Pediatric Cochlear Implantation Research Articles

A Study to Determine Various Factors Influencing Auditory Outcomes in Paediatric Cochlear Implantation.

To evaluate various factors that affects the auditory outcomes in pediatric patients with bilateral profound sensorineural hearing loss who underwent unilateral cochlear implantation. 50 prelingually deaf pediatric patients aged between 1 and 6years with bilateral profound sensorineural hearing loss who underwent unilateral cochlear implantation between January 2016 and June 2018 at our tertiary centre were included in this study. Auditory performance was measured using revised categories of auditory performance score at 1year post cochlear implantation. A Statistical analysis of several factors was performed to reveal any significant relation with outcomes of cochlear implantation. The results of the study showed that patients with younger age at implantation, patient who used hearing aid prior to surgery and patients with normal cochlear morphology had better auditory outcomes post cochlear implantation than their counter group and are the factors which have positive effect on the cochlear implantation outcomes, whereas factors which did not showed any significant relation with the auditory outcomes of cochlear implantation are gender, consanguinity and birth hypoxia. Age at implantation, use of hearing aid prior to surgery and cochlear morphology are the factors with direct impact on the outcomes of cochlear implant.

Risk Factors and Management of Postoperative Infection Following Cochlear Implantation.

To determine factors associated with infection, management, and resultant outcomes following pediatric cochlear implantation. Retrospective cohort study with nested case series. Tertiary academic medical center. Children who underwent either unilateral or bilateral cochlear implantation between June 2011 and September 2016 and were under the age of 18 at the time of surgery. Subjects were compared based on age, cochlea malformation, revision surgery, operative time, device manufacturer, and antibiotic use. Infections were compared based on location, time, bacteria, management, and resolution. Rate of infection, rate of device explantation. There were 16 infections among 246 surgeries, an infection rate of 6.5%. There was a significant age difference between infected and noninfected patients overall (n = 246, 1.4 versus 4.3 years, p = 0.005), but not within the cohort of patients five or younger (n = 172, 1.4 versus 1.8 years, p = 0.363). The most common infectious complication was skin infection, followed by device infection. No cases of meningitis were seen. The most common organism was S Aureus. The implant was salvaged in 9 of 16 patients (56.3%), with higher rates in patients treated with IV versus oral antibiotics (70 versus 40%). Postoperative infection is positively associated with younger age overall, but not in patients below the age of 5. With modern devices and surgical practices, risk of meningitis-though a concern-may be lower than cited in the literature. Prompt and aggressive therapy with IV antibiotics and operative intervention can allow for high rates of device salvage.

The feasibility, validity and reliability of a child friendly vestibular assessment in infants and children candidates to cochlear implant

ObjectivesThe pediatric vestibular assessment has developed significantly in the past two decades, especially in terms of assessment of cochlear implant (CI) candidates. Different methods and test protocols have been applied, however without a general consensus. We present here the feasibility, validity and reliability of a child friendly vestibular testing in use at our department for the assessment of pediatric CI candidates. MethodsThe test battery consisted of head impulse test (HIT), video head impulse test (vHIT), cervical evoked myogenic potentials (cVEMP) and mini ice water caloric test (mIWC), all adapted from previous methods, mentioned in literature. We defined specific criteria for test feasibility, for test validity and test positivity (i.e. indicating vestibular insufficiency). The reliability of the whole protocol was assessed with test agreement analysis. ResultsComplete data from 35 children, all CI candidates, age ranging 4–79 months (67% under 2 years) and recruited over two years, were obtained. All but one child could complete at least one test with valid responses bilaterally, with the best compliance for HIT (97,1%) and least for cVEMP (68,6%). Feasibility did not appear to be affected by age or hearing loss etiology. Among the valid responses there was a substantial test agreement between HIT and vHIT, moderate agreement between vHIT/HIT and mIWC and no apparent agreement between the canal tests and cVEMP. Simple clinical guidelines were introduced to solve the tests’ disagreement and to improve the protocol reliability: a) a pathological response had to be confirmed in at least two different canal tests and in at least three cVEMP trials; b) a canal/otolith disagreement was interpreted as a partial vestibular loss to be opposed to a complete vestibular insufficiency. ConclusionsThe search for vestibular insufficiency in infants and young children can be attained with an opportunely adapted vestibular assessment, such the test battery proposed here. That assessment resulted easy to conduct and to interpret in a representative sample of CI candidates in preschool age, the most of whom were younger than 2 years. This method appears to particularly suit the demands of a vestibular assessment in young children CI candidates.

