Deaf children with cochlear implants before the age of 1 year: comparison of preverbal communication with normally hearing children

OBJECTIVES: To compare preverbal behaviors of deaf children implanted under 1 year of age with age-matched hearing children. METHODS: The study assessed 20 children; 10 deaf children implanted under 1 year of age and 10 normally hearing children of the same age. Preverbal skills were measured before, 6 months, and 1 year after implantation, using Tait Video Analysis that is able to predict later speech outcomes in young implanted children. RESULTS: Regarding vocal turns, the normally hearing group outperformed the implanted group although the latter children became quite vocal, nearly 60% of their turns being taken in this way. The mean vocal autonomy in implanted children, 1 year after implantation, was very close to the respective of hearing children (38.5 versus 43.5). Regarding the non-looking vocal turns, by the 12-month interval, hearing children had somewhat higher scores than implanted children, but the difference was not significant and the increase in implanted children was much higher (40-fold increase versus 4-fold increase). However, implanted children were more likely to use silent communication than hearing children, although gestural turns were decreasing with time. CONCLUSIONS: The small numbers in this study, although two of the largest European cochlear implant centers were combined to recruit such young implantees, led us to be cautious in interpreting the results. However, it seems that in deaf implanted children under 1 year of age, some preverbal communication behaviors are developing to an extent (although at a somewhat lower level) not significantly different from those of age-matched normally hearing children.     

Endoscopic laterofixation in bilateral vocal cords paralysis in children

Introduction

Vocal cords paralysis is the second most frequent cause of laryngeal stridor in children. Symptoms of congenital vocal cords paralysis can occur shortly after birth or later. Vocal cords paralysis can be unilateral or bilateral. Symptoms of unilateral paralysis include hoarse weeping or stridor during a deep inhalation. In children unilateral vocal cords paralysis often retreats spontaneously or can be completely compensated. Children with bilateral vocal cords paralysis present mainly breathing disorders while phonation is normal. Symptoms are different, starting from complete occlusion of respiratory tracts and ending on small symptoms connected with the lack of effort tolerance. When symptoms are severe, patients from this group require a tracheotomy. The lack of restoration of normal function of vocal cords or lack of complete compensation and maintenance of symptoms are an indication for surgical treatment.

Objective

The aim of this study is to present results of the treatment of bilateral vocal cords paralysis in children using the endoscopic method of laterofixation of vocal cords.

Material and methods

In the Pediatric ENT Department between 1998 and 2009 sixty four children with dyspnoea and/or phonation disorders caused by vocal cords paralysis were treated.

Results

In ten cases laterofixation of vocal cords was performed, in most cases with good result. In this article the authors present the method of endoscopic laterofixation and achieved results.

Conclusions

Endoscopic laterofixation of vocal cords in children is a safe and an easy method of surgical treatment of bilateral vocal cords paralysis. This method can be used as a first and often as a one stage treatment of vocal cords paralysis. In some cases this procedure is insufficient and has to be completed with other methods.     

Tinnitus is prevalent in children with cochlear implants

Objectives

To explore the prevalence and the perceived impact of tinnitus in children using cochlear implants.

Method

Cross-sectional study of implanted children attending a cochlear implant family event organized annually by our academic tertiary pediatric care center. Children were interviewed together with their parents, using open-questioning and structured interview qualitative methodologies. The main outcome measures were the prevalence of tinnitus and any impact of these symptoms.

Results

40 children (age range: 3-15, mean: 7 years) and their families were interviewed. These included unilateral implantees (n = 21), and bilateral implantees (n = 19) whose two procedures were simultaneous (n = 6), within 6-12 months (n = 3), or >2 years apart (n = 10). Tinnitus was reported by 38% (n = 15). Tinnitus occurred most commonly in the implanted ear, when the implants were not in use (e.g. in bed at night). The children were generally untroubled by the tinnitus, although two reported difficulty sleeping. Tinnitus was most frequent in children aged 6-8 years (8/17, 47%), and in bilateral implantees with an inter-procedure delay of at least 2 years (6/10, 60%). Tinnitus was least reported in those implanted bilaterally simultaneously (1/6, 17%), and in those 5 years old or younger (3/11, 27%). No obvious relationship was identified between the prevalence of tinnitus and the etiology of deafness, age of implantation, or time elapsed since implantation.

