Longitudinal Evaluation of Auditory and Speech Performance in Pediatric Cochlear Implant Recipients Using IT-MAIS, MESP, CAP, and SIR Scales.

Auditory performance and speech intelligibility of Mandarin-speaking children implanted before age 5

Evidence for the utility of electrically-evoked auditory responses, as measures of objective hearing assessments in pediatric cochlear implant (CI) recipients, is proliferating. Recently, we demonstrated the relationship between electrical auditory brainstem response (EABR) and measures of auditory performance and speech intelligibility in pediatric CI users (Wang, Pan, Deshpande, & Ma, 2015). However, the EABR reflects activity only up to the auditory brainstem. The electrical auditory middle-latency response (EAMLR) is sensitive to the functioning of the sub-cortical structures as well as the auditory cortex and thus has greater utility in predicting auditory perception and processing. Here, we present data from 40 pre-lingually hearing impaired, pediatric CI recipients. The relationship between components of the EAMLR (latencies of Na, Pa, Nb, Pb; Na-Pa amplitude; and Na-Pa interval) and measures of auditory performance and speech intelligibility assessed using care-giver rating scales such as Categories of Auditory Performance (CAP) (Archbold, Lutman, & Marshall, 1995) and Speech Intelligibility Rating (SIR) (Allen, Nikolopoulos, Dyar, & O'Donoghue, 2001), respectively, are analyzed. EAMLR profiles of “good” versus “poor” CI users (based on CAP and SIR ratings) will be discussed. Additionally, the effect of age of implantation on the EAMLR, CAP and SIR outcomes will be considered.

ABSTRACTImportanceCochlear implantation (CI) is an effective therapy for patients with severe to profound sensorineural hearing loss. It remains controversial whether children younger than 12 months of age should undergo CI.ObjectiveTo evaluate the safety and effectiveness of CI in children younger than 12 months of age.MethodsWe performed a retrospective study of clinical data of pediatric patients younger than 12 months of age who underwent CI and were followed up for 1 to 2 years. Patients’ developmental levels were evaluated by the Gesell score before CI. Intraoperative and postoperative complications were recorded to evaluate the safety of CI. Auditory and speech abilities were scored by the LittlEARS® auditory questionnaire (LEAQ), categories of auditory performance (CAP), speech intelligibility rating (SIR), infant‐toddler meaningful auditory integration scale (IT‐MAIS), and meaningful use of speech scale (MUSS) at 1, 2, 3, 6, 9, and 12 months after CI. The associations between clinical characteristics before CI and postoperative scores at 1 year after CI were analyzed by the linear mixed‐effects model.ResultsEighty‐nine children (47 boys and 42 girls) were included in this study (mean age at CI, 9.2 ± 1.6 months). Sixteen patients were diagnosed with cochlear malformation and 16 underwent bilateral CI. No severe complications occurred in any patients. The mean developmental quotient of the Gesell score was 78.00 ± 10.03. The median LEAQ scores were 0, 5, 10, 16, 22, 26 and 30 before and at 1, 2, 3, 6, 9, and 12 months after CI, respectively. These findings implied that the LEAQ score greatly improved in the first year after CI. The overall CAP, SIR, IT‐MAIS, and MUSS scores also increased with increasing duration after CI. No significant associations were detected between clinical characteristics (age, sex, implant number, pre‐CI Gesell score, and inner ear malformation) and LEAQ outcomes at 12 months after CI.InterpretationWith increasing duration after CI, auditory and speech behavior dramatically improve in young children. Our findings indicate that CI is feasible for children younger than 12 months of age.

Cochlear implantation in children with auditory neuropathy spectrum disorder: A multicenter study on auditory performance and speech production outcomes

Evaluation of the language development of children with cochlear implant users living in a multilingual environment

Long term outcome of cochlear implantation in five children with common cavity deformity

Objectives:To determine whether family environment and demographic factors such as family income and education produce any significant difference in postoperative performance of cochlear implant (CI)patients.Methods:In this study, 49 participants who received cochlear implant devices at King Abdullah Ear Specialist Center, Riyadh, Saudi Arabia before the age 5 years were included. Data were collected between July 2019 and August 2019. Postoperative performance was assessed by speech intelligibility rating (SIR) and categories of auditory performance (CAP) scales. Family environment was assessed with family environment scale (FES) survey. Data of demography, average income, and maternal and paternal education were obtained through review of patient’s medical files. The data obtained were analyzed using Statistical Package for Social Sciences for Mac, version 23 (IBM Corp, Armonk, NY, USA).Results:A significant difference between the organization categories of FES (p<0.05) was observed in terms of postoperative CAP scores, while a significant effect of the expressiveness category on both postoperative CAP and SIR scores (p<0.05) was observed. The scores on both CAP and SIR scales were significantly affected by maternal education, and the scores on SIR scale were positively correlated with paternal education.Conclusion:This study suggests that post-procedural performance of auditory perception and speech intelligibility in CI patients is significantly related to the family environment as well as the education levels of the parents.

