Developing a music programme for preschool children with cochlear implants

Abstract

Although music perception is especially challenging for cochlear implant (CI) users, young CI users' musical perception abilities are improved by participation in structured musical activities.

Objectives

To design, implement, evaluate, and publish a music training programme with a monitoring tool for preschool CI users, for use in family-centred habilitation programmes.

Methods

We devised a programme of musical activities, Musical EARS^®, and a curriculum-related hierarchical Evaluation Form to represent performance. The programme included sections on singing; recognizing songs, tunes, and timbre; and responding appropriately to music and rhythm. It was implemented over 18 months at Ilkses Rehabilitation Centre, with 25 paediatric MED-EL CI users split into three groups of varying age, duration of CI use, and ability.

Results

Mean total scores increased significantly for all groups. Scores increased unevenly across subscales. Participation in and enjoyment of musical activities increased for both children and parents. Significant correlations were found between scores and length of CI use.

Discussion

The training programme effectively enriches child CI users' musical experience. To varying degrees, children learned to perform the Musical EARS^® activities. The study allowed us to validate the lesson content and the hierarchical nature of the Evaluation Form. We conclude that prelingually deafened CI users should be systematically involved in musical activities to help them acquire skills acquired more easily by hearing peers.     

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.     

Comparison of outcomes in children with hearing aids and cochlear implants

Abstract

Objectives

The purpose of this study was to document the performance of a group of children with moderately severe to severe hearing loss who use hearing aids on a range of speech recognition, speech–language, and literacy measures and to compare these results to children with severe to profound hearing loss, who have learned language through cochlear implants.

Methods

This study involved 41 children with bilateral sensorineural hearing impairment, aged 6–18 years. Twenty children had moderately severe/severe hearing loss and used hearing aids, and 21 had severe to profound hearing loss and used cochlear implants. Communication and academic skills were assessed using speech recognition tests and standardized measures of speech production, language, phonology, and literacy.

Results

The two groups did not differ in their open-set speech recognition abilities or speech production skills. However, children with hearing aids obtained higher scores than their peers with cochlear implants in the domains of receptive vocabulary, language, phonological memory, and reading comprehension. The findings also indicate that children with moderately severe or severe hearing loss can develop spoken language skills that are within the range expected for normal hearing children.

Conclusions

School-aged children with moderately severe and severe hearing loss performed better in several domains than their peers with profound hearing loss who received cochlear implants between age 2 and 5 years. Further research is required to evaluate the benefits of hearing aids and cochlear implants in children with hearing loss who are diagnosed and receive intervention within the first year of life.     

Evolution of communication abilities after cochlear implantation in prelingually deaf children

Objective

This study tries to evaluate different factors on communication ability outcomes in cochlear implanted children.

Methods

Communication abilities are studied using the validated APCEI-scale based on five components of the language: cochlear implant acceptance, perceptive language performance, comprehension of the oral orders, expressive language and speech intelligibility.APCEI-scores were calculated every 6 months for the first 2 years, then yearly.The studied variables were: gender, social origin, preoperative residual hearing, age, aetiology of hearing loss, and associated disabilities.

Results

Communication ability scores increased with high socioeconomic level, presence of residual hearing, younger patients when no residual hearing, connexin mutation related deafness, and absence of associated disabilities. No significant difference has been noted between both sexes.

Conclusion

Many different factors influence the evolution of communication abilities of cochlear implanted children.Investigating the cause of hearing loss, presence of associated disabilities and residual hearing before surgery may help to predict outcome and plan appropriate care to those children with negative predictive factors.     

小儿电子耳蜗植入后的听功能变化

目的:探讨小儿电子耳蜗植入后不同时期的听功能变化。方法:将接受电子耳蜗植入的47例患儿分为NucleusN24和ClarionS两组,使用Nottingham大学的听觉活用进步教育听力进程评价体系(Nottingham大学LIP)观察患儿术后不同时期的听功能变化。结果:术前及开机后3、6、12个月的Nottingham大学LIP平均得分,NucleusN24组分别为(8.5±9.9)、(35.0±8.6)、(39.0±2.4)、(40.0±2.9)分,ClarionS组分别为(5.6±6.5)、(28.1±13.4)、(34.4±9.2)、(39.8±3.5)分。开机后的最初3个月听功能提高显著,3～12个月提高缓慢。开机后1年两组的听功能测试均接近满分。结论:两种电子耳蜗植入后听功能均可获得不同程度的提高,且两者无明显差异。     

Health-related quality of life in children and adolescents who use cochlear implants

Objective

Examination of health-related quality of life (HRQoL) in children and adolescents who wear a cochlear implant (CI) primarily has depended on parent proxy report of the child's HRQoL rather than child self-report and generic domains rather than CI-specific issues. This study simultaneously assessed self-report ratings on a generic HRQoL instrument and a preliminary CI module in pediatric CI users. The impact of demographic factors (chronologic age, age at CI, and CI experience) on HRQoL also was explored.

