Cochlear Implantation In Deaf Children Research Articles

Cerebral cortex functional reorganization in preschool children with congenital sensorineural hearing loss: a resting-state fMRI study.

How cortical functional reorganization occurs after hearing loss in preschool children with congenital sensorineural hearing loss (CSNHL) is poorly understood. Therefore, we used resting-state functional MRI (rs-fMRI) to explore the characteristics of cortical reorganization in these patents. Sixty-three preschool children with CSNHL and 32 healthy controls (HCs) were recruited, and the Categories of Auditory Performance (CAP) scores were determined at the 6-month follow-up after cochlear implantation (CI). First, rs-fMRI data were preprocessed, and amplitude of low-frequency fluctuation (ALFF) and regional homogeneity (ReHo) were calculated. Second, whole-brain functional connectivity (FC) analysis was performed using bilateral primary auditory cortex as seed points. Finally, Spearman correlation analysis was performed between the differential ALFF, ReHo and FC values and the CAP score. ALFF analysis showed that preschool children with CSNHL had lower ALFF values in the bilateral prefrontal cortex and superior temporal gyrus than HCs, but higher ALFF values in the bilateral thalamus and calcarine gyrus. And correlation analysis showed that some abnormal brain regions were weak negatively correlated with CAP score (p < 0.05). The ReHo values in the bilateral superior temporal gyrus, part of the prefrontal cortex and left insular gyrus were lower, whereas ReHo values in the bilateral thalamus, right caudate nucleus and right precentral gyrus were higher, in children with CSNHL than HCs. However, there was no correlation between ReHo values and the CAP scores (p < 0.05). Using primary auditory cortex (PAC) as seed-based FC further analysis revealed enhanced FC in the visual cortex, proprioceptive cortex and motor cortex. And there were weak negative correlations between the FC values in the bilateral superior temporal gyrus, occipital lobe, left postcentral gyrus and right thalamus were weakly negatively correlated and the CAP score (p < 0.05). After auditory deprivation in preschool children with CSNHL, the local functions of auditory cortex, visual cortex, prefrontal cortex and somatic motor cortex are changed, and the prefrontal cortex plays a regulatory role in this process. There is functional reorganization or compensation between children's hearing and these areas, which may not be conducive to auditory language recovery after CI in deaf children.

Cochlear Implantation in Deaf Children with Coexisting Otitis Media with Effusion: A comparative study.

Cochlear implantation (CI) is a definitive treatment for profound hearing loss in children and adults. Operating on an infected ear is considered a challenge. Hence, CI in the presence of otitis media with effusion (OME) prior to CI surgery has sparked a debate among neurotologists: treat the OME first or go ahead with surgical intervention. This study was conducted to determine whether CI in patients with OME at the time of the surgery has any influence on the surgery procedure, post-operative complications and surgical outcome. A retrospective descriptive analysis of data collected from records of patients who underwent CI surgery in Al Nahdha Hospital, Muscat, Oman, from 2000 to 2018 was conducted. The targeted age group was six months to 14 years old, excluding all adults and patients whose operations were done outside the chosen institution. Out of 369 children, 175 had OME preceding surgery compared to 194 who did not have OME. Intraoperative oedematous hypertrophied middle ear mucosa was observed only in patients with OME (n = 18; P <0.050). Moreover, among the patients with OME, mild intraoperative bleeding occurred in six cases compared to only one case in the non-OME group (P <0.050). Overall, no significant difference was observed in postoperative surgical complications between the two groups (P >0.050). The presence of OME is associated with intraoperative technical difficulties, such as impaired visualisation and bleeding. However, OME is not determinative in performing CI in terms of postoperative complications and outcome. Therefore, there is no need to delay CI until the OME resolves.

Cochlear Implants for Deaf Children With Early Developmental Impairment.

