Cochlear Implantation In Young Children Research Articles

The effects of cochlear implantation on middle ear function: A prospective study.

Although sound conduction mechanisms may influence by cochlear implantation (CI), it is not very clear whether, how, and to what extent these mechanisms may be influenced the pediatric population. Wideband tympanometry (WBT) is a sensitive tool to evaluate alternations in the middle ear mechanics in a wide frequency range. The current study aimed to explore CI's impacts on sound conduction across the middle ear cavity using WBT in pediatrics. In a prospective design, 35 unilaterally implanted children (<24 months of age) with normal temporal bone anatomy were included in this study. Traditional tympanometry (226-Hz) and WBT measures were compared for each child in the implanted and non-implanted ears preoperatively and three months postoperatively. No significant changes in the "static acoustic admittance" and "peak pressure" parameters were observed between the pre-CI and post-CI conditions in the implanted and non-implanted ears in the 226-Hz tympanometry test. Wideband absorbance recordings before CI surgery exhibited a double-peaked pattern over a frequency range of 250 to 8000Hz. The pre- and postoperative acoustic energy absorbance comparisons indicated a significantly reduced mid-frequency (1260 to 3175Hz) and high-frequency (5040 to 8000Hz) absorbance in the implanted ears. However, our results indicated no significant differences in sound absorbance between the pre- and postoperative conditions in non-implanted ears. Our findings suggested that WBT is a more sensitive method than traditional tympanometry for monitoring the mechanical status of the middle ear after cochlear implantation in pediatrics. Cochlear implantation in young children can significantly reduce mid- and high-frequency acoustic absorbance measured by WBT.

Prelinguistic Vocal Development in Children With Cochlear Implants: A Systematic Review.

This systematic review is designed to (a) describe measures used to quantify vocal development in pediatric cochlear implant (CI) users, (b) synthesize the evidence on prelinguistic vocal development in young children before and after cochlear implantation, and (c) analyze the application of the current evidence for evaluating change in vocal development before and after cochlear implantation for young children. Investigations of prelinguistic vocal development after cochlear implantation are only beginning to uncover the expected course of prelinguistic vocal development in children with CIs and what factors influence that course, which varies substantially across pediatric CI users. A deeper understanding of prelinguistic vocal development will improve professionals' abilities to determine whether a child with a CI is exhibiting sufficient progress soon after implantation and to adjust intervention as needed. We systematically searched PubMed, ProQuest, and CINAHL databases for primary reports of children who received a CI before 5 years 0 months of age that included at least one measure of nonword, nonvegetative vocalizations. We also completed supplementary searches. Of the 1916 identified records, 59 met inclusion criteria. The included records included 1125 total participants, which came from 36 unique samples. Records included a median of 8 participants and rarely included children with disabilities other than hearing loss. Nearly all of the records met criteria for level 3 for quality of evidence on a scale of 1 (highest) to 4 (lowest). Records utilized a wide variety of vocalization measures but often incorporated features related to canonical babbling. The limited evidence from pediatric CI candidates before implantation suggests that they are likely to exhibit deficits in canonical syllables, a critical vocal development skill, and phonetic inventory size. Following cochlear implantation, multiple studies report similar patterns of growth, but faster rates producing canonical syllables in children with CIs than peers with comparable durations of robust hearing. However, caution is warranted because these demonstrated vocal development skills still occur at older chronological ages for children with CIs than chronological age peers with typical hearing. Despite including a relatively large number of records, the evidence in this review regarding changes in vocal development before and after cochlear implantation in young children remains limited. A deeper understanding of when prelinguistic skills are expected to develop, factors that explain deviation from that course, and the long-term impacts of variations in vocal prelinguistic development is needed. The diverse and dynamic nature of the relatively small population of pediatric CI users as well as relatively new vocal development measures present challenges for documenting and predicting vocal development in pediatric CI users before and after cochlear implantation. Synthesizing results across multiple institutions and completing rigorous studies with theoretically motivated, falsifiable research questions will address a number of challenges for understanding prelinguistic vocal development in children with CIs and its relations with other current and future skills. Clinical implications include the need to measure prelinguistic vocalizations regularly and systematically to inform intervention planning.

When Can Stable AutoNRT Thresholds be Expected? A Clinical Implication When Fitting Young Children.

