Age at implantation: its importance in pediatric cochlear implantation

Temporal Trends in Early Pediatric Cochlear Implantations in California from 2018 to 2020

OBJECTIVE

To characterize the demographics of children receiving cochlear implantations, identify factors associated with delayed implantations, and trend these factors over time.

DESIGN

Retrospective cross-sectional study.

SETTING

Healthcare Cost and Utilization Project California State Ambulatory Surgery Database for calendar years 2018-2020.

PATIENTS

Children 5 years or younger undergoing cochlear implantation.

INTERVENTIONS

Cochlear implantation.

MAIN OUTCOMES MEASURES

The population-controlled number of cochlear implantations was calculated and stratified by race and insurance. Early implantation was defined as implantation at age 2 years or younger. A mixed-effects logistic regression model was generated to identify factors associated with early implantation and how that association changed from 2018 to 2020.

RESULTS

The final cohort included 467 children. The number of implantations increased from 141 to 175 implants from 2018 to 2020 (24.1% increase); 229 (49.0%) children were implanted at 2 years or younger. Medicaid insurance was associated with decreased odds of early implantation (odds ratio, 0.18 [95% confidence interval, 0.15-0.23], p < 0.001); this association with Medicaid insurance was significant when stratified across all racial groups. The percentage of children with Medicaid who were implanted at 2 years or younger increased from 20.9 to 62.0% from 2018 to 2020.

CONCLUSIONS AND RELEVANCE

Among children in California, socioeconomic factors, in particular public insurance, are correlated with age of cochlear implantation. These disparities improved significantly from 2018 to 2020. Further investigation into changes and initiatives in California during this time frame may aid in directing national efforts to improve pediatric cochlear implantation access.

Indicators for cochlear implantation in children with auditory neuropathy spectrum disorder: A systematic review

PURPOSE

ANSD refers to a group of auditory diseases demonstrating intact outer hair cells and desynchronized neural firings of the auditory nerve. A cochlear implant is a promising intervention strategy for severe to profound sensorineural hearing loss (SNHL). However, due to its variable outcomes in children with ANSD, a consensus has yet to be reached on its performance. This study aimed to review the literature to determine the efficacy of cochlear implants in children with ANSD and to determine prognostic indicators. The study identifies the pre-operative and post-operative predictors of success for CI in children with ANSD.

METHOD

The review was carried out using PRISMA guidelines. This resulted in 9630 topic-related articles. Among these, 17 articles met the inclusion and exclusion criteria that were included for the study. The quality and potential risks associated with each article were evaluated using the quality impact assessment protocol (QUIPS) tool.

RESULTS

A review of 17 articles was conducted to highlight these predictors. Most selected studies included case reports, case series, cohorts, and comparisons between children with ANSD and SNHL. Assessment of study quality reported an overall low risk of bias. The overall result showed cochlear implant would be an effective option for children with ANSD. However, there are specific prognostic indicators about which clinician needs to be aware before recommending CI for children with ANSD. Our review study identified a set of pre-operative and post-operative indicators that predicted speech and auditory performance and gave some insight into the lesion site in ANSD individuals.

CONCLUSION

This review concludes CI is an effective option for children with ANSD. However, before recommending CI, a detailed assessment is required from different perspectives, which could serve as predictors of postoperative outcomes. This review highlights the need to include more precise tools, such as genetic testing to describe the lesion site to choose the most appropriate management strategy for children with ANSD. Knowledge about the prognostic indicators and the effective assessment protocols would help clinicians for the better candidacy selection.

Audiological and Speech Outcomes of Cochlear Implantation in Inner Ear Malformation Compared to the Normal Inner Ear

To compare the overall clinical outcomes of cochlear implantation in children with structural inner ear abnormalities, with results of implantation in children with radiologically 'normal' inner ears. To study the incidence and performance outcomes of cochlear implantation in children with inner ear malformations (IEMs). It is a retrospective case control study of 57 normal and 57 abnormal inner ear patients operated for cochlear implant between Jan 1, 2014 and Aug 1, 2017, by Veria technique. The age range was between 12 months and 15 years. The prevalence of IEMs was 13.8%. Of the 57 cases with IEMs, 33.3% were of enlarged vestibular acqueduct, 7% were of isolated Incomplete Partition type-2, 21.1% cases were of Mondini's dysplasia, 3.5% of Incomplete partition type-1 and 8.8% of cochlear nerve hypoplasia. Most commonly encountered malformation was EVA while IP-1 was the least common malformation. A CSF gusher was experienced in 11 cases. There was a statistically significant difference between the CAP and SIR scores of both IEM and control groups, both at 1 year and at 2 years (1 year CAP score p value < 0.001, 2 year CAP score p value 0.002 and 1 year SIR score, p value < 0.001, 2 year SIR score, p value 0.013). There was progressive improvement in the scores (of both groups) at the 2 year mark, compared to 1 year scores. Cochlear implantation is safe and surgically feasible in children with IEMs. However, the hearing outcome and speech perception outcomes are poor than those of patients with normal anatomy, with an exception seen in enlarged vestibular aqueduct.

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.

Intelligibility of Word-Initial Obstruent Consonants in Mandarin-Speaking Prelingually Deafened Children With Cochlear Implants

PURPOSE

This study assessed the intelligibility of obstruent consonants in prelingually deafened Mandarin-speaking children with cochlear implants (CIs).

METHOD

Twenty-two Mandarin-speaking children with normal hearing (NH) aged 3.25-10.0 years and 35 Mandarin-speaking children with CIs aged 3.77-15.0 years were recruited to produce a list of Mandarin words composed of 17 word-initial obstruent consonants in different vowel contexts. The children with CIs were assigned to chronological age-matched (CA) and hearing age-matched (HA) subgroups with reference to the NH controls. One hundred naïve NH adult listeners were recruited for a consonant identification task that consisted of a total of 2,663 stimulus tokens through an online research platform. For each child speaker, the consonant productions were judged by seven to 12 different adult listeners. An average percentage of consonants correct was calculated across all listeners for each consonant.

RESULTS

The CI children in both the CA and HA subgroups showed lower intelligibility in their consonant productions than the NH controls. Among the 17 obstruents, both CI subgroups showed higher intelligibility for stops, but they demonstrated major problems with the sibilant fricatives and affricates and showed a different confusion pattern from the NH controls on these sibilants. Of the three places (alveolar, alveolopalatal, and retroflex) in Mandarin sibilants, both CI subgroups showed the lowest intelligibility and the greatest difficulties with alveolar sounds. For the NH children, there was a significant positive relationship between overall consonant intelligibility and chronological age. For the children with CIs, the best fit regression model revealed significant effects of chronological age and age at implantation, with their quadratic terms included.

CONCLUSIONS

Mandarin-speaking children with CIs experience major challenges in the three-way place contrasts of sibilant sounds in consonant production. Chronological age and the combined effect of CI-related time variables play important roles in the development of obstruent consonants in the CI children.

Predictors of Time Spent in Special Education Among Students With Severe-to-Profound Hearing Loss

OBJECTIVE

Determine if students with severe-to-profound hearing loss with cochlear implants (CIs) mainstream (transition to general education) more than students with hearing amplification at the population level.

STUDY DESIGN

Cross-sectional secondary analysis of data from the National Center of Education Statistics.

SETTING

Special education (SpEd) students in the United States who had severe to profound "hearing impairment" and were 6 to 16 years old at enrollment from 2000 to 2001.

METHODS

We weighted the data to produce national estimates, performed multiple imputations for missingness, and built a multivariate linear regression model, which was cross-validated with a multivariate Poisson regression model. We used a theory-based approach to model-building using a directed acyclic graph to identify the minimally sufficient adjustment set of variables, which included school district urbanicity, student's age when they started SpEd, other disabilities, home language, and caregiver education.

RESULTS

We identified 7267 students with CIs and 28,794 students with hearing amplification. CI users mainstreamed more than peers using hearing amplification during secondary school (40.29% less daily time in special education, p = .004) but not during primary school (9.19% less daily time in SpEd, p = .155). Additional significant predictors of mainstreaming varied between the primary and secondary school cohorts and included school district urbanicity and the student's age when they started SpEd.

