Young Cochlear Implant Recipients Research Articles

Cochlear implant-specific risks should be considered, when assessing the quality of life of children and adolescents with hearing loss and cochlear implants-not just cochlear implant-specific benefits-Perspective.

Cochlear implants (CIs) are electronic medical devices that enable hearing in cases where traditional hearing aids are of minimal or no use. Quality of life (QoL) studies of children and adolescents with a CI have so far focused on the CI-specific benefits. However, the CI-specific risks listed by the U.S. Food and Drug Administration have not yet been considered. From this list, medical and device-related complications, lifelong dependency on the implanted device, and neurosecurity risks (CI technology is an interface technology) may be particularly relevant for young CI users. Medical and device-related complications can cause physical discomfort (e.g., fever, pain), as well as functioning problems (e.g., in speech discrimination, social behavior, and mood). In the worst case, reimplantation is required. Clinical experience shows that these complications are perceived as a burden for young CI users. Furthermore, many young patients are worried about possible complications. Additionally, CIs can be at least a temporary burden when children, typically at the age of 8-9 years, realize that they need the CI for life, or when they become peer victims because of their CI. Concerning neurosecurity risks, it is still unknown how young CI recipients perceive them. In summary, CI-specific risks can be perceived as a burden by young CI users that impairs their QoL. Therefore, they should not be ignored. There is an urgent need for studies on this topic, which would not only be important for professionals and parents, but also for the design of CI-specific QoL instruments.

Quality of Life and Cochlear Implant: Results in Saudi Children.

ObjectiveTo assess the quality of life (QoL) in Saudi children with cochlear implants (CI) and determine sociodemographic and clinical factors that have an impact on the perceived QoL.MethodsA cross-sectional study is performed by comparing the QoL of Saudi toddlers and young CI recipients with normal children, using the Paediatric Quality of Life Inventory 4.0 - Generic core scale (PedsQLTM 4.0 - GCS). A self-administered questionnaire was sent to parents of paediatric patients, who had cochlear implantation at King Abdulaziz University Hospital (KAUH), from March 2016 to March 2018. Mothers of age-matched normal children who attended the obstetrics and gynaecology clinics at King Khalid University Hospital (KKUH), in November 2019 were considered as a control group.ResultsWhen children with CI and normal children PedsQLTM 4.0 - GCS subscales (physical, emotional, social, and school) and total functioning scores were compared, no single significant difference was noted between the groups. The sociodemographic and clinical factors that have an impact on the perceived QoL were: gender, birth order, and distance from the CI center. Emotional, social, psychosocial, and total functioning were the main dimensions affected.ConclusionThe QoL of Saudi children with CI is comparable to those of normal children. However, among children with CI, gender, birth order, and distance from the CI center were found to have different effects on the QoL dimensions.

Experiences With the University Admission Process and Educational Support Among Students With Cochlear Implants in South Korea.

ObjectivesThe aim of this study was to investigate the current university admission rate and experiences of educational support among students with cochlear implants (CIs) in South Korea.MethodsA prospective online survey was conducted to examine the university admission process and academic support for students with CIs. Thirty individuals who took the college entrance exams at least 3 years after CI surgery were invited to participate, although two did not respond. The survey consisted of three topics (demographics, university admission process, and academic support) and 25 items regarding laws and policies related to university admission and support for students with hearing disabilities in Korea.ResultsThe university matriculation rate for students with CI was 85.7% (24/28), of whom 50% were admitted through the special admission process for students with disabilities. Most universities provided teaching and learning support and rental services for assistive devices for students with disabilities to help them better adapt to school life. However, only a small percentage of the students benefited from accommodation services, and 62.5% and 12.5% of the students received teaching and learning support and used assistive devices, respectively.ConclusionTo the best of our knowledge, this is the first study to investigate the university admission process and university disability services for students with CIs in South Korea. The results of this study will be helpful for young CI recipients and their parents as they prepare for university entrance.

Early Vocabulary Profiles of Young Deaf Children Who Use Cochlear Implants.

