Bilateral cochlear implantation versus unilateral cochlear implantation in deaf children: Effects of sentence context and listening conditions on recognition of spoken words in sentences

Quality of Life and Audiological Benefits in Pediatric Cochlear Implant Users in Romania: Systematic Review and Cohort Study

Profound sensorineural hearing loss (SNHL) can be successfully treated with a cochlear implant (CI), and treatment is usually accompanied by increased quality of life (QoL). Therefore, the aim of this study was to investigate generic and health-related QoL, as well as the level of audiological outcomes, of CI users, in addition to whether Qol can be restored to the extent of those with normal hearing. Furthermore, different implantation timepoints were compared (early vs. late), and a possible correlation between health and generic QoL questionnaires was investigated. The outcomes from 93 pediatric CI users from Romania were analyzed in the study. Two QoL questionnaires (SSQ12, AQoL-6D), as well as the HSM sentence test and Soundfield measurements, were assessed. The outcomes revealed that the CI users were able to achieve the same QoL as their age- and-gender matched peers with normal hearing, and hearing was restored with good speech comprehension. No significant difference between early- and late-implanted children was detected, although a tendency of a better Word Recognition Score (+10%) in the early-implanted group was discovered. A moderate and significant correlation between the generic and health-related Qol questionnaire was observed. Audiological examinations are still the standard practice by which to measure the benefit of any hearing intervention; nonetheless, generic and health-related QoL should be assessed in order to provide a full picture of a successful and patient-satisfactory cochlear implant procedure.

Neurobehavioral effects of general anesthesia and cochlear implantation on hearing-impaired infants: A prospective observational cohort study

INTRODUCTION

The potential adverse effects of prolonged exposure to anesthetics in pediatric patients with severe-to-profound sensorineural hearing loss remain unclear. This study aimed to examine whether early bilateral cochlear implantation involving long-duration anesthetic exposure caused greater developmental impairment than that with unilateral cochlear implantation.

METHODS

This prospective observational study included normally developing infants with bilateral severe-to-profound sensorineural hearing loss aged 6 months to 2 years who were candidates for unilateral/bilateral cochlear implantation surgery. Baseline (T0), 6-month (T1), and 1-year (T2) Gesell Scale scores were measured. The outcomes included fine motor, adaptability, gross motor, language, and social skills scale 6 and 12 months postoperatively.

RESULT

The 90 enrolled children with bilateral severe-to-profound sensorineural hearing loss (unilateral n = 43; bilateral n = 47) had a younger bilateral group (11.00 ± 3.66 vs. 15.63 ± 6.99 months, p < .001). Anesthesia duration was longer in the bilateral group (271.57 ± 36.09 vs. 148.81 ± 25.60 min, p < .001). Gross motor, fine motor, adaptability, and language scores improved in both groups, and no significant between-group differences occurred in the fine motor scale at T1 and T2. Language developmental quotients improved significantly in the bilateral group compared with the unilateral group at T1 (mean differences: 25.07 ± 4.37 vs. 10.88 ± 4.61, p < .001) and T2 (mean differences: 34.98 ± 5.94 vs. 15.28 ± 6.55, p < .001). Stepwise regression revealed that gross motor, adaptability, language, and social skill developmental quotients at T1 were positively correlated with those at T0. Gross motor, fine motor, and social skill developmental quotients at T2 were negatively correlated with age at operation. Language developmental quotients were positively correlated with T0 values (p < .001) and in the bilateral group (p < .001) at T1 and T2.

CONCLUSIONS

When evaluating young children with bilateral severe-to-profound sensorineural hearing loss, despite longer exposures to general anesthesia, bilateral cochlear implantations were associated with more improvement in language scores and no differences in other skills compared with those with only unilateral implantation.

Bilateral simultaneous cochlear implantation is a safe method of hearing rehabilitation in adults

PURPOSE

Bilateral cochlear implantation is an effective treatment for patients with bilateral profound hearing loss. In contrast to children, adults mostly choose a sequential surgery. This study addresses whether simultaneous bilateral CI is associated with higher rates of complications compared to sequential implantation.

METHODS

169 bilateral CI surgeries were analyzed retrospectively. 34 of the patients were implanted simultaneously (group 1), whereas 135 patients were implanted sequentially (group 2). The duration of surgery, the incidence of minor and major complications and the duration of hospitalization of both groups were compared.