CONCLUSION

CI status predicts daily time spent in SpEd among a secondary school cohort. These findings do not establish causation. The National Center of Education Statistics should consider linking to clinical databases in future studies.

Complications and outcomes of cochlear implantation in children younger than 12 months: A multicenter study

OBJECTIVES

Evidence suggests that Cochlear Implantation (CI) is a beneficial approach for auditory and speech skills improvement in children with severe to profound hearing loss. However, it remains controversial if implantation in children <12 months is safe and effective compared to older children. The present study aimed to determine whether children's ages affect surgical complications and auditory and speech development.

METHODS

The current multicenter study enrolled 86 children who underwent CI surgery at <12 months of age (group A) and 362 children who underwent implantation between 12 and 24 months of age (group B). The Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) scores were determined pre-impanation, and "one-year" and "two-year" post-implantation.

RESULTS

All children had full insertions of the electrode array. Four complications (overall rate: 4.65%; three minor) occurred in group A and 12 complications (overall rate: 4.41%; nine minor) occurred in group B. We found no statistically significant difference in the complication rates between the groups (p > 0.05). The mean SIR and CAP scores improved over time following CI activation in both groups. However, we did not find significant differences in CAP and SIR scores between the groups across different time points.

CONCLUSION

Cochlear implantation in children younger than 12 months is a safe and efficient procedure, providing substantial auditory and speech benefits. Furthermore, rates and nature of minor and major complications in infants are similar to those of children undergoing the CI at an older age.

The 100 Most-Cited Manuscripts in Hearing Implants: A Bibliometrics Analysis

The aim of the study was to characterise the most frequently cited articles on the topic of hearing implants. A systematic search was carried out using the Thomson Reuters Web of Science Core Collection database. Eligibility criteria restricted the results to primary studies and reviews published from 1970 to 2022 in English dealing primarily with hearing implants. Data including the authors, year of publication, journal, country of origin, number of citations and average number of citations per year were extracted, as well as the impact factors and five-year impact factor of journals publishing the articles. The top 100 papers were published across 23 journals and were cited 23,139 times. The most-cited and influential article describes the first use of the continuous interleaved sampling (CIS) strategy utilised in all modern cochlear implants. More than half of the studies on the list were produced by authors from the United States, and the Ear and Hearing journal had both the greatest number of articles and the greatest number of total citations. To conclude, this research serves as a guide to the most influential articles on the topic of hearing implants, although bibliometric analyses mainly focus on citations. The most-cited article was an influential description of CIS.

Brain MRI findings of prelingually deaf children and cochlear implant outcome: Preliminary results

OBJECTIVE

To estimate the incidence of brain abnormalities in a cohort of prelingually deaf children and whether these abnormalities can impact the hearing outcomes of patients eligible for cochlear implantation (CI).

METHODS

We performed a retrospective review of consecutive medical charts of prelingually deaf children under 12 years of age who underwent brain magnetic resonance imaging (MRI) during their preoperative workup for CI surgery. We used the category of auditory performance (CAP) test and the speech intelligibility rating (SIR) test to assess the hearing and speech performance of the children, respectively.

RESULTS

The MRIs of 285 patients, 174 boys and 111 girls with a mean age of 36.4 (±16) months, were evaluated for this study. We identified 31 patients with abnormal findings (10.88%): (17/31) (54.8%) had MRI brain abnormalities, (9/31) (29%) had inner ear anomalies, and (5/31) (16.1%) had both inner ear and brain abnormalities. The most frequent inner ear anomaly was an enlarged vestibular aqueduct, while white matter lesions were the most common brain abnormality. The CAP and SIR mean score of patients with inner ear anomalies was slightly, but not significantly, higher than those of patients with brain abnormalities.

CONCLUSION

CAP and SIR scores were not significantly different in children with brain abnormalities than inner ear anomalies. These patients can still benefit from CI to improve their overall hearing and speech performance.

Pitch Accuracy of Vocal Singing in Deaf Children With Bimodal Hearing and Bilateral Cochlear Implants

OBJECTIVES

The purpose of the present study was to investigate the pitch accuracy of vocal singing in children with severe to profound hearing loss who use bilateral cochlear implants (CIs) or bimodal devices [CI at one ear and hearing aid (HA) at the other] in comparison to similarly-aged children with normal-hearing (NH).

DESIGN

The participants included four groups: (1) 26 children with NH, (2) 13 children with bimodal devices, (3) 31 children with bilateral CIs that were implanted sequentially, and (4) 10 children with bilateral CIs that were implanted simultaneously. All participants were aged between 7 and 11 years old. Each participant was recorded singing a self-chosen song that was familiar to him or her. The fundamental frequencies (F0) of individual sung notes were extracted and normalized to facilitate cross-subject comparisons. Pitch accuracy was quantified using four pitch-based metrics calculated with reference to the target music notes: mean note deviation, contour direction, mean interval deviation, and F0 variance ratio. A one-way ANOVA was used to compare listener-group difference on each pitch metric. A principal component analysis showed that the mean note deviation best accounted for pitch accuracy in vocal singing. A regression analysis examined potential predictors of CI children's singing proficiency using mean note deviation as the dependent variable and demographic and audiological factors as independent variables.

RESULTS

The results revealed significantly poorer performance on all four pitch-based metrics in the three groups of children with CIs in comparison to children with NH. No significant differences were found among the three CI groups. Among the children with CIs, variability in the vocal singing proficiency was large. Within the group of 13 bimodal users, the mean note deviation was significantly correlated with their unaided pure-tone average thresholds (r = 0.582, p = 0.037). The regression analysis for all children with CIs, however, revealed no significant demographic or audiological predictor for their vocal singing performance.

CONCLUSION

Vocal singing performance in children with bilateral CIs or bimodal devices is not significantly different from each other on a group level. Compared to children with NH, the pediatric bimodal and bilateral CI users, in general, demonstrated significant deficits in vocal singing ability. Demographic and audiological factors, known from previous studies to be associated with good speech and language development in prelingually-deafened children with CIs, were not associated with singing accuracy for these children.

Use of Functional Near-Infrared Spectroscopy to Predict and Measure Cochlear Implant Outcomes: A Scoping Review

Outcomes following cochlear implantation vary widely for both adults and children, and behavioral tests are currently relied upon to assess this. However, these behavioral tests rely on subjective judgements that can be unreliable, particularly for infants and young children. The addition of an objective test of outcome following cochlear implantation is therefore desirable. The aim of this scoping review was to comprehensively catalogue the evidence for the potential of functional near infrared spectroscopy (fNIRS) to be used as a tool to objectively predict and measure cochlear implant outcomes. A scoping review of the literature was conducted following the PRISMA extension for scoping review framework. Searches were conducted in the MEDLINE, EMBASE, PubMed, CINAHL, SCOPUS, and Web of Science electronic databases, with a hand search conducted in Google Scholar. Key terms relating to near infrared spectroscopy and cochlear implants were used to identify relevant publications. Eight records met the criteria for inclusion. Seven records reported on adult populations, with five records only including post-lingually deaf individuals and two including both pre- and post-lingually deaf individuals. Studies were either longitudinal or cross-sectional, and all studies compared fNIRS measurements with receptive speech outcomes. This review identified and collated key work in this field. The homogeneity of the populations studied so far identifies key gaps for future research, including the use of fNIRS in infants. By mapping the literature on this important topic, this review contributes knowledge towards the improvement of outcomes following cochlear implantation.

Assessment of the cochlear implant pathway for newborn hearing screening referrals

OBJECTIVE

To evaluate the cochlear implant (CI) assessment pathway for children referred through the newborn hearing screening programme (NHSP) and identify potential reasons for delay in CI surgery at a large UK centre.

METHODS

Retrospective analysis of electronic notes of children referred through NHSP from 2016 to 2019. Key points in the assessment pathway from referral to switch-on were assessed.

RESULTS

Of the 46 referrals, 44 went on to have CI surgery. Median age at CI surgery was 15 months (interquartile range (IQR) 13 to 17 months). Only 5% of referrals were implanted before the age of 12 months. Delayed referral and the presence of otitis media with effusion (OME) were associated with delayed implantation. The median period of monitoring for OME was 48 days (IQR 20 to 93 days), with a natural resolution rate of only 11%. The median time from surgery to switch-on was 5 weeks (IQR 4.1 to 5.4 weeks).

