Longitudinal formant analysis after cochlear implantation in school-aged children

INTRODUCTION: The purpose of this investigation was to describe the correlation between vocal and hearing development by longitudinal analysis of sound spectrograms, as a basic system for evaluating progress in vocal development. SUBJECTS AND METHODS: Two school-aged children with prelingual deafness were evaluated diachronically to assess speech perception and speech intelligibility after cochlear implantation. One child had non-syndromic hearing impairment without any known neurological deficit except for hearing loss, while the other had hearing impairment accompanied by mild mental retardation and attention deficit disorder. Their voices were recorded for monthly follow-up after cochlear implantation; these were used for formant analysis and compared with their mother's voice, and alteration of the formant data was also compared with monosyllable speech perception. RESULTS: Formant analysis demonstrated high concordance was observed between monosyllable speech perception and speech intelligibility. F1-F2 forms of the patients more closely resembled those of their mothers after 1 year's follow-up. The time point at which speech development altered was very similar in both cases although the final outcomes were different. CONCLUSION: Fair improvement of articulation after cochlear implant was demonstrated by the F1-F2 gram analysis. This procedure can be used for data sharing and cooperation between medical and educational specialists.     

Pediatric cochlear implantation: A quarter century in review

Objective: To review the growth of a pediatric cochlear implant (CI) program at one large tertiary care medical center over a 25-year period in order to (1) describe the population of pediatric cochlear implant recipients, (2) document word recognition outcomes, and (3) describe changes in candidacy criteria over time.

Design: A retrospective review of population demographics and trends included etiology of hearing loss, device use and type, expansion of inclusion criteria, and word recognition outcomes.

Results: Ninety-one percent of the children studied were from North Carolina and reflect the ethnic distribution of the state. The population is heterogeneous for etiology and the presence of syndromes and/or co-morbidities. A trend of lower age of implant and greater residual hearing was documented overtime. As a single metric, monosyllable word recognition for the children assessed is good with the mean CNC test word score of 76.13% (range 0–100, S.D?=?19.94).

Conclusions: Pediatric cochlear implant candidacy criteria have evolved despite no change in FDA-approved regulations since 2000. There is great diversity among recipients but word recognition outcomes are generally good in this population and have improved over time. Professionals who may refer children for cochlear implantation should be aware of current clinical practices and general outcomes.     

Pediatric cochlear implantation in Taiwan: long-term communication outcomes

OBJECTIVES/HYPOTHESIS: Cochlear implantation is an established method of auditory rehabilitation for severely and profoundly hearing impaired individuals. Although numerous studies have examined communication outcomes in pediatric cochlear implant (CI) recipients, data concerning the benefits of cochlear implantation in children who speak Mandarin Chinese are lacking. This study examined communication outcomes in 29 Mandarin-speaking children implanted at Chung Gung Memorial Hospital. DESIGN: A prospective between-groups design was used to compare communication outcomes as a function of age at time of implantation. METHODS: Children in the Younger group were implanted before 3 years of age, whereas children in the Older group were implanted after 3 years of age. Outcome measures assessed auditory thresholds, speech perception, speech intelligibility, receptive and expressive language skills, communication barriers, and communication mode. Correlation analysis was used to examine the relationship between communication outcome and age at implantation. RESULTS: Children in the Younger group demonstrated a significant level of difference on Mandarin vowels, consonants, tones, and open-set speech perception compared with the children in the Older group. Between-group differences were also shown on receptive and expressive language skills. But, no significant differences were noted on speech intelligibility or in self-ratings of communication barriers. A larger proportion of children in the Younger group used oral communication and were educated in mainstream classrooms. Communication mode change of the Younger group reached a significant level after cochlear implant. Speech perception performance was negatively correlated with age at implantation as well as chronological age. Mandarin-speaking children can obtain substantial communication benefits from cochlear implantation, with earlier implantation yielding superior results.     

Early prelingual auditory development and speech perception at 1-year follow-up in Mandarin-speaking children after cochlear implantation

Objective

The primary purpose of the current study was to evaluate early prelingual auditory development (EPLAD) and early speech perception longitudinally over the first year after cochlear implantation in Mandarin-speaking pediatric cochlear implant (CI) recipients. Outcome measures were designed to allow comparisons of outcomes with those of English-speaking pediatric CI recipients reported in previous research.

