Language skills and phonological awareness in children with cochlear implants and normal hearing

ObjectivesEarly auditory experience plays a major role in language acquisition. Linguistic and metalinguistic abilities of children aged 5–5.5 years with cochlear implants (CIs) were compared to age-matched children with normal hearing (NH) to investigate the effect of hearing on development of these two skills.MethodsEighteen children with NH and 18 children with CIs took part in the study. The Test of Language Development-Primary, third edition, was used to assess language and metalinguistic skills by assessment of phonological awareness (PA). Language skills and PA were then compared between groups. Hierarchical linear regression was conducted to determine whether the language skills explained the unique variance in PA.ResultsThere were significant differences between children with NH and those with CIs for language skills and PA (p ≤ 0.001). All language skills (semantics, syntax, listening, spoken language, organizing, and speaking) were uniquely predictive of PA outcome in the CI children. Linear combinations of listening and semantics and listening, semantics, and syntax correlated significantly with PA.ConclusionThe results show that children with CIs may have trouble with language skills and PA. Listening, semantics, and syntax, among other skills, are significant indicators of the variance in PA for children with CIs.     

Oral communicating children using a cochlear implant: Good reading outcomes are linked to better language and phonological processing abilities

Introduction/objective

Cochlear implantation provides children with a significant hearing loss the potential to engage in phonological processing via audition; however these children can still have poor or inadequately detailed mental (phonological) representations of speech and as such phonological awareness and reading difficulties. Heterogeneous participant profiles, particularly varying modes of communication have clouded the research regarding reading outcomes of children using a cochlear implant. The objective of this study was to explore the relationships between word reading and reading comprehension outcomes, and a range of variables of a relatively homogenous group of children using cochlear implants.

Method

Forty-seven oral communicating children using a cochlear implant and who had attended auditory-verbal therapy served as participants. They were administered a comprehensive battery of 10 different assessments covering 22 different tasks across the domains of speech perception, speech production, language, phonological processing and reading. Correlation and principal component analyses were used to examine the relationships between outcome areas.

Results

Audiologic and demographic variables were not significantly related to reading outcomes, with the exception of family size. Language and word reading were most strongly related to reading comprehension, while phonological awareness and language were most strongly related to word reading. It is proposed that the development of well-specified phonological representations might underlie these relationships.

Conclusion

For oral communicating children using a cochlear implant, good reading outcomes are linked to better language and phonological processing abilities.     

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.     

Functional performance among children with cochlear implants and additional disabilities

Abstract

Objective

To assess daily functional skills among young cochlear implant (CI) recipients with additional disabilities.

Methods

Children with CI and developmental disabilities and a hearing control group containing similar ages and similar disabilities were enrolled in a cross-sectional study of language and functional skills. Daily functional skills were measured using the Pediatric Evaluation of Disability Inventory (PEDI), which provides standard and scaled scores in Self-Care, Mobility, and Social Functioning domains. Language was assessed using the Preschool Language Scales, 4th edition which provides standard scores and age equivalents.

Results

Fourteen children with CIs and seven hearing controls were included in this analysis. Most children in this study (90.5%) had cognitive disabilities and 57% had motor disabilities. Compared with the hearing controls, children with CIs were less likely to have functional independence in any PEDI domain. Children with CI had significantly lower median social functioning standard scores compared with controls (17.3 vs. 27.5, P = 0.009). After controlling for nonverbal cognitive abilities and language level, the difference was no longer significant (19.1 vs. 24, P = 0.3). Among children with CI, age at implant and duration with device were not associated (P > 0.4) with PEDI scores.

Discussion

Although children with CI and developmental disabilities had similar functional skills as hearing children with similar disabilities regarding the PEDI domains of Self-Care and Mobility, they had lower Social Function standard scores. This lower social functioning among children with implants may be related to lower language levels and possible language deficits seen in the CI group. Regular assessments of functional abilities coupled with language abilities are essential in providing every child with the opportunity for maximizing the potential for independence.     

