Meaningful Auditory Integration Scale Research Articles

The Neural Processing of Vocal Emotion After Hearing Reconstruction in Prelingual Deaf Children: A Functional Near-Infrared Spectroscopy Brain Imaging Study.

As elucidated by prior research, children with hearing loss have impaired vocal emotion recognition compared with their normal-hearing peers. Cochlear implants (CIs) have achieved significant success in facilitating hearing and speech abilities for people with severe-to-profound sensorineural hearing loss. However, due to the current limitations in neuroimaging tools, existing research has been unable to detail the neural processing for perception and the recognition of vocal emotions during early stage CI use in infant and toddler CI users (ITCI). In the present study, functional near-infrared spectroscopy (fNIRS) imaging was employed during preoperative and postoperative tests to describe the early neural processing of perception in prelingual deaf ITCIs and their recognition of four vocal emotions (fear, anger, happiness, and neutral). The results revealed that the cortical response elicited by vocal emotional stimulation on the left pre-motor and supplementary motor area (pre-SMA), right middle temporal gyrus (MTG), and right superior temporal gyrus (STG) were significantly different between preoperative and postoperative tests. These findings indicate differences between the preoperative and postoperative neural processing associated with vocal emotional stimulation. Further results revealed that the recognition of vocal emotional stimuli appeared in the right supramarginal gyrus (SMG) after CI implantation, and the response elicited by fear was significantly greater than the response elicited by anger, indicating a negative bias. These findings indicate that the development of emotional bias and the development of emotional perception and recognition capabilities in ITCIs occur on a different timeline and involve different neural processing from those in normal-hearing peers. To assess the speech perception and production abilities, the Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS) and Speech Intelligibility Rating (SIR) were used. The results revealed no significant differences between preoperative and postoperative tests. Finally, the correlates of the neurobehavioral results were investigated, and the results demonstrated that the preoperative response of the right SMG to anger stimuli was significantly and positively correlated with the evaluation of postoperative behavioral outcomes. And the postoperative response of the right SMG to anger stimuli was significantly and negatively correlated with the evaluation of postoperative behavioral outcomes.

Round window versus conventional bony cochleostomy technique in pediatric cochlear implantation; A Randomized controlled double blinded trial.

<p><strong>Background:</strong> Objective of the study was to investigate the outcomes of cochlear implantation when done via two different techniques namely, the round window or the bony cochleostomy.</p><p><strong>Methods:</strong> A single-center, double-blinded randomized controlled trial including forty prelingual, bilateral severe to profoundly deaf children less than six years from the year 2014 to 2016 in a tertiary referral center in India were randomly allocated to round window and bony cochleostomy group. Our primary outcome measures were intraoperative neural response telemetry levels, behavioral threshold (t) and comfortable (c) loudness levels. The secondary subjective outcomes were measured via the category of auditory performance (CAP) and the meaningful auditory integration scale (MAIS) score. The cases were followed up for 9 months.</p><p><strong>Results:</strong> Intra-operative, electrically evoked compound action potentials (ECAP) showed comparable mean thresholds for both the techniques except intermediate electrodes (p~0.04) showed lower values for the round window. Similarly, a lower threshold (p~0.03) and comfortable mean current levels (p~0.03) were noticed for the round window group at 6 months post-implantation. Secondary speech perception outcome scores measured via category of auditory performance (CAP) and MAIS score were comparable. </p><p><strong>Conclusions:</strong> The round window insertion technique has physiological benefit as compared to the bony cochleostomy as evidenced by better stimulation levels in the intermediate electrodes and lower mean threshold and comfortable levels in the round window with more beneficial peri-modiolar position of electrode arrays. However, comparable speech perception outcomes revealed no clinical benefit in the cochlear implant performance depending on the technique of electrode insertion. </p>

The Correlation of Congenital CMV Infection and the Outcome of Cochlear Implantation

