Chinese tonal language rehabilitation following cochlear implantation in children

Cantonese language rehabilitation in 28 prelingually deaf children who underwent cochlear implantation was evaluated. All patients were implanted with multichannel devices and the operations went smoothly. They all had improved scores on audiological assessments and speech perception tests. The speech evaluation tests included the recognition of sounds, vowels, consonants and tone. Sentence recognition and story comprehension were both improved after training for 2 years. Cochlear implantation is a useful measure for the speech rehabilitation of prelingually profound deaf children when hearing aids are of no benefit. The multichannel implant device is of clinical significance in the rehabilitation of those patients using tonal language.     

Performance of prelingually and postlingually deaf patients using single-channel or multichanel cochlear implants

The auditory and aided lipreading performance of 8 prelingually and 11 postlingually deaf patients who had received a single-channel or multichannel cochlear implant was evaluated during 2 years of follow-up. Although all the patients improved on both closed-set pattern recognition and speech drimination tests and on a Continouous Discourse Tracking task, the most significant improvement was observed in the postlingually deaf patients who were using a multichannel implant. These patients were the only ones to achieve open-set speech recognition in the auditory-only condition. Only small differences were found between prelingually deaf patients who were using a single-channel system and those who were using a multichannel system. The users' evaluations, obtained by means of a questionnaire, were generally positive in all patients. Based on the study results, the authors concluded that it is feasible to use cochlear implants in highly motivated prelingaully deaf patients who have learned to use oral-aural communication.     

多通道人工耳蜗在语前聋儿童及青少年中的应用

目的 通过对植入人工耳蜗的语前聋儿童和青少年的听力和语言能力的评估,探讨我国儿童在使用人工耳蜗后的听力和言语能力发展规律及影响因素。方法 ２５例行人工耳蜗植入的语前聋儿童及青少年患者参与本组测试。选用《聋儿听觉言语康复评估方法》作为测试材料,分别进行声音,言语声和环境声的辨别,数词,单字词,双字词,３字词,韵母,声母,声调,封闭项列短句的识别,开放项列字词和开放项列短句识别,语言清晰度,模仿句长,     

先天性语前聋中国儿童双耳人工耳蜗植入疗效观察

目的：评估双侧耳人工耳蜗植入对极重度感音神经性语前聋患儿的听觉与言语康复疗效。方法：2例先天性极重度感音神经性聋儿童，单侧耳人工耳蜗植入术后2年和3年分别施行对侧耳人工耳蜗植入。术后1年评估患儿左、右耳单耳及双耳人工耳蜗助听听阈和言语识别率。以及言语清晰度。结果：①双耳人工耳蜗助听与单耳人工耳蜗助听相比。平均听阈降低分别为13dB和11dB；②在安静环境中双耳人工耳蜗植入儿童的言语识别率(开放项列)分别平均提高为9％和10％，2例双耳人工耳蜗植入儿童的言语识别率(开放项列)分别达97％和95％；③在嘈杂环境中对言语的识别能力明显提高；④言语清晰度有明显改善。结论：双耳人工耳蜗植入可明显提高极重度感音神经性语前聋患儿在安静和噪声环境下的言语识别率，对语前聋儿童的言语和语言发育有明显的帮助。     

多导人工耳蜗的临床应用

目的：探讨多导人工耳蜗植入对深度感音神经性耳聋患者的治疗效果。方法;对１１例深度耳聋患者行Ｍｉｎｓｉ Ｓｙｓｔｅｍ ２２导和Ｎｕｃｌｅｕｓ２４导人工耳蜗植入术,其中语前聋６例,语后聋５例。术后１－１．５个月开机调试。结果;１１例虱全部恢复了听力;语后聋患者不需要经过唇读或简单的语言训练就能进行对话和打电话,患者能回到有声世界进行正常的生活和工作;     

