Cochlear implants before 9 months of age led to more natural spoken language development without increased surgical risks

Early cochlear implantation in children with complex medical needs: A multidisciplinary approach

OBJECTIVES

To determine if children with hearing loss and additional medical diagnoses are achieving early cochlear implantation when compared to their peers with hearing loss as their sole diagnosis.

STUDY DESIGN

Retrospective study.

SETTING

Pediatric outpatient clinic.

PATIENTS

43 infants diagnosed with bilateral hearing loss, at least severe to profound sensorineural hearing loss (SNHL) in one ear, by three months of age and received cochlear implant(s) between 2017 and 2022.

MAIN OUTCOME MEASURE

Difference in cochlear implant (CI) evaluation time between patients with additional medical diagnoses and patients with hearing loss only.

RESULTS

20 patients had additional diagnoses and 23 had hearing loss without other diagnoses. On average, patients with additional diagnoses had a longer CI evaluation time than patients without an additional diagnosis (13.5 months evaluation period for patients with additional diagnosis vs 12 months for patients without additional diagnosis). Appointments prior to cochlear implantation were reviewed for both groups. There was no difference in the number of appointments with the core CI team between the two groups studied. Patients with additional diagnoses had significantly more appointments with specialties outside of the core CI team prior to cochlear implantation than their peers.

CONCLUSIONS

Patients with additional diagnoses had a longer CI evaluation time than those with hearing loss alone. This may be attributed to the need for appointments with medical specialties outside of the core CI team. A medical diagnosis in addition to hearing loss should not preclude a child from progressing through the candidacy evaluation process. However, it may be helpful to manage expectations regarding the potential delays in cochlear implantation.

Imaging of inner ear malformation in paediatric patients-a 10-year tertiary centre review

OBJECTIVE

Sennaroglu's classification is the most accepted classification worldwide for inner ear and/or nerve malformation, although only limited data is available for the Asian population. This study aims to assess their relative frequency, summarise their radiological features, and determine their correlation with hearing impairment.

MATERIALS AND METHODS

Retrospective analysis of patients with imaging-proven inner ear and/or nerve malformation in a single tertiary hospital in Hong Kong in 2014-2023. Clinical data were reviewed along with relevant imaging findings.

RESULTS

A total of 155 abnormal ears from 94 patients were included. All cases of Michel deformity (n = 4), rudimentary otocyst (n = 5), cochlear aplasia (n = 6) and common cavity (n = 3) show severe/profound hearing loss. Cochlear hypoplasia Type I (n = 2) and Type II (n = 6), and incomplete partition Type I (n = 5) also show severe/profound hearing loss; while cochlear hypoplasia Types III (n = 4) and Type IV (n = 8) and incomplete partition Type II (n = 28) show variable degrees of hearing deficit. Cochlear and vestibulocochlear nerve abnormalities were detected in 66% and 54% of cases, respectively. Generalised linear model analyses showed a correlation between the degree of hearing deficit with the presence of cochlear aperture atresia (OR = 2.562, p = 0.015), cochlear nerve atresia (OR = 2.599, p = 0.014), and vestibulocochlear nerve atresia (OR = 2.747, p = 0.064); and remained significant adjusting for the presence of cochlear abnormalities.

CONCLUSION

A higher relative frequency of vestibulocochlear nerve and cochlear nerve abnormalities is observed in our study when compared with the existing literature. Cochlear nervous system abnormalities are most predictive of the degree of hearing impairment.

KEY POINTS

Question Accurate assessment of the inner ear/cochlear nerve is important for guiding treatment, but literature on their relative frequency and correlation with hearing impairment is lacking. Findings Cochlear system abnormalities are more frequent than reported in the literature. Cochlear aperture atresia, cochlear, or vestibulocochlear nerve aplasia are significant predictors of hearing impairment. Clinical relevance This study highlights the importance of assessment of the cochlear nervous system with the use of high-resolution MRI in the evaluation of paediatric sensorineural hearing loss.

Language Interventions for School-Aged Children Who Are d/Deaf and Hard of Hearing: A Systematic Review and Meta-Analysis

PURPOSE

The main aim of the systematic review and meta-analysis was to evaluate the effectiveness of language interventions for school-aged children who are d/Deaf and hard of hearing (DHH). We focused on studies targeting meaning-based aspects of language, such as vocabulary, grammar, and narrative skills. We included randomized controlled trials and quasi-experiments with a control group and a pre-post design. A secondary aim was to describe the characteristics of effective interventions identified in the systematic review.

METHOD

The review was preregistered in PROSPERO (ID CRD42021236085). We searched 10 academic databases for peer-reviewed journal articles reporting language interventions for children who are DHH aged 6-12 years. We assessed the quality of included studies using Critical Appraisal Skills Programme checklists. A meta-analysis was conducted on the overall effect of interventions. In addition, we calculated separate effect sizes for vocabulary and morphosyntactic knowledge.

RESULTS

We identified 14 studies totaling 794 children. Quality assessment revealed concerns of risk of bias in most studies because study characteristics were not comprehensively reported. The meta-analyses of language interventions revealed a large main effect of g = 0.79. Subdomain analyses revealed similar effects for morphosyntactic knowledge g = 0.81 and vocabulary g = 0.71.

CONCLUSIONS

Few high-quality studies examine the effects of language interventions for children who are DHH. However, the studies that exist reveal robust effects, especially for morphosyntactic abilities. Intervention approaches were diverse, and the largest intervention effects were found in studies with a randomized controlled design and near-transfer outcome measures closely aligned with the intervention content. Future studies should adhere to established guidelines for reporting results from controlled experimental study designs.

Cochlear Implant in Prelingual Children: Predicting the First-word Utterance from LittlEARS Auditory Questionnaire

OBJECTIVE

The LittlEARS Auditory Questionnaire (LEAQ) is a reliable tool for assessing children's auditory development. This study investigates the expected time for the first-word utterance in children with cochlear implant (CI) based on the LEAQ score.

METHODS

An observational study was conducted on 94 children (50 males and 44 females) with bilateral severe to profound sensorineural hearing loss (SNHL) who underwent CI surgery at a tertiary center between January 2022 and November 2024. The study included children with prelingual hearing loss and satisfactory auditory responses post-surgery, while those with post-lingual onset or an intelligence quotient (IQ) below 85 were excluded. The LEAQ was applied every 3 months postoperatively. The total score was calculated from all 'yes' answers, and hearing age was determined until the child uttered their first word.

RESULTS

Children were expected to utter their first word at an average LEAQ score of 11.3 ± 4.1 and an average hearing age of 0.8 ± 0.5 years. The average chronological age at first-word utterance was 4.0 ± 1.1 years, when the average implantation age was 3.3 ± 1.1 years. Significant positive correlations were found between the LEAQ score and the chronological and hearing ages at first-word utterance. The age of implantation did not significantly affect the LEAQ score.

CONCLUSION

The first-word development among CI children is predicted by the LEAQ score, influenced by the child's chronological age and duration of CI use. While the age at which the child underwent the implantation seemed to be a non-significant predictor.

Mastoid Growth and the Configuration of Cochlear Implant Electrode Lead

ObjectivesTo study the changes in the coiled configuration of electrode excess lead in the mastoid cavity in the cochlear implant recipients over time.MethodsPost-operative CT scans at two different appointments of fourteen patients with cochlear implants (CI) were retrospectively analyzed using a DICOM viewer software (3D-slicer). Mastoid thickness (MT) was measured in the oblique coronal plane from the round window (RW) entrance to the mastoid edge and inter-cochlear distance (ICD) was measured in the axial plane at the fundus level between two ears. 3D segmentation of the entire inner ear of both sides and coiled electrode excess lead was performed to visually compare the changes in coiled configuration between the two CT scan time points.ResultMT and ICD increased logarithmically with the patient's age, as has been measured from both the 1st and the 2nd CT scans and a weak linear correlation between MT and ICD was observed. Growth in MT and ICT measured between the time of 1st and 2nd CT scans showed a strong linear correlation. In eight cases, changes in the electrode excess lead have been observed in the 2nd CT scan, either a change in the coiling configuration of electrode excess lead or shifted laterally toward the mastoid edge. The ICD growth between the 1st and the 2nd CT scans was >2 mm in only seven cases and all of them were children. All other six cases had no observed changes in the coiled electrode lead. In addition, the mastoid growth between the 1st and the 2nd CT scan was >2.5 mm in only 4 cases.ConclusionCoiled configuration of electrode excess lead could change when the MT and ICD increased over time.

[Early language performance in the ELFRA questionnaire : Analysis of multicentre data from children with bilateral cochlear implants]

BACKGROUND

Very early bilateral cochlear implant (CI) provision is today's established standard for children. Therefore, the assessment of preverbal and verbal performance in very early stages of development is becoming increasingly important. Performance data from cohorts of children were evaluated and presented based on diagnostic assessment using chronological age (CA) and hearing age (HA).

METHODS

The present study, as part of a retrospective multicentre study, included 4 cohorts (N = 72-233) of children with bilateral CI without additional disabilities. Their results in the German parent questionnaires Elternfragebögen zur Früherkennung von Risikokindern(ELFRA‑1 and ELFRA-2) subdivided for CA and HA were statistically analysed. The data were also analysed in terms of mono-/bilingualism and age at CI provision.