Prelingual auditory-perceptual skills as indicators of initial oral language development in deaf children with cochlear implants

ObjectivesTo assess when prelingually deaf children with a cochlear implant (CI) achieve the First Milestone of Oral Language, to study the progression of their prelingual auditory skills in the first year after CI and to investigate a possible correlation between such skills and the timing of initial oral language development.MethodsThe sample included 44 prelingually deaf children (23 M and 21 F) from the same tertiary care institution, who received unilateral or bilateral cochlear implants. Achievement of the First Milestone of Oral Language (FMOL) was defined as speech comprehension of at least 50 words and speech production of a minimum of 10 words, as established by administration of a validated Italian test for the assessment of initial language competence in infants. Prelingual auditory-perceptual skills were assessed over time by means of a test battery consisting of: the Infant Toddler Meaningful Integration Scale (IT-MAIS); the Infant Listening Progress Profile (ILiP) and the Categories of Auditory Performance (CAP).ResultsOn average, the 44 children received their CI at 24 ± 9 months and experienced FMOL after 8 ± 4 months of continuous CI use. The IT-MAIS, ILiP and CAP scores increased significantly over time, the greatest improvement occurring between baseline and six months of CI use. On multivariate regression analysis, age at diagnosis and age at CI did not appear to bear correlation with FMOL timing; instead, the only variables contributing to its variance were IT-MAIS and ILiP scores after six months of CI use, accounting for 43% and 55%, respectively.ConclusionPrelingual auditory skills of implanted children assessed via a test battery six months after CI treatment, can act as indicators of the timing of initial oral language development. Accordingly, the period from CI switch-on to six months can be considered as a window of opportunity for appropriate intervention in children failing to show the expected progression of their auditory skills and who would have higher risk of delayed oral language development.     

Reading skills in Persian deaf children with cochlear implants and hearing aids

ObjectivesReading skills are necessary for educational development in children. Many studies have shown that children with hearing loss often experience delays in reading. This study aimed to examine reading skills of Persian deaf children with cochlear implant and hearing aid and compare them with normal hearing counterparts.MethodThe sample consisted of 72 s and third grade Persian-speaking children aged 8–12 years. They were divided into three equal groups including 24 children with cochlear implant (CI), 24 children with hearing aid (HA), and 24 children with normal hearing (NH). Reading performance of participants was evaluated by the “Nama” reading test. “Nama” provides normative data for hearing and deaf children and consists of 10 subtests and the sum of the scores is regarded as reading performance score.ResultsResults of ANOVA on reading test showed that NH children had significantly better reading performance than deaf children with CI and HA in both grades (P < 0.001). Post-hoc analysis, using Tukey test, indicated that there was no significant difference between HA and CI groups in terms of non-word reading, word reading, and word comprehension skills (respectively, P = 0.976, P = 0.988, P = 0.998).ConclusionConsidering the findings, cochlear implantation is not significantly more effective than hearing aid for improvement of reading abilities. It is clear that even with considerable advances in hearing aid technology, many deaf children continue to find literacy a challenging struggle.     

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.     

Lexical and semantic ability in groups of children with cochlear implants,language impairment and autism spectrum disorder

Objective

Lexical-semantic ability was investigated among children aged 6–9 years with cochlear implants (CI) and compared to clinical groups of children with language impairment (LI) and autism spectrum disorder (ASD) as well as to age-matched children with normal hearing (NH). In addition, the influence of age at implantation on lexical-semantic ability was investigated among children with CI.

Methods

97 children divided into four groups participated, CI (n = 34), LI (n = 12), ASD (n = 12), and NH (n = 39). A battery of tests, including picture naming, receptive vocabulary and knowledge of semantic features, was used for assessment. A semantic response analysis of the erroneous responses on the picture-naming test was also performed.

Results

The group of children with CI exhibited a naming ability comparable to that of the age-matched children with NH, and they also possessed a relevant semantic knowledge of certain words that they were unable to name correctly. Children with CI had a significantly better understanding of words compared to the children with LI and ASD, but a worse understanding than those with NH. The significant differences between groups remained after controlling for age and non-verbal cognitive ability.

Conclusions

The children with CI demonstrated lexical-semantic abilities comparable to age-matched children with NH, while children with LI and ASD had a more atypical lexical-semantic profile and poorer sizes of expressive and receptive vocabularies. Dissimilar causes of neurodevelopmental processes seemingly affected lexical-semantic abilities in different ways in the clinical groups.     

