Examination of Communication Skills in Children with Cochlear Implants and Hearing Children

Purpose The overall goal of the current study was to identify an optimal level and duration of acoustic experience that facilitates language development for pediatric cochlear implant (CI) recipients-specifically, to determine whether there is an optimal duration of hearing aid (HA) use and unaided threshold levels that should be considered before proceeding to bilateral CIs. Method A total of 117 pediatric CI recipients (ages 5-9 years) were given speech perception and standardized tests of receptive vocabulary and language. The speech perception battery included tests of segmental perception (e.g., word recognition in quiet and noise, and vowels and consonants in quiet) and of suprasegmental perception (e.g., talker and stress discrimination, and emotion identification). Hierarchical regression analyses were used to determine the effects of speech perception on language scores, and the effects of residual hearing level (unaided pure-tone average [PTA]) and duration of HA use on speech perception. Results A continuum of residual hearing levels and the length of HA use were represented by calculating the unaided PTA of the ear with the longest duration of HA use for each child. All children wore 2 devices: Some wore bimodal devices, while others received their 2nd CI either simultaneously or sequentially, representing a wide range of HA use (0.03-9.05 years). Regression analyses indicate that suprasegmental perception contributes unique variance to receptive language scores and that both segmental and suprasegmental skills each contribute independently to receptive vocabulary scores. Also, analyses revealed an optimal duration of HA use for each of 3 ranges of hearing loss severity (with mean PTAs of 73, 92, and 111 dB HL) that maximizes suprasegmental perception. Conclusions For children with the most profound losses, early bilateral CIs provide the greatest opportunity for developing good spoken language skills. For those with moderate-to-severe losses, however, a prescribed period of bimodal use may be more advantageous for developing good spoken language skills.

Validation of the LittlEARS Auditory Questionnaire in cochlear implanted infants and toddlers

Music to the Impaired or Implanted Ear

Background and Aim: Expressive language is the most basic and widespread means of communication; children with hearing impairments are one of the largest groups of children with speech and language disorders. Therefore, this study compares the relationship between the development of expressive language and social skills in children with cochlear implants (CIs), hearing aid (HA) users and normal Persian-speaking peers aged five to seven years old. Methods: The present study is a cross-sectional comparative study. 45 children in three groups; normal hearing, CIs and HA users were selected by convenience sampling. The child’s communication and social skills were assessed using Matson and children’s communication checklist (CCC) tests. Through the analysis of a descriptive speech sample of language indicators, the mean length of utterance- morpheme (MLU-m), number of different words (NDW) and the percentage of intelligible utterances (PIU) of the child were obtained and examined. ANOVA test was used to compare the groups and Pearson test was used to examine the correlation between variables. Results: The mean score of CCC test, PIU and NDW are significantly different in the three groups. MLU and Matson subtests are not significantly different in three groups. Correlation between variables was different in each group. Conclusion: Communication skills, intelligibiResults: The mean score of CCC test, PIU and NDW are significantly different in the three groups. MLU and Matson subtests are not significantly different in three groups. Correlation between variables was different in each group. Conclusion: Communication skills, intelligibiResults: The mean score of CCC test, PIU and NDW are significantly different in the three groups. MLU and Matson subtests are not significantly different in three groups. Correlation between variables was different in each group. Conclusion: Communication skills, intelligibility, and lexical diversity are significantly different between normal and hearing- impaired children. MLU and Matson subtests are not significantly different in three groups. The correlation patterns among different subtests of CCC and Matson for children with hearing impairment were different form normal hearing children. Keywords: Hearing impairment; communication skills; mean length of utterance; percentage of intelligible utterances; number of different words; social skills