Objectives: Cytomegalovirus (CMV) infection is the most common intrauterine viral infection, affecting approximately 0.5-2.5% of all live births in the world. The majority of patients are asymptomatic at birth, but several clinical consequences are related to this infection, including neuro-sensory hearing loss. The cochlear implant is the treatment of choice when the hearing loss is severe to profound. Compare the audiological evolution after cochlear implant surgery in a group of children born with congenital CMV infection compared to a control group of children born with a genetic cause of congenital hearing loss. Determine prognostic factors predicting the outcome of patients with congenital hearing loss secondary to CMV infection following cochlear implantation.Methods: Our retrospective study aimed at the analysis of 48 patients with cochlear implants, 25 patients with congenital CMV, and 23 patients in the control group with cochlear cause of hearing loss, who were matched for gender, age of onset, and type of hearing loss. Primary outcomes are auditory evolution with the Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS) and the multimedia audiologic test (MAT). Secondary outcomes are evaluation of prognostic factors for the CMV group, like MRI severity sign, antiviral treatment, and neuropsychological disorder.Results: For the MAT, the results are 73.9% in the CMV group and 81.6% in the control group (P = .03). For the IT-MAIS, the results are 29.3/40 in the CMV group and 29.2/40 in the control group (P = .96). In the CMV group, the children treated with antiviral treatment have IT-MAIS difference of 28.5/40 compared to 23.2/40 for the children without antiviral treatment (P = .03). We found a little trend in the correlation between auditory results and the presence of neuropsychological disorders, but there are no statistically significant results.Conclusion: The results of the audiological tests in the CMV group allow an adequate functioning, even if lower than in the control group. There are benefits of implantation in patients with CMV, and audiological results are still satisfactory for proper functioning. CMV patients enjoy superior results in terms of hearing, with antiviral treatment.

A Comprehensive Outcome Framework of a Cochlear Implant Program at a University Hospital in Chennai: A Preliminary Report.

The primary goal of the study wasto assess the progress achieved across different implant age groups (0-2 years, 2.1-4 years and 4.1-6 years) using a comprehensive test battery approach targeting areas such as Audition, Speech Perception, Speech Intelligibility and Speech-Language.This cross-sectional study evaluated the outcomes of 40 children who underwent cochlear implantation at Sri Ramachandra Medical Centre, Chennai. A battery of tests included aided audiogram, Categorical Auditory Performance, Meaningful Auditory Integration Scale; Picture speech identification test in Tamil; Speech Intelligibility Rating Scale and Communication Developmental Eclectic Approach to Language Learning (COMDEALL) were administered to evaluate their auditory, speech perception, speech intelligibility and speech and language skills, respectively. The results of the study suggested that children implanted between 0 and 2 years of age demonstrated better performance in all tasks including audition, speech perception and intelligibility as well as speech and language when compared to the other two older groups. Children implanted between 0 and 2 years reached target milestones early in life similar to their hearing peers. However, children between (2.1- 4 years) also performed well and results indicated that they could catch up with intensive training. The present study reestablished the findings that early implantation (0-2 years) facilitates optimal progress when compared to implantation at later ages within the age range of 0-6 years. It also facilitates parent counseling regarding the realistic expectations with reference to different ages of implantation.

Translation in Ukrainian and adaptation of the English questionnaires: scales of meaningful auditory integration (MAIS) and scales of meaningful language use (MUSS) scales for assessing language development in children with deafness after cochlear implantation

Introduction: The world community is concerned with the assessment of the speech and hearing development of children with sensorineural deafness after cochlear implantation, since the most important result of rehabilitation is the success of social integration of such children. In most countries of the world, the Meaningful Auditory Integration Scale (MAIS) and the Meaningful Use of Language Scale (MUSS) are used to assess the auditory and language integration of children with sensorineural hearing loss after cochlear implantation (CI). Unfortunately, in Ukraine there are still no Ukrainian questionnaires for assessing the auditory development of children with sensorineural hearing loss after cochlear implantation. The aim of our study was to translate MAIS and MUSS manuals into Ukrainian, to adapt and validate them culturally. Materials and methods: Materials for translation and cultural adaptation were English-language versions of the Meaningful Auditory Integration Scale (MAIS) and Meaningful Use of Language Scale (MUSS), developed by the Nottingham Group of Cochlear Implantation, which are recognized and recommended for use by all cochlear implant manufacturers. Results obtained: The evaluation consisted of the following stages: preparatory stage – collection and analysis of literature; translation of original texts from English into Ukrainian; reversed translation by an independent translator of Ukrainian text into English; collation of the translation and comparison with the original questionnaire by an independent linguist; Cognitive analysis; field-testing of textbooks translated into Ukrainian with a small group of children after the CI; corrections, final revision of translations to identify and correct any grammatical, orthographic and other errors. The Ukrainian version of the questionnaire demonstrated a high level of internal compliance, testability and validity. Conclusions: Given the considerable relevance and demand ability of the materials, the tests can be recognized as valid and recommended for use in cochlear implant rehabilitation process.