RESULTS

Overall, verbal performance in relation to CA was lower than in relation to HA. Preverbal skills were largely CA appropriate. Children with bi-/multilingual language acquisition performed significantly lower. Verbal performance in ELFRA‑2 referenced to CA was negatively correlated with age at CI provision.

CONCLUSION

In the case of early CI provision, CA should be the preferred reference mark in preverbal and verbal assessment in order to obtain exact individual performance levels and avoid bias in results. The percentiles determined are of limited use as generally valid reference values to which the individual performance of bilaterally implanted children could be compared. Further multicentre studies should be initiated.

[Language development test for 3-5-year-old children (3;0-5;11 years)-diagnostics of language and auditory memory : Retrospective analysis of children with bilateral cochlear implantation in early childhood]

BACKGROUND

Fitting of a cochlear implant (CI) influences the development of auditory memory and thus the development of speech. Speech development is a prerequisite for the acquisition of written language and reading and, thus, the later educational biography.

MATERIALS AND METHODS

Language development tests for 3-5-year-old children (SETK 3-5) represent a standardized procedure to assess receptive and expressive speech development as well as auditory memory. In a retrospective cross-sectional study, data of children who were fitted with bilateral CIs from six CI centers of the ACIR (Arbeitsgemeinschaft CI Rehabilitation) were evaluated. The study group was divided into groups that were analyzed on the basis of age (chronological age; LA) and hearing experience with CI (hearing age; HA). In addition, a distinction was made between CI surgery before the age of 1 year (CI ≤ 12 months) and CI surgery from the second to the fourth year of life (CI > 12 ≤ 48 months). The study group was then subdivided according to the SETK 3;0-3;11 years test into G1LA (CI ≤ 12 months), G2LA (CI > 12 ≤ 48 months), G1HA (CI ≤ 12 months), and G2HA (CI > 12 ≤ 48 months). The study group for the SETK 4;0-5;11 years test was subdivided into G3LA (CI ≤ 12 months), G4LA (CI > 12 ≤ 48 months), G3HA (CI ≤ 12 months), and G4HA (CI > 12 ≤ 48 months).

RESULTS

The groups G1LA, G1HA, G3LA, and G3HA (CI ≤ 12 months) achieved age-appropriate values in all subtests of the SETK (3-5). Children who receive CI within the second year of life catch up in terms of language acquisition and some also develop language skills, but the T scores are below the age-adapted norm values. Children with a multilingual background show results below the norm of their hearing peers in both test settings (chronological age and hearing age).

CONCLUSION

Early provision of CI in the first year of life is an important prerequisite for children to develop age-appropriate language skills. Nevertheless, there is wide variation within the groups, so that speech diagnostics and therapy are required as part of follow-up treatment during primary language acquisition to detect and avoid major language delay.

Differences in language outcomes after cochlear implantation in children: Exploring the impact of auditory verbal therapy duration (0, 1, or 3 years)

OBJECTIVES

This study aimed to evaluate the impact of Auditory Verbal Therapy (AVT) on spoken language and pragmatic skills five years after cochlear implantation in children enrolled in rehabilitation programs of varying durations (0, 1, 3 years).

METHODS

The design was a retrospective cohort study, including 87 children with cochlear implants, grouped based on the duration of AVT: 19 in the 0-year group, 33 in the 1-year group, and 35 in the 3-year group. Language and pragmatic skills were assessed five years post-implantation, using the Clinical Evaluation Language Fundamentals.

RESULTS

Significant differences were found in language development five years post-implant, with children receiving 3 years of AVT achieving higher Core Language Scores (CLS) and Expressive Language Index (ELI) scores than those with 0 or 1 year of AVT. No significant differences were found between the 0- and 1-year groups. The percentage of children performing within the normal range increased from 47 % (CLS) and 53 % (ELI) in the 0-year AVT group, to 61 % (CLS + ELI) in the 1-year AVT group, and 83 % and 80 %, respectively, in the 3-year AVT group. No group differences were found in pragmatic skills.

CONCLUSION

This study underscores the critical importance of early and extended AVT in facilitating optimal language development in children with cochlear implants. After five years, children who received 3 years of AVT continued to outperform those who received only 0 or 1 year of AVT. Longitudinal studies are needed to assess whether the effects of AVT on language and pragmatic skills persist or evolve over time.

Detailed Clinical, Ophthalmic, and Genetic Characterization of MYO7A-Associated Usher Syndrome

Purpose

To analyze the clinical spectrum and natural history of MYO7A-associated Usher syndrome type I (USH1).

Methods

Patients with molecularly confirmed MYO7A-associated USH1 in a single tertiary referral center. Data was extracted from physical and electronic case notes, including imaging and electrophysiology. Genetic results were reviewed, and the detected variants were assessed. Main outcome measures were clinical findings, qualitative and quantitative analysis of retinal imaging, and electrophysiology.

Results

Eighty patients were identified and evaluated longitudinally. The mean age (±SD) of onset of symptoms was 12.0 ± 5.8 years of age, and a mean follow-up time of 16.2 years. BCVA was 0.4 ± 0.5 LogMAR at baseline, and 0.7 ± 0.8 LogMAR at the last visit for both eyes. The change in BCVA over time was 0.02 LogMAR per year. A hyperautofluorescent (hyperAF) ring was present in 51% of the patients. The mean ellipsoid zone width (EZW) at baseline was 2568.2 ± 1528.9 µm OD and 2527.9 ± 1609.3 µm OS, which decreased to 2012.3 ± 1705.1 µm OD and 1806.3 ± 1647.1 µm OS at last visit. Electrophysiology revealed rod and cone dysfunction with relative or complete sparing of macular function. There were statistically significant changes in BCVA, EZW, and hyperAF ring between baseline and follow-up. Genetic analysis identified 83 variants in MYO7A, including 18 novel variants.

Conclusions

Longitudinal analysis shows that the majority of patients retain central visual function and structure until the fifth decade of life, which informs advice on prognosis and the window for therapeutic intervention.

Unraveling the impact of congenital deafness on individual brain organization

Research on brain plasticity, particularly in the context of deafness, consistently emphasizes the reorganization of the auditory cortex. But to what extent do all individuals with deafness show the same level of reorganization? To address this question, we examined the individual differences in functional connectivity (FC) from the deprived auditory cortex. Our findings demonstrate remarkable differentiation between individuals deriving from the absence of shared auditory experiences, resulting in heightened FC variability among deaf individuals, compared to more consistent FC in the hearing group. Notably, connectivity to language regions becomes more diverse across individuals with deafness. This does not stem from delayed language acquisition; it is found in deaf native signers, who are exposed to natural language since birth. However, comparing FC diversity between deaf native signers and deaf delayed signers, who were deprived of language in early development, we show that language experience also impacts individual differences, although to a more moderate extent. Overall, our research points out the intricate interplay between brain plasticity and individual differences, shedding light on the diverse ways reorganization manifests among individuals. It joins findings of increased connectivity diversity in blindness and highlights the importance of considering individual differences in personalized rehabilitation for sensory loss.

Hearing Early Opens More Doors: Long-Term Effects of Age at Implantation on Metaphor Comprehension in Adolescents and Young Adults With Cochlear Implants

PURPOSE

There is solid evidence that an early age at cochlear implantation, which reduces the period of auditory deprivation, positively impacts early spoken language development. However, there is an urgent need for more research to understand the long-term effects of early implantation on higher linguistic skills, such as metaphor comprehension. In this study, we explored metaphor comprehension in Swedish-speaking adolescents and young adults with cochlear implant (CI), compared to that of typically hearing peers, as well as its relationship with the age at first CI.

METHOD

The participants consisted of 39 individuals who received CI before 30 months of age (Mage = 16.9 years, mean age at implant = 15.7 months) and a group of 27 individuals with typical hearing (Mage = 14.9 years). To assess metaphor comprehension, we developed a multiple-choice task that was administrated verbally. Standardized tests were used to evaluate vocabulary, reading skills, and nonverbal cognitive skills.

RESULTS

No significant differences were found in metaphor comprehension or other linguistic or cognitive skills between individuals with CI and the typically hearing peers. Further analysis indicated a moderate negative correlation between metaphor comprehension and age at implantation and other linguistic skills.

CONCLUSIONS

Early-implanted children develop metaphor comprehension comparable to their typically hearing peers, with earlier age at implantation being associated with better metaphor comprehension in adolescence. However, age at implantation only partially explains the variation in metaphor comprehension abilities. Further research is needed to identify other factors that influence the development of metaphor comprehension in individuals with CI.

The everyday speech environments of preschoolers with and without cochlear implants

Children who receive cochlear implants develop spoken language on a protracted timescale. The home environment facilitates speech-language development, yet it is relatively unknown how the environment differs between children with cochlear implants and typical hearing. We matched eighteen preschoolers with implants (31-65 months) to two groups of children with typical hearing: by chronological age and hearing age. Each child completed a long-form, naturalistic audio recording of their home environment (appx. 16 hours/child; >730 hours of observation) to measure adult speech input, child vocal productivity, and caregiver-child interaction. Results showed that children with cochlear implants and typical hearing were exposed to and engaged in similar amounts of spoken language with caregivers. However, the home environment did not reflect developmental stages as closely for children with implants, or predict their speech outcomes as strongly. Home-based speech-language interventions should focus on the unique input-outcome relationships for this group of children with hearing loss.