Purpose This study examined vocabulary profiles in young cochlear implant (CI) recipients and in children with normal hearing (NH) matched on receptive vocabulary size to improve our understanding of young CI recipients' acquisition of word categories (e.g., common nouns or closed-class words). Method We compared receptive and expressive vocabulary profiles between young CI recipients (n = 48; mean age at activation = 15.61 months, SD = 4.20) and children with NH (n = 48). The two groups were matched on receptive vocabulary size as measured by the MacArthur-Bates Communicative Development Inventories (Fenson et al., 2006): Words and Gestures form. The CI group had, on average, 8.98 months of hearing experience. The mean chronological age at completing the MacArthur-Bates Communicative Development Inventories was 23.99 months (SD = 5.14) for the CI group and 13.72 months (SD = 1.50) for the NH group. Results The CI group had a larger expressive vocabulary size than the receptive vocabulary size-matched NH group. The larger expressive vocabulary size was associated with the group difference in social words but not with common nouns. The analyses for predicate words and closed-class words included only children who produced the target categories. The CI group had a larger proportion of predicate words than the NH group, but no difference was found in closed-class words in expressive vocabulary. Conclusions Differences found in expressive vocabulary profiles may be affected by spoken vocabulary size and their age. A further examination is warranted using language samples to understand the effect of language input on children's vocabulary profiles.

Grammatical Abilities in Young Cochlear Implant Recipients and Children With Normal Hearing Matched by Vocabulary Size.

This study sought to expand understanding of the impact of cochlear implantation on grammatical acquisition by comparing young children who have vocabularies of comparable size. Two research questions were investigated: (a) Do young cochlear implant (CI) recipients have grammatical skills comparable to those of children with normal hearing (NH) matched by spoken vocabulary size? (b) Do these groups show associations between vocabulary size and grammatical measures? The participants included 13 CI recipients at 24 months postactivation (chronological ages = 33-60 months; M = 44.62) and 13 children with NH between 27 and 30 months old (M = 20.69). The 2 groups were matched by their vocabulary size. Four grammatical outcomes were analyzed from the MacArthur Communicative Development Inventory (Fenson, Marchman, Thal, Dale, & Reznick, 2007) and 20-min language samples: (a) grammatical complexity, (b) mean length of utterances, (c) tense marker total, and (d) productivity scores. The 2 groups showed comparable grammatical skills across the 4 measures. Consistently significant associations between vocabulary size and grammatical outcomes were found in the CI group, with fewer associations in the NH group. The 2 groups showed similar grammatical abilities. The young CI recipients appeared to be following a typical pattern of linguistic development.

Consonant Acquisition in Young Cochlear Implant Recipients and Their Typically Developing Peers.

Consonant acquisition was examined in 13 young cochlear implant (CI) recipients and 11 typically developing (TD) children. A longitudinal research design was implemented to determine the rate and nature of consonant acquisition during the first 2 years of robust hearing experience. Twenty-minute adult-child (typically a parent) interactions were video and audio recorded at 3-month intervals following implantation until 24 months of robust hearing experience was achieved. TD children were similarly recorded between 6 and 24 months of age. Consonants that were produced twice within a 50-utterance sample were considered "established" within a child's consonant inventory. Although the groups showed similar trajectories, the CI group produced larger consonant inventories than the TD group at each interval except for 21 and 24 months. A majority of children with CIs also showed more rapid acquisition of consonants and more diverse consonant inventories than TD children. These results suggest that early auditory deprivation does not significantly affect consonant acquisition for most CI recipients. Tracking early consonant development appears to be a useful way to assess the effectiveness of cochlear implantation in young recipients.

Beginning to Talk Like an Adult: Increases in Speech-Like Utterances in Young Cochlear Implant Recipients and Typically Developing Children

Speech-like utterances containing rapidly combined consonants and vowels eventually dominate the prelinguistic and early word productions of typically developing (TD) toddlers. It seems reasonable to expect a similar phenomenon in young recipients of cochlear implants (CIs). The authors of this study sought to determine the number of months of robust hearing experience needed to achieve a majority of speech-like utterances in both of these groups. Speech samples were recorded from CI recipients at 3-month intervals during the first 2 years of CI experience, and from TD children at time points between 6 and 24 months of age. Speech-like utterances were operationally defined as those belonging to the basic canonical syllables (BCS) or advanced forms (AF) levels of the Consolidated Stark Assessment of Early Vocal Development-Revised ( Ertmer, Young, & Nathani, 2007). On average, the CI group achieved a majority of speech-like utterances after 12 months of robust hearing experience and the TD group after 18 months. The CI group produced greater percentages of speech-like utterances at each interval until 24 months, when both groups approximated 80%. Auditory deprivation did not limit progress in vocal development as young CI recipients showed more-rapid-than-typical speech development during the first 2 years of device use. Implications for the infraphonological model of speech development are considered.