Conclusions

To our knowledge this is the first study to report the widespread prevalence of tinnitus in implanted children. Further work, particularly examining the effect of inter-implant delay on tinnitus in bilateral implantees, may contribute to our understanding of the neuronal plasticity after implantation.     

Quantification of vocal tract configuration of older children with Down syndrome: A pilot study

Objective

To quantify the vocal tract (VT) lumen of older children with Down syndrome using acoustic reflection (AR) technology.

Design

Comparative study.

Setting

Vocal tract lab with sound-proof booth.

Participants

Ten children (4 males and 6 females), aged 9-17 years old diagnosed with Down syndrome. Ten typically developing children (4 males and 6 females) matched for age, gender, and race.

Intervention

Each participant's vocal tract measurements were obtained by using an Eccovision Acoustic Pharyngometer.

Main outcome measures

Six vocal tract dimensional parameters (oral length, oral volume, pharyngeal length, pharyngeal volume, total vocal tract length, and total vocal tract volume) from children with Down syndrome and the typically developing children were measured and compared.

Results

Children with Down syndrome exhibited small oral cavities when compared to control group (F(1, 18) = 6.55, p = 0.02). They also demonstrated a smaller vocal tract volumes (F(1, 18) = 2.58, p = 0.13), although the results were not statistically significant at the 0.05 level. Pharyngeal length, pharyngeal volume, and vocal tract length were not significantly different between the two groups.

Conclusion

Children with Down syndrome had smaller oral cavities, and smaller vocal tract volumes. No significant differences were found for pharyngeal length, pharyngeal volume, and vocal tract length between these two groups.     

Parental and program's decision making in paediatric simultaneous bilateral cochlear implantation: Who says no and why?

Objective

To evaluate initial candidacy for bilateral simultaneous cochlear implantation in children.

Design

Prospective case series.

Setting

Tertiary academic pediatric hospital.

Participants

As part of our research protocol all children eligible for cochlear implantation were assessed for suitability to receive a simultaneous bilateral implant. Over a 12-month period (January to December 2007) 78 children received a total of 95 cochlear implants. Children with sequential second implants (24), revision cases (4), and out of province recipients (4) were excluded. The remaining 46 patients were assessed for bilateral simultaneous implantation.

Main outcome measures

Team/parental decision to proceed with bilateral simultaneous implantation.

Results

17 children (37%) received simultaneous bilateral implants. 29 children (63%) were not considered suitable for simultaneous bilateral implantation. Reasons included developmental delay (10), residual borderline hearing in the second ear (9), parental/patient refusal (6), abnormally poor speech development for age (2), and abnormal cochlear anatomy precluding implantation (2). None were considered unsuitable for the more prolonged operative procedure on medical grounds.

Conclusions

Although bilateral implantation is thought to produce the optimal auditory outcome, not all patients are suitable, nor do all parents wish to proceed, when assessed for simultaneous implantation. Some of these patients are likely to be candidates for sequential bilateral implantation in due course.     

Articulation skills in Turkish speaking children with cochlear implant

Objective

The benefits of using cochlear implant (CI) on speech perception and production have been documented. The aim of this study is to investigate the effect of age of cochlear implantation performed and length of auditory experience with CI on the development of articulation skills in prelingual children with CI.

