The influence of age at implantation on performance with a cochlear implant in children

Perceived benefits of cochlear implants by parents: expectations, decision-making process, and barriers to care

BACKGROUND

Identifying predictive factors of the cochlear implant outcomes in pediatric patients is critical in guiding tailored rehabilitation programs. The study aimed to assess cochlear implant outcomes, identify predictors, and highlight decision-making factors and barriers to quality care.

METHODS

This cross-sectional study included parents of children who received unilateral cochlear implants for bilateral severe- to- deep sensorineural hearing loss. Inclusion criteria were age ≤ 5 years and intelligence quotient (IQ) Scores ≥ 85, A pre-designed structured questionnaire was used to collect data from parents/guardians of the children attending follow-up. The Arabic validated Glasgow Children Benefit Inventory score was used to assess the health-related quality of life (QOL) after intervention.

RESULTS

The quality of life (QOL) score (outcome) after surgery was positive in all cases. Multivariate analysis showed that the site of operation (Bahtim hospital and Ain Shams Hospital [AOR(95% confidence interval CI), 5.7 (1.4-23), 5 (1.4-17.9), p = 0.015, 0.013, respectively]), education of the father (university/postgraduate [AOR (95% CI): 5 (1.4-17.9), p = 0.013]), the parents' expectation that their child would be able to participate in regular classroom activities [AOR (95% CI): 8.9 (3.7-21.3), p < 0.001], and history of Attention deficit/hyperactivity disorder (ADHD), perinatal hypoxia, and low birth weight [AOR (95% CI): 2.5 (1.2-5.1), 3.7 (1.7-8.1), 4.7 (2.1-10.5), p = 0.013, 0.001, ≤ 0.001, respectively] are significant independent predictors of good outcome.

CONCLUSION

All parents expressed a positive change in their child's QOL. Almost all parents of children with cochlear implants face many barriers in obtaining quality healthcare services for their children. Parents, especially those with lower schooling, should receive good counselling to increase their confidence in their children's capabilities and maximize benefits of regular follow-up. Improving the quality of healthcare centers is recommended.

Association of Genetic Diagnoses for Childhood-Onset Hearing Loss With Cochlear Implant Outcomes

Importance

In the US, most childhood-onset bilateral sensorineural hearing loss is genetic, with more than 120 genes and thousands of different alleles known. Primary treatments are hearing aids and cochlear implants. Genetic diagnosis can inform progression of hearing loss, indicate potential syndromic features, and suggest best timing for individualized treatment.

Objective

To identify the genetic causes of childhood-onset hearing loss and characterize severity, progression, and cochlear implant success associated with genotype in a single large clinical cohort.

Design, Setting, and Participants

This cross-sectional analysis (genomics) and retrospective cohort analysis (audiological measures) were conducted from 2019 to 2022 at the otolaryngology and audiology clinics of Seattle Children's Hospital and the University of Washington and included 449 children from 406 families with bilateral sensorineural hearing loss with an onset younger than 18 years. Data were analyzed between January and June 2022.

Main Outcomes and Measures

Genetic diagnoses based on genomic sequencing and structural variant analysis of the DNA of participants; severity and progression of hearing loss as measured by audiologic testing; and cochlear implant success as measured by pediatric and adult speech perception tests. Hearing thresholds and speech perception scores were evaluated with respect to age at implant, months since implant, and genotype using a multivariate analysis of variance and covariance.

Results

Of 406 participants, 208 (51%) were female, 17 (4%) were African/African American, 32 (8%) were East Asian, 219 (54%) were European, 53 (13%) were Latino/Admixed American, and 16 (4%) were South Asian. Genomic analysis yielded genetic diagnoses for 210 of 406 families (52%), including 55 of 82 multiplex families (67%) and 155 of 324 singleton families (48%). Rates of genetic diagnosis were similar for children of all ancestries. Causal variants occurred in 43 different genes, with each child (with 1 exception) having causative variant(s) in only 1 gene. Hearing loss severity, affected frequencies, and progression varied by gene and, for some genes, by genotype within gene. For children with causative mutations in MYO6, OTOA, SLC26A4, TMPRSS3, or severe loss-of-function variants in GJB2, hearing loss was progressive, with losses of more than 10 dB per decade. For all children with cochlear implants, outcomes of adult speech perception tests were greater than preimplanted levels. Yet the degree of success varied substantially by genotype. Adjusting for age at implant and interval since implant, speech perception was highest for children with hearing loss due to MITF or TMPRSS3.

Conclusions and Relevance

The results of this cross-sectional study suggest that genetic diagnosis is now sufficiently advanced to enable its integration into precision medical care for childhood-onset hearing loss.

Outcomes of cochlear implantation in children with Usher syndrome: a long-term observation

PURPOSE

To evaluate auditory performance and speech intelligibility of children with Usher syndrome up to 10 years after cochlear implantation.

METHODS

Thirty-five children with USH were compared to 46 non-syndromic patients regarding age at implantation. Auditory performance and speech intelligibility was assessed with standard tools. Genetic counseling, vestibular tests, imaging studies, and ophthalmological findings were evaluated, depending on the availability.

RESULTS

The mean age of implantation in USH children was 6.3 years (SD 4.6, range 0.3-17.6 years). Post-implantation values of the studied parameters were compared between USH and NS children and presented as follows: PTA = 25.0 dB HL vs. 28.4, CAP = 5.3 vs. 5.1, SIR = 4.1 vs. 3.9, MAIS = 82.3% vs. 80.5%, MUSS = 81.8% vs. 76.6%. There were no statistically significant differences between the USH and NS groups (p > 0.005). USH patients reached a higher score ceiling earlier compared to NS patients. Children implanted before 3 years of age achieved significantly higher results than older children in USH and NS groups (p < 0.005). In all patients with USH, the electroretinogram was abnormal. Vestibular examination was abnormal in 29 of 31 patients with USH1. Imaging studies revealed no inner ear or auditory nerve anomalies in patients with USH.

CONCLUSION

Cochlear implantation successfully improves auditory performance and speech intelligibility in patients with USH, especially those implanted under 3 years of age. The electroretinogram is the only reliable test to establish a diagnosis of USH. Logopedic outcomes are associated with early implantation, and early diagnosis of USH contributes to optimizing speech therapy.

Consistency of Using an Auditory Prosthesis Device Post a Sequentially Implanted Cochlear Implant: Data-Logging Evidence

Objectives

The aim of this study was to explore: 1) the average use of each device in sequentially implanted cochlear implants; 2) whether the inter-implant duration between implants produced any significant difference in the average use of the second implant; and 3) whether wearing hearing aids before the implantation of the second cochlear implant affects its average use.

