categorization and production was not tested.

CONCLUSIONS

The results suggest that acoustic, electric, and bimodal hearing have a measurable impact on vowel acoustics of post-lingually deaf adults when their hearing devices are turned on and off temporarily. Also, changes in f o and F 1 with the use of hearing devices may be largely driven by changes in intensity.

Spontaneous speech intelligibility: early cochlear implanted children versus their normally hearing peers at seven years of age

Speaking intelligibly is an important achievement in children's language development. How far do congenitally severe-to-profound hearing-impaired children who received a cochlear implant (CI) in the first two years of their life advance on the path to intelligibility in comparison to children with typical hearing (NH)? Spontaneous speech samples of children with CI and children with NH were orthographically transcribed by naïve transcribers. The entropy of the transcriptions was computed to analyze their degree of uniformity. The same samples were also rated on a continuous rating scale by another group of adult listeners. The transcriptions of the NH children's speech were more uniform, i.e., had significantly lower entropy, than those of the CI children, suggesting that the latter group displayed lower intelligibility. This was confirmed by the ratings on the continuous scale. Despite the relatively restricted age ranges, older children reached better intelligibility scores in both groups.

Speech intelligibility of children with an auditory brainstem implant: a triple-case study

Auditory brainstem implantation (ABI) is a relative recent development in paediatric hearing restoration. Consequently, young-implanted children's productive language has not received much attention. This study investigated speech intelligibility of children with ABI (N = 3) in comparison to children with cochlear implants (CI) and children with typical hearing (TH). Spontaneous speech samples were recorded from children representing the three groups matched on cumulative vocabulary level. Untrained listeners (N = 101) rated the intelligibility of one-word utterances on a continuous scale and transcribed each utterance. The rating task yielded a numerical score between 0 and 100, and similarities and differences between the listeners' transcriptions were captured by a relative entropy score. The speech intelligibility of children with CI and children with TH was similar. Speech intelligibility of children with ABI was well below that of the children with CI and TH. But whereas one child with ABI's intelligibility approached that of the control groups with increasing lexicon size, the intelligibility of the two other children with ABI did not develop in a similar direction. Overall, speech intelligibility was only moderate in the three groups of children, with quite low ratings and considerable differences in the listeners' transcriptions, resulting in high relative entropy scores.

Early Cochlear Implantation Allows Deaf Children to Control Voice Pitch and Loudness independently

OBJECTIVE

Congenitally deaf children with a cochlear implant (CI) improve their speech production intelligibility, but their prosody, including stress and intonation produced by voice pitch and loudness changes, often differs from normal hearing people, which affects their fluent oral communication. This study is aimed to clarify abnormal characteristics of voice pitch and loudness control in CI recipients using a newly developed visually guided pitch change task.

METHODS

We included 13 normal hearing volunteers (NH group) and 17 congenitally deaf CI users who showed good speech intelligibility. The 17 CI users were divided into Early-CI and Late-CI groups, based on their age at implantation of 2.5 years. Using the visually guided pitch change task and acoustic voice analysis of sustained vowels, we assessed their vocal skills to maintain constant pitch and loudness and intentionally change the voice pitch independent from loudness. At the time of examination, the mean age was 24.1, 12.7, and 18.9 years in the NH, Early-CI, and Late-CI groups.

RESULTS

During constant vowel production, Early-CI and Late-CI groups showed more significant fluctuations in pitch and loudness than the NH group. However, when focusing on intentionally changing only the pitch of the voice, the Early-CI group was significantly better than the Late-CI group and comparable to the NH group in terms of their ability to change vocal pitch independently from loudness.

CONCLUSION

Among congenitally deaf patients, age at implantation was associated with the development of voice skills to control voice pitch and loudness separately, which may influence their fluent prosody production.

Inteligibilidad: diferentes perspectivas de su concepto y evaluación. Una revisión sistemática

Una adecuada inteligibilidad es un indicador del éxito en la comunicación. Su interferencia, a causa de cualquier patología, debe ser abordada en los objetivos primordiales de la terapia. No obstante, los métodos para su evaluación son poco conocidos. Objetivo: desarrollar una revisión sistemática que describa los métodos empleados en la medición de la inteligibilidad y discutir la conceptualización de este constructo. Metodología: se realiza una búsqueda en las bases de datos PubMed, ScieLo y Science Direct para identificar artículos publicados entre 1990 y 2018. Análisis y discusiones: Se seleccionan 50 investigaciones en inglés, español y portugués, que mostraron preferencia por medidas objetivas de evaluación, por sobre las medidas subjetivas de escala. La inteligibilidad se define mejor como un constructo dependiente de la señal acústica, a diferencia del concepto de comprensibilidad. Esta revisión ofrece información actualizada y organizada para optimizar procedimientos clínicos y científicos de medición de la inteligibilidad. 

Early pediatric Cochlear implantation: An update

The criteria and candidacy for pediatric cochlear implantation (CI) has significantly transformed over the past few decades and continues to evolve with technological advancements, and recognition of benefit in more diverse populations. Prolonged auditory deprivation among patients with profound sensorineural hearing loss has been shown to cause widespread degeneration in the central auditory system. Thus, there is increasing evidence advocating for earlier implantation within a critical neuroplastic window. However, there is a lack of consensus on this optimal age of implantation. Historically, there were concerns regarding surgical feasibility and safety, anesthesia risk, and logistical considerations in very young infants <12 months. Recent literature has investigated surgical safety and anesthesia risk as well speech and language outcomes with early implantation, resulting in the long-awaited reduction in approved age by the FDA (<9 months for certain devices). This article reviews logistical considerations, surgical safety, anesthesia risk, and language developmental outcomes associated with early CI (<12 months).