Methods

For this purpose, 14 children with CI were administered through the standardized articulation test named AAT (Ankara Articulation Test). In order to evaluate the development of articulation skills, AAT was applied to each child with CI at the first and the fourth years of CI. The test group was selected among those congenitally hearing impaired children who had used hearing aids bilaterally before the age of one and a half, and received intervention after fitting hearing aids. The test group was divided into two subgroups: Group 1 consisted of the children implanted at and below the age of 3 and Group 2 consisted of the children implanted after the age of 3. Evaluations of articulation skills between groups and within groups were performed in the first and fourth years of implantation. In the study, nonparametric statistics have been used to compare the test scores. Mann-Whitney U-test and Wilcoxon test have been used in the comparisons made between groups and within groups, respectively.

Results

While there has not been observed any statistically significant difference between the first year articulation skills of children with CI at and below the age of three and children with CI above the age of 3, for the fourth year this difference has been found to be statistically significant.

Conclusions

The results demonstrate the importance of the early application of CI and length of auditory experience with CI in the development of articulation skills.     

Laser arytenoidectomy in the management of bilateral vocal cord paralysis in children

Objective

To analyse the efficacy of CO₂ laser arytenoidectomy in the management of bilateral vocal cord paralysis in children.

Methods

Retrospective series of 17 patients who underwent laser arytenoidectomy for bilateral vocal cord between 1995 and 2008 in a tertiary care institution. All patients had bilateral laryngeal paralysis, in isolation (n = 5) or associated with concomitant airway conditions (n = 12). All cases had anterior prolapse of the arytenoids with partial obstruction of the airway on inspiration. 12/17 patients (70.5%) were tracheotomy-dependant, 2/17 were in-extubatable, and 3/17 had severe airway limitation, effort dyspnea and poor sleep pattern. Main outcome measures were decannulation rate for patients with tracheotomy, occurrence of aspiration and quality of voice.

Results

The mean age was 2.8 years old. 9/12 patients with tracheotomy (75%) were decannulated with a median delay of 2 months (2 days to 18 months). Both of the intubated patients were extubated with a median delay of 36 h. One of the decannulated patients who re-presented with a residual dyspnea after the arytenoidectomy was improved by a further laser cordotomy. 2/17 patients (11.7%) had post-operative persistent aspirations (with pneumopathies in one case), 5/17 patients were dysphonic, 3 improved with speech therapy and 2 with intracordal lipoinjection.

Conclusions

Laser arytenoidectomy is effective for improving the breathing in children presenting with a bilateral vocal fold paralysis associated with obstructive arytenoid prolapse. Results are good as a first-line surgery or following laryngo-tracheal surgery. Voice outcomes are satisfactory. However, aspiration is a rare complication.     

Inferences and metaphoric comprehension in unilaterally implanted children with adequate formal oral language performance

Objectives

To assess skills in inferences during conversations and in metaphors comprehension of unilaterally cochlear implanted children with adequate abilities at the formal language tests, comparing them with well-matched hearing peers; to verify the influence of age of implantation on overall skills.

Methods

The study was designed as a matched case–control study. 31 deaf children, unilateral cochlear implant users, with normal linguistic competence at formal language tests were compared with 31 normal hearing matched peers. Inferences and metaphor comprehension skills were assessed through the Implicit Meaning Comprehension, Situations and Metaphors subtests of the Italian Standardized Battery of “Pragmatic Language Skills MEDEA”. Differences between patient and control groups were tested by the Mann–Whitney U test. Correlations between age at implantation and time of implant use with each subtest were investigated by the Spearman rank correlation coefficient.

Results

No significant differences between the two groups were found in inferencing skills (p = 0.24 and p = 0.011 respectively for Situations and Implicit Meaning Comprehension). Regarding figurative language, unilaterally cochlear implanted children performed significantly below their normal hearing peers in Verbal Metaphor comprehension (p = 0.001). Performances were related to age at implantation, but not with time of implant use.