Materials and methods

The study included 20 participants with bilateral Nucleus 24 implants (Cochlear Corporation, Lone Tree, CO). Data regarding various variables were extracted and then analyzed with IBM SPSS Statistics for Mac, version 23 (IBM Corp., Armonk, NY).

Results

The pediatric group included 14 subjects (average age 7.5 years) while the adult group comprised six subjects (average age 37.5 years). The average use of the second device was 0.9 hours per day more than the first in the pediatric group while it was 1.22 hours per day more in the adult group. We also divided the subjects on the basis of duration between the first and second devices and calculated the average use of each device by them. There was no significant difference (p>0.05). The average use by subjects who did and did not use hearing aids before implantation was also insignificant (p>0.05).

Conclusions

No significant difference between the average use of the first and second implants, between the inter-implant duration of the first and second implants, the average use of the second implant, and between using hearing aids before the implantation of the second device and the average use was observed.

Understanding and treating paediatric hearing impairment

Sensorineural hearing impairment is the most frequent form of hearing impairment affecting 1-2 in 1000 newborns and another 1 in 1000 adolescents. More than 50% of congenital hearing impairment is of genetic origin and some forms of monogenic deafness are likely targets for future gene therapy. Good progress has been made in clinical phenotyping, genetic diagnostics, and counselling. Disease modelling, e.g. in transgenic mice, has helped elucidate disease mechanisms underlying genetic hearing impairment and informed clinical phenotyping in recent years. Clinical management of paediatric hearing impairment involves hearing aids, cochlear or brainstem implants, signal-to-noise improvement in educational settings, speech therapy, and sign language. Cochlear implants, for example, have much improved the situation of profoundly hearing impaired and deaf children. Nonetheless there remains a major unmet clinical need for improving hearing restoration. Preclinical studies promise that we will witness clinical trials on gene therapy and a next generation of cochlear implants during the coming decade. Moreover, progress in generating sensory hair cells and neurons from stem cells spurs disease modelling, drug screening, and regenerative approaches. This review briefly summarizes the pathophysiology of paediatric hearing impairment and provides an update on the current preclinical development of innovative approaches toward improved hearing restoration.

Treating the Individual Ear in Children: Results of Cochlear Implantation in Children With Asymmetric Sensory Hearing Loss

OBJECTIVE

Determine speech outcomes of children undergoing cochlear implantation with severe-to-profound hearing loss in the implanted ear and moderate or better hearing loss in nonimplanted ear.

STUDY DESIGN

Retrospective chart review.

SETTING

Tertiary referral center.

PATIENTS

Forty-nine children with severe-to-profound hearing loss in the ear to be implanted (pure-tone average), and no worse than moderate hearing loss in the nonimplant ear.

INTERVENTION

Subjects underwent cochlear implantation from 2007 and 2017 in the ear with severe-to-profound hearing loss.

MAIN OUTCOME MEASURES

Consonant Nucleus Consonant or Phonetically Balanced Kindergarten word scores pre- and postoperatively were compared in both the implanted ear and binaural setting. Comparisons were made between Phonetically Balanced Kindergarten scores pre- and postoperatively or Consonant Nucleus Consonant scores pre- and postoperatively.

RESULTS

The average pure-tone average for the implant ear was 92 ± 13 dB HL and 55 ± 12 dB HL in the nonimplant ear. Word scores for the implant ear increased an average of 58 (±27) % following cochlear implantation at 12 months and 62 (±20) % at 24 months. Binaural best-aided word scores increased an average of 36 (±29) % at 12 months and 49 (±24) % at 24 months.

CONCLUSION

Children with asymmetric sensory hearing loss should have each ear treated individually as significant benefits can be gained not only in the implanted ear, but also in binaural hearing.

The Effect of Age at Cochlear Implantation on Speech and Auditory Performances in Prelingually Deaf Children

To understand the effect of age at implantation on speech and auditory performances of 74 prelingually deaf Indian children after using cochlear implants for 3, 6 and 12 months. We also evaluate the causes of late implantation in this population. Seventy four children who underwent cochlear implantation from December 2013 to December 2015 in the Department of Otorhinolaryngology and Head Neck Cancer in SMS Medical College, Jaipur were participated in this study. To compare the efficacy of cochlear implant, candidates are classified into 2 groups according to the age at the time of implantation: 1-4 years and 4.1-7 years. The sample size is 37 in both age groups. Their auditory performance and speech intelligibility were rated using the Revised Categories of Auditory Perception scales, Speech Intelligibility Rating scales and Meaningful Auditory Integration Scale. The evaluations were made before implantation and 3, 6 and 12 months after implantation. The scores when compared in both the groups revealed that the results were comparable and significant after 12 months of follow up while the scores were not significant after 3 and 6 months. The results were statistically significant when baseline is compared with different postoperative stages. The children implanted before the age of 4 years had significantly better auditory and linguistic performances. At least 12 months of audio-verbal rehabilitation and speech and language therapy are required to compare the effects of cochlear implant in any set of children. Our study shows that hearing impaired children who receive cochlear implantation below 4 years of age acquires better auditory ability for developing language skills.

Long-term Outcomes in Down Syndrome Children After Cochlear Implantation: Particular Issues and Considerations

OBJECTIVE

The aim of the study was to analyze the long-term outcomes after cochlear implantation in deaf children with Down syndrome (DS) regarding age at the first implantation and refer the results to preoperative radiological findings as well as postoperative auditory and speech performance. Additionally, the influence of the age at implantation and duration of CI use on postoperative hearing and language skills were closely analyzed in children with DS.

STUDY DESIGN

Retrospective analysis.

SETTING

Referral center (Cochlear Implant Center).

MATERIALS AND METHODS

Nine children with Down syndrome were compared with 220 pediatric patients without additional mental disorders or genetic mutations. Patients were divided into four categories depending on the age of the first implantation: CAT1 (0-3 yr), CAT2 (4-5 yr), CAT3 (6-7 yr), and CAT4 (8-17 yr). The auditory performance was assessed with the meaningful auditory integration scales (MAIS) and categories of auditory performance (CAP) scales. The speech and language development were further evaluated with meaningful use of speech scale (MUSS) and speech intelligibility rating (SIR). The postoperative speech skills were analyzed and compared between the study group and the reference group by using nonparametric statistical tests. Anatomic abnormalities of the inner ear were examined using magnetic resonance imaging (MRI) and high-resolution computed tomography of the temporal bones (HRCT).