The role of age in pediatric cochlear implantation

OBJECTIVE: To document progress, benefit and importance of age in paediatric cochlear implantation. DESIGN: The EARS (Evaluation of Auditory Responses to Speech) test battery was performed on 33 prelingually deaf children at regular intervals up to 36 months following implantation. All children participated in individually tailored intensive audiological rehabilitation programs after receiving their implants. In this respect, it was attempted to evaluate speech perception scores in children implanted before and after the age of 3 in a homogenous group. RESULTS: All children demonstrated encouraging improvements over time in their speech recognition abilities. Furthermore, it was observed that the children who were implanted under the age of 3 achieved higher levels of speech perception performance. CONCLUSION: In order to shorten the process of central maturation of the auditory system, it is desirable to implant the children as young as possible. Early intervention seems to be the ideal strategy in enabling prelingually deaf children to derive maximum benefit from cochlear implantation.     

Speech perception after cochlear implantation over a 4-year time period

OBJECTIVE: To evaluate the long-term speech perception of cochlear implantees and to compare the developing auditory performance patterns of prelingual children and postlingual deaf adults. MATERIAL AND METHODS: Twenty-nine prelingually deaf children and 17 postlingually deaf adults who had been followed up for 4 years were included in the study. Speech perception ability was assessed by means of vowel and consonant confusion tests and the Korean version of the Central Institute of Deafness (K-CID) test (performed without visual cues). The test results were analyzed at 3 and 6 months after implantation and then annually. RESULTS: In the prelingually deaf children, the average results continuously improved over the 4-year period. In the postlingually deaf adults, the average results did not improve further after the first 2 years. Individuals with < 5 years of deafness had a faster rate of recovery of speech perception than those who had been deaf for > 5 years. The K-CID scores were negatively correlated with age at implantation for the prelingually deaf group and with the duration of deafness in the postlingually deaf group. Children fitted with implants at a younger age showed better speech perception ability than those fitted with implants at an older age. Interestingly, prelingually deaf children aged 5-7 years at implantation showed the widest variation in individual outcomes. Amongst this group of children with highly variable outcomes, the metabolic status of brain cortices determined by means of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) was available for three patients. The individual with the widest hypometabolic area had the best speech perception ability. CONCLUSION: The extent of hypometabolism as assessed by FDG-PET seemed to be one of the major factors predicting the outcome of cochlear implantation.     

Use of a multichannel cochlear implant in the congenitally and prelingually deaf population.

Fourteen children and three adults, each congenitally and prelinguistically deaf, received the Nucleus multichannel implant. All underwent extensive evaluations and rehabilitation. The surgery was uneventful, and no patients have been lost to follow-up. Results have shown a significant increase in auditory and speech reception and perception skills in all children. Some children have open-set speech recognition using the prosthesis alone. The adults have shown an increased awareness of sound along with minimal improvement in perceptual skills. This supports the concept that early implantation of congenitally and prelinguistically deaf individuals results in improved performance.     

Speech perception and speech intelligibility in children after cochlear implantation

OBJECTIVE: This study aimed to evaluate the long-term speech perception and speech intelligibility of congenitally and prelingually deaf children after cochlear implantation. It was a longitudinal study following 63 congenitally or prelingually deaf children up to 5 years after implantation. They each received a nucleus multichannel cochlear implant before they were 10 years old. METHODS: Perception is evaluated using the Test for the Evaluation of Voice Perception and Production (TEPP) and concerns closed- and open-set word and sentence perception without lip-reading. The intelligibility is classified according to the Speech Intelligibility Rating (SIR). The evaluations have been made every 3 months for 1 year, then at 18 months, 2 years, 3 years and 5 years after the cochlear implantation. RESULTS: After 5 years of implantation, the median percentage of closed-words speech perception (CSW) is 95.5%-93.67% for closed-sentence speech perception (CSS) and 76.3% for open-sentence speech perception (OSS); the median Speech Intelligibility Rating is 3.83. CONCLUSIONS: Congenitally and prelingually deaf children who receive cochlear implant before the age of 10 years develop speech perception and speech intelligibility abilities. The closed-set perception progresses quickly and seems to reaching a plateau at 5 years post implantation. The improvement of open-sentence perception is not significant until the first year post implantation. The speech intelligibility improves regularly the five first year post implantation.     