Infants with profound hearing loss are typically considered for cochlear implantation. Many insurance providers deny implantation to children with developmental impairments because they have limited potential to acquire verbal communication. We took advantage of differing insurance coverage restrictions to compare outcomes after cochlear implantation or continued hearing aid use. Young children with deafness were identified prospectively from 2 different states, Texas and California, and followed longitudinally for an average of 2 years. Children in cohort 1 (n = 138) had normal cognition and adaptive behavior and underwent cochlear implantation. Children in cohorts 2 (n = 37) and 3 (n = 29) had low cognition and low adaptive behavior. Those in cohort 2 underwent cochlear implantation, whereas those in cohort 3 were treated with hearing aids. Cohorts did not substantially differ in demographic characteristics. Using cohort 2 as the reference, children in cohort 1 showed more rapid gains in cognitive, adaptive function, language, and auditory skills (estimated coefficients, 0.166 to 0.403; P ≤ .001), whereas children in cohort 3 showed slower gains (-0.119 to -0.243; P ≤ .04). Children in cohort 3 also had greater increases in stress within the parent-child system (1.328; P = .02), whereas cohorts 1 and 2 were not different. Cochlear implantation benefits children with deafness and developmental delays. This finding has health policy implications not only for private insurers but also for large, statewide, publicly administered programs. Cognitive and adaptive skills should not be used as a "litmus test" for pediatric cochlear implantation.

The Effectiveness of Cochlear Implantation for Children of Hereditary Deafness: A Multicenter Retrospective Study.

Aim To study the effectiveness of cochlear implantation in deaf children with gene mutation. Method 420 children from three medical centers with cochlear implants were selected. Before wearing the cochlear implant and 6 months after wearing the cochlear implant, the children's rehabilitation efficacy was evaluated through categories of auditory performance (CAP) and speech intelligibility rating (SIR). The SSF-MCDI and MUSS before and after the treatment were also compared. Results The CAP and SIR scores of the children after the intervention were higher than those before the intervention (P < 0.05). Univariate analysis found that the age of cochlear implantation, parents' education level, and monthly family income were all influencing factors of the CAP score of children with prelingual cochlear implantation (P < 0.05). Multivariate logistic regression analysis shows that the age of cochlear implantation <5 years, parents' education level, and monthly household income are all independent risks of CAP scores in children with prelingual deaf cochlear implantation. Univariate analysis found that the age of cochlear implantation, parents' education level, and monthly household income are all based on the SIR scores of children with prelingual cochlear implantation. Multivariate logistic regression analysis can be obtained: the age of cochlear implantation less than 5 years, the education level of parents, and the monthly family income are independent risk factors for SIR scores in children with prelingual deaf cochlear implantation (P < 0.05). Conclusion The rehabilitation effect of cochlear implants is significant, and the age of cochlear implantation, parents' education level, and monthly family income are all related factors that affect the rehabilitation effect.

Cognitive improvement after cochlear implantation in deaf children with associated disabilities.

To monitor functional auditory and non-verbal cognitive skills in children with cochlear implants who had associated disabilities over a 24-month period and define how cochlear implantation may impact on non-verbal cognition by restoring functional auditory skills. Sixty-four children with cochlear implants (36 females, 28 males; mean age 4y 3mo, SD 3y 5mo, 9mo-14y 5mo) were recruited and divided into three groups: children with typical development group (TDG); children with associated disabilities not linked to non-verbal cognitive disorders group (ADG1); and children with associated disabilities linked to non-verbal cognitive disorders group (ADG2). Tests of functional auditory, communicative, and non-verbal cognitive skills were performed before cochlear implantation and at 12 and 24 months after cochlear implantation. Functional auditory and communicative skills improved similarly in the three groups at 12 and 24 months after implantation. An increase in non-verbal cognitive scores was present in children in the ADG2 from baseline to 12 and 24 months (p<0.01), whereas scores remained stable in children in the TDG and ADG1. The increased functional auditory skills scores after cochlear implantation corresponded to an increase in non-verbal cognitive scores (p=0.032) in children in the ADG2. Children with associated disabilities, especially if linked to non-verbal cognitive disorders, benefitted from cochlear implantation. They improved their comprehension of acoustic information inferred from the environment, improving not only functional auditory skills but also non-verbal cognition.

