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

Objective

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

Methods

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

Results

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

Conclusions

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

Barriers to early pediatric cochlear implantation

Objectives

Universal newborn hearing screening has significantly improved the ability to identify patients with congenital sensorineural hearing loss (SNHL), which results in earlier treatment and better hearing and development outcomes. It is recommended that patients born with SNHL who meet criteria receive cochlear implants (CIs) by a target age of 12 months, however many children are being implanted at an older age. This study aims to describe populations of pre-lingual patients with SNHL that are at risk for delayed implantation and to identify and analyze barriers that cause this delay.

Methods

Charts of patients receiving a CI between January 2008 and June 2012 at a tertiary care cochlear implant center were reviewed retrospectively. We looked at patient demographics, age at hearing loss diagnosis, age at implantation, and etiology of hearing loss. Barriers to implantation were identified through surveys completed by team members.

Results

Fifty-seven CI recipients were identified of which 42 were in patients with pre-lingual SNHL. SNHL etiology included: cochlear dysplasia (18%), GJB2/GJB6 (17%), acquired (10%) extreme prematurity (9%), and idiopathic (46%). The median age of SNHL diagnosis for pre-lingual patients was 15 months. Compared to private insurance, public insurance status was associated with SNHL diagnosis at a significantly later median age (20.0 vs. 4.0 months, p = 0.024), and with a significantly longer median interval from diagnosis to implantation (25.5 vs. 11.0 months, p = 0.029). While cochlear implant team members identified delayed insurance approval and medical comorbidities as reasons for delayed implantation, the most significant factor identified was parental, with delayed/missed appointments or reluctance for evaluations or surgery.

Conclusion

52% of patients with pre-lingual SNHL that met criteria for CI were implanted more than 12 months after diagnosis. Having public or no insurance was significantly associated with delayed implantation. Parental barriers were most common factors cited for delays in implantation. Overcoming these delays necessitates appropriate identification of at risk patients and creating a system to educate families and chaperone them through the process.     

Auditory, speech and language development in young children with cochlear implants compared with children with normal hearing

Objective

This study had two aims: (1) to document the auditory and lexical development of children who are deaf and received the first cochlear implant (CI) by the age of 16 months and the second CI by the age of 31 months and (2) to compare these children's results with those of children with normal hearing (NH).

Methods

This longitudinal study included five children with NH and five with sensorineural deafness. All children of the second group were observed for 36 months after the first fitting of the device (cochlear implant). The auditory development of the CI group was documented every 3 months up to the age of two years in hearing age and chronological age and for the NH group in chronological age. The language development of each NH child was assessed at 12, 18, 24 and 36 months of chronological age. Children with CIs were examined at the same age intervals at chronological and hearing age.

Results

In both groups, children showed individual patterns of auditory and language development. The children with CIs developed differently in the amount of receptive and expressive vocabulary compared with the NH control group. Three children in the CI group needed almost 6 months to make gains in speech development that were consistent with what would be expected for their chronological age. Overall, the receptive and expressive development in all children of the implanted group increased with their hearing age.

Conclusion

These results indicate that early identification and early implantation is advisable to give children with sensorineural hearing loss a realistic chance to develop satisfactory expressive and receptive vocabulary and also to develop stable phonological, morphological and syntactical skills for school life. On the basis of these longitudinal data, we will be able to develop new diagnostic tools that enable clinicians to assess child's progress in hearing and speech development.     

Language development in children after receiving bilateral cochlear implants between 5 and 18 months

Objective

The objective of this study was to examine receptive and expressive language development in children who received simultaneous bilateral cochlear implants (CIs) between 5 and 18 months of age and to compare the results with language development in chronologically age-matched children with normal hearing.

Methods

The study used a prospective, longitudinal matched-group design. Data were collected in a clinical setting at postoperative cochlear implant check-ups after 3, 6, 9, 12, 18, 24, 36, and 48 months of implant use. The sample included 42 children: 21 cochlear implant users and 21 with normal hearing, matched pairwise according to gender and chronological age. Communication assessments included the LittlEARS questionnaire, the Mullen Scale of Early Learning, and the Minnesota Child Development Inventory.

