Abstract Background Cochlear implantation is widely regarded as the most effective auditory augmentative rehabilitation for children with sensorineural hearing loss. However, post-implantation remediation programs need further refinement to better meet the evolving communication demands of these children in daily life. Methods This study aimed to develop an Arabic Socio-Cognitive Linguistic Rehabilitation Program (ASCLP) for pre-lingual, unilaterally implanted Egyptian children and evaluate its efficacy in improving social language use and overall language outcomes. A total of 100 pre-lingual, unilaterally implanted children were randomly assigned to two groups: Group A, which received the ASCLP, and Group B, which received a conventional therapeutic program. Assessments using the Preschool Language Scale, 4th edition (Arabic version), and the Egyptian Arabic Pragmatics Language Test (EAPLT) were conducted before and after the program. Both groups were further subdivided by age: Group 1 (4–6 years) and Group 2 (6–8 years). Results The data revealed that younger and older cochlear-implanted children who participated in the rehabilitation program significantly improved their linguistic competencies. Overall linguistic competence was positively correlated with initial pragmatic language scores, particularly in manner and pragmatic functions. Receptive language skills were specifically linked to the age at early implantation, while expressive language abilities significantly correlated with pragmatic factors. Conclusion All groups in the ASCLP showed significant improvements, regardless of implantation age or therapy start. Higher initial pragmatic scores and earlier implantation ages were key for better outcomes.

The study investigates the emotion perception abilities of Mandarin-speaking preschool children with cochlear implants (CI) compared with their normal-hearing peers. It examines their proficiency across three sensory modalities: auditory-only, visual-only, and audiovisual. The objective is to understand the role of these modalities in aiding emotional recognition for CI users. The research involved 40 preschool children aged 3 to 6 years, divided evenly into normal-hearing and CI groups. Using a controlled experimental setup, the children were evaluated on their ability to recognize basic emotions (happiness, anger, sadness, surprise) through auditory, visual, and combined cues. The findings revealed that CI children face considerable challenges in perceiving emotions through auditory cues alone, while their performance significantly improved when visual information was incorporated. This underscores the critical compensatory role that visual cues play in aiding emotional perception for CI users. The study highlights the importance of multisensory approaches in education and therapy for children with CIs. The benefits of visual and audiovisual integration suggest potential strategies to enhance emotional and social communication skills in this population. Future research should address the limitations, such as sample size and diversity, to further explore cross-modal emotion perception in cochlear-implanted children.

Abstract Background Among all sensory deficiencies, hearing impairment is thought to be the most common. Communication in hearing-impaired persons depends on the amount of residual hearing, type of deafness, language skills, age of onset of hearing difficulty, speech-reading skills and educational background (J Speech Lang Hear Res 65:3539–3547, 2022). The objective of this work was to compare the language and speech acquisition and perception in children with bimodal fitting and those with unilateral cochlear implantation. This study was carried out on 30 patients with pre-lingual hearing impairment who underwent unilateral cochlear implantation surgery—15 with unilateral cochlear implant and 15 with bimodal fitting—to evaluate the outcome after language and speech therapy with bimodal fitting and unilateral cochlear implant CI. Complete pre-operative and post-operative phoniatric evaluation was done 6 months after finishing programming of the cochlear implant device with intensive language and speech therapy for 12 months through applying the Modified Preschool Language Scale (PLS4) (Ain Shams Med J 14:10–18, 2011) and Articulation Test (Kotby et al., Standardization of an articulation test, 1986) and The Auditory Skills Checklist (ASC) (Ann Otol Rhinol Laryngol 116:812–818, 2007). Results The results suggested that the bimodal fitting improved total language age over the unilateral cochlear implantation as there is a statistically significant difference between mean of total language age in bimodal group (28 ± 6 months) than mean of total language age in bimodal group (34.47 ± 6.34 months) as ( t = − 2.24, p = 0.006). As regards receptive language age there was a highly statistically significant difference between mean of receptive language age in unilateral group (29.87 ± 7.8 months) versus mean of receptive language age in bimodal group (37.6 ± 6.3 months) as ( t = − 2.9, p = 0.006). Conclusion Bimodal stimulation demonstrated superior language outcomes compared with unilateral cochlear implantation in children with pre-lingual hearing loss. Significant improvements were seen in both expressive and receptive language domains following 12 months of treatment, and articulatory results were similar across groups. In order to maximize early language development in children with aidable residual hearing, our results recommend the use of bimodal fitting.

