Language evaluation in children with pre-lingual hearing loss and cochlear implant

IntroductionThe cochlear implant is an effective device for children with severe and/or profound prelingual hearing loss, since it provides considerable improvement in oral language acquisition through the auditory pathway. The use of a cochlear implant contributes to the development of auditory perception, favoring the acquisition of the linguistic processes related to communication skills, which might have a positive effect on other areas of development.ObjectiveThe aim of this study was to verify the performance of children using cochlear implants for expressive and receptive oral language.MethodsThis was a prospective cross-sectional study that used the following tests: Child language test in the phonology, vocabulary, fluency and pragmatics areas, and the Peabody picture vocabulary test. Thirty children participated in this study, of both genders, aged between 36 and 72 months, with severe and/or profound bilateral sensorineural hearing loss, without other impairments and users of unilateral cochlear implant with full electrode insertion for a minimum of 12 months.ResultsThe longer duration of the cochlear implant use, the younger age at surgery and the better performance in the auditory perception of speech influenced the performance in expressive and receptive oral language. Even though when compared to the normative language acquisition process, the results showed that these children had patterns of linguistic skills that are below their chronological age; the results indicate that these children are developing expressive and receptive oral language skills, and this is the outcome that should be taken into account in this study.ConclusionThe longer duration of the cochlear implant use, the younger age at surgery and the better performance in the auditory perception of speech influenced the performance in expressive and receptive oral language skills, but not in all the studied semantic categories.     

Is there a best side for cochlear implants in post-lingual patients?

Introduction

Cochlear Implant is a sensory prosthesis capable of restoring hearing in patients with severe or profound bilateral sensorineural hearing loss.

Performance of hearing skills in children with auditory neuropathy spectrum disorder using cochlear implant: a systematic review

IntroductionCurrently, there are no doubts about the benefits of cochlear implants for the development of children with severe or profound hearing loss. However, there is still no consensus among researchers and professionals regarding the benefits for the improvement of hearing skills in children with auditory neuropathy spectrum disorder using cochlear implants.ObjectiveReview the available evidence in the literature to answer the following: “What is the performance of hearing skills in children with auditory neuropathy spectrum disorder using cochlear implants?”MethodsSystematic review of the literature through electronic database consultation, considering publications in the period 2002–2013.ResultsTwenty-two studies met the criteria and were included in the systematic review.ConclusionThe analyzed studies demonstrated that after cochlear implant surgery, individuals with auditory neuropathy spectrum disorder improved their performance of hearing skills and had similar performance to that of children with sensorineural hearing loss using cochlear implant.     

Benefit and predictive factors for speech perception outcomes in pediatric bilateral cochlear implant recipients

IntroductionDespite recent advancement in the prediction of cochlear implant outcome, the benefit of bilateral procedures compared to bimodal stimulation and how we predict speech perception outcomes of sequential bilateral cochlear implant based on bimodal auditory performance in children remain unclear.ObjectivesThis investigation was performed: (1) to determine the benefit of sequential bilateral cochlear implant and (2) to identify the associated factors for the outcome of sequential bilateral cochlear implant.MethodsObservational and retrospective study. We retrospectively analyzed 29 patients with sequential cochlear implant following bimodal-fitting condition. Audiological evaluations were performed; the categories of auditory performance scores, speech perception with monosyllable and disyllables words, and the Korean version of Ling. Audiological evaluations were performed before sequential cochlear implant with the bimodal fitting condition (CI1 + HA) and one year after the sequential cochlear implant with bilateral cochlear implant condition (CI1 + CI2). The good performance group (GP) was defined as follows; 90% or higher in monosyllable and bisyllable tests with auditory-only condition or 20% or higher improvement of the scores with CI1 + CI2. Age at first implantation, inter-implant interval, categories of auditory performance score, and various comorbidities were analyzed by logistic regression analysis.ResultsCompared to the CI1 + HA, CI1 + CI2 provided significant benefit in categories of auditory performance, speech perception, and Korean version of Ling results. Preoperative categories of auditory performance scores were the only associated factor for being GP (odds ratio = 4.38, 95% confidence interval – 95% = 1.07–17.93, p = 0.04).ConclusionsThe children with limited language development in bimodal condition should be considered as the sequential bilateral cochlear implant and preoperative categories of auditory performance score could be used as the predictor in speech perception after sequential cochlear implant.     