CONCLUSION

Achieving implantation prior to the age of 12 months for NHSP referrals can be challenging for a variety of reasons. The delays in the system and the steps that our implant programme has taken to address these will be highlighted.

A review of the outcomes of children with designated additional needs receiving cochlear implantation for severe to profound hearing loss

OBJECTIVE

To evaluate one year outcomes of children with additional needs receiving cochlear implantation at the Yorkshire Auditory Implant Service (YAIS) over a ten-year period.

METHODS

Retrospective chart review yielded 270 children who received cochlear implants (CIs) at YAIS between 2007 and 2017; 49 children were classified as having additional needs. Audiological performance scales (Meaningful Auditory Information Scale (MAIS), Meaningful Use of Speech Scale (MUSS), Listening in Progress (LIP), Categories of Auditory Performance (CAP), and Speech Intelligibility Rating Scale (SIR)) were analysed pre- and 12 months post-implantation. Comparison was made with children without additional needs.

RESULTS

Children with additional needs demonstrated significantly lower pre-implantation audiological performance in MAIS, LIP, and MUSS (P <0.05). Despite showing improvement, children with additional needs consistently achieved lower scores in all metrics at one year (P < 0.05). Similarly, the rate of change was statistically significantly lower in children with additional needs.

CONCLUSION

All children were able to gain access to sound following CI. Improvements were seen in all outcome measures especially in the MAIS, CAP and LIP whereas limited improvement was seen in measures assessing speech production and improvement. The rate of improvement was statistically significantly lower in children with additional needs.

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).

Risk Factors and Management of Postoperative Infection Following Cochlear Implantation

OBJECTIVE

To determine factors associated with infection, management, and resultant outcomes following pediatric cochlear implantation.

STUDY DESIGN

Retrospective cohort study with nested case series.

SETTING

Tertiary academic medical center.

PATIENTS

Children who underwent either unilateral or bilateral cochlear implantation between June 2011 and September 2016 and were under the age of 18 at the time of surgery.

INTERVENTION(S)

Subjects were compared based on age, cochlea malformation, revision surgery, operative time, device manufacturer, and antibiotic use. Infections were compared based on location, time, bacteria, management, and resolution.

MAIN OUTCOME MEASURE(S)

Rate of infection, rate of device explantation.

RESULTS

There were 16 infections among 246 surgeries, an infection rate of 6.5%. There was a significant age difference between infected and noninfected patients overall (n = 246, 1.4 versus 4.3 years, p = 0.005), but not within the cohort of patients five or younger (n = 172, 1.4 versus 1.8 years, p = 0.363). The most common infectious complication was skin infection, followed by device infection. No cases of meningitis were seen. The most common organism was S Aureus. The implant was salvaged in 9 of 16 patients (56.3%), with higher rates in patients treated with IV versus oral antibiotics (70 versus 40%).

CONCLUSIONS

Postoperative infection is positively associated with younger age overall, but not in patients below the age of 5. With modern devices and surgical practices, risk of meningitis-though a concern-may be lower than cited in the literature. Prompt and aggressive therapy with IV antibiotics and operative intervention can allow for high rates of device salvage.

Cochlear implantation in children with white matter lesions: Prediction of hearing outcomes by multiple regression analysis

Brain magnetic resonance imaging (MRI) white matter lesions have been reported in some preoperative cochlear implant children. However, the role of white matter lesions in predicting the hearing outcome is yet unclear. The present study investigated the outcomes of cochlear implantation (CI) in 40 children with white matter lesions.The data from children with white matter lesions were reviewed in this retrospective study. Based on brain MRI, the patients were divided into 3 groups: mild, moderate, and severe. The children were treated with unilateral CI and monitored for a follow-up period of at least 3 years. The main outcome measures were category of auditory performance (CAP) and speech intelligibility rating (SIR). MRI white matter lesions, age at implant, gender, physical impairment, and cognitive impairment were obtained from a research database to assess the correlation with long-term CAP and SIR outcome by multiple regression analysis.The data of children with white matter lesions were reviewed (18 females and 23 males). The mean age at implantation was 31.6 months. Strikingly, all children obtained better CAP and SIR scores. The age at implantation, brain white matters lesions on MRI, and cognitive and physical disabilities were associated with CAP and SIR scores. Multiple regression established a weak correlation between the degree of white matter lesions on brain MRI and long-term CAP and SIR, while cognitive impairment strongly accounted for long-term CAP and SIR outcome.The majority of the children with brain white matter lesions obtained a satisfactory postoperative effect. The cognitive impairment before CI is a major factor, and such factor should be considered.

Auditory perception skills in children receiving simultaneous bilateral cochlear implants: early speech-discrimination results

PURPOSE

The objective of the present study is to evaluate early speech-perception abilities using VRISD in toddlers who received simultaneous bilateral CIs between 12 and 36 months of age and to compare them with the findings in NH infants and to monitor the development of speech-perception skills within 6 months after cochlear implantation.

METHODS

The VRISD test was performed using video visual reinforcement to assess speech-discrimination ability in the CI and NH groups. Four stimuli were used for testing in the present study: /a/, /i/, /ba/, and /da/. The two contrasts used for the research were /a-i/ and /ba-da/. Auditory and listening skills in the CI group were assessed using the IT-MAIS.

RESULTS

The responses to the /a-i/ and /ba-da/ phoneme contrast were found to be similar in the NH and CI groups. No statistically significant difference was found between the groups (p > 0.05). VRISD test result and the IT-MAIS score were highly correlated in CI group (p = 0.001, r = 0.822).

CONCLUSION

The VRISD test can be effectively used to evaluate the development of speech-discrimination skills in hearing-impaired babies before and after CI. This research suggests that the development of speech-perception ability with CI is seriously influenced by environmental exposure and sound access. To the best of our knowledge, this is the first study to evaluate the speech-perception skills in toddlers with simultaneous bilateral CI.

Subtotal Petrosectomy and Cochlear Implantation: A Systematic Review and Meta-analysis

IMPORTANCE

Subtotal petrosectomy (STP) has been more frequently performed to prepare ears with unfavorable conditions for cochlear implantation.

OBJECTIVES

To provide an overview of indications for and complications of STP and cochlear implantation and to compare outcomes between single vs multistage procedures and between pediatric vs adult populations.

DATA SOURCES

A search of PubMed, Scopus, Ovid, and the Cochrane Library was performed from the databases' inception to January 23, 2020, for studies evaluating STP for cochlear implantation.

STUDY SELECTION

Studies with a minimum follow-up of 3 months and no missing data regarding postoperative outcomes were included. Of the initial 570 studies identified, 27 (4.7%) met selection criteria.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently assessed study eligibility according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines; discrepancies were resolved by a third reviewer. Extracted data included patient demographics, indications for STP, rates of complications, and cholesteatoma recidivism when applicable. Data were pooled using a random- or a fixed-effects model when appropriate.

MAIN OUTCOMES AND MEASURES

The primary study outcome was rate of global complications stratified by patient- and surgery-level characteristics.

RESULTS

Twenty-seven unique studies with 377 unique patients (54.2% male; mean age, 50.6 [range, 1-99] years) undergoing 397 STP procedures and cochlear implantation were included. Of these procedures, 299 of 394 cases with the information reported (75.9%) were single procedures and 95 (24.1%) were multistage procedures. Of the total 397 STP procedures, most common indications included chronic otitis media (220 cases [55.4%]), previous open mastoid cavity (141 [35.5%]), cholesteatoma (74 [18.6%]), and cochlear ossification (29 [7.3%]). The overall complication rate was 12.4% (95% CI, 9.4%-15.9%); overall cholesteatoma recidivism rate was 9.3% (95% CI, 4.3%-17.1%). Complication rates did not significantly differ based on stage or age of patients. Cases with cholesteatoma more often underwent multistage vs single-stage procedures (23 of 54 [42.6%] vs 35 of 174 [20.1%]).