Consonant Production Accuracy in Young Cochlear Implant Recipients: Developmental Sound Classes and Word Position Effects

To compare young cochlear implant (CI) recipients' consonant production accuracy with that of age- and gender-matched peers who were typically developing (TD). In addition to examining initial consonants, the authors compiled new data regarding the accuracy of final consonants and the order of consonant acquisition. Eleven young CI recipients with 24 months of CI experience and 11 age- and gender-matched TD peers produced target words in short sentences. Consonant production accuracy was examined for total scores, initial and final word positions, and three developmental sound classes: Early, Middle, and Late. Initial consonants were produced with relatively greater accuracy than were final consonants by the TD and CI groups. Whereas initial consonants appeared to be acquired in a typical order, descriptive data suggest that this might not be the case for final consonants. Although still delayed compared to age-matched peers, young CI recipients showed substantial progress in consonant acquisition. Their accuracy levels after 2 years of CI experience support the notion that implantation at a young age has added value for phonological development.

Prelinguistic vocal development in young cochlear implant recipients and typically developing infants: year 1 of robust hearing experience.

This investigation examined the time course and sequence of prelinguistic vocal development during the first year of cochlear implant (CI) experience. Thirteen children who were implanted between 8 and 35 months and 11 typically developing (TD) infants participated in this longitudinal study. Adult-child play interactions were video- and audio-recorded at trimonthly intervals for each group, and child utterances were classified into categories representing progressively more mature productions: Precanonical Vocalizations, Basic Canonical Syllables, and Advanced Form vocalizations. Young CI recipients met the 20% criterion for establishment of the Basic Canonical Syllables and Advanced Forms levels with fewer months of robust hearing experience than the TD infants. Most CI recipients followed the sequence of development predicted by the Stark Assessment of Early Vocal Development-Revised. The relatively rapid progress of the CI children suggests that an earlier period of auditory deprivation did not have negative consequences for prelinguistic vocal development. It also supports the notion that young CI recipients comparatively advanced maturity facilitated expeditious auditory-guided speech development.

Speech Production Accuracy and Variability in Young Cochlear Implant Recipients: Comparisons With Typically Developing Age-Peers

The speech production accuracy and variability scores of 6 young cochlear implant (CI) recipients with 2 years of device experience were compared with those of typically developing (TD) age-peers. Words from the First Words Speech Test (FWST; Ertmer, 1999) were imitated 3 times to assess the accuracy and variability of initial consonants, vowels, and words. The initial consonants in the 4 sets of the FWST followed a typical order of development. The TD group produced targets with high accuracy and low variability. Their scores across FWST sets reflected the expected order of development. The CI group produced most targets less accurately and with more variability than the TD children. Relatively high accuracy for the consonants of Sets 1 and 2 indicated that these phonemes were acquired early and in a typical developmental order. A trend toward greater accuracy for Set 4 as compared with Set 3 suggested that later-emerging consonants were not acquired in the expected order. Variability was greatest for later-emerging initial consonants and whole words. Although considerable speech production proficiency was evident, age-level performance was not attained after 2 years of CI experience. Factors that might influence the order of consonant acquisition are discussed.

Accuracy of Consonant–Vowel Syllables in Young Cochlear Implant Recipients and Hearing Children in the Single-Word Period

Purpose Attaining speech accuracy requires that children perceive and attach meanings to vocal output on the basis of production system capacities. Because auditory perception underlies speech accuracy, profiles for children with hearing loss (HL) differ from those of children with normal hearing (NH). Method To understand the impact of auditory history on emergence of speech capacities, the authors compared consonant–vowel (CV) syllable accuracy in early words in 4 NH children and 4 children with HL who received cochlear implantation (CI) before age 2 years. Participants were video-recorded monthly for 6 months following word onset. CV vocalizations were coded perceptually with broad phonetic transcription. Observed-to-expected ratios of CV productions and accuracy were tested with chi-square analysis. An ordered multinomial model tested level of accuracy, including both accuracy and error patterns. Results Most frequently produced sequences were most accurately produced across group and time. NH children were more accurate overall than children with CI. Both groups improved accuracy over time by decreasing partially accurate productions (accurate consonant–inaccurate vowel). Both groups favored CV patterns with compatible place of articulation between consonant and vowel in absolute frequency and level of accuracy. Conclusion Differences in emergence of CV syllable accuracy arise from differences in auditory perception between the NH and CI groups.