Objective measurements are important for programming cochlear implants in young children and other individuals who cannot participate in behavioral measurements. AutoNRT, the automatic method used to record responses from the auditory nerve in the Cochlear Ltd., implant system, is often used as a basis for estimating the threshold level and comfort level (C-level) for these patients. However, it has not been sufficiently established if AutoNRT measurements remain consistent over time. This study aimed to determine if/when AutoNRT thresholds stabilize. The study design was a longitudinal prospective study. AutoNRT thresholds were obtained from 52 young children and 80 adults. All subjects received the same implant (CI24RE Contour Advance). AutoNRT thresholds were measured on all intracochlear electrodes during the surgery and at the initial activation. During the following year, children were measured at 1, 3, 6, and 12 months, and adults were measured at 6 and 12 months. The results were analyzed based on mean values, correlation, and absolute mean differences. There were large variations for all electrodes between the intraoperative and postoperative AutoNRT thresholds of both children and adults. For children, the thresholds were considered to be stable from 1 month. The correlations obtained between the last two measurements, 6 and 12 months, for both children and adults were generally high for all electrodes. The present results demonstrate the importance of repeating the AutoNRT measurement postoperatively, at about 1 month after initial activation, to obtain reliable and stable thresholds for estimating the T- and C-level profiles.

Waardenburg syndrome: characteristics and long-term outcomes of paediatric cochlear implant recipients

Objective: To assess the long-term outcomes after cochlear implantation in children under 3 years of age with Waardenburg syndrome (WS), concerning preoperative radiological imaging, intraoperative surgical findings and postoperative auditory and speech performance.Material and methods: A retrospective analytical study conducted on the young WS children with bilateral profound sensorineural hearing loss (SNHL) who underwent the cochlear implantation. Postoperative outcomes were confronted with results obtained by aged-matched peers without additional disabilities. The auditory performance was assessed with the MAIS and CAP. The speech and language development were evaluated with the MUSS and SIR. Radiological evaluation was performed with the MRI and HRCT scans.Results: There were 22 children with WS, who received a multichannel implant at a mean age of 23.5 months of age (SD 7.5, range: 12–36 months). WS group outperformed non-syndromic (NS) children in SIR (4.7, 95%, SD 0.8 vs. 4.3, 95%, SD 0.8) and MUSS (35.6, 95%, SD 3.4 vs. 30.3, 95%, SD 7.6). Auditory performance assessed in MAIS/IT-MAIS improved similarly in both groups (34.8, 95%, SD 1.8 in WS vs. 35, 95%, SD 2.5 in NS children). The reference group gained significantly higher scores in CAP (6.2, 95%, SD 0.7 vs. 5.8, 95%, SD 1.8). Additional anomalies of the inner ear were observed including the enlarged vestibular aqueduct (EVA), common cavity deformity (CCD), incomplete partition type II (IP-II). Two cases presented various forms of mental retardation.Conclusion: The study demonstrated that cochlear implantation in young children with WS is a beneficial method treating profound SNHL. The most beneficial outcomes may be achieved thanks to the early implantation, parental involvement and comprehensive care from speech therapists, preferably implemented altogether. The detailed radiological examination and psychological assessment should be considered before the implantation. The results support the concept of early cochlear implantation in children with genetic disorders.

Safety and Effectiveness of Cochlear Implantation of Young Children, Including Those With Complicating Conditions.

Objective:Determine safety and effectiveness of cochlear implantation of children under age 37 months, including below age 12 months.Study Design:Retrospective review.Setting:Tertiary care children's medical center.Patients:219 children implanted before age 37 mos; 39 implanted below age 12 mos and 180 ages 12–36 mos. Mean age CI = 20.9 mos overall; 9.4 mos (5.9–11.8) and 23.4 mos (12.1–36.8) for the two age groups, respectively. All but two ≤12 mos (94.9%) received bilateral implants as did 70.5% of older group. Mean follow-up = 5.8 yrs; age last follow-up = 7.5 yrs, with no difference between groups.Interventions:Cochlear implantation.Main outcome measures:Surgical and anesthesia complications, measurable open-set speech discrimination, primary communication mode(s).Results:Few surgical complications occurred, with no difference by age group. No major anesthetic morbidity occurred, with no critical events requiring intervention in the younger group while 4 older children experienced desaturations or bradycardia/hypotension. Children implanted under 12 mos developed open-set earlier (3.3 yrs vs 4.3 yrs, p ≤ 0.001) and were more likely to develop oral-only communication (88.2% vs 48.8%, p ≤ 0.001). A significant decline in rate of oral-only communication was present if implanted over 24 months, especially when comparing children with and without additional conditions associated with language delay (8.3% and 35%, respectively).Conclusions:Implantation of children under 37 months of age can be done safely, including those below age 12 mos. Implantation below 12 mos is positively associated with earlier open-set ability and oral-only communication. Children implanted after age 24 months were much less likely to use oral communication exclusively, especially those with complex medical history or additional conditions associated with language delay.

