Results following cochlear implantation and rehabilitation

Nine post-lingually deafened adults received single-electrode cochlear implants and afterwards participated in a rehabilitation program. For these nine patients the average threshold sensitivity in soundfield was significantly better with use of the cochlear prosthesis than with hearing aid amplification in the same ear prior to implantation. Significant changes also occurred in discrimination of environmental sounds, recognition of words and stress patterns, and in speechreading skill. Certain aspects of phonation (harshness, control of intensity, and habitual pitch) and some articulation problems improved, while inflection abnormalities were not altered. Data concerning daily hours of implant activation, an indicator of patient acceptance, reveal that seven of the nine use their cochlear prosthesis for at least eight hours per day. These results suggest that the single electrode cochlear implant is a clinically useful tool in the rehabilitation of selected profoundly deaf individuals.     

Development of spoken language grammar following cochlear implantation in prelingually deaf children

OBJECTIVES: To assess the development of grammar comprehension in spoken language in prelingually deaf children following cochlear implantation and compare their grammatical abilities with those of their hearing peers. DESIGN: A prospective study of 82 consecutive prelingually deaf children up to 5 years following implantation. The children were less than 7 years old at the time of implantation (mean age +/- SD, 4.2 +/- 1.3 years). All received the same multichannel cochlear implant system. No child was lost to follow-up and there were no exclusions from the study. SETTING: Tertiary referral cochlear implant center. METHODS: The children were assessed using the Test for Reception of Grammar. This individually administered, multiple-choice test designed to assess the understanding of grammatical contrasts in the English language also allows direct comparison of grammar comprehension between test subjects and their normal-hearing peers. RESULTS: Before implantation, only a small proportion (2%) of prelingually deaf children were above the first percentile of their normal-hearing peers. This percentage increased to 40% and 67%, respectively, 3 and 5 years after implantation; and 5 years after implantation, 20% of the children performed between the 25th and the 75th percentile or better. In the subgroup of children who received their cochlear device before the age of 4 years, this percentage reached 36%. CONCLUSIONS: Spoken language grammar acquisition in prelingually deaf children with a cochlear implant was found to be considerably delayed. However, there was a clear trend toward the development of grammar skills following cochlear implantation, and the greatest advance was made by children who received their implant at a younger age. These findings support the present trend toward early implantation.     

Balance in children following cochlear implantation

Objectives: To assess the vestibular function of children who had unilateral and bilateral cochlear implants compared with a control group of otherwise healthy children who had not been implanted.

Study design: Observational case–control study.

Methods: Posturography was carried out in the form of a Modified Clinical Test of Sensory Interaction on Balance using a Wii Balance Board and the Vestio App on an iPod Touch. Thirty children in total were tested, 10 children in each cohort. Results in the form of root mean square calculations were available for each child.

Results: Results showed a significant difference in the vestibular function of implanted children and the non-implanted control group (P?P?Conclusions: Our study demonstrates posturography as an inexpensive, easily operated tool that can be used to assess paediatric vestibular function. It showed a significant difference between the control group and the implanted groups. Further work prompted by this study will include interval post-operative testing to more accurately assess the effect that implantation has on vestibular function.     

人工耳蜗植入术295例语言康复临床分析

目的 研究耳蜗植入术后听觉言语康复效果及其影响因素。 方法 采用听觉行为分级(CAP)、言语可懂度分级(SIR)及视频和录音言语清晰度分析法分别对295例人工耳蜗植入术后患者进行听觉言语康复效果评估。 结果 2例蜗神经细小合并内耳畸形患者开机听阈为45 dB,其余听阈为25~40 dB。单因素分析结果显示:术前助听器的佩戴、植入年龄、植入后时间、术前残余听力、内耳畸形程度、脑白质病变对CAP及SIR差异有统计学意义;手术方法、中耳炎、Waardenburg综合征对CAP、SIR差异无统计学意义。多因素Logistic回归分析结果显示:植入后时间、脑白质病变与CAP、SIR显著相关。 结论 大部分患者可从人工耳蜗植入术中获得满意效果,其听觉言语康复程度受多种因素的影响。     

儿童语言习得理论在人工耳蜗术后康复中的理解和应用

目的探讨儿童语言习得理论在人工耳蜗术后康复训练中的应用，以期为人工耳蜗术后康复提供理论基础。方法结合相关理论，阐述儿童语言习得理论在康复实践中的应用。结果儿童语言习得理论在人工耳蜗术后康复中具有广泛的应用基础，并发挥着重要的作用。结论儿童语言习得理论为人工耳蜗术后康复提供理论支持，并为术后康复的有效进行提供了坚实的方法论依据。     

