Audiophonological results after cochlear implantation in 40 congenitally deaf patients: preliminary results

Intelligibility of the Patient's Speech Predicts the Likelihood of Cochlear Implant Success in Prelingually Deaf Adults

OBJECTIVES

The objective of this study was to determine the validity and clinical applicability of intelligibility of the patient's own speech, measured via a Vowel Identification Test (VOW), as a predictor of speech perception for prelingually deafened adults after 1 year of cochlear implant use. Specifically, the objective was to investigate the probability that a prelingually deaf patient, given a VOW score above (or below) a chosen cutoff point, reaches a postimplant speech perception score above (or below) a critical value. High predictive values for VOW could support preimplant counseling and implant candidacy decisions in individual patients.

DESIGN

One hundred and fifty-two adult cochlear implant candidates with prelingual hearing impairment or deafness took part as speakers in a VOW; 149 speakers completed the test successfully. Recordings of the speech stimuli, consisting of nonsense words of the form [h]-V-[t], where V represents one of 15 vowels/diphthongs ([(Equation is included in full-text article.)]), were presented to two normal-hearing listeners. VOW score was expressed as the percentage of vowels identified correctly (averaged over the 2 listeners). Subsequently, the 149 participants enrolled in the cochlear implant selection procedure. Extremely poor speakers were excluded from implantation, as well as patients who did not meet regular selection criteria as developed for postlingually deafened patients. From the 149 participants, 92 were selected for implantation. For the implanted group, speech perception data were collected at 1-year postimplantation.

RESULTS

Speech perception score at 1-year postimplantation (available for 77 of the 92 implanted participants) correlated positively with preimplant intelligibility of the patient's speech, as represented by VOW (r = 0.79, p < 0.00001): the more intelligible the patient's speech, the higher the predicted postimplant speech perception score. This correlation is explained by the hypothesis that the two variables have a common driving force, i.e., (in)adequacy of auditory speech input in the earliest years of life. With a 60% cutoff point, VOW can discriminate between individuals with "above-chance" postimplant speech perception and those with "chance level" postimplant speech perception with sensitivity and specificity of 0.84 and 0.86, respectively. The probability that a patient with a VOW score ≥ 60% achieves "above-chance" speech perception after implantation is 0.91. Conversely, the probability that a patient with VOW < 60% reaches "above-chance" speech perception is 0.25.

CONCLUSIONS

For prelingually deaf adults, intelligibility of the patient's speech-as represented by VOW-is a valid predictor of postimplant speech perception. A patient with a VOW score above a preset cutoff is much more likely to develop acceptable speech perception after implantation than a patient with a VOW score below that cutoff. The binary classification based on VOW and the associated probabilities of cochlear implant success in terms of speech perception can be used-in addition to existing criteria-to support the clinician in guiding patient expectations and in considering implant candidacy for individual patients.

Effects of residual hearing on cochlear implant outcomes in children: A systematic-review

OBJECTIVES

to investigate if preoperative residual hearing in prelingually deafened children can interfere on cochlear implant indication and outcomes.

METHODS

a systematic-review was conducted in five international databases up to November-2016, to locate articles that evaluated cochlear implantation in children with some degree of preoperative residual hearing. Outcomes were auditory, language and cognition performances after cochlear implant. The quality of the studies was assessed and classified according to the Oxford Levels of Evidence table - 2011. Risk of biases were also described.

RESULTS

From the 30 articles reviewed, two types of questions were identified: (a) what are the benefits of cochlear implantation in children with residual hearing? (b) is the preoperative residual hearing a predictor of cochlear implant outcome? Studies ranged from 04 to 188 subjects, evaluating populations between 1.8 and 10.3 years old. The definition of residual hearing varied between studies. The majority of articles (n = 22) evaluated speech perception as the outcome and 14 also assessed language and speech production.

CONCLUSION

There is evidence that cochlear implant is beneficial to children with residual hearing. Preoperative residual hearing seems to be valuable to predict speech perception outcomes after cochlear implantation, even though the mechanism of how it happens is not clear. More extensive researches must be conducted in order to make recommendations and to set prognosis for cochlear implants based on children preoperative residual hearing.

Factors Affecting Speech Perception Improvement Post Implantation in Congenitally Deaf Adults

OBJECTIVES

To identify factors preimplantation associated with postimplantation speech perception improvement in the adult congenitally deaf population.