Cortical organization restored by cochlear implantation in young children with single sided deafness

Early treatment of single sided deafness in children has been recommended to protect from neurodevelopmental preference for the better hearing ear and from social and educational deficits. A fairly homogeneous group of five young children (≤3.6 years of age) with normal right sided hearing who received a cochlear implant to treat deafness in their left ears were studied. Etiology of deafness was largely cytomegalovirus (n = 4); one child had an enlarged vestibular aqueduct. Multi-channel electroencephalography of cortical evoked activity was measured repeatedly over time at: 1) acute (0.5 ± 0.7 weeks); 2) early chronic (1.1 ± 0.2 months); and 3) chronic (5.8 ± 3.4 months) cochlear implant stimulation. Results indicated consistent responses from the normal right ear with marked changes in activity from the implanted left ear. Atypical distribution of peak amplitude activity from the implanted ear at acute stimulation marked abnormal lateralization of activity to the ipsilateral left auditory cortex and recruitment of extra-temporal areas including left frontal cortex. These abnormalities resolved with chronic implant use and contralateral aural preference emerged in both auditory cortices. These findings indicate that early implantation in young children with single sided deafness can rapidly restore bilateral auditory input to the cortex needed to improve binaural hearing.

Medical and bioethical considerations in elective cochlear implant array removal

ObjectiveCochlear explantation for purely elective (e.g. psychological and emotional) reasons is not well studied. Herein, we aim to provide data and expert commentary about elective cochlear implant (CI) removal that...

Simultaneous Bilateral Cochlear Implantation for a 6-Month Child with a History of Meningitis

The article presents the first case of simultaneous bilateral cochlear implantation for a 6-month child with IV degree sensorineural hearing loss after meningocephalitis in Russia. Despite partial ossification of the cochlear basal turns, the early timing of implantation allowed to fully implant active electrodes to both ears. The simultaneous bilateral cochlear implantation in young children, who had meningitis, is a minimally invasive and highly efficient procedure with good long-term results of oral-aural after-care.

The ethics of cochlear implants in young children.

The ethics of cochlear implants in young children.

The influence of newborn hearing screening on the age at cochlear implantation in children.

To evaluate the influence of the introduction of newborn hearing screening programs on the age at cochlear implantation in children. Retrospective, multicenter cohort study. All 1,299 pediatric cochlear implant users who received their implants before the age of 5 years between 1995 and 2011 in the Medical University Hannover, Germany and University Medical Center Utrecht, the Netherlands were enrolled in this study. Age at implantation and the number of children implanted within the first year of life was assessed for each center. Age at cochlear implantation gradually declined over the years in both centers. The introduction of the screening resulted in significant decline in the age at implantation in the Netherlands; simultaneously, the number of children implanted within their first year of life increased significantly. Comparing 4-year epochs immediately before and after introduction of the screening, the mean age decreased from 2.4 to 1.2 years, and the percentage of early implanted children increased from 9% to 37%. In the German population, a similar effect of the introduction of the hearing screening program was absent. The introduction of the national newborn hearing screening program has reduced the age at cochlear implantation in young children in the Netherlands but not in Germany. Correspondingly, it resulted in an increase in the number of children implanted early in life. The difference between the Dutch and German population might be due to differences in the follow-up and referral after the hearing screening.