WYNIKI WSZCZEPIENIA IMPLANTU ŚLIMAKOWEGO U DZIECI Z NIEDOSŁUCHEM PRELINGWALNYM Z NIEPRAWIDŁOWYMI WYNIKAMI PRZEDOPERACYJNYCH BADAŃ OBRAZOWYCH

BackgroundIn pediatric patients who are about to undergo cochlear implantation, preimplantation imaging to assess any abnormality in the inner ear or brain is crucial. The literature has shown that inner ear malformation affects auditory and speech development. The objective of this study was to analyze the outcomes of cochlear implant (CI) in children with abnormal imaging findings.Material and methodsAll children had undergone high resolution computed tomography (HRCT) of the temporal bone and magnetic resonance imaging (MRI) of the internal acoustic canal and brain as part of routine preimplantation evaluations. Outcomes of CI were measured using Category of Auditory Performance II (CAP-II) and Meaningful Auditory Integration Scale (MAIS).ResultsThere were 25 patients who initially underwent unilateral CI, but 2 patients were excluded, leaving 23 patients in the study. There were 4 patients who had inner ear malformations and another 3 presented with brain findings, while the remaining 16 children had normal findings. In both prelingual hearing impaired children with abnormal and normal imaging findings, there were significant improvements in CAP-II score following CI (p = 0.020 and p = 0.002, respectively). Similarly, there were statistically significant in MAIS scores in prelingual hearing impaired children with abnormal imaging (p = 0.017) as well as with normal imaging (p = 0.001). However, when comparing the CAP-II and MAIS scores between children with normal and abnormal imaging, there were no significant differences observed (p = 0.624 and p = 0.376, respectively).ConclusionsThis study demonstrated that prelingually hearing impaired children with abnormal HRCT and MRI findings gained benefits from CI. Therefore, abnormal imaging findings should not be a limiting factor in CI candidacy.

Children with Auditory Brainstem Implant: How Do They Perform in Motor and Language Skills?

Background: Young children are able to explore new objects and practice language through the acquisition of motor skills that lead to their overall development. Congenital hearing loss and total vestibular loss may contribute to the delay in speech and motor skill development. Objectives: To investigate the relationship between motor development performance, speech perception, and language performance in children with auditory brainstem implant (ABI). Method: Ten children, aged 4–17 years (mean age 9.76 ± 4.03), fitted with unilateral ABI for at least 2 years due to the presence of labyrinthine aplasia and rudimentary otocyst at least 1 side were included in the study. Several standardized tests, such as Bruininks-Oseretsky Motor Proficiency Test-2 (BOT-2), Children’s Auditory Perception Test Battery, Meaningful Auditory Integration Scale (MAIS), and Test of Early Language Development-3, were performed to evaluate their skills of fine motor control, balance, manual dexterity, language, and auditory perception. Results: A significant correlation was established between the BOT-2 manual dexterity and MAIS scores (r = 0.827, p < 0.05) and between the manual dexterity and language skills (for expressive language, r = 0.762, p < 0.05; for receptive language, r = 0.650, p < 0.05). Some of the BOT-2 balance tasks, such as standing on 1 leg on a line with eyes closed, standing on 1 leg on a balance beam with eyes open, standing heel-to-toe on a balance beam, and walking forward heel-to-toe on a line, showed a strong correlation with their receptive and expressive language performance (p < 0.05). Conclusion: The current study has indicated that significantly poor manual and balance performances are associated with poor speech perception and language skills in children with ABI. The authors recommend performing a vestibular assessment before and after ABI surgery and the use of a holistic rehabilitation approach, including auditory and vestibular rehabilitation, to support development of the children with ABI.