DESIGN

Forty-four adult cochlear implant (CI) patients who had a severe to profound hearing loss from birth were identified from this centre's database. Eight preimplantation factors, speech intelligibility, preimplantation hearing levels, communication mode, preimplantation speech perception scores, progression of hearing loss, age at implantation, hearing aid use preimplantation, and gender, were recorded during the CI assessment process. These factors were investigated to determine their effect on speech perception improvement postimplantation. The outcome measures were the improvement in scores for the BKB Sentence test and CUNY Sentence test with lipreading after implantation. In the final analysis, 26 patients were included in the CUNY analysis, and 30 patients were included in the BKB analysis.

RESULTS

Speech intelligibility rating, preimplantation hearing levels, and communication mode were shown to be significantly associated with improvements in speech perception postimplantation.

CONCLUSION

Three factors were identified that affected speech perception improvement postimplantation: speech intelligibility, preimplantation hearing levels, and communication mode. These factors can be used to counsel CI patients regarding potential speech perception improvements from cochlear implantation, although these are based on average data and may not reflect individual performance.

A Systematic Review to Define the Speech and Language Benefit of Early (<12 Months) Pediatric Cochlear Implantation

Objective: This review aimed to evaluate the additional benefit of pediatric cochlear implantation before 12 months of age considering improved speech and language development and auditory performance. Materials and Methods: We conducted a search in PubMed, EMBASE and CINAHL databases and included studies comparing groups with different ages at implantation and assessing speech perception and speech production, receptive language and/or auditory performance. We included studies with a high directness of evidence (DoE). Results: We retrieved 3,360 articles. Ten studies with a high DoE were included. Four articles with medium DoE were discussed in addition. Six studies compared infants implanted before 12 months with children implanted between 12 and 24 months. Follow-up ranged from 6 months to 9 years. Cochlear implantation before the age of 2 years is beneficial according to one speech perception score (phonetically balanced kindergarten combined with consonant-nucleus-consonant) but not on Glendonald auditory screening procedure scores. Implantation before 12 months resulted in better speech production (diagnostic evaluation of articulation and phonology and infant-toddler meaningful auditory integration scale), auditory performance (Categories of Auditory Performance-II score) and receptive language scores (2 out of 5; Preschool Language Scale combined with oral and written language skills and Peabody Picture Vocabulary Test). Conclusions: The current best evidence lacks level 1 evidence studies and consists mainly of cohort studies with a moderate to high risk of bias. Included studies showed consistent evidence that cochlear implantation should be performed early in life, but evidence is inconsistent on all speech and language outcome measures regarding the additional benefit of implantation before the age of 12 months. Long-term follow-up studies are necessary to provide insight on additional benefits of early pediatric cochlear implantation.

Health-related quality of life in cochlear implanted patients in Romania

OBJECTIVES

Cochlear implantation is a well established treatment method in severe to profound hearing impaired people. Hearing devices do not cure hearing loss, but correct the disability, so it is important to assess the benefits not only on auditory-verbal performances but in terms of health-related quality of life.

MATERIALS AND METHODS

We evaluated the health-related quality of life in a cochlear implant group (84 patients), split into two subgroups, according to the age of implantation and compared with a hearing aided group (50 patients). We used the Nijmegen cochlear implant HRQoL questionnaire which was sent to the parents. In the study group, all patients had unilateral MedEl device and at least 6 months of experience with the speech processor.

RESULTS

Although there were differences between hearing aided and implanted children in all areas of quality of life, in the physical area, these differences were greater than those in the psychological and social domains. HRQoL was positively correlated with auditory performance, speech intelligibility and negatively correlated with implantation age. The correlation coefficient, R=0.78, indicates that between these three variables, implantation age, SIR and CAP and quality of life, there was a very good linear and direct proportional correlation. According to the determination coefficient (R(2) adjusted=0.59), 59.5% of quality of life's variation was explained by the variation of these three parameters.

CONCLUSIONS

Cochlear implant improves the auditory performance and speech production much more than hearing aids. Associated diseases have a negative effect on the evolution of cochlear implanted children but the cochlear implant may have an important impact on these children quality of life. It is well known that children implanted at a young age evolve better than older ones, but we should take into consideration that even older children can get good results, good performances if they are properly selected and well trained.