Early pediatric Cochlear implantation: An update

The criteria and candidacy for pediatric cochlear implantation (CI) has significantly transformed over the past few decades and continues to evolve with technological advancements, and recognition of benefit in more diverse populations. Prolonged auditory deprivation among patients with profound sensorineural hearing loss has been shown to cause widespread degeneration in the central auditory system. Thus, there is increasing evidence advocating for earlier implantation within a critical neuroplastic window. However, there is a lack of consensus on this optimal age of implantation. Historically, there were concerns regarding surgical feasibility and safety, anesthesia risk, and logistical considerations in very young infants <12 months. Recent literature has investigated surgical safety and anesthesia risk as well speech and language outcomes with early implantation, resulting in the long-awaited reduction in approved age by the FDA (<9 months for certain devices). This article reviews logistical considerations, surgical safety, anesthesia risk, and language developmental outcomes associated with early CI (<12 months).

Impact of visual and auditory deprivation on speech perception and production in adults

Speech perception relies on auditory and visual cues and there are strong links between speech perception and production. We aimed to evaluate the role of auditory and visual modalities on speech perception and production in adults with impaired hearing or sight versus those with normal hearing and sight. We examined speech perception and production of three isolated vowels (/i/, /y/, /u/), which were selected based on their different auditory and visual perceptual saliencies, in 12 deaf adults who used one or two cochlear implants (CIs), 14 congenitally blind adults, and 16 adults with normal sight and hearing. The results showed that the deaf adults who used a CI had worse vowel identification and discrimination perception and they also produced vowels that were less typical or precise than other participants. They had different tongue positions in speech production, which possibly partly explains the poorer quality of their spoken vowels. Blind individuals had larger lip openings and smaller lip protrusions for the rounded vowel and unrounded vowels, compared to the other participants, but they still produced vowels that were similar to those produced by the adults with normal sight and hearing. In summary, the deaf adults, even though they used CIs, had greater difficulty in producing accurate vowel targets than the blind adults, whereas the blind adults were still able to produce accurate vowel targets, even though they used different articulatory strategies.

Cross-modal plasticity and central deficiencies: the case of deafness and the use of cochlear implants

The primary objective of this chapter is to describe the consequences of central deficiencies on the neurodevelopment of children. We approach this topic from the standpoint of congenital deafness. Thus we first present the current state of knowledge on cortical reorganization following congenital deafness. The allocation of auditory cortices to other sensory systems can enhance sensory processing and therefore the cognitive functions related to them. Second, we explore the linguistic development of deaf children. Given that the English written system is speech-based, its acquisition is complex and atypical for deaf children, usually leading to poorer achievements. Next, we explore the impact of a neural prosthesis named the cochlear implant on the neurocognitive and linguistic development of deaf children. In some cases, it allows the individuals to, at least partially, regain access to the lost sense. We also comment on the specific needs of the deaf population when it comes to neuropsychological assessment. Finally, we touch on the specific context of deaf children born of deaf parents, and therefore naturally exposed to sign language as the only means of communication.

Vowel duration measurement in school-age children with cochlear implant

OBJECTIVES

Normal hearing system is an essential factor for accurate production of speech segments. It seems that cochlear implant prosthesis helps children with hearing impairment to speak more accurately than before receiving prosthesis. The current research aimed to compare the vowel duration in school-aged children with cochlear implants and that in children with normal hearing. Additionally, the performance of girls and boys in two groups were investigated.

METHODS

A cross-sectional and descriptive-analytical study was carried out to compare the vowel duration in 9- to 12-year-old children with cochlear implant and those with normal hearing. Participants were 52 children who were matched by age and sex. We asked the children to read the target words with each word including one vowel and then participants' voice samples were recorded. Then, vowel duration was measured using Praat software. Finally, the vowel duration was compared between the two groups running independent sample t-test. The level of significance was (P < 0.05).

RESULTS

There was no statistically significant difference observed between the two groups in the mean values of the vowel duration for the six Persian vowels (P > 0.05). Also, no significant difference was found between boys and girls in the mean value of the vowel duration between the two groups (P > 0.05).

CONCLUSION

Persian vowels in school-aged children with cochlear implant and with typical hearing are produced with similar durations. This finding is probably related to the increased duration of using prosthesis in this age range and speech mode used to measure vowel duration in the present study.

Rhythmic Abilities of Children With Hearing Loss

OBJECTIVES

Children with hearing loss (HL), in spite of early cochlear implantation, often struggle considerably with language acquisition. Previous research has shown a benefit of rhythmic training on linguistic skills in children with HL, suggesting that improving rhythmic capacities could help attenuating language difficulties. However, little is known about general rhythmic skills of children with HL and how they relate to speech perception. The aim of this study is twofold: (1) to assess the abilities of children with HL in different rhythmic sensorimotor synchronization tasks compared to a normal-hearing control group and (2) to investigate a possible relation between sensorimotor synchronization abilities and speech perception abilities in children with HL.

DESIGN

A battery of sensorimotor synchronization tests with stimuli of varying acoustic and temporal complexity was used: a metronome, different musical excerpts, and complex rhythmic patterns. Synchronization abilities were assessed in 32 children (aged from 5 to 10 years) with a severe to profound HL mainly fitted with one or two cochlear implants (n = 28) or with hearing aids (n = 4). Working memory and sentence repetition abilities were also assessed. Performance was compared to an age-matched control group of 24 children with normal hearing. The comparison took into account variability in working memory capacities. For children with HL only, we computed linear regressions on speech, sensorimotor synchronization, and working memory abilities, including device-related variables such as onset of device use, type of device, and duration of use.

