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.     

Parent versus child assessment of quality of life in children using cochlear implants

Objective

Children with hearing loss who use cochlear implants have lower quality of life (QoL) in social situations and lower self-esteem than hearing peers. The child's QoL has been assessed primarily by asking the parent rather than asking the child. This poses a problem because parents have difficulty judging less observable aspects like self-esteem and socio-emotional functioning, the domains most affected by hearing loss.

Methods

This case-control study evaluated QoL in 50 preschoolers using a cochlear implant and their parents with the Kiddy KINDL^®, an established QoL measure. Children's responses were compared to a hearing control group and correlated with demographic variables. We used a questionnaire for parents and a face-to-face interview with children. T-tests were used to compare (a) paired parent-child ratings and (b) children with cochlear implants versus normal hearing. Pearson rank correlations were used to compare QoL with demographic variables.

Results

Children using cochlear implants rated overall QoL significantly more positively than their parents (M_Difference = 4.22, p = .03). Child rating of QoL did not differ significantly by auditory status (cochlear implant (82.8) vs. hearing (80.8), p = .42). Overall QoL correlated inversely with cochlear implant experience and chronologic age, but did not correlate with implantation age.

Conclusions

Preschool children using cochlear implants can assess adequately their own QoL, but parents afford valuable complementary perspective on the child's socio-emotional and physical well-being. Preschool children using cochlear implants rate overall QoL measures similar to hearing peers. A constellation of QoL measures should be collected to yield a better understanding of general QoL as well as specific domains centered on hearing loss.     

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.     

Educational performance of pediatric cochlear implant recipients in mainstream classes

OBJECTIVES: The present study documents the school performance of 20 pediatric cochlear implant recipients who attended mainstream classes and compares their educational performance with their normally hearing peers. METHODOLOGY: All 20 school-aged children who underwent cochlear implantation at the Universiti Kebangsaan Malaysia cochlear implant programme participated in this study. Three measures were employed to assess the school performance. First, using the SIFTER teacher-rating scale, the second measure was the child's examination results, and the third was the child's standing compared to his/her peers in language subject, mathematics, and the overall academic performance during the end of semester examinations. RESULTS: The SIFTER rating scale indicated that only 11.8% of the children were identified as not educationally at risk, 17.6% passed four of the SIFTER subtests, whereas the other 71.6% failed in at least two of the subtests on SIFTER. The highest pass rate was obtained in behavior subtest (76.5%), followed by classroom participation (70.6%), attention (58.8%), academic (47.1%), and communication (11.8%). On the educational performance, the cochlear implant recipients performed significantly better in mathematics (mean scores 62.67%; S.D. 22.24) than in language (mean scores 49.96%, S.D. 25.88) (p<0.01). In the overall examination performance, 25.00% had above average performance (>75th percentile), 18.75% had average performance (25-75th percentile), and another 56.25% performed at below average (<25th percentile). CONCLUSION: Children with cochlear implant were rated poorly in the SIFTER communication subtest. It is possible that language deficit presents an educational challenge in these children. The educational performance of children with cochlear implants in mainstream classes varies. Although 43.75% of them thrive well in a full-time mainstream setting, a significant percentage of them (56.25%) performed at below the average level. These findings reemphasize that although a cochlear implant has successfully provided deaf children with a good hearing potential, the majority of its recipients still require additional educational supports in order to function well in the mainstream educational setting.     

Academic achievements and classroom performance in Mandarin-speaking prelingually deafened school children with cochlear implants

Objectives

To document academic achievements and classroom performance in 35 Mandarin-speaking, congenital/pre-lingual, deafened children who used cochlear implants (CIs) for 5–11 years. The possible associated factors were also analyzed.

Study design

Cross-sectional case series.

Methods

Standardized Chinese literacy ability and mathematics tests were administered to evaluate the academic achievement of these children. Raw scores derived from both literacy ability and mathematics tests were compared with normative data from children with normal hearing (NH). A modified Mandarin edition of the Screening Instrument for Targeting Educational Risk (SIFTER) and a Regular School Adjustment Scale (RSAS) for students with hearing impairments filled out by regular classroom teachers were used to assess the children's classroom performances.