Conclusions

Unilaterally cochlear implanted children with normal language level showed responses similar to NH children in discourse inferences, but not in figurative language comprehension. Metaphors still remains a challenge for unilateral implant users and above all when they have not any reference, as demonstrated by the significant difference in verbal rather than figurative metaphors comprehension. Older age at implantation was related to worse performance for all items. These aspects, until now less investigated, had to receive more attention to deeply understand specific mechanisms involved and possible effects of different levels of figurative language complexity (presence or absence of contextual input, degree of transparency and syntactic frozenness). New insight is needed to orient programs in early intervention settings in considering and adequately responding to all these complex communicative need of children with hearing loss.     

Comparison of bilateral and unilateral cochlear implants in children with sequential surgery

Objective

The objective of this study was to evaluate the effect of bilateral versus unilateral cochlear implants and the importance of the inter-implant interval.

Methods

Seventy-three prelingually deaf children received sequential bilateral cochlear implants. Speech recognition in quiet with the first, second and with both implants simultaneously was evaluated at the time of the second implantation and after 12 and 24 months.

Results

Mean bilateral speech recognition 12 and 24 months after the second implantation was significantly higher than that obtained with either the first or the second implant. The addition of a second implant was demonstrated to have a beneficial effect after both 12 and 24 months. Speech recognition with the second implant increased significantly during the first year. A small, non-significant improvement was observed during the second year. The inter-implant interval significantly influenced speech recognition with the second cochlear implant both at 12 and 24 months, and bilateral speech recognition at 12 months, but not at 24 months.

Conclusions

A small, but statistically significant improvement in speech recognition was found with bilateral cochlear implants compared with a unilateral implant. A major increase in speech recognition occurred with the second cochlear implant during the first year. A shorter time interval between the two implantations resulted in better speech recognition with the second implant. However, no definitive time-point was found for when the second implant could no longer add a positive effect.     

Cochlear implantation under the first year of age—The outcomes. A critical systematic review and meta-analysis

Objective

To review the current knowledge on cochlear implantation in infancy, regarding auditory perception/speech production outcomes.

Study-design

Meta-analysis. EBM level: II.

Methods

Literature-review from Medline and database sources. Related books were also included.

Results

The number of cohort-studies comparing implanted infants with under 2-year-old children was five; three represented type-III and two type-II evidence. No study was supported by type I evidence. Overall, 125 implanted infants were identified. Precise follow-up period was reported in 82. Median follow-up duration ranged between 6 and 12 months; only 17 children had follow-up duration equal or longer than 2 years. Reliable outcome measures were reported for 42 infants; 15 had been assessed with open/closed-set testing, 14 with developmental rating scales, and 13 with prelexical speech discrimination tools.Ten implanted infants assessed with open/closed-set measures had been compared with under 2-year-old implanted children; 4 had shown better performance, despite the accelerated rate of improvement after the first postoperative year.

Conclusion

Neuroplasticity/neurolinguistic issues have led cochlear implant centers to implant deaf children in infancy; however, widespread policies regarding the aforementioned issue are still not justified. Evidence of these children's outperformance regarding auditory perception/speech production outcomes is limited. Wide-range comparisons between infant implantees and under 2-year-old implanted children are lacking. Longer-term follow-up outcomes should be also made available. There is a need to develop and validate robust measures of monitoring implanted infants. Potential factors of suboptimal outcomes (e.g. misdiagnosis, additional disorders, device tuning, parental expectations) should also be weighted, when considering cochlear implantation in infancy.     

Non-invasive assessment of benign vocal folds lesions in children by means of ultrasonography

Objectives

Flexible fiberoptic endoscopes have made pediatric laryngeal examinations an everyday practice, even though fiberoptic-flexible laryngoscopy (FFL) is not always well tolerated in young children because of limited cooperation. Laryngeal ultrasonography (LUS) has been applied to normal and pathological findings in infants and children, allowing the assessment of subglottic hemangiomas, laryngeal stenosis and paralysis. No previous study assessed benign vocal folds lesions by LUS in children. The aim of this study is to evaluate the possibility of LUS to detect benign vocal fold lesions in children by comparing the results of FFL in 16 children with those of LUS.