Factors impacting early cochlear implantation in Chinese children

This study aimed to determine the factors that impact early cochlear implantation (CI) in Chinese children. The charts of 56 pediatric cochlear implant recipients were retrospectively reviewed. Parental interviews were conducted to collect information regarding the factors that potentially impact early CI in Chinese children. The mean age at CI was 40.98 months, and the median age was 24 months. Thirty patients received an implant before 24 months of age, and the other 26 patients received the implant after 24 months of age. By univariate logistic regression analysis, newborn hearing screening (NHS), financial burden impacted early CI significantly (p < 0.05), while the multivariate analysis indicated that only NHS significantly influenced the early CI (p < 0.05). The following factors were associated with a moderately increased risk of late implantation: lack of NHS [odds ratio (OR) = 5.833], living in a rural community (OR = 2.714), and communication barriers (OR = 2.691). Living in a rural community, financial burden and communication barriers negatively impact the age at CI, whereas NHS positively influence the age at CI. Increased awareness of these factors could promote early CI and improve the quality of life of congenitally deaf children.     

New cochlear implant coding strategy for tonal language speakers

Accurate pitch perception on the basis of fundamental frequency patterns is essential for the processing of lexical tones in tonal languages such as Cantonese. Speech intelligibility in Cantonese-speaking CI recipients was compared using current signal processing strategies, which typically result in poor pitch perception, and a new strategy, known as the multi-channel envelope modulation (MEM) strategy, was designed to enhance temporal periodicity cues to the fundamental frequency. Performance of nine postlingually hearing-impaired adult cochlear implant users was measured twice using each strategy, initially after a four week trial, and again after two weeks of use with each strategy. Speech intelligibility in speech-spectrum shaped noise was measured using the Cantonese hearing in noise test. A fixed noise level of 65 dB A was used and the signal-to-noise ratios were fixed at either +10, +15, or +20 dB, depending on the baseline performance of individual subjects using the clinical processor. Self-reported benefit in 18 listening situations and overall preference for strategies were obtained at the end of these trial periods. Results showed poorer speech intelligibility with CIS while results obtained using ACE and MEM were comparable. Unfamiliar place coding might have contributed to poorer performance using CIS. Self-reported benefit across strategies did not differ in most listening situations. Participants preferred ACE for listening overall in daily situations, and a few preferred MEM in noise. Whilst the results did not demonstrate any advantages for speech recognition in noise when using MEM compared to ACE, no degradation in performance was observed. This implies that the form of processing employed by MEM retains similar segmental information to that provided by ACE and that potentially, future variations/optimizations of MEM may lead to some improvement in tone perception.     

Speech and language acquisition in young children after cochlear implantation.

Auditory and speech intelligibility scores of 22 prelingually profoundly deaf children who had used cochlear implants for between 1 and 7 years in an intensive auditory/oral educational program greatly exceeded those previously obtained from similar samples of deaf children using hearing aids. Half of the children obtained language quotient scores within the average range for normal-hearing children and the majority obtained reading quotients within 80% of normal levels. Normal levels of language and reading development were associated with early implantation and open set speech perception.     

Trends in rehabilitation after cochlear implantation

Although postimplant rehabilitation is generally considered to be an important aspect of a cochlear implant program, the literature reports widely varying practices in the implementation of such programs. The National Institutes of Health consensus statement on cochlear implantation (May 1988), while recognizing that aural rehabilitation facilitates maximal use of the implant, offers no specific guidelines or recommendations. A questionnaire survey was made of over 200 otolaryngologists to determine current practices in a variety of aspects of their cochlear implant programs. Results were obtained from a total of more than 1400 patients, including adults, adolescents, and children. Rehabilitation is an integral part of the cochlear implant program in the vast majority of active programs surveyed. General aspects of cochlear implant programs, as well as those of rehabilitation programs in particular, are discussed.     

The development of auditory perception in children following cochlear implantation

The time course for the development of auditory perception in prelingually deaf children following cochlear implantation may extend over many years, thus making long-term studies necessary to evaluate any such outcome. However, few such studies exist in the literature. We prospectively followed-up a consecutive group of 133 prelingually deaf children up to 6 years following implantation. All children were prelingually deaf with age at onset of deafness < 3 years and age at implantation < 8 years. The aetiology of deafness was meningitis for 45 children (34%), congenital deafness for 77 children (58%) and other causes for 11 children (8%). All were implanted with a Nucleus-22 multi-channel cochlear implant and followed the same rehabilitation programme. No child was lost to follow-up and there were no exclusions from the study. Prelingually deaf children showed significant improvement in the auditory perception with implant experience. 82% of children who reached the 6-year interval could understand conversation without lip-reading. The respective percentage in the 4-year interval was 70%. The long-term results of cochlear implantation reveal that the majority of prelingually deaf children, when implanted before the age of 8 years, will develop significant auditory perception.     