Novel Variants in Hearing Loss Genes and Associations With Audiometric Thresholds in a Multi-ethnic Cohort of US Patients With Cochlear Implants.

To investigate novel variants in hearing loss genes and clinical factors affecting audiometric outcomes of cochlear implant (CI) patients. Approximately 50% of hearing loss has a genetic etiology, with certain genetic variants more prevalent in specific ethnic groups. Different variants and some clinical variables including inner ear malformations result in different prognoses or clinical outcomes after CI. Medical and genetic testing records of pediatric CI patients were reviewed for clinical variables. Minor allele frequencies of variants were obtained from Genome Aggregation Database (gnomAD) and variants were classified for pathogenicity. Standard statistical testing was done using Fisher's exact, Wilcoxon, and Spearman correlation tests. Eighteen CI patients with genetic test results had pathogenic variants, including six patients with syndromic hearing loss and six patients with known GJB2 variants. Novel pathogenic variants were noted in CHD7, ADGRV1, and ARID1B, with variants in the latter two genes identified in Hispanic patients. Overall, carriage of genetic variants was associated with better pre-CI audiometric thresholds at 2000 Hz (p = 0.048). On the other hand, post-CI thresholds were significantly worse in patients with inner ear malformations, particularly in patients with atretic cochlear nerve canals. Four novel pathogenic variants were identified, which contributes to knowledge of allelic spectrum for hearing loss especially in Hispanic patients. In this cohort, carriage of pathogenic variants particularly of GJB2 variants was associated with better pre-CI audiometric thresholds, while patients with inner ear malformations had worse post-CI audiometric thresholds.

Cochlear Implant Nonuse: Insight from Deaf Adults.

Research examining the outcome of pediatric cochlear implantation consists of certain limitations, including the use of assessments that are often restricted to auditory-spoken skills, biased recruitment practices, and lack of consideration for identity development. To better understand the long-term outcome of implantation, it is vital to seek out individuals who decide to stop using their device and elicit feedback related to their decision. Thus, 11 adults, who were past cochlear implant (CI) users, were interviewed to gain insight into factors that had led to their decision regarding cochlear implant nonuse. Results indicated several variables to have played a role, but the most prominent factors were limitations in postimplant auditory perceptual development and development of a d/Deaf identity. Although cochlear implant practices and technology have improved over the past few decades, we need to recognize the continued variability in outcome to ensure the provision of the most accurate information and appropriate services.

Long-term Change in the Speech Perception Ability in Pediatric Cochlear Implants and the Effect of the Age at Implantation.

We analyzed the long-term changes in speech perception ability of pediatric cochlear implants (CIs) to evaluate the effect of the age at the time of surgery. Retrospective. Tertiary care academic center. One hundred fourteen prelingually deaf children with CI use duration >10 years. Categories of auditory performance (CAP) scores and monosyllabic word recognition scores using the Asan-Samsung Korean word list (ASK-WRS) and a conventional word list (KS-WRS) were the main outcomes. Outcomes were compared according to the age at surgery (group I, 1-2 yr; II, 2.1-3 yr; III, 3.1-7 yr; IV, 7.1-13 yr). CAP scores reached plateaus at 2.6 to 3.3 years post-CI; groups I to III showed better scores than group IV. The maximum CAP score was obtained in all children of groups I to III and in 65% of group IV. ASK-WRSs reached plateaus at 3.2 to 4.8 years post-CI. Younger patients at CI operation showed better ASK-WRSs (97, 93, 90, and 54% in groups I-IV, respectively), but the differences were not significant (I versus II and II versus III). Ceiling effect (perfect score) was observed in early groups (67, 44, 30, and 0% in groups I-IV). KS-WRSs, which is a challenging test, reached plateaus at 7.2 to 8.4 years postsurgery with no ceiling effect. Early implantees showed significantly better scores (88, 82, 73, and 46% in groups I-IV). Speech perception ability after CI showed audiological age-specific improvement evaluated by various test methods. The most challenging test demonstrated long-term performance differences by the age at CI operation.