Methods

Sixteen children (9 males and 7 females) with a mean age of 7.5 ± 4.0 years were included in the study. Each child underwent FFL performed by a skilled phoniatrician and LUS performed blindly by an expert radiologist.

Results

On FFL bilateral vocal folds nodules were found in 9 patients, vocal fold cyst in 2 other patients, while in 2 children the vocal folds appeared normal. Laryngeal papyllomatosis, vocal fold polyp and vocal fold irregularity were found in only one patient. LUS enabled the diagnosis in all the 14 patients with vocal fold lesions. Bilateral hyperechoic lesions were visible in 10 patients, while hypoechoic lesions were found in three patients. No lesion were found in two children, while one patient presented with a monolateral hyperechoic lesion.

Conclusions

LUS was accurate, safe, well accepted and tolerated. LUS appears to be a useful diagnostic tool for supplementing FFL in the assessment of benign vocal fold lesions in children and may represent an interesting alternative in everyday clinical practice.     

Exploring factors that affect the age of cochlear implantation in children

Objective

Early access to sound through early cochlear implantation has been widely advocated for children who do not derive sufficient benefit from acoustic amplification. Early identification through newborn hearing screening should lead to earlier intervention including earlier cochlear implantation when appropriate. Despite earlier diagnosis and the trend towards early implantation, many children are still implanted well into their preschool years. The purpose of this study was to examine the factors that affected late cochlear implantation in children with early onset permanent sensorineural hearing loss.

Methods

Data were examined for 43 children with cochlear implants who were part of a group of 71 children with hearing loss enrolled in a Canadian outcomes study. Eighteen (41.9%) of the 43 children were identified through newborn screening and 25 (58.1%) through medical referral to audiology. Medical chart data were examined to determine age of hearing loss diagnosis, age at cochlear implant candidacy, and age at cochlear implantation. Detailed reviews were conducted to identify the factors that resulted in implantation more than 12 months after hearing loss confirmation.

Results

The median age of diagnosis of hearing loss for all 43 children was 9.0 (IQR: 5.1, 15.8) months and a median of 9.1 (IQR: 5.6, 26.8) months elapsed between diagnosis and unilateral cochlear implantation. The median age at identification for the screened groups was 3.3 months (IQR: 1.4, 7.1) but age at implantation (median 15.8 months: IQR: 5.6, 37.1) was highly variable. Eighteen of 43 children (41.9%) received a cochlear implant more than 12 months after initial hearing loss diagnosis. For many children, diagnosis of hearing loss was not equivalent to the determination of cochlear implant candidacy. Detailed reviews of audiologic profiles and study data indicated that late implantation could be accounted for primarily by progressive hearing loss (11 children), complex medical conditions (4 children) and other miscellaneous factors (3 children).

Conclusions

This study suggests that a substantial number of children will continue to receive cochlear implants well beyond their first birthday primarily due to progressive hearing loss. In addition, other medical conditions may contribute to delayed decisions in pediatric cochlear implantation.     

Evaluation of auditory development in infants and toddlers who received cochlear implants under the age of 24 months with the LittlEARS Auditory Questionnaire

Background and Aims

Newborn hearing screening and early intervention for congenital hearing loss have created a need for tools assessing the hearing development of very young children. A multidisciplinary evaluation of children's development is now becoming standard in clinical practice, though not many reliable diagnostic instruments exist. For this reason, the LittlEARS^® Auditory Questionnaire (LEAQ) was created to assess the auditory skills of a growing population of infants and toddlers who receive hearing instruments. The LEAQ relies on parent report, which has been shown to be a reliable way of assessing child development. Results with this tool in a group of children who received very early cochlear implantation are presented.