Method

A hierarchical outcome assessment battery designed to measure EPLAD and early speech perception was used to evaluate 39 pediatric CI recipients implanted between the ages of 1 and 6 years at baseline and 3, 6, and 12 months after implantation. The battery consists of the Mandarin Infant-Toddler Meaningful Auditory Integration Scale (ITMAIS), the Mandarin Early Speech Perception (MESP) test, and the Mandarin Pediatric Speech Intelligibility (MPSI) test. The effects of age at implantation, duration of pre-implant hearing aid use, and Mandarin dialect exposure on performance were evaluated. EPLAD results were compared with the normal developmental trajectory and with results for English-speaking pediatric CI recipients. MESP and MPSI measures of early speech perception were compared with results for English-speaking recipients obtained with comparable measures.

Results

EPLAD, as measured with the ITMAIS/MAIS, was comparable in Mandarin- and English-speaking pediatric CI recipients. Both groups exceeded the normal developmental trajectory when hearing age in CI recipients and chronological age in normal were equated. Evidence of significant EPLAD during pre-implant hearing aid use was observed; although at a more gradual rate than after implantation. Early development of speech perception, as measures with the MESP and MPSI tests, was also comparable for Mandarin- and English-speaking CI recipients throughout the first 12 months after implantation. Both Mandarin dialect exposure and the duration of pre-implant hearing aid use significantly affected measures of early speech perception during this time period.

Conclusions

EPLAD and early speech perception exhibited similar patterns of improvement during the first 12 months after early cochlear implantation. The duration of pre-implant hearing aid use had a significant positive effect on both categories of outcome measures. Consistent post-implant EPLAD trajectories and early speech perception results provide objective evidence that can guide best practices in early intervention protocols.     

人工耳蜗植入术295例语言康复临床分析

目的 研究耳蜗植入术后听觉言语康复效果及其影响因素。 方法 采用听觉行为分级(CAP)、言语可懂度分级(SIR)及视频和录音言语清晰度分析法分别对295例人工耳蜗植入术后患者进行听觉言语康复效果评估。 结果 2例蜗神经细小合并内耳畸形患者开机听阈为45 dB,其余听阈为25~40 dB。单因素分析结果显示:术前助听器的佩戴、植入年龄、植入后时间、术前残余听力、内耳畸形程度、脑白质病变对CAP及SIR差异有统计学意义;手术方法、中耳炎、Waardenburg综合征对CAP、SIR差异无统计学意义。多因素Logistic回归分析结果显示:植入后时间、脑白质病变与CAP、SIR显著相关。 结论 大部分患者可从人工耳蜗植入术中获得满意效果,其听觉言语康复程度受多种因素的影响。     

Early cochlear implantation: Verbal working memory,vocabulary, speech intelligibility and participant variables

Objectives: The purpose of this study was to compare performance in the areas of verbal working memory (VWM), vocabulary skills, and speech intelligibility between children with cochlear implants (CIs) and children with typical development (TD). The correlations between participant variables and the scores of children with CIs in VWM and the measures of language were examined. Also, it was important to identify which variables predict VWM in children with CIs.

Methods: A total of 59 children participated in this study with the study group being comprised of 31 children who had received a CI and the control group being comprised of 28 children with TD. The assessment techniques utilized in this study were the backward digit span (BDS), non-word repetition, speech intelligibility, and vocabulary skills.

Results: The study results revealed significant differences in the non-word repetition, speech intelligibility, and vocabulary tasks. The results all favored the typically developing children while the findings for the BDS were equal for both groups.

Discussion: In children with CIs the results for VWM observed in this study are believed to be related to the modality of assessment presentation, prior vocabulary knowledge, and familiarity with the presented material. The results from this study also revealed that the variables which predicted VWM in children with CIs were speech perception, duration of CI use, and vocabulary knowledge.     

Orbital sequelae of rhinosinusitis after cochlear implantation in children

OBJECTIVES: The objectives of this retrospective case review were to describe orbital complications in children after cochlear implantation, to define rhinosinusitis as a possible preoperative risk factor, and to suggest a possible pathophysiological mechanism for this previously unreported occurrence. METHODS: Records of children undergoing cochlear implantation over a 7-year period at a tertiary academic medical center were reviewed. Four children who experienced postoperative orbital sequelae were identified. We describe the demographics, clinical course, and radiologic findings in these children. RESULTS: The records of 91 children who underwent cochlear implantation were reviewed. The mean age was 6.0 years (range, 0.9-16.9 years). Forty-nine children (54%) were female and 51 (56%) were white. Four children developed postoperative orbital complications on the ipsilateral side to implantation. Orbital complications were characterized by periorbital edema and preseptal cellulitis necessitating prolonged hospitalization in all four children (mean length of stay, 3.3 days). Each child's orbital complication resolved with medical therapy that included intravenous antibiotics and nasal saline. Temporal bone images before implantation showed evidence of rhinosinusitis in all four cases. Of 76 available preoperative scans from the unaffected children, only 11 (14%) studies showed evidence of rhinosinusitis. CONCLUSIONS: Children with preoperative radiologic evidence of rhinosinusitis may be at risk of orbital sequelae after cochlear implantation. Positioning of the patient during surgery, length of surgery, and minor trauma to the lamina papyracea during drilling of the mastoid may be important etiologic factors. A careful review of medical history and computed tomography imaging before implantation may identify at-risk children.     