Results

The cochlear implant users’ hearing function according to LittlEARS was comparable to that of normal-hearing children within 9 months post-implantation. The mean scores after 9 and 12 months were 31 and 33, respectively in the prelingually deaf versus 31 and 34 in the normal-hearing children. The children's receptive and expressive language scores showed that after 12-48 months with cochlear implants, 81% had receptive language skills within the normative range and 57% had expressive language skills within the normative range. The number of children who scored within the normal range increased with increasing CI experience.

Conclusions

The present study showed that prelingually deaf children's ability to develop complex expressive and receptive spoken language after early bilateral implantation appears promising.The majority of the children developed language skills at a faster pace than their hearing ages would suggest and over time achieved expressive and receptive language skills within the normative range.     

UK and Ireland experience of cochlear implants in children with Down Syndrome

Objectives

Down Syndrome (DS) is associated with a high incidence of hearing loss. The majority of hearing loss is conductive, but between 4 and 20% is sensorineural, which in the main is mild or moderate and is managed with conventional behind-the-ear hearing aids. Cochlear implantation is an elective invasive procedure, performed to provide some form of hearing rehabilitation in individuals with severe to profound sensorineural hearing loss, and initially candidacy criteria were strict—excluding patients with additional disabilities. With good results and expanding experience, more candidates with additional disabilities are now being implanted. A survey of UK and Ireland Cochlear Implant Programmes sought to identify the number of individuals with DS who have been implanted with a cochlear implant (CI) and to provide relevant information on outcomes of implantation in these individuals.

Methods

E-mail survey of all programmes within the British Cochlear Implant Group (BCIG). Postal questionnaire to programmes identified to have implanted a child with Down Syndrome, with data collection on pre-operative assessment, surgical and post-operative outcomes. Case series review.

Results

Three of 23 BCIG programmes have implanted a child with Down Syndrome. Four children have received implants. No intraoperative or post-operative surgical complications were encountered. All children had middle ear disease, but no problems with implantation were associated with their middle ear condition. All children remain implant users, 12 months to 4 years post-implantation.

Conclusion

Cochlear implantation is an option for a child with Down Syndrome and associated severe to profound sensorineural hearing loss. Clinicians caring for these children and their families should consider referral for assessment by a Cochlear Implant Programme.     

Evolution of communication abilities after cochlear implantation in prelingually deaf children

Objective

This study tries to evaluate different factors on communication ability outcomes in cochlear implanted children.

Methods

Communication abilities are studied using the validated APCEI-scale based on five components of the language: cochlear implant acceptance, perceptive language performance, comprehension of the oral orders, expressive language and speech intelligibility.APCEI-scores were calculated every 6 months for the first 2 years, then yearly.The studied variables were: gender, social origin, preoperative residual hearing, age, aetiology of hearing loss, and associated disabilities.

Results

Communication ability scores increased with high socioeconomic level, presence of residual hearing, younger patients when no residual hearing, connexin mutation related deafness, and absence of associated disabilities. No significant difference has been noted between both sexes.

Conclusion

Many different factors influence the evolution of communication abilities of cochlear implanted children.Investigating the cause of hearing loss, presence of associated disabilities and residual hearing before surgery may help to predict outcome and plan appropriate care to those children with negative predictive factors.     

Evaluation of auditory development in infants and toddlers who received cochlear implants under the age of 24 months with the LittlEARS Auditory Questionnaire

Background and Aims

Newborn hearing screening and early intervention for congenital hearing loss have created a need for tools assessing the hearing development of very young children. A multidisciplinary evaluation of children's development is now becoming standard in clinical practice, though not many reliable diagnostic instruments exist. For this reason, the LittlEARS^® Auditory Questionnaire (LEAQ) was created to assess the auditory skills of a growing population of infants and toddlers who receive hearing instruments. The LEAQ relies on parent report, which has been shown to be a reliable way of assessing child development. Results with this tool in a group of children who received very early cochlear implantation are presented.

Methods

The LEAQ is the first module of the LittlEARS^® comprehensive test battery for children under the age of two who have normal hearing (NH), cochlear implants (CIs) or hearing aids (HAs). The LEAQ is a parent questionnaire comprised of 35 “yes/no” questions which can be completed by parents in less than 10 min. Sixty-three children who received unilateral CIs at a young age were assessed longitudinally and their performance was compared to that of a NH group.