Methods

The LEAQ is the first module of the LittlEARS^® comprehensive test battery for children under the age of two who have normal hearing (NH), cochlear implants (CIs) or hearing aids (HAs). The LEAQ is a parent questionnaire comprised of 35 “yes/no” questions which can be completed by parents in less than 10 min. Sixty-three children who received unilateral CIs at a young age were assessed longitudinally and their performance was compared to that of a NH group.

Results

All CI children reached the maximum possible score on the LEAQ on average by 22 months of hearing age, i.e. 38 months of chronological age. In comparison, the NH group reached the maximum score by 24 months of age demonstrating that auditory skills of CI children often develop quicker than those of NH children. In the two comparison groups of children aged (a) younger and older than 12 months, and (b) between 6-9 and 21-24 months at first fitting, the early implanted children reached the highest scores faster than the later implanted children. Furthermore, three children with additional needs were tested. They showed slower growth over time but also received benefits from early implantation.

Conclusions

The LEAQ is a quick and effective tool for assessing auditory skills of very young children with or without hearing loss. In our study, the auditory skills of children with CI progressed very quickly after implantation and were comparable with those of NH peers.     

A comparison of the speech recognition and pitch ranking abilities of children using a unilateral cochlear implant, bimodal stimulation or bilateral hearing aids

Objective

The present study compared the speech recognition and pitch ranking abilities of normally hearing children (n = 15) to children using a cochlear implant (CI) alone (n = 8), bilateral hearing aids (HAs) (n = 6), or bimodal stimulation (BMS) (n = 9). It was hypothesised that users of BMS would score higher on tasks of speech and pitch perception than children using a CI alone, but not children using HAs.

Methods

Participants were assessed on tasks of monosyllabic word recognition in quiet, sentence recognition in quiet and noise (10 dB signal-to-noise ratio), and a pitch ranking task using pairs of sung vowels one, half, and a quarter of an octave apart.

Results

There were no significant differences between the mean percentage-correct scores of the four participant groups for either words in quiet or sentences in quiet and noise. However, the proportion of bimodal users who scored >80% correct (80%) was significantly greater than the proportion of high-scoring unilateral CI (25%) or bilateral HA users (17%). Contrary to expectations, there was also no significant difference between the pitch ranking scores of users of BMS and users of a CI alone for all three interval sizes (p < 0.05, RM-ANOVA). However participants using only acoustic hearing (i.e. the NH and HA groups) scored significantly higher than participants using electrical stimulation (i.e. the CI and BMS groups) on the pitch ranking task (p < 0.05; RM-ANOVA).

Conclusions

Contrary to findings in postlingually deafened adults, we found no significant bimodal advantage for pitch perception in prelingually deafened children. However, the performance of children using electrical stimulation was significantly poorer than children using only acoustic stimulation. Further research is required to investigate the contribution of the non-implanted ears of users of BMS to pitch perception, and the effect of hearing loss on the development of pitch perception in children.     

Screening for delayed-onset hearing loss in preschool children who previously passed the newborn hearing screening

Objective

The goal of this study was to investigate the prevalence of delayed-onset hearing loss in preschool children who previously passed newborn hearing screening in Shanghai, China.

Methods

Between October 2009 and September 2010, 21,427 preschool children were enrolled from five areas of Shanghai, who had passed newborn hearing screening. Children were screened for delayed-onset hearing loss with pediatric audiometers. Children with positive results in initial and re-screening tests were assessed audiologically and for risk indicators according to the Year 2007 Statement of the American Joint Committee on Infant Hearing (JCIH).

Results

During the study period, 445 children (2.08%) were referred for audiologic assessment; 16 (0.75/1000, 95% CI 0.38-1.12) had permanent delayed-onset hearing loss. Of these, five (0.23/1000) had bilateral moderate hearing loss; seven (0.33/1000) had mild bilateral hearing loss; and four (0.19/1000) had unilateral moderate or mild hearing loss. JCIH risk indicators were established for six children (6/16, 37.5%), including parental concern regarding speech and language developmental delay, neonatal intensive care unit with assisted ventilation or hyperbilirubinemia, recurrent otitis media with effusion, craniofacial malformation, and family history (n = 1 for each). The remaining ten (62.5%) had no related risk factors.