RESULTS

In group 1, the total operating room time was significantly shorter. The incidences of minor and major surgical complications showed no statistically significant differences. A fatal non-surgical complication in group 1 was particularly extensively reappraised without evidence of a causal relationship to the chosen mode of care. The duration of hospitalization was 0.7 days longer than in unilateral implantation but 2.8 days shorter than the combined two hospital stays in group 2.

CONCLUSION

In the synopsis of all considered complications and complication-relevant factors, equivalence of simultaneous and sequential cochlear implantation in adults in terms of safety was found. However, potential side effects related to longer surgical time in simultaneous surgery must be considered individually. Careful patient selection with special consideration to existing comorbidities and preoperative anesthesiologic evaluation is essential.

Use of Virtual Reality-Based Games to Improve Balance and Gait of Children and Adolescents with Sensorineural Hearing Loss: A Systematic Review and Meta-Analysis

BACKGROUND

Children and adolescents with sensorineural hearing loss (SNHL) often experience motor skill disturbances, particularly in balance and gait, due to potential vestibular dysfunctions resulting from inner ear damage. Consequently, several studies have proposed the use of virtual reality-based games as a technological resource for therapeutic purposes, aiming to improve the balance and gait of this population.

OBJECTIVE

The objective of this systematic review is to evaluate the quality of evidence derived from randomized or quasi-randomized controlled trials that employed virtual reality-based games to enhance the balance and/or gait of children and adolescents with SNHL.

METHODS

A comprehensive search was conducted across nine databases, encompassing articles published in any language until 1 July 2023. The following inclusion criteria were applied: randomized or quasi-randomized controlled trials involving volunteers from both groups with a clinical diagnosis of bilateral SNHL, aged 6-19 years, devoid of physical, cognitive, or neurological deficits other than vestibular dysfunction, and utilizing virtual reality-based games as an intervention to improve balance and/or gait outcomes.

RESULTS

Initially, a total of 5984 articles were identified through the searches. Following the removal of duplicates and screening of titles and abstracts, eight studies remained for full reading, out of which three trials met the eligibility criteria for this systematic review. The included trials exhibited a very low quality of evidence concerning the balance outcome, and none of the trials evaluated gait. The meta-analysis did not reveal significant differences in balance improvement between the use of traditional balance exercises and virtual reality-based games for adolescents with SNHL (effect size: -0.48; [CI: -1.54 to 0.57]; p = 0.37; I² = 0%).

CONCLUSION

Virtual reality-based games show promise as a potential technology to be included among the therapeutic options for rehabilitating the balance of children and adolescents with SNHL. However, given the methodological limitations of the trials and the overall low quality of evidence currently available on this topic, caution should be exercised when interpreting the results of the trials analyzed in this systematic review.

School adjustment of adolescents with sequential bilateral cochlear implants in mainstream school

OBJECTIVES

Little is known about the school adjustment of adolescents with sequential bilateral cochlear implants (CIs) in mainstream educational settings. This study aims to investigate the school adjustment of adolescents with sequential bilateral CIs, in comparison to those of age-matched adolescents with typical hearing (TH), to explore the relationships between individual variables and school adjustment in the bilateral CI group, and to assess the factors leading to strong school adjustment in the bilateral CI group.

METHODS

Twenty-five adolescents with sequential bilateral CIs and 30 adolescents with TH, aged 13-19 years, participated in this study. The adolescents completed the school adjustment scale (SAS).

RESULTS

The two groups were not significantly different on overall SAS scores. However, the TH group scored higher on the SAS than the sequential bilateral CI group with regard to communication skills and relationships with peers. In the bilateral CI group, SAS scores significantly correlated with open-set sentence and receptive vocabulary scores. Receptive vocabulary scores were a significant predictive factor for the level of school adjustment for the bilateral CI group.

CONCLUSION

Adolescents who received sequential bilateral CIs adapted well to mainstream schools. However, they did experience barriers to communication and to make friends in mainstream schools, and their level of school adjustment was affected by their receptive vocabulary skills.