RESULTS

The mean follow-up time was 14.9 years (range, 13.1-18.3 yr). Patients with DS received a multichannel implant at a mean age of 75.3 months (SD 27.9; ranging from 21 to 127 mo) and 220 non-syndromic children from reference group at a mean age of 51.4 months (SD 34.2; ranging from 9 to 167 mo). The intraoperative neural response was present in all cases. The auditory and speech performance improved in each DS child. The postoperative mean CAP and SIR scores were 4.4 (SD 0.8) and 3.2 (SD 0.6), respectively. The average of scores in MUSS and MAIS/IT-MAIS scales was 59.8% (SD 0.1) and 76.9% (SD 0.1), respectively. Gathered data indicates that children with DS implanted with CI at a younger age (<6 years of age) benefited from the CI more than children implanted later in life, similarly in a control group. There were additional anomalies of the temporal bone, external, middle, or inner ear observed in 90% of DS children, basing on MRI or HRCT.

CONCLUSIONS

The early cochlear implantation in children with DS is a similarly useful method in treating severe to profound sensorineural hearing loss (SNHL) as in non-syndromic patients, although the development of speech skills present differently. Due to a higher prevalence of ear and temporal bone malformations, detailed diagnostic imaging should be taken into account before the CI qualification. Better postoperative outcomes may be achieved through comprehensive care from parents/guardians and speech therapists thanks to intensive and systematic rehabilitation.

Surgical timing for bilateral simultaneous cochlear implants: When is best?

INTRODUCTION

Hearing loss is considered the most common congenital disease and the prevalence of neonatal deafness can be estimated between 1 and 2 cases per 1000 live births. Infant deafness must be diagnosed as early as possible and an effective therapeutic intervention needs to be carried out in order to avoid the serious consequences of hearing deprivation during the evolutionary period: alterations in the development of central auditory pathways and lack of language acquisition. The cochlear implant (CI) has proved to be the best instrument to solve the problem of auditory deprivation. In particular, the bilateral CI gives the patient access to binaural hearing which results in benefits in terms of sound localisation and discrimination. The optimal age of application of the CI is a widely discussed topic in the scientific community and the current guidelines indicate a period between 12 and 24 months of age, even though the supporters of the application before 12 months of age are nowadays increasing.

MATERIALS AND METHODS

The study is observational, retrospective, monocentric. 49 paediatric patients (<18 years) with simultaneous bilateral CIs were included. The audiometric threshold and speech tests were carried out during the follow-up 3, 6 and 12 months after the CIs activation and when the patient reached 2 years of age.

RESULTS

The statistical analysis showed that undergoing bilateral implantation surgery before 2 years of age allows a satisfactory audiometric performance, while there are no particular benefits in performing the surgery before 1 year of age. As far as the speech outcome is concerned, the statistical analysis didn't show significant correlation between the earlier age of implantation and better speech performance if the operation is carried out before 2.5 years of age.

CONCLUSIONS

The results of the study indicate that the optimal age to perform the simultaneous bilateral CIs surgery is between 12 and 24 months, without demonstrating any particular benefit in carrying out the procedure before 1 year of age. This may be clinically relevant in terms of avoiding the risks of diagnostic mistakes and reducing the related surgical risk in children under 1 year of age.

Guideline on cochlear implants

INTRODUCTION

In the last decade numerous hospitals have started to work with patients who are candidates for a cochlear implant (CI) and there have been numerous and relevant advances in the treatment of sensorineural hearing loss that extended the indications for cochlear implants.

OBJECTIVES

To provide a guideline on cochlear implants to specialists in otorhinolaryngology, other medical specialities, health authorities and society in general.

METHODS

The Scientific Committees of Otology, Otoneurology and Audiology from the Spanish Society of Otolaryngology and Head and Neck Surgery (SEORL-CCC), in a coordinated and agreed way, performed a review of the current state of CI based on the existing regulations and in the scientific publications referenced in the bibliography of the document drafted.

RESULTS

The clinical guideline on cochlear implants provides information on: a) Definition and description of Cochlear Implant; b) Indications for cochlear implants; c) Organizational requirements for a cochlear implant programme.

CONCLUSIONS

A clinical guideline on cochlear implants has been developed by a Committee of Experts of the SEORL-CCC, to help and guide all the health professionals involved in this field of CI in decision-making to treathearing impairment.

Speech processor data logging helps in predicting early linguistic outcomes in implanted children

OBJECTIVE

To analyse the value of listening-data logged in the speech processor on the prediction of the early auditory and linguistic skills in children who received a cochlear implant in their first 2 years of life.

STUDY DESIGN

Prospective observational non-randomized study.

METHODS

Ten children with profound congenital sensorineural hearing loss were included in the study. The mean age at CI activation was 16.9 months (SD ± 7.2; range 10-24). The auditory skills were evaluated with the Infant Toddler Meaningful Inventory Scale and the Category of Auditory Performance. Lexical level was assessed with the MacArthur-Bates Communicative Development Inventory. The overall data of average daily use and acoustic scene-analyses were extracted from Data Logging system. The effect of the one-year cumulative listening time to speech (in quiet) and speech-in-noise on the auditory and lexical scores was analysed.

RESULTS

A significant positive correlation was found between speech in quiet exposure time at low loudness level (<70 dB) and lexical quotient after one year of CI use. Infant Toddler Meaningful Inventory Scale was negatively correlated with the highest speech-in-noise loudness levels (>80 dB). The Category of Auditory Performance was not related to the logged data.

CONCLUSION

The listening environment can influence the early functional outcomes in younger implanted children. In this perspective, the data logging system is a promising tool in predicting early linguistic and auditory outcomes.

Diffusion Kurtosis Imaging of Microstructural Alterations in the Brains of Paediatric Patients with Congenital Sensorineural Hearing Loss

Our aim was to assess microstructural alterations in the cerebrums of paediatric patients with congenital sensorineural hearing loss (SNHL) using diffusion kurtosis imaging (DKI). Seventy-two paediatric SNHL patients and 38 age-matched healthy volunteers were examined via DKI using a 3.0 T magnetic resonance (MR) imager. Fractional anisotropy (FA) and mean kurtosis (MK) values were computed for 12 cerebral regions in both the controls and the SNHL patients. Compared with patients below age 3, patients in the older age group were found to have more significant differences in MK than in FA, and these appeared in more major areas of the brain. In contrast, in 1- to 3-year-old children, a few major brain areas exhibited differences in FA, but none exhibited appreciable differences in MK. There were significant decreases in the FA or MK values (P < 0.05, all) in more areas of the brain in patients with lesions than in patients with normal-appearing brains. DKI offers comprehensive measurements for quantitative evaluation of age-related microstructural changes in both white and grey matter in SNHL patients. DKI scans of children with SNHL exhibiting significant decreases in MK might play an important role in evaluating the severity of developmental delay.

Diffusion tensor imaging and MR spectroscopy of microstructural alterations and metabolite concentration changes in the auditory neural pathway of pediatric congenital sensorineural hearing loss patients

PURPOSE

Our objective was to evaluate age-dependent changes in microstructure and metabolism in the auditory neural pathway, of children with profound sensorineural hearing loss (SNHL), and to differentiate between good and poor surgical outcome cochlear implantation (CI) patients by using diffusion tensor imaging (DTI) and magnetic resonance spectroscopy (MRS).