Conclusions

A significant proportion of preschool children have undiagnosed delayed-onset hearing loss. Hearing screening in preschool is recommended for an early detection.     

Sphenoid sinus development in choanal atresia

Objectives

To study the growth and size of the sphenoid sinuses in choanal atresia patients.

Study design

Case-control single blinded retrospective study.

Methods

Fifteen non-syndromic patients (ages 0-26 years old) were selected because they had at least one suitable CT scan (nine bilateral and 11 unilateral = total 20 scans). Twenty age-matched CT scans were used as controls. The following linear measurements were obtained: (1) fronto-zygomatic width, (2) zygomatic width, (3) width of the maxillary sinuses, (4) width of the sphenoid sinuses. Statistical analysis was performed with the exact permutation test in the framework of a parametric analysis of a randomized completed block.

Results

The width measurements of the choanal atresia CT scans did not show any statistically significant difference when compared to their control CT scans except for the zygomatic width in the bilateral choanal atresia patients. In the latter, the width was smaller (p = 0.03).

Conclusions

In unilateral and bilateral choanal atresia patients, there is normal growth of the width of the sphenoid sinuses.     

Laryngovideostroboscopy in children--diagnostic possibilities and constraints

Objective

The aim of this study was to report our experience with laryngovideostroboscopy (LVS) in consecutively examined children patients.

Methods

The study included 150 children (2.5-14 years of age) diagnosed with dysphonia. Patients were divided into three age groups: group I - from 2.5 to 6 years of age (n = 31), group II - from 6 to 10 years of age (n = 73), and group III - from 10 to 14 years of age (n = 46). LVS was performed during the second visit. 3.5 mg of dormicum were administered orally 30 min prior to LVS in all children from group I and in some patients belonging to group II. Local anesthesia of the pharyngeal mucosa was not needed in any case.

Results

In nine out of 150 children, it was not possible to perform LVS during the first attempt. In eight of these children, the examination was performed successfully during another visit with satisfactory LVS images obtained. LVS revealed soft vocal fold nodules in 85 patients along with other organic changes found in five children: congenital laryngeal web (n = 1), vocal fold cysts (n = 3), and vocal fold paralysis (n = 1). Hyper-functional dysphonia was diagnosed in the remaining 60 subjects.

Conclusions

In order to perform successful LVS in children patient, the purpose and methodology of this examination should be explained to parents on the first visit whereas an attempt to perform LVS should be undertaken during the second visit. Oral administration of dormicum 30 min prior to the examination is advisable, particularly in younger children, and allows us to avoid the use of local anesthetics.     

A comparison of the consonant production between Dutch children using cochlear implants and children using hearing aids

Objectives

The main purpose of the present study was to compare the consonant error patterns of Dutch prelingually deaf CI children with prelingually hearing-impaired hearing aid (HA) children. The authors hypothesized that subjects using conventional hearing aids would have poorer consonant production skills. Additionally, the impact of the age at implantation (CI) and the degree of hearing loss (HA) was determined.

Methodology

This is a comparative study of 29 prelingually deaf CI children (m.a. 9;0 y) and 32 prelingually hearing-impaired HA children (m.a. 9;11 y) who received their first hearing aid before the age of 2 years. Nineteen CI children were implanted before the age of 5 years. Nine HA children had thresholds above 90 dB (range: 91-105 dB), 15 between 70 and 90 dB (range: 72-90 dB) and 8 below 70 dB (range: 58-68 dB). Speech samples of all the children were elicited by means of a picture naming test and were video-recorded for further phonetic and phonological analysis.

Results

Considerably more phonetic and phonologic errors were observed in the HA children with thresholds above 70 dB (range: 72-105 dB). No notable differences could be found between deaf CI children and HA children with thresholds below 70 dB. Even children implanted after the age of 5 years showed significantly fewer phonetic and phonological errors than HA children.