RESULTS

Compared to the normal-hearing group, children with HL performed poorly in all sensorimotor synchronization tasks, but the effect size was greater for complex as compared to simple stimuli. Group differences in working memory did not explain this result. Linear regression analysis revealed that working memory, synchronization to complex rhythms performances, age, and duration of device use predicted the number of correct syllables produced in a sentence repetition task.

CONCLUSION

Despite early cochlear implantation or hearing aid use, hearing impairment affects the quality of temporal processing of acoustic stimuli in congenitally deaf children. This deficit seems to be more severe with stimuli of increasing rhythmic complexity highlighting a difficulty in structuring sounds according to a temporal hierarchy.

Development of fricative production in French-speaking school-aged children using cochlear implants and children with normal hearing

In the course of productive phonological development, fricatives are among the last speech sounds to emerge and to be mastered by children, probably because of the high degree of articulatory precision they require or because of difficulties with their perception. Children with cochlear implants (CI) face additional difficulties with fricative perception, since high spectral frequency components are shown to be especially difficult to perceive with a cochlear implant. Studying fricative production in children with CIs allows to study how the partial transmission of speech sounds by cochlear implants influences children's speech production, and therefore to explore how perceptual abilities influence the late stages of phonological development. This acoustic study focuses on fricative production at three places of articulation (i.e., /f/, /s/ and /ʃ/), comparing productions by two groups of children (20 children with normal hearing (NH) vs. 13 children with CIs, all aged 5;7 to 10;7 years), and taking into account their consistency in coarticulation and the stability of their production across two different tasks (word-repetition and picture-naming). Statistical analyses were carried out by means of linear mixed-effect models. The results show that while both groups produce /ʃ/ with similar acoustic characteristics, between-group differences are found for /f/ and /s/. Furthermore, effects of consonant-vowel coarticulation are found for children with NH, and are absent for children with CIs. Effects of chronological age are only found for children with CIs (production in older children with CIs nearing that of children with NH). Our study shows that the development of fricative production of five- to 11-year-old children with CIs is affected by the children's hearing abilities and late access to auditory information. These limitations however do not prevent the children from eventually reaching a consistency similar to that of children with NH, as suggested by the fact that their production is still evolving during that age span. The results also show that the acquisition of coarticulation strategies can be impeded by degraded or delayed access to audio.

Long-term effects of cochlear implantation on the intelligibility of speech in French-speaking children

Our study compares the intelligibility of French-speaking children with a cochlear implant (N = 13) and age-matched children with typical hearing (N = 13) in a narrative task. This contrasts with previous studies in which speech intelligibility of children with cochlear implants is most often tested using repetition or reading tasks. Languages other than English are seldom considered. Their productions were graded by naive and expert listeners. The results show that (1) children with CIs have lower intelligibility, (2) early implantation is a predictor of good intelligibility, and (3) late implantation after two years of age does not prevent the children from eventually reaching good intelligibility.

Is the spontaneous speech of 7-year-old cochlear implanted children as intelligible as that of their normally hearing peers?

OBJECTIVES

Studies on speech intelligibility usually focus on either individual words, sentences or longer sequences of speech. Since these different kinds of speech samples can be judged using different methodologies, a difference in the reported intelligibility scores can either be due to the difference in the type of sample or methodology. The present study compares the speech intelligibility of seven-year-old children with a cochlear implant (CI) with that of their normally hearing (NH) peers. The first aim is to compare the intelligibility of short sentences and longer sequences of speech using the same methodology. Secondly, it has been suggested that i.a. advances in CI technology and changes in candidacy criteria may have had a positive influence on the intelligibility of children with CI. In order to assess this issue, the intelligibility of seven-year-olds implanted ten years apart will be compared.

METHOD

The speech of two cohorts of early implanted children with CI (n = 16) and NH peers (n = 16), matched on several criteria but implanted in different years, was collected. More specifically, short and longer samples were selected from recordings of a wordless picture book retelling. Both types of samples were judged on a visual analogue scale by 105 inexperienced listeners.

RESULTS

The results showed that the intelligibility of children with CI was lower than that of their NH peers. Moreover, longer samples were significantly more intelligible than short samples for both groups. No significant effect was found between the two cohorts of children with CI. However, the intelligibility of three out of four children with CI was found to be on a par with that of their NH peers, indicating a large amount of variability between subjects.

CONCLUSION

Listeners ascribed higher intelligibility to longer samples than to short samples, despite the fact that both types were extracted from the same recordings and listeners followed the same judgement procedure. The amount of context thus facilitated speech decoding. No effect of the calendar year of implantation was found, suggesting that e.g., the evolution in CI technology did not have a significant impact on CI users' intelligibility after six years of device use.

[General anesthesia influence on cochlear implant intraoperative testing]

In this article, we consider the influence of combined general anesthesia on the results of electrically-involved stapedial reflex threshold (esrt) registration. We pay a special attention to the anesthesia to exclude its influence on the esrt. This study included 52 patients with bilateral chronic neurosensory hearing impairment. We conducted a retrospective (from 2014 to 2016) and prospective (from 2017 to 2018) analysis of anesthesia protocols. Even though the inhaled anesthesia (sevoflurane in this case) has a depressive effect on esrt registration (the higher the minimal alveolar concentration of anesthetic agent, the higher the reflex threshold), our study shows a possibility of using it in an extended anesthesia monitoring. Inclusion of myorelaxants in cochlear implantation anesthesia protocol not only provides a safe anesthesia, but also does not prevent a timely intraoperative cochlear implant testing.