MATERIALS AND METHODS

Ninety-two SNHL children (49 males, 43 females; mean age, 4.9 years) were studied by conventional MR imaging, DTI and MRS. Patients were divided into three groups: Group A consisted of children≤1 years old (n=20), Group B consisted of children 1-3 years old (n=31), and group C consisted of children 3-14 years old (n=41). Among the 31 patients (19 males and 12 females, 12m- 14y ) with CI, 18 patients (mean age 4.8±0.7 years) with a categories of auditory performance (CAP) score over five were classified into the good outcome group and 13 patients (mean age, 4.4±0.7 years) with a CAP score below five were classified into the poor outcome group. Two DTI parameters, fractional anisotropy (FA) and apparent diffusion coefficient (ADC), were measured in the superior temporal gyrus (STG) and auditory radiation. Regions of interest for metabolic change measurements were located inside the STG. DTI values were measured based on region-of-interest analysis and MRS values for correlation analysis with CAP scores.

RESULTS

Compared with healthy individuals, 92 SNHL patients displayed decreased FA values in the auditory radiation and STG (p<0.05). Only decreased FA values in the auditory radiation was observed in Group A. Decreased FA values in the auditory radiation and STG were both observed in B and C groups. However, in Group C, the N-acetyl aspartate/creatinine ratio in the STG was also significantly decreased (p<0.05). Correlation analyses at 12 months post-operation revealed strong correlations between the FA, in the auditory radiation, and CAP scores (r=0.793, p<0.01).

CONCLUSIONS

DTI and MRS can be used to evaluate microstructural alterations and metabolite concentration changes in the auditory neural pathway that are not detectable by conventional MR imaging. The observed changes in FA suggest that children with SNHL have a developmental delay in myelination in the auditory neural pathway, and it also display greater metabolite concentration changes in the auditory cortex in older children, suggest that early cochlear implantation might be more effective in restoring hearing in children with SNHL. This article is part of a Special Issue entitled SI: Brain and Memory.

Universal newborn screening for congenital CMV infection: what is the evidence of potential benefit?

Congenital CMV infection is a leading cause of childhood disability. Many children born with congenital CMV infection are asymptomatic or have nonspecific symptoms and therefore are typically not diagnosed. A strategy of newborn CMV screening could allow for early detection and intervention to improve clinical outcomes. Interventions might include antiviral drugs or nonpharmaceutical therapies such as speech-language therapy or cochlear implants. Using published data from developed countries, we analyzed existing evidence of potential benefit that could result from newborn CMV screening. We first estimated the numbers of children with the most important CMV-related disabilities (i.e. hearing loss, cognitive deficit, and vision impairment), including the age at which the disabilities occur. Then, for each of the disabilities, we examined the existing evidence for the effectiveness of various interventions. We concluded that there is good evidence of potential benefit from nonpharmaceutical interventions for children with delayed hearing loss that occurs by 9 months of age. Similarly, we concluded that there is fair evidence of potential benefit from antiviral therapy for children with hearing loss at birth and from nonpharmaceutical interventions for children with delayed hearing loss occurring between 9 and 24 months of age and for children with CMV-related cognitive deficits. We found poor evidence of potential benefit for children with delayed hearing loss occurring after 24 months of age and for children with vision impairment. Overall, we estimated that in the United States, several thousand children with congenital CMV could benefit each year from newborn CMV screening, early detection, and interventions.

Pre-school children have better spoken language when early implanted

OBJECTIVES

The objectives of this study were: (1) to investigate the effect of age at cochlear implantation (CI) on vocabulary development; (2) to evaluate the age effect at CI surgery on the syntactic development; and (3) to examine the role of gender, age at first diagnosis and maternal education level on spoken language development.

MATERIAL AND METHODS

Retrospective study. Thirty children with congenital severe- to -profound sensorineural hearing loss (SNHL) were sampled. They were diagnosed and fitted with hearing aids through six months of age. They were implanted between 8 and 17 months of age. The MacArthur-Bates Communicative Development Inventory (MCDI) was administrated at the age of 36 months. The total productive vocabulary (word number raw score), the mean length of utterance (M3L) and the sentences complexity were analysed.

RESULTS

The average word number raw score was 566.3 for the children implanted before 12 months of age versus 355 for those implanted later. The M3L was 8.3 for those implanted under 1 year versus 4.2 of those implanted later. The average sentences complexity was 82.3% for those receiving CI before 12 months, while it was 24.4% for those underwent at CI after 12 months. Regression analysis revealed a highly significant and negative linear effect of age at CI surgery on all outcomes. Females had better outcomes. Age at diagnosis was not correlated with the linguistic results. The mother's education level had a positive significant effect on sentences complexity.

CONCLUSION

The CI in pre-school children with SNHL implanted under 1 year has a positive effect on spoken language. Females seem to have better linguistic results. Finally high maternal educational level appears to have some positive effect on language development.

Vowel Production in Persian Deaf Children with Cochlear Implant: is the Age of Implantation an Important Factor?

Proper production of vowels has great significance in speech intelligibility. Evidence shows that cochlear implantation has a significant impact on language and reading abilities in some children immediately after the surgery. The aim of the present study is comparing the quality of 6 simple Persian vowels between two groups of cochlear-implanted children under and over 2 years old. This was a cross-sectional analytic study conducted on 70 children who were implanted under the age of 2, 70 children who were implanted over the age of 2 and 238 normal children as control group. For data analysis, the SFS win acoustic analysis was used. Result of this study showed that F2/i/, f1/e/, f2/e/, f2/∞/, f1/a/, F2/a/, f1/o/, F2/o/and F2/u/means had significant difference between three groups (P < 0.05). Children implanted under the age of 2 showed similar performance as normal children in vowel production. Early cochlear implantation (under the age of 2) affects the quality of simple Persian vowel production significantly as well as the increase of speech intelligibility.

Communication development in children who receive a cochlear implant by 12 months of age

OBJECTIVE

Describe the long-term benefits of early cochlear implantation. Provide a comprehensive description of outcomes, including: language, speech production, and speech perception. Compare the communication outcomes for the early implanted children to those of normally hearing children and children who received a cochlear implant at a comparatively older age.

METHOD

Retrospective review of the communication development of 35 children implanted between 6 and 12 months of age and 85 children implanted between 13 and 24 months of age. Audiologic assessments included unaided and aided audiograms, auditory brainstem response (ABR), auditory steady state response (ASSR), and otoacoustic emissons (OAEs). Formal language, speech production, and speech perception measures were administered, preimplant and at 1, 2, 3, and 5 years postimplant.

