Auditory Performance In Children Research Articles

The use of a computer-based program focused on the syllabic method to support early literacy in children with cochlear implants

BackgroundChildren with cochlear implants (CIs) often lag behind children with normal hearing (NH) in early literacy skills. Furthermore, the development of language skills associated with their emergent literacy skills seems to depend on good auditory access. Supporting language acquisition and early literacy in children with CIs may prevent difficulties in primary school. The use of technology may facilitate auditory and speech recovery in children with CIs, but evidence on computer-based early literacy programs is limited. ObjectiveThis study investigates (a) the effects of a computer-based program focusing on the syllabic method on the literacy skills of children with CIs (CIs group), comparing them with the literacy skills of a group of age-matched NH (normal hearing) peers (NHs group); (b) the associations between language and early literacy skills in the NHs group and between language, auditory and early literacy skills in the CIs group. MethodNine prelingually deaf children with CIs (M = 61.11, SD = 6.90) with severe to profound sensorineural hearing loss and nine age-matched NH children participated in the program. Categories of Auditory Performance (CAP) as measures of children's auditory skills were collected. All participants were tested on phonological, morphosyntax (grammatical comprehension and repetition), and early literacy skills (syllable blending and segmentation, syllable and word reading) (T1). Next, all children participated in the computer-based program for 12 weeks. After the program was completed (T2), only early literacy tests were administered to the children. ResultsAlthough, on average, both groups obtained higher scores in all literacy tasks at T2, the CIs group scored lower than the NHs group. In the CIs group, at T2 we found significant improvements in syllable segmentation (p = 0.042) and word reading (p = 0.035). In the NHs group, at T2 we found significant improvements in syllable segmentation (p = 0.034), syllable blending (p = 0.022), syllable reading (p = 0.008), and word reading (p = 0.009). We also found significant associations in both groups between measures of morphosyntax at T1 and measures of early literacy at T2. In addition, for the CIs group, we found significant associations between children's auditory performance at T1 and measures of morphosyntax at T1 and early literacy at T2. Conclusiona computer-based program focused on the syllabic method could support children with CIs in acquiring emergent literacy abilities. The auditory performance of children with CIs seems to influence their morphosyntax and later early literacy skills.

Auditory performance and language skills in children with auditory brainstem implants and cochlear implants

PurposeThis study aims to evaluate school-age language skills and auditory performance in different listening situations in children with cochlear implants and auditory brainstem implants.MethodThe study included 60 children between the ages of 5 and 9 years with cochlear implants (CI) and auditory brainstem implants (ABI). The volunteer children were divided into two groups: bimodal CI-ABI and bilateral CI users. Test of Language Development: Primary (TOLD-P:4), which assesses components of language such as phonology, morphology, syntax and semantics, was used to evaluate school-age language skills. Children’s Auditory Performance Scale (CHAPS) was used to measure their listening performance in quiet, noisy, multi-stimulus environments and their auditory attention and memory skills in daily life. The correlations between language and auditory performance were analyzed and compared between the two groups.ResultsChildren with ABI showed poorer performance in school-age language skills and auditory performance in different listening environments (p < 0.05). Significant correlations were between school-age language skills and auditory performance (p < 0.05).ConclusionImproved auditory performance is crucial for the development of school-age language skills. To improve auditory performance in children with ABI in different listening environments, assistive listening devices, acoustic environmental arrangements, informative activities, etc., should be used.

Analysis of speech development and auditory performance in children after cochlear implantation