Bilateral cochlear implantation versus unilateral cochlear implantation in deaf children: Effects of sentence context and listening conditions on recognition of spoken words in sentences

ObjectivesPrevious studies have investigated the efficacy of bilateral cochlear implants (CIs) in deaf children. The current study focused on the use of sentence-context information in different listening conditions to better explain the benefits of bilateral cochlear implantation. We compared the word recognition abilities of children with bilateral CIs and children with unilateral CIs in relation to sentence context and listening conditions. Additionally, we investigated whether sentence context- and listening condition-dependent word recognition scores can differentiate children with bilateral CIs from children with unilateral CIs. MethodsTwenty children with bilateral CIs and 20 children with unilateral CIs participated in this study. All children were presented with semantically controlled sentences (high vs. low predictability) in quiet and noisy conditions and were asked to repeat the final words of each sentence. ResultsChildren with bilateral CIs had significantly higher word recognition scores than children with unilateral CIs on words embedded in both high- and low-predictability sentences in noisy conditions. The two groups recognized more words in high-predictability sentences than in low-predictability sentences in noisy conditions. The scores on the high-predictability sentences in noisy conditions significantly differentiated children with bilateral CIs from children with unilateral CIs. ConclusionBilateral cochlear implantation is more advantageous than unilateral cochlear implantation at the auditory-linguistic processing level in complex listening conditions.

Saccular function evolution related to cochlear implantation in hearing impaired children.

Vestibular sensorial input is essential for psychomotor development of the very small children. In consequence, possible vestibular impairment induced by cochlear implantation in deaf children could affect the balance and walking learning process. Some of cochlear implanted children can present congenital vestibular deficit. The anatomical and embryological relation between auditory and vestibular system explains why congenital neurosensorial hearing loss may associate vestibular impairment. The cochlear implant surgery presents a vestibular lesion risk. Bilateral vestibulopathy, as it appears in early childhood, has a poor prognosis for the psychomotor and cognitive development. Even probably rare, bilateral vestibulopathy induced by simultaneous bilateral cochlear implantation can delay the acquisition of motor skills. This pathology can be avoided by an appropriate surgical indication related to the vestibular preoperative status. This study reports the vestibular saccular functional modifications after the cochlear implantation in children. The cervical vestibular evoked myogenic potentials (cVEMPs) were performed in children before and after the cochlear implantation. Since previous studies report different vestibular impairment related to the portelectrode insertion approach, another objective of our study was to assess the saccular postoperative status depending of the insertion by cochleostomy (CO) or through the round window (RW). We performed cVEMPs for 80 patients (135 cochlear implanted ears) before and after cochlear implantation. We have detected preoperative saccular areflexia in 33 (24.4%) ears. In the group of 102 (75.6%) ears with preoperative normal saccular function, 72 (70.6%) ears preserved the cVEMP response after the surgery, while in 30 (29.4%) ears the cVEMP response was lost. Reporting our findings to the portelectrode insertion method, we found normal saccular function in 73.3% of the cochlear implanted ears by RW surgical approach and in 68.42% ears by CO approach. These results suggest that the RW portelectrode insertion is the recommended strategy in order to avoid the saccular vestibular impairment.

Long-term Outcomes in Down Syndrome Children After Cochlear Implantation: Particular Issues and Considerations.

