Children with cochlear implants: changing parent and deaf community perspectives

OBJECTIVE: To examine changing parent and deaf community perspectives related to pediatric cochlear implantation. DESIGN: This research is based primarily on 2 nonrandom study designs. In the first study, conducted by the Gallaudet University Research Institute, Washington, DC, in the spring of 1999, a 12-page questionnaire was distributed to 1841 parents of children with cochlear implants; 439 questionnaires were returned. In the second study, we conducted 56 interviews with parents of 62 children with implants (and 1 without). SUBJECTS: Parents of children with cochlear implants; Gallaudet University faculty, staff, students, and alumni. RESULTS: While parents frequently receive conflicting information about educational and communication options for their child, they generally support signing before and after implantation. The parents of a child with an implant have a great interest in their child's spoken language development, and most would like to have had their child receive an implant earlier. Children with implants are educated in a variety of educational settings. Mainstreamed children with implants often continue to require classroom support services, and children with implants are frequently not isolated from both deaf and hearing peers. Parents have mixed experiences when getting information from persons in the deaf community. COMMENT: Opposition to pediatric cochlear implantation within the deaf community is giving way to the perception that it is one of a continuum of possibilities for parents to consider. To ensure optimal use of the cochlear implant, parents need to remain involved in their child's social and educational development.     

Exploring the language and literacy outcomes of pediatric cochlear implant users

OBJECTIVE: The principal goal of this study was to investigate the relationship between language and literacy (i.e., reading and writing) skills in pediatric cochlear implant users. A peripheral objective was to identify the children's skills that were in need of remediation and subsequently to provide suggestions for remedial programming. It was predicted that the robust language skills often associated with children who have cochlear implant experience would facilitate the development of literacy skills. It was further proposed that the language and literacy skills of pediatric cochlear implant users would approximate the language and literacy skills of children with normal hearing. DESIGN: Sixteen pediatric cochlear implant users' language and literacy skills were evaluated and then compared with a reference group of 16 age-matched, normal-hearing children. All 32 participants were educated in mainstream classes within the public school system in the Midwest. The "Sentence Formulation" and "Concepts and Directions" subtests of the Clinical Evaluation of Language Fundamentals-3 test were used to evaluate receptive and expressive language skills. Reading comprehension was evaluated with the "Paragraph Comprehension" subtest of the Woodcock Reading Mastery Test. Performance measures for the writing analyses included productivity, complexity and grammaticality measures. RESULTS: Children with cochlear implants performed within 1 SD of the normal-hearing, age-matched children on measures of language comprehension, reading comprehension and writing accuracy. However, the children with cochlear implants performed significantly poorer than the children with normal hearing on the expressive "Sentence Formulation" subtest. The cochlear implant users also produced fewer words on the written narrative task than did the normal-hearing children, although there was not a significant difference between groups with respect to total words per clause. Furthermore there was a strong correlation between language performance and reading performance, as well as language performance and total words produced on the written performance measure for the children using cochlear implants. CONCLUSIONS: The results of this study suggest that the language skills of pediatric cochlear implant users are related to and correlated with the development of literacy skills within these children. Consequently, the performance of the cochlear implant users, on various language and literacy measures, compared favorably to an age-matched group of children with normal hearing. There were significant differences in the ability of the cochlear implant users to correctly utilize grammatical structures such as conjunctions and correct verb forms when they were required to formulate written and oral sentences. Given this information, it would be appropriate for their educational or remedial language programs to emphasize the use and development of these structures.     

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.     

Cochlear implantation in children with congenital inner ear malformations

OBJECTIVE/HYPOTHESIS: To assess the audiologic and surgical outcomes for pediatric cochlear implant patients with inner ear malformations. STUDY DESIGN: Retrospective review of 315 pediatric cochlear implant cases from 1994 to 2002. METHODS: Twenty-eight pediatric cochlear implant patients with known inner ear malformations determined on high-resolution computed tomography (HRCT) of the temporal bone were the subjects of review. Results of HRCT findings, intraoperative findings, postoperative complications, and objective measures of both closed- and open-set testing of speech perception were analyzed. RESULTS: Patients with the constellation of an incompletely partitioned (IP) cochlea, enlarged vestibular aqueduct (EVA), and a dilated vestibule (i.e., Mondini's malformation) as well as those with an isolated EVA or partial semicircular canal aplasia have relatively good levels of speech perception. Patients with total semicircular canal aplasia, isolated IP, cochlear hypoplasia, or common cavity demonstrated lower levels of performance. Poor performance may be related to associated developmental delays rather than labyrinthine anatomy alone. Complications of surgery were relatively limited. CONCLUSIONS: Cochlear implantation can be successfully performed in children with inner ear malformations. These children and their parents can expect significant auditory benefits from this intervention. The various types of inner ear malformations may have quite different prognoses for good auditory performance.     