Conclusion

The consonant production of implanted children is more adequate than the consonant production of HA children with a hearing loss of 70 dB or more. In addition, the results also indicate that even after the age of 5 years, implantation can still have an advantageous effect on a child's consonant production.     

Value of ultrasonography in diagnosis of pediatric vocal fold paralysis

Objectives

To investigate the appearance of the pediatric larynx on ultrasound images and the diagnostic potential of ultrasound in cases of pediatric vocal fold paralysis.

Methods

First, we confirmed the ultrasonographic features of the laryngeal landmarks in 2 pediatric cadaveric larynxes. Secondly, 45 children were enrolled in a clinical study (13 patients with vocal fold paralysis and 32 normal children). Quantitative analysis of vocal fold mobility was carried out by measuring the maximum glottic angle (MGA) and vocal fold-arytenoid angle (VAA).

Results

All the paralyzed vocal folds showed abnormal mobility, and were flaccid during breathing and phonation. The rima glottis appeared as a hyperechoic air-column band in ultrasound images during phonation. The mean value of the MGA was 61.47 ± 9.00 in the normal larynx and 42.25 ± 10.41 in the paralyzed larynx. In the affected side of the paralyzed larynx, the VAA in maximum abduction was smaller than that in the normal larynx or in the unaffected side. The median difference of the VAA between maximum abduction and maximum adduction was less than that in the normal larynx. The kappa value was 0.96.

Conclusion

MGA and VAA are quantitative indicators of vocal fold immobility. Ultrasound is a reliable method of diagnosis of pediatric VFP. To diagnose VFP from an ultrasound image, the criteria are: (1) abnormal mobility (this was the most important and direct evidence), (2) hyperechoic air-column band of the glottic rima during phonation, (3) flaccid vocal fold and (4) asymmetry of the glottal structures.     

Hearing status in children with congenital cytomegalovirus: up-to-6-years audiological follow-up

Objective

To evaluate the audiological outcome of children with congenital cytomegalovirus infection.

Methods

In a prospective study, the hearing of ninety seven congenitally cytomegalovirus-infected children, born between January 2003 and July 2009, was systematically evaluated until the age of six, applying the Flemish CMV protocol. Depending on the age of the child, the protocol provides hearing evaluation by objective-, play- or conventional audiometry. Symptomatic children with hearing loss at birth were treated with ganciclovir, if parents consented.

Results

Seventy children had a pass on initial screening, 27 had unilateral or bilateral hearing loss. Within the normal hearing group, one asymptomatic and two symptomatic children developed late-onset hearing loss. Within the group with hearing loss, 8 children received ganciclovir, while 8 symptomatic and 11 asymptomatic children did not receive ganciclovir. As for the treated group, 37.5% of the children had stable hearing loss, one child had progressive and one child had fluctuating hearing loss. Improvement of hearing threshold occurred in 37.5% of the children. Among the untreated symptomatic children, hearing loss remained stable in 50%, while progression occurred in 37.5%. In the group of asymptomatic children with hearing loss, hearing loss was most commonly stable (72.7%).Within the group of normal hearing ears at birth (n = 156), there is a significant better progression in pure tone average for ears of asymptomatic subjects in comparison to ears of symptomatic subjects (p ≤ 0.0001). As for the group of ears with hearing loss at birth (n = 38), analysis shows no evidence for a difference in pure tone average progression between the different groups (p = 0.38).

Conclusions

Cytomegalovirus infection may cause hearing loss, in both symptomatic and asymptomatic children. Our data show a significant difference, between both groups, in the progression of pure tone average of normal hearing ears at birth, in favor of the asymptomatic children. This is not the case for ears with hearing loss at birth. However, this may be due to the small number of ears in this group. Our data show the tendency that treatment with ganciclovir increases the likelihood of improvement and reduces the likelihood of deterioration of the hearing.