A cochleovestibular nerve deficiency (CVND) could compromise stimulation of nerve by electrical pulses delivered from a cochlear implant, thereby hindering activity along auditory pathway. The evaluation of children with congenital hearing loss with a high-resolution magnetic resonance imaging is presently the investigative modality of choice to diagnose CVND. The aim of this study was to determine the outcomes in pediatric cochlear implant recipients with a diagnosis of CVND. The objectives included (1) to study the prevalence of CVND among children with prelingual congenital severe to profound hearing loss; (2) to assess post cochlear implantation (CI) outcomes in children with CVND using categories of auditory performance (CAP), speech intelligibility rating (SIR), and cortical auditory evoked potentials (CAEPs); and (3) to propose a management protocol for these children. All CI procedures performed during the study period in children 5 years or younger were included in study. All patients who were older than 5 years or had syndromic associations, multiple disabilities, second side or revision CI were excluded from the study. Children with unilateral cochleovestibular nerve aplasia and all other cases of CVND (type IIa and IIb) were advised to undergo CI on side with more radiologically robust nerve and/or cochlea anatomy. Children with bilateral CVND were included in group A, and age-matched cochlear implant candidates with normal cochleovestibular nerve anatomy were included in group B for statistical comparison of outcomes. In group A, post CI CAP and SIR, CAEP amplitude and latency at 12 months showed statistically significant difference (p<0.05) compared with preoperative values. However, mean score of CAEP latency and amplitude and SIR score was worse for group A compared with group B at 12 months, which was statistically significant (p<0.05). This study supports the fact that CI is a viable option to be offered in children with CVND (type IIa and IIb) for the development of auditory perception and speech.

Objective:The aim of this study was to present an institution's experience with cochlear reimplantation（CRI）, to assess surgical challenges and post-operative outcomes and to increase the success rate of CRI. Methods:We retrospectively evaluated data from 76 reimplantation cases treated in a tertiary center between 2001 and 2022. Clinical features include caused of CRI, type of failure, surgical issues, and auditory speech performance were analyzed. Categorical Auditory Performance （CAP） and Speech Intelligibility Rating （SIR） scores were used to evaluate pre-and post-CRI outcomes. Our center's consecutive cohort of 1 126 patients had seven patients, while 69 patients were from other cochlear implant centers. Device failure was the most common cause of CRI（68/76）, with the remaining cases including flap complications（3/76）, magnet displacement（3/76）, secondary meningitis（1/76）, and foreign bodies around the implant（1/76）. Postoperative auditory and speech outcome improved in 31.6%（24/76） of patients, remained unchanged in 63.2%（48/76）, and decreased in CAP and SIR scores in 5.2%（4/76） of patients. Postoperatively, the seven patients with cochlear ossification and fibrosis scored lower on the overall CAP and SIR scale than non-ossification individuals, which is a significant factor in surgical success rates and auditory-speech outcomes. Conclusion:CRI surgery is a challenging but relatively safe procedure, and most reimplanted patients experience favorable postoperative outcomes. Medical complications and intracochlear damage are the main causes of poor postoperative results. Therefore, minimally invasive CI has a positive significance for reducing the difficulty of CRI surgery and improving the CI performance.

Correlation between cortical auditory evoked potential and auditory speech performance in children with cochlear implants.

This study aims to evaluate speech production outcomes and auditory performance in children with post-meningitis deafness who were treated with cochlear implants. Additionally, the study assesses the impact of electrode insertion depth on surgical outcomes.". We conducted a study on 66 pediatric patients with bilateral postmeningitis hearing loss who were being prepared for cochlear implantation at four tertiary referral academic institutions. The speech intelligibility rating (SIR) and categories of auditory performance (CAP) were evaluated after the first and second years following implantation. The patients were divided into two groups based on electrode insertion depth: one group had full electrode insertion (more than two-thirds), while the other had partial electrode insertion (less than two-thirds). We compared the SIR and CAP scores between the two groups to assess the impact of electrode insertion depth on outcomes. Before implantation, the median CAP score was one, but it improved significantly to six within two years after the procedure (P-value < 0.001). Similarly, the median SIR score before implantation was one, but it improved significantly to three within two years after surgery (P-value < 0.001). However, there was no significant difference between the partial and full electrode insertion groups in terms of CAP and SIR scores during the follow-up evaluations conducted after the first and second years. The study found that cochlear implantation significantly improved speech production skills and auditory performance in children with postmeningitis deafness. Importantly, the amount of electrode insertion at the time of implantation did not have a significant impact on the outcomes.

Introduction: The result of cochlear implantation is commonly assessed postoperatively by scores such as Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) scores. Since parents are the main people involved in the day-to-day life of children, parental satisfaction also counts for the assessment of the child's progress after implantation. The objective of the study is to compare the auditory and speech outcome score with parental satisfaction after cochlear implantation in children. Methods: The auditory performance was assessed by the CAP score and the speech by the SIR score. The parents were asked for their satisfaction in their children's audiological and speech progress after surgery by questionnaire. The two results were compared to see the difference in the rating scales and the parents' satisfaction. Results: The CAP score reached a maximum of 7 in children implanted before 3 years of age and reached a maximum of 6 in children implanted after 3 years of age. The SIR score reached the highest of 5 in children before 3 years of age and a maximum of 3 in children implanted after 3 years of age. The parental score of satisfaction was also better in children implanted before 3 years of age and correlated with the CAP and SIR score results. Conclusion: The CAP and SIR scores were better in children implanted at an earlier age. The CAP and SIR scores were comparable with parental satisfaction after 1 year of auditory and speech habilitation.