The Role of Combined Rehabilitation (Linguistic, Auditory and PA) in Promoting Literacy among Cochlear-Implanted Children

Backround Simultaneous bilateral cochlear implantation in children offers auditory and developmental advantages but can be limited by longer operative times and increased intraoperative risks. Aims and Objectives To describe and evaluate the safety and efficiency a modified surgical technique for simultaneous bilateral cochlear implantation in children. Materials and Methods This prospective study included 27 pediatric patients (<4 years) who underwent simultaneous bilateral implantation at a tertiary referral center. All surgeries were performed using a modified subperiosteal pocket technique specifically designed to shorten operative duration and minimize intraoperative risks. Surgical times, perioperative complications, and postoperative outcomes were recorded and compared with data reported in the literature. Results The mean bilateral surgical time was 79.2 ± 18.0 min, and the mean total operative time was 106.2 ± 19.3 min and substantially shorter than previously reported series. No major or minor complications were observed. Importantly, no cases of internal receiver–stimulator migration occurred. The technique allowed safe use of monopolar cautery before device placement in the contralateral ear. Conclusion and Significance The modified technique significantly reduced operative duration while avoiding complications. This method may provide a safe and efficient alternative for simultaneous bilateral cochlear implantation in pediatric patients.

Parental attitudes play a decisive role in post-implant rehabilitation engagement and long-term outcomes following pediatric cochlear implantation. The present study examined parental attitudes toward cochlear implantation among families of children with hearing loss residing in Mumbai and Nashik city of Maharashtra. A cross-sectional descriptive survey was conducted with 60 parents using a 20-item attitude scale assessing emotional acceptance, perceived benefits, rehabilitation commitment, and expectations from implantation. Descriptive and inferential statistical analyses were employed. Findings revealed that 66% of parents demonstrated a positive attitude toward cochlear implantation (M = 73.22, SD = 12.15). Domain-wise analysis indicated high emotional acceptance and strong perceived benefits, while comparatively moderate scores were observed for rehabilitation commitment and expectations. A significant regional difference was found, with parents from Mumbai reporting higher attitude scores than those from Nasik (t = 2.41, p<.05). The results underscore the importance of sustained counseling, realistic expectation-setting, and parent-centered educational interventions within cochlear implant programs, particularly in urban contexts.

While cochlear implantation (CI) is increasingly offered to children with cochlear nerve deficiency (CND), long-term outcomes and their predictors remain understudied. We evaluated 5-year auditory-speech performance and identified factors influencing outcomes. A retrospective review of the UKM Cochlear Implant Program (2007-2024) included 12 children with CND (CI aged 14-52 months). Primary outcomes measured were unaided/aided hearing thresholds, Categories of Auditory Performance II (CAP-II), Speech Intelligibility Rating (SIR) scores preoperatively and at 1/3/5 years post-CI. 11/12 children achieved CAP-II ≥ 5 (understanding phrases without lipreading); 7/12 attained SIR ≥ 3 (intelligible speech with lipreading) 5 years post-CI. Earlier implantation correlated with better hearing thresholds (p < 0.05). Higher baseline CAP-II/SIR scores predicted superior outcomes (p < 0.05). Visible cochlear nerves (vs. absent) were associated with higher 5-year CAP-II/SIR scores (p < 0.05). CI provides significant long-term benefits for children with CND, with outcomes influenced by age at implantation, preoperative function, and nerve visibility. These factors should guide candidacy and parental counselling, reinforcing CI's viability even in radiologically severe CND.