Longitudinal changes in children's speech and voice physiology after cochlear implantation

OBJECTIVES: The purposes of this investigation were 1) to describe speech/voice physiological characteristics of prelingually deafened children before and after cochlear implantation and determine whether they fall into a range that would be considered deviant, 2) to determine whether selected deviant articulatory and phonatory behaviors of children with cochlear implants persist despite long-term cochlear implant use and continued participation in aural rehabilitation services, and 3) to determine whether further development of deviant articulatory and phonatory behaviors occurs postimplantation. DESIGN: Seven prelingually deafened children who received cochlear implants after 5 yr of age were followed from shortly before implantation until 5 to 6 yr postimplantation. These children received their early education in a Total Communication environment and used the Nucleus 22-electrode cochlear implant. All of them initially used the MPEAK speech processing strategy, and five of them eventually upgraded to the SPEAK speech processing strategy. Speech/voice physiological measurements that were obtained periodically from the children included intraoral air pressure (P(o)), nasal and phonatory air flow, voice onset time (VOT), and fundamental frequency (F(o)). Data from the deaf children were compared with a database from 56 children with normal hearing to determine when the deaf children exhibited "deviant" speech/voice behaviors. Speech/voice behaviors were considered "deviant" if they never occurred for children with normal hearing or were associated with z-scores that were outside the range of +/-2.0. RESULTS: The deaf children showed a wide range of deviant speech and voice behaviors both pre- and post-cochlear implant. The most frequently occurring atypical behaviors were use of negative P(o), high P(o) for [b, m], long and short VOT for [p], and high F(o). Some deviant behaviors improved post-cochlear implant. However, deviant behaviors often persisted for several years post-cochlear implant. There was considerable evidence of further development of deviant behaviors post-cochlear implant. All of the deaf children demonstrated deviancy on at least two of our measures at the last data collection interval (5 to 6 yr post-cochlear implant). CONCLUSIONS: Children who received cochlear implants after 5 yr of age and who were educated in a Total Communication setting showed persistence and further development of deviant speech/voice behaviors for several years post-cochlear implant. Although our findings cannot be generalized to other populations of children with cochlear implants (i.e., those who were implanted earlier, those educated in auditory-oral programs), it seems wisest at the present time not to assume that children's deviant speech/voice behaviors will remit spontaneously with continued cochlear implant use. Our data provide an important comparative database for future investigations of pediatric cochlear implant users who have had shorter periods of auditory deprivation and who have received cochlear implants with more current technological features. Longitudinal Changes in Children's Speech and Voice Physiology after Cochlear Implantation     

Cochlear implantation at under 12 months: report on 10 patients

OBJECTIVES: There is growing evidence that early application of a cochlear implant in children affected by profound congenital hearing loss is of paramount importance for the development of an adequate auditory performance and language skills. For these reasons and as a result of advances in audiologic diagnosis and an enhanced awareness of the safety of cochlear implants, the age of implantation has substantially decreased over recent years. Children aged as little as 12 months are now being implanted in some centers. On the basis of our experience with very young children, we believe that the date of implantation may be further reduced to only 4 to 6 months of age. STUDY DESIGN: Over the period from November 1998 to April 2004, 103 children have been fitted with cochlear implants and 11 with auditory brainstem implants in our department, including 65 children aged below 3 years. The present study focuses on 10 children aged less than 12 months fitted with cochlear implants from November 1998 to December 2003. METHODS: The children's ages ranged from 4 to 11 (mean 9.5) months. Five were males and five females. All received a Nucleus CI 24 M. Postoperative auditory performance, as evaluated at the latest follow-up, was based on the category of auditory performance (CAP). The results obtained in these 10 children were compared with those obtained with cochlear implants in children belonging to older age brackets. The criteria used to assess speech performance were onset of babbling onset and babbling spurt, and the results observed were compared with those of a control group of 10 normally hearing children. RESULTS: Surgery was uneventful, and no immediate or delayed complications were encountered. Auditory performance was seen to increase as function of early age of implantation and length of implant use. All 10 children had a CAP score of 3 within 6 months of cochlear implant activation. The onset of babbling occurred very early (i.e., within 1 to 3 months of activation of the implant in all 10 patients), regardless of age at implantation, whereas the babbling spurt was recorded at times ranging from 3 to 5 months after implant activation. The positive impact of early implantation on babbling was clearly shown by the fact that the earlier the activation of the cochlear implant, the closer the results were to the outcomes of normally hearing children. CONCLUSIONS: We encourage very early implantation to facilitate a series of developmental processes occurring in the critical period of initial language acquisition. The indices we used in the present study (i.e., CAP and babbling) suggest that early cochlear implantation tends to yield normalization of audio-phonologic parameters, which enables us to consider the performance of children implanted very early as being similar to that of their normally hearing peers.     