Cochlear implantation in children with inner ear malformation: A multicenter study on auditory performance and speech production outcomes

This multicenter study aimed to evaluate the auditory and speech outcomes of cochlear implantation (CI) in deaf-blind patients compared with deaf-only patients. Retrospective cohort study. Multiple cochlear implant centers. The current study was conducted on 17 prelingual deaf-blind children and 12 postlingual deaf-blind adults who underwent CI surgery. As a control group, 17 prelingual deaf children and 12 postlingual deaf adults were selected. Cochlear implantation. Auditory and linguistic performances in children were assessed using the categories of auditory performance (CAP) and Speech Intelligibility Rating (SIR) scales, respectively. The word recognition score (WRS) was also used to measure speech perception ability in adults. The mean CAP, SIR, and WRS cores were compared between the deaf-only and deaf-blind groups before CI surgery and at "12 months" and "24 months" after device activation. Cohen's d was used for effect size estimation. We found no significant differences in the mean CAP and SIR scores between the deaf-blind and deaf-only children before the CI surgery. For both groups, SIR and CAP scores improved with increasing time after the device activation. The mean CAP scores in the deaf-only children were either equivalent or slightly higher than those of the deaf-blind children at "12 months post-CI" (3.94 ± 0.74 vs 3.24 ± 1.25; mean difference score, 0.706) and "24 months post-CI" (6.01 ± 0.79 vs 5.47 ± 1.06; mean difference score, 0.529) time intervals, but these differences were not statistically significant. The SIR scores in deaf-only implanted children were, on average, 0.870 scores greater than the deaf-blind children at "12 months post-CI" (2.94 ± 0.55 vs 2.07 ± 1.4; p = 0.01, d = 0.97) and, on average, 1.067 scores greater than deaf-blind children at "24 months post-CI" (4.35 ± 0.49 vs 3.29 ± 1.20; p = 0.002; d = 1.15) time intervals. We also found an improvement in WRS scores from the "preimplantation" to the "12-month post-CI" and "24-month post-CI" time intervals in both groups. Pairwise comparisons indicated that the mean WRS in the deaf-only adults was, on average, 10.61% better than deaf-blind implanted adults at "12 months post-CI" (62.33 ± 9.09% vs 51.71 ± 10.73%, p = 0.034, d = 1.06) and, on average, 15.81% better than deaf-blind adults at "24-months post-CI" (72.67 ± 8.66% vs 56.8 ± 9.78%, p = 0.002, d = 1.61) follow-ups. Cochlear implantation is a beneficial method for the rehabilitation of deaf-blind patients. Both deaf-blind and deaf-only implanted children revealed similar auditory performances. However, speech perception ability in deaf-blind patients was slightly lower than the deaf-only patients in both children and adults.

To evaluate the auditory and speech benefit of bimodal stimulation for prelingual deafened cochlear implantation recipients. Retrospective and comparative study. Tertiary referral center. Fifty-six children with bilateral prelingual profound sensorineural hearing loss were enrolled, including 28 consecutive children with unilateral cochlear implantation (CI group), and 28 consecutive children with bimodal stimulation (BI group) who used an additional hearing aid (HA) in the contralateral ear. Hearing assessments included the Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS) and Categories of Auditory Performance (CAP). Speech evaluations included the Meaningful Use of Speech Scale (MUSS), and Speech Intelligibility Rating (SIR). These measurements were evaluated at the first mapping of cochlear implants and 0.5, 1, 3, 6, 12, 18, 24 months after. Data were analyzed by repeated measures analysis. The mean ages of BI and CI groups were similar (17.6 ± 6.87 vs 19.0 ± 8.10 months, p = 0.497). The initial scores for hearing and speech assessments showed no differences between the two groups, apart from IT-MAIS (2.46 ± 0.631 in BI group vs 0.50 ± 0.279 in CI group, p = 0.004). The auditory and speech development over time were different in the two groups as seen in IT-MAIS (p < 0.001), CAP (p = 0.029), MUSS (p < 0.001), and SIR (p < 0.001). A continuing but stable difference was observed in CAP, MUSS, and SIR at 3, 18, and 12 months after the first mapping, respectively. In addition, the BI group had better IT-MAIS scores at 3 and 6 months compared with the CI group; however, the difference was not significant after 12 months. Bimodal stimulation is beneficial for prelingually deafened CI recipients who have minimal contralateral residual hearing when bilateral CIs are not available. Hearing aid use in the contralateral ear might be recommended for children after unilateral cochlear implantation to facilitate the development of auditory and speech skills.