This study aimed to report a 10-year single-centre experience of cochlear implantation in children with CHARGE syndrome (manifests as coloboma, heart defects, atresia of the choanae, growth retardation and genital and ear anomalies) and evaluate surgical strategies and outcomes. Children with CHARGE syndrome who underwent cochlear implantation between 2014 and 2024 were retrospectively reviewed. Patient characteristics and post-operative auditory outcomes were analysed. Six patients (nine ears) were included. Most had airway anomalies, one-third required post-operative intensive care. Temporal bone malformations were present in 78 per cent of ears. Standard posterior tympanotomy was feasible in one-third; the remainder required transcanal or combined approaches. Full-electrode insertion was achieved in all ears. Median follow-up was 3.4 years; aided thresholds ranged 25 to 50 dB hearing level. Three patients developed reliable open-set speech perception, two achieved closed-set recognition and one demonstrated environmental sound awareness. Cochlear implantation provides meaningful auditory benefit in selected children with CHARGE syndrome. Pre-operative cochlear nerve imaging, flexible surgical planning and coordinated peri-operative airway management are essential.

Rating scales as predictors of speech perception in paediatric cochlear implant users.

To determine long-term audiological and subjective outcomes of cochlear implantation in children with congenital single-sided deafness (SSD), with emphasis on factors potentially influencing the degree of benefit. Retrospective single-center study. Tertiary referral center. Twenty congenitally deaf children with a mean age at implantation of 2.6 (±1.7) years and a mean cochlear implant (CI) experience of 6.8 (±3.2) years were included. Unilateral cochlear implantation. Assessment of speech understanding in quiet (Freiburger/Göttinger/Mainzer tests) and in noise (OLSA/OLKiSA), sound localization ability (RMS, MAE), subjective assessments by parents and children adapted to the developmental age (SSQ, E-HAK, Bochum questionnaires), and CI usage time. Significant improvements were observed in speech in noise with speech from the implanted and noise from the normal hearing side (SNR 1.08dB without vs. -1.67dB with CI, P =0.0021), in sound localization measured by RMS (69.76 degrees without vs. 52.38 degrees with CI, P =0.0040), and in the subjective assessment using the SSQ ( P <0.005) and the E-HAK ( P =0.018). No clear correlation was found between the subjective rating by parents or children and the objective benefits with the implant. There was considerable interindividual variability in outcome, which could not be explained solely by age at implantation, duration of CI usage, or CI experience. Although the CI is predominantly rated positively by parents and children, a thorough counseling regarding the anticipated benefits is required. Multicenter studies with well-documented data on potential influencing factors will provide greater clarity in the future.

ObjectiveThe objective of this study was to evaluate hearing and language outcomes in children with Waardenburg syndrome (WS) who underwent cochlear implantation (CI) at a single center in Japan.MethodsA retrospective review was performed on 12 children with WS who received CI between 1995 and 2020. Preoperative and postoperative auditory thresholds, speech recognition and language comprehension scores, and school placement were analyzed. Outcomes were compared according to the timing of intervention and the presence of cochlear malformations.ResultsThe mean age at CI was 2.5 years. Early intervention was correlated with higher 67S and CI-2004 word/sentence scores. Children without cochlear malformations or delayed treatment achieved mean speech recognition scores exceeding 80%. All participants advanced to regular junior high school classes.ConclusionEarly CI in children with WS contributes to substantial improvements in hearing, language comprehension, and educational integration.