RESULTS

The children who received their cochlear implant by 12 months of age demonstrated language growth rates equivalent to their normally hearing peers and achieved age appropriate receptive language scores 3 years postimplant. The children who received their cochlear implant between 13 and 24 months demonstrated a significant language delay at 3 years postimplant. Speech production development followed a similar pattern to that of normal-hearing children, although was delayed, for both groups of children. Mean open-set speech perception scores were comparable with previous reports for children and adults who use cochlear implants.

CONCLUSION

Children implanted by 12 months of age demonstrate better language development compared with children who receive their cochlear implant between 13 and 24 months. This supports the provision of a cochlear implant within the first year of life to enhance the likelihood that a child with severe-to-profound hearing impairment will commence elementary school with age-appropriate language skills.

Speech perception outcomes after cochlear implantation in prelingually deaf infants: the Western Sicily experience

OBJECTIVES

To describe audiometric characteristics and speech perception performances of prelingually deaf Sicilian children after cochlear implantation; to identify the influence of cochlear implant (CI) user and family's characteristics on speech recognition and intelligibility outcomes.

METHODS

Twenty-eight infants with a congenital or acquired hearing impairment and implanted before the 3rd year of life were studied; all children suffered from bilateral sensorineural hearing loss (SNHL) with evidence of lack of hearing aids benefit and no evidence of intellectual disability. The study of the main characteristics associated with CI user and family's profile was performed with a clinical assessment including pre-implant and post-implant (1, 3, 6, 12 and 18 months) behavioural audiometry (evaluating average threshold for the frequencies 0.5, 1, 2 and 4KHz) and speech recognition tests (IT-MAIS, MUSS, CAP and SIR).

RESULTS

Our cohort was characterized by an early diagnosis of SNHL (5.77 and 12.17 months for congenital and acquired HL respectively), a short length of deafness (average=6.78 months) and an implantation before the 3rd year of life (mean=24.25 months; range from 10 to 36). Analysis of audiometric threshold revealed a significantly improved capacity to detect sounds within the conversational speech spectrum after 12 months from implantation (r=0.99; p<0.001). The main speech recognition test evidenced speech perception and speech intelligibility performances (CAP median value of 3; SIR category=3 in 46.42%) equal to those children with same characteristics reported by literature. With the exception of 'daily CI use' (p<0.001), none of the variables associated with CI user and family's profile resulted significant predictor of speech perception improvement.

CONCLUSIONS

This work demonstrates that all children of our cohort, with an early diagnosis of SNHL and a CI surgery performed before the 3rd year of life, presented a progressive audiometric and speech improvement through the first 12-18 months after cochlear implantation. The study also highlights that, differently from the others variables studied, a continuous CI use influences significantly speech perception and recognition outcomes.

New criteria of indication and selection of patients to cochlear implant

Numerous changes continue to occur in cochlear implant candidacy. In general, these have been accompanied by concomitant and satisfactory changes in surgical techniques. Together, this has advanced the utility and safety of cochlear implantation. Most devices are now approved for use in patients with severe to profound unilateral hearing loss rather then the prior requirement of a bilateral profound loss. Furthermore, studies have begun utilizing short electrode arrays for shallow insertion in patients with considerable low-frequency residual hearing. This technique will allow the recipient to continue to use acoustically amplified hearing for the low frequencies simultaneously with a cochlear implant for the high frequencies. The advances in design of, and indications for, cochlear implants have been matched by improvements in surgical techniques and decrease in complications. The resulting improvements in safety and efficacy have further encouraged the use of these devices. This paper will review the new concepts in the candidacy of cochlear implant. Medline data base was used to search articles dealing with the following topics: cochlear implant in younger children, cochlear implant and hearing preservation, cochlear implant for unilateral deafness and tinnitus, genetic hearing loss and cochlear implant, bilateral cochlear implant, neuropathy and cochlear implant and neural plasticity, and the selection of patients for cochlear implant.

The right not to hear: the ethics of parental refusal of hearing rehabilitation

OBJECTIVE

To explore the ethics of parental refusal of auditory-oral hearing rehabilitation.

STUDY DESIGN

Case study with medical ethical discussion and review.

METHODS

Two young brothers present with severe-to-profound congenital sensorineural hearing loss. The parents, both of whom have normal hearing and work as sign language interpreters, have decided to raise their children with American Sign Language as their only form of communication. They have chosen not to pursue cochlear implantation nor support the use of hearing aids.

DISCUSSION

This case raises significant questions concerning whether hearing rehabilitation should be mandated, and if there are circumstances in which parental preferences should be questioned or overridden with regard to this issue. In addition, legal concerns may be raised regarding the possible need to file a report with Child Protective Services. Although similar cases involving the Deaf community have historically favored parental rights to forego hearing rehabilitation with either cochlear implantation or hearing aids, we explore whether conclusions should be different because the parents in this case are not hearing impaired.

CONCLUSIONS

The ethics of parental rights to refuse hearing rehabilitation are complex and strikingly context-dependent. A comprehensive appreciation of the medical, practical, and legal issues is crucial prior to intervening in such challenging situations.

Mandarin Chinese speech recognition by pediatric cochlear implant users

OBJECTIVES

Because of difficulties associated with pediatric speech testing, most pediatric cochlear implant (CI) speech studies necessarily involve basic and simple perceptual tasks. There are relatively few studies regarding Mandarin-speaking pediatric CI users' perception of more difficult speech materials (e.g., words and sentences produced by multiple talkers). Difficult speech materials and tests necessarily require older pediatric CI users, who may have different etiologies of hearing loss, duration of deafness, CI experience. The present study investigated how pediatric CI patient demographics influence speech recognition performance with relatively difficult test materials and methods.

METHODS

In this study, open-set recognition of multi-talker (two males and two females) Mandarin Chinese disyllables and sentences were measured in 37 Mandarin-speaking pediatric CI users. Subjects were grouped according to etiology of deafness and previous acoustic hearing experience. Group 1 subjects were all congenitally deafened with little-to-no acoustic hearing experience. Group 2 subjects were not congenitally deafened and had substantial acoustic hearing experience prior to implantation. Multiple linear regression analyses were performed within each group using subject demographics such as age at implantation and age at testing.

RESULTS

Pediatric CI performance was generally quite good. For Group 1, mean performance was 82.3% correct for disyllables and 82.8% correct for sentences. For Group 2, mean performance was 76.6% correct for disyllables and 84.4% correct for sentences. For Group 1, multiple linear regression analyses showed that age at implantation predicted disyllable recognition, and that age at implantation and age at testing predicted sentence recognition. For Group 2, neither age at implantation nor age at testing predicted disyllable or sentence recognition. Performance was significantly better with the female than with the male talkers.