Auditory performance of children with cochlear ossification and partial implant insertion.

The management of the profoundly deaf child with a cochlear implant poses a special challenge, particularly when total ossification of the cochlea is present. In this setting, insertion of an electrode array into a child's cochlea is often difficult. Our experience supports the feasibility of partial insertion of a multichannel implant into the basal turn of an ossified cochlea. Five children with ossified cochleae who had undergone partial implantation of a multichannel electrode were compared with the performance of matched controls who had full insertion of multichannel implants. No dramatic differences were detected during a 6- to 18-month follow-up period on selected test measures. These preliminary results suggest that active electrode number may exert a limited effect on performance with a cochlear implant. Drilling out the basal turn of an ossified cochlea in conjunction with partial insertion of a multichannel implant appears to be an acceptable surgical and rehabilitational alternative for placement of a cochlear implant prosthesis in children with complete cochlear ossification.     

Audiovisual speech perception in elderly cochlear implant recipients

OBJECTIVES/HYPOTHESIS: This study examined the speech perception skills of a younger and older group of cochlear implant recipients to determine the benefit that auditory and visual information provides for speech understanding. STUDY DESIGN: Retrospective review. METHODS: Pre- and postimplantation speech perception scores from the Consonant-Nucleus-Consonant (CNC), the Hearing In Noise sentence Test (HINT), and the City University of New York (CUNY) tests were analyzed for 34 postlingually deafened adult cochlear implant recipients. Half were elderly (i.e., >65 y old) and other half were middle aged (i.e., 39-53 y old). The CNC and HINT tests were administered using auditory-only presentation; the CUNY test was administered using auditory-only, vision-only, and audiovisual presentation conditions RESULTS: No differences were observed between the two age groups on the CNC and HINT tests. For a subset of individuals tested with the CUNY sentences, we found that the preimplantation speechreading scores of the younger group correlated negatively with auditory-only postimplant performance. Additionally, older individuals demonstrated a greater reliance on the integration of auditory and visual information to understand sentences than did the younger group CONCLUSIONS: On average, the auditory-only speech perception performance of older cochlear implant recipients was similar to the performance of younger adults. However, variability in speech perception abilities was observed within and between both age groups. Differences in speechreading skills between the younger and older individuals suggest that visual speech information is processed in a different manner for elderly individuals than it is for younger adult cochlear implant recipients.     

Effects of central nervous system residua on cochlear implant results in children deafened by meningitis

BACKGROUND: This study explored factors associated with speech recognition outcomes in postmeningitic deafness (PMD). The results of cochlear implantation may vary in children with PMD because of sequelae that extend beyond the auditory periphery. OBJECTIVE: To determine which factors might be most determinative of outcome of cochlear implantation in children with PMD. DESIGN: Retrospective chart review. SETTING: A referral center for pediatric cochlear implantation and rehabilitation. SUBJECTS: Thirty children with cochlear implants who were deafened by meningitis were matched with subjects who were deafened by other causes based on the age at diagnosis, age at cochlear implantation, age at which hearing aids were first used, and method of communication used at home or in the classroom. MAIN OUTCOME MEASURE: Speech perception performance within the first 2 years after cochlear implantation and its relationship with presurgical cognitive measures and medical history. RESULTS: There was no difference in the overall cognitive or postoperative speech perception performance between the children with PMD and those deafened by other causes. The presence of postmeningitic hydrocephalus, however, posed greater challenges to the rehabilitation process, as indicated by significantly smaller gains in speech perception and a predilection for behavioral problems. By comparison, cochlear scarring and incomplete electrode insertion had no impact on speech perception results. CONCLUSIONS: Although the results demonstrated no significant delay in cognitive or speech perception performance in the PMD group, central nervous system residua, when present, can impede the acquisition of speech perception with a cochlear implant. Central effects associated with PMD may thus impact language learning potential; cognitive and behavioral therapy should be considered in rehabilitative planning and in establishing expectations of outcome.     