Morphosyntactic production and processing skills in relation to age effects and lexical-phonological levels among children with cochlear implants and typically hearing peers: a focus on vowel nasality

Introduction

Significant variability in the language performance of children with cochlear implant (CI) is widely recognized in the literature, particularly concerning morphosyntactic (MS) skills. The perceptual limitations of the CI, which can lead to phonological difficulties, may be responsible for this increased vulnerability in grammatical abilities. In this context, the present study focuses on the morphophonemic processing of items distinguished by nasal and oral vowels in the French language - the feature of vowel nasality being known as challenging for the CI population. Links between these performances with chronological/auditory ages and phonological and grammatical production skills will also be explored.

Method

Nineteen children with CIs and 47 children with typical hearing (TH) were assessed for phonological skills through a picture-naming task, perceptual skills through a task involving the sentence/word-picture matching task with word target containing nasal vs. oral vowels, and morphosyntactic production skills through narrative productions. Various measures of linguistic complexity [Mean Length of Utterance (MLU), verbs/utterances (V/U)] and lexical diversity (D index) were evaluated among our groups and linked to perceptual and productive phonological performances. Chronological and auditory ages as well as phonological accuracy and vocabulary levels as been studied as covariates.

Results

Children with CIs displayed significantly lower morphosyntactic (MS) performance compared to peers with TH of the same chronological age, particularly in measures such as MLU in morphemes, complexity of function words, and processing of morphemes carried by nasal and oral vowels. However, when controlling for auditory age or phonological/lexical levels, these differences were no longer significant, suggesting a potential for compensation when similar auditory or linguistic experiences are achieved. Despite this, CI users showed distinct patterns of function word use, with fewer complex forms and more frequent errors, likely reflecting the perceptual challenges linked to CI. Additionally, a specific strong relationship between MS skills and phonological accuracy was observed in the CI group, potentially accounting for the marked inter-individual variability in MS development.

Conclusion

The perceptual limitations of the CI have a significant impact on the linguistic development of children with CI and contribute to the widely documented variability in performance.

Teenagers and Young Adults with Cochlear Implants: A Multidisciplinary Follow-Up Study Approach and Baseline Characteristics

Background/Objectives: Early pediatric cochlear implantation positively impacts early language outcomes. The Teenager and Young Adults Cochlear Implant (TAYACI) study investigates the long-term outcomes of early implantation and factors influencing variability among cochlear implant (CI) users. This article outlines participants' background, early language outcomes, and multidisciplinary study protocol. Methods and Materials: Individuals aged 12-22 received CIs before 30 months of age, followed-up at the same hearing implant center, and adhered to a standard school curriculum were invited to participate. Out of 109 eligible CI users, 50 participated; 46 agreed to undergo clinical assessments, while four completed questionnaires only. Results: The mean age at the first CI was 15.63 months (SD = 6.0). All but one communicated with spoken language(s). Participants attended mainstream schools and had highly educated parents. Over half (56%) had received Auditory Verbal Therapy in early childhood. Earlier implantation correlated with better language understanding one year post-CI. Conclusions: Earlier implantation was associated with better early language outcomes, with parental education level and early family-centered intervention likely contributing. Future sub-studies will investigate multidisciplinary long-term effects of pediatric cochlear implantation in adolescents.

The relationship between AutoNRT thresholds and subjective programming levels revisited

OBJECTIVES

The aim of this study wasto systemically examine the relationship between AutoNRT thresholds and subjective programming levels by controlling for individual subject variation, and further, to propose an alternative way to calculate the AutoNRT threshold profile for programming purposes.

METHODS

The study was a prospective observational study. AutoNRT thresholds, T- and C-levels were recorded at six and twelve months after activation. All subjects had received a CI24RE implant.

RESULTS

Forty-one adults participated in the study. A linear mixed-effects model analysis of the relationship between the AutoNRT thresholds and the T-and C-levels resulted in a large unexplainable variation between subjects, the standard deviation was between 15.42 and 18.89 CL. However, the study showed that the profiles for the T- and C-levels could be predicted with an acceptable accuracy from AutoNRT. A model for calculating profiles from AutoNRT thresholds based on linear regression resulted in the lowest deviation from the subjective programming thresholds, with somewhat better results for C-levels than T-levels.

CONCLUSION

The results from this study showed that the predictability was reasonable when calculating the profiles for the T- and C-levels based on AutoNRT. And, further, that AutoNRT thresholds can be used when programming cochlear implants, to make global adjustments without predicting actual T- or C-levels.

The use of gestures in book reading and play situations related to vocabulary in young children with cochlear implants

Gestures are essential in early language development. We investigate the use of gestures in children with cochlear implants (CIs), with a particular focus on deictic, iconic, and conventional gestures. The aim is to understand how the use of gestures in everyday interactions relates to age, vocabulary testing results, and language development reported by parents. Seven children with CIs, aged 27-39 months, participated in the study. The children's use of gestures was analysed in caregivers' video recordings of daily life interactions. The Picture Naming Game was used to test vocabulary. The Swedish version of CDI was used for caregiver reports of vocabulary and gesture use. All seven children used gestures, with deictic gestures being the most common type. Iconic gestures were more frequent during play than during book reading, and iconic gestures were more frequent when vocabulary was low. The results suggest that the use of gestures in combination with speech or vocalisations is related to vocabulary development. This connection is more pronounced during book reading, indicating the significance of this activity for language and gesture use in children with CIs. The study highlights the importance of gestures in communication and language development, especially in children with CIs. It emphasises that assessing gesture use should be a routine part of language assessments for children with challenges in their language development, such as hearing impairments. The study has some limitations, which are discussed in terms of small sample size and lack of detailed information on sign language use in the participating families.

The Correlation between Age at Implant, Consistent Device Use, and Language Outcomes for Children Implanted under 18 Months

INTRODUCTION

Research suggests deaf children who receive cochlear implants (CIs) at an early age can achieve age-appropriate language. Recent studies suggest age at full-time CI use is a better predictor of language outcomes than age at implant. The aim of this study was to investigate whether there are correlations between age at implantation, establishing consistent device use, and language outcomes in a cohort of young children in Aotearoa New Zealand.

METHODS

A retrospective analysis was conducted. The study included 46 participants, implanted by the Southern Cochlear Implant Programme by age 18 months. The median age at implant was 8 months. Device use was measured via data logging. Consistent device use was defined as ≥8 h per day. Language outcomes were measured at 2- and 3-year post-implantation using PLS-5.

RESULTS

Consistent use was established by 78.3% by 3 years. Language results were at least one SD higher for children who achieved consistent use within 2 years of implant. Language scores for Maori children were more than one SD lower than non-Maori, a finding not entirely explained by less usage. There was no correlation between age of implantation and length of time to consistent device use. The presence of additional disabilities affected consistent device use.

CONCLUSION

Simply offering CIs earlier is not sufficient to improve language outcomes in the congenitally deaf population. Earlier consistent use was associated with better language outcomes for those implanted before 18 months of age, and language scores were higher for children who achieved consistent use within 2 years of implantation. There is a need to understand why children with pre-lingual deafness may not be achieving consistent device use, and by doing so, we would be a step closer to being able to tailor culturally appropriate supports and services that could help more children achieve better outcomes.

Factors affecting consonant production accuracy in children with cochlear implants: Expressive vocabulary and maternal education

BACKGROUND

Despite the ability of cochlear implants (CIs) to provide children with access to speech, there is considerable variability in spoken language outcomes. Research aimed at identifying factors influencing speech production accuracy is needed.

AIMS

To characterize the consonant production accuracy of children with cochlear implants (CWCI) and an age-matched group of children with typical hearing (CWTH) and to explore several factors that potentially affect the ability of both groups to accurately produce consonants.

METHODS & PROCEDURES

We administered the Bankson-Bernthal Test of Phonology (BBTOP) to a group of 25 CWCI (mean age = 4;9, SD = 1;6, range = 3;2-8;5) implanted prior to 30 months of age with a mean duration of implant usage of 3;6 and an age-matched group of 25 CWTH (mean age = 5;0, SD = 1;6, range = 3;1-8;6). The recorded results were transcribed, and the accuracy of the target consonants was determined. Expressive vocabulary size estimates were obtained from a language sample using the number of different words (NDW). A parent questionnaire provided information about maternal education, duration of CIs experience and other demographic characteristics of each child.

OUTCOMES & RESULTS

The CWCI group demonstrated some similarities to, and some differences from, their hearing peers. The CWCI demonstrated poorer consonant production accuracy overall and in various phonetic categories and word positions. However, both groups produced initial consonants more accurately than final consonants. Whilst CWCI had poorer production accuracy than CWTH for all phonetic categories (stops, nasals, fricatives, affricates, liquids and glides and consonant clusters), both groups exhibited similar error patterns across categories. For CWCI, the factors most related to consonant production accuracy when considered individually were expressive vocabulary size, followed by duration of CI experience, chronological age, maternal education and gender. The combination of maternal education and vocabulary size resulted in the best model of consonant production accuracy for this group. For the CWTH, chronological age followed by vocabulary size were most related to consonant production accuracy. No combination of factors yielded an improved model for the CWTH.