Results

The mean standard T-scores for Chinese literacy ability and mathematics ability were 48.6 and 50.3 (NORM = 50 ± 10), respectively. A total of 85.7% of children with CIs scored within or above the normal range of their age-matched hearing peers in Chinese literacy ability, and 82.9% were within normal ranges in mathematics ability. The SIFTER results showed that 45.7% failure was noted on the communication subscale, and the RSAS also indicated 40% of CI students to have communication problems. The academic subscale scores on the SIFTER were associated with the children's Chinese literacy abilities. The Verbal Comprehension Index (VCI) of the Wechsler IQ test IV was related to the children's mathematics abilities.

Conclusions

The academic achievements of Mandarin-speaking children who receive CIs from a young age and are integrated into mainstream elementary school system appear to fall within the normal range of their age-matched hearing counterparts after 5–11 years of use. This study strongly suggests the need for future ongoing support for these children in communication field.     

Children with hearing impairment--living with cochlear implants or hearing aids

Objective

The aim of this study was to enhance knowledge about the life circumstances of children with cochlear implants or hearing aids, regarding daily functioning and attitude to the impairment.

Methods

Data were obtained from 36 children with cochlear implants and 38 children with hearing aids via study-specific questionnaires with fixed answer alternatives. The questions covered (1) usage of aids and related factors, (2) hearing in different everyday situations, (3) thoughts about the children's own hearing and others’ attitudes to it, and (4) choice of language. The data were analyzed using SPSS, and presented via the theoretical frame of the International Classification of Functioning, Disability and Health, Child and Youth version (ICF-CY).

Results

Children with CI and HA functioned equally well in daily life, but there were also certain differences. Symptoms from neck and shoulders were more common among children with hearing aids than among children with cochlear implants (p < .001). Children with hearing aids used their aids significantly less often than those with cochlear implants (p < .001). The participation variables showed that children with hearing aids had significantly more hearing problems in team sports (p = .033) and outdoor activities (p = .019), in comparison to children with cochlear implants. The two groups had similar thoughts regarding their own hearing, mostly considering it not to be a problem. They also did not generally think that other people found their hearing to be a problem.

Conclusions

Children with cochlear implants and children with hearing aids have, in some aspects, equally good functioning in everyday life situations. However, certain differences were found in dimensions of functioning, regarding neck and shoulder pain, usage of aids and sign language, and hearing problems in some activities.     

Deafness-related self-perceptions and psychological well-being in deaf adolescents with cochlear implants

Abstract

Objective

This study aimed to examine the relationship between psychological well-being and self-perception in adolescents with cochlear implants, in relation to their perceptions of hearing, deaf signing, and orally communicating deaf peers.

Method

Self-perceptions were examined in 22 cochlear implant users aged 12–18 years, using the repertory grid technique that allows the respondent to generate personally relevant ‘identity’ constructs. Psychological well-being was assessed using the Beck Youth Inventory, a series of five self-report questionnaires assessing anxiety, depression, disruptive behaviour, anger, and self-esteem.

Results

Correlational analyses indicated that perceiving oneself as close to any peer, irrespective of which peer, was associated with better psychological well-being. There was also a significant positive association between perceived degree of similarity specifically to hearing peers, and psychological well-being. The closer the implanted adolescents perceived themselves to be to their hearing peers, the better their overall psychological well-being. In contrast, perceiving oneself as more similar to deaf signing peers or deaf oral peers was not significantly associated with psychological well-being.

Discussion

The findings are discussed in the context of previous research on social comparison, Deaf identity, and the aims of cochlear implantation.     

Identifying emotions in music through electrical hearing in deaf children using cochlear implants

Abstract

Objective: Cochlear implant (CI) devices are the choice of treatment for individuals with severe to profound hearing loss. The CI devices provide the opportunity for children who are deaf to perceive sound by electrical stimulation of the auditory nerve, with the goal of optimizing oral communication. A natural benefit of acquiring hearing using CIs is the ability to hear, and perhaps enjoy, music. Music is a non-verbal auditory stimulus and a powerful tool for transmitting emotion. Identifying emotional cues is an important part of normal social development and communication and thus music may play an important role in establishing these skills during development. To date, it is not known whether children who use cochlear implants to hear can identify the emotional content carried in music. Our objective in the present study was to determine whether children who have been deaf from infancy and are experienced CI users have acquired the ability to identify emotion in musical phrases.