Effects of early auditory experience on the spoken language of deaf children at 3 years of age

OBJECTIVE: By age 3, typically developing children have achieved extensive vocabulary and syntax skills that facilitate both cognitive and social development. Substantial delays in spoken language acquisition have been documented for children with severe to profound deafness, even those with auditory oral training and early hearing aid use. This study documents the spoken language skills achieved by orally educated 3-yr-olds whose profound hearing loss was identified and hearing aids fitted between 1 and 30 mo of age and who received a cochlear implant between 12 and 38 mo of age. The purpose of the analysis was to examine the effects of age, duration, and type of early auditory experience on spoken language competence at age 3.5 yr. DESIGN: The spoken language skills of 76 children who had used a cochlear implant for at least 7 mo were evaluated via standardized 30-minute language sample analysis, a parent-completed vocabulary checklist, and a teacher language-rating scale. The children were recruited from and enrolled in oral education programs or therapy practices across the United States. Inclusion criteria included presumed deaf since birth, English the primary language of the home, no other known conditions that interfere with speech/language development, enrolled in programs using oral education methods, and no known problems with the cochlear implant lasting more than 30 days. RESULTS: Strong correlations were obtained among all language measures. Therefore, principal components analysis was used to derive a single Language Factor score for each child. A number of possible predictors of language outcome were examined, including age at identification and intervention with a hearing aid, duration of use of a hearing aid, pre-implant pure-tone average (PTA) threshold with a hearing aid, PTA threshold with a cochlear implant, and duration of use of a cochlear implant/age at implantation (the last two variables were practically identical because all children were tested between 40 and 44 mo of age). Examination of the independent influence of these predictors through multiple regression analysis revealed that pre-implant-aided PTA threshold and duration of cochlear implant use (i.e., age at implant) accounted for 58% of the variance in Language Factor scores. A significant negative coefficient associated with pre-implant-aided threshold indicated that children with poorer hearing before implantation exhibited poorer language skills at age 3.5 yr. Likewise, a strong positive coefficient associated with duration of implant use indicated that children who had used their implant for a longer period of time (i.e., who were implanted at an earlier age) exhibited better language at age 3.5 yr. Age at identification and amplification was unrelated to language outcome, as was aided threshold with the cochlear implant. A significant quadratic trend in the relation between duration of implant use and language score revealed a steady increase in language skill (at age 3.5 yr) for each additional month of use of a cochlear implant after the first 12 mo of implant use. The advantage to language of longer implant use became more pronounced over time. CONCLUSIONS: Longer use of a cochlear implant in infancy and very early childhood dramatically affects the amount of spoken language exhibited by 3-yr-old, profoundly deaf children. In this sample, the amount of pre-implant intervention with a hearing aid was not related to language outcome at 3.5 yr of age. Rather, it was cochlear implantation at a younger age that served to promote spoken language competence. The previously identified language-facilitating factors of early identification of hearing impairment and early educational intervention may not be sufficient for optimizing spoken language of profoundly deaf children unless it leads to early cochlear implantation.     

The effect of GJB2 allele variants on performance after cochlear implantation

OBJECTIVES/HYPOTHESIS: It has been hypothesized that etiology of hearing loss may serve as an independent variable in performance after cochlear implantation. To test this hypothesis, the authors identified pediatric cochlear implant recipients with gap junction protein beta2 (GJB2)-related deafness. The study examines performance outcomes associated with GJB2 deafness-causing allele variants. STUDY DESIGN: Pediatric cochlear implant patients were screened for GJB2 allele variants; statistical comparisons were made with prospectively obtained performance measures. METHODS: From 181 children who participated in a nationwide cochlear implant research program, 122 children were identified with congenital nonsyndromic sensorineural hearing loss and invited to participate. Screening for GJB2 allele variants was completed for 55 children. The children were homogeneous with respect to age (8 or 9 y) and age at implant (before age 5 y). All patients have previously undergone a prospective regimented battery of performance measures. RESULTS: Performance measures were compared between 22 children with and 33 children without mutations to determine whether GJB2 status was a significant predictor of cochlear implant outcomes. Reading and cognitive outcomes were significantly dependent on connexin status. The group of children who tested positive for GJB2-related deafness scored significantly higher on a nonverbal cognitive measure, Block Design, and on a measure of reading comprehension. CONCLUSION: The isolated insult to the cochlea created by GJB2 allele variants allows for preservation of central cognitive function. Better reading performance is seen in children with GJB2-related deafness.     