Bimodal stimulation (BMS) has been shown to be beneficial for the performance of pitch ranking in postlingually deafened adults. However, the contribution of nonimplanted ears to pitch perception with respect to duration of hearing aid (HAs) use for prelingually cochlear implantees remained unclear. This study aimed to investigate whether experiences/duration of HAs use in the nonimplanted ear improved pitch perception ability in this population of subjects. Twenty-nine children with congenital/prelingual deafness of profound degree were studied. Test stimuli consisted of 2 sequential piano tones, ranging from C (256 Hz) to B (495 Hz). Children were asked to identify the pitch relationship between the 2 tones (i.e., same, higher, or lower). Duration of HAs use was the major factor related to the correct rate for pitch perception. Overall correct rate for pitch perception (O) could be best predicted by duration of HAs use (DuA) (O = 0.561XDuA, r = 0. 315, p = 0.002). Experiences of HAs use appear to improve pitch perception ability in prelingually cochlear implantees. This suggests that incorporation of HAs use early in life and through the postoperative rehabilitation program for prelingually deafened children with cochlear implants would be beneficial, although an association does not guarantee causality. A longitudinal study is needed to show whether improvement of music performance with duration of HAs use in these children is measurable using auditory evoked potentials.

A cochlear implant (CI) is a hearing device introduced in the 1980s for profoundly deaf subjects who gained little or no benefit from powerful hearing aids. This device comprises an electrode array inserted in the cochlea, connected to an internal receiver, and an externally worn speech processor. The CI transforms acoustic signals into electrical currents which directly stimulate the auditory nerve. Since the early 1990s, cochlear implantation in children has been developing rapidly. Although it is still difficult to predict how a child will perform with a cochlear implant, the success of cochlear implantation can no longer be denied. In this paper, some recent papers and reports, and the results of the various Nijmegen cochlear implant studies, are reviewed. Issues about selection, examinations, surgery and the outcome are discussed. Overall, our results were comparable with those of other authors. It can be concluded that cochlear implantation is an effective treatment for postlingually deaf as well as prelingually (congenital or acquired) deaf children with profound bilateral sensorineural deafness.

ObjectivesThe purpose of this current study was to investigate whether pitch, lexical tone, and/or speech-in-noise perception were significantly correlated for Singaporean teenagers or adults who spoke both Mandarin and English.MethodsThirty-three normal hearing or near-normal hearing listeners who did not use a hearing device (NNH group), eight postlingually deafened cochlear implant (CI) recipients (CI group), and three postlingually deafened bilateral hearing aid (HA) users (HA group) were recruited. All participants were bilingual Mandarin–English-speaking Singaporean residents. Participants were assessed on tests of pitch-ranking, lexical tone perception, and speech-in-noise.ResultsThe NNH group scored significantly better than the CI group for all tests and subtests. There were no significant differences for the pitch test between the HA group and either the CI or NNH group. However, HA users scored significantly better than the CI group, and more aligned with the NNH group's scores for both the lexical tone and Mandarin speech-in-noise test. There were highly significant moderate positive correlations between all three tests.DiscussionOverall, the performance of the CI users in this study indicates that CI recipients still struggle on pitch-related auditory perception tasks. Additionally, although the test scores from the HA users were better than the CI recipients, they were not as good as the NNH listeners. The significant moderate correlations between all three tests indicate that there is at least some degree of overlap in the skills required to accurately perceive these stimuli.ConclusionThe overall results suggest that CI users, and to a lesser extent HA users, still struggle with complex auditory perceptual tasks, particularly when it requires the perception of pitch. However, it may be possible that training one of these skills (e.g. musical pitch) may then generalize to other tasks (e.g. lexical tone and/or speech-in-noise). This is important for counseling, as well as for planning effective rehabilitation programs.

Aural Habilitation Update: The Role of Speech Production Skills of Infants and Children With Hearing Loss

Identify likely predictors for the outcome after contralateral cochlear implantation with a long interimplant delay. Retrospective case reviews. Outpatient cochlear implant (CI) center. Seventy-three children and adolescents who underwent sequential bilateral cochlear implantation with an interval between both implantations of 5 years or longer. The mean age of the patients at the first and second cochlear implantations was 2.72 ± 1.52 and 11.57 ± 2.9 years, respectively. The mean duration of experience with both implants was 4.01 ± 1.57 years. Rehabilitative. All 73 patients underwent periodic speech perception testing in quiet and noise. The most recent unilateral data for each side were statistically analyzed. The speech test results were evaluated by the age at first implantation, the interval between both implantations, the duration of hearing aid use in the second side, and the duration of the bilateral CI use. A statistically significant difference for speech test results was obtained between the early-implanted ears and the late-implanted ears for all children. These results were dependent on the interimplant interval. All age groups demonstrated significant differences (p > 0.05) for the second side between the speech test results and the interval between both cochlear implantations. In addition, statistically significant differences influenced by the duration of hearing aid use were found for speech test results for the second side. Experience was also a factor for the second CI, yielding significantly higher speech test scores with longer use. The development of hearing abilities in a second-implanted side depends on the interimplant interval, the hearing aid use, and the duration of the second CI use.