CONCLUSIONS & IMPLICATIONS

Whilst group differences in production accuracy between the CWCI and CWTH were found, the pattern of errors was similar for the two groups of children, suggesting that the children are at earlier stages of overall consonant production development. Although duration of CI experience was a significant covariate in a single-variable model of consonant production accuracy for CWCI, the best multivariate model of consonant production accuracy for these children was based on the combination of expressive vocabulary size and maternal education.

WHAT THIS PAPER ADDS

What is already known on the subject Research has shown that a range of factors is associated with consonant production accuracy by CWCIs, including factors such as the age at implant, duration of implant use, gender, other language skills and maternal education. Despite numerous studies that have examined speech sound production in these children, most have explored a limited number of factors that might explain the variability in scores obtained. Research that examines the potential role of a range of child-related and environmental factors in the same children is needed to determine the predictive role of these factors in speech production outcomes. What this paper adds to the existing knowledge Whilst the consonant production accuracy was lower for the CWCIs than for their typically hearing peers, there were some similarities suggesting that these children are experiencing similar, but delayed, acquisition of consonant production skills to that of their hearing peers. Whilst several factors are predictive of consonant production accuracy in children with implants, vocabulary diversity and maternal education, an indirect measure of socio-economic status, were the best combined predictors of consonant production accuracy. What are the potential or actual clinical implications of this work? Understanding the factors that shape individual differences in CWCI speech production is important for effective clinical decision-making and intervention planning. The present findings point to two potentially important factors related to speech sound production beyond the duration of robust hearing in CWCI, namely, a lexical diversity and maternal education. This suggests that intervention is likely most efficient that addresses both vocabulary development and speech sound development together. The current findings further suggest the importance of parental involvement and commitment to spoken language development and the importance of receiving early and consistent intervention aimed both at skill development and parental efficacy.

A qualitative exploration of the assessment process to cochlear implantation for children with hearing loss

OBJECTIVE

To explore the process of paediatric cochlear implant assessment, from referral to implantation, from the perspective of parents, cochlear implant professionals, and through observations of clinics.

DESIGN

Qualitative approach, using grounded theory methodology.

STUDY SAMPLE

Twelve families with children under 5 years with permanent hearing loss referred for a cochlear implant or received an implant in the past year, and six professionals who refer or assess children for cochlear implants. Data collection involved interviews and ethnographic observations of assessment clinics.

RESULTS

The core theme derived from interview and observation data related to the work of the cochlear implant assessment for families. The relationship between the work generated by the assessment process and capacity of parents to do the work provides a model to examine access to early implantation, consistent with the Burden of Treatment theory. We identified variation in terms of workload, relating to factors such as a child's additional needs or number of appointments required, and in terms of capacity, relating to factors such as social circumstances or health literacy. Social, peer and professional support and information helped families manage the workload.

CONCLUSIONS

Findings have implications for delivery of paediatric cochlear implant services.

A Systematic Review and Meta-analysis Examining Outcomes of Cochlear Implantation in Children With Bilateral Cochlear Nerve Deficiency

OBJECTIVE

To assess hearing and speech outcomes in pediatric patients with bilateral cochlear nerve deficiency (CND) who underwent cochlear implantation (CI) and to identify factors associated with improved outcomes.

DATABASES REVIEWED

PubMed, Embase, Web of Science, and Cochran databases were searched following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

METHODS

Studies that reported hearing and speech outcomes of pediatric patients with bilateral CND who underwent CI were included. Demographics, comorbidities, inner ear abnormalities, CND classification (aplasia or hypoplasia), details of diagnostic workup, and outcomes data were extracted. Outcomes were assessed using the four-level auditory performance level (APL) scale. Meta-analysis, using Cochran-Armitage tests, was performed on patients with individual data to assess factors associated with performance.

RESULTS

A total of 314 papers were screened, and 40 papers with 378 total patients met inclusion criteria. A total of 339 patients had patient-level data and were included in the meta-analysis. Of the 339 patients, 19% (n = 63) of patients had no measurable stimulation, 28% (n = 95) had improved detection, 22% (n = 76) achieved closed-set speech perception, and 31% (n = 105) achieved open-set speech perception. Patients with cochlear nerve aplasia (p = 0.016) and syndromes (p < 0.001) had significantly worse APL scores relative to patients with cochlear nerve hypoplasia and patients without syndromes, respectively.

CONCLUSIONS

While most patients with bilateral CND benefit from CI and almost one-third of patients achieved open-set speech perception, outcomes were heterogenous and one-fifth of patients did not experience measurable benefit from CI.

Cortical auditory evoked potentials (P1 latency) in children with cochlear implants in relation to clinical language tests

Objective - To study the correlation between P1 latency and the results of clinical language tests (Reynell III and TROG-2), the latter were used as they are recommended for follow-up assessments of children with cochlear implants (Cis) by the Swedish National Quality Register for children with hearing impairment.Design - A clinical cohort study.Study sample - Cross-sectional and consecutive sampling of 49 children with CIs coming for clinical follow-up assessment from March 2017 - December 2019.Results - For all children tested, there was a significant negative correlation (Spearman's rho= -0.403, p = 0.011) between hearing age and P1 latency. A significant correlation between P1 latency and the Reynell III result (Spearman's rho =  -0.810, p = 0.015) was found. In the TROG-2 group, there was no significant correlation between their P1 latency and their language test results (Spearman's rho -0.239, p = 0.196).Conclusion - This method seems to be feasible and easily accepted. The study was conducted in a heterogeneous group of children that we meet daily in our clinic. The results indicated that P1 latency has a negative correlation with language development among our youngest patients fitted with CIs and might be a clinical tool to assess the maturation of central auditory pathways.

A systematic review of acoustic change complex (ACC) measurements and applicability in children for the assessment of the neural capacity for sound and speech discrimination

OBJECTIVE

The acoustic change complex (ACC) is a cortical auditory evoked potential (CAEP) and can be elicited by a change in an otherwise continuous sound. The ACC has been highlighted as a promising tool in the assessment of sound and speech discrimination capacity, and particularly for difficult-to-test populations such as infants with hearing loss, due to the objective nature of ACC measurements. Indeed, there is a pressing need to develop further means to accurately and thoroughly establish the hearing status of children with hearing loss, to help guide hearing interventions in a timely manner. Despite the potential of the ACC method, ACC measurements remain relatively rare in a standard clinical settings. The objective of this study was to perform an up-to-date systematic review on ACC measurements in children, to provide greater clarity and consensus on the possible methodologies, applications, and performance of this technique, and to facilitate its uptake in relevant clinical settings.

DESIGN

Original peer-reviewed articles conducting ACC measurements in children (< 18 years). Data were extracted and summarised for: (1) participant characteristics; (2) ACC methods and auditory stimuli; (3) information related to the performance of the ACC technique; (4) ACC measurement outcomes, advantages, and challenges. The systematic review was conducted using PRISMA guidelines for reporting and the methodological quality of included articles was assessed.

RESULTS

A total of 28 studies were identified (9 infant studies). Review results show that ACC responses can be measured in infants (from < 3 months), and there is evidence of age-dependency, including increased robustness of the ACC response with increasing childhood age. Clinical applications include the measurement of the neural capacity for speech and non-speech sound discrimination in children with hearing loss, auditory neuropathy spectrum disorder (ANSD) and central auditory processing disorder (CAPD). Additionally, ACCs can be recorded in children with hearing aids, auditory brainstem implants, and cochlear implants, and ACC results may guide hearing intervention/rehabilitation strategies. The review identified that the time taken to perform ACC measurements was often lengthy; the development of more efficient ACC test procedures for children would be beneficial. Comparisons between objective ACC measurements and behavioural measures of sound discrimination showed significant correlations for some, but not all, included studies.

CONCLUSIONS

ACC measurements of the neural capacity to discriminate between speech and non-speech sounds are feasible in infants and children, and a wide range of possible clinical applications exist, although more time-efficient procedures would be advantageous for clinical uptake. A consideration of age and maturational effects is recommended, and further research is required to investigate the relationship between objective ACC measures and behavioural measures of sound and speech perception for effective clinical implementation.

Reading achievement and deaf students with cochlear implants

OBJECTIVES

The purpose of this study was to investigate the reading outcomes of a Canadian cohort of school-aged deaf learners with cochlear implants (CIs). The goal was to investigate whether achievement approached that of hearing age peers and identify demographic factors influencing performance.

METHODS

Participants represent a subset of 13 students with CIs from a larger sample of 70 deaf students in grades four through 12 educated in inclusive settings within a large school board in central Canada. Data sources included demographic information, teachers' ratings on the Categories of Auditory Performance (CAP), and scores from the Woodcock-Johnson III Diagnostic Reading Battery [WJ III-DRB].Results/Discussion: Participants performed within the low average range in all areas except for Phonological Awareness, which was in the low range; however, there was wide variability in scores across participants. None of the demographic variables (e.g. home language, additional disabilities) had a statistically significant association with performance, although older students had higher mean scores on the Phonological Awareness cluster.

CONCLUSION

These findings add to the body of research on literacy achievement and cochlear implantation, providing evidence that this technology has a significant positive effect on outcomes for a population that has heretofore underperformed in this area.