Mode of communication and classroom placement impact on speech intelligibility

OBJECTIVE: To examine the impact of classroom placement and mode of communication on speech intelligibility scores in children aged 8 to 9 years using multichannel cochlear implants. DESIGN: Classroom placement (special education, partial mainstream, and full mainstream) and mode of communication (total communication and auditory-oral) reported via parental rating scales before and 4 times after implantation were the independent variables. Speech intelligibility scores obtained at 8 to 9 years of age were the dependent variables. PARTICIPANTS: The study included 131 congenitally deafened children between the ages of 8 and 9 years who received a multichannel cochlear implant before the age of 5 years. RESULTS: Higher speech intelligibility scores at 8 to 9 years of age were significantly associated with enrollment in auditory-oral programs rather than enrollment in total communication programs, regardless of when the mode of communication was used (before or after implantation). Speech intelligibility at 8 to 9 years of age was not significantly influenced by classroom placement before implantation, regardless of mode of communication. After implantation, however, there were significant associations between classroom placement and speech intelligibility scores at 8 to 9 years of age. Higher speech intelligibility scores at 8 to 9 years of age were associated with classroom exposure to normal-hearing peers in full or partial mainstream placements than in self-contained, special education placements. CONCLUSIONS: Higher speech intelligibility scores in 8- to 9-year-old congenitally deafened cochlear implant recipients were associated with educational settings that emphasize oral communication development. Educational environments that incorporate exposure to normal-hearing peers were also associated with higher speech intelligibility scores at 8 to 9 years of age.     

Revision cochlear implant surgery in adult patients with suspected device malfunction.

OBJECTIVE: To report the outcomes of patients that have undergone revision cochlear implant surgery for suspected device malfunction. STUDY DESIGN: Retrospective case series. SETTING: Academic medical center. PATIENTS: Adult cochlear implant patients with devices that fail to lock or maintain a lock but are associated with troubling signs and symptoms. INTERVENTION: Revision cochlear implant surgery. MAIN OUTCOME MEASURES: Demographics, presenting signs and symptoms, surgical findings, complications, audiologic performance and device analysis. RESULTS: To date, 33 revision cochlear implant operations have been performed in 30 patients. Eight (24%) presented with a failure of the speech processor to lock with the internal device (i.e., hard failure). Twenty-five (76%) presented with either aversive auditory (n = 23 [92%]) or nonauditory (n = 21 [84%]) symptoms or performance-related issues (n = 16 [64%]) while maintaining a lock (i.e., suspected soft failure). Revision surgery resulted in resolution of the patient's presenting signs and symptoms in nearly 90% of cases and significant improvements in auditory performance. Perioperative complications were uncommon. Preoperative testing and device analysis frequently did not reveal the reason for presumed device malfunction. CONCLUSION: Revision cochlear implantation should be considered in patients significantly affected by intolerable auditory and/or nonauditory symptoms or when performance issues have been documented.     