Method: Study participants were 18 CI users (ages 7–13 years) who received right unilateral CIs (mean age at CI activation of 2.9 years) and 18 age-and gender-matched controls. Participants were asked to judge 32 brief musical excerpts as happy or sad by pointing to simple graphics of a smiling or frowning face.

Results: Children using CIs were able to correctly distinguish happy versus sad music well above chance levels, but performed more poorly on this task than their peers with typical hearing. Age at CI activation and time since CI activation were both uncorrelated with outcome measures.

Conclusion: Children with CIs show the ability to perceive emotion in music but do so less accurately than typically hearing peers.     

Measuring listening effort expended by adolescents and young adults with unilateral or bilateral cochlear implants or normal hearing

Abstract

Objectives

To compare the listening effort expended by adolescents and young adults using implants versus their peers with normal hearing when these two groups are achieving similar speech perception scores. The study also aimed to compare listening effort expended by adolescents and young adults with bilateral cochlear implants when using two implants versus one.

Methods

Eight participants with bilateral cochlear implants and eight with normal hearing aged 10–22 years were included. Using a dual-task paradigm, participants repeated consonant–nucleus–consonant (CNC) words presented in noise and performed a visual matching task. Signal-to-noise ratios were set individually to ensure the word perception task was challenging but manageable for all. Reduced performance on the visual task in the dual-task condition relative to the single-task condition was indicative of the effort expended on the listening task.

Results

The cochlear implant group, when using bilateral implants, expended similar levels of listening effort to the normal hearing group when the two groups were achieving similar speech perception scores. For three individuals with cochlear implants, and the group, listening effort was significantly reduced with bilateral compared to unilateral implants.

Discussion

The similar amount of listening effort expended by the two groups indicated that a higher signal-to-noise ratio overcame limitations in the auditory information received or processed by the participants with implants. This study is the first to objectively compare listening effort using two versus one cochlear implant. The results provide objective evidence that reduced listening effort is a benefit that some individuals gain from bilateral cochlear implants.     

Comparison of primary musicality development between children with cochlear implants and children with normal hearing

Abstract

Background: It is beneficial for CI patients listen to music. However it is necessary to take steps to improve the musicality of CI patients.

Objectives: The aims of the study were to evaluate the primary musicality of children with cochlear implants versus those with normal hearing.

Material and methods: Children participating in this study were divided into two groups: the cochlear implant group (CI group) and the normal hearing group (NH group). The ‘Musical Ears Evaluation Form for Professionals’ was used to evaluate the subjects’ primary musicality.

Results: The scores for overall and the three subcategories of primary musicality in children with cochlear implants and in those with normal hearing also improved significantly over time (p?<?.05). The score for overall primary musicality was not significantly different between CI and NH groups in the same hearing age (p?>?.05). There were significant differences between the two groups in the same chronological age (p?<?.05).

Conclusions and significance: The primary musicality in children with cochlear implants was not significantly different from normal hearing ones at the same hearing age. The primary musicality in children with cochlear implants was significantly lower than that of children with normal hearing at the same chronological age.     

Receptive language as a predictor of cochlear implant outcome for prelingually deaf adults

Abstract

Objective: This study investigated outcomes and predictive factors, specifically language skills, for a group of prelingually hearing-impaired adults who received a cochlear implant. Design: Speech perception data, demographic information, and other related variables such as communication mode, residual hearing, and receptive language abilities were explored. Pre- and post-implant speech perception scores were compared and multiple regression analysis was used to identify significant predictive relationships. Study sample: The study included 43 adults with a prelingual onset of hearing loss, who proceeded with cochlear implantation at the Royal Victorian Eye and Ear Hospital in Melbourne, Australia. Results: The majority of patients experienced benefit from their cochlear implants, with 88% demonstrating significant improvement in speech perception performance. Volunteers achieved better post-operative speech perception scores if they had a shorter duration of severe-to-profound hearing loss, better language skills, and used an exclusively oral communication mode. Conclusions: Although post-operative speech perception performance is significantly poorer for prelingually hearing-impaired adults compared to postlingually hearing-impaired patients, the study group demonstrated significant benefit from their cochlear implants. The variability in post-operative outcomes can be predicted to some extent from the hearing history and language abilities of the individual patient.     