Background/Objectives: Cochlear implantation (CI) has been shown to be effective in children with inner ear malformations (IEMs). However, outcomes vary with malformation type and anatomical complexity. Advances in radiological classification may improve the understanding of such variability to better guide patient counseling. We aimed to assess one-year post-implant auditory outcomes in children with IEMs using radiology-based classifications, and to explore genetic and perinatal predictors. We also propose a preliminary severity score derived from the INCAV system. Methods: Out of 303 pediatric CI recipients assessed at a tertiary center, we retrospectively analyzed 41 children (82 ears) diagnosed with IEMs. Malformations were categorized with the Sennaroğlu system and re-coded using INCAV, from which a severity score was derived. Postoperative outcomes were assessed in 56 implanted ears, including pure-tone average (PTA), word recognition score (WRS), and post-surgical complications. Statistical analyses included Spearman’s correlation, linear regression, and exploratory discriminant MANOVA. Results: The most frequent malformation was enlarged vestibular aqueduct (33%), followed by incomplete partition type II (22%). CI was performed in 56 malformed ears with a complication rate of 10.7%. PTA and WRS correlated with the INCAV-derived severity score, with higher severity linked to poorer thresholds and lower WRS. Linear regression showed severity explained ~20% of PTA variance, with outcomes more frequently impaired in ears with scores > 3. Exploratory analysis revealed inter-subject variability, with partial separation of mild versus moderate/severe groups mainly driven by PTA and WRS. Conclusions: CI in pediatric IEMs is safe and consistently improves hearing thresholds. PTA was the most robust predictor of performance, while the INCAV-derived severity score, though exploratory, may provide additional value for anatomical stratification, prognostic counseling, and rehabilitation planning.

Cochlear implantation (CI) is the state-of-the-art treatment option for sensorineural hearing loss condition including patients with congenital inner ear malformations. Recently our centre started treating children with CI who were diagnosed with inner ear malformations. Objectives of this retrospective study are to create three-dimensional (3D) model of malformed inner ears, identification of cochlear nerve bundle from pre-operative images, visualize electrode placement inside the cochlear portion from post-operative images, and evaluate hearing benefits post-operatively received from CI. Slicer software was used to 3D segment the inner ear and the electrode from the pre-, and post of CT scans. Using the same software, cross-section of internal auditory canal (IAC) was navigated to visualize the presence or absence of cochlear nerve. Speech intelligibility rating (SIR) and pure tone average (PTA) thresholds were evaluated for the benefits received from CI. Our database showed a total of 12 children radiologically diagnosed with inner ear malformation and out of which 19 ears were treated with MED-EL CI devices. Enlarged vestibular aqueduct (EVA, incomplete partition (IP) types I, and II, cochlear hypoplasia (CH), cochlear aperture stenosis, common cavity (CA) were the different malformation types found in this cohort. Intra-operative gusher was observed in EVA and IP type II malformation types. Higher SIR scores and lower PTA thresholds were seen for less severe malformation types and vice-versa. Severity of malformation have a negative effect on the hearing outcomes with CI. MRI is an important tool in the identification of cochlear nerve bundle in subjects diagnosed with malformed inner ear anatomies.

The relationship between intraoperative and postoperative Neural Response Thresholds (NRT) and postoperative auditory perception and speech intelligibility in cochlear implanted patients.

Is to compare two tomographic measurements that can be used to predict the visibility of the round window: the angle formed by the junction of the line that goes from the round window Membrane Center Point (MJR) to the Facial Nerve surface (FN) with the Coronal Plane (CP) traced over this surface (RWM-FN-CP Angle) and the vertical distance between the midpoint of the RWM and this Coronal Plane (RWM-CP Vertical Distance); in adults and children, in order to verify if there are significant differences between the groups, which would justify the greater surgical difficulty caused by the lower visibility of the RW in children. In this retrospective study, the RWM-FN-CP angle and the RWM-CP vertical distance were measured in Computerized Tomography Scans (CT) of patients who underwent CI surgeries. 32 individuals who underwent CT in the period 2015-2018, 16 adults aged 27-73 years, and 16 children, with a mean age of 3.4 (±2.7) years were evaluated. The mean of the RWM-FN-CP angle in children was significantly lower, than the mean in adults. The mean RWM-CP vertical distance in children was significantly lower than the mean in adults (p = 0.0001). In children, the RWM-FN-CP angle is more acute, and the measured MJR-PC vertical distance is smaller when compared to adults. The anatomical differences observed in the tomographies justify the lower visibility of the RW during the surgical act of cochlear implantation in children.