From Bimodal Hearing to Sequential Bilateral Cochlear Implantation in Children-A Within-Subject Comparison.

To evaluate the performance changes after sequential bilateral cochlear implantation in a pediatric population of bimodal cochlear implant (CI) users. To evaluate the factors which influence the parental and recipient decision to discontinue hearing aid use and seek a second implant. Retrospective case review, within-subject comparison. Tertiary referral center. Thirty-one pediatric (<18 yr) bimodal CI users who underwent sequential bilateral CI. Sequential bilateral CI. Parental and/or recipient's reasons for discontinuing their hearing aid and pursuing a second implant, device usage from datalogs, speech understanding in the bimodal and bilateral CI condition. Parents/patients were motivated to pursue sequential bilateral CI based on their positive performance with CI1, the expectation of further improvement with a second CI, and the prospect of having a second independently functional ear. In the bimodal condition, mean word recognition score (WRS), sentence recognition in quiet (SIQ), and sentence recognition in noise (SIN) scores were 87.4, 97.3, and 92.9% respectively. At 1-year post-sequential bilateral CI, the mean WRS, SIQ, and SIN score were 92.7, 98.7, and 97.7%, respectively. The improvement in bilateral CI speech scores compared with bimodal scores was statistically significant for WRS (p = 0.015). A ceiling effect limited the ability to detect further meaningful differences on speech perception testing. The bilateral CI condition demonstrates equivalent or slightly superior performance compared with the bimodal condition. Several non-speech benefits were elicited from parents as reasons for pursuing a second implant. Close monitoring of the residual acoustic hearing, inquiring about the perceived benefits provided by the HA, and early counseling regarding the potential for sequential bilateral CI are important aspects in determining if and when a second implant is indicated.

High Electrode Impedance Values in Pediatric Cochlear Implant Recipients May Imply Insufficient Auditory and Language Skills Development.

Background: Measurements of electrode impedance values are routinely performed after cochlear implantation. The primary objective of the study was to determine if pediatric, prelingually deafened patients with different postoperative performances showed significantly different impedance values one year after implantation. Methods: This study comprised 42 pediatric cochlear implant recipients provided with the device in a single academic tertiary referral center between 1 January 2000, and 31 December 2016. Medical chart analysis was performed in order to assess evolution of impedance values during the first postoperative year on a monthly basis. Electrode impedance values measurements one year postoperatively were compared between children with successful and unsuccessful auditory and language skills development assessed using the EARS protocol (a name of a performance test). Furthermore, values were compared among recipients of different implant types and among different cochlear segments. Results: A gradual rise of average impedance values was found during the first months of implant use (1st month, 7.32 kΩ; 3rd month, 7.86 kΩ) with the peak at the 4th postoperative month (7.96 kΩ), followed by a gradual decrease towards the 12th month (6th month, 7.62 kΩ; 12th month, 6.86 kΩ). Lower values at the 12th postoperative month were observed in recipients with successful development compared to patients presented with unsuccessful development (6.22 kΩ vs. 7.82 kΩ; p = 0.001). Mean impedance values were different when compared among cochlear segments and among different implant types. Conclusion: High electrode impedance values one year after implantation in pediatric patients may imply insufficient auditory and language skills development. Further studies are needed in order to validate our results.

Electrode Array Type and Its Impact on Impedance Fluctuations and Loss of Residual Hearing in Cochlear Implantation.

Determine variables associated with electrode impedance fluctuations and loss of residual hearing in cochlear implant (CI) recipients. CI recipients with postoperative hearing preservation demonstrate superior speech perception with an electric-acoustic stimulation (EAS) device as compared with a CI-alone device. Maintaining superior speech perception over time relies on long-term hearing preservation; therefore, understanding variables that may contribute to loss of residual hearing is needed. Recent reports suggest a relationship between changes in electrode impedance and loss of residual hearing. The variables influencing this relationship have yet to be determined. Review of pediatric and adult CI cases from 2013 to 2016 who presented with preoperative residual hearing. Regression analysis was performed to evaluate effects of array type (lateral wall vs. perimodiolar), manufacturer, age at implantation, and preoperative hearing on impedance. The correlation between peak impedance change and change in low-frequency hearing was determined. One hundred forty-six CI recipients presented with preoperative residual hearing. A multivariate regression analysis demonstrated a statistically significant association between preoperative hearing thresholds (p = 0.017), device manufacturer (p = 0.011), and array type (p = 0.038) on postoperative impedance changes. Hearing preservation rates and change in impedance differed by electrode array type. The association between peak impedance changes and loss of residual hearing differed between manufacturers (R = 0.208, p = 0.029 vs. R = 0.016, p = 0.609). Impedance fluctuation appears to be a marker for loss of residual hearing for specific electrode array types and manufacturers. Specific arrays may affect the cochlear microenvironment differently, with different effects on postoperative hearing preservation.