人工耳蜗植入儿童使用无线调频系统的效果评价

目的评估无线调频系统在改善人工耳蜗植入儿童聆听效果中的作用。方法采用儿童助听系统评估问卷（Amplification Evaluation for Children）,对26名在机构康复的人工耳蜗植入儿童佩戴无线调频系统前后的聆听效果进行比较分析。结果对安静环境、嘈杂环境、远距离以及所有情景下的总体得分进行比较,仅使用助听设备与使用助听设备加无线调频系统之间均有显著性差异(P＜0.05)。结论人工耳蜗植入儿童使用无线调频系统后,聆听效果明显改善。     

Childhood Development after Cochlear Implantation (CDaCI) study: design and baseline characteristics

Children with severe to profound sensorineural hearing loss face communication challenges that influence language, psychosocial and scholastic performance. Clinical studies over the past 20 years have supported wider application of cochlear implants in children. The Childhood Development after Cochlear Implantation (CDaCI) study is the first longitudinal multicentre, national cohort study to evaluate systematically early cochlear implant (CI) outcomes in children. The objective of the study was to compare children who have undergone cochlear implantation, with similarly aged hearing peers across multiple domains, including oral language development, auditory performance, psychosocial and behavioural functioning, and quality of life. The CDaCI study is a multicentre national cohort study of CI children and normal hearing (NH) peers. Eligibility criteria include informed consent, age less than 5 years, pre- or post-lingually deaf, developmental criteria met, commitment to educate the child in English and bilateral cochlear implants. All children had a standardised baseline assessment that included demographics, hearing and medical history, communication history, language measures, cognitive tests, speech recognition, an audiological exam, psychosocial assessment including parent-child videotapes and parent reported quality of life. Follow-up visits are scheduled at six-month intervals and include a standardised assessment of the full battery of measures. Quality assurance activities were incorporated into the design of the study. A total of 188 CI children and 97 NH peers were enrolled between November 2002 and December 2004. The mean age, gender and race of the CI and NH children are comparable. With regard to parental demographics, the CI and NH children's families are statistically different. The parents of CI children are younger, and not as well educated, with 49% of CI parents reporting college graduation vs. 84% of the NH parents. The income of the CI parents is also lower than the NH parents. Assessments of cognition suggest that there may be baseline differences between the CI and NH children; however the scores were high enough to suggest language learning potential. The observed group differences identified these baseline characteristics as potential confounders which may require adjustment in analyses of outcomes. This longitudinal cohort study addresses questions related to high variability in language outcomes. Identifying sources of that variance requires research designs that: characterise potential predictors with accuracy, use samples that adequately power a study, and employ controls and approaches to analysis that limit bias and error. The CDaCI study was designed to generate a more complete picture of the interactive processes of language learning after implantation.     

Parental reported benefits and shortcomings of cochlear implantation: Pilot study findings from Southeast Asia

Abstract

Objective

The aim of the study was to understand the reported benefits and shortcomings by parents of children with cochlear implants and who contribute towards the cost of the implant.

Method

Thirty parents of children with cochlear implants from a hearing impaired school in Southeast Asia completed open-ended questionnaires and the data were analysed using content analysis.

Results

A wide range of benefits and shortcomings were reported. However, it is notable that the single most reported shortcoming was related to cost.

Discussion

The results suggest that, even though, in general, the reports about benefits and shortcomings were similar to previous results from western countries, the emphasis given to various aspects of shortcomings was different. In particular, it appears that parentally reported outcomes could be related to many factors including the hearing healthcare system with the costs involved for the implanted individuals and their families. These findings help us understand the parental perspectives of the success of cochlear implantation and will be useful during parental counselling sessions.     

Language and speech perception of young children with bimodal fitting or bilateral cochlear implants

Abstract

Objectives

This paper compares language development and speech perception of children with bimodal fitting (a cochlear implant in one ear and a hearing aid in the opposite ear) or bilateral cochlear implantation.

Methods

Participants were children enrolled in the Longitudinal Outcomes of Children with Hearing Impairment study. Language development was assessed at 3 years of age using standardized tests. Speech perception was evaluated at 5 years of age. Speech was presented from a frontal loudspeaker, and babble noise was presented either from the front or from both sides.