Results

All CI children reached the maximum possible score on the LEAQ on average by 22 months of hearing age, i.e. 38 months of chronological age. In comparison, the NH group reached the maximum score by 24 months of age demonstrating that auditory skills of CI children often develop quicker than those of NH children. In the two comparison groups of children aged (a) younger and older than 12 months, and (b) between 6-9 and 21-24 months at first fitting, the early implanted children reached the highest scores faster than the later implanted children. Furthermore, three children with additional needs were tested. They showed slower growth over time but also received benefits from early implantation.

Conclusions

The LEAQ is a quick and effective tool for assessing auditory skills of very young children with or without hearing loss. In our study, the auditory skills of children with CI progressed very quickly after implantation and were comparable with those of NH peers.     

Cochlear implantation in children with cerebral palsy

Objective

Few studies have looked at the outcomes of children with complex needs following cochlear implantation. Increasing evidence supports the case for implantation in these children. To date there is very little evidence available evaluating the role of cochlear implantation in children with cerebral palsy. In this paper we look at the Manchester Cochlear Implant Programme's experience of implantation in 36 children with cerebral palsy.

Methods

A retrospective review of prospectively collected data for all children with cerebral palsy was undertaken. Cognitive and physical disability was scored by members of the cochlear implant team. A modified version of Geers and Moogs 1987 Speech Reception Score was used to assess outcome. Data was analysed looking at the relationship between cognitive and physical impairment, age at implantation and the SRS outcomes.

Results

This study demonstrated that children with cerebral palsy and a mild cognitive impairment do significantly better following implantation than those with a severe impairment (p = 0.008). Children with mild physical impairment did not appear to do significantly better than those with moderate or severe impairments (mild versus severe p = 0.13). Age at implantation was not a significant prognostic factor in this study group.

Conclusions

Children with complex needs are increasingly being referred for consideration of cochlear implantation. Further research is required to help guide candidacy, but each case must be considered individually. Higher functioning does appear to be the most important prognostic indicator regarding outcome but the effect of modest improvement in sound perception should not be underestimated.     

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.     

Development of Mandarin spoken language after pediatric cochlear implantation

Objective

The purpose of this study was to evaluate early spoken language development in young Mandarin-speaking children during the first 24 months after cochlear implantation, as measured by receptive and expressive vocabulary growth rates. Growth rates were compared with those of normally hearing children and with growth rates for English-speaking children with cochlear implants.

Method

Receptive and expressive vocabularies were measured with the simplified short form (SSF) version of the Mandarin Communicative Development Inventory (MCDI) in a sample of 112 pediatric implant recipients at baseline, 3, 6, 12, and 24 months after implantation. Implant ages ranged from 1 to 5 years. Scores were expressed in terms of normal equivalent ages, allowing normalized vocabulary growth rates to be determined. Scores for English-speaking children were re-expressed in these terms, allowing direct comparisons of Mandarin and English early spoken language development.

Results

Vocabulary growth rates during the first 12 months after implantation were similar to those for normally hearing children less than 16 months of age. Comparisons with growth rates for normally hearing children 16–30 months of age showed that the youngest implant age group (1–2 years) had an average growth rate of 0.68 that of normally hearing children; while the middle implant age group (2–3 years) had an average growth rate of 0.65; and the oldest implant age group (>3 years) had an average growth rate of 0.56, significantly less than the other two rates. Growth rates for English-speaking children with cochlear implants were 0.68 in the youngest group, 0.54 in the middle group, and 0.57 in the oldest group. Growth rates in the middle implant age groups for the two languages differed significantly.

Conclusions

The SSF version of the MCDI is suitable for assessment of Mandarin language development during the first 24 months after cochlear implantation. Effects of implant age and duration of implantation can be compared directly across languages using normalized vocabulary growth rates. These comparisons for Mandarin and English reveal comparable results, despite the diversity of these languages, underscoring the universal role of plasticity in the developing auditory system.     

How is the Children's Implant Profile used in the Cochlear Implant Candidacy Process?