Background: Hearing loss is a frequent congenital condition. If not treated promptly, the disease’s progression may endanger newborns and young children’s proper growth and development. Cochlear implants (CIs) are the only viable treatment for severe or extremely severe sensorineural hearing loss. Aims and Objectives: This study aimed to see how auditory performance and speech development changed after cochlear implantation in children born deaf and whether there is a link between sociodemographic parameters and the outcome. Materials and Methods: Analyze the improvement of speech and auditory performance in congenitally deaf children aged 1–6 years who underwent CI surgery at Government Rajaji Hospital, Madurai Medical College, Madurai, from January 2016 to June 2018. The data acquired in this study were statistically analyzed to provide detailed findings. Results: Among the study population with age distribution, 18 (26.87%) were in 3 years, followed by 17 (25.37%) in 4 years and least 1 (1.49%) were in 1 year. Sex distribution – 42 (62.69%) were male, and 25 (37.31%) were female children. Progress in hearing and speech was observed, which was evident from the 2-year assessment of categories of auditory performance (CAP) (2.7–4.4) and speech intelligibility rating (SIR) scores (1.04–3.67), increasing every 3 months (P&lt;0.001). Scores of children in age group 2 (CAP2 and SIR 3.3) were the highest, yet differed significantly among age groups, implying that the earlier the CI implantation age, the better their language outcomes were. Conclusion: The importance of age at implantation and the role of family members in effective audioverbal therapy and aural stimulation at home were highlighted in this study.

Cochlear Implantation in Children with Meningitis: A Multicenter Study on Auditory Performance and Speech Production Outcomes.

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.

Parental Reports on the Auditory Performance of Children With Normal Hearing and Children With Hearing Loss via the Hebrew Adaptation of the Parents' Evaluation of Aural/Oral Performance of Children Scale

The aims of this study were to adapt the Parents' Evaluation of Aural/Oral Performance of Children (PEACH) scale into Hebrew, to explore the auditory performance of children with normal hearing (NH) or hearing loss (HL), to examine changes with age, and to investigate the effect of descriptive variables on the performance of children with HL. The PEACH scale was adapted into Hebrew using the "back-translation" method. The study included 260 parents of children with NH and 32 parents of children with HL. Children were between 9 and 72 months old. Inclusion criteria for children with HL are as follows: bilateral, congenital, or moderate-severe to profound sensorineural HL using bilateral sensory devices. Parents evaluated their child's auditory performance in real-life situations using the PEACH scale. A Cronbach's alpha analysis (N = 292) scored medium-to-high values: α = .86, α = .74, and α = .78 for the entire scale and in quiet and noisy situations, respectively. Noise affected the auditory performance of both groups, with the effect being more pronounced than the hearing status, although it was more prominent in children with HL. The auditory performance of children with NH improved rapidly up to 18 months of age and then progressed more gradually to reach a plateau of 85% at 36 months of age. Chronological age contributed to auditory performance over the entire scale and in quiet situations for children with NH, whereas maternal education contributed to auditory performance in quiet situations for children with HL. The Hebrew version of the PEACH scale provides a useful tool for evaluating the auditory performance of young children, although it is influenced by cultural differences beyond 36 months of age.

Functional Outcomes of Cochlear Implantation in Children with Bilateral Cochlear Nerve Aplasia.

Background and Objectives: Many otologists face a dilemma in the decision-making process of surgical management of patients with cochlear nerve (CN) aplasia. The goal of this study is to provide fresh evidence on cochlear implantation (CI) results in patients with CN aplasia. Materials and Methods: We scrutinized functional outcomes in 37 ears of 21 children with bilateral CN aplasia who underwent unilateral or bilateral CI based on cross-sectional and longitudinal assessments. Results: The Categories of Auditory Performance (CAP) scores gradually improved throughout the 3-year follow-up; however, variable outcomes existed between individuals. Specifically, 90% of recipients with a 1-year postoperative CAP score ≤1 could not achieve a CAP score over 1 even at 3-year postoperative evaluation, while the recipients with a 1-year postoperative CAP score >1 had improved auditory performance, and 72.7% of them were able to achieve a CAP score of 4 or higher. Meanwhile, intraoperative electrically evoked compound action potential was not correlated with postoperative CAP score. Conclusions: Our results further refine previous studies on the clinical feasibility of CI as the first treatment modality to elicit favorable auditory performance in children with CN aplasia. However, special attention should be paid to pediatric patients with an early postoperative CAP score ≤1 for identification of unsuccessful cochlear implants and switching to auditory brainstem implants.