Waardenburg syndrome as a challenging experience in pediatric cochlear implantation

Background Waardenburg syndrome (WS) is a major cause of symptomatic sensorineural hearing loss, which accounts for 2–5% of patients with congenital hearing loss. Cochlear implantation (CI) has shown improvement in auditory perception and language skills of syndromic sensorineural hearing-impaired children and is now accepted as a gold standard treatment. Aim The aim of the present study was to evaluate the outcome of CI in cases with WS and to compare the results with nonsyndromic CI cases. Participants and methods A total of 268 children of less than 7 years of age underwent CI in the National Hearing and Speech Institute, and of these, six children, as group A, had WS, whereas the control group, as group B, consisted of 16 congenitally deaf children without any other comorbidities or inner ear anomalies. The following assessments were done: intraoperative impedance and auditory response threshold, and then at 3 and at 12 months, impedance, aided average pure tone threshold, Meaningful Auditory Integration Scale questionnaire, LittlEARS Auditory Questionnaire, and language assessment using modified Arabic preschool language scale-4. Results Intraoperative impedance, auditory response threshold, and neural response impedance were measured. Aided free field response at 500–4000 kHz and speech detection threshold were measured for both groups at 3 and 12 months after initiation. There was no statistically significant difference between both groups at all measured parameters. Meaningful Auditory Integration Scale questionnaire, LittlEARS Auditory Questionnaire, and language assessment using modified Arabic preschool language scale-4 revealed improvements in speech perception and production; however, comparison of the results between the WS group and the control group was insignificant. Conclusion CI is a good rehabilitation option for children with WS. The study indicates that children with WS benefit from CI similar to typically developing CI children.

Modification and verification of the Infant\u2013Toddler Meaningful Auditory Integration Scale: a psychometric analysis combining item response theory with classical test theory

BackgroundEarly prelingual auditory development (EPLAD) is a fundamental and important process in the speech and language development of infants and toddlers. The Infant–Toddler Meaningful Auditory Integration Scale (ITMAIS) is a widely used measurement tool for EPLAD, however it has not yet undergone a comprehensive psychometric analysis. The aim of this research was to modify and verify the psychometric properties of ITMAIS using a combination of Item Response Theory (IRT) and Classical Test Theory (CTT).MethodsStage 1—1730 children were retrospectively recruited to enable the application of an IRT model, specifically the graded response model, to modify the ITMAIS. Stage 2—another 450 infants and toddlers with normal hearing or permanent hearing loss before auditory intervention were recruited to verify the psychometric properties of the modified ITMAIS (ITMAIS-m) using the CTT method.ResultsUsing the metric of the graded response model, by removing item 2 from the ITMAIS, ITMAIS-m demonstrated discrimination parameters ranging from 3.947 to 5.431, difficulty parameters from − 1.146 to 1.150, item information distributed between 4.798 and 9.259 and a test information score of 48.061. None of the items showed differential item functioning. ITMAIS-m was further verified in Stage 2, showing Cronbach’s α of 0.919 and item-total correlations ranging from 0.693 to 0.851. There was good convergent validity of ITMAIS-m with other auditory outcome measure (r = 0.932) and pure tone average thresholds (r ranging from − 0.670 to − 0.909), as well as a high ability to discriminate between different hearing grades (Cohen d ranging from 0.41 to 5.83).ConclusionsThe ITMAIS-m is a reliable and valid tool for evaluating EPLAD in infants and toddlers, which can be efficiently and precisely applied in clinical practice. The combined use of IRT and CTT provides a powerful means to modify psychometrically robust scales aimed at childhood auditory outcome measurements.

Auditory, Speech and Language Development in Cochlear Implant Children: A One Year Longitudinal Study.

The advent of Cochlear Implants (CI) has bought with it, the goal of spoken language performance for severe-profound sensori-neural hearing loss (SNHL) as par with the normal hearing listeners. The aim of this study was to evaluate the outcome of paediatric cochlear implantation in auditory and speech skills below the age of 5years. The present study consisted of 50 childrens. Auditory skills were assessed in terms of audiometric thresholds and localization abilities. Speech - Language skills were measured using; Categories of Auditory Performance -CAP; Meaningful Use of Speech Scale - MUSS; Meaningful Auditory Integration Scale - MAIS and Speech intelligibility Rating - SIR. Hearing thresholds obtained from all the subjects for pre implant and post implant conditions of 3rd, 6th, 9th, 12th month conditions, evidenced a high significant (p < 0.001) improvement across all test frequencies 500, 1000, 2000 and 4000Hz. There was also a statistically significant difference across successive measurements of auditory and speech skills, as determined by ANOVA (F (4, 245) = 151.33, p < 0.001 for CAP; F (4, 245) = 89.636, p < 0.001 for SIR; F (4, 245) = 812.282 p < 0.001 for MAIS and F(4, 245) = 435.677 p < 0.001 for MUSS). Auditory localization abilities were also improved considerably over a period of one year. The present study added the evidence to the literature that cochlear implants significantly improved the hearing ability of children with severe-to-profound hearing loss. This study also demonstrated that, children were better able to make use of the auditory information perceived through the implant.