The auditory and speech performance of children with intellectual disability after cochlear implantation

CONCLUSION

The results revealed that children with intellectual disability (ID) who underwent cochlear implantation (CI) showed gradual progress in their auditory perception and speech development. ID in children should not be considered a contraindication for CI, because they are able to obtain a chance to develop oral communication skills following CI.

OBJECTIVE

The purpose of this study was to assess the auditory and speech performance of 14 young deaf children with ID after CI.

METHODS

Fourteen children with ID who underwent CI between December 2002 and February 2010 were included. Improvement in auditory perception and speech production over time was evaluated longitudinally with the Categories of Auditory Performance (CAP) score and Korean version of Ling's stages (K-Ling). The results were compared with those of age- and gender-matched implanted controls without additional disabilities. All tests were performed four times in each patient: before implantation and at 3, 6, and 12 months after implantation. Preoperative and postoperative communication modes were also assessed and compared between the two groups.

RESULTS

Auditory perception and speech production of deaf children with an ID improved consistently after CI. In addition, the communication mode also took a favorable turn from nonverbal to vocalizations or oral communication or from vocalizations to oral communication.

Preoperative voice parameters affect the postoperative speech intelligibility in patients with cochlear implantation

OBJECTIVES

Verbal communication depends on a good function of voice and speech organs. Some of the voice characteristics of deaf people differ considerably from those of speakers with normal hearing. After cochlear implantation (CI), auditory control of voice production is possible and the quality of the voice is improved. CI improves quality of voice, speech and hearing with deafness. The aim of our study was to investigate the relationship between acoustic analysis before CI and the speech intelligibility before and after CI.

METHODS

Twelve prelingually deafened children implanted unilaterally at the age of 3.4-9 years were included in the study. For all of the children an acoustic analysis of the Slovene vowel 'a' was performed before CI. The fundamental frequency (F0), jitter, shimmer and noise-to-harmonic ratio (NHR) were studied before the implantation. For all of the children the speech intelligibility was performed before and 12 months after CI. Preoperative hearing was divided on existing residual hearing. The results of the acoustic analyses and speech intelligibility before and after CI were compared for preoperative hearing. The results of the speech intelligibility were compared for the age of operation and preoperative acoustic analysis (F0, jitter, shimmer, NHR).

RESULTS

Preoperative hearing had no influence on preoperative voice analysis. The children with residual hearing had a high grade of speech intelligibility before and after CI. The preoperative shimmer had positive correlation with postoperative 12 month speech intelligibility (r=0.618, P=0.032). The preoperative jitter had positive correlation with postoperative 12 month speech intelligibility, but was not statistically significant (r=0.479, P=0.116).

CONCLUSION

Shimmer on preoperative voice analyses had influence on speech intelligibility after CI.

Speech intelligibility as a predictor of cochlear implant outcome in prelingually deafened adults

OBJECTIVES

Among adult patients with prelingual deafness, interindividual variability in speech perception outcome after cochlear implantation is generally large. It was hypothesized that the intelligibility of the patient's own speech may be predictive of speech perception with a cochlear implant. The objectives were (1) to provide a validation of a new test battery as a measurement tool for intelligibility using a group of prelingually deafened patients; (2) to investigate the validity of the test battery as a predictor of postimplant speech perception, based on preliminary data with a cochlear implant from a subgroup of patients; and (3) to investigate the validity of the test battery as a predictor of postimplant health-related quality of life (HRQoL) for the same subgroup of patients.

DESIGN

Twenty-five adult cochlear implant candidates with prelingual deafness participated in this study. Average age at onset of deafness was 8 mos (range 0 to 4 yrs). Speech samples from the participants were recorded and presented to two normal-hearing listeners. Results from the seven intelligibility tests in the battery were subjected to analyses of reliability and validity. Furthermore, the multiple test outcomes were submitted to a Principal Component Analysis to investigate the possibility of summarizing the data. Subsequently, from the group of 25 participants, 9 participants with above-average intelligibility were selected for implantation. Speech perception data with a cochlear implant from the nine implantees were collected at 12 mos postimplantation, as well as HRQoL data. Predictive validity of the intelligibility test battery was determined, using the postimplant data as the criterion.