Speech detection and localization results and clinical outcomes for children receiving sequential bilateral cochlear implants before four years of age

The aim of this study was to describe the adaptation to bilateral cochlear implant use and the perceptual benefits demonstrated by 10 children who were successful users of a first implant when a second was received before four years of age. Although one subject rejected the second implant at switch-on, the nine subjects who accepted the device adapted easily to bilateral implant use and developed useful listening skills with the second implant. Tests of localization (left versus right) and speech detection in noise were administered in the unilateral and bilateral conditions, usually after six months experience. All subjects demonstrated some bilateral benefit on speech detection testing (mostly due to a headshadow effect), and the majority localized left versus right. Results suggested that outcomes may be negatively impacted by increased age at the time of second implant switch-on. The majority of the subjects adapted well to bilateral implant use within six months and demonstrated some perceptual benefit and, according to subjective parent reports, improved daily functioning; however, device rejection must be discussed pre-operatively as a possibility.     

Speech development in children after cochlear implantation

We evaluated the long-term speech intelligibility of young deaf children after cochlear implantation (CI). A prospective study on 47 consecutively implanted deaf children with up to 5 years cochlear implant use was performed. The study was conducted at a pediatric tertiary referral center for CI. All children in the study were deaf prelingually. They each receive implant before the program of auditory verbal therapy. A speech intelligibility rating scale evaluated the spontaneous speech of each child before and at frequent interval for 5 years after implantation. After cochlear implantation, the difference between the speech intelligibility, rating increased significantly each year for 3 years (P < 0.05). For the first year, the average rating remained “prerecognizable words” or “unintelligible speech”. After 2 year of implantation the children had intelligible speech if someone concentrates and lip-reads (category 3). At the 4- and 5-year interval, 71.5 and 78% of children had intelligible speech to all listeners (category 5), respectively. So, 5 years after rehabilitation mode and median of speech intelligibility rating was five. Congenital and prelingually deaf children gradually develop intelligible speech that does not plateau 5 years after implantation.     

听神经病及蜗神经发育不良儿童人工耳蜗植入的有效性

目的 通过问卷量表评估,探讨听神经病及蜗神经发育不良儿童的人工耳蜗植入效果.方法 实验组为2004年1月至2010年10月期间接受人工耳蜗植入的符合听神经病或蜗神经发育不良诊断标准、且术前至少佩戴3个月助听器并接受语言训练的患儿,共21例,其中听神经病9例,蜗神经发育不良12例.植入对照组为20例同期植入人工耳蜗的感音神经性聋患儿.所有人工耳蜗植入患儿均开机使用6个月以上.正常听力对照组为42例听力正常的儿童,按年龄分为正常听力A组(年龄在24个月以下)18例、正常听力B组(年龄24～ 48个月)16例和正常听力C组(年龄在48个月以上)8例.采用听觉行为分级(Categories of Auditory Performance,CAP)和言语可懂度分级(Speech Intelligibility Rating,SIR)两个量表进行评分,使用SPSS16.0软件对实验组得分与植入对照组和正常听力对照组进行比较.结果 听神经病组、蜗神经发育不良组、感音神经性聋组以及三组正常听力儿童的CAP得分(x±s,下同)分别为(4.44±1.50)分、(4.83±1.69)分、(4.55±1.66)分、(5.22±1.11)分、(6.75±0.45)分和(7.00±0.00)分,SIR得分分别为(2.66±1.11)分、(2.33±1.15)分,(2.40±0.75)分,(2.56±1.04)分、(4.12±0.81)分和(5.00±0.00)分.CAP和SIR得分在六组受试者间差异均具有统计学意义(x2=35.481,P＜0.001;x2 =40.549,P＜0.001);组内两两比较,听神经病组/蜗神经发育不良组与感音神经性聋组及正常听力A组得分比较,差异无统计学意义(P值均＞0.05),而与正常听力B组及C组相比,差异具有统计学意义(P值均＜0.01).结论 听神经病和蜗神经发育不良儿童接受人工耳蜗植入后,同感音神经性聋患儿一样,能够获得听觉及言语能力的进步,但落后于听力正常的同龄儿童.人工耳蜗提高此类患儿听觉及言语能力的远期效果还有待进一步随访和评估.     