Tone and sentence perception in young Mandarin-speaking children with cochlear implants

ObjectivesThe purpose of this study was to examine the outcomes of cochlear implantation in young children in terms of (1) perception of lexical tones in quiet, (2) perception of sentences in quiet and in noise, (3) the effects of five demographic variables (i.e., preoperative hearing level, age at implantation, duration of cochlear implants use, maternal educational level, and whether a child underwent a hearing aid trial before implantation) on lexical tone perception and sentence perception, and (4) the relationship between lexical tone perception and sentence perception. Methods96 participants, aged from 2.41 years to 7.09 years, were recruited in mainland China. The children exhibited normal cognitive abilities and received unilateral implants at an average age of 2.72 years, with ages ranging from 0.69 to 5 years of age. ResultsThe mean score for tone identification was 77% (SD=13%; chance level=50%). Tone 2/tone 3 was the most difficult tone contrast to identify. Children with a longer duration of CI use and whose mothers had more years of education tended to perform better in sentence perception in quiet and in noise. Having undergone a hearing aid trial before implantation and more residual hearing were additional factors contributing to better sentence perception in noise. The only demographical variable that related to tone perception in quiet was duration of CI. In addition, while there was a modest correlation between tone perception and sentence perception in quiet (rs=0.47, p<0.001), the correlation between tone perception in quiet and sentence perception in noise was much weaker (rs=−0.28, p<0.05). ConclusionsThe findings suggested that most young children who had been implanted before 5 years of age and had 1–3 years of implant use did not catch up with their aged peers with normal hearing in tone perception and sentence perception. The weak to moderate correlation between tone perception in quiet and sentence perception might imply that the improvement of tone perception in quiet may not necessarily contribute to sentence perception, especially in noise condition.

Language development after cochlear implantation: an epigenetic model.

Growing evidence supports the notion that dynamic gene expression, subject to epigenetic control, organizes multiple influences to enable a child to learn to listen and to talk. Here, we review neurobiological and genetic influences on spoken language development in the context of results of a longitudinal trial of cochlear implantation of young children with severe to profound sensorineural hearing loss in the Childhood Development after Cochlear Implantation study. We specifically examine the results of cochlear implantation in participants who were congenitally deaf (N = 116). Prior to intervention, these participants were subject to naturally imposed constraints in sensory (acoustic–phonologic) inputs during critical phases of development when spoken language skills are typically achieved rapidly. Their candidacy for a cochlear implant was prompted by delays (n = 20) or an essential absence of spoken language acquisition (n = 96). Observations thus present an opportunity to evaluate the impact of factors that influence the emergence of spoken language, particularly in the context of hearing restoration in sensitive periods for language acquisition. Outcomes demonstrate considerable variation in spoken language learning, although significant advantages exist for the congenitally deaf children implanted prior to 18 months of age. While age at implantation carries high predictive value in forecasting performance on measures of spoken language, several factors show significant association, particularly those related to parent–child interactions. Importantly, the significance of environmental variables in their predictive value for language development varies with age at implantation. These observations are considered in the context of an epigenetic model in which dynamic genomic expression can modulate aspects of auditory learning, offering insights into factors that can influence a child’s acquisition of spoken language after cochlear implantation. Increased understanding of these interactions could lead to targeted interventions that interact with the epigenome to influence language outcomes with intervention, particularly in periods in which development is subject to time-sensitive experience.

Cyborgization: Deaf Education for Young Children in the Cochlear Implantation Era

The author, who was raised oral deaf himself, recounts a visit to a school for young deaf children and discovers that young d/Deaf children and their rights are subverted by the cochlear implantation empire. The hypercapitalist, techno-manic times of cochlear implantation has wreaked havoc to the lives of not only young children with deafness but also the parents themselves are indoctrinated into a system that first strips them of their competency through the diagnosing ritual to finally stripping the parents of their own rights to make fully informed choices for their children. The genre of this exposé is DeafCrit, drawing on journalistic traditions of muckraking and the methods of new journalism to report on, deconstruct, and critique the involvement of audist/ableist medical, business, welfare, and education stakeholders in the rise of cochlear implants in young children and how this operation is altering the landscape of deaf education.

C023 Accessing performance of Cochlear Implantation in young children in a developing economy – India

C023 Accessing performance of Cochlear Implantation in young children in a developing economy – India

Bilateral cochlear implants in young children.