Behavioral inhibition and clinical outcomes in children with cochlear implants

OBJECTIVES/HYPOTHESIS: Individual speech and language outcomes of deaf children with cochlear implants (CIs) are quite varied. Individual differences in underlying cognitive functions may explain some of this variance. The current study investigated whether behavioral inhibition skills of deaf children were related to performance on a range of audiologic outcome measures. DESIGN: Retrospective analysis of longitudinal data collected from prelingually and profoundly deaf children who used CIs. METHODS: Behavioral inhibition skills were measured using a visual response delay task that did not require hearing. Speech and language measures were obtained from behavioral tests administered at 1-year intervals of CI use. RESULTS: Female subjects showed higher response delay scores than males. Performance increased with length of CI use. Younger children showed greater improvement in performance as a function of device use than older children. No other subject variable had a significant effect on response delay score. A series of multiple regression analyses revealed several significant relations between delay task performance and open set word recognition, vocabulary, receptive language, and expressive language scores. CONCLUSIONS: The present results suggest that CI experience affects visual information processing skills of prelingually deaf children. Furthermore, the observed pattern of relations suggests that speech and language processing skills are closely related to the development of response delay skills in prelingually deaf children with CIs. These relations may reflect underlying verbal encoding skills, subvocal rehearsal skills, and verbally mediated self-regulatory skills. Clinically, visual response delay tasks may be useful in assessing behavioral and cognitive development in deaf children after implantation.     

Correlation of neurocognitive processing subtypes with language performance in young children with cochlear implants

Abstract

Objectives

Test data were used to explore the neurocognitive processing of a group of children with cochlear implants (CIs) whose language development is below expectations.

Methods

This cross-sectional study examines the relationship between neurocognitive processing, as assessed by the Kaufman Assessment Battery for Children-Second Edition, and verbal language standard scores, assessed using either the Comprehensive Assessment of Spoken Language or the Clinical Evaluation of Language Fundamentals in 22 school-age children with CIs. Processing scores of CI recipients with language scores below expectations were compared to those of children meeting or exceeding language expectations. Multiple linear regression estimated the associations of simultaneous and sequential processing with language scores.

Results

Though simultaneous processing scores between the two groups were similar, the mean sequential processing score (91.2) in the below expectations group (n = 13) was significantly lower (P = 0.002) than that of children (n = 9) meeting expectations (110.8). After adjusting for age at implantation, a 10-point higher sequential processing score was associated with a 7.4 higher language score (P = 0.027).

Discussion

Simultaneous processing capacity was at least within the average range of cognitive performance, and was not associated with language performance in children with CIs. Conversely, reduced sequential processing capacity was significantly associated with lower language scores.

Conclusion

Neurocognitive skills, specifically cognitive sequencing, serial ordering, and auditory-verbal memory may be targets for therapeutic intervention. Intensive cognitive and educational habilitation and in milieu intervention may improve language learning in children with CIs.     

Language skills of profoundly deaf children who received cochlear implants under 12 months of age: a preliminary study

Conclusion. This study demonstrated that children who receive a cochlear implant below the age of 2 years obtain higher mean receptive and expressive language scores than children implanted over the age of 2 years. Objective. The purpose of this study was to compare the receptive and expressive language skills of children who received a cochlear implant before 1 year of age to the language skills of children who received an implant between 1 and 3 years of age. Subjects and methods. Standardized language measures, the Reynell Developmental Language Scale (RDLS) and the Preschool Language Scale (PLS), were used to assess the receptive and expressive language skills of 91 children who received an implant before their third birthday. Results. The mean receptive and expressive language scores for the RDLS and the PLS were slightly higher for the children who were implanted below the age of 2 years compared with the children who were implanted over 2 years old. For the PLS, both the receptive and expressive mean standard scores decreased with increasing age at implantation.     

An exploratory study of visual sequential processing in children with cochlear implants

ObjectiveThe objective of the study was to compare visual sequential processing in school-age children with cochlear implants (CIs) and their normal-hearing (NH) peers. Visual sequential processing was examined using both behavioral and an event-related potential (ERP) measures.MethodsEighteen children with CIs and nineteen children who had hearing within normal limits (NH) participated in the behavioral study. Subtests from the Test of Visual Perceptual Skills and the Sensory Integration and Praxis Test were administered to all children. ERP measures were collected from five children with CI and five age-matched peers. Peak latencies (N200 and P300) and reaction times for visual sequential processing were compared in these two groups.ResultsThe findings of the study revealed significant group differences in visual sequential memory and visuo-motor sequencing tasks suggesting that children with severe-profound hearing loss may have difficulties in visual sequential tasks. The study also revealed longer P300 latencies and longer reaction times for a visual sequential matching task in children with CI when compared to their NH peers suggesting slower or delayed processing of visual sequential stimuli.ConclusionsThis exploratory study involving behavioral and ERP measures showed that as a group, children with prelingual, severe-profound hearing loss who use CIs have difficulties with visual sequential processing. These findings may have implications for rehabilitation for children with hearing loss in the light of recent evidence that accurate and efficient processing of sequentially presented visual stimuli is important for language and reading outcomes.     