Consonant and sign phoneme acquisition in signing children following cochlear implantation

Abstract

Deaf children from signing programs provide new opportunities to investigate changes in sign and speech acquisition following cochlear implantation. We describe the acquisition of sign phonemes (location, movement, and handshapes) and speech phonemes (consonants) in 22 implanted children with diverse demographic backgrounds. New consonants and new sign phonemes emerged in developmentally expected sequences and with statistically significant correlation coefficients between cumulative number of new consonants and new sign phonemes over time. Regression slopes from plotted z scores revealed a burst in consonant and sign growth in early months post-implant, with continuous but plateauing growth over time. These results and documentation of developmental levels of sign and speech phoneme trajectories should be helpful to other researchers and to clinicians working with signing children who have cochlear implants.     

Reading abilities after cochlear implantation: the effect of age at implantation on outcomes at 5 and 7 years after implantation

OBJECTIVES: The reading skills of deaf children have typically been delayed and this delay has been found to increase with age. This study explored the reading ability of a large group of children who had received cochlear implants 7 years earlier and investigated the relationship between reading ability and age at implantation. METHODS: The reading ages of 105 children, with age at implantation less than 7 years and onset of deafness below the age of three, were assessed 5 and 7 years after implantation using the Edinburgh reading test. Net reading age was calculated by using the difference between chronological age and reading age. Non-verbal intelligence was measured for a subset of 71 children, using Raven's coloured progressive matrices. Further investigation of this subset looked at the association of nonverbal intelligence, age at implantation and reading ability. RESULTS: There was a strong negative correlation at both 5 and 7 years after implant between net reading score and age at implantation. In the subset of 71 children who had an IQ score within normal range, those implanted at or before 42 months had age-appropriate reading both 5 and 7 years post-implant. This was not the case for children implanted after 42 months. Reading progress at the two post-implant assessment intervals were found to be highly related. CONCLUSIONS: Age at implantation was a significant factor in the development of reading skills in this group. In children implanted below the age of 42 months, reading progress was in line with chronological age, which has not been the case previously with profoundly deaf children. With earlier implantation more common in present groups, and improved technology, there is every reason to be optimistic about the influence of cochlear implantation on the development of reading skills in deaf children.     

Predictors of pediatric cochlear implantation outcomes in South Africa

ObjectiveTo identify and describe predictors of pediatric cochlear implantation outcomes in a South African population.MethodsA retrospective study of 301 pediatric cochlear implant (CI) recipients from five CI programs was conducted and cross-sectional outcome data were added at the time of data collection. Twenty potential prognostic factors were identified from the retrospective dataset, including demographical, CI, risk and family factors. Multiple regression analyses were performed to identify predictor variables that influence outcomes in terms of auditory performance (CAP scores), speech production (SIR scores), communication mode and educational placement.ResultsAlthough implanted children within this sample did not have equal opportunity to access a second implant, bilateral implantation was strongly predictive of better auditory performance and speech production scores, an oral mode of communication and mainstream education. NICU admittance/prematurity were associated with poorer auditory performance and speech production scores, together with a higher probability for non-oral communication and non-mainstream education. The presence of one or more additional developmental condition was predictive of poorer outcomes in terms of speech production and educational placement, while a delay between diagnosis and implantation of more than one year was also related to non-mainstream education. Ethnicities other than Caucasian were predictive of poorer auditory performance scores and a lower probability for mainstream education.ConclusionAn extensive range of prognostic indicators were identified for pediatric CI outcomes in South Africa. These predictive factors of better and poorer outcomes should guide pediatric CI services to promote optimal outcomes and assist professionals in providing evidence-based informational counseling.     

Revision pediatric cochlear implantation in a large tertiary center since 1986

Objective: To identify the rate of cochlear implantation (CI) re-implantation and assess audiologic outcomes.

Methods: Demographic, audiometric, radiographic, and clinical data were collected from the medical records of the first 834 pediatric patients (age < 18) who underwent CI at a tertiary-care center.