Bimodal Stimulation in Children With Bilateral Profound Sensorineural Hearing Loss: A Suitable Intervention Model for Children at the Early Developmental Stage.

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

Factors affecting outcome of cochlear implant: an observational study

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Aim and objectives of the study was to evaluate various factors affecting outcome in cochlear implant surgery.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A hospital based retrospective observational study in which 51 patients who underwent cochlear implant surgery from July 2017 to January 2019 were evaluated at Dr. Babasaheb Ambedkar Memorial Hospital, Byculla, Mumbai using 3 parameters i.e. Revised CAP score (CAP), meaningful auditory integration scale (MAIS), speech intelligibility rating (SIR) at various intervals postoperatively and outcome was evaluated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;It was found that the postoperative mean scores in all age groups were comparable but not significant at 3, 6 and 9 months interval while the difference was statistically significant at 12 and 24 months interval post implantation with less than 2 years age group performing better than other age groups patients with less than 2 years duration of auditory deprivation, the mean scores were found to be statistically significant at 12 and 24 months implantation Relationship to common causes such as prenatal infections, low birth weight, prolonged labour, hyperbilirubinemia, meningitis and consanguineous marriage were considered but not significant. No significant difference was observed in parent’s education level, urban-rural population to the outcome of cochlear implantation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Two most important factors that affect the outcome cochlear implantation are the age at implantation and the duration of auditory deprivation. Other factors are important but not significant and do not affect the outcome significantly.&lt;/p&gt;

Audiological Performance in Children with Inner Ear Malformations Before and After Cochlear Implantation: A Cohort Study of 274 Patients.

Inner ear malformations (IEMs) are common in children with hearing loss. The different types of IEMs form a unique subgroup of cochlear implant (CI) candidates. We aimed to evaluate the auditory perception outcomes of CI in children with different types of IEMs and compare them with CI users without IEMs. The study included 274 CI users with and without IEMs as two groups (n=137, each). Both groups' chronological age at implantation and duration of CI usage was matched (± 8months). All subjects were evaluated pre-operatively and post-operatively by the Ling's sound test and the auditory perception test battery, which includes the Meaningful Auditory Integration Scale (MAIS), closed-set Pattern Perception Test (PPT) and open-set Sentence Recognition Test (SRT). Besides, children with IEMs were assessed for language development. Progress in the IEMs' group differed according to the type of ear anomaly. CI users with enlarged vestibular aqueduct had the highest scores, while users with common cavity had the lowest. Children with IEMs performed well on the closed-set test while having difficulty with the open-set test. Cochlear implantation outcomes are favourable in IEMs' patients with a cochlear nerve visible on magnetic resonance imaging. Our results indicate that it is critical to take the anatomical differences into account during follow-up and rehabilitation programmes. Each CI user should be evaluated according to his or her individual needs.

Long-term evaluation of development in patients with bilateral microtia using softband bone conducted hearing devices