Effect of Age at Cochlear Implantation in Educational Placement and Peer Relationships.

The education and school life of children who have undergone cochlear implantation (CI) is very important and should be monitored continuously. This study assessed auditory performance in children with cochlear implants over time, along with educational placement and peer relationship, and compared the results based on the age at CI and the presence of additional disabilities. In total, 77 children who had undergone CI at the Hearing Center in Ajou University Hospital at less than 10 years old and who were presently attending school or had already graduated from school within 3 years were enrolled in this study. All children had congenital bilateral severe or profound hearing loss at the diagnosis. They were classified based on the age at which they received CI: the "early-implanted group," younger than 3.5 years (n = 38), and the "late-implanted group," between 3.5 and 10 years old (n = 39). The early-implanted group had worse short-term auditory performance than the late group, but after 2 years of the implant use, auditory performance was similar in both groups. The early and late groups did not differ significantly in terms of the proportions of children who were enrolled in a regular school (94.7% and 89.7%, respectively). However, the early-implanted group had a larger proportion of children who were enrolled in a regular school without additional needs (73.0%), compared with the late group (48.6%) (p = .034). Children with multiple disabilities showed poorer performance (word score of 57.7% and sentence score of 44.7%) than children with hearing disability only (91.8% and 87.2%, respectively), which affected full-time enrollment in regular schools. With regard to peer relationships, 19.0% of children in the early-implanted group required close observation and assistance, and 9.5% even required help and counseling. Children who underwent early CI had a high tendency toward social restraint, apathy, and over-commitment. No correlations were observed between audiological factors and the aspects of peer relationships assessed in this study. Early CI and the absence of other disabilities were the two main factors that increased the likelihood of full-time enrollment in mainstream classes at regular schools. Nevertheless, many children who underwent earlier CI still encountered difficulties in peer relationships.

Auditory Performance in Early Implanted Children with Cochleovestibular Malformation and Cochlear Nerve Deficiency.

This study aimed to report the auditory performance in children with cochleovestibular malformation (CVM)/cochlear nerve deficiency (CND) who were implanted early at the Universiti Kebangsaan Malaysia Medical Centre, using Categorical Auditory Performance (CAP)-II score and Speech Intelligibility Rating (SIR) scales, and to compare the outcome of their matched counterparts. A total of 14 children with CVM/CND with unilateral cochlear implant (CI) implanted before the age of 4 years old were matched and compared with 14 children with normal inner ear structures. Their improvement in auditory performance was evaluated twice using CAP-II score and SIR scales at 6-month intervals, with the baseline evaluation done at least 6 months after implantation. The average age of implantation was 31±8 and 33±7 months for the control group and the case (CVM/CND) group, respectively. Overall, there were no significant differences in outcome when comparing the entire cohort of case subjects and their matched control subjects in this study. However, the improvement in CAP-II scores and SIR scales among the case subjects in between the first and second evaluations was statistically significant (p=0.040 and p=0.034, respectively). With longer duration of CI usage, children with CVM/CND showed significant speech perception outcome evident by their SIR scales (p=0.011). Children with radiographically malformed inner ear structures who were implanted before the age of 4 years have comparable performance to their matched counterparts, evident by their similar improvement of CAP-II scores and SIR scales over time. Hence, this group of children benefited from cochlear implantation.

Auditory Performance in Late Implanted Congenitally Hearing Impaired Children: A Reality Check

The present study aimed at determining auditory performance in children with congenital hearing impairment who underwent cochlear implant surgery unilaterally at or after age of 5years. Study also aimed at studying association of factors such as chronological age (CA), implant age (IA), age at implantation (AAI), hearing age (HA), parental support, compliance to therapy, mode of therapy and parental satisfaction with auditory performance. It is a retrospective study. Files of 41 participants who fulfilled the inclusion criteria were reviewed for scores of Revised categories of auditory perception (CAP), Listening skills scale (LSS) and Speech intelligibility rating (SIR) along with other factors. Only 20 participants with complete data were included in the study. Researcher rated parental support and compliance to therapy while parental satisfaction was noted prospectively using a single yes-no type question. Participants showed improvement on CAP, LSS, SIR however they did not reach normal or near normal scores. CAP and LSS did not correlate with CA nor AAI or with IA. However CAP and LSS showed significant correlation with HA. SIR showed significant correlation with CA, AAI, IA and HA. Good auditory performance was associated with parental support and compliance to therapy but not with mode of therapy offered. 17 out of 20 parents were satisfied with outcomes of cochlear implant. Late implanted children showed improved auditory performance with implantation when they had previous hearing aid experience and parent support and compliance to therapy though they did not reach normal levels.