RESULTS

Results from the 25 participants averaged over listeners showed that all tests in the battery had good reliability and validity as measures of intelligibility. Principal Component Analysis showed that the multiple test outcomes could be summarized by a single underlying variable. Despite the early age at onset of deafness, the subgroup of nine participants who received a cochlear implant included several good performers in terms of speech perception with the implant. The intelligibility test battery summary score had good validity as a predictor of postimplant outcome: the more intelligible the participant's speech, the better his or her speech perception outcome with the cochlear implant. Availability of effective auditory input in early life may be the fundamental factor underlying the potential for speech perception with a cochlear implant in later life. The intelligibility test battery can be reduced to a single test to minimize testing time without negatively affecting its predictive validity. Predictive validity of the intelligibility test battery can be generalized to HRQoL outcomes of cochlear implantation, provided these outcomes are concerned with speech processing abilities.

CONCLUSIONS

The new test battery (or its reduced version), used as a measure of intelligibility, is a promising tool for guiding cochlear implant candidacy decisions and counseling for individual patients with prelingual deafness. Because intelligibility has superior predictive power in comparison to age at onset of deafness, the latter should be discarded as an exclusion criterion for cochlear implantation.

Single word and sentence intelligibility in children with cochlear implants

This study examined the intelligibility of speech produced by 17 children (aged 4-11 years) with cochlear implants. Stimulus items included sentences from the Beginners' Intelligibility Test (BIT) and words from the Children Speech Intelligibility Measure (CSIM). Naïve listeners responded by writing sentences heard or with two types of responses to the word recordings; open transcription (CSIM-T) and closed set multiple choice (CSIM-MC). Percentage of items understood, averaged across three naïve judges, were compared across the three measures. Additionally, scores were examined for any relationships with chronological age, age of implantation, and amount of implant experience. Strong positive correlations were observed among all three intelligibility tasks. Scores on all three tasks were found to be significantly different from each other. A significant correlation was obtained between intelligibility and amount of implant experience, but not with chronological age or age of implantation. Results suggest that judging the intelligibility of speech produced by children with cochlear implants using both single word and sentence levels would provide a better overall estimate of their intelligibility. The results also emphasize the vital role of auditory input in the development of intelligible speech.

Intelligibility of spontaneous conversational speech produced by children with cochlear implants: a review

OBJECTIVE

The emergence of cochlear implant technology has raised hopes about improved outcomes for children with severe and profound hearing impairments. This study sought to examine the current literature to help evaluate whether the new technology is living up to its promise specifically relative to the intelligibility of conversational speech produced by these children.

METHOD

At least 20 studies to date have reported findings for the intelligibility of speech produced by children fitted with cochlear implants. The current review involved a descriptive, summary examination of 10 of these studies that analyzed spontaneous conversational speech.

RESULTS

The review suggested that intelligibility outcomes for these children appear to be considerably better than we have historically seen in this population (i.e., prior to the development of cochlear implant technology). For children implanted very early it appears that progress toward intelligible speech is more rapid, and the development of fully intelligible speech may be a reasonable goal for many such children. Even for children implanted somewhat later, progress on speech intelligibility appears to continue for at least 10 years post-implantation.

CONCLUSION

It would appear that cochlear implants are providing much better outcomes compared to older intervention approaches, at least relative to the intelligibility of spontaneous conversation.

Production of consonants by prelinguistically deaf children with cochlear implants

Consonant production following the sensory restoration of audition was investigated in 22 prelinguistically deaf French children who received cochlear implants. Spontaneous speech productions were recorded at 6, 12, and 18 months post-surgery and consonant inventories were derived from both glossable and non-glossable phones using two acquisition criteria. The results showed that children initiated appropriate production of consonants after six months of implant use. Stops and labials were the most frequently produced speech sounds, whereas glides and palatals were still infrequent after 18 months. Speech accuracy also improved throughout the study. Consonant visibility appeared to influence the order of acquisition in the first months following the implantation and, as experience with auditory information increased, patterns of development tended to resemble those seen in children with normal hearing. Finally, a signed mode of communication and oral rehabilitation programs prior to implantation were better outcome predictors than age at implantation.