Objective

The complex process of cochlear implant candidacy assessment at The Children's Hospital of Philadelphia (CHOP) is guided by a modified version of the Children's Implant Profile (ChIP) that has been used world wide over the past 18 years. The aim of this study is to analyze the use of the modified ChIP (mChIP) in the candidacy process by the CHOP Cochlear Implant Program. Of special interest were those cases in which the recommendation regarding implantation appeared inconsistent with the mChIP score. These were further analyzed to understand the real-life decision processes.

Methods

This retrospective study involved 121 children assessed for cochlear implant candidacy at CHOP over a 2-year period. The mChIP ratings of No Concern, Some Concern and Great Concern were assigned values of 1, 2 and 3, respectively. Values of 1.5 and 2.5 were used when the check mark was on the boundary between two categories. An average score was calculated and the relationships between mChIP scores and the recommendation regarding implantation were examined.

Results

Eighty-seven children were considered suitable for cochlear implantation; implantation was not recommended for 20. Another 14 cases in which one or more areas of the mChIP had not been completed were excluded. Using a criterion based solely on the mean score would correctly predict 75% of the team's recommendations to implant and 75% of recommendations not to implant. Examination of the cases where implantation was not recommended illuminated the decision-making process.

Conclusions

A statistical analysis of the mChIP fails to capture the complexity of the decision-making process. Most important, it appears that the team's practice is generally to recommend implantation when there is at least a modest prospect of benefit, unless there are absolute contraindications or many areas of Great Concern.     

Autism spectrum disorders in 24 children who are deaf or hard of hearing

Objectives

Approximately 4% of children who are deaf or hard of hearing have co-occurring autism spectrum disorder (ASD). Making an additional diagnosis of ASD in this population can be challenging, given the complexities of determining whether speech/language and social delays can be accounted for by their hearing loss, or whether these delays might be indicative of a comorbid ASD diagnosis. This exploratory study described a population of 24 children with the dual diagnosis of ASD and hearing loss.

Methods

Children completed a comprehensive ASD evaluation using standardized autism diagnostic instruments (Autism Diagnostic Observation Schedule, language and psychological testing). Children with permanent hearing loss who had a developmental evaluation between 2001 and 2011 and were diagnosed with an ASD based on the results of that evaluation were included. Information on communication modality, language and cognitive abilities was collected.

Results

The median age of diagnosis was 14 months (range 1–71) for hearing loss and 66.5 months (range 33–106) for ASD. Only 25% (n = 6) children were diagnosed with ASD ≤48 months of age and 46% by ≤6 years. Twelve (50%) children were diagnosed with ASD, 11 were diagnosed with pervasive developmental disorder not otherwise specified and 1 child had Asperger's. Most (67%) had profound degree of hearing loss. Fourteen (58%) children had received a cochlear implant, while 3 children had no amplification for hearing loss. Nine (38%) of the 24 children used speech as their mode of communication (oral communicators).

Conclusions

Communication delays in children who are deaf or hard of hearing are a serious matter and should not be assumed to be a direct consequence of the hearing loss. Children who received cochlear implants completed a multidisciplinary evaluation including a developmental pediatrician, which may have provided closer monitoring of speech and language progression and subsequently an earlier ASD diagnosis. Because children who are deaf or hard of hearing with ASD are challenging to evaluate, they may receive a diagnosis of ASD at older ages.     

Parental and program's decision making in paediatric simultaneous bilateral cochlear implantation: Who says no and why?

Objective

To evaluate initial candidacy for bilateral simultaneous cochlear implantation in children.

Design

Prospective case series.

Setting

Tertiary academic pediatric hospital.

Participants

As part of our research protocol all children eligible for cochlear implantation were assessed for suitability to receive a simultaneous bilateral implant. Over a 12-month period (January to December 2007) 78 children received a total of 95 cochlear implants. Children with sequential second implants (24), revision cases (4), and out of province recipients (4) were excluded. The remaining 46 patients were assessed for bilateral simultaneous implantation.

Main outcome measures

Team/parental decision to proceed with bilateral simultaneous implantation.