Early complications following cochlear implantation in children and their management

Objectives

To report the early postoperative complications of cochlear implantation (CI) in the pediatric population and discuss the intervention measures.

Methods

We retrospectively analyzed 260 consecutive pediatric cochlear implantations performed at the First Affiliated Hospital of Zhengzhou University between March 2010 and July 2013. All patients were younger than 12 years old at the time of implantation, with a mean age of 4.3 years, and 47 cases had inner ear malformations. Complications correlated to age at CI and inner ear malformations were analyzed using the χ² test.

Results

Of the 260 patients, early postoperative complications were observed in 17 (6.54%) cases, of which 16 (6.15%) were minor and one (0.38%) was major, none required surgical device removal or reimplantation. Among the 16 minor complications, transient vertigo was the most common (nine cases, 3.46%), three (1.15%) of them with severe CSF gusher during the surgery; followed by transient facial nerve palsy (two cases, 0.77%, both were reversible); external auditory canal injury, subcutaneous hematoma each in two cases (0.77%), and minor dural injury in one case (0.38%). One major complication included an epidural hematoma in a 7-year-old boy who recovered completely without any neurologic deficits following immediate evacuation. Inner ear malformations were significantly associated with the surgical complications, especially vertigo and gusher (P < 0.05).

Conclusions

Cochlear implantation in children is fairly a safe procedure with a relatively low complication rate. The most common early postoperative complications are minor, but serious and life threatening complications rarely may occur. Awareness of complications helps clinicians to adopt the specific preventive measures and immediate interventions so that the outcome will be successful.     

Hearing rehabilitation in cerebral palsy: development of language and hearing after cochlear implantation

IntroductionAuditory rehabilitation in children with bilateral severe-to-profound sensorineural hearing loss with cochlear implant has been developed in recent decades; however, the rehabilitation of children with cerebral palsy still remains a challenge to otolaryngology and speech therapy professionals.ObjectiveTo verify the effectiveness of cochlear implants in the development of auditory and language skills in children with cerebral palsy.MethodsA prospective analytical study. The evaluation of auditory responses to speech test was applied to the children in this study at regular intervals following implantation. Standardized tests that assess and quantify the development of auditory and language skills were administered and speech therapy video records and speech therapy files were analyzed. All children went through individually tailored intensive audiological rehabilitation programs following cochlear implantation.ResultsTwo participants had gradual auditory and language development when compared to other participants who reached advanced levels in hearing and oral language classifications.ConclusionThe use of the Cochlear implant enabled participants to reach advanced stages of hearing and language skills in three of the five participants with cerebral palsy in this study. This electronic device is a viable therapeutic option for children with cerebral palsy to help them achieve complex levels of auditory and language skills.     

Suprameatal approach for cochlear implantation in 45 Chinese children

OBJECTIVE: To investigate the feasibility of applying the suprameatal approach (SMA) for cochlear implantation in Chinese children with profound sensory hearing loss, and to demonstrate a technical modification incorporated in the procedure due to an observed racial difference. STUDY DESIGN: Retrospective study. SETTING: University hospital. PATIENTS: Forty-five Chinese children (total 47 ears) with profound sensory hearing loss were surgically treated from May 2005 to May 2006. The patients were followed anywhere from 1 month to 20 months post-surgery, with 30 patients being followed for more than 6 months. INTERVENTIONS: All patients received cochlear implantation through the suprameatal approach. In this procedure, the cochleostomy was performed in one stage after the suprameatal tunnel was finished, rather than the two-stage approach described by Kronenberg (who firstly introduced the suprameatal approach). Three patients with low-lying dura (which is considered to be the contraindication for cochlear implantation with SMA) were treated with a further modified surgical approach. RESULTS: Among the 47 ears, full electrode pairs were completely inserted in 45 ears without surgical difficulties, but 1 ear was only fitted with 9 pairs of electrodes because of an ossified cochlea, and another with just 8 pairs of electrodes due to serious cochlear dysplasia. An intraoperative "gusher" occurred in the dysplasia case, and a small piece of temporalis muscle was used, along with biology glue, to seal the cochleostomy and prevent further leakage. In 1 case, the electrode was inserted into the cochlea through the tunnel lateral to the chorda tympani because adhesion had occurred between the incus and chorda tympani. There were no postoperative complications in any case. Thirty cases exhibited better hearing or speech development from cochlear implantation after more than 6 months of follow-up. CONCLUSIONS: The SMA was found to be a simple and safe technique for cochlear implantation in Chinese children. It enables wide exposure of the middle ear, and is especially suitable for cases with a narrow facial recess, an anteriorly located facial nerve, or an ossified cochlea. It is almost impossible to injure the facial nerve or the chorda tympani nerve. The cochleostomy can be performed in one stage in those patients with a normal cochlea. With some modifications, a low-lying dura will not be the absolute contraindication of SMA.     