The influence of cochlear implantation on aggression behaviors in children

OBJECTIVE

It has been suggested that children with higher degree of hearing loss may show more severe externalizing (e.g., aggression) and internalizing (e.g., depression and anxiety) behavioral problems compared to that of their normally hearing peers. The purpose of this study was to investigate the influence of sound amplification through cochlear implants (CIs) on aggressive behaviors in Persian children.

METHODS

During a prospective study design, 72 children (40 girls, 32 boys) who underwent unilateral implantation and 72 (40 girls, 32 boys) age-matched normally hearing children (control group) participated. All CI children had age of <4 years at the time of implantation. The Aggression Scale for Preschoolers (ASFP) was utilized to measure various types of aggression including verbal aggression, physical aggression, relational aggression, and impulsive anger. The speech performance of children was also evaluated using Speech Intelligibility Rating (SIR). The ASFP and SIR measurements were conducted at the pre-implantation phase and at 6, 12, and 18 months post-implantation period.

RESULTS

A repeated measures analysis of variance showed significant reduction in ASFP scores from "pre-operation" to "post-operative" conditions in CI group. However, aggression level in CI recipients were significantly higher than children in control group. In the analyses of ASFP subscales, we found a reduction and a consequent improvement in verbal aggression, physical aggression and impulsive anger. However, no significant difference was found in relational aggression across various time intervals. Furthermore, children who received CI before 2 years old exhibited better aggression level than children who received their devices at later ages. The significantly negative correlation (r = -0.76, p < 0.001) was found between the SIR and ASFP scores, so that lower speech intelligibity ability scores were associated with more aggressive behavior problems.

CONCLUSION

This study suggests that young children with noticeable degree of hearing loss may experience higher level of aggression compared to normally hearing peers. However, when they undergo early implantation and attend at regular post-operative rehabilitation programs, their aggression status will improve seriously.

Vowel intelligibility in children with cochlear implants: An acoustic and articulatory study

In child cochlear implant (CI) users, early implantation generally results in highly intelligible speech. However, for some children developing a high level of speech intelligibility may be problematic. Studies of speech production in CI users have principally been based on perceptual judgment and acoustic measures. Articulatory measures, such as those collected using ultrasound provide the opportunity to more precisely evaluate what makes child CI users more intelligible. This study investigates speech production and intelligibility in children with CI using acoustic and articulatory measures. Ten children with unilateral or bilateral CIs and 13 children with normal hearing (NH) participated in the study. Participants repeated five English vowels (/a/, /e/, /i/, /o/, /u/) with and without auditory feedback. Ultrasound was used to capture tongue positions and acoustic signals were recorded simultaneously. The results showed that, despite quite similar acoustic results, the two speaker groups made different use of the tongue to implement vowel contrasts. Indeed, the tongue position was lower in the feedback OFF condition than the feedback ON condition for all participants, but the magnitude of this difference was larger for CI users than for their NH peers. This difference led to diminished intelligibility scores for CI users. This study shows the limitation of acoustic measurements alone and demonstrates how the use of articulatory measurements can explain intelligibility patterns. Moreover, our results show that when cochlear implantation occurs early in life and auditory feedback is available, CI users' intelligibility is comparable to that of their NH peers.

Speech Intelligibility and Psychosocial Functioning in Deaf Children and Teens with Cochlear Implants

Deaf children with cochlear implants (CIs) are at risk for psychosocial adjustment problems, possibly due to delayed speech-language skills. This study investigated associations between a core component of spoken-language ability-speech intelligibility-and the psychosocial development of prelingually deaf CI users. Audio-transcription measures of speech intelligibility and parent reports of psychosocial behaviors were obtained for two age groups (preschool, school-age/teen). CI users in both age groups scored more poorly than typically hearing peers on speech intelligibility and several psychosocial scales. Among preschool CI users, five scales were correlated with speech intelligibility: functional communication, attention problems, atypicality, withdrawal, and adaptability. These scales and four additional scales were correlated with speech intelligibility among school-age/teen CI users: leadership, activities of daily living, anxiety, and depression. Results suggest that speech intelligibility may be an important contributing factor underlying several domains of psychosocial functioning in children and teens with CIs, particularly involving socialization, communication, and emotional adjustment.

Vowel production of Mandarin-speaking hearing aid users with different types of hearing loss

In contrast with previous research focusing on cochlear implants, this study examined the speech performance of hearing aid users with conductive (n = 11), mixed (n = 10), and sensorineural hearing loss (n = 7) and compared it with the speech of hearing control. Speech intelligibility was evaluated by computing the vowel space area defined by the Mandarin Chinese corner vowels /a, u, i/. The acoustic differences between the vowels were assessed using the Euclidean distance. The results revealed that both the conductive and mixed hearing loss groups exhibited a reduced vowel working space, but no significant difference was found between the sensorineural hearing loss and normal hearing groups. An analysis using the Euclidean distance further showed that the compression of vowel space area in conductive hearing loss can be attributed to the substantial lowering of the second formant of /i/. The differences in vowel production between groups are discussed in terms of the occlusion effect and the signal transmission media of various hearing devices.