Cochlear implantation in obstructed cochleas: the effect of the degree of obstruction on the number of activated electrodes and the amount of postoperative speech perception

OBJECTIVE

With cochlear implantation, insertion of the electrodes can be hampered by cochlear obstructions. The aim of this study was to investigate the effects of these obstructions on the number of activated electrodes and postoperative speech perception.

STUDY DESIGN AND SETTING

Retrospective analysis of the operation reports and CT-scans of patients who underwent cochlear implantation, at the Department of Otorhinolaryngology of the University Medical Center of Utrecht (n = 295).

PATIENTS AND INTERVENTIONS

Fifty patients with a certain degree of cochlear obstruction were included. Based on the surgical intervention to overcome these obstructions they were subdivided into first-, second- and third degree obstructions. The number of implanted and activated electrodes was determined.

MAIN OUTCOME MEASURES

Three different speech perception tests after 12 months of cochlear implant use.

RESULTS

The number of activated electrodes significantly diminished with increasing obstruction degree (P < 0.01). This was caused by a lower amount of implanted electrodes combined with a higher amount of switched off electrodes. With a higher degree of obstruction the amount of postoperative speech perception decreased significantly (P < 0.01). This is partly explained by the lower number of activated electrodes and partly explained by the fact that a higher obstructions degree correlates with a higher degree of (retro-) cochlear pathology. Significantly more electrodes can be inserted into the severely obstructed cochlea using a Double Array Cochlear Implant.

CONCLUSION

Cochlear obstructions pose a surgical threat and negatively influence the postoperative speech perception results. Fortunately, due to surgical techniques, first and second degree obstructed cochleas can often be bypassed. Implanting of a Double Array implant brightens the prospects of patients with third (severe) degree obstructed cochleas.

Intelligibility of conversational speech produced by children with cochlear implants

The intelligibility of conversational speech produced by six children fitted with cochlear implants before age 3 years was measured longitudinally. Samples were obtained every 3 months during periods of 12-21 months. Intelligibility was measured using both an utterance-by-utterance approach and an approach to the sample as a whole. Statistically significant differences were observed between the two approaches, but the differences were all within the realm of measurement error. Findings indicated that intelligible speech emerges quite rapidly in these children. Conversational intelligibility appears to be superior to that reported in the literature for similar children who use hearing aids but not necessarily as good as in children with normal hearing. Both intelligibility measures were significantly correlated with chronological age, hearing age, and amount of implant use, but were most strongly correlated with chronological age.

LEARNING OUTCOMES

The reader will be able to (1) describe some of the issues involved in measuring speech intelligibility in children with cochlear implants and (2) describe the pattern of outcomes for the intelligibility of speech produced by children receiving cochlear implants before age 3 years.

Cochlear implantation in children with internal ear malformations

OBJECTIVE

To evaluate surgical aspects and results of cochlear implantation in inner ear malformations.

STUDY DESIGN

Retrospective cohort study.

SETTING

Ear, nose, and throat department of a tertiary referral hospital.

PATIENTS

Out of 260 implanted children, 18 (6.9%) had inner ear malformations: complex cochleovestibular malformation (n = 11), common cavity (n = 1), and enlarged vestibular aqueduct (EVA) (n = 6). Deafness was progressive in 12 cases (G1) and congenital in 6 cases (G2). Genetics lead to diagnosis in 12 of 13 cases: PSD mutation (n = 11), Waardenburg syndrome (n = 1), negative (1). Mean age at implant was 7.8 years. Mean follow-up period was 48 months.

MAIN OUTCOME MEASURES

Medical and surgical outcomes were reported. Closed (CSW) and open (OSW) set word perception and level of speech production were evaluated each year. The results were compared pre- and postoperatively and between the two groups.

RESULTS

Gusher at surgery was observed in 50% of cases, with a persistent leak in one case. No facial injury or infectious complications were observed. At 12 months, 83% of the population had achieved more than 75% recognition in CSW, versus 16% before implant (p = 0.001). After 2 years, 64% of patients had more than 50% recognition in OSW. Good oral language was seen in 76% at 2 years and 100% at 3 years, versus 55% before implant (respectively, p > 0.05 and p = 0.03). At 1 year after implant, 83% of the G1 and 20% of the G2 achieved more than 50% recognition in OSW (p = 0.02). After 24 months, 83% of G1 and 40% of G2 had more than 50% in OSW (p > 0.05). Before implant, 75% in G1 and 0% in G2 had good oral language (p = 0.01). At 1 year, 83% in G1 and 16% in G2 had good oral language (p = 0.02). At 2 years, 100% in G1 and 20% in G2 had good oral language (p = 0.02). One child in G1 had no improvement after implantation.