Performance with an Auditory Brainstem Implant and Contralateral Cochlear Implant in Pediatric Patients

Objective: To assess bimodal auditory performance in children with a cochlear implant (CI) and contralateral auditory brainstem implant (ABI). Methods: This is a retrospective case review performed at a tertiary referral center. Four patients with cochlear nerve deficiency initially underwent cochlear implantation but were not benefiting from their devices and underwent ABI in the contralateral ear. The main outcome measures included age-appropriate speech perception and production assessments. Results: Three subjects performed better on their auditory perception assessments using both of their devices than with either device alone. One subject had only preliminary outcomes, but subjectively performed best with both devices. Conclusions: We observed continued improvement in CI performance over time, even if no benefit was evident before the decision for ABI. This could suggest that ABI and CI have a synergistic effect, or it could simply be the adaptive ability of the developing brain to utilize the signals coming from these devices. There is preliminary evidence to support choosing the ear contralateral to the CI for an ABI in a pediatric patient with bilateral cochlear nerve deficiency.

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.

Visually Evoked Visual-Auditory Changes Associated with Auditory Performance in Children with Cochlear Implants.

Activation of the auditory cortex by visual stimuli has been reported in deaf children. In cochlear implant (CI) patients, a residual, more intense cortical activation in the frontotemporal areas in response to photo stimuli was found to be positively associated with poor auditory performance. Our study aimed to investigate the mechanism by which visual processing in CI users activates the auditory-associated cortex during the period after cochlear implantation as well as its relation to CI outcomes. Twenty prelingually deaf children with CI were recruited. Ten children were good CI performers (GCP) and ten were poor (PCP). Ten age- and sex- matched normal-hearing children were recruited as controls, and visual evoked potentials (VEPs) were recorded. The characteristics of the right frontotemporal N1 component were analyzed. In the prelingually deaf children, higher N1 amplitude was observed compared to normal controls. While the GCP group showed significant decreases in N1 amplitude, and source analysis showed the most significant decrease in brain activity was observed in the primary visual cortex (PVC), with a downward trend in the primary auditory cortex (PAC) activity, but these did not occur in the PCP group. Meanwhile, higher PVC activation (comparing to controls) before CI use (0M) and a significant decrease in source energy after CI use were found to be related to good CI outcomes. In the GCP group, source energy decreased in the visual-auditory cortex with CI use. However, no significant cerebral hemispheric dominance was found. We supposed that intra- or cross-modal reorganization and higher PVC activation in prelingually deaf children may reflect a stronger potential ability of cortical plasticity. Brain activity evolution appears to be related to CI auditory outcomes.

Correlating derived relational responding with linguistic and cognitive ability in children with Autism Spectrum Disorders

Many children with Autism Spectrum Disorders (ASD) show substantial deficits in linguistic and cognitive ability. When considered from the perspective of Relational Frame Theory (RFT), it is possible that these deficits are rooted in a deficiency in the capacity to derive relations. One key aim of the Training and Assessment of Relational Precursors and Abilities (TARPA) protocol is to assess derived relational responding. A number of previous studies have shown correlations between TARPA performance and linguistic ability in children with ASD. The current study has extended this work by (i) showing correlations between TARPA performance and cognitive as well as linguistic ability in a larger (n=35) sample of children with ASD; (ii) providing evidence of TARPA test–retest reliability; (iii) providing additional evidence indicating differences in visual and auditory performance in children with ASD.