A survey of pediatric cochlear implant recipients as young adults

ObjectivesTo identify the influence of pediatric cochlear implantation on long term communication modality, education, and income. MethodsA telephone survey was conducted with 56 young adults who had received cochlear implants (CI) as children. The participants were, on average, 10.6 (SD = 64) when they received their CI and 21 (SD = 2.29) when they participated in this study. All of the participants used a unilateral CI at the time of the survey. Where applicable, survey results were compared to the general population of similar aged individuals in Ontario using chi-squared tests of proportionality. ResultsParticipants (49/56, 88%) indicated that they used their CI all waking hours and 75% (42/56) reported using spoken language as their primary mode of communication. They attended post-secondary school at higher rates than the general population (χ2(1) = 14.35, p < .001); a wide range of study areas were identified with a greater proportion involved in fine arts than the general population (χ2(1) = 25.50, p < .001). The rates of employment in this group were below general rates (χ2(1) = 21.87, p < .001). However, those who were employed reported salaries similar to their hearing peers. ConclusionThe findings from this study suggest that young adults who received a unilateral CI in childhood typically continue to use their CIs to support spoken language. Their increased rates of post-secondary education are encouraging and they may be choosing unique areas of study. Longer term studies are required to further investigate lower rates of employment in this cohort.

The impact of auditory nerve functional states on the correlations between human and computer decisions for electrically evoked compound action potential threshold

ObjectivesThe electrically evoked compound action potential (ECAP) is widely used in clinical to reflect the functional states of the auditory nerve in cochlear implant (CI) recipients, especially in pediatric CI users. Currently, the software can automatically provide the ECAP threshold, which is convenient and not affected by the subjective judgement of the clinicians. However, it remains unclear whether the correlations between human and computer decisions for ECAP threshold can be affected by auditory nerve functional states, which is also the main purpose of our present study. MethodsIntracochlear electrical stimulation, which can decrease the excitability of the auditory nerve, was used to change the auditory nerve functional states of guinea pigs. Ten normal-hearing guinea pigs were implanted with CIs unilaterally. ECAPs were recorded both before and after the electrical stimulation, representing different functional states of the auditory nerve. Forward masking (FwdMsk) and alternating polarity (AltPol), two most commonly-used artifact-reduction methods, were applied to the measurements. All measurements recorded by the software were saved for computer and human analysis with linear regression and visual detection methods. ResultsThe correlations between human and computer performance in the peak-picking process were not affected by auditory nerve states and artifact-reduction methods. However, complicated findings were observed for ECAP threshold. With FwdMsk utilized, weaker correlations between human and computer performance were observed in abnormal state compared to those in normal state. Regardless of the functional states of the auditory nerve, the results revealed stronger correlations in AltPol than those in FwdMsk. Furthermore, when compared with human decision, computer linear-regression threshold (C-LRT) was always less accurate than computer visual-detection threshold (C-VDT), which was not affected by auditory nerve states. Conclusions(1) the functional states of the auditory nerve can definitely affect the correlations between human and computer decisions for ECAP threshold, but the impact is limited to the FwdMsk method; (2) AltPol can produce stronger correlations compared with FwdMsk, which is not affected by auditory nerve states; and (3) regardless of the auditory nerve states, C-VDT can always show higher consistency with human decision, while C-LRT reveals more variability.

Machine Learning and Cochlear Implantation-A Structured Review of Opportunities and Challenges.