Research has shown that the cochlear implant may improve deaf children's speech and communication skills. However, little is known about its effect on children's ability to socialize with hearing peers. Using a standardized psychological measure completed by parents and a longitudinal design, this study examined the development of communication, socialization, and daily living skills of children who used hearing aids or cochlear implants for an average of 11 and 6 years, respectively. Results show that children with cochlear implants, who were more delayed than children with hearing aids at the outset, made significant progress over time. Children with both devices achieved age-appropriate development after years of hearing aid or cochlear implant use. The pattern of results suggests that cochlear implants may be effective in improving deaf children's communication and social skills.

Variability in the vocabulary outcomes of children with cochlear implants (CIs) is partially explained by child-directed speech (CDS) characteristics. Yet, relatively little is known about whether and how mothers adapt their lexical and prosodic characteristics to the child's hearing status (before and after implantation, and compared with groups with normal hearing (NH)) and how important they are in affecting vocabulary development in the first 12 months of hearing experience. To investigate whether mothers of children with CIs produce CDS with similar lexical and prosodic characteristics compared with mothers of age-matched children with NH, and whether they modify these characteristics after implantation. In addition, to investigate whether mothers' CDS characteristics predict children's early vocabulary skills before and after implantation. A total of 34 dyads (17 with NH, 17 with children with CIs; ages = 9-32 months), all acquiring Italian, were involved in the study. Mothers' and children's lexical quantity (tokens) and variety (types), mothers' prosodic characteristics (pitch range and variability), and children's vocabulary skills were assessed at two time points, corresponding to before and 1 year post-CI activation for children with CIs. Children's vocabulary skills were assessed using parent reports; lexical and prosodic characteristics were observed in semi-structured mother-child interactions. Results showed that mothers of children with CIs produced speech with similar lexical quantity but lower lexical variety, and with increased pitch range and variability, than mothers of children with NH. Mothers generally increased their lexical quantity and variety and their pitch range between sessions. Children with CIs showed reduced expressive vocabulary and lower lexical quantity and variety than their peers 12 months post-CI activation. Mothers' prosodic characteristics did not explain variance in children's vocabulary skills; their lexical characteristics predicted children's early vocabulary and lexical outcomes, especially in the NH group, but were not related to later language development. Our findings confirm previous studies on other languages and support the idea that the lexical characteristics of mothers' CDS have a positive effect on children's early measures of vocabulary development across hearing groups, whereas prosodic cues play a minor role. Greater input quantity and quality may assist children in the building of basic language model representations, whereas pitch cues may mainly serve attentional and emotional processes. Results emphasize the need for additional longitudinal studies investigating the input received from other figures surrounding the child and its role for children's language development. What is already known on the subject Mothers' CDS is thought to facilitate and support language acquisition in children with various language developmental trajectories, including children with CIs. Because children with CIs are at risk for language delays and have acoustic processing limitations, their mothers may have to produce a lexically simpler but prosodically richer input, compared to mothers of children with NH. Yet, the literature reports mixed findings and no study to our knowledge has concurrently addressed the role of mothers' lexical and prosodic characteristics for children's vocabulary development before implantation and in the first 12 months of hearing experience. What this study adds to the existing knowledge The study shows that mothers of children with CIs produce input of similar quantity but reduced variety, and with heightened pitch characteristics, compared to mothers of children with NH. There was also a general increase in mothers' lexical quantity and variety, and in their pitch range, between sessions. Only their lexical characteristics predicted children's early vocabulary skills. Their lexical variety predicted children's expressive vocabulary and lexical variety only in the NH group. What are the practical and clinical implications of this work? These findings expand our knowledge about the effects of maternal input and may contribute to the improvement of early family-centred intervention programmes for supporting language development in children with CIs.