Methods

This cross-sectional study included 138 children grouped by chronologic age: 4-7, 8-11 and 12-16 years. The KINDL^R questionnaire for measuring HRQoL in children and adolescents (generic) and a preliminary CI module (specific) were completed as a researcher-administered interview (4-7 years) or self-administered questionnaire (8-16 years) at CI summer camp or home. Scores were transformed to a 100-point scale with 100 representing the most positive response. The impact of chronologic age group on HRQoL ratings was evaluated using Analysis of Variance. Spearman rank-order correlations and point-biserial correlations tested associations between demographic factors and HRQoL scores. Principal factor analysis was used to discover the factor structure and internal consistency of the preliminary CI module.

Results

The youngest group (M = 82.8) rated generic HRQoL significantly more positively than older children (8-11 years: M = 75.3; 12-16 years: M = 70.4). Similar significant results emerged on the overall CI module (4-7 years: M = 79.8; 8-11 years: M = 77.8; 12-16 years: M = 71.3). The youngest group rated CI-specific items on friends and self-image more positively than older groups, but reported greater difficulties hearing teachers at school. The oldest group provided more consistent responses than younger groups on the CI module (Cronbach α = 0.72). Generic and CI module scores correlated positively (r = 0.19, p = .03) but this association reflects the strong correlation in the oldest group (r = 0.49, p = 0.0033) and camouflages non-significant results in younger groups.

Conclusion

Chronologic age impacts self-report of HRQoL for pediatric CI users such that younger children rate HRQoL more positively than older children and adolescents on a generic instrument and preliminary CI module. Older children provide more consistent responses on the CI module. Results support the need for further development of a CI-specific self-report HRQoL instrument.     

Static balance function in children with cochlear implants

Objective

This study aimed to assess the static balance function in deaf adolescents with cochlear implants.

Methods

We included 24 adolescents who had received unilateral cochlear implantation for at least 5 years. Each subject underwent stabilometry testing under 4 different conditions: (A) firm surface with eyes open; (B) firm surface with eyes closed; (C) foam pad with eyes open; and (D) foam pad with eyes closed. All of them received tests with their cochlear implant turned on and off. Another 24 age- and sex-matched adolescents with normal hearing were tested in the same way for comparison. Sway velocity and circular area were measured and analyzed.

Results

The mean sway velocity of the cochlear implant group under conditions A-D was 1.68, 1.98, 2.36, and 5.25 cm/s, respectively, and the mean circular area of the cochlear implant group under conditions A-D was 7.39, 6.68, 12.21, and 34.27 cm², respectively. Both of the parameters showed statistical significance between the cochlear implant group and the normal hearing group for conditions A, C and D (p < 0.05). Furthermore, there was no significant balance function change among cochlear implant group with their implant “on” and “off”.

Conclusions

This study showed that the static balance function in adolescents with long-term use of cochlear implants was worse than those of normal hearing peers. The difference between the cochlear implant group and normal hearing group was the highest when both visual and somatosensory inputs were disrupted. The postural stability was similar whether or not the cochlear implant was activated.     

人工耳蜗植入后儿童的声调发声的初步研究

目的多导人工耳蜗对言语信号中的声调不能有效地提取并体现，本文探讨可能影响讲声调语言的儿童在人工耳蜗植入后的声调的发育状况。方法受试者为4例接受了人工耳蜗植入的语前聋患儿及7例同年龄组（3～9岁）的正常听力儿童。对受试者用10个音节发四声所录取的共40个语音样本的基频（F0）进行分析，F0的提取方法为自相关分析法。此外，正常成人对受试儿童的四声发声进行了主观评判。结果正常听力儿童的四声发声呈典型的（1）高平、（2）上升、（3）低谷及（4）下降四种形式，而人工耳蜗植入患儿四声发声从混乱无章至接近正常均有体现；正常听力成人对受试儿童的四声发声主观评判的结果表明，正常儿童的四声发声被认为准确无误，而人工耳蜗植入患儿则从毫无声调至接近正常均有分布。结论人工耳蜗植入后儿童的声调发声有不同程度的障碍，大量病例的进一步研究将有助于阐明个体差异的原由。     

Neuroelectrical imaging study of music perception by children with unilateral and bilateral cochlear implants

Abstract

Objective

To investigate by means of non-invasive neuroelectrical imaging the differences in the perceived pleasantness of music between children with cochlear implants (CI) and normal-hearing (NH) children.