Effects of Sequential Bilateral Cochlear Implantation in Children: Evidence from Speech-Evoked Cortical Potentials and Tests of Speech Perception

INTRODUCTION

Benefits of bilateral cochlear implants (CI) may be compromised by delays to implantation of either ear. This study aimed to evaluate the effects of sequential bilateral CI use in children who received their first CI at young ages, using a clinical set-up.

METHODS

One-channel cortical auditory evoked potentials and speech perception in quiet and noise were evoked at repeated times (0, 3, 6, 12 months of bilateral CI use) by unilateral and bilateral stimulation in 28 children with early-onset deafness. These children were unilaterally implanted before 3.69 years of age (mean ± SD of 1.98 ± 0.73 years) and received a second CI after 5.13 ± 2.37 years of unilateral CI use. Comparisons between unilaterally evoked responses were used to measure asymmetric function between the ears and comparisons between bilateral responses and each unilateral response were used to measure the bilateral benefit.

RESULTS

Chronic bilateral CI promoted changes in cortical auditory responses and speech perception performance; however, large asymmetries were present between the two unilateral responses despite ongoing bilateral CI use. Persistent cortical differences between the two sides at 1 year of bilateral stimulation were predicted by increasing age at the first surgery and inter-implant delay. Larger asymmetries in speech perception occurred with longer inter-implant delays. Bilateral responses were more similar to the unilateral responses from the first rather than the second CI.

CONCLUSION

These findings are consistent with the development of the aural preference syndrome and reinforce the importance of providing bilateral CIs simultaneously or sequentially with very short delays.

Benefit of Bilateral Cochlear Implantation on Phonological Processing Skills in Deaf Children

HYPOTHESIS

Children with bilateral cochlear implants (CIs) would have better phonological processing skills than children with unilateral CIs because those with bilateral CIs have better speech perception abilities in noisy environments and higher levels of central auditory system development than those with unilateral CIs.

BACKGROUND

Previous studies have focused on the performance of children with bilateral CIs on standardized clinical assessments. However, these tests are not sufficiently sensitive to explain better speech and language outcomes in children with bilateral CIs than children with unilateral CIs. Thus, this study focused on phonological processing skills at more central levels of analysis that reflect the operation of cognitive processes.

METHOD

Twenty children with bilateral CIs and 20 children with unilateral CIs, aged 4 to 6 years, participated in this study. The children completed the experience-dependent tasks and phonological processing tasks. The experience-dependent tasks involved the monosyllabic word, articulation, and receptive vocabulary tests. The phonological processing tasks involved the phonological awareness, phonological memory, and rapid automatic naming tasks. Task performance was compared between the unilateral and bilateral CI groups.

RESULTS

Children with unilateral CIs performed similarly to children with bilateral CIs on all three experience-dependent tasks. However, children with bilateral CIs significantly outperformed children with unilateral CIs on all three phonological processing tasks. Among the phonological processing tasks, the rapid automatic naming task scores differentiated children with unilateral CIs from children with bilateral CIs.

CONCLUSIONS

Bilateral cochlear implantation may positively impact the phonological processing skills of deaf children.

Effect of unilateral cochlear implant use on contralateral electrically evoked auditory brainstem responses to round window membrane electrical stimulation

BACKGROUND

Long-term use of a unilateral cochlear implant (CI) may lead to abnormal development of contralateral auditory pathway.

OBJECTIVES

To investigate the usefulness of measuring the electrically evoked auditory brainstem response (eABR) with the electrical stimulation at the round window membrane and the effect of unilateral CI use on the contralateral auditory pathway functions.

MATERIALS AND METHODS

According to duration of unilateral CI use, 45 children with severe or profound sensorineural hearing loss were divided into sCI (≤12 months), lCI (≥24 months) and nCI (no CI use) groups. Intra-operative eABRs evoked by electrical stimulation at the round window membrane were recorded.

RESULTS

The latencies of eIII and eV were significantly longer in lCI group than in sCI group and in nCI group, respectively, but not significantly different between sCI group and nCI group. The eABR thresholds and eIII-eV latency intervals were not significantly different among three groups.

CONCLUSIONS AND SIGNIFICANCE

The eABR evoked by the electrical stimulation at the round window membrane is a reliable and effective way of evaluating functions of the auditory pathway in deaf children. Long-term use of a unilateral CI may promote the degenerative process of the contralateral auditory pathway to the level of the brainstem.