ObjectiveThe ability of early intervention with softband bone conducted hearing device (BCHD) to ensure normal development of speech, language and psychosocial situations remains undetermined. We aimed to evaluate auditory and speech development, as well as psychosocial situations of children with bilateral microtia fitted with a softband BCHD for 3–5 years. MethodsThe study included 53 patients with bilateral microtia and 53 sex- and age-matched children with normal hearing. Auditory development was evaluated using the Meaningful Auditory Integration Scale (MAIS) and Categories of Auditory Performance (CAP). Speech Intelligibility Rating (SIR) and Meaningful Use of Speech Scale (MUSS) were used to assess speech development. The psychometric properties of these patients were evaluated using Achenbach's Child Behavior Checklist (CBCL), and subjective benefits were measured using the Glasgow Children's Benefit Inventory (GCBI) questionnaire. ResultsThe average unaided and aided hearing thresholds measured using VRA were 73.8 ± 5.1 dB HL and 30.5 ± 6.0 dB HL, respectively. The total MAIS scores of the patients were 89.6 ± 9.6% and 93.0 ± 8.8% of normal hearing children at the last follow-up. The CAP scores of the two groups were 6.5 ± 1.3 and 6.9 ± 0.3, respectively. The mean MUSS score of the patients and the control group were 31.9 ± 7.0 and 34.3 ± 6.0, respectively. The mean SIR score of the two groups were 4.6 ± 0.7 and 4.8 ± 0.4. CBCL found that only two patients could be considered problematic psychosocially. The average benefit score on the GCBI was 32.9 ± 29.3. ConclusionsSoftband BCHD significantly improved auditory development in patients with bilateral microtia, with speech development reaching the level of normal hearing peers. No significant behavioral problems were found in the patients, with subjective evaluations showing that softband BCHD improved patient quality of life.

Effects of 'Perinatal Risk Factors Associated with Hearing Loss' on Auditory Outcomes in Cochlear Implant Recipient Children.

Cochlear implantation (CI) is used for rehabilitation of children with bilateral severe to profound permanent childhood hearing loss (PCHL). Recently, treatment of such children has been influenced by diagnostic technological advances. Children with perinatal risk factors associated with PCHL can undergo CI. The primary aim of this study was to determine the effects of 'perinatal risk factor associated with PCHL' on post-CI auditory outcomes. In this prospective study at a tertiary care centre we evaluated 50 cochlear implanted children from October 2011 to March 2013. The case group consisted of 6 (12%) children who had presence of 'perinatal risk factor associated with PCHL' and control group consisted of 44 (88%) children without any 'perinatal risk factor associated with PCHL'. All patients received auditory and speech rehabilitation and we evaluated their auditory perception outcomes by categories of auditory performance (CAP) and meaningful auditory integration scale (MAIS) scores at 1year post-CI. There were significantly decreased mean MAIS scores (decrease of 8.6%) and mean CAP scores (decrease of 6.7%) in CI recipient children with 'perinatal risk factor associated with PCHL' as compared to those who were without any 'perinatal risk factor associated with PCHL' at 1year after CI. However, in children with 'perinatal risk factor associated with PCHL', mean CAP & MAIS scores (auditory perception outcomes) were still more than 80% of maximum achievable CAP & MAIS scores. In this study, CI recipient children who were without any 'perinatal risk factor associated with PCHL' had significantly better mean MAIS & CAP scores (auditory perception outcomes) 1year post-CI. However, even in children who had 'perinatal risk factor associated with PCHL', there was substantial improvement in auditory perception outcomes at 1year post-CI and CI was still helpful in these children. Hence, knowledge of 'perinatal risk factor associated with PCHL' can provide reasonable help in predicting the auditory perception outcome and optimal counselling of families of CI candidates.

Correlation of cochlear nerve cross-sectional area and auditory performance after cochlear implantation in prelingual children with bilateral profound hearing loss

ObjectiveTo assess whether cochlear nerve (CN) cross-sectional area as measured with parasagittal magnetic resonance imaging (MRI) in prelingual pediatric deaf patients correlates with auditory performance after cochlear implantation. Study designProspective Cohort study. MethodsThirty-two prelingual children with bilateral profound sensorineural hearing loss (SNHL) who received unilateral cochlear implant were included in this study. Diameters of CN at Internal auditory canal (IAC) fundus and mid-point of IAC were retrospectively measured on parasagittal images of FIESTA (Fast Imaging Employing Steady-state Acquisition) sequence MRI by two independent observers. Cross-sectional areas [π (Height/2) (Width/2)] were then correlated with post-operative CAPS (Categories of Auditory Performance) and IT-MAIS (Infant-Toddler Meaningful Auditory Integration Scale) scores regularly assessed at 3 monthly intervals post device activation. ResultsThe cochlear nerve was identified in all the 32 patients. Mean cross-sectional areas (CSA) of cochlear nerve were 0.71 ± 0.16 mm2 at IAC fundus and 0.73 ± 0.18 mm2 at mid-point of IAC. The correlation value between CSA at mid-point of IAC and CAPS score at 6 months was 0.271 (p-value- 0.140) and correlation value between CSA at mid-point of IAC and IT-MAIS score at 6 months was 0.282 (p-value- 0.124) which were statistically not significant. ConclusionThere was no significant correlation between the cross-sectional areas of the cochlear nerve on MRI and postoperative auditory scores as measured by CAPS and IT-MAIS scores at six months from the device activation. Hence, we conclude that above an adequate diameter, which can affect the minimum required neurons, the changes in the diameter do not have significant bearing on auditory outcomes after cochlear implantation.