A normative study of auditory development in Mandarin-speaking infants

The aim of this study is to investigate the development of auditory skills in Mandarin-speaking infants with normal hearing using IT-MAIS, set up normal comparison data for evaluating the auditory performance of children with hearing loss and provide a basis for establishing an appropriate hearing and speech rehabilitation program for them. A total of 183 infants with Mandarin-speaking patents participated in this investigation which was conducted in Beijing, China. 160 infants aged from 1 to 36 months were finally included, whose hearing were considered normal according to the history collection, high-risk registers for hearing loss and hearing screening using DPOAE. All infants were divided into 8 groups with 20 infants in each group by their ages. They were 1 month, 2-3 months, 4-6 months, 7-9 months, 10-12 months, 13-18 months, 19-24 months and 25-36 months group. The IT-MAIS/MAIS were administered to evaluate their development of auditory skills. All statistical analyses were executed using the MATLAB R2010a. The detection scores improved with age and reached ceiling at 19 months in infants with normal hearing, the regression function for prediction of scores from age was score = 0.26×ln(age) + 0.23 and prediction of age from score was age = e([score-0.23])/0.26, r(2) = 0.93. The recognition scores also increased with age and reached ceiling at 24 months in infants with normal hearing, the regression function for prediction of scores from age was score = 0.26×ln(age)-0.07 and prediction of age from score was age = e([score+0.07])/0.34, r(2) = 0.93. The overall scores which combine the above two aspects augmented with age and reached ceiling at 22 months. The regression function for prediction of scores from age was score = 0.3×ln(age)+0.09 and prediction of age from score was age = e([score-0.09])/0.3, r(2) = 0.95. Auditory skills showed a growth trend with age in infants with normal hearing. Scores of different auditory skills can be predicted according to their age. Age can also be predicted according to their scores of different auditory skills.

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Comparisons of Auditory Performance and Speech Intelligibility in Children With Cochlear Implants Placed Using Different Approaches

To demonstrate whether there are differences in the outcomes of children with cochlear implants using the techniques between mastoidectomy with posterior tympanotomy (MPTA) and suprameatal approach (SMA). A total of 44 congenitally deaf children who underwent cochlear implantation before the age of 5 years at the Sixth Hospital Affiliated to Shanghai Jiao tong University from January 2005 to March 2008 were included in this study. Children with severe mental retardation or with cochlear malformations were excluded. Each group had 22 patients; however, 4 patients in the SMA group and 5 in the MPTA group were not included in this study because the assessments for these patients were not available. All children were assessed before surgery and 6, 12, and 24 months after surgery with Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR). Each assessment was given by the child's speech therapist in the familiar environment of the child's home or school. At each interval, the CAP and SIR scores of each group were compared. For the both groups, CAP and SIR scores increased with the time of implant usage during the follow-up period after implantation. However, there were no significant differences in scores of CAP and SIR at the 4 time points between the SMA group and the MPTA group. Intelligible speech and auditory performance of children with cochlear implantation using the SMA were good. There were no differences between children implanted with the SMA technique versus the MPTA technique.

Auditory Brainstem Implants

The development of cochlear implantation has allowed the majority of patients deafened after the development of language to regain significant auditory benefit. In a subset of patients, however, loss of hearing results from destruction of the cochlear nerves, rendering cochlear implantation ineffective. The most common cause of bilateral destruction of the cochlear nerves is neurofibromatosis type 2 (NF2). The hallmark of this genetic disorder is the development of bilateral acoustic neuromas, the growth or removal of which causes deafness in most patients. Patients with NF2 may benefit from direct stimulation of the cochlear nucleus. We describe the development, use, and results of the auditory brainstem implant (ABI), which is typically implanted via craniotomy at the time of tumor removal. Most patients with the implant have good appreciation of environmental sounds, but obtain more modest benefit with regard to speech perception. The majority of patients make use of the implant to facilitate lip reading; some can, to varying degrees, comprehend speech directly. We discuss future directions in central implants for hearing, including the penetrating ABI, the use of ABI in nontumor patients, and the auditory midbrain implant.