Methods

5 NH children and 5 children who received a sequential bilateral CI were assessed by means of High-Resolution EEG with Source Reconstruction as they watched a musical cartoon. Implanted children were tested before and after the second implant. For each subject the scalp Power Spectral Density was calculated in order to investigate the EEG alpha asymmetry.

Results

The scalp topographic distribution of the EEG power spectrum in the alpha band was different in children using one CI as compared to NH children (see figure). With two CIs the cortical activation pattern changed significantly, becoming more similar to the one observed in NH children.

Conclusions

The findings support the hypothesis that bilateral CI users have a closer-to-normal perception of the pleasantness of music than unilaterally implanted children.     

Bilateral paediatric cochlear implants: A critical review

A recent trend has been the implantation of bilateral cochlear implants (CIs) for children with severe to profound hearing loss. A review of available research on bilateral CIs was conducted to determine the support for this trend. A replicable review was undertaken to evaluate published research studies that examined the effectiveness of bilateral paediatric cochlear implantation. Databases, reference lists, and journals were searched for relevant documents using a pre-determined search protocol. Twenty-nine articles met the review's inclusion criteria and were retrieved and reviewed. This review adds to the previously published reviews on the topic by identifying additional paediatric studies. Sound localization and speech recognition in noise appear to be improved with bilateral compared to unilateral cochlear implants. Similarly, evoked potential measures suggest improved morphology when the second CI is implanted early. Well-designed and controlled studies that explore a variety of outcomes including cost-effectiveness, quality of life, speech, language, and psycho-educational measures should be further explored in order to provide additional support for parents and clinicians confronted with the bilateral cochlear implant decision.     

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.     

学前听障儿童人工耳蜗术后语言康复教学研究

目的通过总结18名学前听障儿童植入人工耳蜗后1年内语言康复情况,分析儿童人工耳蜗术后语言康复的特点．为合理制订语言康复教学目标寻找依据,提出建议。方法定期对人工耳蜗术后儿童语言能力进行评估,记录儿童达到各个阶段语言目标的时间。1年后对以上材料进行整理、对比。分析儿童术后语言发展情况。结果18名儿童人工耳蜗术后康复1年的语言能力较术前有明显提高（P〈0．01）;语言康复呈现明显的阶段发展规律。结论依据儿童语言发展的阶段规律,通过多角度评估和观察,合理制订术后语言康复教学目标,开展多种途径的语言康复教学活动,能够促进儿童人工耳蜗术后语言康复的效果。     

Preliminary results of video Head Impulse Testing (vHIT) in children with cochlear implants

ObjectiveTo evaluate the lateral semicircular canal high frequency vestibulo-oculomotor reflex (LSC HF VOR) in children with cochlear implant.Methods16 children (10 females and 6 males, age range = 5–17 years) receiving a unilateral (n = 12) or a bilateral (n = 4) cochlear implant were included and compared to a control group of 20 age-matched normal-hearing (NH) children. Both implanted and NH children received a vestibular function test battery, including a Vestibulo-Ocular Reflex (VOR) gain assessment by means of a video-Head Impulse Test (vHIT), which represented the main outcome measure. In implanted subjects, vHIT was measured on both sides in the “CI-ON” and “CI-OFF” conditions.ResultsOverall, no significant LSC HF VOR gain difference was found between CI users and NH peers. In the unilaterally implanted group, the LSC HF VOR gain measured in the “CI-ON” condition was significantly higher than in the “CI-OFF” condition, both in the implanted and in the non-implanted ear. In the bilaterally implanted group there was no such a difference between the two conditions, on either side.ConclusionThis is the first study investigating the LSC HF VOR gain in children with unilateral and bilateral CI. The study demonstrates that the LSC HF VOR of bilaterally implanted children is comparable to normal hearing children.     

Auditory, speech and language development in young children with cochlear implants compared with children with normal hearing

Objective

This study had two aims: (1) to document the auditory and lexical development of children who are deaf and received the first cochlear implant (CI) by the age of 16 months and the second CI by the age of 31 months and (2) to compare these children's results with those of children with normal hearing (NH).

Methods

This longitudinal study included five children with NH and five with sensorineural deafness. All children of the second group were observed for 36 months after the first fitting of the device (cochlear implant). The auditory development of the CI group was documented every 3 months up to the age of two years in hearing age and chronological age and for the NH group in chronological age. The language development of each NH child was assessed at 12, 18, 24 and 36 months of chronological age. Children with CIs were examined at the same age intervals at chronological and hearing age.