The aim of the study was to analyze the long-term outcomes after cochlear implantation in deaf children with Down syndrome (DS) regarding age at the first implantation and refer the results to preoperative radiological findings as well as postoperative auditory and speech performance. Additionally, the influence of the age at implantation and duration of CI use on postoperative hearing and language skills were closely analyzed in children with DS. Retrospective analysis. Referral center (Cochlear Implant Center). Nine children with Down syndrome were compared with 220 pediatric patients without additional mental disorders or genetic mutations. Patients were divided into four categories depending on the age of the first implantation: CAT1 (0-3 yr), CAT2 (4-5 yr), CAT3 (6-7 yr), and CAT4 (8-17 yr). The auditory performance was assessed with the meaningful auditory integration scales (MAIS) and categories of auditory performance (CAP) scales. The speech and language development were further evaluated with meaningful use of speech scale (MUSS) and speech intelligibility rating (SIR). The postoperative speech skills were analyzed and compared between the study group and the reference group by using nonparametric statistical tests. Anatomic abnormalities of the inner ear were examined using magnetic resonance imaging (MRI) and high-resolution computed tomography of the temporal bones (HRCT). The mean follow-up time was 14.9 years (range, 13.1-18.3 yr). Patients with DS received a multichannel implant at a mean age of 75.3 months (SD 27.9; ranging from 21 to 127 mo) and 220 non-syndromic children from reference group at a mean age of 51.4 months (SD 34.2; ranging from 9 to 167 mo). The intraoperative neural response was present in all cases. The auditory and speech performance improved in each DS child. The postoperative mean CAP and SIR scores were 4.4 (SD 0.8) and 3.2 (SD 0.6), respectively. The average of scores in MUSS and MAIS/IT-MAIS scales was 59.8% (SD 0.1) and 76.9% (SD 0.1), respectively. Gathered data indicates that children with DS implanted with CI at a younger age (<6 years of age) benefited from the CI more than children implanted later in life, similarly in a control group. There were additional anomalies of the temporal bone, external, middle, or inner ear observed in 90% of DS children, basing on MRI or HRCT. The early cochlear implantation in children with DS is a similarly useful method in treating severe to profound sensorineural hearing loss (SNHL) as in non-syndromic patients, although the development of speech skills present differently. Due to a higher prevalence of ear and temporal bone malformations, detailed diagnostic imaging should be taken into account before the CI qualification. Better postoperative outcomes may be achieved through comprehensive care from parents/guardians and speech therapists thanks to intensive and systematic rehabilitation.

¿El uso de implantes cocleares determina las estrategias lectoras de los estudiantes sordos?

El objetivo del presente trabajo de investigación ha sido evaluar tanto la competencia lingüística como las estrategias de lectura que emplean los estudiantes sordos con y sin implante coclear (IC). En una sociedad como la nuestra, donde el acceso a la información y la comunicación requiere de una buena competencia lectora, el uso de implantes cocleares en niños sordos juega un papel importante, sobre todo, y en mayor medida, cuando el implante ha sido colocado de forma precoz (antes de los 30 meses). El presente trabajo pone de manifiesto que los niveles lectores de los niños sordos implantados precozmente no difieren significativamente de los obtenidos por niños oyentes de su misma edad cronológica. Sin embargo, al analizar las estrategias de lectura empleadas para alcanzar ese nivel lector, se observa cómo los estudiantes sordos (implantados y no implantados) hacen uso de la estrategia de palabras clave, la cual consiste en leer frases procesando únicamente las palabras con contenido semántico propio (sustantivos, verbos y adjetivos) y, a partir de ahí, generar el significado de las mismas sin procesar las palabras funcionales (preposiciones, conjunciones y adverbios). Esta situación muestra las dificultades que los estudiantes sordos tienen con el procesamiento morfosintáctico de la lengua.

Comparative study of speech and language development in children with normal hearing and cochlear implant in Iran

Today, cochlear implant provides an appropriate opportunity for the development of speech and language in children. In some studies, the age of children at the time of surgery has been stated as the most important factor in the development of speech and language of children after cochlear implant, while in other studies factors, including participation in rehabilitation programs, parental educational level, and lack of other disability have been regarded as key factors in the development of speech and language in these children. This review aims to assess the conducted studies in Iran to identify factors contributing to improving the auditory perception, language, and other skills in children with cochlear implants in comparison to children with normal hearing. The purpose of this study is to review the results of studies conducted on speech and language abilities in children with cochlear implant compared to the normal group in Iran. Directory of Open Access Journals, Google Scholar, PubMed (NLM), LISTA (EBSCO), and Web of Science have been searched. cochlear implants in deaf children before language learning results in the acquisition of speech and language skills in children. Timely detection of hearing impairment, early implantation, duration of hearing, and parental involvement in the rehabilitation process are important factors that affect the development of speech and language. The child's age at the time of implantation, continued participation in rehabilitation programs and the lack of associated problems directly impact the development of auditory perception, speech and language of children with cochlear implant while family education level indirectly impacts this developmental process.