CONCLUSIONS AND RELEVANCE

Across all age groups, STP has been shown to be an effective surgical operation in preparing an ear with unfavorable conditions for cochlear implantation. The potential indications for which cochlear implantation can be performed have expanded with the use of STP. Presence of cholesteatoma might indicate that a multistage procedure should be performed. Lastly, with complication rates comparable to those in adult patients, STP can be considered in children requiring cochlear implantation to minimize ear-related issues and allow benefit from cochlear implantation.

Anatomical Correlates and Surgical Considerations for Localized Therapeutic Hypothermia Application in Cochlear Implantation Surgery

Application of localized, mild therapeutic hypothermia during cochlear implantation (CI) surgery is feasible for residual hearing preservation.

Data logging variables and speech perception in prelingually deafened pediatric cochlear implant users

OBJECTIVES

To investigate the relationship among objectively gathered data logging measurements, patient-related variables, and speech recognition performance of pediatric CI users.

METHODS AND MATERIALS

Thirty-two prelingually implanted children who have the ability to perform word discrimination test were included in this study. To reveal the relationship between speech perception abilities and auditory exposure, seven data logging variables were analyzed: "on-air," "off-air," "coil-off," "speech," "speech in noise," "music" and "noise. In addition, implantation age (months) and CI usage duration (months) were taken into account. Finally, it was investigated the differences between unilateral, sequential bilateral, and simultaneous bilateral CI users in terms of all study variables.

RESULTS

The average on-air time ranged between 10.52 and 12.30 in the groups. In the case of sequential implantation, smaller on-air and higher coil off values were observed with the second CI. In the case of simultaneous bilateral implantation, data logging measurements were almost the same in both implants. WRS was significantly correlated (p < 0.05) with on-air time (r = 0.62), coil-off count (r = -0.48), chronological age (r = 0.48), and CI duration (r = 0.44). Multiple linear regression model was fit to predict the WRS, with on-air time, CI duration, and chronological age as predictors.

CONCLUSIONS

The critical importance of early intervention and long-term use of CI is well-established in the literature and is also corroborated by our findings. However, the key findings of the present study are that consistent CI use and the quality of daily listening environment also exerted a major and positive effect on the speech recognition performance of pediatric CI users. Therefore, during the monitoring of pediatric CI recipients, it is important to know the device usage data in order to detect problems in the early stages after CI.

Acoustic and Aerodynamic Analyses of the Voice of Prelingually Deaf Young Men After Cochlear Implantation

OBJECTIVE

The purpose of this study was to characterize the acoustic and aerodynamics of the voice of young men with prelingual deafness after cochlear implantation (CI) to provide a theoretical basis for their rehabilitation after CI.

METHODS

The CI group included 17 young men with prelingual deafness who implanted cochlear at 18-24 years old. The control group included 17 normally hearing young men at the same age. The 10-item Voice Handicap Index, acoustic parameters, and aerodynamic parameters were evaluated.

RESULTS

For the acoustic parameters, the F0, SDF0, and Jitter of the CI group were higher than those of the Control group, and these differences were statistically significant. Additionally, The difference in mean shimmer and mean NHR values between the CI group and the Control group was not statistically significant For the aerodynamic parameters, the subglottal pressure and aerodynamic power of the CI group were significantly higher than those of the Control group, whereas the MPT was significantly shorter.

DISCUSSION

Due to excessive stress on the laryngeal muscle and limited pneumo-phono-articulatory coordination, the young men in the CI group had a thin voice and poor voice control and muscle coordination, and they exhibited excessive laryngeal resistance. We propose that after CI, in addition to regular hearing and speech rehabilitation, voice training is also extremely important for prelingually deaf young men.

Systematic Analysis of Environmental Chemicals That Dysregulate Critical Period Plasticity-Related Gene Expression Reveals Common Pathways That Mimic Immune Response to Pathogen

The tens of thousands of industrial and synthetic chemicals released into the environment have an unknown but potentially significant capacity to interfere with neurodevelopment. Consequently, there is an urgent need for systematic approaches that can identify disruptive chemicals. Little is known about the impact of environmental chemicals on critical periods of developmental neuroplasticity, in large part, due to the challenge of screening thousands of chemicals. Using an integrative bioinformatics approach, we systematically scanned 2001 environmental chemicals and identified 50 chemicals that consistently dysregulate two transcriptional signatures of critical period plasticity. These chemicals included pesticides (e.g., pyridaben), antimicrobials (e.g., bacitracin), metals (e.g., mercury), anesthetics (e.g., halothane), and other chemicals and mixtures (e.g., vehicle emissions). Application of a chemogenomic enrichment analysis and hierarchical clustering across these diverse chemicals identified two clusters of chemicals with one that mimicked an immune response to pathogen, implicating inflammatory pathways and microglia as a common chemically induced neuropathological process. Thus, we established an integrative bioinformatics approach to systematically scan thousands of environmental chemicals for their ability to dysregulate molecular signatures relevant to critical periods of development.

A Ten-Year Review of Audiological Performance in Children with Inner Ear Abnormalities after Cochlear Implantation in Singapore

Objectives

To evaluate children with inner ear malformations following cochlear implantation (CI) in a tertiary pediatric hospital in Singapore to identify factors influencing outcomes after CI.

Methods

This is a retrospective cohort study of children aged 0 to 18 years, who had CI between 2000 and 2013. Demographic information, data on risk factors, type of inner ear malformation (IEM), age at implantation, speech pre- and postimplantation, and duration of follow-up were collected from clinical records. Operative details and audiological outcomes were also analyzed.

Results

A total of 70 children underwent 83 CI surgeries. The mean age of the patients was 4.05 ± 3.17 years (range 1–18 years). Twenty patients (28.57%) had abnormal CT scan findings. CSF gusher occurred in 15 out of 26 CI (57.69%) in the group with IEM. Nine out of twenty patients (45.00%) had poor IT-MAIS scores prior to implantation. The average preoperative IT-MAIS score for children with anomalous inner ear anatomy was 14.1. The older CI patients, 3/20 (15.00%), mean age 8.33 years (range 7–10 years), were mostly referred for persistently unclear speech following hearing aids. Eleven patients (55.00%) had good speech and aided hearing threshold within speech limits after CI and were eligible for reintegration into mainstream schools. Five patients (25.00%) had improvement in speech but continued to receive education in special schools. Four patients (20.00%) had poor progress after surgery.

Conclusion

The presence of absent cochlear nerve, electrode folding, and underlying neurological disorders seemed to be associated with poorer outcomes.

Functional Outcomes in Cochleostomy and Round Window Insertion Technique: Difference or No Difference?

With the introduction and rapid development of Cochlear Implants since the 1970s, there has been marked improvement in the speech recognition and spoken language skills of the implanted profoundly deaf children. The cochlear implant can be done by means of different techniques, traditionally by Cochleostomy method and round window membrane (RWM) insertion technique. Post operatively, the functional outcomes are measured by many scores more commonly by Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) scores. To study the speech and hearing perception skills in pediatric cases of Congenital non syndromic bilateral profound sensorineural hearing loss after Cochleostomy and Round Window Insertion technique of Cochlear Implantation. 31 patients clinically diagnosed as congenital non syndromic bilateral profound sensorineural hearing loss who had undergone Cochlear implantation either by Cochleostomy or by RWM insertion technique and fulfilling the eligibility criteria were enrolled for study. Post operatively functional outcomes were assessed subjectively by measuring CAP and SIR scores. All the patients showed increase in their CAP and SIR scores post-operatively, measured at 03 months, 06 months and 01 year after Cochlear Implantation. The mean CAP and SIR scores in the two groups were comparable at 03 months, 06 months and 1 year after surgery. There was no significant difference in the speech and hearing perception skills of post implantees in the two groups (p value < 0.05). There is no difference in functional outcomes of Cochlear implantation by Cochleostomy and round window membrane insertion technique.