Results

In both groups, children showed individual patterns of auditory and language development. The children with CIs developed differently in the amount of receptive and expressive vocabulary compared with the NH control group. Three children in the CI group needed almost 6 months to make gains in speech development that were consistent with what would be expected for their chronological age. Overall, the receptive and expressive development in all children of the implanted group increased with their hearing age.

Conclusion

These results indicate that early identification and early implantation is advisable to give children with sensorineural hearing loss a realistic chance to develop satisfactory expressive and receptive vocabulary and also to develop stable phonological, morphological and syntactical skills for school life. On the basis of these longitudinal data, we will be able to develop new diagnostic tools that enable clinicians to assess child's progress in hearing and speech development.     

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.     

构音干预对人工耳蜗植入儿童言语清晰度的影响

目的考查构音干预对人工耳蜗植入儿童言语清晰度的影响。方法选取17名人工耳蜗植入儿童进行研究,实验组11名聋儿接受构音干预。对照组6名聋儿不接受干预,对两组儿童实验前后言语清晰度的变化情况进行比较。结果实验组聋儿言语清晰度提高速度快,平均增幅约为30％;对照组聋儿言语清晰度提高速度相对较慢。结论针对性构音干预对提高人工耳蜗儿童声母、韵母、声调的清晰度有着积极的影响。     

The effect of pre-operative developmental delays on the speech perception of children with cochlear implants

Objective

The objective of this study was to evaluate the relationship between developmental delays and speech perception in pre-lingually deafened cochlear implant recipients.

Methods

This study was a retrospective review of patient charts conducted at a tertiary referral center. Thirty-five pre-lingually deafened children underwent multichannel cochlear implantation and habilitation at the Kyoto University Hospital Department of Otolaryngology-Head and Neck Surgery. A pre-operative cognitive–adaptive developmental quotient was evaluated using the Kyoto scale of psychological development. Post-operative speech performance was evaluated with speech perception tests two years after cochlear implantation. We computed partial correlation coefficients (controlled for age at the time of implantation and the average pre-operative aided hearing level) between the cognitive–adaptive developmental quotient and speech performance.

Results

A developmental delay in the cognitive–adaptive area was weakly correlated with speech perception (partial correlation coefficients for consonant–vowel syllables and phrases were 0.38 and 0.36, respectively).

Conclusion

A pre-operative developmental delay was only weakly associated with poor post-operative speech perception in pre-lingually deafened cochlear implant recipients.     

Neuroelectrical imaging investigation of cortical activity during listening to music in prelingually deaf children with cochlear implants

Objective

To date, no objective measure of the pleasantness of music perception by children with cochlear implants has been reported. The EEG alpha asymmetries of pre-frontal cortex activation are known to relate to emotional/affective engagement in a perceived stimulus. More specifically, according to the “withdrawal/approach” model, an unbalanced de-synchronization of the alpha activity in the left prefrontal cortex has been associated with a positive affective state/approach toward a stimulus, and an unbalanced de-synchronization of the same activity in the right prefrontal cortex with a negative affective state/withdrawal from a stimulus. In the present study, High-Resolution EEG with Source Reconstruction was used to compare the music-induced alpha asymmetries of the prefrontal cortex in a group of prelingually deaf implanted children and in a control group of normal-hearing children.

Methods

Six normal-hearing and six age-matched deaf children using a unilateral cochlear implants underwent High-Resolution EEG recordings as they were listening to a musical cartoon. Musical stimuli were delivered in three versions: Normal, Distort (reverse audio flow) and Mute. The EEG alpha rhythm asymmetry was analyzed: Power Spectral Density was calculated for each Region of Interest, together with a right-left imbalance index. A map of cortical activation was then reconstructed on a realistic cortical model.

Results

Asymmetries of EEG alpha rhythm in the prefrontal cortices were observed in both groups. In the normal-hearing children, the asymmetries were consistent with the withdrawal/approach model, whereas in cochlear implant users they were not. Moreover, in implanted children a different pattern of alpha asymmetries in extrafrontal cortical areas was noticed as compared to normal-hearing subjects.

Conclusions

The peculiar pattern of alpha asymmetries in implanted children's prefrontal cortex in response to musical stimuli suggests an inability by these subjects to discriminate normal from dissonant music and to appreciate the pleasantness of normal music. High-Resolution EEG may prove to be a promising tool for objectively measuring prefrontal cortex alpha asymmetries in child cochlear implant users.