Improvement of the video analysis method for the evaluation of communication skills in deaf children with complex needs

Several papers report important benefits from cochlear implants for deaf children with complex needs but these improvements are difficult to assess with standard tests. The communication strategies of deaf children with complex needs are comparable to those of very young children without comorbidities because both are in a preverbal stage of communication. For this reason we propose a new use of video analysis in deaf children with associated disabilities. The set-up of the recording is the same as the standard method and 20 communication turns are evaluated. The adult stays in front of the child at eye level (especially if a child has a visual impairment). The abilities and progress of the children are evaluated in the standard four areas: turn-taking, autonomy, awareness and eye contact. Non-verbal behaviours are examined. When it is possible to evaluate the category of the eye contact, the most important parameter to take is the adequacy of the use of this ability. For deaf children with complex needs, it is very important to add to the standard parameters the analysis of the maternal communicative style. In conclusion, video analysis can be a useful tool of evaluation when dealing with deaf children with associated disabilities even if not applied in its standard form.

Long-term clinical outcomes of cochlear implantation in children with symptomatic epilepsy

ObjectivesTo describe long-term clinical outcomes of cochlear implantation in deaf children with symptomatic epilepsy. Materials and methodsA retrospective data analysis review of patients implanted at the Cochlear Implant Center of the University of Parma, Italy, was performed, searching for implanted children with a confirmed diagnosis of symptomatic epilepsy. Clinical data, imaging findings, pre- and post-operative epilepsy pattern and EEG traces were analyzed; communicative skills were assessed using the Profile of Actual Linguistic Skills. ResultsSearch retrieved two patients affected by profound bilateral sensorineural hearing loss and symptomatic epilepsy (associated respectively with methylmalonic acidemia and cerebral palsy). After careful parental counselling both patients were offered and underwent cochlear implantation. Activation and use of cochlear implant did not determine substantial changes of pre-existing seizure pattern and EEG traces. Both patients showed substantial development of their communicative abilities. ConclusionsCochlear implantation in children with symptomatic epilepsy did not determine variations in seizure pattern or EEG traces. Both patients experienced substantial benefit from cochlear implantation.

HEALTH TECHNOLOGY ASSESSMENT, DELIBERATIVE PROCESS, AND ETHICALLY CONTESTED ISSUES.

Healthcare technology assessment (HTA) aims to support decisions as to which technologies should be used in which situations to optimize value. Because such decisions will create winners and losers, they are bound to be controversial. HTA, then, faces a dilemma: should it stay away from such controversies, remaining a source of incomplete advice and risking an important kind of marginalization, or should it enter the controversy? The question is a challenging one, because we lack agreement on principles that are fine grained enough to tell us what choices we should make. In this study, we will argue that HTA should take a stand on ethical issues raised by the technology that is being investigated. To do so, we propose adding a form of procedural justice to HTA to arrive at decisions that the public can regard as legitimate and fair. A fair process involves deliberation about the reasons, evidence, and rationales that are considered relevant to meeting population-health needs fairly. One important way to make sure that there is real deliberation about relevant reasons is to include a range of stakeholders in the deliberative process. To illustrate how such deliberation might work, we use the case of cochlear implants for deaf children.