Clinical outcomes of scala vestibuli cochlear implantation in children with partial labyrinthine ossification

Conclusion. Cochlear implantation via the scala vestibuli is a viable approach in those with ossification in the scala tympani. With extended cochlear implant experience, there is no significant difference in the mapping parameters and auditory performance between those implanted via scala vestibuli and via scala tympani. Objectives. To assess the clinical outcomes of cochlear implantation via scala vestibuli. Patients and methods. In a cohort follow-up study, 11 prelingually deafened children who received cochlear implantation between age 3 and 10 years through the scala vestibuli served as participants. The mapping parameters (i.e. comfortable level (C), threshold level (T), dynamic range) and auditory performance of each participant were evaluated following initial cochlear implant stimulation, then at 3 month intervals for 2 years, then semi-annually. The follow-up period lasted for 9 years 9 months on average, with a minimum of 8 years 3 months. Results. The clinical results of the mapping parameters and auditory performance of children implanted via the scala vestibuli were comparative to those who were implanted via the scala tympani. No balance problem was reported by any of these patients. One child exhibited residual low frequency hearing after implantation.

Nonverbal Cognitive Abilities and Auditory Performance in Children Fitted With Auditory Brainstem Implants: Preliminary Report

Auditory brainstem implants (ABIs) can provide excellent open set speech recognition in adults without auditory tumors. These favorable results prompted us to extend ABI indications to children with profound hearing loss (HL) who are not candidates for a cochlear implant (CI). This article reports on the auditory performance and cognitive development measured in children with ABIs. This study quantifies the development of auditory perceptual and nonverbal cognitive abilities of children with profound HL undergoing ABI. From 2000 to 2006, 17 children aged 14 months to 16 years received an ABI for different tumor and nontumor diseases in our department in Verona, and nine children were operated in other countries. Six of the children had been previously fitted elsewhere with a CI with no auditory results. Fourteen children had multiple associated psychomotor handicaps. The retrosigmoid approach was used in all children. Intraoperative and postoperative electrically evoked auditory brainstem responses were performed in all children. Perceptual auditory abilities were evaluated with the Evaluation of Auditory Responses to Speech battery and the Category of Auditory Performance test. Cognitive evaluation was performed on 10 children using the Leiter International Performance Scale-Revised test. All children consistently use their devices for 8 h/d at average and have environmental sound awareness and utterance of words and simple sentences. Their category of auditory performance test scores increased significantly with ABI use. Scores on two of the four subtests considered for cognitive evaluation in this study increased significantly (P < .05) during the first year of ABI use. Postimplant cognitive outcomes were positively related to the auditory results. The present investigation clearly indicates that children who are not candidates for CI fitted with ABI obtain significant development of their hearing ability and a significant improvement in some cognitive parameters. The outcomes of the present study suggest that children with cochlear or cochlear nerve abnormalities with associated cognitive deficits should not be excluded from ABI implantation.

The Pakistan (Lahore) cochlear implant programme: issues relating to implantation in a developing country

The Pakistan cochlear implant programme was started in Lahore in August 2000. It was initially established with the technical support of the Manchester cochlear implant team. There are no government resources available for cochlear implantation in Pakistan and the cost of cochlear implantation is met by the candidates and their families. Up till December 2005, 52 individuals have been implanted. Forty-four (84.6 per cent) of these patients were children and eight (15.4 per cent) patients were adults. Congenital deafness (94 per cent) is the main aetiological factor in children. Seventy-six per cent of these children were born to blood related parents. All patients received a Med-El Combi 40+ device. The listening progress profile, the meaningful auditory integration scale and the meaningful use of speech scale were used to assess the auditory performance in children. Thirty-nine children achieved an average listening progress profile score of 37.7 after 12 months of implantation. The overall rate of major and minor complications was 11.5 per cent. Failure rate for the device itself has been 3.8 per cent. In addition to considering these preliminary outcomes and funding issues, the problems of setting up a cochlear implant programme in a developing country are discussed.