Tone and sentence perception in young Mandarin-speaking children with cochlear implants

ObjectivesThe purpose of this study was to examine the outcomes of cochlear implantation in young children in terms of (1) perception of lexical tones in quiet, (2) perception of sentences in quiet and in noise, (3) the effects of five demographic variables (i.e., preoperative hearing level, age at implantation, duration of cochlear implants use, maternal educational level, and whether a child underwent a hearing aid trial before implantation) on lexical tone perception and sentence perception, and (4) the relationship between lexical tone perception and sentence perception.Methods96 participants, aged from 2.41 years to 7.09 years, were recruited in mainland China. The children exhibited normal cognitive abilities and received unilateral implants at an average age of 2.72 years, with ages ranging from 0.69 to 5 years of age.ResultsThe mean score for tone identification was 77% (SD = 13%; chance level = 50%). Tone 2/tone 3 was the most difficult tone contrast to identify. Children with a longer duration of CI use and whose mothers had more years of education tended to perform better in sentence perception in quiet and in noise. Having undergone a hearing aid trial before implantation and more residual hearing were additional factors contributing to better sentence perception in noise. The only demographical variable that related to tone perception in quiet was duration of CI. In addition, while there was a modest correlation between tone perception and sentence perception in quiet (r_s = 0.47, p < 0.001), the correlation between tone perception in quiet and sentence perception in noise was much weaker (r_s = −0.28, p < 0.05).ConclusionsThe findings suggested that most young children who had been implanted before 5 years of age and had 1–3 years of implant use did not catch up with their aged peers with normal hearing in tone perception and sentence perception. The weak to moderate correlation between tone perception in quiet and sentence perception might imply that the improvement of tone perception in quiet may not necessarily contribute to sentence perception, especially in noise condition.     

Working memory in children with cochlear implants: Problems are in storage,not processing

Background

There is growing consensus that hearing loss and consequent amplification likely interact with cognitive systems. A phenomenon often examined in regards to these potential interactions is working memory, modeled as consisting of one component responsible for storage of information and another component responsible for processing of that information. Signal degradation associated with cochlear implants should selectively inhibit storage without affecting processing. This study examined two hypotheses: (1) A single task can be used to measure storage and processing in working memory, with recall accuracy indexing storage and rate of recall indexing processing; (2) Storage is negatively impacted for children with CIs, but not processing.

Method

Two experiments were conducted. Experiment 1 included adults and children, 8 and 6 years of age, with NH. Procedures tested the prediction that accuracy of recall could index storage and rate of recall could index processing. Both measures were obtained during a serial-recall task using word lists designed to manipulate storage and processing demands independently: non-rhyming nouns were the standard condition; rhyming nouns were predicted to diminish storage capacity; and non-rhyming adjectives were predicted to increase processing load. Experiment 2 included 98 8-year-olds, 48 with NH and 50 with CIs, in the same serial-recall task using the non-rhyming and rhyming nouns.

Results

Experiment 1 showed that recall accuracy was poorest for the rhyming nouns and rate of recall was slowest for the non-rhyming adjectives, demonstrating that storage and processing can be indexed separately within a single task. In Experiment 2, children with CIs showed less accurate recall of serial order than children with NH, but rate of recall did not differ. Recall accuracy and rate of recall were not correlated in either experiment, reflecting independence of these mechanisms.

Conclusions

It is possible to measure the operations of storage and processing mechanisms in working memory in a single task, and only storage is impaired for children with CIs. These findings suggest that research and clinical efforts should focus on enhancing the saliency of representation for children with CIs. Direct instruction of syntax and semantics could facilitate storage in real-world working memory tasks.     