伴脑白质病语前聋患儿人工耳蜗植入术后听觉言语康复效果分析

目的 探讨伴脑白质病的语前极重度感音神经性聋患儿人工耳蜗植入的可行性及术后听觉言语康复效果.方法 海南省人民医院耳鼻咽喉科2013年9~11月行人工耳蜗植入的14例伴脑白质病语前聋患儿为研究组(年龄1~6岁,平均3.79±1.93岁),同期无中枢神经系统病变的语前聋患儿16例为对照组(年龄1~6岁,平均4.38±1.93岁),术前均行临床听力学、影像学检查及语言能力、智力水平等评估,经乳突后鼓室面神经隐窝入路一期行人工耳蜗植入术,术后均到海南省聋儿康复中心进行言语康复训练;采用听觉行为分级标准(categories of auditory performance,CAP)和言语可懂度分级标准(speech intelligibility rate,SIR)对两组术后康复效果进行评估,比较两组患儿术后不同阶段的CAP和SIR分级.结果 所有患儿人工耳蜗植入术后均获得听觉反应和不同程度的言语交流能力,随着康复时间延长两组患儿CAP及SIR分级均呈上升趋势;研究组术后6、12和24个月CAP平均分级分别为2.571±0.416、3.714±0.496、5.000±0.492级,SIR平均分级分别为1.357±0.133、2.143±0.275、3.071±0.245级,与对照组CAP(分别为2.688±0.313、3.875±0.364、5.000±0.354级)及SIR(分别为1.500±0.129、2.313±0.176、2.875±0.221级)比较,差异均无统计学意义(P>0.05).结论 伴脑白质病的语前极重度感音性聋患儿经过术前充分评估后可以实施人工耳蜗植入,术后2年内听觉言语康复效果与不伴脑白质病的同龄患儿相当.     

大前庭水管语前聋患儿的人工耳蜗植入

目的探讨大前庭水管语前聋患儿人工耳蜗植入手术方法及可行性,并对术后听觉言语康复效果进行评估。方法回顾性分析2001年7月～2011年9月收治的27例大前庭水管语前聋患儿的临床资料,均为极重度聋或全聋,其中男19例,女8例,年龄1.6～4.0岁,平均2.5岁。均行右耳人工耳蜗植入,于术后6个月行声场测听,测试言语频率平均听阈,开机训练1年后,进行限定词表言语测听及非限定词表言语测听评估听力康复效果。结果 27例患儿中,术中发生"井喷"者4例,经术中采用小块肌肉或筋膜严密封堵电极周围空隙,有效防止了外淋巴漏。术后经开机康复训练6个月后,声场测听言语频率平均听阈为25～30dB nHL,平均27.5±4.5dBnHL;开机训练1年后,限定词表言语测听言语识别率平均为83.3%,非限定词表言语测听言语识别率平均为81.6%。结论大前庭水管语前聋患者可行人工耳蜗植入;术前完善的影像学评估、良好的手术视野以及术中严密封堵电极周围空隙是预防"井喷"及手术成功的关键;术后听觉言语康复效果满意。     

Development of audiovisual comprehension skills in prelingually deaf children with cochlear implants

OBJECTIVE: The present study investigated the development of audiovisual comprehension skills in prelingually deaf children who received cochlear implants. DESIGN: We analyzed results obtained with the Common Phrases (Robbins et al., 1995) test of sentence comprehension from 80 prelingually deaf children with cochlear implants who were enrolled in a longitudinal study, from pre-implantation to 5 years after implantation. RESULTS: The results revealed that prelingually deaf children with cochlear implants performed better under audiovisual (AV) presentation compared with auditory-alone (A-alone) or visual-alone (V-alone) conditions. AV sentence comprehension skills were found to be strongly correlated with several clinical outcome measures of speech perception, speech intelligibility, and language. Finally, pre-implantation V-alone performance on the Common Phrases test was strongly correlated with 3-year postimplantation performance on clinical outcome measures of speech perception, speech intelligibility, and language skills. CONCLUSIONS: The results suggest that lipreading skills and AV speech perception reflect a common source of variance associated with the development of phonological processing skills that is shared among a wide range of speech and language outcome measures.     