The use of machine learning technology to automate intellectual processes and boost clinical process efficiency in medicine has exploded in the past 5 years. Machine learning excels in automating pattern recognition and in adapting learned representations to new settings. Moreover, machine learning techniques have the advantage of incorporating complexity and are free from many of the limitations of traditional deterministic approaches. Cochlear implants (CI) are a unique fit for machine learning techniques given the need for optimization of signal processing to fit complex environmental scenarios and individual patients' CI MAPping. However, there are many other opportunities where machine learning may assist in CI beyond signal processing. The objective of this review was to synthesize past applications of machine learning technologies for pediatric and adult CI and describe novel opportunities for research and development. The PubMed/MEDLINE, EMBASE, Scopus, and ISI Web of Knowledge databases were mined using a directed search strategy to identify the nexus between CI and artificial intelligence/machine learning literature. Non-English language articles, articles without an available abstract or full-text, and nonrelevant articles were manually appraised and excluded. Included articles were evaluated for specific machine learning methodologies, content, and application success. The database search identified 298 articles. Two hundred fifty-nine articles (86.9%) were excluded based on the available abstract/full-text, language, and relevance. The remaining 39 articles were included in the review analysis. There was a marked increase in year-over-year publications from 2013 to 2018. Applications of machine learning technologies involved speech/signal processing optimization (17; 43.6% of articles), automated evoked potential measurement (6; 15.4%), postoperative performance/efficacy prediction (5; 12.8%), and surgical anatomy location prediction (3; 7.7%), and 2 (5.1%) in each of robotics, electrode placement performance, and biomaterials performance. The relationship between CI and artificial intelligence is strengthening with a recent increase in publications reporting successful applications. Considerable effort has been directed toward augmenting signal processing and automating postoperative MAPping using machine learning algorithms. Other promising applications include augmenting CI surgery mechanics and personalized medicine approaches for boosting CI patient performance. Future opportunities include addressing scalability and the research and clinical communities' acceptance of machine learning algorithms as effective techniques.

Pediatrik Koklear İmplantasyon Sonrası İletişim Becerilerinin Değerlendirilmesi Ölçeği'nin Türkçe Sürümünün Geçerlilik ve Güvenirlilik Çalışması

Pediatrik Koklear İmplantasyon Sonrası İletişim Becerilerinin Değerlendirilmesi Ölçeği'nin Türkçe Sürümünün Geçerlilik ve Güvenirlilik Çalışması

Comparison of the Pediatric Cochlear Implantation Using Round Window and Cochleostomy.

Introduction:Cochlear implantation (CI) is now regarded as a standard treatment for children with severe to profound sensor neural hearing loss. This study aimed to compare the efficacy of the round window approach (RWA) and standard cochleostomy approach (SCA) in the preservation of residual hearing after CI in pediatric patients.Materials and Methods:This double-blind randomized controlled trial was conducted on 97 pediatric patients receiving CI with 12-month follow-up. The study population was divided into two groups according to the surgical approaches they received, including RWA and SCA. Consequently, the patients were evaluated based on the Categories of Auditory Performance scale (CAP) and Speech Intelligibility Rating (SIR) test 45-60 days and 3, 6, 9, and 12 months post-surgery.Results:The CAP and SIR mean scores increased in both groups during the 12-month follow-up. This upward trend was significant in both groups (P<0.001). There was no significant difference between the two treatment groups in any of the follow-up stages regarding the CAP mean score. The mean SIR score (P=1.14±0.40) was significantly higher in the RWA group 3(P=0.001), 6(P=0.008), and 9(P=0.006) months after the surgery. However, there was no significant difference between the RWA and SCA groups, regarding 1-year SIR (P=0.258).Conclusion:The CI with either RWA or SCA could improve hearing and speech performance in pediatric patients. Although mid-term speech intelligibility was better for RWA, there was no significant difference in the 1-year outcome between these two methods.

Effect of Microphone Location and Beamforming Technology on Speech Recognition in Pediatric Cochlear Implant Recipients