Effects of Age at Cochlear Implantation on Vocabulary and Grammar: A Review of the Evidence

Purpose The increasing prevalence of pediatric cochlear implantation over the past 25 years has left little doubt that resulting improvements in hearing offer significant benefits to language development for many deaf children. Furthermore, given the documented importance of access to language from birth, there has been strong support for providing congenitally deaf children with implants as early as possible. Earliest implantation, in many ways, has become the "gold standard" in pediatric cochlear implantation, on the assumption that it is the key to language development similar to that of hearing children. Empirical evidence to support this assumption, however, appears more equivocal than generally is believed. This article reviews recent research aimed at assessing the impact of age at implantation on vocabulary and grammatical development among young implant users. Method Articles published between 2003 and 2018 that included age at implantation as a variable of interest and in which it was subjected to statistical analysis were considered. Effect sizes were calculated whenever possible; we conducted a multivariate meta-analysis to compare outcomes in different language domains. Results Taken together, findings from 49 studies suggest that age at implantation is just one of a host of variables that influence vocabulary and grammatical development, its impact varying with several factors including whether age at implantation is treated as a dichotomous or continuous variable. Results from a meta-analysis showed significant differences across language domains. Conclusion The pattern of results obtained indicates the importance of considering various child, family, and environmental characteristics in future research aimed at determining how early "early implantation" needs to be and the extent to which age at implantation, duration of implant use, and other factors influence language and language-related outcomes. Supplemental Material https://doi.org/10.23641/asha.9789041.

Validation of the Persian version of the LittlEARS® auditory questionnaire for assessment of auditory development in children with normal hearing

OBJECTIVES

To adapt the LittlEARS^® Auditory Questionnaire into Persian and evaluate the psychometric properties of the Persian version of the questionnaire for children with normal hearing.

METHODS

A "back-translation" method was used to translate and adapt the LittlEARS Auditory Questionnaire into Persian. The translated version was first evaluated by means of an expert-appraisal method. After having improved the Persian version of LittlEARs with the results obtained from that evaluation, various psychometric analyses were carried out to determine the validity and reliability. A group of 240 Persian speaking parents of children below 24 months of age with normal hearing completed the LittlEARS^® Auditory Questionnaire. Various psychometric analyses (scale analysis and item analysis) were conducted.

RESULTS

In the current study, the following scale and item characteristics were investigated: Corrected item-total correlations ranged from 0.14 to 0.74; Cronbach's alpha coefficient value was 0.960; the split-half reliability r was 0.734; predictive accuracy Guttman's lambda was 0.965; the correlation between the overall score and age of the children was 0.808 (p < 0.001). The regression curve, which reflects the age-dependence of auditory behavior, was produced. The regression analysis that was conducted to obtain normative data showed that 80% of the variance in the total scores could be explained by age.

CONCLUSION

The data obtained from psychometric analysis support the use of the Persian version of the LittlEARS Auditory Questionnaire as a reliable and valid tool to assess the development of auditory behavior in Persian speaking children who are 24 months old or younger.

Theoretical Evaluation and Experimental Validation of Localized Therapeutic Hypothermia Application to Preserve Residual Hearing After Cochlear Implantation

OBJECTIVES

Cochlear implantation surgery has been shown to result in trauma to inner ear sensory structures, resulting in loss of residual hearing. Localized therapeutic hypothermia has been shown in clinical care to be a neuroprotective intervention. Previously, we have shown in an experimental model that localized hypothermia protects cochlear hair cells and residual hearing function against surgical and cochlear implantation trauma. Using experimental temperature measurements carried out in human cadaver temporal bones and a finite element model of the inner ear, the present study examined the temperature distribution of a custom-designed hypothermia delivery system in the human inner ear organs.

DESIGN

The efficacy of the hypothermia probe and resulting heat distribution across human cochlea and surrounding tissues were modeled in three-dimensional in COMSOL. The geometry and dimensions of inner ear and temporal bones were derived from computed tomographic and magnetic resonance imaging images. Model predictions were compared with experimental observations from five human temporal bones.

RESULTS

In both the modeling and experimental studies, the cochlear temperature was lowered by 4 to 6 °C on the round window from a baseline of 37 °C within 16 to 18 minutes. The model simulations showed uniformly distributed cooling across the cochlea. This study provides insight for design, operation, and protocols for efficacious delivery of mild therapeutic hypothermia to the human cochlea that may significantly benefit patients undergoing surgical cochlear implantation by preserving residual hearing.

CONCLUSION

There was a close correlation between the results of the numerical simulations and experimental observations in this study. Our custom-designed system is capable of effectively providing mild therapeutic hypothermia locally to the human cochlea. When combined with results from in vivo animal experiments, the present study suggests that the application of localized therapeutic hypothermia may hold potential for patients with an aim to preserve residual hearing after cochlear implantation.

Mutation screening in non-syndromic hearing loss patients with cochlear implantation by massive parallel sequencing in Taiwan

Objectives

To explore the molecular epidemiology of rare deafness genes in Taiwanese sensorineural hearing impairment (SNHI) patients with cochlear implantation (CI) by performing massive parallel sequencing (MPS) and correlating genetic factors and CI outcomes.

Methods

We enrolled 41 Taiwanese non-syndromic deafness patients with CI that lacked known mutations in common deafness genes. All probands were screened by a targeted exon amplification method that used massively parallel sequencing to screen a customized panel that included 40 relatively rare non-syndromic deafness genes.

Results

Thirteen candidate variants in nine relatively rare deafness genes (MYO15A, TMC1, MYH14, MYO3A, ACTG1, COL11A2, DSPP, GRHL2, and WFS1) were identified in 24.4% (10/41) of the non-syndromic deafness probands with CI. According to the ACMG Standards and Guidelines, five variants in MYO15A and ACTG1 were classified as likely pathogenic variants. Two of three multi-generational pedigrees exhibiting deafness were analyzed for the segregation of the disorder with the possible disease-causing variants. Patients with variants detected in most of the identified variant-bearing genes showed relatively good CI outcomes.

Conclusions

We successfully identified candidate variants in partially deaf Taiwanese probands who lacked the known mutations in common deafness genes. Comparing the progress of hearing rehabilitation in CI patients with their apparent causative variants and the expression profiles of their altered genes allowed us to speculate on how alterations in specific gene sets may influence outcomes in hearing rehabilitation after CI.

A tonal-language benefit for pitch in normally-hearing and cochlear-implanted children

In tonal languages, voice pitch inflections change the meaning of words, such that the brain processes pitch not merely as an acoustic characterization of sound but as semantic information. In normally-hearing (NH) adults, this linguistic pressure on pitch appears to sharpen its neural encoding and can lead to perceptual benefits, depending on the task relevance, potentially generalizing outside of the speech domain. In children, however, linguistic systems are still malleable, meaning that their encoding of voice pitch information might not receive as much neural specialization but might generalize more easily to ecologically irrelevant pitch contours. This would seem particularly true for early-deafened children wearing a cochlear implant (CI), who must exhibit great adaptability to unfamiliar sounds as their sense of pitch is severely degraded. Here, we provide the first demonstration of a tonal language benefit in dynamic pitch sensitivity among NH children (using both a sweep discrimination and labelling task) which extends partially to children with CI (i.e., in the labelling task only). Strong age effects suggest that sensitivity to pitch contours reaches adult-like levels early in tonal language speakers (possibly before 6 years of age) but continues to develop in non-tonal language speakers well into the teenage years. Overall, we conclude that language-dependent neuroplasticity can enhance behavioral sensitivity to dynamic pitch, even in extreme cases of auditory degradation, but it is most easily observable early in life.

Bimodal Cochlear Implant Listeners' Ability to Perceive Minimal Audible Angle Differences

BACKGROUND

Bilateral inputs should ideally improve sound localization and speech understanding in noise. However, for many bimodal listeners [i.e., individuals using a cochlear implant (CI) with a contralateral hearing aid (HA)], such bilateral benefits are at best, inconsistent. The degree to which clinically available HA and CI devices can function together to preserve interaural time and level differences (ITDs and ILDs, respectively) enough to support the localization of sound sources is a question with important ramifications for speech understanding in complex acoustic environments.

PURPOSE

To determine if bimodal listeners are sensitive to changes in spatial location in a minimum audible angle (MAA) task.

RESEARCH DESIGN

Repeated-measures design.

STUDY SAMPLE

Seven adult bimodal CI users (28-62 years). All listeners reported regular use of digital HA technology in the nonimplanted ear.