Nasal/Oral Vowel Perception in French-Speaking Children With Cochlear Implants and Children With Typical Hearing

PURPOSE

The present study investigates the perception of vowel nasality in French-speaking children with cochlear implants (CIs; CI group) and children with typical hearing (TH; TH group) aged 4-12 years. By investigating the vocalic nasality feature in French, the study aims to document more broadly the effects of the acoustic limitations of CI in processing segments characterized by acoustic cues that require optimal spectral resolution. The impact of various factors related to children's characteristics, such as chronological/auditory age, age of implantation, and exposure to cued speech, has been studied on performance, and the acoustic characteristics of the stimuli in perceptual tasks have also been investigated.

METHOD

Identification and discrimination tasks involving French nasal and oral vowels were administered to two groups of children: 13 children with CIs (CI group) and 25 children with TH (TH group) divided into three age groups (4-6 years, 7-9 years, and 10-12 years). French nasal vowels were paired with their oral phonological counterpart (phonological pairing) as well as to the closest oral vowel in terms of phonetic proximity (phonetic pairing). Post hoc acoustic analyses of the stimuli were linked to the performance in perception.

RESULTS

The results indicate an effect of the auditory status on the performance in the two tasks, with the CI group performing at a lower level than the TH group. However, the scores of the children in the CI group are well above chance level, exceeding 80%. The most common errors in identification were substitutions between nasal vowels and phonetically close oral vowels as well as confusions between the phoneme /u/ and other oral vowels. Phonetic pairs showed lower discrimination performance in the CI group with great variability in the results. Age effects were observed only in TH children for nasal vowel identification, whereas in children with CIs, a positive impact of cued speech practice and early implantation was found. Differential links between performance and acoustic characteristics were found within our groups, suggesting that in children with CIs, selective use of certain acoustic features, presumed to be better transmitted by the implant, leads to better perceptual performance.

CONCLUSIONS

The study's results reveal specific challenges in children with CIs when processing segments characterized by fine spectral resolution cues. However, the CI children in our study appear to effectively compensate for these difficulties by utilizing various acoustic cues assumed to be well transmitted by the implant, such as cues related to the temporal resolution of stimuli.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25328704.

Early-stage use of hearing aids preserves auditory cortical structure in children with sensorineural hearing loss

Hearing is critical to spoken language, cognitive, and social development. Little is known about how early auditory experiences impact the brain structure of children with bilateral sensorineural hearing loss. This study examined the influence of hearing aid use and residual hearing on the auditory cortex of children with severe to profound congenital sensorineural hearing loss. We evaluated cortical preservation in 103 young pediatric cochlear implant candidates (55 females and 48 males) by comparing their multivoxel pattern similarity of auditory cortical structure with that of 78 age-matched children with typical hearing. The results demonstrated that early-stage hearing aid use preserved the auditory cortex of children with bilateral congenital sensorineural hearing loss. Children with less residual hearing experienced a more pronounced advantage from hearing aid use. However, this beneficial effect gradually diminished after 17 months of hearing aid use. These findings support timely fitting of hearing aids in conjunction with early implantation to take advantage of neural preservation to maximize auditory and spoken language development.

Bilateral simultaneous cochlear implants in children: Best timing of surgery and long-term auditory outcomes

PURPOSE

Evaluate the hearing outcomes of bilateral deaf children implanted simultaneously and define the most appropriate timing for surgery.

MATERIALS AND METHODS

Audiological CI results were retrieved in both the short-term and long-term period and compared by stratifying the patients into different subcohorts according to their age at surgery. Additional data collected were age at implant activation, etiology and timing of onset of deafness, presence of psychomotor delay.

RESULTS

fifty-six bilaterally implanted children were included. The short-term outcomes differed significantly when comparing groups of different ages at implantation: younger patients achieved better aided pure tone audiometry results. Considering long-term follow-up, a significant correlation was identified between an early age at implantation and the hearing outcome at ages 2 to 5 years. Perceptive levels were better at 4 years of age in the younger group. No significant differences were found between children implanted at before 12 months and between 12 and 16 months of age.

CONCLUSIONS

The results of the analyzed follow-up data support the hypothesis that children implanted at before 24 months are expected to have better hearing performances. Nevertheless, these results are referred to a widely heterogeneous group of patients and the duration of auditory deprivation should be considered.

Variability in Receptive Language Development Following Bilateral Cochlear Implantation

OBJECTIVES

The primary aim was to investigate the variability in language development in children aged 5-7.5 years after bilateral cochlear implantation (CI) up to the age of 2 years, and any impact of the age at implantation and additional noncognitive or anatomical disorders at implantation.

DESIGN

Data of 84 congenitally deaf children that had received simultaneous bilateral CI at the age of ≤ 24 months were included in this retrospective study. The results of language comprehension acquisition were evaluated using a standardized German language acquisition test for normal hearing preschoolers and first graders. Data on speech perception of monosyllables and sentences in quiet and noise were added.

RESULTS

In a monosyllabic test, the children achieved a median performance of 75.0 ± 12.88%. In the sentence test in quiet, the median performance was 89 ± 12.69%, but dropped to 54 ± 18.92% in noise. A simple analysis showed a significant main effect of age at implantation on monosyllabic word comprehension (p < .001), but no significant effect of comorbidities that lacked cognitive effects (p = .24). Language acquisition values correspond to the normal range of children with normal hearing. Approximately 25% of the variability in the language acquisition tests is due to the outcome of the monosyllabic speech perception test.

CONCLUSIONS

Congenitally deaf children who were fitted bilaterally in the 1st year of life can develop age-appropriate language skills by the time they start school. The high variability in the data is partly due to the age of implantation, but additional factors such as cognitive factors (e.g., working memory) are likely to influence the variability.

Early Postoperative Benefits in Receptive and Expressive Language Development After Cochlear Implantation Under 9 Months of Age in Comparison to Implantation at Later Ages

OBJECTIVES

The recent expansion of eligibility for cochlear implantation (CI) by the U.S. Food and Drug Administration (FDA) to include infants as young as 9 months has reignited debates concerning the clinically appropriate cut-off age for pediatric CI. Our study compared the early postoperative trajectories of receptive and expressive language development in children who received CI before 9 months of age with those who received it between 9 and 12 months. This study involved a unique pediatric cohort with documented etiology, where the timing of CI was based on objective criteria and efforts were made to minimize the influence of parental socioeconomic status.

METHODS

A retrospective review of 98 pediatric implantees recruited at a tertiary referral center was conducted. The timing of CI was based on auditory and language criteria focused on the extent of delay corresponding to the bottom 1st percentile of language development among age-matched controls, with patients categorized into very early (CI at <9 months), early (CI at 9-12 months) and delayed (CI at 12-18 months) CI groups. Postoperative receptive/expressive language development was assessed using the Sequenced Language Scale for Infants receptive and expressive standardized scores and percentiles.

RESULTS

Only the very early CI group showed significant improvements in receptive language starting at 3 months post-CI, aligning with normal-hearing peers by 9 months and maintaining this level until age 2 years. During this period (<2 years), all improvements were more pronounced in receptive language than in expressive language.

CONCLUSION

CI before 9 months of age significantly improved receptive language development compared to later CI, with improvements sustained at least up to the age of 2. This study supports the consideration of earlier CI, beyond pediatric Food and Drug Administration labeling criteria (>9 months), in children with profound deafness who have a clear deafness etiology and language development delays (<1st percentile).

Cochlear Implantation in Children Under 9 Months of Age: Safety and Efficacy

OBJECTIVE

To assess the safety of cochlear implants (CIs) in children under 9 months of age to better understand expected postoperative complication rates, and to provide a preliminary look at efficacy.

STUDY DESIGN

Single-center retrospective review.

SETTING

Tertiary referral center.

PATIENTS

Children 5 to 8 months of age who received a CI between 2011 and 2021.

INTERVENTIONS

Therapeutic-CI.

MAIN OUTCOME MEASURES

The primary outcome was 6-month postoperative complication rate. Secondary outcomes included length of stay, device explantation/reimplantation, rehabilitation supports, and hearing and language outcomes. Complications of children implanted under than 9 months of age was compared with a cohort of children implanted 9 to 18 months of age between the years 2011 and 2016 using a chi-squared test ( p < 0.05).

RESULTS

One hundred six children under 9 months of age were implanted (204 CIs) at a mean age of 6.6 months (range: 5-8). Postoperative complications occurred in 28 patients (26%) and were often minor. There were no mortalities. There was no statistically significant difference in complications, including reimplantation rates, between patients implanted under 9 months of age and those implanted 9 to 18 months of age. Speech discrimination outcomes were excellent, and mean spoken language outcomes were near normative for typically developing children.

CONCLUSIONS

Cochlear implantation can be a safe and effective treatment option for children 5 to 8 months of age. Early hearing screening and referral for infants to receive appropriate intervention will continue to play a critical role in optimizing speech and language outcomes.

Executive functions in preschool and school-age cochlear implant users: do they differ from their hearing peers? A systematic review and meta-analysis

PURPOSE

Executive functions (EF) play a fundamental role in planning and executing goal-driven behaviours. The purpose of this systematic review and meta-analysis was to investigate EF skills mastered by preschool/school-age cochlear implanted children (CIC) without morpho-functional abnormalities and to compare their outcomes with typically hearing children (THC).

METHODS

Bibliographic search for observational studies of any language/date up to 16 December 2022 was performed with the following electronic databases: PubMed, Scopus, and Web of Science. After removal of duplicates, 2442 records were subjected to a three-stage screening process and 83 potentially eligible articles were identified. A total of 15 studies was included in the final analysis: 9 articles directly meeting the eligibility criteria plus 6 more studies thanks to the authors sharing their data set, specifically for participants who met present inclusion criteria.