Speech Perception Benefits of Bilateral Cochlear Implantation for Deaf Children

Speech Perception Benefits of Bilateral Cochlear Implantation for Deaf Children

A World of Difference. Parental Perspectives on Cochlear Implantation in Deaf Children with Additional Disabilities

An increasing number of deaf children with additional disabilities receive a cochlear implant (CI). International studies on cochlear implantation in deaf children with additional disabilities show less and slower speech and language gains, but improvement in overall quality of life. In order to qualify the concept of quality of life this study examined the perspectives and experiences of the Dutch parents of twenty-three of these children. A qualitative approach with in-depth interviews was chosen to capture the perspectives of parents and to provide a description of daily life before and after implantation, the processes of referral, assessment, and deliberation, and the parental satisfaction with the services and support they received from the CI centres. Thematic analysis was used to identify themes inductively from the data without trying to fit them into an existing model or theory. Twenty-three children started the CI trajectory, twenty received a CI, three of them at a second CI centre after rejection by the first. Half of the parents were satisfied with the CI centre they visited. The other half reported mild criticism or dissatisfaction, most often because of a lack of case management. Our findings suggest that according to the parents most deaf children with additional disabilities benefit from cochlear implantation: the vast majority in terms of quality of life, a significant minority in terms of speech perception and production.

Understanding minds: Early cochlear implantation and the development of theory of mind in children with profound hearing impairment

ObjectiveThe present study investigates how auditory stimulation from cochlear implants (CI) is associated with the development of Theory of Mind (ToM) in severely and profoundly hearing impaired children with hearing parents. Previous research has shown that deaf children of hearing parents have a delayed ToM development. This is, however, not always the case with deaf children of deaf parents, who presumably are immersed in a more vivid signing environment. MethodsSixteen children with CI (4.25 to 9.5 years of age) were tested on measures of cognitive and emotional ToM, language and cognition. Eight of the children received their first implant relatively early (before 27 months) and half of them late (after 27 months). The two groups did not differ in age, gender, language or cognition at entry of the study. ToM tests included the unexpected location task and a newly developed Swedish social–emotional ToM test. The tests aimed to test both cognitive and emotional ToM. A comparison group of typically developing hearing age matched children was also added (n=18). ResultsCompared to the comparison group, the early CI-group did not differ in emotional ToM. The late CI-group differed significantly from the comparison group on both the cognitive and emotional ToM tests. ConclusionThe results revealed that children with early cochlear implants solved ToM problems to a significantly higher degree than children with late implants, although the groups did not differ on language or cognitive measures at baseline. The outcome suggests that early cochlear implantation for deaf children in hearing families, in conjunction with early social and communicative stimulation in a language that is native to the parents, can provide a foundation for a more normalized ToM development.

Dealing with moral dilemma raised by adaptive preferences in health technology assessment: The example of growth hormones and bilateral cochlear implants

The aim of this article is to assess dilemma raised by adaptive preferences in the economic evaluation of growth hormone (GH) treatment for non-GH-deficient short children, and of bilateral cochlear implants for deaf children. Early implementation of both technologies and their irreversible consequences increase the potential conflicts faced by the assessors of health-related quality of life (HRQoL) states (on behalf of patients) who could be interviewed (parents, individuals with an experience of the same disability, or representative samples of the general public). Indeed, assessors' preferences may be influenced by their own situation and they are likely to vary according to age and the experience of disability. Three options are put forward which aim to resolve these moral dilemma and help economists make methodological choices that cannot be avoided in order to carry out this assessment. They are grounded on three specific egalitarian theories of social justice. The main contribution of this article is to show that a dialogue between ethics and economics, prior to an assessment, makes it possible to redefine the choice of effectiveness criteria (subjective well-being, capabilities or social outcomes), the choice of perspective (patients or the able-bodied), as well as the scope of assessment (medical and non-medical care).

Verbal short-term memory development and spoken language outcomes in deaf children with cochlear implants.