DATA COLLECTION AND ANALYSIS

Seven bimodal listeners were asked to balance the loudness of prerecorded single syllable utterances. The loudness-balanced stimuli were then presented via direct audio inputs of the two devices with an ITD applied. The task of the listener was to determine the perceived difference in processing delay (the interdevice delay [IDD]) between the CI and HA devices. Finally, virtual free-field MAA performance was measured for different spatial locations both with and without inclusion of the IDD correction, which was added with the intent to perceptually synchronize the devices.

RESULTS

During the loudness-balancing task, all listeners required increased acoustic input to the HA relative to the CI most comfortable level to achieve equal interaural loudness. During the ITD task, three listeners could perceive changes in intracranial position by distinguishing sounds coming from the left or from the right hemifield; when the CI was delayed by 0.73, 0.67, or 1.7 msec, the signal lateralized from one side to the other. When MAA localization performance was assessed, only three of the seven listeners consistently achieved above-chance performance, even when an IDD correction was included. It is not clear whether the listeners who were able to consistently complete the MAA task did so via binaural comparison or by extracting monaural loudness cues. Four listeners could not perform the MAA task, even though they could have used a monaural loudness cue strategy.

CONCLUSIONS

These data suggest that sound localization is extremely difficult for most bimodal listeners. This difficulty does not seem to be caused by large loudness imbalances and IDDs. Sound localization is best when performed via a binaural comparison, where frequency-matched inputs convey ITD and ILD information. Although low-frequency acoustic amplification with a HA when combined with a CI may produce an overlapping region of frequency-matched inputs and thus provide an opportunity for binaural comparisons for some bimodal listeners, our study showed that this may not be beneficial or useful for spatial location discrimination tasks. The inability of our listeners to use monaural-level cues to perform the MAA task highlights the difficulty of using a HA and CI together to glean information on the direction of a sound source.

The maxillary nerve block for in-office hybrid balloon sinus dilation procedures: A preliminary study

Transitioning of rhinologic procedures from the operating room to the office setting in selected patients is a rising trend. An effective pain-control, patient-preparation protocol is essential, especially with advanced in-office rhinologic procedures such as hybrid balloon sinus dilation (BSD), in which other procedures such as ethmoidectomy, turbinate reduction, and other procedures are concomitantly performed. A regimen using oral sedation, topical tetracaine gel, topical tetracaine/epinephrine-soaked cottonoid packs, and intranasal local infiltrative anesthesia can vary significantly in effectiveness and be suboptimal at times (as determined by using treated patients as historical controls). A modification of this regimen was subsequently used, incorporating the maxillary nerve block, and qualitative differences were then assessed retrospectively between the two regimens. Twenty-five consecutive patients were retrospectively studied who underwent hybrid BSD procedures in the office setting using the maxillary nerve-block regimen modification. All patients underwent BSD of the sphenoid, frontal, and maxillary sinuses with anterior and partial posterior ethmoidectomies. Five patients also underwent septoplasty, and 18 patients underwent inferior turbinate reduction procedures. Twenty-four patients received oral sedation, and all patients received topical tetracaine/epinephrine-soaked cottonoid packs. The topical tetracaine gel was dropped after 5 patients because it was not felt to be needed anymore. No intranasal local infiltrative anesthesia was used. Several qualitative differences were observed after modifying the patient-preparation regimen incorporating the maxillary nerve block. The most important observation seen with this modification was a consistently reproducible, dense anesthesia coverage over the entire nasal cavity with good paranasal sinus coverage. This modification eliminated intranasal bleeding and swelling associated with intranasal local anesthetic injections. No complications were encountered. This preliminary study provides support for use and further evaluation of the maxillary nerve block for in-office rhinologic procedures. If the trend continues to rise in performing advanced in-office rhinologic procedures in selected patients, the maxillary nerve block may find a place in the patient-preparation protocol.

Outcome of Cochlear Implantation in Prelingually Deafened Children According to Molecular Genetic Etiology

OBJECTIVES

About 60% of Korean pediatric cochlear implantees could be genetically diagnosed (GD) and we previously reported that a substantial portion of undiagnosed cases by deafness gene panel sequencing were predicted to have a nongenetic or complex etiology. We aimed to compare the outcomes of cochlear implantation (CI) in GD and genetically undiagnosed (GUD) patients and attempted to determine CI outcomes according to etiology.

DESIGN

Ninety-three pediatric cochlear implantees underwent molecular genetic testing. Fifty-seven patients carried pathogenic variants and 36 patients remained GUD after panel sequencing of 204 known or potential deafness genes (TRS-204). Among them, 55 cochlear implantees with reliable speech evaluation results with a follow-up of longer than 24 months were recruited. Longitudinal changes in the audiologic performance were compared between the GD (n = 31) and GUD (n = 24) groups. The GD group was subdivided into cochlear implantee with SLC26A4 mutations (group 1) and cochlear implantee with other genetic etiology (group 2), and the GUD group was subdivided into groups 3 and 4, that is, patients with or without inner ear anomaly, respectively.

RESULTS

Group 1 related to SLC26A4 mutations had the highest categories of auditory perception scores among all groups pre- and postoperatively. Group 4 with inner ear anomaly had the lowest categories of auditory perception scores. At 24 months post-CI, the group 2 with another genetic etiology had significantly better outcomes than molecularly undiagnosed group 3, which had with the same condition as group 2 except that the candidate gene was not detected. This finding was recapitulated when we limited cases to those that underwent CI before 24 months of age to minimize age-related bias at implantation. Furthermore, on extending the follow-up to 36 months postoperatively, this tendency became more prominent. Additionally, our preliminary clinical data suggest a narrower sensitive window period for good CI outcomes for implantees with OTOF mutation rather than the GJB2 and other genes.

CONCLUSIONS

Current molecular genetic testing including deafness panel sequencing helps to predict the 2-year follow-up outcomes after CI in prelingually deafened children. GD cochlear implantees show better functional outcomes after CI than undiagnosed cochlear implantees as determined by deafness panel sequencing, suggesting a genotype-functional outcome correlation. The genetic testing may provide a customized optimal window period in terms of CI timing for favorable outcome according to genetic etiology.

Cochlear implantation in children with auditory neuropathy spectrum disorder: A multicenter study on auditory performance and speech production outcomes

OBJECTIVES

To evaluate the auditory performance and speech production outcome in children with auditory neuropathy spectrum disorder (ANSD). The effect of age on the outcomes of the surgery at the time of implantation was also evaluated.

METHODS

Cochlear implantation was performed in 136 children with bilateral severe-to- profound hearing loss due to ANSD, at four tertiary academic centers. The patients were divided into two groups based on the age at the time of implantation; Group I: Children ≤24 months, and Group II: subjects >24 months. The categories of auditory performance (CAP) and speech intelligibility rating (SIR) scores were evaluated after the first and second years of implantation. The differences between the CAP and SIR scores in the two groups were assessed.

RESULTS

The median CAP scores improved significantly after the cochlear implantation in all the patients (p value < 0.001). The improvement in the CAP scores during the first year in Group II was greater than Group I (p value: 0.007), but the improvement in CAP scores tended to be significantly higher in patients who were implanted at ≤24 months (p value < 0.001). There was no significant difference between two groups in SIR scores at first-year and second-year follow-ups. The evaluation of the SIR improvement revealed significantly higher values for Group I during the second-year follow-up (p value: 0.003).

CONCLUSION

The auditory performance and speech production skills of the children with ANSD improved significantly after cochlear implantation, and this improvement was affected by age at the time of implantation.

Plasticity after pediatric cochlear implantation: Implication from changes in peripheral plasma level of BDNF and auditory nerve responses

INTRODUCTION

Sensory neural hearing loss could lead to some structural and physiological changes in the auditory pathways, such as alteration in the expression of neurotrophins. These factors, especially Brain-Derived Neurotrophic Factor (BDNF), play an important role in synaptic functions and experience-related plasticity. Restoring cochlear function after hearing loss is possible through cochlear implantation (CI). Evaluation of the blood concentration changes of neurotrophins as prerequisites of plasticity could help scientists to determine the prognosis of CI as in the candidacy procedure or enhancing prosthesis function by adding the exact needed amount of BDNF to the electrode array.