Accuracy of Consonant-Vowel Syllables in Young Cochlear Implant Recipients and Hearing Children in the Single-Word Period

Attaining speech accuracy requires that children perceive and attach meanings to vocal output on the basis of production system capacities. Because auditory perception underlies speech accuracy, profiles for children with hearing loss (HL) differ from those of children with normal hearing (NH). To understand the impact of auditory history on emergence of speech capacities, the authors compared consonant-vowel (CV) syllable accuracy in early words in 4 NH children and 4 children with HL who received cochlear implantation (CI) before age 2 years. Participants were video-recorded monthly for 6 months following word onset. CV vocalizations were coded perceptually with broad phonetic transcription. Observed-to-expected ratios of CV productions and accuracy were tested with chi-square analysis. An ordered multinomial model tested level of accuracy, including both accuracy and error patterns. Most frequently produced sequences were most accurately produced across group and time. NH children were more accurate overall than children with CI. Both groups improved accuracy over time by decreasing partially accurate productions (accurate consonant-inaccurate vowel). Both groups favored CV patterns with compatible place of articulation between consonant and vowel in absolute frequency and level of accuracy. Differences in emergence of CV syllable accuracy arise from differences in auditory perception between the NH and CI groups.

Music and Cochlear Implants

Music and Cochlear Implants

The development of intonation in young children with cochlear implants: a preliminary study of the influence of age at implantation and length of implant experience

This study describes the development of emerging intonation in six children who had received a cochlear implant (CI) before the age of 3 years. At the time their implant was activated, the children ranged in age from 11–37 months. Spontaneous longitudinal speech samples were recorded from 30‐minute sessions in which the child interacted with his or her mother. Data were collected 2 months before activation of each child's CI and at monthly intervals after activation for 6 months. The findings were compared to the typical pattern of early intonation development in children with normal hearing (NH). The results suggested that young CI recipients progress through stages similar to those observed in children with NH. However, the intonation development of children with a CI reflects a marked interaction between chronological age at implantation and amount of CI experience. That is, after 2 months of CI‐assisted hearing experience, the older children demonstrated a later stage of intonation development than younger children. These preliminary results support the idea that children acquire some foundations or prerequisites of intonation production through maturation, as measured by chronological age, even without robust auditory experience.

Speech Intelligibility in Young Cochlear Implant Recipients: Gains During Year Three

Speech Intelligibility in Young Cochlear Implant Recipients: Gains During Year Three

Profiles of Vocal Development in Young Cochlear Implant Recipients

The main purpose of this investigation was to examine the effects of cochlear implant experience on prelinguistic vocal development in young deaf children. Procedure A prospective longitudinal research design was used to document the sequence and time course of vocal development in 7 children who were implanted between 10 and 36 months of age. Speech samples were collected twice before implant activation and on a monthly basis thereafter for up to 2 years. Children's vocalizations were classified according to the levels of the Stark Assessment of Early Vocal Development--Revised (SAEVD-R; S. Nathani, D. J Ertmer, & R. E. Stark, 2006). The main findings were (a) 6 of 7 children made advancements in vocal development after implantation; (b) children implanted between 12 and 36 months progressed through SAEVD-R levels in the predicted sequence, whereas a child implanted at a younger age showed a different sequence; (c) milestones in vocal development were often achieved with fewer months of hearing experience than observed in typically developing infants and appeared to be influenced by age at implantation; and (d) in general, children implanted at younger ages completed vocal development at younger chronological ages than those implanted later in life. Specific indicators of benefit from implant use were also identified. The time course of vocal development in young cochlear implant recipients can provide clinically useful information for assessing the benefits of implant experience. Studies of postimplantation vocal development have the potential to inform theories of spoken language development.