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.     

Open fitting: performance verification of receiver in the ear and receiver in the aid

ObjectiveTo verify the receiver in the ear and receiver in the aid adaptations by measuring in situ the speech perception and users’ level of satisfaction.MethodsThe study was approved by the research ethics committee (Process: 027/2011). Twenty subjects older than 18 years with audiological diagnosis of mild and moderate bilateral descending sensorineural hearing loss were evaluated. The subjects were divided into two groups, where G1 (group 1) was fitted with open-fit hearing aids with the built-in receiver unit (receiver in the ear) and G2 (group 2) was fitted with open-fit hearing aids with RITE. A probe microphone measurement was performed to check the gain and output provided by the amplification and for assessment of speech perception with Hearing in Noise Test with and without hearing aids. After a period of six weeks of use without interruption, the subjects returned for follow-up and answered the Satisfaction with Amplification in Daily Life questionnaire, and were again subjected to Hearing in Noise Test.ResultsBoth groups presented better test results for speech recognition in the presence of noise.ConclusionGroups 1 and 2 were satisfied with the use of hearing aids and improved speech recognition in silent and noisy situations with hearing aids.     

Development of auditory and language skills in children using cochlear implants with two signal processing strategies

IntroductionThe increase in the spectral information offered by the sound processing strategy HiRes 120 has led to great expectations for the pediatric population. Due to a shorter duration of auditory deprivation and higher neural plasticity, children could benefit more substantially from the spectral information of this sound processing strategy.ObjectiveTo compare auditory and language skills in Brazilian children with cochlear implants using the HiRes and HiRes 120 sound processing strategies.MethodsThirty children, aged 1–3 years, with congenital hearing loss, were divided into two groups, according to the signal processing strategy adjusted at the time of the cochlear implant activation. The assessed children were matched according to chronological age and the time of the cochlear implant use. The auditory and language skills were evaluated longitudinally through the Infant-Toddler Meaningful Auditory Integration Scale and Production Infant Scale Evaluation, carried out before surgery, and 3, 6 and 12 months after device implantation. The Mann–Whitney test was applied for the comparison between the two groups with a 5% significance level.ResultsThe findings indicated development of hearing and language skills in the first year of cochlear implant use; however, there was no statistically significant difference in the evolution of such skills due to the adjusted processing strategy in the activation of the cochlear implant electrodes.ConclusionThe development of auditory and language skills in the assessed children was similar during the entire study period, regardless of which signal processing strategy was used.     

Development and validation of the protocol for the evaluation of voice in patients with hearing impairment (PEV-SHI)

IntroductionThe voice of individuals with hearing impairment has been widely described, and can be compromised in all levels of the phonatory system.ObjectiveTo develop and validate an instrument for evaluating the voice of this population.MethodsThe instrument underwent the validation steps suggested by the Scientific Advisory Committee of the Medical Outcomes Trust. The study sample consisted of seventy-eight Brazilian people with cochlear implants (experimental group) and 78 individuals with normal hearing (control group), divided in groups by age range — children from 3 to 5 years; children from 6 to 10 years and adults from 18 to 46 years. The study sample participated in a voice recording of the sustained vowel /a/, connected speech and spontaneous conversation, in which three voice specialists rated using the proposed instrument. It consists of visual-analog scales of suprasegmental aspects, respiratory-phonatory coordination, resonance, phonation, additional parameters and general vocal perception.ResultsEvaluation by an expert committee and a pilot test established content validity. Reliability measures showed excellent test-retest reproducibility for the majority of the parameters. Analysis with the ROC curve showed that perceptual evaluation with the sustained vowel did not strongly differentiate individuals with cochlear implants from those with normal hearing, and the parameter “speech rate” did not differentiate the groups at all. For the connected speech and spontaneous conversation, the majority of the parameters differentiated the experimental group from the control group with an area under the curve ≥0.7. The cutoff values with maximum specificity and sensitivity were 30.5 for mild, 49.0 for moderate and 69.5 for intense deviation.ConclusionsThe protocol for the evaluation of voice in subjects with hearing impairment, PEV-SHI, is a reliable and useful tool for assessing the particularities of the voice of individuals with hearing impairment treated with cochlear implants and can be used in research and clinical settings to standardize evaluation and facilitate information exchange among services.     