CONCLUSIONS

Consistent with previous studies' findings, early implantation provided a significant advantage for profoundly deaf children. Performance for both groups was generally quite good for the relatively difficult materials and tasks, suggesting that open-set word and sentence recognition may be useful in evaluating speech performance with older pediatric CI users. Differences in disyllable recognition between Groups 1 and 2 may reflect differences in adaptation to electric stimulation. The Group 1 subjects developed speech patterns exclusively via electric stimulation, while the Group 2 subjects adapted to electric stimulation relative to previous acoustic patterns.

Long term outcomes of early cochlear implantation in Korea

Objectives

The objective of this study was to compare the long-term auditory performance and language skill depending on the age of cochlear implantation in the Korean population. We especially tried to separate the effect of maturation/development from that of the age at implantation.

Methods

Eighty-six pre-lingual children with profound hearing loss who underwent a cochlear implantation before the age of six and had been followed for more than 3 yr were included in this study prospectively. Categories of Auditory Performance (CAP) and Korean Picture Vocabulary Test (K-PVT) were serially followed up. In order to separate the age at implantation effect, K-PVT results were readjusted to the child's chronological age in the normal hearing population.

Results

When the CAP and K-PVT scores were directly compared without chronological readjustment, we failed to show a significant difference for improvements according to the age at implantation. Early cochlear implantation was associated with better language development, only when the K-PVT scores were readjusted to percentile scores of their chronological age.

Conclusion

Early cochlear implantation was associated with better language development even within the critical period. This advantage may be recognized only when the effect of the age at implantation is separated from the effect of maturation/development.

Cochlear Implant Outcomes for Children With Auditory Neuropathy Spectrum Disorder

Cochlear implantation is currently the intervention option of choice for many children with auditory neuropathy spectrum disorder (ANSD) who are unable to obtain benefit from conventional amplification. The aim of this study was to review the speech perception and language outcomes for children with ANSD who had received a cochlear implant and highlight specific clinical considerations for working with this population of children with hearing impairment who are being considered for implantation. Finds for the group of 17 children with ANSD using cochlear implants were compared to previously reported outcomes for children with sensori-neural (SN) type hearing loss using cochlear implants.

Two children, identified with cochlear nerve deficiency pre-operatively, received no useful auditory percepts from their cochlear implant and discontinued device use. The remaining children demonstrated speech perception and language outcomes comparable to those observed for SN hearing loss peers using cochlear implants.

This paper highlights a number of considerations for clinicians to be aware of and the importance of careful counseling pre-operatively regarding the potential for less-than-optimal outcomes, particularly for those children identified with cochlear nerve deficiency.

Three-Year Postimplantation Auditory Outcomes in Children with Sequential Bilateral Cochlear Implantation

Objectives:

We report on the auditory abilities and speech performance in quiet and noise of 35 children with sequential bilateral cochlear implantation after 3 years of bilateral implant use.

Methods:

Testing was done in bilateral and both unilateral listening conditions. The assessments took place before the second implantation and at several time intervals after fitting. As different auditory tests were used, the children were categorized by their age at the second implantation: Younger or older than 6 years.

Results:

The pure tone averages for the bilateral condition were significantly better than those for either unilateral condition after 12 months of bilateral implant use and remained so from that test interval onward. The speech recognition outcomes in quiet and noise also improved significantly for almost all children after 36 months, although a linear regression analysis showed a beneficial effect of younger age at first implantation on the speech-in-noise results.

Conclusions:

Bilateral cochlear implantation offered advantages to all children in comparison with the first implant — Even the children who received the second implant after the age of 6 years. Compared to the younger children, the older children needed a longer adjustment period to gain bilateral benefit. However, they obtained similar results after 2 years of bilateral implant use.

What can be expected from a late cochlear implantation?

OBJECTIVE

Verify if late cochlear implantation allows pre-lingual deafs to convert from visual to oral communication mode only.

METHOD

Thirteen pre-lingual profoundly deaf patients implanted the ages of 8 and 22 years were included in the study. Before cochlear implantation, none of the patients used the oral language. Six patients used cued speech and seven used the sign language to communicate. Evaluations were made with measures of hearing thresholds, phoneme identification, categories of auditory performance and rating of the intelligibility of speech before and after implantation. Changes in principal mode of communication (i.e. oral, cued speech or sign language) were also monitored.

RESULTS

The former users of cued speech benefited significantly more from cochlear implantation than the sign language users for phoneme identification and categories of auditory performance, although all had similar hearing thresholds before and after cochlear implantation. After a mean implant use of 4.5 years, four out of six cued speech users converted to exclusive use of the oral language, while only one out of seven former users of the sign language converted to the use of the oral language.

DISCUSSION

It is possible for pre-lingual or congenital deafs to convert totally from a visual to an oral communication mode even in case of late cochlear implantation. Previous awareness of the structure of the oral language, even without hearing (e.g. via cued speech) influences positively the outcome of delayed implantations. We recommend the adoption of oral communication with the cued speech code in cases where a late cochlear implantation is envisioned.

Relational learning in children with deafness and cochlear implants

This four-experiment series sought to evaluate the potential of children with neurosensory deafness and cochlear implants to exhibit auditory-visual and visual-visual stimulus equivalence relations within a matching-to-sample format. Twelve children who became deaf prior to acquiring language (prelingual) and four who became deaf afterwards (postlingual) were studied. All children learned auditory-visual conditional discriminations and nearly all showed emergent equivalence relations. Naming tests, conducted with a subset of the children, showed no consistent relationship to the equivalence-test outcomes. This study makes several contributions to the literature on stimulus equivalence. First, it demonstrates that both pre- and postlingually deaf children can acquire auditory-visual equivalence relations after cochlear implantation, thus demonstrating symbolic functioning. Second, it directs attention to a population that may be especially interesting for researchers seeking to analyze the relationship between speaker and listener repertoires. Third, it demonstrates the feasibility of conducting experimental studies of stimulus control processes within the limitations of a hospital, which these children must visit routinely for the maintenance of their cochlear implants.

Functional magnetic resonance imaging of hearing-impaired children under sedation before cochlear implantation

OBJECTIVE

To investigate functional magnetic resonance imaging (fMRI) in pediatric cochlear implantation candidates with residual hearing who are under sedation for evaluation of auditory function.

DESIGN

During fMRI, subjects heard a random sequence of tones (250-4000 Hz) presented 10 dB above hearing thresholds. Tones were interleaved with silence in a block-periodic fMRI design with 30-second on-off intervals. Twenty-four axial sections (5 mm thick) covering most of the brain were obtained every 3 seconds for a total acquisition time of 5.5 minutes.

SETTING

Single tertiary academic medical institution.

PATIENTS

Severely to profoundly hearing-impaired children (n=10; mean age, 49.1 months). During fMRI, subjects were awake (n=2) or sedated with pentobarbital sodium if their weight was 10 kg or greater (n=4) or chloral hydrate if their weight was less than 10 kg (n=4).