Background: Despite improvements in cochlear implant (CI) technology, pediatric CI recipients continueto have more difficulty understanding speech than their typically hearing peers in background noise. Avariety of strategies have been evaluated to help mitigate this disparity, such as signal processing, remotemicrophone technology, and microphone placement. Previous studies regarding microphoneplacement used speech processors that are now dated, and most studies investigating the improvementof speech recognition in background noise included adult listeners only.Purpose: The purpose of the present study was to investigate the effects of microphone location andbeamforming technology on speech understanding for pediatric CI recipients in noise.Research Design: A prospective, repeated-measures, within-participant design was used to compareperformance across listening conditions.Study Sample: A total of nine children (aged 6.6 to 15.3 years) with at least one Advanced Bionics CIwere recruited for this study.Data Collection and Analysis: The Basic English Lexicon Sentences and AzBio Sentences were presentedat 0° azimuth at 65-dB SPL in +5 signal-to-noise ratio noise presented from seven speakers usingthe R-SPACE system (Advanced Bionics, Valencia, CA). Performance was compared across three omnidirectionalmicrophone configurations (processor microphone, T-Mic 2, and processor + T-Mic 2) andtwo directional microphone configurations (UltraZoom and auto UltraZoom). The two youngest participantswere not tested in the directional microphone configurations.Results: No significant differences were found between the various omnidirectional microphone configurations.UltraZoom provided significant benefit over all omnidirectional microphone configurations(T-Mic 2, p = 0.004, processor microphone, p &lt; 0.001, and processor microphone + T-Mic 2, p = 0.018)but was not significantly different from auto UltraZoom (p = 0.176).Conclusions: All omnidirectional microphone configurations yielded similar performance, suggesting thata child’s listening performance in noise will not be compromised by choosing the microphone configurationbest suited for the child. UltraZoom (adaptive beamformer) yielded higher performance than all omnidirectional microphonesin moderate background noise for adolescents aged 9 to 15 years. The implicationsof these data suggest that for older children who are able to reliably use manual controls, UltraZoom willyield significantly higher performance in background noise when the target is in front of the listener.

Use of intraoperative CT scanning for quality control assessment of cochlear implant electrode array placement*

Background: Imaging of cochlear implant (CI) electrode arrays (EAs) consists of intraoperative fluoroscopy to rule out tip fold-over and/or post-operative computerized tomography (CT) if concern exists regarding extrusion or misplacement of the EA. Intraoperative CT (iCT) can satisfy these current needs and enables specification of final intracochlear position.Aims/objectives: To describe iCT scanning of CI recipients at an academic medical center.Materials and methods: iCT was used to scan CI recipients within the operating room before recovering from general anesthesia.Results: In fiscal year 2019, 301 CI were placed (83 children, 218 adult). One hundred, seventy-five iCTs were performed (58% of total CIs) of which 52 were children (63% of pediatric CIs) and 123 were adult (57% of adult CIs). Of 7 CI surgeons, use of iCT ranged from 14% to 100% (mean 60%). Four tip fold-overs were identified and corrected intraoperatively. Surgeons reported using the images to improve technique (i.e. pulling back precurved EAs to improve perimodiolar positioning).Conclusion and significance: The current standard of care for CI is to insert EAs without feedback as to final location. iCT provides surgeons with rapid post-insertion feedback which allows detection and correction of suboptimally placed EAs as well as refinement of surgical technique.

Health-related quality of life in South African children who use cochlear implants

Objective: To describe health-related quality of life (HRQoL) outcomes of school-going paediatric cochlear implant (CI) recipients in a South African cohort from the perspectives of parents.Design: Parents of school-going CI recipients completed the Children with Cochlear Implants: Parental Perspectives (CCIPP) CI-specific HRQoL questionnaire. The effect of different demographic variables on HRQoL outcomes was also determined.Study sample: The study sample included 54 parents of school-going (mean age = 12.2 years; SD = 3.6; range = 6.6–18.3 years) CI recipients with at least six months CI experience.Results: Children’s communication and general functioning with a CI received the most positive parental ratings. Among a number of confirmed statistically significant (p < 0.05) associations between HRQoL outcomes and demographic variables, pre-lingual onset of deafness was linked to better HRQoL in terms of general functioning and well-being. While shorter duration of deafness and unilateral implantation were associated with higher parental ratings for self-reliance and well-being respectively, longer duration of CI use was linked to improved HRQoL outcomes in terms of general functioning.Conclusion: Parents assigned positive ratings to their child’s HRQoL. This exploration of children’s HRQoL related to their CIs contributes to evidence-based paediatric CI services that promote optimal psychosocial outcomes.

Effects of Early Acoustic Hearing on Speech Perception and Language for Pediatric Cochlear Implant Recipients.