Willingness-to-pay for pediatric cochlear implantation

OBJECTIVE: This paper presents the results of the first willingness-to-pay (WTP) study to be undertaken on cochlear implantation. It aims to measure the values parents place on the UK having a pediatric cochlear implantation (PCI) programme. METHODS: Face-to-face semi-structured interviews were conducted with parents of children from the Nottingham Pediatric Cochlear Implant programme, whom had been implanted for a period ranging from 1 month to 13 years. Parents willingness-to-pay for the UK to have a pediatric cochlear implantation programme were elicited using a bidding process question format and via a discrete choice question. To see if income was a significant determinant of willingness-to-pay an analysis of variance (ANOVA) was undertaken in the statistical package SPSS version 10. RESULTS: Two hundred and sixteen parents were interviewed over the period July 2001-August 2002, representing over 130h of interviewing. The mean and median willingness-to-pay values elicited were UK pound 127 and 50 per month, respectively (UK pound 2001/2002). Willingness-to-pay was positively related to income (P<0.020). When the income constraint was removed, 99% of parents choose the implant over having the money the implant would cost to spend in some other way to benefit their child. CONCLUSIONS: Parents of implanted children were willing to pay substantial monthly amounts for pediatric cochlear implantation. Most parents saw no alternative to pediatric cochlear implantation that could improve their child's quality of life to the same extent. Willingness-to-pay was sensitive to income as expected suggesting that the values elicited are both valid and influenced by a respondent's budget constraint.     

Communication abilities of children with aided residual hearing: comparison with cochlear implant users

OBJECTIVE: To compare the communication outcomes between children with aided residual hearing and children with cochlear implants. DESIGN: Measures of speech recognition and language were administered to pediatric hearing aid users and cochlear implant users followed up longitudinally as part of an ongoing investigation on cochlear implant outcomes. The speech recognition measures included the Lexical Neighborhood Test, Phonetically Balanced-Kindergarten Word Lists, and the Hearing in Noise Test for Children presented in quiet and noise (+5 dB signal-to-noise ratio). Language measures included the Peabody Picture Vocabulary Test: Third Edition (PPVT-III), the Reynell Developmental Language Scales, and the Clinical Evaluation of Language Fundamentals-Revised.Subjects The experimental group was composed of 39 pediatric hearing aid users with a mean unaided pure-tone average threshold of 78.2 dB HL (hearing level). The comparison group was composed of 117 pediatric cochlear implant users with a mean unaided pure-tone average threshold of 110.2 dB HL. On average, both groups lost their hearing at younger than 1 year and were fitted with their respective sensory aids at 2 to 2.6 years of age. Not every child was administered every test for a variety of reasons. RESULTS: Between-group performance was equivalent on most speech recognition and language measures. The primary difference found between groups was on the PPVT-III, in which the hearing aid group had a significantly higher receptive vocabulary language quotient than the cochlear implant group. Notably, the cochlear implant group was substantially younger than the hearing aid group and had less experience with their sensory devices on this measure. CONCLUSION: Data obtained from children with aided residual hearing can be useful in determining cochlear implant candidacy.     

Sensory aids in conjunction with cochlear implants.

The use of cochlear implants in profoundly hearing-impaired individuals can restore varying degrees of auditory capabilities. Although very little auditory information is transmitted to these patients through amplification systems, we hypothesized that some of the cues obtained from sensory aids might be helpful when used in conjunction with the cochlear implant postoperatively. Eight patients implanted at NYU Medical Center, Bellevue Hospital Center, have used some sensory aid in addition to the Nucleus multichannel cochlear prosthesis. All subjects were evaluated using standard auditory tests including pure-tone and speech audiometry, portions of the Minimal Auditory Capabilities (MAC), Speech Pattern Contrast Perception (SPAC), Iowa test batteries; and the Early Speech Perception (ESP), Word Intelligibility by Picture Identification (WIPI), and Glendonald Auditory Screening Procedure (GASP), where appropriate. Subjects were evaluated under three conditions: implant alone, implant plus sensory aid, and sensory aid alone. Results indicate that the interaction between a multichannel cochlear implant and a sensory aid can provide some improved performance for adult implanted patients (i.e., they do better under the dual condition than in the implant-alone condition). Variables such as thresholds in the nonimplanted ear and usage time can affect the outcome.     

Not a “sound” decision: Is cochlear implantation always the best choice?

Objective

To review the candidacy criteria used to counsel parents of profoundly deaf children, to determine if these criteria have changed over time, and to evaluate eventual communication outcomes for these patients.

Design

Retrospective review of 483 pediatric cochlear implant candidates from September 1995 to December 2006 seen at a tertiary care pediatric hospital.

Results

Out of 483 implant candidates, 191 patients were initially felt not to be favorable candidates based on CI team evaluation. Of this group, 3 had insufficient records to review and were excluded. The remaining 188 patients underwent a detailed analysis of specific possible contraindications to implantation. This included audiologic, medical and psychosocial parameters. The data was divided into two time periods: Group 1 included 44 patients from 1995 to 2000, and Group 2 included 144 patients from 2001 to 2006. In Group 1, there was a higher percentage of children with language deprivation and developmental concerns and patients not ready, compared to Group 2 which had a higher percentage of families not ready and inadequate support systems. Group 1 had a higher percentage of patients who ultimately underwent cochlear implant, but otherwise the two groups were largely similar.