MAIN OUTCOME MEASURES

Detection of brain activation by fMRI in the primary auditory cortex (A1) in hearing-impaired patients under sedation, and correlation of A1 activation with hearing levels measured after cochlear implantation.

RESULTS

In most subjects, fMRI detected significant levels of activation in the A1 region before cochlear implantation. The improvement in hearing threshold after cochlear implantation correlated strongly (linear regression coefficient, R=0.88) with the amount of activation in the A1 region detected by fMRI before cochlear implantation.

CONCLUSIONS

Functional MRI can be considered a means of assessing residual function in the A1 region in sedated hearing-impaired toddlers. With improvements in acquisition, processing, and sedation methods, fMRI may be translated into a prognostic indicator for outcome after cochlear implantation in infants.

Relationship between Intraoperative eCAP Thresholds and Postoperative Psychoacoustic Levels as a Prognostic Tool in Evaluating the Rehabilitation of Cochlear Implantees

A sufficient correlation between objective (e.g. eCAP of the auditory nerve) and psychoacoustic data has not yet been possible due to high interindividual variability in cochlear implantees. Therefore, the application of objective data in the evaluation of speech rehabilitation after cochlear implantation was investigated. eCaps of all electrodes were measured intraoperatively. The 'threshold' and 'comfort' levels, speech recognition and pure tone thresholds were determined at follow-up. The correlation coefficient was calculated between eCap thresholds and psychoacoustic levels. This correlation coefficient was ranked with other individual items in relation to their influence on the development of speech recognition. Only the duration of preimplant deafness, the pure tone hearing threshold and the correlation between eCAP and psychoacoustic levels have a significant influence on the rehabilitation within this selection of variables. Based on these results, an individualized mathematical modeling approach was introduced to predict the development of postoperative speech recognition by incorporating objective data.

Hearing-Impaired Children in the United Kingdom, IV: Cost-Effectiveness of Pediatric Cochlear Implantation

OBJECTIVE

To estimate the cost-effectiveness of pediatric cochlear implantation by conducting a cost-utility analysis from a societal perspective.

DESIGN

In a cross-sectional survey, the parents of a representative sample of hearing-impaired children assessed the health utility of their child using a revised version of the Health Utilities Index Mark III questionnaire. Linear regression was used to estimate the gain in health utility associated with implantation while controlling for eight potentially confounding variables: average (4-frequency, unaided, preoperative) hearing level (AHL), age at onset of hearing-impairment, age, gender, number of additional disabilities, parental occupational skill level, ethnicity, and parental hearing status. The gain in health utility was accumulated to estimate the number of quality-adjusted life years (QALYs) that would be gained from implantation over 15 yr and over a child's lifetime. The incremental societal cost of implantation, calculated in euros at 2001/2 levels, was estimated by summing the incremental costs of implantation that are incurred in the health sector, in the education sector, and by the child's family. The cost-effectiveness of cochlear implantation was estimated by calculating the incremental societal cost per QALY gained and was compared with an upper limit of acceptability of 50,000 euros per QALY.

RESULTS

The parents of 403 implanted children, and 1863 nonimplanted children, completed the health utility questionnaire. Higher health utility was associated with a more favorable AHL, an older age at onset of hearing impairment, female gender, having fewer additional disabilities, having parents with a greater occupational skill level, white ethnicity, and implantation. The gain in health utility associated with implantation was estimated to be higher for children with a worse preoperative AHL and who were implanted when younger. Over 15 yr, for a child implanted at age 6 with a preoperative loss of 115 dB, 2.23 QALYs were estimated to be gained, compared with a mean incremental societal cost of 57,359 euros, yielding a mean cost per QALY of 25,629 euros. Cost-effectiveness was more favorable: (1) when estimated over a child's lifetime rather than 15 yr, (2) for children with a worse preoperative AHL, and (3) for children who were implanted when younger.

CONCLUSIONS

The mean cost of gaining a QALY for the children in the present sample falls within acceptable limits. The strategy of giving highest priority for implantation to children with the greatest loss of hearing, and who are younger, maximizes benefit for a given cost.

Sensorineural hearing loss in children

During the past three to four decades, the incidence of acquired sensorineural hearing loss (SNHL) in children living in more developed countries has fallen, as a result of improved neonatal care and the widespread implementation of immunisation programmes. The overall decrease has been accompanied by a relative increase in the proportion of inherited forms of SNHL. The contribution made by one gene in particular, GJB2, to the genetic load of SNHL has strongly affected the assessment and care of children with hearing loss. These changes in the incidence of SNHL have not been seen in children living in less developed countries, where the prevalence of consanguinity is high in many areas, and both genetic and acquired forms of SNHL are more common, particularly among children who live in poverty. Focused genetic counselling and health education might lead to a decrease in the prevalence of inherited SNHL in these countries. Establishment of vaccination programmes for several vaccine-preventable infectious diseases would reduce rates of acquired SNHL. Although the primary purpose of such programmes is the prevention of serious and in many cases fatal infections, a secondary benefit would be a reduction in disease-related complications such as SNHL that cause permanent disability in survivors.

Modeling the relationship between psychophysical perception and electrically evoked compound action potential threshold in young cochlear implant recipients: clinical implications for implant fitting

OBJECTIVE

In cochlear implant recipients, the threshold of the electrically evoked compound action potential (ECAP) has been shown to correlate with the perceptual detection threshold and maximum comfortable loudness levels (respectively, T- and C-levels) used for implant programming. Our general objective was to model the relationship between ECAP threshold and T/C-levels by taking into account their relative changes within each subject. In particular, we were interested in investigating further the validity of ECAP threshold as a predictor of psychophysical levels, depending on intra-cochlear electrode location and time of testing (from 1 to 18 months post-implantation).

METHODS

A total of 370 ECAP thresholds, measured in 49 children, using a Nucleus 24 cochlear implant, were compared with the corresponding T- and C-levels obtained at the same visit, for the same electrode. Response profiles for the whole group of patients were modeled across four test electrodes spaced equally along the electrode array from base towards apex. A linear regression model was constructed and the quality of the ECAP threshold-based predictions was assessed by testing for correlation between measured and predicted psychophysics. Comparison was made with a more simplistic model (described here as the 'parallel profiles method') stipulating, within each subject, a 1 microA increase in psychophysical levels for every 1 microA increase in ECAP threshold.