Results

17 children (37%) received simultaneous bilateral implants. 29 children (63%) were not considered suitable for simultaneous bilateral implantation. Reasons included developmental delay (10), residual borderline hearing in the second ear (9), parental/patient refusal (6), abnormally poor speech development for age (2), and abnormal cochlear anatomy precluding implantation (2). None were considered unsuitable for the more prolonged operative procedure on medical grounds.

Conclusions

Although bilateral implantation is thought to produce the optimal auditory outcome, not all patients are suitable, nor do all parents wish to proceed, when assessed for simultaneous implantation. Some of these patients are likely to be candidates for sequential bilateral implantation in due course.     

Prevalence of auditory neuropathy (AN) among infants and young children with severe to profound hearing loss

Auditory neuropathy is a challenging disorder and needs special habilitative/rehabilitative approach. This study aimed to detect its prevalence among infants and young children with severe to profound hearing loss. 112 infants and young children with age ranged 6-32 months were examined and diagnosed as having severe to profound hearing loss and were referred for hearing aid fitting. Those infants were reassessed in our centers for detecting cases with auditory neuropathy. The study group was subjected to immittancemetry, behavioral observation audiometry, ABR and cochlear microphonics.

Results

15 patients were found to have auditory neuropathy according to our criteria for diagnosis.

Conclusions

The prevalence of AN in the study group was 13.4%. CM were recommended to be tested routinely during ABR assessment whenever abnormal results are obtained.     

Articulation skills in Turkish speaking children with cochlear implant

Objective

The benefits of using cochlear implant (CI) on speech perception and production have been documented. The aim of this study is to investigate the effect of age of cochlear implantation performed and length of auditory experience with CI on the development of articulation skills in prelingual children with CI.

Methods

For this purpose, 14 children with CI were administered through the standardized articulation test named AAT (Ankara Articulation Test). In order to evaluate the development of articulation skills, AAT was applied to each child with CI at the first and the fourth years of CI. The test group was selected among those congenitally hearing impaired children who had used hearing aids bilaterally before the age of one and a half, and received intervention after fitting hearing aids. The test group was divided into two subgroups: Group 1 consisted of the children implanted at and below the age of 3 and Group 2 consisted of the children implanted after the age of 3. Evaluations of articulation skills between groups and within groups were performed in the first and fourth years of implantation. In the study, nonparametric statistics have been used to compare the test scores. Mann-Whitney U-test and Wilcoxon test have been used in the comparisons made between groups and within groups, respectively.

Results

While there has not been observed any statistically significant difference between the first year articulation skills of children with CI at and below the age of three and children with CI above the age of 3, for the fourth year this difference has been found to be statistically significant.

Conclusions

The results demonstrate the importance of the early application of CI and length of auditory experience with CI in the development of articulation skills.     

Static balance function in children with cochlear implants

Objective

This study aimed to assess the static balance function in deaf adolescents with cochlear implants.

Methods

We included 24 adolescents who had received unilateral cochlear implantation for at least 5 years. Each subject underwent stabilometry testing under 4 different conditions: (A) firm surface with eyes open; (B) firm surface with eyes closed; (C) foam pad with eyes open; and (D) foam pad with eyes closed. All of them received tests with their cochlear implant turned on and off. Another 24 age- and sex-matched adolescents with normal hearing were tested in the same way for comparison. Sway velocity and circular area were measured and analyzed.

Results

The mean sway velocity of the cochlear implant group under conditions A-D was 1.68, 1.98, 2.36, and 5.25 cm/s, respectively, and the mean circular area of the cochlear implant group under conditions A-D was 7.39, 6.68, 12.21, and 34.27 cm², respectively. Both of the parameters showed statistical significance between the cochlear implant group and the normal hearing group for conditions A, C and D (p < 0.05). Furthermore, there was no significant balance function change among cochlear implant group with their implant “on” and “off”.

Conclusions

This study showed that the static balance function in adolescents with long-term use of cochlear implants was worse than those of normal hearing peers. The difference between the cochlear implant group and normal hearing group was the highest when both visual and somatosensory inputs were disrupted. The postural stability was similar whether or not the cochlear implant was activated.     

Inferences and metaphoric comprehension in unilaterally implanted children with adequate formal oral language performance

Objectives

To assess skills in inferences during conversations and in metaphors comprehension of unilaterally cochlear implanted children with adequate abilities at the formal language tests, comparing them with well-matched hearing peers; to verify the influence of age of implantation on overall skills.