Cochlear implants (CIs) help many deaf children achieve near-normal speech and language (S/L) milestones. Nevertheless, high levels of unexplained variability in S/L outcomes are limiting factors in improving the effectiveness of CIs in deaf children. The objective of this study was to longitudinally assess the role of verbal short-term memory (STM) and working memory (WM) capacity as a progress-limiting source of variability in S/L outcomes after CI in children. Longitudinal study of 66 children with CIs for prelingual severe-to-profound hearing loss. Outcome measures included performance on digit span forward (DSF), digit span backward (DSB), and four conventional S/L measures that examined spoken-word recognition (Phonetically Balanced Kindergarten word test), receptive vocabulary (Peabody Picture Vocabulary Test ), sentence-recognition skills (Hearing in Noise Test), and receptive and expressive language functioning (Clinical Evaluation of Language Fundamentals Fourth Edition Core Language Score; CELF). Growth curves for DSF and DSB in the CI sample over time were comparable in slope, but consistently lagged in magnitude relative to norms for normal-hearing peers of the same age. For DSF and DSB, 50.5% and 44.0%, respectively, of the CI sample scored more than 1 SD below the normative mean for raw scores across all ages. The first (baseline) DSF score significantly predicted all endpoint scores for the four S/L measures, and DSF slope (growth) over time predicted CELF scores. DSF baseline and slope accounted for an additional 13 to 31% of variance in S/L scores after controlling for conventional predictor variables such as: chronological age at time of testing, age at time of implantation, communication mode (auditory-oral communication versus total communication), and maternal education. Only DSB baseline scores predicted endpoint language scores on Peabody Picture Vocabulary Test and CELF. DSB slopes were not significantly related to any endpoint S/L measures. DSB baseline scores and slopes taken together accounted for an additional 4 to 19% of variance in S/L endpoint measures after controlling for the conventional predictor variables. Verbal STM/WM scores, process measures of information capacity, develop at an average rate in the years after cochlear implantation, but were found to consistently lag in absolute magnitude behind those reported for normal-hearing peers. Baseline verbal STM/WM predicted long-term endpoint S/L outcomes, but verbal STM slopes predicted only endpoint language outcomes. Verbal STM/WM processing skills reflect important underlying core elementary neurocognitive functions and represent potential intervention targets for improving endpoint S/L outcomes in pediatric CI users.

Evaluating Benefits of Cochlear Implantation in Deaf Children With Additional Disabilities

Cochlear-implanted deaf children having additional disabilities may develop speech perception and language skills at a slower pace than their implanted peers without such disorders. Nevertheless, it has been shown that, even for these special cases, cochlear implantation (CI) provides benefits for a larger range of neuropsychological functions including social and relational skills. These benefits are frequently mentioned by parents, but rarely objectively measured by tests. This article presents a new evaluation tool aimed at assessing the global benefits offered by CI in these special cases. The new tool has been designed as a closed-format questionnaire, divided into five areas. It is based on observing the frequency of preselected behaviors in daily activities, which imply specific social, neuropsychological, and perceptual skills. The questionnaire has been presented to the parents of 50 deaf children with additional disabilities, before and at least 6 months after CI. The data show significant improvements in all investigated areas. However, not all skills improve in the same way, and only those skills related to language and communication correlate positively with time after implantation. The present article further discusses changes in skills for which parents have higher expectations, such as the preferred communication mode, speech intelligibility, and the ability to communicate on the telephone. The questionnaire has a simple-to-use format, and it has been proven to be sufficiently sensitive for the detection of changes in each examined area. Because the questionnaire is based on observed behaviors, it can be used even when other existing tests involve tasks that are too complex for these children.

Outcomes of cochlear implantation in deaf children of deaf parents: comparative study

This retrospective study compared the cochlear implantation outcomes of first- and second-generation deaf children. The study group consisted of seven deaf, cochlear-implanted children with deaf parents. An equal number of deaf children with normal-hearing parents were selected by matched sampling as a reference group. Participants were matched based on onset and severity of deafness, duration of deafness, age at cochlear implantation, duration of cochlear implantation, gender, and cochlear implant model. We used the Persian Auditory Perception Test for the Hearing Impaired, the Speech Intelligibility Rating scale, and the Sentence Imitation Test, in order to measure participants' speech perception, speech production and language development, respectively. Both groups of children showed auditory and speech development. However, the second-generation deaf children (i.e. deaf children of deaf parents) exceeded the cochlear implantation performance of the deaf children with hearing parents. This study confirms that second-generation deaf children exceed deaf children of hearing parents in terms of cochlear implantation performance. Encouraging deaf children to communicate in sign language from a very early age, before cochlear implantation, appears to improve their ability to learn spoken language after cochlear implantation.