Cochlear implants (CIs) are provided to a growing number of people who are deaf. Single CIs offer opportunity for language acquisition, but there exist remaining challenges. In normal‐hearing individuals binaural hearing provides cues that are important for sound localization and speech understanding in noisy environments. Provision of bilateral CIs to many children occurs with the expectation that they will develop spatial hearing abilities. Outcomes in these children are mixed; while some are able to localize sound significantly better with bilateral CIs than with a single CI, other children demonstrate poor spatial hearing skills. Factors that seem to contribute to performance include amount of auditory deprivation prior to implantation and auditory experience following bilateral activation. Hardware/software limitations in implanted devices result in binaural cues being distorted or discarded. Studies using research processors show that these cues can be transmitted with fidelity to the patients, but that perceptual sensitivity to these cues may depend on the period of auditory deprivation that listeners have experienced. This talk will focus on progress and outcomes in children who are deaf and use bilateral CIs, with suggestions for future development that will depend on improved audio signal processing and signal delivery to the implantable devices.

Cochlear implantations in young children with cochlear nerve deficiency diagnosed by MRI

Objective To investigate postoperative outcomes after cochlear implantation in young children with cochlear nerve deficiency and compare the results with those of cochlear implantation in patients with normal cochlear nerve. Study Design Historical cohort study. Setting Tertiary referral center. Subjects and Methods Six children under the age of 36 months with cochlear nerve deficiency, as determined by magnetic resonance imaging (MRI), received cochlear implantation between July 2006 and March 2008. Fifteen children under the age of 36 months with normal cochlear nerve in the implanted ear underwent cochlear implantation during the same period and were selected as the control group. Medical records, imaging studies, and speech evaluations were reviewed. Results Our study group scored lower in the Infant-Toddler Meaningful Auditory Integration Scale compared to the control group. Our study group produced categories of auditory performance scores not less than 4 except for one patient. Speech intelligibility rating scores in the control group gradually increased after cochlear implantation, but for the study group, the score remained zero 12 months after the implantation. In open-set one-syllable tests, five patients with cochlear nerve deficiency showed no response at the latest follow-up, whereas patient 6 began to show delayed improvement after 18 months. The results of the open-set two-syllable test were similar to those of the open-set one-syllable test. Conclusion Young children with nonvisualized cochlear nerve on MRI showed worse outcomes compared to the children with normal cochlear nerve. Cochlear nerve deficiency on MRI is a marker of very poor outcome with cochlear implantations.

Spoken Language Development in Children Following Cochlear Implantation

Cochlear implantation is a surgical alternative to traditional amplification (hearing aids) that can facilitate spoken language development in young children with severe to profound sensorineural hearing loss (SNHL). To prospectively assess spoken language acquisition following cochlear implantation in young children. Prospective, longitudinal, and multidimensional assessment of spoken language development over a 3-year period in children who underwent cochlear implantation before 5 years of age (n = 188) from 6 US centers and hearing children of similar ages (n = 97) from 2 preschools recruited between November 2002 and December 2004. Follow-up completed between November 2005 and May 2008. Performance on measures of spoken language comprehension and expression (Reynell Developmental Language Scales). Children undergoing cochlear implantation showed greater improvement in spoken language performance (10.4; 95% confidence interval [CI], 9.6-11.2 points per year in comprehension; 8.4; 95% CI, 7.8-9.0 in expression) than would be predicted by their preimplantation baseline scores (5.4; 95% CI, 4.1-6.7, comprehension; 5.8; 95% CI, 4.6-7.0, expression), although mean scores were not restored to age-appropriate levels after 3 years. Younger age at cochlear implantation was associated with significantly steeper rate increases in comprehension (1.1; 95% CI, 0.5-1.7 points per year younger) and expression (1.0; 95% CI, 0.6-1.5 points per year younger). Similarly, each 1-year shorter history of hearing deficit was associated with steeper rate increases in comprehension (0.8; 95% CI, 0.2-1.2 points per year shorter) and expression (0.6; 95% CI, 0.2-1.0 points per year shorter). In multivariable analyses, greater residual hearing prior to cochlear implantation, higher ratings of parent-child interactions, and higher socioeconomic status were associated with greater rates of improvement in comprehension and expression. The use of cochlear implants in young children was associated with better spoken language learning than would be predicted from their preimplantation scores.