RESULTS

Meta-analysis showed a statistically significant difference only for verbal short-term memory, whereas group differences for visuospatial short-term memory and verbal/visuospatial working memory were not significant. For fluency skills, meta-analysis revealed statistical significance for the semantic fluency task but not for the rapid naming test. Qualitative analysis reflected group similarities in flexibility but CIC's difficulties in auditory attention/planning skills. Controversial findings for inhibitory control skills were observed.

CONCLUSIONS

EF performance comparisons between CIC and THC show inter-skill and inter-test variances. Due to the paucity of existing studies, present findings should be interpreted with caution. Future research in this domain is strongly recommended.

Children then, adults now: long-term outcomes-performance at 15, 20, and 25 years of cochlear implant use

Motivation

Severe to profound sensorineural hearing loss interferes with a child's development at the cognitive, linguistic, academic, and social levels. Since the beginning of the pediatric auditory rehabilitation program through cochlear implantation in the Ear, Nose, and Throat (ENT) Service of the Coimbra Hospital and University Center (CHUC), Portugal, its mentors defended the early diagnosis of hearing loss followed by timely intervention, and this was considered the starting point to optimize (re)habilitation through this method. Three decades or so later, recently we conducted this study to evaluate the performance of patients implanted in the initial phase of the cochlear implantation program.

Objectives

The study aimed to evaluate the performance of individuals with severe to profound congenital hearing loss who underwent pediatric cochlear implantation and have used the cochlear implant for at least 25 years, to analyze the beneficial effect of early intervention in improving performance results.

Methods

The study sample is composed of 31 individuals with severe to profound congenital hearing loss and no other comorbidities, divided into two groups (Group 1: age at implantation was under 3 years; Group 2: age at implantation was over 3 years). All 31 subjects were evaluated at 15, 20, and 25 years of cochlear implant (CI) use with a comprehensive set of tests. In addition, data were collected regarding the academic level of each participant. The results of both groups were compared to find out if there is an effect of age at implantation on auditory performance, and if there is an improvement in the performance with CI over time (15, 20, and 25 years of use).

Results

The results show that there is a positive effect, with statistical significance, of early implantation on auditory performance, and telephone use. In both groups, there is an increase in performance over time, but it tends to stabilize after 20 years of CI use.

Discussion and conclusion

The results obtained in this work support the importance of early intervention in patients with severe to profound hearing loss who are cochlear implant users and show that CI is an effective and reliable method in the treatment of these patients, contributing to their improved socio-educational integration, and that the benefits last over time.

Time course from cochlear implant surgery to non-use for congenitally deaf recipients implanted as children over ten years ago

Objective

To determine the time-course from first cochlear implantation to non-use, to characterise non-users' receptive and expressive communication, and document known risk factors for inconsistent use, for congenitally deaf non-users of cochlear implants implanted as children at least ten years ago.

Methods

Retrospective service evaluation. All congenitally deaf patients who received a first cochlear implant as children at least ten years ago at a regional service, and were currently non-users, were identified. They were characterised in terms of ages at implantation and non-use, known risk factors for inconsistent CI use or CI non-use, and outcome measures were the Meaningful Auditory Integration Scale (MAIS) and Meaningful Use of Speech Scale (MUSS) scores.

Results

Seventeen patients met the inclusion criteria. They were implanted from 1990 to 2006. Median age at implantation was 4 years (range: 2-11), median age at non-use was 17 years (range: 9-31), and median duration of use was 8.5 years (range: 4-25). All used sign or gesture as their primary expressive and receptive communication modes. In addition, each child had at least one other known risk factor for inconsistent CI use. At 3 years post-implantation, mean Parent-rated MAIS scores were 76.5% (N = 14), and mean MUSS scores were 43.1% (N = 9).

Discussion

This cohort included cases where CI use was rejected following longer periods of time than previously reported, highlighting a need for long-term support, particularly around the ages of life transitions. Studies conducted when the earliest cohort of paediatric CI users were younger, and studies reliant on parent or patient reports, may under-estimate long-term non-use rates. No non-users were identified among congenitally-deaf children implanted 10-15 years ago. Further research is warranted to explore relationships between risk factors, including communication mode, and non-use to inform expectation setting and candidacy selection.

Evaluation of Parental Perspectives and Concerns about Pediatric Cochlear Implantation: A Social Media Analysis

OBJECTIVE

Parents often experience uncertainty during decision-making for their child's cochlear implantation (CI) surgery, and online forums provide insight on parental opinions that might not be expressed in clinic. This study aims to evaluate parental perspectives and concerns about pediatric CI using social media analysis.

STUDY DESIGN

Qualitative study.

SETTING

Three online forums involving parental posts about pediatric CI.

INTERVENTION/METHODS

Forums were queried using keywords (e.g., "cochlear implant") to gather all U.S. parent-initiated posts about pediatric CI from 2006 to 2021. Thematic content analysis was performed to classify posts by overarching domain, themes, and subthemes. Posts were reviewed for thematic synthesis and double coded. Descriptive statistics were calculated for each theme by unique users.

RESULTS

A total of 79 posts by 41 unique users were analyzed. Themes relating to decision for CI included facilitators, inhibitors, resources, and feelings. Parents posted about lack of benefit from hearing aids promoting decision for CI and high cost as an inhibitor. Some expressed concern about making a major decision for a minor. Parents often mentioned their child's healthcare providers and social media as resources.

CONCLUSION

Through social media posts, parental priorities and concerns for decision-making of CI surgery were identified. Findings may guide discussions between physicians and parents and facilitate shared decision-making about CI.

Min-Max Similarity: A Contrastive Semi-Supervised Deep Learning Network for Surgical Tools Segmentation

A common problem with segmentation of medical images using neural networks is the difficulty to obtain a significant number of pixel-level annotated data for training. To address this issue, we proposed a semi-supervised segmentation network based on contrastive learning. In contrast to the previous state-of-the-art, we introduce Min-Max Similarity (MMS), a contrastive learning form of dual-view training by employing classifiers and projectors to build all-negative, and positive and negative feature pairs, respectively, to formulate the learning as solving a MMS problem. The all-negative pairs are used to supervise the networks learning from different views and to capture general features, and the consistency of unlabeled predictions is measured by pixel-wise contrastive loss between positive and negative pairs. To quantitatively and qualitatively evaluate our proposed method, we test it on four public endoscopy surgical tool segmentation datasets and one cochlear implant surgery dataset, which we manually annotated. Results indicate that our proposed method consistently outperforms state-of-the-art semi-supervised and fully supervised segmentation algorithms. And our semi-supervised segmentation algorithm can successfully recognize unknown surgical tools and provide good predictions. Also, our MMS approach could achieve inference speeds of about 40 frames per second (fps) and is suitable to deal with the real-time video segmentation.

Semantic processing in children with Cochlear Implants: A review of current N400 studies and recommendations for future research

Deaf and hard of hearing children with cochlear implants (CI) often display impaired spoken language skills. While a large number of studies investigated brain responses to sounds in this population, relatively few focused on semantic processing. Here we summarize and discuss findings in four studies of the N400, a cortical response that reflects semantic processing, in children with CI. A study with auditory target stimuli found N400 effects at delayed latencies at 12 months after implantation, but at 18 and 24 months after implantation effects had typical latencies. In studies with visual target stimuli N400 effects were larger than or similar to controls in children with CI, despite lower semantic abilities. We propose that in children with CI, the observed large N400 effect reflects a stronger reliance on top-down predictions, relative to bottom-up language processing. Recent behavioral studies of children and adults with CI suggest that top-down processing is a common compensatory strategy, but with distinct limitations such as being effortful. A majority of the studies have small sample sizes (N < 20), and only responses to image targets were studied repeatedly in similar paradigms. This precludes strong conclusions. We give suggestions for future research and ways to overcome the scarcity of participants, including extending research to children with conventional hearing aids, an understudied group.

Two-Year Outcomes of Cochlear Implant Use for Children With Unilateral Hearing Loss: Benefits and Comparison to Children With Normal Hearing

OBJECTIVES

Children with severe-to-profound unilateral hearing loss, including cases of single-sided deafness (SSD), lack access to binaural cues that support spatial hearing, such as recognizing speech in complex multisource environments and sound source localization. Listening in a monaural condition negatively impacts communication, learning, and quality of life for children with SSD. Cochlear implant (CI) use may restore binaural hearing abilities and improve outcomes as compared to alternative treatments or no treatment. This study investigated performance over 24 months of CI use in young children with SSD as compared to the better hearing ear alone and to children with bilateral normal hearing (NH).

DESIGN

Eighteen children with SSD who received a CI between the ages of 3.5 and 6.5 years as part of a prospective clinical trial completed assessments of word recognition in quiet, masked sentence recognition, and sound source localization at regular intervals out to 24-month postactivation. Eighteen peers with bilateral NH, matched by age at the group level, completed the same test battery. Performance at 24-month postactivation for the SSD group was compared to the performance of the NH group.

RESULTS

Children with SSD have significantly poorer speech recognition in quiet, masked sentence recognition, and localization both with and without the use of the CI than their peers with NH. The SSD group experienced significant benefits with the CI+NH versus the NH ear alone on measures of isolated word recognition, masked sentence recognition, and localization. These benefits were realized within the first 3 months of use and were maintained through the 24-month postactivation interval.