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.     

United Kingdom national paediatric bilateral project: Demographics and results of localization and speech perception testing

Objectives: To assess longitudinal outcomes in a large and varied population of children receiving bilateral cochlear implants both simultaneously and sequentially.

Methods: This observational non-randomized service evaluation collected localization and speech recognition in noise data from simultaneously and sequentially implanted children at four time points: before bilateral cochlear implants or before the sequential implant, 1 year, 2 years, and 3 years after bilateral implants. No inclusion criteria were applied, so children with additional difficulties, cochleovestibular anomalies, varying educational placements, 23 different home languages, a full range of outcomes and varying device use were included.

Results: 1001 children were included: 465 implanted simultaneously and 536 sequentially, representing just over 50% of children receiving bilateral implants in the UK in this period. In simultaneously implanted children the median age at implant was 2.1 years; 7% were implanted at less than 1 year of age. In sequentially implanted children the interval between implants ranged from 0.1 to 14.5 years. Children with simultaneous bilateral implants localized better than those with one implant. On average children receiving a second (sequential) cochlear implant showed improvement in localization and listening in background noise after 1 year of bilateral listening. The interval between sequential implants had no effect on localization improvement although a smaller interval gave more improvement in speech recognition in noise. Children with sequential implants on average were able to use their second device to obtain spatial release from masking after 2 years of bilateral listening. Although ranges were large, bilateral cochlear implants on average offered an improvement in localization and speech perception in noise over unilateral implants.

Conclusion: These data represent the diverse population of children with bilateral cochlear implants in the UK from 2010 to 2012. Predictions of outcomes for individual patients are not possible from these data. However, there are no indications to preclude children with long inter-implant interval having the chance of a second cochlear implant.     

Effects of bilateral cochlear implants in children: Timing of second surgery and the significance of wearing bilateral cochlear implants in Japan

ObjectiveThis study aims to evaluate the speech perception with first, second, or bilateral cochlear implants (CI) and to reveal the effects of wearing bilateral CI in children.MethodsAfter reviewing the medical records, a total of 19 children who underwent bilateral cochlear implantation serially between 2012 and 2015 at Kyoto University Hospital (tertiary referral center) were included in this study. All patients had no delay in language development. The study group comprised nine boys and ten girls, and their age ranged from 3 years 8 months to 12 years 5 months when they underwent the tests in this study. The mean and median ages were 8 years 6 months and 9 years 2 months, respectively.We measured the appropriate signal/noise ratio (SNR) to test speech perception of Japanese language in noise by testing the hearing ability of unilateral CI patients with or without noise and by surveying the sound environment in a classroom of a mainstream elementary school.Speech perception in quiet and noise and the left-right localization ability were examined using first, second, or bilateral cochlear implants in all patients.ResultsConsidering the results of hearing ability tests with noise and the SNR of the elementary school classrooms, we decided to use SNR of +10 dB to evaluate the speech perception ability in noise. The speech perception ability using the second CI was significantly worse in patients undergoing second cochlear implantation after 7 years old than in those who underwent surgery before 3.5 years old. Moreover, patients undergoing second cochlear implantation before 7 years old showed significantly better left–right localization of high-frequency sound.ConclusionsSecond cochlear implantation before 7 years old is a critical factor in acquiring beneficial speech perception ability with the second CI and sound localization ability with the bilateral CI.     