Sensorimotor interaction in deaf children. Relationship between gait performance and hearing input during childhood assessed in pre-lingual cochlear implant users

CONCLUSIONS

The results suggest that auditory input is not neutral in motor skills and the complex interaction between them is generated in the earlier stages of childhood development. Objective The assessment of gait performance in pre-lingual deaf children with cochlear implant (CI).

METHODS

Gait velocity (GV), using a 10-meter test, was measured by means of three inertial sensors in 10 pre-lingual cochlear implant users (CIU) (10-16 years old) in three sensory conditions: (1) cochlear implant turned on with environmental noise (EN), (2) cochlear implant turned on with EN and with cognitive dual task (DT), and (3) CI turned off (CI-OFF). GV with EN and DT was assessed in a normal hearing control group (CG) (n = 14). Mann-Whitney and Wilcoxon Signed ranked test were used for significance validation.

RESULTS

(1) GV in CG was lower in DT than with EN (p = .019). (2) GV was faster in CG with EN compared with the three conditions in CIU (EN, p = .006; DT, p = .0001; CI-OFF, p = .03). (3) CIU had slower GV walking with EN (p = .037) and with DT (p = .022). (4) Dividing the CIU sample by age, the acoustic information generates a slower gait for those implanted after 3 years old.

Speech Intelligibility in Persian Hearing Impaired Children with Cochlear Implants and Hearing Aids

The aim of present study is to evaluate and compare speech intelligibility in hearing impaired children with cochlear implants (CI) and hearing aid (HA) users and children with normal hearing (NH). The sample consisted of 45 Persian-speaking children aged 3 to 5-years-old. They were divided into three groups, and each group had 15, children, children with CI and children using hearing aids in Hamadan. Participants was evaluated by the test of speech intelligibility level. Results of ANOVA on speech intelligibility test showed that NH children had significantly better reading performance than hearing impaired children with CI and HA. Post-hoc analysis, using Scheffe test, indicated that the mean score of speech intelligibility of normal children was higher than the HA and CI groups; but the difference was not significant between mean of speech intelligibility in children with hearing loss that use cochlear implant and those using HA. It is clear that even with remarkabkle advances in HA technology, many hearing impaired children continue to find speech production a challenging problem. Given that speech intelligibility is a key element in proper communication and social interaction, consequently, educational and rehabilitation programs are essential to improve speech intelligibility of children with hearing loss.

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.

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.

Information theoretic evaluation of a noiseband-based cochlear implant simulator

Noise-band vocoders are often used to simulate the signal processing algorithms used in cochlear implants (CIs), producing acoustic stimuli that may be presented to normal hearing (NH) subjects. Such evaluations may obviate the heterogeneity of CI user populations, achieving greater experimental control than when testing on CI subjects. However, it remains an open question whether advancements in algorithms developed on NH subjects using a simulator will necessarily improve performance in CI users. This study assessed the similarity in vowel identification of CI subjects and NH subjects using an 8-channel noise-band vocoder simulator configured to match input and output frequencies or to mimic output after a basalward shift of input frequencies. Under each stimulus condition, NH subjects performed the task both with and without feedback/training. Similarity of NH subjects to CI users was evaluated using correct identification rates and information theoretic approaches. Feedback/training produced higher rates of correct identification, as expected, but also resulted in error patterns that were closer to those of the CI users. Further evaluation remains necessary to determine how patterns of confusion at the token level are affected by the various parameters in CI simulators, providing insight into how a true CI simulation may be developed to facilitate more rapid prototyping and testing of novel CI signal processing and electrical stimulation strategies.

Speech Intelligibility of Cochlear-Implanted and Normal-Hearing Children

INTRODUCTION

Speech intelligibility, the ability to be understood verbally by listeners, is the gold standard for assessing the effectiveness of cochlear implantation. Thus, the goal of this study was to compare the speech intelligibility between normal-hearing and cochlear-implanted children using the Persian intelligibility test.

MATERIALS AND METHODS

Twenty-six cochlear-implanted children aged 48-95 months, who had been exposed to 95-100 speech therapy sessions, were compared with 40 normal-hearing children aged 48-84 months. The average post-implanted time was 14.53 months. Speech intelligibility was assessed using the Persian sentence speech intelligibility test.

RESULTS

The mean score of the speech intelligibility test among cochlear-implanted children was 63.71% (standard deviation [SD], 1.06) compared with 100% intelligible among all normal-hearing children (P<0.000). No effects of age or gender on speech intelligibility were observed in these two groups at this range of ages (P>0.05).

CONCLUSION

Speech intelligibility in the Persian language was poorer in cochlear-implanted children in comparison with normal-hearing children. The differences in speech intelligibility between cochlear-implanted and normal-hearing children can be shown through the Persian sentence speech intelligibility test.

Factors influencing speech and language outcomes of children with early identified severe/profound hearing loss: Clinician-identified facilitators and barriers

PURPOSE

Early identification of severe/profound childhood hearing loss (HL) gives these children access to hearing devices and early intervention to facilitate improved speech and language outcomes. Predicting which infants will go on to achieve such outcomes remains difficult. This study describes clinician identified malleable and non-malleable factors that may influence speech and language outcomes for children with severe/profound HL.

METHOD

Semi-structured interviews were conducted with six experienced auditory verbal clinicians. A collective case study design was implemented. The interviews were transcribed and coded into themes using constant comparative analysis.

RESULT

Clinicians identified that, for children with severe/profound HL, early identification, early amplification and commencing auditory-verbal intervention under 6 months of age may facilitate child progress. Possible barriers were living in rural/remote areas, the clinicians' lack of experience and confidence in providing intervention for infants under age 6-months and belonging to a family with a culturally and linguistically diverse (CALD) background.