A great deal of variability exists in the speech-recognition abilities of postlingually deaf adult cochlear implant (CI) recipients. A number of previous studies have shown that duration of deafness is a primary factor affecting CI outcomes; however, there is little agreement regarding other factors that may affect performance. The objective of the present study was to determine the source of variability in CI outcomes by examining three main factors, biographic/audiologic information, electrode position within the cochlea, and cognitive abilities in a group of newly implanted CI recipients. Participants were 114 postlingually deaf adults with either the Cochlear or Advanced Bionics CI systems. Biographic/audiologic information, aided sentence-recognition scores, a high resolution temporal bone CT scan and cognitive measures were obtained before implantation. Monosyllabic word recognition scores were obtained during numerous test intervals from 2 weeks to 2 years after initial activation of the CI. Electrode position within the cochlea was determined by three-dimensional reconstruction of pre- and postimplant CT scans. Participants' word scores over 2 years were fit with a logistic curve to predict word score as a function of time and to highlight 4-word recognition metrics (CNC initial score, CNC final score, rise time to 90% of CNC final score, and CNC difference score). Participants were divided into six outcome groups based on the percentile ranking of their CNC final score, that is, participants in the bottom 10% were in group 1; those in the top 10% were in group 6. Across outcome groups, significant relationships from low to high performance were identified. Biographic/audiologic factors of age at implantation, duration of hearing loss, duration of hearing aid use, and duration of severe-to-profound hearing loss were significantly and inversely related to performance as were frequency modulated tone, sound-field threshold levels obtained with the CI. That is, the higher-performing outcome groups were younger in age at the time of implantation, had shorter duration of severe-to-profound hearing loss, and had lower CI sound-field threshold levels. Significant inverse relationships across outcome groups were also observed for electrode position, specifically the percentage of electrodes in scala vestibuli as opposed to scala tympani and depth of insertion of the electrode array. In addition, positioning of electrode arrays closer to the modiolar wall was positively correlated with outcome. Cognitive ability was significantly and positively related to outcome; however, age at implantation and cognition were highly correlated. After controlling for age, cognition was no longer a factor affecting outcomes. There are a number of factors that limit CI outcomes. They can act singularly or collectively to restrict an individual's performance and to varying degrees. The highest performing CI recipients are those with the least number of limiting factors. Knowledge of when and how these factors affect performance can favorably influence counseling, device fitting, and rehabilitation for individual patients and can contribute to improved device design and application.

Hearing aids plus cochlear implants: Optimizing the bimodal pediatric fitting

This study explores speech recognition characteristics in background noise and music between normal hearing (NH) listeners, hearing aid (HA) users and cochlear implant (CI) users.Sixty individuals participated in the study: 20 with NH, 20 HA users, and 20 CI users. HA and CI users had a Categories of Auditory Performance score of 6 and open set sentence recognition of 85% or higher. They had been using the devices for at least one year. Babble noise (BN), piano solo (PS), piano + violin (PV), and piano + chorus (PC) were presented at +5- and +10 dB signal-to-noise ratio (SNR). The participants were asked to listen and repeat words and sentences from the Korean Standard Sentence List for Adults. At +5- and +10 dB SNRs, CI users performed worse than those with NH on word and sentence recognition in BN, PS, PV, and PC. HA users outperformed CI users in all conditions. Those with NH showed better sentence recognition than HA users across all conditions at +5 dB SNR and better word recognition in PV and BN at +5 dB SNR and in PC at +10 dB SNR. Correlational analysis revealed that the percentage of life with hearing loss before CI was not correlated with sentence and word recognition across all conditions in both SNRs. Statistically significant negative correlations were observed between the duration of deafness and sentence and word recognition in some conditions. Despite individuals with HL performing well on clinical tests, background music can still interfere with communication for those using hearing devices. To accurately evaluate individuals’ communication abilities clinical tools that include background music need to be developed. Studies using different types of music could help develop and standardize such tools for assessing speech and language abilities in individuals with hearing loss.

Lessons from LOCHI.