Representation of amplified speech at cortical level in good and poor hearing aid performers

IntroductionHearing aid users reject their own hearing aid because of annoyance with background noise. The reason for dissatisfaction is located anywhere from the hearing aid microphone to the integrity of neurons along the auditory pathway. In this preview, the output of hearing aid was recorded at the level of ear canal and at auditory cortex in good and poor hearing aid users, who were classified using acceptable noise level.ObjectiveTo study the representation of amplified speech in good and poor hearing aid performers.MethodsA total of 60 participants (age ranged 15–65 years) with moderate bilateral sensorineural hearing impairment grouped into good (n = 35) and poor (n = 25) hearing aid performers. Gap detection test and aided SNR 50 were administered. In addition, ear canal acoustic measures and cortical auditory evoked potentials were recorded in unaided and aided conditions at 65 dB SPL.ResultsHearing aid minimally alters temporal contrast of speech reflected in envelope difference index. Although having similar temporal impairment, acoustic characteristics of amplified speech sounds and SNR 50 scores from both groups, the aided cortical auditory evoked potentials surprisingly showed significant earlier latencies and higher amplitudes in good performers than poor performers. In addition, good and poor performers classified based on annoyance level was predicted by latencies of 2N1 and 2P2 components of acoustic change complex. Further, a follow-up revealed hearing aid use has relation with acceptance towards noise.ConclusionParticipants who are willing to accept noise from those who are not willing to accept noise have subtle physiological changes evident at the auditory cortex, which supports the hearing aid usage.     

Bilateral cochlear implants: a way to optimize auditory perception abilities in deaf children?

OBJECTIVES: The Würzburg bilateral cochlear implant (CI) program was started with the aim to improve the patients' communicative abilities in complex listening situations. In this study, the auditory skills of children using bilateral cochlear implants were evaluated. STUDY DESIGN AND SETTINGS: Qualitative data based on free observations in the rehabilitation setup were collected in 39 bilaterally implanted children. A speech discrimination in noise test was performed in 18 of these children; lists of bisyllabic words were presented in noise at a signal to noise ratio (SNR) of +15 dB. RESULTS: Qualitative and quantitative data show clearly that bilateral CI improves the children's communicative behaviour, especially in complex listening situations. Children examined with the speech in noise test scored significantly better under the bilateral condition compared to the unilateral condition. Integration of the second implanted side and use of binaural information was observed to be easier and faster in children with a short time lag between both implants. CONCLUSIONS: To be able to obtain optimal benefit from bilateral cochlear implants, an intensive rehabilitation program is necessary. The important aspects of such a program are creating realistic expectations in older children before implantation; performing the first processor fitting of the second side with the first side switched on; and separate intensive training with the new system in order to balance out the hearing competence of the second CI with that of the first.     

Effects of Delayed Second Cochlear Implant

Objective Since Helms' successful bilateral cochlear implantation with good results in 1996, there have been increasing number of reports on bilateral cochlear implantation. Most second device have been implantated within one year after the first. Considering effects of long time auditory deprivation, it is not clear whether a delayed second cochlear implant serves to add additional benefits and how it may interact with central nervous system plasticity. Methods Three cases who received delayed second cochlear implants at People's Hospital of Peking University from 2002 to 2005 were reviewed. The interval between the first and second implants was longer than 2 years in all three patients. Sound perception, and unilateral/bilateral speech discrimination in quiet and noise were evaluated. In addition, GAP detection test was conducted in one patient. Results In one case, having both implants on provided improved performance compared to using only one implant both in quiet and noise. Presumably due to visual interference from lip-reading or short interval between second implant and testing, one patient showed no improvement from using the second implant either in quiet or noise, while the last case demonstrated additional benefits from the second implant only in quiet. In all three patients, performance in recognizing the four tones in Mandarin was superior over word recognition. Conclusions Considerable plasticity in the cerebral auditory center is preserved, despite long acoustic deprivation in some children who have received unilateral cochlear implant. Delayed second implants can result in significant improvements in some of these children. Visual interference from lip-reading may be an obstacle during retraining. The better recognition of tones in the Mandarin language may represent a different sound discrimination mechanism in the auditory system, although it may also be related to the signal processing mechanisms of the implant used (MED-EL COMBI 40 ).     