Results

On average, there was no significant difference in language outcomes between 44 children with bimodal fitting and 49 children with bilateral cochlear implants; after controlling for a range of demographic variables. Earlier age at cochlear implant activation was associated with better outcomes. Speech perception in noise was not significantly different between children with bimodal fitting and those with bilateral cochlear implants. Compared to normal-hearing children, children with cochlear implants required a better signal-to-noise ratio to perform at the same level, but demonstrated spatial release from masking of a similar magnitude.

Conclusions

This population-based study found that language scores for children with bilateral implants were higher than those with bimodal fitting or those with unilateral implants, but neither reached significance level.     

Factors influencing the quality of life of children with cochlear implants

IntroductionThe multidimensional impact of hearing loss on the various demands of life in children using cochlear implants is represented by variables that can influence the hearing, language and quality of life outcomes of this population.ObjectiveTo evaluate the factors influencing the quality of life of children with cochlear implantation, considering age, hearing age, age at evaluation, hearing skills, spoken language, family degree of receptiveness, schooling and socioeconomic status of the parents.MethodsParticipated 30 children using cochlear implants, aged 6 to 12 years and their respective parents. The children were evaluated by the categories auditory performance, by language category, and by the children with cochlear implants: perspectives parents questionnaire. Parents were assessed by the family involvement scale.ResultsThe cochlear implant impacted the quality of life of the children, with more significant results on the increase of the social relations domain and the decrease of the family support domain. Overall, the increase of the age in the evaluation, better hearing and language skills, the mother's level of schooling and the family receptiveness correlated with the quality of life of children with cochlear implants.ConclusionThe influencing factors that correlated with the quality of life of the implanted children were the child's older age at the evaluation, the better hearing and language skills, the mother's level of schooling and the family receptiveness.     

Children with cochlear implants: communication skills and quality of Life

Given the multidimensional scope of cochlear implants, there is a growing need to assess clinical measures related communicative abilities and more general aspects involved in the effectiveness of treatment, such as quality of life.AimTo translate and adapt an international questionnaire of quality of life to Brazilian Portuguese; to apply the questionnaire in parents of children with cochlear implant to assess quality of life of children after cochlear implantation; to analyze correlations among factors related to quality of life; to analyze correlations between quality of life and clinical measures of outcome.Methodprospective study in which parents of children with cochlear implants responded to validated instruments on quality of life and communication abilities.ResultsThe translation and adaptation of the questionnaire was satisfactorily completed. According to the data, cochlear implants had a positive effect on quality of life of the implanted children and their families. Observed correlations for the variable communication demonstrate a direct relationship between oral communication and other variables of quality of life.ConclusionsThis study makes this questionnaire available in Brazilian Portuguese. For parents of Brazilian children with cochlear implants, lexical development(acquisition and use of words) is the variable that relates most to the quality of life of their children.     

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.     

Nasalance in Cochlear Implantees

Objectives

Speech intelligibility is severely affected in children with congenital profound hearing loss. Hypernasality is a problem commonly encountered in their speech. Auditory information received from cochlear implants is expected to be far superior to that from hearing aids. Our study aimed at comparing the percentages of nasality in the speech of the cochlear implantees with hearing aid users and also with children with normal hearing.

Methods

Three groups of subjects took part in the study. Groups I and II comprised 12 children each, in the age range of 4-10 years, with prelingual bilateral profound hearing loss, using multichannel cochlear implants and digital hearing aids respectively. Both groups had received at least one year of speech therapy intervention since cochlear implant surgery and hearing aid fitting respectively. The third group consisted of age-matched and sex-matched children with normal hearing. The subjects were asked to say a sentence which consisted of only oral sounds and no nasal sounds ("Buy baby a bib"). The nasalance score as a percentage was calculated.

Results

Statistical analysis revealed that the children using hearing aids showed a high percentage of nasalance in their speech. The cochlear implantees showed a lower percentage of nasalance compared to children using hearing aids, but did not match with their normal hearing peers.

Conclusion

The quality of speech of the cochlear implantees was superior to that of the hearing aid users, but did not match with the normal controls. The study suggests that acoustic variables still exist after cochlear implantation in children, with hearing impairments at deviant levels, which needs attention. Further research needs to be carried out to explore the effect of the age at implantation as a variable in reducing nasality in the speech and attaining normative values in cochlear implantees, and also between unilateral versus bilateral implantees.