Conclusion

Analysis of our data showed that the degree of concern that the cochlear implant team has in relationship to specific candidacy criteria has changed over time. Recommendations against a cochlear implant were often revisited after initial concerns were addressed. The use of a team approach, in conjunction with a validation tool, is important for establishing criteria for successful cochlear implantation in children to support appropriate counseling of patients and families and to plan post-implant management.     

Rehabilitation and assessment of aural-oral speech development in children with cochlear implants

Updated models of cochlear implants provide good speech audibility and thus complete rehabilitation of children who have lost hearing after learning speech. All the children who lost hearing before learning speech can hear sounds of normal loudness and orient in sound media by means of cochlear implant. However, they need long-term audio-vocal rehabilitation the results of which depend on the age of the child's operation and hi(her) individual traits. Cochlear implants in children aged under 3 years are most perspective. Russian language methodology including 7 tests and 2 questionnaires is described. It is intended for assessment of audio-vocal development in children with cochlear implants and results of audio-vocal rehabilitation as well as of effectiveness of using cochlear implant in children over 2 years of age. Establishment of centers for cochlear implantation and introduction of cochlear implantation state program are recommended.     

Outcomes and achievement of students who grew up with access to cochlear implants

OBJECTIVES/HYPOTHESIS: To provide long-term speech perception and production, educational, vocational, and achievement outcome data for pediatric cochlear implant recipients. STUDY DESIGN: This is a retrospective study using consecutive referrals of prelingually, profoundly deaf children at the University of Iowa Hospitals and Clinics. METHODS: Twenty-seven prelingually deaf young adults who received a cochlear implant between the ages of 2 and 12 years participated. Outcome measures included device-use information, perceptual information, reading results for all participants and educational achievement results for 17 of 27 participants, educational placement information/vocational information for all students, as well as a comparison of the child's educational/vocational outcome with that of the parent's educational/vocational outcome. RESULTS: Speech perception and production scores were highly correlated. Achievement test results indicated that scores were within 1 SD from normative data based on hearing individuals. Over 50% of the college-age eligible students enrolled in college. This initial group of implant users had a nonuse rate of 11% in the first 3 years. Eighty-nine percent of the users maintained full-time use for 7 years, and 71% of this group have maintained full-time use to date. CONCLUSIONS: This cohort of cochlear implant users compared favorably with their hearing peers on academic achievement measures. Although there was a wide distribution of educational and vocational outcomes, the children tended to follow the educational/vocational patterns of their parents. As age of implantation decreases, it will be important to compare achievement outcomes of this first generation with those of subsequent generations of cochlear implant users.     

Cochlear Implantation With Large Vestibular Aqueduct Syndrome

Objectives In this investigation, we report the outcomes of 14 adults (age >18 y) and 9 children (age <18 y) with radiographically proven large vestibular aqueduct syndrome (LVAS) who received cochlear implants at Indiana University School of Medicine. Study Design This is a retrospective case‐control study detailing the outcomes of 23 patients with LVAS and 46 control patients implanted with Nucleus (Cochlear Corp., Englewood, CO), Clarion (Advanced Bionics Corp., Sylmar, CA), or Med‐El (MED‐EL Corp., Innsbruck, Austria) cochlear implants. Methods Performance data on pure‐tone averages, speech detection thresholds, and a variety of auditory and speech recognition tasks from these patients with LVAS were compared with performance data obtained from a matched group of 46 cochlear implant users who did not have LVAS. Specific patient characteristics used in matching included the age of the patient, the age at implant of the patient, and whether the patient was pre‐ or postlingually deafened. Data for the adult group was analyzed using the Student t test, and data for the pediatric patient group was compared using a χ² test. Results The results indicated positive outcomes for both pediatric and adult groups. With both adult and pediatric groups, auditory and speech recognition performance did not differ significantly between those patients with LVAS and control subjects. Conclusions This study adds further support for the use of cochlear implantation in patients with LVAS. Cochlear implantation is beneficial and can be offered as an eventual treatment of LVAS if hearing loss progresses to profound levels in these patients.