Methods

The study was designed as a matched case–control study. 31 deaf children, unilateral cochlear implant users, with normal linguistic competence at formal language tests were compared with 31 normal hearing matched peers. Inferences and metaphor comprehension skills were assessed through the Implicit Meaning Comprehension, Situations and Metaphors subtests of the Italian Standardized Battery of “Pragmatic Language Skills MEDEA”. Differences between patient and control groups were tested by the Mann–Whitney U test. Correlations between age at implantation and time of implant use with each subtest were investigated by the Spearman rank correlation coefficient.

Results

No significant differences between the two groups were found in inferencing skills (p = 0.24 and p = 0.011 respectively for Situations and Implicit Meaning Comprehension). Regarding figurative language, unilaterally cochlear implanted children performed significantly below their normal hearing peers in Verbal Metaphor comprehension (p = 0.001). Performances were related to age at implantation, but not with time of implant use.

Conclusions

Unilaterally cochlear implanted children with normal language level showed responses similar to NH children in discourse inferences, but not in figurative language comprehension. Metaphors still remains a challenge for unilateral implant users and above all when they have not any reference, as demonstrated by the significant difference in verbal rather than figurative metaphors comprehension. Older age at implantation was related to worse performance for all items. These aspects, until now less investigated, had to receive more attention to deeply understand specific mechanisms involved and possible effects of different levels of figurative language complexity (presence or absence of contextual input, degree of transparency and syntactic frozenness). New insight is needed to orient programs in early intervention settings in considering and adequately responding to all these complex communicative need of children with hearing loss.     

An investigation of the first lexicon of Turkish hearing children and children with a cochlear implant

Introduction

Research on early cochlear implantation and first language milestones is limited. To compare language performance in cochlear implant (CI) users and hearing children, the establishment of normative data for both groups would be of benefit. To aid the data collection for Turkish hearing children and children with a CI diaries can be used.

Aims

This study aimed to document the first 100-word lexicon acquired by Turkish hearing children and children with a CI during the first 2 years of hearing experience, to determine the distribution of the first 100-word lexicon per word category, the rate of acquisition of words and the effects of age at implantation on language performance.

Methods

First word data was collected from 63 Turkish hearing children and 71 CI users implanted under 36 months of chronological age using a diary. The mean number of words recorded at each time interval was calculated. The time taken to achieve the first 100-word lexicon and the categories of the first words were documented. Performance under 18 months and over 24 months of age at first fitting was compared.

Results

By 19–21 months of hearing age both hearing and CI user's vocabularies were of similar size. CI users developed a lexicon earlier than hearing children, but once hearing children started to acquire words their acquisition rate was faster. The distribution of words acquired per category were similar. 83% of first words were shared by both groups. No significant difference in performance was found between: hearing versus: implanted children; or earlier (<18 months) versus later (≥24 months) implanted children.

Conclusions

The vocabulary of hearing children compared to CI users are similar in size and the category. Early access to auditory stimuli facilitates children with a hearing loss to develop vocabularies similar to hearing children in the short term.     

Cochlear implantation in children

Cochlear implantation has revolutionized the treatment and prognosis of children with severe to profound sensorineural hearing loss who receive limited benefits from hearing aids. Children who receive cochlear implantation at young age, in particular before 2 years of age, can be expected to reach their normal age-equivalent developmental milestones and have higher chance to integrate into the mainstream educational settings. With the positive outcomes after cochlear implantation and the improvements in technology and surgical techniques, candidacy for cochlear implantation in children has been expanding to include hearing-impaired children with significant residual hearing, severe inner ear malformations, multiple handicaps such as mental retardation or visual impairment, and auditory neuropathy. Furthermore, there is growing interest in offering bilateral cochlear implantation to give children the benefits of binaural hearing. As the candidacy criteria expand, cochlear implant programs including preoperative evaluation, surgery, and habilitation have become more complex. Therefore, candidates should be selected prudently by multidisciplinary approach and cochlear implantation in children is much better to be provided by experienced cochlear implant team consisting of experts in relevant fields for the best results.