CONCLUSIONS

Young children with SSD who use a CI experience significant isolated word recognition and bilateral spatial hearing benefits, although their performance remains poorer than their peers with NH.

Auditory Outcomes in Children Who Undergo Cochlear Implantation Before 12 Months of Age: A Systematic Review

OBJECTIVE

To systematically review the literature to determine auditory outcomes of cochlear implantation in children ≤12 months old.

DATA SOURCE

PubMed, EMBASE, Medline, CINAHL, Cochrane, Scopus, and Web of Science databases were searched from inception to 9/1/2021 using PRISMA guidelines.

REVIEW METHODS

Studies analyzing auditory outcomes after cochlear implantation (CI) in children ≤12 months of age were included. Non-English studies and case reports were excluded. Outcome measures included functional and objective auditory results. Two independent reviewers evaluated each abstract and article. Heterogeneity and bias across studies were evaluated.

RESULTS

Of 305 articles identified, 17 met inclusion criteria. There were 642 children ages 2 to 12 months at CI. The most common etiologies of hearing loss were congenital CMV, meningitis, idiopathic hearing loss, and GJB2 mutations and other genetic causes. All studies concluded that early CI was safe. Overall, outcomes improved following early CI: IT-MAIS (9 studies), LittlEARS (4 studies), PTA (3 studies), CAP (3 studies), GASP (3 studies), and LNT (3 studies). Nine studies compared outcomes to an older implantation group (>12 months); of these (n = 450 early CI, n = 1189 late CI), 8 studies showed earlier CI achieved comparable or better auditory outcomes than later implantation, whereas 1 study (n = 120) concluded no differences in speech perception improvement.

CONCLUSION

Auditory outcomes were overall improved in children ≤12 months old undergoing CI. Studies that compared early to late CI demonstrated similar or better auditory outcomes in early implantation group. Given the comparable safety profile and critical time period of speech and language acquisition, earlier CI should be considered for infants with hearing loss.

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.

Age and Incidence of Cochlear Implantation in the Pediatric Population With Congenital Bilateral Profound Hearing Loss

OBJECTIVES

The current study characterizes age and incidence of cochlear implantation among qualifying children with congenital bilateral profound hearing loss in the U.S.

STUDY DESIGN

Deidentified cochlear implantation data were acquired from prospectively collected patient registries from two cochlear implant (CI) manufacturers (Cochlear Americas and Advanced Bionics). Children <36 months old were assumed to have congenital bilateral profound sensorineural hearing loss.

SETTING

U.S. CI centers.

PATIENTS

Children <36 months old who received CIs.

INTERVENTIONS

Cochlear implantation.

MAIN OUTCOME MEASURES

Age at implantation and incidence.

RESULTS

A total of 4,236 children <36 months old underwent cochlear implantation from 2015 to 2019. The median age at implantation was 16 months (interquartile range, 12-24 mo) and did not change significantly during the 5-year study period (p = 0.09). Patients residing closer to CI centers (p = 0.03) and treated at higher-volume centers (p = 0.008) underwent implantation at a younger age. Bilateral simultaneous implantation increased from 38% to 53% of CI surgeries in 2015 and 2019, respectively. Children who received bilateral simultaneous CIs were younger compared with those receiving unilateral or bilateral sequential CIs (median, 14 versus 18 mo; p < 0.001). The incidence of cochlear implantation increased from 7,648 per 100,000 person-years in 2015 to 9,344 in 2019 (p < 0.001).

CONCLUSION

Although the incidence of pediatric CI recipients and the frequency of bilateral simultaneous implantation increased over the study period, age at implantation did not change significantly and far exceeded current Food and Drug Administration (9 mo) and American Academy of Otolaryngology and Head and Neck Surgery position statement (6-12 mo) guidelines.

Hearing and Cognition in Childhood

The human brain shows extensive development of the cerebral cortex after birth. This is extensively altered by the absence of auditory input: the development of cortical synapses in the auditory system is delayed and their degradation is increased. Recent work shows that the synapses responsible for corticocortical processing of stimuli and their embedding into multisensory interactions and cognition are particularly affected. Since the brain is heavily reciprocally interconnected, inborn deafness manifests not only in deficits in auditory processing, but also in cognitive (non-auditory) functions that are affected differently between individuals. It requires individualized approaches in therapy of deafness in childhood.

Verbal, Figural, and Arithmetic Fluency of Children with Cochlear Implants

Cochlear implantation gives children with prelingual severe hearing loss and deafness the opportunity to develop their hearing abilities, speech, language, cognitive abilities and academic skills with adequate rehabilitation. The aim of the research was to analyze verbal, figural and arithmetic fluency and their interrelationship in children with a cochlear implant (CI) and children with normal hearing (NH). A total of 46 children with CI and 110 children with NH, aged 9 to 16, participated in the research. Verbal fluency was assessed using phonemic and semantic fluency, and non-verbal fluency using figural fluency. Arithmetic fluency was assessed using simple arithmetic tasks within the number range up to 100. The results showed that children with CI achieved poorer results in phonemic fluency (z = -4.92; p < 0.001), semantic fluency (z = -3.89; p < 0.001), figural fluency (z = -3.07; p = 0.002), and arithmetic fluency (z = -4.27; p < 0.001). In both groups, a positive correlation was obtained between the measured modalities and types of fluency. In the group of children with CI, a sex difference was obtained on the phonemic fluency test, in favor of girls. The age of children with CI was correlated with arithmetic fluency. Verbal, figural and arithmetic fluency of children with CI speak in favor of the importance of early auditory and language experiences.

Simultaneous Bilateral Cochlear Implantation in Very Young Children Improves Adaptability and Social Skills: A Prospective Cohort Study

OBJECTIVES

To investigate the value of using the Gesell Development Diagnosis Scale (GDDS) to predict developmental outcomes in very young children who undergo simultaneous bilateral cochlear implantation.

DESIGN

In this prospective cohort study, a repeated-measures investigation was conducted in a tertiary referral hospital. A total of 62 children receiving simultaneous bilateral cochlear implantations were enrolled from April 2017 to August 2018. They were divided into 2 groups depending on the operative age: "Infants" group (6 to 12 months, N = 38) or "Children" group (12 to 36 months, N = 24). Data on the surgical outcomes, auditory development, speech production, and developmental indicators were collected until 2 years after the initial fitting. The primary outcome measure was the GDDS, a neuropsychological development examination. Secondary outcomes included the following: complication rate, aided pure-tone average, Infant-Toddler Meaningful Auditory Integration Scale, Categories of Auditory Performance-II, Meaningful Use of Speech Scale, Speech Intelligibility Rating, and the LittlEARS Auditory Questionnaire.

RESULTS

The mean ages at implantation in infants and children groups were 9.2 ± 1.17 and 16.6 ± 3.60 months, respectively. Significant differences were found in the social skills ( p = 0.001) and adaptability ( p = 0.031) domains of GDDS. The younger the age of bilateral cochlear implants surgery, the higher developmental quotient of language, social skills, and adaptability the child could achieve after 2 years. The complication rates in the infants and children groups were 0% versus 2.1% ( p = 0.57). There was no surgical complication in the infants group. In the children group, 1 case with enlarged vestibular aqueduct and Mondini malformation had a receiver-implant misplacement on the right side (2%, 1/48). In the two groups, auditory performance and speech production had improved similarly. In the infants group, social skills developmental quotient at baseline had a significant positive relationship with Meaningful Use of Speech Scale after 2 years.

CONCLUSIONS

Simultaneous bilateral cochlear implantation in younger children improves adaptability and social skills. GDDS is a sensitive tool of evaluating short-term effect of bilateral cochlear implants in neuropsychological development and constitutes a reliable predictor of speech production for the very younger pediatric cochlear implant users.

Management of Already Inserted Ventilation Tubes During Pediatric Cochlear Implantation: To Remove or Leave the Tube?

OBJECTIVE

Ventilation tube (VT) insertion is usually recommended before cochlear implantation (CI) in pediatric cochlear implant candidates with recurrent acute otitis media (AOM) or chronic otitis media with effusion (OME). However, there is no consensus on whether the VT is beneficial even after CI, that is, whether the tube should be removed or left in place during CI. This study aimed to assess the effect of tube placement after CI, especially on the incidence of post-CI AOM, in pediatric cochlear implant recipients who had undergone VT insertion before CI because of recurrent AOM or chronic OME.

STUDY DESIGN

A retrospective medical record review.

SETTING

A tertiary referral cochlear implant center.

PATIENTS

This study recruited 58 consecutive ears of children who underwent VT insertion followed by CI at age 7 years or younger between 2004 and 2021. Before October 2018, we removed the VT simultaneously with CI (removed group, 39 ears), while since then, the tube has remained in place during CI (retained group, 19 ears).

INTERVENTION

Therapeutic.

MAIN OUTCOME MEASURE

The primary outcome was the proportion of ears that developed AOM at post-CI 6 months in the removed and retained groups.