RESULTS

Offset between ECAP threshold and psychophysics profiles was found to vary significantly along the electrode array for the T-, but not for the C-level. In contrast with the parallel profiles method, our regression model predicted, within each subject, an average increase of 0.23 microA (95% confidence interval: 0.18-0.28) in T-level for every 1 microA increase in ECAP threshold. This correction improved the quality of T-level prediction when our model was run using measured T-level and ECAP threshold from a reference electrode (r=0.77 vs. r=0.62). The shorter the distance between the electrode for which T-level was predicted and the one used as reference, the stronger the correlation between measured and predicted T-levels. In addition, poorer T-level predictions were obtained at the basal end of the array during the first 3 months post-implantation. In contrast to T-level, individual changes in C-level with ECAP threshold exhibited heterogeneous patterns across subjects so that no common coefficient could account for these changes. However, applying the parallel profiles method led to high-quality C-level prediction.

CONCLUSIONS AND SIGNIFICANCE

The results suggest that covariation between ECAP thresholds and psychophysics plays a decisive role in the relationship of ECAP threshold with T-, but not with C-level. Therefore, our regression model and the parallel profiles method should both be used for predicting, respectively, the T- and the C-levels. Although the predictability of our regression model seems to be better for middle and apical electrodes, its utilization should be extended to basal electrodes after 6 months' implant use.

Nonword repetition by children with cochlear implants: accuracy ratings from normal-hearing listeners

Seventy-six children with cochlear implants completed a nonword repetition task. The children were presented with 20 nonword auditory patterns over a loud-speaker and were asked to repeat them aloud to the experimenter. The children's responses were recorded on digital audiotape and then played back to normal-hearing adult listeners to obtain accuracy ratings on a 7-point scale. The children's nonword repetition performance, as measured by these perceptual accuracy ratings, could be predicted in large part by their performance on independently collected measures of speech perception, verbal rehearsal speed, and speech production. The strongest contributing variable was speaking rate, which is widely argued to reflect verbal rehearsal speed in phonological working memory. Children who had become deaf at older ages received higher perceptual ratings. Children whose early linguistic experience and educational environments emphasized oral communication methods received higher perceptual ratings than children enrolled in total communication programs. The present findings suggest that individual differences in performance on nonword repetition are strongly related to variability observed in the component processes involved in language imitation tasks, including measures of speech perception, speech production, and especially verbal rehearsal speed in phonological working memory. In addition, onset of deafness at a later age and an educational environment emphasizing oral communication may be beneficial to the children's ability to develop the robust phonological processing skills necessary to accurately repeat novel, nonword sound patterns.

Examining multiple sources of influence on the reading comprehension skills of children who use cochlear implants

Children with profound deafness are at risk for serious reading difficulties. Multiple factors affect their development of reading skills, including use of cochlear implants. Further, multiple factors influence the overall success that children experience with their cochlear implants. These factors include the age at which they receive an implant, method of communication, vocabulary skills, preoperative residual hearing, and socioeconomic status. Ninety-one children with prelingual and profound hearing impairments who received cochlear implants at varying ages participated in the study. Structural equation modeling confirmed that multiple factors affected young cochlear implant users' reading comprehension skills and that there were significant associations between the predictors of reading comprehension. Pre-implant vocabulary had an indirect positive effect on reading through postimplant vocabulary, which had a direct positive effect on reading. Overall, children with stronger language skills demonstrated stronger reading outcomes. Age at implantation both directly and indirectly, through postimplant vocabulary, affected reading outcomes, and the total effect was large. Children who were younger when they received their implants tended to have higher reading comprehension scores. Socioeconomic status negatively affected reading. Children who used total communication prior to implantation tended to have stronger pre-implant vocabulary scores, but the total effect of pre-implant communication method on children's reading skills was negligible. Research and educational implications are discussed.

Pediatric Cochlear Implant Patient Performance as a Function of Age at Implantation

OBJECTIVE

The objective of this study was to examine the effect that age at implantation has on performance of children who received multichannel cochlear implants.

STUDY DESIGN

This is a retrospective study of 295 children who were broken down into 5 age groups based on age at implantation: 1-3 years, 3-5 years, 5-7 years, 7-9 years, and 9-11 years. Speech perception test scores obtained 12, 24, and 36 months postactivation were compared for the 5 groups using repeated-measures analysis of variance.

SETTING

This study was carried out at a tertiary academic medical center.

PATIENTS

Subjects consisted of 295 children who ranged in age from 12 months to 10 years 11 months at the time they obtained their cochlear implant.

INTERVENTION

All patients received their cochlear implant at a single implant facility.

MAIN OUTCOME MEASURES

Performance on several speech perception tests was compared 12, 24, and 36 months postactivation. Performance was evaluated as a function of age at implantation.

RESULTS

Patients in all 5 groups demonstrated improved scores when compared with scores obtained preoperatively with hearing aids. Repeated-measures analysis of variance (ANOVA) revealed a significant group by time interaction for 3 of the 5 measures. For all three of these measures, children implanted at younger ages demonstrated greater gains in speech perception over time than children implanted at older ages.

CONCLUSIONS

These results are in agreement with those of previous studies indicating that early implantation facilitates improved development of speech perception skills in profoundly deaf children.

Cochlear implants in young children

The past 20 years have seen the cochlear implant evolve from an innovative but radical concept to the standard of care in the management of children with severe to profound hearing loss. All children receiving the cochlear implant achieve substantial benefit; however, performance gains are optimized by a team approach to the evaluation and management of these children. The critical elements of this team include audiologists, speech pathologists, and surgeons with specific interest, expertise, and dedication to the management of children with cochlear implants. Children are not well served by practitioners who delegate follow-up to educational programs not experienced in children with implants. Long-term involvement and dedication on the part of teachers, speech pathologists, audiologists, surgeons, and family are critical to maximizing the benefit the child receives.

School-Based Services for Children With Cochlear Implants

School-based speech, language, and hearing professionals are instrumental in the provision of rehabilitative, consultative, and support services for children with cochlear implants. This article reviews current candidacy requirements as well as factors that are considered when a child is evaluated for a cochlear implant. Following implantation, school professionals play a pivotal role in providing an appropriate educational program that should include auditory training and the integration of listening into the child’s daily routine. The article presents procedures for maintaining and troubleshooting the device, and suggestions for establishing routines for device use and for improving the listening environment for children in classrooms.

Universal newborn hearing screening coming soon: "hear's" why

Screening the hearing of all newborns, both NICU and well nursery, is rapidly becoming the standard of care. The impetus for universal newborn hearing screening (UNHS) has come from outside the domain of nursing and the newborn nursery. Because nursing will be involved in nearly all aspects of UNHS, nurses need a thorough knowledge base about permanent childhood hearing loss (PCHL) and UNHS. Technology exisits today that can objectively and physiologically screen for this condition at a cost comparable to metabolic screening. PCHL occurs more than twice as often as all the hemoglobinopathies and inborn errors of metabolism combined. Undiagnosed hearing loss often leads to permanent developmental delays. The ultimate goal of early diagnosis and intervention for a congenital hearing loss is to enable the child to develop language and communication skills that correspond to his chronological age and innate cognitive abilities.