Medical and Surgical Complications in Pediatric Cochlear Implantation

To report complications of cochlear implantation (CI) in children and to analyze risk factors. Retrospective study from January 1, 1990, through April 30, 2008, with a mean follow-up of 5.5 years (range, 1 month to 17 years). Tertiary academic center. Four hundred thirty-four patients younger than 16 years. Mean age at CI was 4.7 (range, 0.6-16.0) years. Forty-one children (9.4%) underwent CI when younger than 24 months. Forty-three (9.9%) had inner ear malformations. Complications after CI, classified into early (0-8 days) or delayed (>8 days) and major or minor. Spontaneous failures of internal devices were excluded. Correlation to age at CI, local trauma, and inner ear malformations were analyzed using the chi(2) test. Forty-three patients (9.9%) experienced complications. Delayed complications occurred in 28 patients (65.1%), with a mean delay of 2.2 (range, 0.1-8.4) years. Twenty-four patients (5.5%) had major complications, consisting of severe cutaneous infections (15 patients), magnet displacement (3), meningitis (2), cholesteatoma (2), cerebrospinal fluid leak (1), and electrode misplacement (1). Nineteen (4.4%) had minor complications, consisting of vertigo (9 patients), soft-tissue infection (5), persistent otitis media (4), and facial palsy (1). Complications led to reimplantation in 13 of the 43 patients (30.2%). Trauma to the mastoid area (14 patients) and inner ear malformations (51) were highly correlated with major delayed complications (P < .001) and early minor complications (P < .001), respectively. Young age at CI was not correlated with any type of complication. Complications of CI in children are common, with trauma as a major factor. Inner ear malformations should prompt specific preventive management. Cochlear implantation in young children did not appear to be a risk factor in this study.

Bilateral versus unilateral cochlear implantation in young children

Objectives To compare the preverbal communication skills of two groups of young implanted children: those with unilateral implantation and those with bilateral implantation. Material and methods The study assessed 69 children: 42 unilaterally and 27 bilaterally implanted with age at implantation less than 3 years. The preverbal skills of these children were measured before and 1 year after implantation, using Tait Video Analysis that has been found able to predict later speech outcomes in young implanted children. Results Before implantation there was no significant difference between the unilateral group and the bilateral group. There was still no difference at 12 months following implantation where vocal autonomy is concerned, but a strongly significant difference between the groups for vocal turn-taking and non-looking vocal turns, the bilateral group outperforming the unilateral group. Regarding gestural turn-taking and gestural autonomy, there was a strongly significant difference between the two groups at the 12 month interval, and also a difference before implantation for gestural autonomy, the unilateral group having the higher scores. Multiple regression of non-looking vocal turns revealed that 1 year following implantation, bilateral implantation contributed to 51% of the variance ( p < 0.0001), after controlling for the influence of age at implantation and length of deafness which did not reach statistical significance. Conclusions Profoundly deaf bilaterally implanted children are significantly more likely to use vocalisation to communicate, and to use audition when interacting vocally with an adult, compared with unilaterally implanted children. These results are independent of age at implantation and length of deafness.

Functional outcome of sequential bilateral cochlear implantation in young children: 36 months postoperative results

Objective To examine the effects of sequential bilateral cochlear implantation (CI) on the life of young children after 36 months of bilateral implant use. Method Thirty-five children were assessed prior to and 3 until 36 months after activation of the second CI. Main outcome measures were: the Categories of Auditory Performance (CAP), Speech Intelligibility Rating (SIR), communication mode, classroom placement, parent reports and the Würzburg questionnaire. Results were analysed separately for children younger and older than 6 years at the time of the second implantation. Results At the 3-year test interval, 80% of the younger children attended mainstream schools and were comprehensible for all listeners. They all used oral communication and almost 70% of them could have a conversation over the telephone. After 3 years of bilateral implant use less than 50% of the older children obtained the highest score on the SIR and CAP. Approximately 70% of them was integrated in mainstream schools and used oral communication. All parents reported a more natural communication and an improved quality of life. Conclusions Sequential bilateral implantation seems to offer a wide range of participation benefits to all children and facilitates the social intercourse with their hearing environment.