CONCLUSION

The results indicate that multiple factors need to be considered by clinicians working with children with HL and their families to determine how each child functions within their own environment and personal contexts, consistent with the International Classification of Functioning, Disability and Health (ICF) framework. Such an approach is likely to empower clinicians to carefully balance potential barriers to, and facilitators of, optimal speech and language outcomes for all children with HL.

Speech intelligibility in deaf children after long-term cochlear implant use

PURPOSE

This study investigated long-term speech intelligibility outcomes in 63 prelingually deaf children, adolescents, and young adults who received cochlear implants (CIs) before age 7 (M = 2;11 [years;months], range = 0;8-6;3) and used their implants for at least 7 years (M = 12;1, range = 7;0-22;5).

METHOD

Speech intelligibility was assessed using playback methods with naïve, normal-hearing listeners.

RESULTS

Mean intelligibility scores were lower than scores obtained from an age- and nonverbal IQ-matched, normal-hearing control sample, although the majority of CI users scored within the range of the control sample. Our sample allowed us to investigate the contribution of several demographic and cognitive factors to speech intelligibility. CI users who used their implant for longer periods of time exhibited poorer speech intelligibility scores. Crucially, results from a hierarchical regression model suggested that this difference was due to more conservative candidacy criteria in CI users with more years of use. No other demographic variables accounted for significant variance in speech intelligibility scores beyond age of implantation and amount of spoken language experience (assessed by communication mode and family income measures).

CONCLUSION

Many factors that have been found to contribute to individual differences in language outcomes in normal-hearing children also contribute to long-term CI users' ability to produce intelligible speech.

Perioperative complications of cochlear implant surgery in children

Cochlear implant is a commonly performed surgery for hearing loss in pre-school and school children. However, data on anesthesia management and anesthesia-related complications are sparse. We retrospectively reviewed the data of our institute from January, 2007 to December, 2012. Medical records and anesthesia charts of all the patients who had undergone cochlear implant under general anesthesia between this period were reviewed. Information related to the demographic profile, preoperative evaluation, anesthetic techniques, and perioperative complications were collected and analyzed. A total of 190 patients underwent cochlear implant surgery for pre-lingual (175) and post-lingual (15) deafness. General endotracheal anesthesia with inhalational agents was used in all the cases. Difficult intubation was encountered in three patients. Anesthesia-related complications were laryngospasm at extubation (4.73 %), emergence agitation (2.63 %), and postoperative nausea and vomiting (1.05 %). Major surgical complications were CSF leak without meningitis (3.15 %), device migration/failure (1.05 %), and flap infection (1.57 %). Cochlear implant under general anesthesia in small children is safe and anesthesia-related complications were minimal. Surgical complications, although more frequent, were predominantly minor and self-limiting.

Proximate factors associated with speech intelligibility in children with cochlear implants: A preliminary study

The purpose of this descriptive pilot study was to examine possible relationships among speech intelligibility and structural characteristics of speech in children who use cochlear implants. The Beginners Intelligibility Test (BIT) was administered to 10 children with cochlear implants, and the intelligibility of the words in the sentences was judged by panels of naïve adult listeners. Additionally, several qualitative and quantitative measures of word omission, segment correctness, duration, and intonation variability were applied to the sentences used to assess intelligibility. Correlational analyses were conducted to determine if BIT scores and the other speech parameters were related. There was a significant correlation between BIT score and percent words omitted, but no other variables correlated significantly with BIT score. The correlation between intelligibility and word omission may be task-specific as well as reflective of memory limitations.

Auditory performance and speech intelligibility of Mandarin-speaking children implanted before age 5

OBJECTIVES

(1) To report the auditory performance and speech intelligibility of 84 Mandarin-speaking prelingually deaf children after using cochlear implants (CIs) for one, two, three, four, and five years to understand how many years of implant use were needed for them to reach a plateau-level performance; (2) to investigate the relation between subjective rating scales and objective measurements (i.e., speech perception tests); (3) to understand the effect of age at implantation on auditory and speech development.

METHODS

Eighty-four children with CIs participated in this study. Their auditory performance and speech intelligibility were rated using the Categorical Auditory Performance (CAP) and the Speech Intelligibility Rating (SIR) scales, respectively. The evaluations were made before implantation and six months, one, two, three, four, and five years after implantation. At the fifth year after implantation, monosyllabic-word, easy-sentence, and difficult-sentence perception tests were administered.

RESULTS

The median CAP score reached a plateau at category 6 after three years of implant use. The median SIR arrived at the highest level after five years of use. With five years of CI experiences, 86% of the subjects understood conversation without lip-reading, and 58% were fully intelligible to all listeners. The three speech perception tests had a moderate-to-strong correlation with the CAP and SIR scores. The children implanted before the age of three years had significantly better CAP and monosyllabic word perception test scores.

CONCLUSIONS

Five years of follow-up are needed for assessing the post-implantation development of communication ability of prelingually deafened children. It is recommended that hearing-impaired children receive cochlear implantation at a younger age to acquire better auditory ability for developing language skills. Constant postoperative aural-verbal rehabilitation and speech and language therapy are most likely required for the patients to reach the highest level on the CAP and SIR scales.