Jumpstarting auditory learning in children with cochlear implants through music experiences

Abstract

Musical experiences are a valuable part of the lives of children with cochlear implants (CIs). In addition to the pleasure, relationships and emotional outlet provided by music, it serves to enhance or ‘jumpstart’ other auditory and cognitive skills that are critical for development and learning throughout the lifespan. Musicians have been shown to be ‘better listeners’ than non-musicians with regard to how they perceive and process sound. A heuristic model of music therapy is reviewed, including six modulating factors that may account for the auditory advantages demonstrated by those who participate in music therapy. The integral approach to music therapy is described along with the hybrid approach to pediatric language intervention. These approaches share the characteristics of placing high value on ecologically valid therapy experiences, i.e., engaging in ‘real’ music and ‘real’ communication. Music and language intervention techniques used by the authors are presented. It has been documented that children with CIs consistently have lower music perception scores than do their peers with normal hearing (NH). On the one hand, this finding matters a great deal because it provides parameters for setting reasonable expectations and highlights the work still required to improve signal processing with the devices so that they more accurately transmit music to CI listeners. On the other hand, the finding might not matter much if we assume that music, even in its less-than-optimal state, functions for CI children, as for NH children, as a developmental jumpstarter, a language-learning tool, a cognitive enricher, a motivator, and an attention enhancer.     

Vocal singing by prelingually-deafened children with cochlear implants

The coarse pitch information in cochlear implants might hinder the development of singing in prelingually-deafened pediatric users. In the present study, seven prelingually-deafened children with cochlear implants (5.4–12.3 years old) sang one song that was the most familiar to him or her. The control group consisted of 14 normal-hearing children (4.1–8.0 years old). The fundamental frequencies (F0) of each note in the recorded songs were extracted. The following five metrics were computed based on the reference music scores: (1) F0 contour direction of the adjacent notes, (2) F0 compression ratio of the entire song, (3) mean deviation of the normalized F0 across the notes, (4) mean deviation of the pitch intervals, and (5) standard deviation of the note duration differences. Children with cochlear implants showed significantly poorer performance in the pitch-based assessments than the normal-hearing children. No significant differences were seen between the two groups in the rhythm-based measure. Prelingually-deafened children with cochlear implants have significant deficits in singing due to their inability to manipulate pitch in the correct directions and to produce accurate pitch height. Future studies with a large sample size are warranted in order to account for the large variability in singing performance.     

The family oriented musical training for children with cochlear implants: Speech and musical perception results of two year follow-up

Objective

The purpose of this study is to determine whether children can gain benefit from training on pitch and music perception. Our main goals were to prepare a tool for training pitch and rhythm perception and evaluate musical attitude in children, to determine whether pitch and rhythm perception improve more rapidly through training and to assess the impact of training on speech perception.

Method

A family centred habilitation program based on musical training is developed. Nine newly implanted children who were switched on in HiRes and trained from the outset and 9 children using HiRes strategy who did not receive training both undergo assessments to determine pitch and rhythm perception skills and speech perception assessments. Music group was formed by the children who were implanted consecutively. As a control group, children who are being followed for another study which examines “the changes of sound quality perception, speech understanding, speech production, and communication mode” are included. The speech perception test battery contains a comprehensive range of age appropriate tasks covering detection, discrimination, identification, recognition and comprehension abilities. Also meaningful auditory integration scale (MAIS) or infant-toddler MAIS (if more appropriate) and the meaningful use of speech scale (MUSS) were administered in order to collect information about children's use of sound in everyday situations such as device bounding, alerting to sound and deriving meaning from auditory stimuli. Musical training program was based on a take-home electric keybord which is used for listening to different pairs of notes. For this study, three octaves and one extra note at the high end of the keyboard were used. Children were expected to discriminate a pair of notes. Assessments of speech perception at pre-implant, 1-,3-,6-,12-,24-months post switch-on. By the end of the first and second years, parents were given the ‘musical stages questionnaire’ which covers some of the key areas of musical development to compare both groups’ musical development.

Results

Children who were involved in music study demonstrated significant familiarity in both determining pitch differences. No significant difference was found between music group compared with the non-trained group in terms of speech perception (p > 0.05). However, by the end of 3rd month, music group came into prominence particularly at the rate of being linguistically/developmentally ready to carry out formal modified open-set speech perception evaluation (p < 0.05). Both groups seemed to be developed similarly in sound awareness and general reaction, differentiating melody, dynamic, rhythmical changes and emotional aspects of musical development (p > 0.05) whereas music group had more exposure to music at the end of the first year (p < 0.05). However, by the end of the second year music group developed more than the control group in all aspects of musical skills (p < 0.05).