To assess the hearing benefits of cochlear implantation and its daily usage in children with single-sided deafness (SSD). We compared the results of children with congenital/perinatal deafness and those with acquired deafness and evaluated the impact of age at implantation on performance. There were 99 children with SSD in the study, all of whom had more than 14 months of experience with a cochlear implant (CI); 58 had congenital/perinatal SSD, while 41 had acquired SSD. The hearing benefit of the CI was measured with age-appropriate speech discrimination in noise tests and localization tests. Daily processor usage was obtained from parent interviews and datalogging. For speech discrimination in noise, children with congenital/perinatal SSD demonstrated advantages of binaural redundancy and head shadow, while children with acquired SSD additionally benefited from the binaural squelch effect. Significant improvements in sound localization following a cochlear implantation were observed in both groups, with the benefit being slightly greater in the acquired SSD group. The mean daily processor usage was 10.3 h/day as reported by parents, compared with 7.5 h/day as recorded by datalogging, with no significant difference between the groups. There was no significant correlation between age at implantation and the benefits of head shadow, redundancy, and squelch, or in improvements in localization or daily processor usage. Cochlear implantation is an effective treatment for children with both congenital and acquired SSD.

Current State of Knowledge Regarding Cochlear Implantation in Children With Single-Sided Deafness.

Impaired hearing in children such as hearing loss and deafness is crucial medical and social topic. Auditory function deterioration in a child can lead to mental and speech development delays. Preventive measures and timely diagnosis of defective hearing are extremely important to avoid any difficulties with social adaptation. This article covers key methods for diagnosis deafness and hearing loss in children, considers treatment of children with acute and chronic sensorineural hearing loss, and discusses issues of deafness surgical treatment via cochlear implantation in children. Cochlear implantation proved to be the most effective method for rehabilitation and social adaptation of children with significant hearing loss or deafness. Children with grade IV hearing loss and deafness can fully develop and integrate into society after successful cochlear implantation surgery and high-quality postoperative rehabilitation. This article contains basic data that pediatricians and otorhinolaryngologists should know when working with children with severe sensorineural hearing loss. Cochlear implantation is the advanced and effective technique helping children suffering from grade IV sensorineural hearing loss and deafness.

Our aim is to evaluate the safety, efficacy and feasibility of outpatient cochlear implantation in children. Multicentric retrospective study analyzing 681 children who underwent cochlear implantation from October 2016 to May 2024. Ear, Nose, and Throat departments of Mohamed VI Foundation of Sciences and Health, Morocco. In this report, we examined the protocol used, anesthetic and surgical techniques, postoperative data and success rate of ambulatory cochlear implant surgery. Data collection included demographic information, surgical and postoperative results. A total of 721 cochlear implants were performed between October 2016 and May 2024, including 681 in children and 40 in adults. Of these children, 674 were included, of whom 661 (98%) benefited from outpatient surgery and 13 (2%) required overnight hospitalization. Conversion to overnight hospitalization was required for 8 patients who suffered post-operative vomiting, requiring medical management and intravenous infusion, and for 5 patients who suffered post-operative dizziness, requiring in-hospital monitoring. The median age of our patients was 3.7 ± 2.4, with a predominance of males (sex ratio = 1.46) and patients coming from all regions of Morocco. Severe to profound bilateral hearing loss was noted, and in the majority of cases, imaging was normal. Surgeries were performed without major complications, but short-term complications did occur, such as vomiting in 8 patients and vertigo in 5. The satisfaction rate was 100%, the success rate 98% and the failure rate 2%, with no readmissions. Our results demonstrate the efficacy and safety of outpatient cochlear implant protocol for pediatric population in our setting.

Trends in the candidacy for cochlear implantation in children and young people