METHODS

Here we have studied the plasma BDNF concentration before CI surgery and 6 months after using CI device in 15 pediatric CI recipients and compared this level with changes of BDNF concentration in 10 children who were using hearing aid (H.A). In addition, we searched for a possible correlation between post-surgery plasma BDNF concentration and electrical compound action potential (ECAP) and comfort-level (C-level) thresholds.

RESULTS

Plasma BDNF concentration in children with CI increased significantly after CI surgery, while this difference in H.A group was not significant. Analysis of repeated measures of ECAP and C-level thresholds in CI group showed that there were some kinds of steadiness during follow- up sessions for ECAP thresholds in basal and E16 of middle electrodes, whereas C-level thresholds for all selected electrodes increased significantly up to six months follow-up. Interestingly, we did not find any significant correlation between post-surgery plasma BDNF concentration and ECAP or C-level threshold changes.

CONCLUSION

It is concluded that changes in C-level threshold and steady state of ECAP thresholds and significant changes in BDNF concentration could be regarded as an indicator of experienced-related plasticity after CI stimulation.

A comparison of speech intonation production and perception abilities of Farsi speaking cochlear implanted and normal hearing children

INTRODUCTION

Cochlear implant prosthesis facilitates spoken language development and speech comprehension in children with severe-profound hearing loss. However, this prosthesis is limited in encoding information about fundamental frequency and pitch that are essentially for recognition of speech prosody. The purpose of the present study is to investigate the perception and production of intonation in cochlear implant children and comparison with normal hearing children.

METHOD

This study carried out on 25 cochlear implanted children and 50 children with normal hearing. First, using 10 action pictures statements and questions sentences were extracted. Fundamental frequency and pitch changes were identified using Praat software. Then, these sentences were judged by 7 adult listeners. In second stage 20 sentences were played for child and he/she determined whether it was in a question form or statement one.

RESULTS

Performance of cochlear implanted children in perception and production of intonation was significantly lower than children with normal hearing. The difference between fundamental frequency and pitch changes in cochlear implanted children and children with normal hearing was significant (P < 0/05). Cochlear implanted children performance in perception and production of intonation has significant correlation with child's age surgery and duration of prosthesis use (P < 0/05).

DISCUSSION

The findings of the current study show that cochlear prostheses have limited application in facilitating the perception and production of intonation in cochlear implanted children. It should be noted that the child's age at the surgery and duration of prosthesis's use is important in reduction of this limitation. According to these findings, speech and language pathologists should consider intervention of intonation in treatment program of cochlear implanted children.

Breaking the sound barrier: exploring parents' decision-making process of cochlear implants for their children

OBJECTIVE

To understand the dynamic experiences of parents undergoing the decision-making process regarding cochlear implants for their child(ren).

METHODS

Thirty-three parents of d/Deaf children participated in semi-structured interviews. Interviews were digitally recorded, transcribed, and coded using iterative and thematic coding.

RESULTS

The results from this study reveal four salient topics related to parents' decision-making process regarding cochlear implantation: 1) factors parents considered when making the decision to get the cochlear implant for their child (e.g., desire to acculturate child into one community), 2) the extent to which parents' communities influence their decision-making (e.g., norms), 3) information sources parents seek and value when decision-making (e.g., parents value other parent's experiences the most compared to medical or online sources), and 4) personal experiences with stigma affecting their decision to not get the cochlear implant for their child.

CONCLUSION

This study provides insights into values and perspectives that can be utilized to improve informed decision-making, when making risky medical decisions with long-term implications.

PRACTICAL IMPLICATIONS

With thorough information provisions, delineation of addressing parents' concerns and encompassing all aspects of the decision (i.e., medical, social and cultural), health professional teams could reduce the uncertainty and anxiety for parents in this decision-making process for cochlear implantation.

Cochlear implants in children: A cross-sectional investigation on the influence of geographic location in Saudi Arabia

INTRODUCTION:

The role of the family in detecting a child's hearing difficulty and the age at which an implantation is done have been identified as strong predictors of the outcomes of pediatric cochlear implantation. In the absence of screening programs for hearing loss in Saudi neonates, the family's role is of paramount importance. The aim of this study was to investigate the influence of geographic location on the course of identification, examination, and cochlear implantation in children in Saudi Arabia.

MATERIALS AND METHODS:

Pediatric patients who had received either unilateral or bilateral cochlear implantation at King Abdulaziz University Hospital in Riyadh, Saudi Arabia, between January 1, 2012, and December 31, 2014, were surveyed.

RESULTS:

A total of 156 pediatric patients have had a cochlear implant between January 1, 2012, and December 31, 2014. The one-way analysis of variance test to compare the means of the independent sample groups in various geographic zones showed that with a hundred percent access to primary health care, the geographic location of the population had an influence on the detection of hearing loss but not on the cochlear implantation.

CONCLUSION:

This study found that the geographic location of the population has an influence on the time of detection of hearing loss in children but not on the time of cochlear implantation. Raising parental awareness of the importance of early detection of hearing loss is necessary. Further research is also required to define the role of factors such as the income and the educational level of parents on the early detection of neonatal hearing loss.

Clinical outcomes following cochlear implantation in children with inner ear anomalies

OBJECTIVE

A significant proportion of children with congenital hearing loss who are candidates for cochlear implants (CIs) may have inner ear malformations (IEMs). Surgical and speech outcomes following CI in these children have not been widely reported.

METHODS

The charts of children who were evaluated for a CI between 1/1/1986 and 12/31/2014 at a university-based tertiary level pediatric cochlear implant center were reviewed. Principal inclusion criteria included (i) age 1-18 years, (ii) history of bilateral severe to profound sensorineural hearing loss, and (iii) limited benefit from binaural amplification. Exclusion criteria included (i) underlying diagnosis of neurodevelopmental disorder and (ii) lack of follow up for speech assessment if a CI was performed. The following outcome measures were reviewed: (i) imaging findings with magnetic resonance imaging or high resolution computed tomography, (ii) intraoperative complications, and (iii) speech perception categorized as the ability to perceive closed set, open set, or none.

RESULTS

The prevalence of IEMs was 27% (102 of 381), of which 79% were bilateral. Cochlear dysplasia accounted for 30% (40 of 136) of the anomalies. Seventy-eight of the 102 patients received a CI (78%). Surgery was noted to be challenging in 24% (19 of 78), with a perilymphatic gusher being the most common intraoperative finding. Cochlear dysplasia, vestibular dysplasia and cochlear nerve hypoplasia were associated with poor speech perception (open OR closed set speech recognition scores, 0-23%), although the outcomes in children with enlarged vestibular aqueduct were similar to those of children with normal inner ear anatomy (65%).

CONCLUSIONS

Cochlear implantation is safe in children with IEMs. However, the speech perception outcomes are notably below those of patients with normal anatomy, with the exception of when an enlarged vestibular aqueduct is present.

Integrative Analysis of Disease Signatures Shows Inflammation Disrupts Juvenile Experience-Dependent Cortical Plasticity

Throughout childhood and adolescence, periods of heightened neuroplasticity are critical for the development of healthy brain function and behavior. Given the high prevalence of neurodevelopmental disorders, such as autism, identifying disruptors of developmental plasticity represents an essential step for developing strategies for prevention and intervention. Applying a novel computational approach that systematically assessed connections between 436 transcriptional signatures of disease and multiple signatures of neuroplasticity, we identified inflammation as a common pathological process central to a diverse set of diseases predicted to dysregulate plasticity signatures. We tested the hypothesis that inflammation disrupts developmental cortical plasticity in vivo using the mouse ocular dominance model of experience-dependent plasticity in primary visual cortex. We found that the administration of systemic lipopolysaccharide suppressed plasticity during juvenile critical period with accompanying transcriptional changes in a particular set of molecular regulators within primary visual cortex. These findings suggest that inflammation may have unrecognized adverse consequences on the postnatal developmental trajectory and indicate that treating inflammation may reduce the burden of neurodevelopmental disorders.

Classroom Performance of Children with Cochlear Implants in Mainstream Education

Objectives:

We compared classroom performance of children with a cochlear implant (CI) with that of their normal-hearing peers in mainstream education.