Infections following cochlear implantation

Cochlear implantation has become routine in the management of children and adults with profound sensorineural hearing loss. In rare cases postoperative infections necessitate removal of the implant. We present six such cases that have been managed within our programme. Extensive infected granulation tissue was found around the implant at exploration despite prolonged intravenous treatment with appropriate antimicrobial agents. All devices were explanted and three have been reimplanted at our unit. We discuss our management of these cases, the need for explantation, consideration for reimplantation and their functional outcome following reimplantation. We also highlight how systemic inflammatory markers can be unhelpful in detecting significant infection surrounding a cochlear implant.     

Bilateral cochlear implantation in children

AIMS: to determine the benefit of bilateral cochlear implantation in a child on speech and language development. METHOD: This child got her first implant, a Nucleus 24-system, on the right side at the age of 2.5 years. The left side was implanted at the age of 4.4 years with a Nucleus 24Contour-system. On the right side she's now wearing an Esprit 24-speechprocessor (SPR). On the left side she has a Sprint-SPR. M. goes to a mainstream school and receives Speech and Language therapy in a Speech and Hearing Rehab Centre. The etiology of her deafness was hyperbilirubinemia. Auditory capacity and speech recognition tests were performed for both ears separately and together. RESULTS: Aided thresholds give a PTA of 28 dBA with the first implant, 22 dBA with the second implant and with both implants we get a PTA of 23 dBA. Results for speech identification and recognition demonstrated an increased performance when both implants are used together. Speech and language development was equivalent to the mean of age 4.5. At the time of testing M. was 4.8 years. At this time the speech and language development show no delays with normal hearing children. CONCLUSIONS: bilateral cochlear implantation in children may have additional value for their speech and language development. Also, implantation may be considered when auditory neuropathy is likely.     

Revision cochlear implantation in children

Revision cochlear implant (RCI) surgery has become an important tool for the management of cochlear implantation complications. This review encompasses both common and uncommon indications of RCI, diagnostic and management considerations, outcomes, surgical principles, and emerging applications. In summary, early identification of complications and suboptimal device performance is imperative for children who are in critical periods of communicative development. Independent of indications, most RCI achieve a successful restoration of sound. Although rare, it is prudent to discuss the potential complications of revision surgery and their implications with patients and their families.     

Consonant and sign phoneme acquisition in signing children following cochlear implantation

Abstract

Deaf children from signing programs provide new opportunities to investigate changes in sign and speech acquisition following cochlear implantation. We describe the acquisition of sign phonemes (location, movement, and handshapes) and speech phonemes (consonants) in 22 implanted children with diverse demographic backgrounds. New consonants and new sign phonemes emerged in developmentally expected sequences and with statistically significant correlation coefficients between cumulative number of new consonants and new sign phonemes over time. Regression slopes from plotted z scores revealed a burst in consonant and sign growth in early months post-implant, with continuous but plateauing growth over time. These results and documentation of developmental levels of sign and speech phoneme trajectories should be helpful to other researchers and to clinicians working with signing children who have cochlear implants.     

Consonant and sign phoneme acquisition in signing children following cochlear implantation

Deaf children from signing programs provide new opportunities to investigate changes in sign and speech acquisition following cochlear implantation. We describe the acquisition of sign phonemes (location, movement, and handshapes) and speech phonemes (consonants) in 22 implanted children with diverse demographic backgrounds. New consonants and new sign phonemes emerged in developmentally expected sequences and with statistically significant correlation coefficients between cumulative number of new consonants and new sign phonemes over time. Regression slopes from plotted z scores revealed a burst in consonant and sign growth in early months post-implant, with continuous but plateauing growth over time. These results and documentation of developmental levels of sign and speech phoneme trajectories should be helpful to other researchers and to clinicians working with signing children who have cochlear implants.