Auditory and language skills of children using hearing aids

IntroductionHearing loss may impair the development of a child. The rehabilitation process for individuals with hearing loss depends on effective interventions.ObjectiveTo describe the linguistic profile and the hearing skills of children using hearing aids, to characterize the rehabilitation process and to analyze its association with the children's degree of hearing loss.MethodsCross-sectional study with a non-probabilistic sample of 110 children using hearing aids (6–10 years of age) for mild to profound hearing loss. Tests of language, speech perception, phonemic discrimination, and school performance were performed. The associations were verified by the following tests: chi-squared for linear trend and Kruskal–Wallis.ResultsAbout 65% of the children had altered vocabulary, whereas 89% and 94% had altered phonology and inferior school performance, respectively. The degree of hearing loss was associated with differences in the median age of diagnosis; the age at which the hearing aids were adapted and at which speech therapy was started; and the performance on auditory tests and the type of communication used.ConclusionThe diagnosis of hearing loss and the clinical interventions occurred late, contributing to impairments in auditory and language development.     

双侧人工耳蜗植入者在噪声环境下的言语辨别能力

目的探讨双侧人工耳蜗植入患者的言语辨别能力.方法用2例双侧人工耳蜗植入者比较双侧与单侧人工耳蜗在不同信噪比下对广东话声调的辨别能力.结果在+15,+10和+5的信噪比下, 双侧人工耳蜗的平均能力为96%, 92%和88%, 而左耳及右耳单侧人工耳蜗的平均成绩为86%,83%和74%. 在0,-5,-10及-15的信噪比下,单侧人工耳蜗的平均能力近于0%,而双侧人工耳蜗的平均成绩为80%,72%,68%和54%.结论在不同信噪比下,双侧人工耳蜗植入更有助于提高对广东话声调的辨别能力. 进一步证明了双侧人工耳蜗植入患者运用双耳听力的优势.     

Cochlear implantation in autistic children with profound sensorineural hearing loss

Introduction

Cochlear implants have become the method of choice for the treatment of severe-to-profound hearing loss in both children and adults. Its benefits are well documented in the pediatric and adult population. Also deaf children with additional needs, including autism, have been covered by this treatment.

A longitudinal study of the bilateral benefit in children with bilateral cochlear implants

Objective: To study the development of the bilateral benefit in children using bilateral cochlear implants by measurements of speech recognition and sound localization. Design: Bilateral and unilateral speech recognition in quiet, in multi-source noise, and horizontal sound localization was measured at three occasions during a two-year period, without controlling for age or implant experience. Longitudinal and cross-sectional analyses were performed. Results were compared to cross-sectional data from children with normal hearing. Study sample: Seventy-eight children aged 5.1–11.9 years, with a mean bilateral cochlear implant experience of 3.3 years and a mean age of 7.8 years, at inclusion in the study. Thirty children with normal hearing aged 4.8–9.0 years provided normative data. Results: For children with cochlear implants, bilateral and unilateral speech recognition in quiet was comparable whereas a bilateral benefit for speech recognition in noise and sound localization was found at all three test occasions. Absolute performance was lower than in children with normal hearing. Early bilateral implantation facilitated sound localization. Conclusions: A bilateral benefit for speech recognition in noise and sound localization continues to exist over time for children with bilateral cochlear implants, but no relative improvement is found after three years of bilateral cochlear implant experience.     

Influence of signal processing strategy in auditory abilities

The signal processing strategy is a parameter that may influence the auditory performance of cochlear implant and is important to optimize this parameter to provide better speech perception, especially in difficult listening situations.ObjectiveTo evaluate the individual's auditory performance using two different signal processing strategy.Methods: Prospective study with 11 prelingually deafened children with open-set speech recognition. A within-subjects design was used to compare performance with standard HiRes and HiRes 120 in three different moments. During test sessions, subject's performance was evaluated by warble-tone sound-field thresholds, speech perception evaluation, in quiet and in noise.ResultsIn the silence, children S1, S4, S5, S7 showed better performance with the HiRes 120 strategy and children S2, S9, S11 showed better performance with the HiRes strategy. In the noise was also observed that some children performed better using the HiRes 120 strategy and other with HiRes.ConclusionNot all children presented the same pattern of response to the different strategies used in this study, which reinforces the need to look at optimizing cochlear implant clinical programming.     

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.