Results: Reviewing the first 834 pediatric patients who underwent CI between 1986 and 2013, 33 (4%) children have required re-implantation. Seven (0.8%) of these required a second re-implantation, for a total of 40 total revision surgeries (4.8%) and 21.1% of patients who underwent revision required multiple re-implantations. The mean age at initial CI was 3.5 years old, with identification of the failure an average of 2.7 years later (range, 0.1–10.1 years). The most common indications for re-implantation CI were unknown etiology (58%), vendor recall (18%), and trauma (9%). Twenty-three (88.5%) of the 26 patients who underwent only one re-implantation surgery achieved a complete insertion with both procedures. Eleven (91.7%) of 12 patients who had open set speech after their initial procedure maintained this after re-implantation surgery. Eight (38.1%) of 21 patients who did not have open-set speech after their initial implantation achieved open set speech with CI re-implantation.

Conclusion: CI re-implantation is not common in the pediatric population. However, given the time-sensitive nature of speech/language development in children, with the right indications, CI re-implantation can be performed safely without compromising audiologic outcomes. However, re-implanted patients have an increased risk they will require re-implantation again in the future.     

Assessment of outcomes of hearing and speech rehabilitation in children with cochlear implantation

ObjectivesThis study aimed to assess the effect of hearing and speech rehabilitation in patients with Nurotron^® cochlear implants.DesignNinety-eight paediatric patients with bilateral severe-to-profound sensorineural deafness who received cochlear implantation were divided into three groups according to age: group A (≤3 years), group B (4–7 years), and group C (8–16 years). All patients were followed up for one year for hearing and speech performance after the surgery. The comprehensive Auditory Perception Assessment, MAIS, CAP and SIR hearing and speech assessments and rating materials were used for assessment before the surgery and at 3, 6, and 12 months after implant activation.ResultsThe scores of patients in the open-set speech assessment, Chinese Auditory Perception Assessment, MAIS, CAP and SIR significantly improved after cochlear implantation in all age groups. The younger the age at implantation, the better the results. Moreover, the hearing and speech performance of cochlear implant recipients gradually improved with the extension of rehabilitation time.ConclusionsNurotron^® Venus? cochlear implantation can improve the hearing and speech performance of patients with bilateral severe-to-profound sensorineural deafness.     

Hearing benefits of second-side cochlear implantation in two groups of children

OBJECTIVE: To investigate the additional bilateral benefits of a second cochlear implant (CI) in a group of young children (<6 years of age) and a group of older children (>6 years of age). METHOD: This is a Belgian tertiary multi-centre study in which 33 CI-children with a second implant between the age of 2 and 12 participated. Assessments took place pre-second implant and at several time intervals post-fitting on pure tone audiometry and speech recognition in quiet and noise (+10 dBSNR). Testing was done with the first and second implant alone and bilaterally. Results were analysed separately for children younger and older than 6 years at the time of implantation of the 2nd CI. RESULTS: After 18 months of bilateral implant use all children obtained significantly higher hearing thresholds in the bilateral condition in comparison to both the unilateral conditions (p(CI1)=0.035/p(CI2)=0.042 for the younger children and p(CI1)=0.021/p(CI2)=0.007 for the older children). The speech recognition scores in quiet were for all children superior in the bilateral condition (p(CI2)=0.011 for the younger children and p(CI1)=0.016/p(CI2)=0.003 for the older children). In the noisy condition only significant bilateral better results were obtained in the group of younger children (p(CI1)=0.028/p(CI2)=0.034). CONCLUSIONS: Bilateral cochlear implantation offers advantages to all children. Even for the children who received a second implant after the age of 6 a progress is determined after 18 months. However, the data appear to show a beneficial performance for those children who received their second implant before the age of 6, especially in the more challenging conditions.     

Speech recognition outcomes following bilateral cochlear implantation in adults aged over 50 years old

Abstract

Objective: To examine the speech recognition benefit of bilateral cochlear implantation over unilateral implantation in adults aged over 50 years old, and to identify potential predictors of successful bilateral implantation in this group. Design: Retrospective cohort study using data collected during standard clinical practice. Bilateral performance was compared to the unilateral performance with the first and second implanted ear and examined in relation to potential predictive variables. Study sample: Sixty-seven cochlear implant users who received a second implant after the age of 50 years old. Results: Participants obtained significantly greater speech recognition scores with the use of bilateral cochlear implants compared to the use of each individual implant. The score obtained with the first implanted ear was the most reliable predictor of the score obtained with the second and with bilateral implants. Conclusions: Older adults can obtain speech recognition benefits from sequential bilateral cochlear implantation.