Infant hearing loss: from diagnosis to therapy Official Report of XXI Conference of Italian Society of Pediatric Otorhinolaryngology

Hearing loss is one of the most common disabilities and has lifelong consequences for affected children and their families. Both conductive and sensorineural hearing loss (SNHL) may be caused by a wide variety of congenital and acquired factors. Its early detection, together with appropriate intervention, is critical to speech, language and cognitive development in hearing-impaired children. In the last two decades, the application of universal neonatal hearing screening has improved identification of hearing loss early in life and facilitates early intervention. Developments in molecular medicine, genetics and neuroscience have improved the aetiological classification of hearing loss. Once deafness is established, a systematic approach to determining the cause is best undertaken within a dedicated multidisciplinary setting. This review addresses the innovative evidences on aetiology and management of deafness in children, including universal neonatal screening, advances in genetic diagnosis and the contribution of neuroimaging. Finally, therapy remains a major challenge in management of paediatric SNHL. Current approaches are represented by hearing aids and cochlear implants. However, recent advances in basic medicine which are identifying the mechanisms of cochlear damage and defective genes causing deafness, may represent the basis for novel therapeutic targets including implantable devices, auditory brainstem implants and cell therapy.

Listen up: children with early identified hearing loss achieve age-appropriate speech/language outcomes by 3 years-of-age

OBJECTIVES

Age-appropriate speech/language outcomes for children with early identified hearing loss are a possibility but not a certainty. Identification of children most likely to achieve optimal outcomes is complicated by the heterogeneity of the children involved in outcome research, who present with a range of malleable (e.g. age of identification and cochlear implantation, type of intervention, communication mode) and non-malleable (e.g. degree of hearing loss) factors. This study considered whether a homogenous cohort of early identified children (≤ 12 months), with all severities of hearing loss and no other concomitant diagnoses could not only significantly outperform a similarly homogenous cohort of children who were later identified (>12 months to <5 years), but also achieve and maintain age-appropriate speech/language outcomes by 3, 4 and 5 years of age.

METHODS

A mixed prospective/retrospective comparative study of a homogenous cohort of 45 early identified (≤ 12 months) and 49 late identified (> 12 months to < 5 years) children with hearing loss was conducted. The children all attended the same oral auditory-verbal early intervention programme. Speech/language assessments standardized on typically developing hearing children were conducted at 3, 4 and 5 years of age.

RESULTS

The early identified children significantly outperformed the late identified at all ages and for all severities of HL. By 3 years of age, 93% of all early identified participants scored within normal limits (WNL) for speech; 90% were WNL for understanding vocabulary; and 95% were WNL for receptive and expressive language. Progress was maintained and improved so that by 5 years of age, 96% were WNL for speech, with 100% WNL for language.

CONCLUSIONS

This study found that most children with all severities of hearing loss and no other concomitant diagnosed condition, who were early diagnosed; received amplification by 3 months; enrolled into AV intervention by 6 months and received a cochlear implant by 18 months if required, were able to "keep up with" rather than "catch up to" their typically hearing peers by 3 years of age on measures of speech and language, including children with profound hearing loss. By 5 years, all children achieved typical language development and 96% typical speech.

Defining and evaluating success in paediatric cochlear implantation--an exploratory study

OBJECTIVES

This work is a preliminary study that sought to investigate and develop a method for defining and evaluating "success" in paediatric cochlear implantation (PCI) and to apply a process by which a clinical team could optimally achieve this aim.

METHODS

A pilot group of 25 profoundly deaf children who received a unilateral cochlear implant from 1995 to 2008 was used to develop the process. The cases displayed features that are commonly encountered in PCI. Individual case records were examined retrospectively for adverse factors that might impact on the implantation outcome with particular reference to the probability and severity of impact of each factor. Case prognosis was then rated on a 1-4 basis (1: excellent, 2: good, 3: fair, 4: poor). The subsequent outcomes were assessed using standardised speech (GFW, DEAP), language (PLS-4; CELF) and vocabulary (PPVT; EVT) assessments. Auditory performance outcomes were assessed using a new Categories of Auditory Performance Index (CAPI) that incorporated criteria, testing and scoring aspects. Family issues were also evaluated. Case outcomes were rated 1-4 as above and the prognoses and outcomes were then compared.

RESULTS

Accurate prognostication was seen in 14 cases, 5 had better outcomes than expected and 6 obtained poorer results. "Success", where the outcome equalled or exceeded the prognosis, occurred in 19 (76%) of cases. The successful group contained some "limited gains" cases where the results were nonetheless in line with expectations and parental satisfaction. The detrimental effect of delayed implantation was evident; Connexin 26 (GJB2) mutation had little influence. Poor general medical condition and adverse family situations commonly produced poorer outcomes.

CONCLUSIONS

Success in PCI is achieved when the outcome matches or exceeds the pre-operative expectations of the well-counselled family, without adverse side effects. The assessments achieved a good success rate, but further research is required to clearly identify potential problems and a skilled team is needed to evaluate their risk to the PCI outcome. Unforseen events may also intervene. Currently, differing outcome evaluation techniques impede comparison of studies, particularly in the speech and hearing domains. Rationalisation of these is recommended to facilitate future research.