CONCLUSIONS

No major complication was seen. Perceptive and linguistic results were variable and depended on the type of the deafness. In progressive deafness, the perceptive and linguistic result are expected to be good. In congenital deafness, the results are more variable.

[Cochlear implant in postlingual adults with progressive hearing loss]

OBJECTIVES

To analize the results of patients with cohlear implants in postlingual adults with progressive hearing loss and to analize various predictive factors.

MATERIAL AND METHODS

Prospective study of 42 patients with profound and progressive hearing loss. We analized the outcomes in the first two years of follow-up. We examined the results in regards to the of age at time of implantation, other handicaps, cause of hearing loss, age of onset, cochlear ossification and actives electrodes. We use the logo-auditory protocol developed at the University Spanish of navarra.

RESULTS

All tests presented a significative improvement in the first six months (p<0.01 Student t or Wilcoxon test). After six months the results were not statistically significant. The more important predictive factors were percentage of life with hearing loss, percentage of life with profound hearing loss, cochlear ossification and actives electrodes thus the significancy was more relevant at a follow-up period of 3 months (p<0.05 Student t or Mann-Withney test).

CONCLUSIONS

These patients showed clear benefits in a short period of time and the patients with unfavourable circumstances had a more slow progression but a similar final outcome.

Monosyllable speech perception of Japanese hearing aid users with prelingual hearing loss: implications for surgical indication of cochlear implant

OBJECTIVE

The monosyllable speech perception ability after years of educational intervention was compared between prelingually deafened pediatric hearing aid users and their cochlear implant counterparts.

DESIGN

An open-set monosyllabic speech perception test was conducted on all subjects. The test required subjects to indicate a corresponding Japanese character to that spoken by the examiner. Fifty-two subjects with prelingual hearing impairment (47 hearing aid users and 5 cochlear implant users) were examined.

RESULTS

Hearing aid users with average pure-tone thresholds less than 90 dB HL demonstrated generally better monosyllable perception than 70%, which was equivalent or better performance than that of the cochlear implant group. Widely dispersed speech perception was observed within the 90-99 dB HL hearing-aid user group with most subjects demonstrating less than 50% speech perception. In the cluster of >100 dB HL, few cases demonstrated more than 50% in speech perception. The perception ability of the vowel part of each mora within the cochlear implant group was 100% and corresponding to that of hearing aid users with moderate and severe hearing loss.

CONCLUSION

Hearing ability among cochlear implant users can be comparable with that of hearing aid users with average unaided pure-tone thresholds of 90 dB HL, after monosyllabic speech perception testing was performed.

Language development of a multiply handicapped child after cochlear implantation

The presence of additional handicaps in hearing-impaired children makes the prediction of language ability after cochlear implantation unreliable. Only limited follow-up data on developmental improvement after implantation among multiply handicapped children is available. The present study reports the course of development (audiological and linguistic) after cochlear implantation in one subject with moderate mental retardation. Preoperatively, his language development showed 34 months delay when compared to chronological age. The difference had shortened to 23 months by 2 years post-surgery. The subject's cognitive delay had not changed upon 2-year follow-up. The cochlear implant can be credited to his improvement in language development.

Usher syndrome and cochlear implantation

OBJECTIVE

To evaluate the symptoms leading to diagnosis and the quality of rehabilitation after cochlear implantation in Usher syndrome.

STUDY DESIGN

Retrospective cohort study.

SETTING

ENT department of a tertiary referral hospital.

PATIENTS

Among 210 patients given an implantation in the Ear, Nose, and Throat department, 185 were congenitally deaf and 13 had Usher syndrome (7.0%). Five had a family history of Usher, and eight were sporadic cases. Eleven cases were Usher type I, one was Usher type III, and one was not classified. The age at implantation ranged from 18 months to 44 years (mean, 6 years 1 month). The mean follow-up was 52 months (range, 9 months to 9 years).