Behavioral inhibition and clinical outcomes in children with cochlear implants

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

38例人工耳蜗植入儿童康复效果及其影响因素研究

目的通过对38例7岁以下语前聋植入人工耳蜗儿童进行分阶段的听觉言语康复效果评估,探讨经过1年术后康复,植入人工耳蜗儿童的听觉言语康复效果及其影响因素。方法本研究采用评估词表、标准评估程序及希内智力测试标准,对植入人工耳蜗的38例语前聋聋儿进行听觉、言语,智力评估,同时采用f检验和单因素方差分析检验康复各个阶段聋儿的听觉言语能力是否存在差异。结果听觉识别率平均值由康复训练3个月的44．2％上升至12个月的88．0％,语言平均年龄由康复训练3个月的1．1岁上升至12个月的2．7岁,统计表明差异显著（P〈0．01）。结论经过1年系统的术后康复,聋儿在听觉能力和语言能力上较术前均有显著提高,人工耳蜗术后康复具有普遍有效性。在术后康复中,年龄、智力、随读家长类型及其文化程度等是影响术后康复效果的重要因素。     

243例人工耳蜗植入围手术期处理与术后效果

目的总结243例多导人工耳蜗植入术围手术期的处理经验和听觉语言康复效果。方法介绍我们在多导人工耳蜗植入术围手术期的处理方法。术前评估：主要包括听力学评估、影像学评估和智力心理评估。手术方法介绍了不同型号人工耳蜗插入电极的要领，特别强调了24R（Contuor Advance）型植入电极时，不要主动向外拔金属丝。结果243例患者术后6个月用声场测听啭音语言频率平均听阈达到25-35dB（nHL），平均27．4±4．8dB。开机后1年的开放词表言语分辨率平均达到87．7％。其中成人语后聋患者术后Mapping后全部能听到家人叫他名字。经2个月3～5次调试，声场测听阈在28．1±5．4dB，非限定词表（Openset）言语测听，识别率达82％～93％，平均91．6％。学龄前的语前聋儿童，开机后1～2个月，声场测听都能达到30dB（nHL）或更佳。经过1年以上语训，测定63名可合作儿童的限定词表（Closeset）言语测听，言语识别率平均达N88．6％，非限定词表（Openset）言语测听，识别率平均达83．7％。7岁以上语前聋的儿童，开机后12个月测定26例合作语前聋儿童的Closeset言语识别率平均达Nsl．6％，Openset言语识别率平均达78．2％。结论人工耳蜗植入是治疗全聋患者的最佳选择。对语前聋患者而言，植入年龄最好在7岁前。人工耳蜗植入后，听觉语言康复工作将是一项长期的工作，需要家庭、社会、医生和聋康老师的共同努力。     

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.     

Development of spoken language grammar following cochlear implantation in prelingually deaf children

OBJECTIVES: To assess the development of grammar comprehension in spoken language in prelingually deaf children following cochlear implantation and compare their grammatical abilities with those of their hearing peers. DESIGN: A prospective study of 82 consecutive prelingually deaf children up to 5 years following implantation. The children were less than 7 years old at the time of implantation (mean age +/- SD, 4.2 +/- 1.3 years). All received the same multichannel cochlear implant system. No child was lost to follow-up and there were no exclusions from the study. SETTING: Tertiary referral cochlear implant center. METHODS: The children were assessed using the Test for Reception of Grammar. This individually administered, multiple-choice test designed to assess the understanding of grammatical contrasts in the English language also allows direct comparison of grammar comprehension between test subjects and their normal-hearing peers. RESULTS: Before implantation, only a small proportion (2%) of prelingually deaf children were above the first percentile of their normal-hearing peers. This percentage increased to 40% and 67%, respectively, 3 and 5 years after implantation; and 5 years after implantation, 20% of the children performed between the 25th and the 75th percentile or better. In the subgroup of children who received their cochlear device before the age of 4 years, this percentage reached 36%. CONCLUSIONS: Spoken language grammar acquisition in prelingually deaf children with a cochlear implant was found to be considerably delayed. However, there was a clear trend toward the development of grammar skills following cochlear implantation, and the greatest advance was made by children who received their implant at a younger age. These findings support the present trend toward early implantation.     