Application of the new SMS system of cochleovestibular anomalies: our experience with nine cases of type III anomaly.

To present and analyse the radiological findings, surgical findings, pre-implantation and post-implantation speech and hearing outcomes of nine children with SMS Type III cochleovestibular malformation. Retrospective case series of nine children with pre-lingual profound sensorineural hearing loss who underwent cochlear implantation (Jan 2012 to July 2019). These children had been classified as Type III malformation according to theSMS Classification of cochleovestibular anomalies. Facial nerve anomalies, CSF leaks and any other significant surgical finding were noted. Meaningful Auditory Integration Scale (MAIS) was used to report the child's pre-operative and two-year post-implantation auditory and speech abilities. Any significant improvement was assessed using the Wilcoxon signed rank test. P value < 0.05 was considered significant. Out of nine patients, five patients sustained CSF gushers, while three patients had mild CSF leak, which were plugged adequately. No facial nerve anomalies were encountered. Post-op course was uneventful for all nine patients. MAIS scores at a two-year follow-up showed significant statistical improvement (P < 0.05) when compared to pre-operative scores. Cochlear implant is the treatment of choice for children with type III cochleovestibular malformation. There are significant auditory and speech improvements expected. However, the surgeon should bear in mind the risk of CSF leak and subsequent meningitis.

Clinical evaluation of cochlear implantation in children younger than 12 months of age.

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

A Retrospective Clinical Audit of Outcomes of Cochlear Implantation in Children with Multiple Disabilities in Comparison with Normal Implantees: A South Indian Experience

AimsCochlear implantation (CI) is established as a standard remedy for children with congenital bilateral profound hearing loss to attain hearing perception and thereby develop speech and language. A subgroup includes children with multiple disabilities in whom the implant helps to improve their quality of life and also of their families via enhanced communication skills. Cochlear implants today form an integral part of their multi-handicap rehabilitation process.Material and MethodsA retrospective cohort study was carried out on children with and without multiple handicaps who have received cochlear implantation at the cochlear implant clinic of MERF, Chennai, India over the past decade. Category of Auditory Performance (CAP) scores, Speech Intelligibility Rating (SIR) scores, and also Meaningful Auditory-Integration Scale (MAIS) and Meaningful Use of Speech Scale (MUSS) scores were compared at set time frequencies of 6 months and 12 months post-implantation between the two groups of implanted children.ResultsAll the four CAP, SIR, MAIS and MUSS scores showed improvement over time with auditory and speech therapy in both groups of children as reflected by the improvement in their quality of life. The normative group of implantees showed better improvement compared to the group of children with multiple disabilities.ConclusionIntensive habilitation is essential especially for children with multiple disabilities who have received cochlear implantation in which their special needs are addressed individually and optimised for the best outcome. The study shows that restoration of the special sense of hearing helps as a remedy to alleviate their other multi-handicaps to a notable extent.

Auditory and language skills in children with auditory brainstem implants

ObjectiveThe aim of this study is to characterize the development of auditory and language skills in children during the first 3 years of auditory brainstem implant (ABI) use. MethodIt is a retrospective longitudinal analysis of auditory and language skills in 12 children and pre-adolescents with pre-lingual deafness following ABI surgery (mean age at surgery: 4 years; age range: 2–11 years). Responses were analyzed aboutInfant Toddler Meaningful Auditory Integration Scale (IT-MAIS), MAIS, and Meaningful Use of Speech Scale (MUSS) at 1, 3, 6, 12, 18, 24, and 36 months after ABI activation. ResultsMaximum IT-MAIS/MAIS and MUSS scores after 3 years of ABI use were 45.35% and 35.28%, respectively. ConclusionPediatric patients exhibit slow progressive development of auditory and language skills following ABI activation.