RESULTS

The age at CI was significantly higher in the removed group than in the retained group (mean [standard deviation]: the removed group, 2.9 [1.2] yr; the retained group: 1.5 [0.8] yr; p < 0.001). The removed group showed a significantly higher proportion of ears with post-CI AOM (8 of 39 ears; 20.5%) than the retained group (none of 19 ears; 0%) 6 months after CI ( p = 0.044). The AOM-free proportion at post-CI 12 months was 76.9% in the removed group and 83.3% in the retained group, demonstrating no significant difference ( p = 0.49), probably because the VT was spontaneously extruded in the retained group at a median of 6.5 months after CI. Throughout the study period, 17 ears (13 from the removed group) were affected by post-CI AOM. Of these, three ears in the removed group and two in the retained group after spontaneous extrusion of the VT were hospitalized and treated with intravenous antibiotics for AOM that had failed to respond to oral antibiotic therapy. Only one ear in the removed group required an explanation of the infected implant. None suffered from chronic perforation of the tympanic membrane or secondary cholesteatoma after VT insertion or meningitis associated with post-CI AOM.

CONCLUSION

Our results suggest that in CI for children who already have a VT because of a recurrent AOM or chronic OME, retaining the tube in position, rather than removing the tube, may decrease the incidence of AOM at least within 6 months after CI, during which most cochlear implant device infection was reported in the pediatric population.

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.

Cochlear nerve dysplasia in unilateral severe to profound congenital sensorineural hearing loss - Prevalence in Australian children and the impact of socioeconomic disadvantage on its management

INTRODUCTION

Congenital unilateral sensorineural hearing loss (cuSNHL) carries potentially significant social, educational, and developmental consequences. Early diagnosis enables investigation, and consideration of options for management and early intervention, helping to mitigate the effects of hearing loss. Cochlear nerve dysplasia (CND) is a prominent cause of cuSNHL and may affect candidacy for cochlear implantation. Socioeconomic disadvantage may impact on a patient's family's capacity to participate in necessary intervention and follow-up.

METHODS

Infants with severe-profound cuSNHL referred to a large Australian quaternary pediatric center between October 2004 and December 2020 were retrospectively included. Audiometric and clinical data, and the presence of hearing loss risk factors were obtained from a prospectively collated database. In Australia MRI scans are provided free-of-charge to citizens and residents. MRI scans were reviewed to determine the status of the nerves within the internal acoustic meatus (IAM grade) along with attendance rates. Travel distance to the hospital was also calculated. Reasons for non-attendance at MRI were obtained from patient medical records and correspondence. Socioeconomic, educational, and occupational indices, and travel distances were obtained using patient residential postcodes with reference to Australian Bureau of Statistics data.

RESULTS

A total of 98 patients were reviewed, 64.3% (n = 63) of whom underwent MRI. The median age at diagnosis was 40 days (IQR 27). The prevalence of CND was 75% (n = 47). Importantly, there was no significant difference in the degree of hearing loss between IAM grades (F(4,57) = 1.029, p = 0.405). Socioeconomic indices were significantly lower in patients not attending MRI investigations compared with patients who did attend. Travel distance was not significantly different between the two groups.

CONCLUSION

CND is a prominent cause of cuSNHL in Australian infants. MRI at a young age allows parent education regarding management options and timely intervention where indicated. Socioeconomic disadvantage significantly impacts on participation in further routine assessment of cuSNHL, potentially limiting management options for these children long term.

Restoration of the senses and human communication: Sustainable Development Goals 3 and 9

PURPOSE

This invited commentary addresses the importance of the senses in human communication, outlines advances achieved with cochlear implants, and new research directions to improve neural prostheses.

RESULT

In severely deaf people, cochlear implants restore speech understanding and enable children to achieve spoken language. Research in neural prostheses is advancing the restoration of hearing, vision, tactile senses, movement and the management of epilepsy. Bio-inspired stimulation strategies incorporating temporal and spatial characteristics of neural responses may deliver improved speech, vision and tactile perception using prostheses. To achieve stable long-term stimulation, chronic inflammation at the brain-electrode interface may be reduced using ROCK/Rho signalling pathway inhibitors and materials with brain-mimicking properties.

CONCLUSION

This commentary paper addresses two Sustainable Development Goals: industry, innovation and infrastructure (SDG 9) and good health and well-being (SDG 3).

The feasibility of cochlear implantation in early infancy

OBJECTIVES

To determine the key image anatomical parameters that are relevant to cochlear implantation (CI) using temporal bone high-resolution computed tomography (HRCT) scans and to identify age group differences in order to provide image anatomical support for early CI.

METHODS

The data of 346 temporal bone HRCTs of 173 children from 5 months to 18 years of age were retrospectively selected and reviewed. Parameters of the human temporal bone that are relevant to CI key surgical steps include mastoid thickness (MT), the facial recess width (FRW), and an angle representing the round window visibility. All measurements are performed on axial images.

RESULTS

There was no significant difference in the above morphological values by gender (p > 0,05). Two-sided FRW was not significantly different (p > 0,05), but MT and angle A were significantly different (p < 0,001). FRW and angle were independent of age (p > 0,05). However, MT had been found to exhibit postnatal development. The linear function of MT were calculated as y = 2463 × group(s) + 20,574 (p < 0,001).

CONCLUSIONS

Based on preoperative imaging analysis at different ages, middle ear development was stable at 5 months of age, allowing early CI in infancy with severe to severe hearing loss at this age. These data must be considered exploratory and more extensive clinical studies are needed.

The effect of sentence length on question comprehension in children with cochlear implants

OBJECTIVES

The present study investigated the comprehension of subject and object who and which questions in children with cochlear implants (CI).

METHODS

Growth Curve Analysis (GCA) was used to compare eye gaze fixations and gaze patterns to the appropriate subject or object nouns within a four-picture array between 16 children with CI and 31 children with typical hearing (aged 7;0-12;0) on wh-questions with and without added adjectives to increase length. Offline accuracy was also compared.

RESULTS

Findings indicated children with typical hearing exhibited more fixations to the target noun across all conditions, supporting higher comprehension accuracy. Both groups of children demonstrated more fixations to the target noun in object questions and questions without added length. Patterns of eye movement were significantly different between groups, suggesting different patterns of eye gaze across the array before fixation on the target noun. Children with CI exhibited fewer fixations, slower speed to fixation, and differences in gaze patterns that may imply the presence of processing limitations. Error analyses also suggested that children with CI frequently fixated on a picture similar to the target noun.

CONCLUSIONS

Results indicate children with CI comprehend questions more slowly than their hearing peers, which may be related to limitations in working memory.

[The time range in sequential bilateral cochlear implantation]

The article is devoted to the problems of binaural cochlear implantation, especially in patients with a long time interval between surgeries. The purpose of the study was to evaluate the effect of the time range between successive interventions in patients with binaural prosthetics using the CI system.

MATERIALS AND METHODS

the study included 50 patients aged 10 to 14 years, divided into 3 study groups: patients with unilateral cochlear implantation (group I), patients with bilateral implantation with a less than 1 year range between operations (group II) and patients with bilateral implantation with a more than 5 year range between interventions (group III). Comparative analysis was carried out using speech audiometry in silence and noise, assessment of sound localization and questionnaires to assess the auditory dynamics and speech development.

RESULTS

Patients in groups II and III showed comparable results in speech intelligibility in noise and sound localization. At the same time, these indicators turned out to be higher than in patients of group I. Patients from all three groups did not show statistically significant differences in speech intelligibility in silence and in the level of speech development.

CONCLUSION

a long interval (more than 5 years) after the first implantation should not be considered as a contraindication to binaural implantation.

Trends in Timing and Provision of Pediatric Cochlear Implant Care During COVID‐19

Objectives

To identify trends in timing of pediatric cochlear implant (CI) care during COVID-19.

Study Design

Retrospective cohort.

Setting

Tertiary care center.

Methods

Patients under 18 years of age who underwent CI between 1/1/2016 and 2/29/2020 were included in the pre-COVID-19 group, and patients implanted between 3/1/2020 and 12/31/2021 comprised the COVID-19 group. Revision and sequential surgeries were excluded. Time intervals between care milestones including severe-to-profound hearing loss diagnosis, initial CI candidacy evaluation, and surgery were compared among groups, as were the number and type of postoperative visits.

Results

A total of 98 patients met criteria; 70 were implanted pre-COVID-19 and 28 during COVID-19. A significant increase in the interval between CI candidacy evaluation and surgery was seen among patients with prelingual deafness during COVID-19 compared with pre-COVID-19 (µ = 47.3 weeks, 95% confidence interval [CI]: 34.8-59.9 vs µ = 20.5 weeks, 95% CI: 13.1-27.9; p < .001). Patients in the COVID-19 group attended fewer in-person rehabilitation visits in the 12 months after surgery (µ = 14.9 visits, 95% CI: 9.7-20.1 vs µ = 20.9, 95% CI: 18.1-23.7; p = .04). Average age at implantation in the COVID-19 group was 5.7 years (95% CI: 4.0-7.5) versus 3.7 years in the pre-COVID-19 group (95% CI: 2.9-4.6; p = .05). The time interval between hearing loss confirmation and CI surgery was on average 99.7 weeks for patients implanted during COVID-19 (95% CI: 48.8-150) versus 54.2 weeks for patients implanted pre-COVID (95% CI: 39.6-68.8), which was not a statistically significant difference (p = .1).

Conclusion

During the COVID-19 pandemic patients with prelingual deafness experienced delays in care relative to patients implanted before the pandemic.