Age at implantation: its importance in pediatric cochlear implantation

OBJECTIVE: To assess the influence of age at implantation on speech perception and speech intelligibility following pediatric cochlear implantation. STUDY DESIGN: A prospective study was undertaken on a consecutive group of 126 congenital and prelingually deaf children up to 4 years after implantation. The study group was confined to prelingually deaf children less than 7 years of age at the time of implantation. All had implantation with the same multichannel cochlear implant system. No child was lost to follow-up, and there were no exclusions from the study. METHODS: The Iowa Matrix Closed Set Sentence test, connected discourse tracking, categories of auditory performance, and speech intelligibility rating were used to assess the speech perception (closed and open set) and speech intelligibility of the children with implants. Regression analysis and Spearman rank correlation coefficients were used to assess the correlation between the outcome measures with age at implantation. The setting was a tertiary referral pediatric cochlear implant center in the United Kingdom. RESULTS: Age at implantation positively correlated with preimplantation assessment performance and with most of the outcome measures up to 24 months following implantation. However, at the 3-and 4-year intervals following implantation, age at implantation was found to be a strong negative predictor of all the outcomes studied (correlation coefficients ranging from -0.44 to -0.58, all statistically significant [P<.05]). CONCLUSIONS: The results of the present study provide strong evidence that prelingually deaf children should receive implants as early as possible to facilitate the later development of speech perception skills and speech intelligibility and thus maximize the health gain from the intervention. However, because of the wide variation in individual outcomes, age alone should not be used as a criterion to decide implant candidacy.     

Cochlear implantation in prelingually deafened children with residual hearing

OBJECTIVE: The purpose of this study was to examine the speech perception skills of prelingually deafened French children with preoperative residual hearing who received multichannel cochlear implants. DESIGN: The design of the study incorporated a within-subject, repeated measures design for assessing speech perception skills. SETTING: Montpellier, Toulouse and Lyon Pediatric Cochlear Implant Centers. SUBJECTS: Seven prelingually deafened children demonstrating marginal benefit from conventional amplification prior to implantation with a Nucleus multichannel cochlear implant, served as subjects for the speech perception assessment (a speech recognition score less than 30% defines marginal benefit from acoustic amplification on open set materials). The mean age at implantation was 7 years, 9 months. OUTCOME MEASURES: Speech perception skills were assessed using open set materials and the MUSS and MAIS questionnaires. RESULTS: Open-set speech recognition averaged 21.4% before implantation, and 83.6% after 1 year's cochlear implant experience. All children demonstrated an open-set score over 60% after 12 months of CI use. MAIS test scores averaged 18.1/40 before implantation and 35.1/40 after 9 months of CI use. MUSS test scores averaged 24.4/40 before implantation and 34.1/40 after 9 months of CI use. CONCLUSIONS: Cochlear implantation should be considered for prelingually hearing impaired children demonstrating marginal benefit from hearing aids, with a speech recognition score less than 30% on open set materials, in order to improve their speech discrimination skills.     

Speech and language acquisition in young children after cochlear implantation.

Auditory and speech intelligibility scores of 22 prelingually profoundly deaf children who had used cochlear implants for between 1 and 7 years in an intensive auditory/oral educational program greatly exceeded those previously obtained from similar samples of deaf children using hearing aids. Half of the children obtained language quotient scores within the average range for normal-hearing children and the majority obtained reading quotients within 80% of normal levels. Normal levels of language and reading development were associated with early implantation and open set speech perception.