Purpose The overall goal of the current study was to identify an optimal level and duration of acoustic experience that facilitates language development for pediatric cochlear implant (CI) recipients-specifically, to determine whether there is an optimal duration of hearing aid (HA) use and unaided threshold levels that should be considered before proceeding to bilateral CIs. Method A total of 117 pediatric CI recipients (ages 5-9 years) were given speech perception and standardized tests of receptive vocabulary and language. The speech perception battery included tests of segmental perception (e.g., word recognition in quiet and noise, and vowels and consonants in quiet) and of suprasegmental perception (e.g., talker and stress discrimination, and emotion identification). Hierarchical regression analyses were used to determine the effects of speech perception on language scores, and the effects of residual hearing level (unaided pure-tone average [PTA]) and duration of HA use on speech perception. Results A continuum of residual hearing levels and the length of HA use were represented by calculating the unaided PTA of the ear with the longest duration of HA use for each child. All children wore 2 devices: Some wore bimodal devices, while others received their 2nd CI either simultaneously or sequentially, representing a wide range of HA use (0.03-9.05 years). Regression analyses indicate that suprasegmental perception contributes unique variance to receptive language scores and that both segmental and suprasegmental skills each contribute independently to receptive vocabulary scores. Also, analyses revealed an optimal duration of HA use for each of 3 ranges of hearing loss severity (with mean PTAs of 73, 92, and 111 dB HL) that maximizes suprasegmental perception. Conclusions For children with the most profound losses, early bilateral CIs provide the greatest opportunity for developing good spoken language skills. For those with moderate-to-severe losses, however, a prescribed period of bimodal use may be more advantageous for developing good spoken language skills.

Effects of Age at Cochlear Implantation on Vocabulary and Grammar: A Review of the Evidence

Purpose The increasing prevalence of pediatric cochlear implantation over the past 25 years has left little doubt that resulting improvements in hearing offer significant benefits to language development for many deaf children. Furthermore, given the documented importance of access to language from birth, there has been strong support for providing congenitally deaf children with implants as early as possible. Earliest implantation, in many ways, has become the "gold standard" in pediatric cochlear implantation, on the assumption that it is the key to language development similar to that of hearing children. Empirical evidence to support this assumption, however, appears more equivocal than generally is believed. This article reviews recent research aimed at assessing the impact of age at implantation on vocabulary and grammatical development among young implant users. Method Articles published between 2003 and 2018 that included age at implantation as a variable of interest and in which it was subjected to statistical analysis were considered. Effect sizes were calculated whenever possible; we conducted a multivariate meta-analysis to compare outcomes in different language domains. Results Taken together, findings from 49 studies suggest that age at implantation is just one of a host of variables that influence vocabulary and grammatical development, its impact varying with several factors including whether age at implantation is treated as a dichotomous or continuous variable. Results from a meta-analysis showed significant differences across language domains. Conclusion The pattern of results obtained indicates the importance of considering various child, family, and environmental characteristics in future research aimed at determining how early "early implantation" needs to be and the extent to which age at implantation, duration of implant use, and other factors influence language and language-related outcomes. Supplemental Material https://doi.org/10.23641/asha.9789041.

Cost-effective analysis of unilateral cochlear implantation under the Taiwan national healthcare insurance

Objective: The value of cochlear implantation (CI) has not been established in Taiwan. The purpose of this study was to evaluate the cost-effectiveness of paediatric CI within the context of Taiwan’s national health insurance (NHI) programme.Design: A Markov model-based cost-utility analysis (CUA) was conducted to evaluate the cost-effectiveness of a unilateral CI (UCI) with a contralateral acoustic hearing aid (UCI-HA) compared with a bilateral HA. We performed one-way sensitivity analyses to identify the cost variables that affected the incremental cost-effectiveness ratio (ICER) the most. Monte Carlo simulation was used to explore the simultaneous effect of all uncertain parameters on cost-effectiveness.Study sample: Not applicable.Results: Compared with bilateral HAs, the ICER for UCI-HA was $6487 per quality-adjusted life year (QALY) gained. The ICERs were consistently below $7000 per QALY gained and were most sensitive to the selling price of the external CI device. When this selling price increased by 10%, the ICER of UCI-HA would increase to $6954 per QALY gained. UCI-HA has a probability greater than 50% of being cost-effective if the cost-effectiveness threshold exceeds approximately $10,000 per QALY.Conclusions: Our analysis suggested that within the context of Taiwan’s NHI programme, UCI is highly cost-effective for deaf children.