Methods:

Thirty-two CI children in mainstream education, congenitally or prelingually deaf, participated in this study, as did 37 hearing classmates. Their teachers filled out 2 questionnaires: the Assessment of Mainstream Performance (AMP) and the Screening Instrument for Targeting Educational Risk (SIFTER). A high Fletcher index and open-set speech perception scores were obtained.

Results:

The children with CIs scored above average on the AMP and sufficiently well in all but one area (communication) of the SIFTER questionnaire. Class rankings did not differ significantly between the CI students and their normal-hearing peers. Overall, the normal-hearing group outperformed the CI group. The classroom performance of CI children correlated negatively with duration of deafness and age at implantation. All longitudinal audiological data of the CI children showed improvement in open-set speech recognition.

Conclusions:

Although the results are encouraging, the CI group scored significantly less well than their normal-hearing peers on most questionnaire domains of both the AMP and the SIFTER. The most important variables for the outcome in this study were age at implantation and duration of deafness.

Production and evaluation of a Spanish version of the LittlEARS(®) Auditory Questionnaire for the assessment of auditory development in children

BACKGROUND AND AIMS

To adapt the LittlEARS(®) Auditory Questionnaire (LEAQ) into Spanish and evaluate the psychometric properties of the Spanish version of the questionnaire.

METHODS

The LEAQ was translated into Spanish by a back-translation design. Following the Guidelines for Adapting Tests of the International Test Commission (ITC), for the first time with the LEAQ adaptations, two qualitative methods were used to evaluate the translated version of the LEAQ: an expert appraisal method followed by cognitive interviewing. Having improved the Spanish version of the LEAQ with these evaluations, a psychometric analysis was conducted. 215 parents of children with normal hearing aged between 1.7 and 24.0 months participated in the study. Corrected item-total correlations were calculated to analyze to what extent items distinguish levels of auditory development of assessed children. Cronbach's alpha coefficient - to evaluate internal consistency across items - was also calculated. To obtain validity evidence, correlations between item-total score and age were calculated. A non-linear regression model was also estimated to obtain normative data for expected and minimum value of total scores from the questionnaire according to age.

RESULTS

Expert appraisal and cognitive interviewing pointed out some translation errors and difficulties parents had while responding to the Spanish LEAQ. Such errors and difficulties were fixed in the Spanish LEAQ version applied for psychometric analysis. Corrected item-total correlations ranged from 0.15 to 0.75. Cronbach's alpha coefficient value was 0.92, indicating that the measurements are highly reliable. The value of the correlation between total scores and age was 0.86 (p<001). The regression analysis conducted to obtain normative data shows that 79% of the variation in the total scores can be explained by age.

CONCLUSIONS

The results of psychometric analyses provide evidence supporting the use of the Spanish version of the LEAQ as a valid and culturally appropriate tool to assess the development of auditory behaviour in Spanish children who are 24 months old or younger.

Deficits in the Sensitivity to Pitch Sweeps by School-Aged Children Wearing Cochlear Implants

Sensitivity to static changes in pitch has been shown to be poorer in school-aged children wearing cochlear implants (CIs) than children with normal hearing (NH), but it is unclear whether this is also the case for dynamic changes in pitch. Yet, dynamically changing pitch has considerable ecological relevance in terms of natural speech, particularly aspects such as intonation, emotion, or lexical tone information. Twenty one children with NH and 23 children wearing a CI participated in this study, along with 18 NH adults and 6 CI adults for comparison. Listeners with CIs used their clinically assigned settings with envelope-based coding strategies. Percent correct was measured in one- or three-interval two-alternative forced choice tasks, for the direction or discrimination of harmonic complexes based on a linearly rising or falling fundamental frequency. Sweep rates were adjusted per subject, in a logarithmic scale, so as to cover the full extent of the psychometric function. Data for up- and down-sweeps were fitted separately, using a maximum-likelihood technique. Fits were similar for up- and down-sweeps in the discrimination task, but diverged in the direction task because psychometric functions for down-sweeps were very shallow. Hits and false alarms were then converted into d′ and beta values, from which a threshold was extracted at a d′ of 0.77. Thresholds were very consistent between the two tasks and considerably higher (worse) for CI listeners than for their NH peers. Thresholds were also higher for children than adults. Factors such as age at implantation, age at profound hearing loss, and duration of CI experience did not play any major role in this sensitivity. Thresholds of dynamic pitch sensitivity (in either task) also correlated with thresholds for static pitch sensitivity and with performance in tasks related to speech prosody.

Functional near-infrared spectroscopy for neuroimaging in cochlear implant recipients

Functional neuroimaging can provide insight into the neurobiological factors that contribute to the variations in individual hearing outcomes following cochlear implantation. To date, measuring neural activity within the auditory cortex of cochlear implant (CI) recipients has been challenging, primarily because the use of traditional neuroimaging techniques is limited in people with CIs. Functional near-infrared spectroscopy (fNIRS) is an emerging technology that offers benefits in this population because it is non-invasive, compatible with CI devices, and not subject to electrical artifacts. However, there are important considerations to be made when using fNIRS to maximize the signal to noise ratio and to best identify meaningful cortical responses. This review considers these issues, the current data, and future directions for using fNIRS as a clinical application in individuals with CIs. This article is part of a Special Issue entitled <Annual Reviews 2016>.

Schooling Relates to Mental Health Problems in Adolescents with Cochlear Implants-Mediation by Hearing and Family Variables

Aim of this multicenter study was to investigate whether schooling relates to mental health problems of adolescents with cochlear implants (CI) and how this relationship is mediated by hearing and family variables. One hundred and forty secondary school students with CI (mean age = 14.7 years, SD = 1.5), their hearing parents and teachers completed the Strengths and Difficulties Questionnaire (SDQ). Additional audiological tests (speech comprehension tests in quiet and noise) were performed. Students of special schools for hearing impaired persons (SSHIs) showed significantly more conduct problems (p < 0.05) and a significantly higher total difficulty score (TDS) (p < 0.05) compared to students of mainstream schools. Mental health problems did not differ between SSHI students with sign language education and SSHI students with oral education. Late implanted students and those with indication for additional handicaps were equally distributed among mainstream schools and SSHIs. However, students in SSHIs were more restricted to understand speech in noise, had a lower social background and were more likely to come from single-parent families. These factors were found to be partial mediators of the differences in mental health problems between the two school types. However, no variable could explain comprehensively, why students of SSHIs have more mental health problems than mainstream pupils.

A semi-supervised Support Vector Machine model for predicting the language outcomes following cochlear implantation based on pre-implant brain fMRI imaging

INTRODUCTION

We developed a machine learning model to predict whether or not a cochlear implant (CI) candidate will develop effective language skills within 2 years after the CI surgery by using the pre-implant brain fMRI data from the candidate.

METHODS

The language performance was measured 2 years after the CI surgery by the Clinical Evaluation of Language Fundamentals-Preschool, Second Edition (CELF-P2). Based on the CELF-P2 scores, the CI recipients were designated as either effective or ineffective CI users. For feature extraction from the fMRI data, we constructed contrast maps using the general linear model, and then utilized the Bag-of-Words (BoW) approach that we previously published to convert the contrast maps into feature vectors. We trained both supervised models and semi-supervised models to classify CI users as effective or ineffective.

RESULTS

Compared with the conventional feature extraction approach, which used each single voxel as a feature, our BoW approach gave rise to much better performance for the classification of effective versus ineffective CI users. The semi-supervised model with the feature set extracted by the BoW approach from the contrast of speech versus silence achieved a leave-one-out cross-validation AUC as high as 0.97. Recursive feature elimination unexpectedly revealed that two features were sufficient to provide highly accurate classification of effective versus ineffective CI users based on our current dataset.

CONCLUSION

We have validated the hypothesis that pre-implant cortical activation patterns revealed by fMRI during infancy correlate with language performance 2 years after cochlear implantation. The two brain regions highlighted by our classifier are potential biomarkers for the prediction of CI outcomes. Our study also demonstrated the superiority of the semi-supervised model over the supervised model. It is always worthwhile to try a semi-supervised model when unlabeled data are available.