Current and planned cochlear implant research at New York University Laboratory for Translational Auditory Research

The Laboratory of Translational Auditory Research (LTAR/NYUSM) is part of the Department of Otolaryngology at the New York University School of Medicine and has close ties to the New York University Cochlear Implant Center. LTAR investigators have expertise in multiple related disciplines including speech and hearing science, audiology, engineering, and physiology. The lines of research in the laboratory deal mostly with speech perception by hearing impaired listeners, and particularly those who use cochlear implants (CIs) or hearing aids (HAs). Although the laboratory's research interests are diverse, there are common threads that permeate and tie all of its work. In particular, a strong interest in translational research underlies even the most basic studies carried out in the laboratory. Another important element is the development of engineering and computational tools, which range from mathematical models of speech perception to software and hardware that bypass clinical speech processors and stimulate cochlear implants directly, to novel ways of analyzing clinical outcomes data. If the appropriate tool to conduct an important experiment does not exist, we may work to develop it, either in house or in collaboration with academic or industrial partners. Another notable characteristic of the laboratory is its interdisciplinary nature where, for example, an audiologist and an engineer might work closely to develop an approach that would not have been feasible if each had worked singly on the project. Similarly, investigators with expertise in hearing aids and cochlear implants might join forces to study how human listeners integrate information provided by a CI and a HA. The following pages provide a flavor of the diversity and the commonalities of our research interests.

Effects of parents' level of education and economic status on the age at cochlear implantation in children

INTRODUCTION

Cochlear implantation can facilitate the development of communication skills in children with profound hearing loss. The objectives of our study were to determine the average ages at suspicion and diagnosis of hearing loss, amplification, intervention, and performing the cochlear implantation and to investigate the effects of the parents' level of education and economic circumstances on the age of the child at cochlear implantation.

MATERIALS AND METHODS

The parents of 96 children with profound sensorineural hearing loss who had received a cochlear implant at Amir-Alam Cochlear Implant Center between 2008 and 2010 were asked to complete a survey. The survey included demographic information, and birth, medical, and hearing loss history of their child. Study data were obtained through the patient database in the Cochlear Implant Center and interviews with the parents.

RESULTS

The mean times between the age of the children at diagnosis of hearing loss and amplification, beginning the rehabilitation program, and performing the cochlear implantation were 4.05 (±0.86), 2.59 (±0.9), and 25.43 (±1.45) months, respectively; delays that were statistically significant (P≤0.004). In 47.9 percent of cases, the parents were the first people to suspect the occurrence of hearing loss in their child. Statistical analysis indicated that the age at cochlear implantation decreases as the educational level of the parents increases (P≤0.003). There was also a significant difference between parents' economic circumstances and the age of cochlear implantation (P<0.0001).

CONCLUSION

There is still a remarkable delay between the diagnosis of hearing loss and aural rehabilitation in hearing-impaired children. Parents' levels of education and economic circumstances have a noticeable effect on the age of cochlear implantation in hearing-impaired children.

Anesthetic complications in pediatric patients undergoing cochlear implantation

OBJECTIVES/HYPOTHESIS

Cochlear implantation (CI) is effective in the treatment of childhood sensorineural hearing loss and is associated with minimal surgical complications. We investigated the incidence of anesthetic complications in young patients undergoing general anesthesia for CI.

STUDY DESIGN

Retrospective chart review.

METHODS

A retrospective chart review of 123 patients younger than 18 years, who underwent CI between 2007 and 2008, was conducted for identification of intra- and postoperative anesthesia-related complications. The relation of collected variable to the complication events was analyzed using logistic regression.

RESULTS

Of the 123 CI procedures, eight patients had nine anesthesia-related complications, yielding a complication rate of 6.5% and included the following: postoperative wheezing/stridor (5 cases), laryngospasm (3 cases), and emesis during inhalational induction (1 case). Divided by age group, 12 patients were <12 months with one complication (8%), 18 patients were between 1 and 2 years with one complication (5.6%), 35 patients were between 2 and 5 years with one complication (3%), 39 patients were between 5 and 12 years with five complications (13%), and 19 patients were older than 12 years with no complication (0%). Logistic regression failed to identify a significant association of any collected variable(s) with the observed complications. The incidence of complications is similar to that previously reported in elderly patients (4.3%) (Pearson χ(2) , P = .523).

CONCLUSIONS

General anesthesia is well tolerated by pediatric patients undergoing CI, even under 1 year of age. Significant perioperative complications are primarily respiratory, are usually free of long-term sequelae, and occur with an incidence similar to other reported age groups.

A new measurement tool for speech development based on Ling's stages of speech acquisition in pediatric cochlear implant recipients

OBJECTIVES

With the rapid increase of pediatric cochlear implantation (CI), there exists a need for a standardized assessment tool regarding speech and communication skills in children with CI. However, the current testing tools are not appropriate for the longitudinal evaluation of young children after CI. The aims of this study were to describe a progressive testing tool developed for the evaluation of speech acquisition and production in young children who have undergone CI and to examine its validity.

METHODS

Sixty children younger than six years of age with CI participated in this study. A Korean version of Ling's stages (K-Ling) was developed based on the Ling speech teaching model to longitudinally assess phonologic and phonetic developments in young children after CI. The K-Ling, the Categories of Auditory Performance (CAP), and the Sequenced Language Scale for Infants (SELSI) were performed in the children with CI preoperatively and three, six, and 12 months postoperatively. Correlations among these three testing tools were analyzed.

RESULTS

Auditory, language, and speech skills assessed using the CAP, SELSI, and K-Ling improved continuously for 12 months in young children following CI. Strong correlations were obtained among K-Ling's level, CAP scores, and the equivalent age of SELSI; correlation indices ranged from 0.540 to 0.800.

CONCLUSIONS

The K-Ling was a valid evaluation tool regarding speech development in young children who are using CI and who are in the early stages of speech development. Longitudinal assessments of phonetic and phonologic developments may be attainable in young children using the K-Ling.