Conclusion

Music training program helps appreciation of music and may enhance their progress in other auditory domains after cochlear implantation in children. While, effects of the musical training program on daily listening attitudes and social aspects such as closer parent-child relationship were significantly observed future training programs that should strive to improve satisfaction with music listening and its effect on auditory perception.     

The contribution of short-term memory capacity to reading ability in adolescents with cochlear implants

ObjectiveThis study aimed to establish the relationship between short-term memory capacity and reading skills in adolescents with cochlear implants.Methods and materialsA between-groups design compared a group of young people with cochlear implants with a group of hearing peers on measures of reading, and auditory and visual short-term memory capacity. The groups were matched for non-verbal IQ and age. The adolescents with cochlear implants were recruited from the Cochlear Implant Programme at a specialist children's hospital. The hearing participants were recruited from the same schools as those attended by the implanted adolescents. Participants were 18 cochlear implant users and 14 hearing controls, aged between 12 and 18 years. All used English as their main language and had no significant learning disability or neuro-developmental disorder.Short-term memory capacity was assessed in the auditory modality using Forward and Reverse Digit Span from the WISC IV UK, and visually using Forward and Reverse Memory from the Leiter-R. Individual word reading, reading comprehension and pseudoword decoding were assessed using the WIAT II UK.ResultsA series of ANOVAs revealed that the adolescents with cochlear implants had significantly poorer auditory short-term memory capacity and reading skills (on all measures) compared with their hearing peers. However, when Forward Digit Span was entered into the analyses as a covariate, none of the differences remained statistically significant.ConclusionsDeficits in immediate auditory memory persist into adolescence in deaf children with cochlear implants. Short-term auditory memory capacity is an important neurocognitive process in the development of reading skills after cochlear implantation in childhood that remains evident in later adolescence.     

UK and Ireland experience of cochlear implants in children with Down Syndrome

Objectives

Down Syndrome (DS) is associated with a high incidence of hearing loss. The majority of hearing loss is conductive, but between 4 and 20% is sensorineural, which in the main is mild or moderate and is managed with conventional behind-the-ear hearing aids. Cochlear implantation is an elective invasive procedure, performed to provide some form of hearing rehabilitation in individuals with severe to profound sensorineural hearing loss, and initially candidacy criteria were strict—excluding patients with additional disabilities. With good results and expanding experience, more candidates with additional disabilities are now being implanted. A survey of UK and Ireland Cochlear Implant Programmes sought to identify the number of individuals with DS who have been implanted with a cochlear implant (CI) and to provide relevant information on outcomes of implantation in these individuals.

Methods

E-mail survey of all programmes within the British Cochlear Implant Group (BCIG). Postal questionnaire to programmes identified to have implanted a child with Down Syndrome, with data collection on pre-operative assessment, surgical and post-operative outcomes. Case series review.

Results

Three of 23 BCIG programmes have implanted a child with Down Syndrome. Four children have received implants. No intraoperative or post-operative surgical complications were encountered. All children had middle ear disease, but no problems with implantation were associated with their middle ear condition. All children remain implant users, 12 months to 4 years post-implantation.

Conclusion

Cochlear implantation is an option for a child with Down Syndrome and associated severe to profound sensorineural hearing loss. Clinicians caring for these children and their families should consider referral for assessment by a Cochlear Implant Programme.     

Lexical tone recognition in noise in normal-hearing children and prelingually deafened children with cochlear implants

Abstract

Objective: The purpose of the present study was to investigate Mandarin tone recognition in background noise in children with cochlear implants (CIs), and to examine the potential factors contributing to their performance. Design: Tone recognition was tested using a two-alternative forced-choice paradigm in various signal-to-noise ratio (SNR) conditions (i.e. quiet,?+12,?+6, 0, and ?6?dB). Linear correlation analysis was performed to examine possible relationships between the tone-recognition performance of the CI children and the demographic factors. Study sample: Sixty-six prelingually deafened children with CIs and 52 normal-hearing (NH) children as controls participated in the study. Results: Children with CIs showed an overall poorer tone-recognition performance and were more susceptible to noise than their NH peers. Tone confusions between Mandarin tone 2 and tone 3 were most prominent in both CI and NH children except for in the poorest SNR conditions. Age at implantation was significantly correlated with tone-recognition performance of the CI children in noise. Conclusions: There is a marked deficit in tone recognition in prelingually deafened children with CIs, particularly in noise listening conditions. While factors that contribute to the large individual differences are still elusive, early implantation could be beneficial to tone development in pediatric CI users.