MAIN OUTCOME MEASURES

All patients had audiophonological and clinical examination, computed tomography scan of the temporal bones, ophthalmologic examination with fundoscopy, and an electroretinogram. Cerebral magnetic resonance imaging and vestibular examination were performed in 9 of 13 and 10 of 13 cases, respectively. Logopedic outcome measured preimplant and postimplant closed- and open-set word recognition and oral expression at follow-up.

RESULTS

The most frequent initial sign of Usher syndrome was delayed walking, with a mean age of 20 months. Among the 172 other congenitally deaf children with implants, when deafness was not associated with other neurologic disorders, the mean age at walking was 14 months (p < 0.001). The fundoscopy was always abnormal after the age of 5 years, and the electroretinogram was abnormal in all cases. Vestibular function was abnormal in all but one case (nonclassified). The computed tomography scan and the magnetic resonance imaging were always normal. Logopedic results with cochlear implants showed good perception skills in all but one case. The best perceptive results were obtained in children implanted before the age of 9 years. Oral language had significantly progressed in 9 of 13 at follow-up. There was no relation between the visual acuity and the logopedic results.

CONCLUSION

The earliest clinical sign associated with deafness evoking Usher syndrome is late walking. The electroretinogram is the only reliable examination to enable the diagnosis. When severe profound deafness is associated with late walking, the electroretinogram should be systematically proposed. Logopedic results are linked to precocity of implantation, and early Usher's diagnosis contributes to optimize speech therapy.

Analysis of spiral ganglion cell populations in children with normal and pathological ears

This study analyzed features of total and segmental spiral ganglion cell populations in children with normal ears and those with various pathological conditions. Sixty-three human temporal bone specimens, obtained from 43 children 4 days to 9 years of age, were studied histopathologically. These specimens were divided into 5 diagnostic groups: group 1, normal ears (13 ears); group 2, congenital infectious diseases (13 ears); group 3, chromosomal aberrations (11 ears); group 4, multiple craniofacial anomalies with hereditary or genetic causes (21 ears); and group 5, perinatal and postnatal asphyxia (5 ears). Eighteen of the 63 ears had documented profound deafness. In either normal ears (group 1) or those with various pathological conditions (groups 2 through 5), the total number of ganglion cells did not change as a function of age during the first 10 years. The total number of ganglion cells was significantly larger in group 1 (33,702) than in each of groups 2, 3, 4, and 5 (p < .01), and the number was significantly larger in group 2 than in each of groups 4 and 5 (p < .01 and p < .05, respectively). The ratio of basal to apical ganglion cell populations remained constant in both normal and pathological ears. Each ratio of the number of basal and apical ganglion cells in groups 2, 3, 4, and 5 to the mean number in group 1 (basal and apical survival ratios) was at least approximately 40%. There was no statistical difference between these two ratios in groups 2, 3, 4, and 5. The mean (+/-SD) total number of ganglion cells in ears with documented profound deafness was 15,417 +/- 5,944, which is approximately 40% of those present in normal ears. Our results suggest that normally, cochlear neurons are completely present at birth and minimally regress during the first decade of life. In addition, although intergroup differences among various pathological groups were present, the majority of pathological ears had more than 10,000 spiral ganglion cells present. Cochlear implantation has gradually been recognized as an effective and reliable tool for rehabilitation of children who have profound deafness, even congenitally or prelingually deafened children. On the basis of the results obtained in this study, we discuss the implications for cochlear implantation in children.

Better speech performance in cochlear implant patients with GJB2-related deafness

OBJECTIVE

We applied mutation screening in seven cochlear implant users to identify those persons with GJB2-related deafness to determine whether etiology of deafness was predictive of speech performance after implantation.

METHODS

Direct sequence of GJB2 was conducted over seven cochlear implant users with prelingual hearing impairment and their speech, language and cognitive performance was examined.

RESULTS

The three persons with GJB2-related deafness had a mean vocabulary of 1243 words compared to a mean vocabulary of 195 words in the four children with GJB2-unrelated deafness, although the number of patients examined here was limited. The developmental quotient (DQ) of cognitive ability also was higher in those children with GJB2-related deafness.

CONCLUSIONS

These preliminary results suggest that better speech performance after cochlear implantation may be observed in persons with GJB2-related deafness. In the future, detailed phenotypic studies and mutation screening for non-syndromic hearing loss may play an important role in the preoperative assessment of prelingually-deafened children.