A Predictive Model of Hearing Outcome for Cochlear Implantation in Children below 5 Years of Age

Background: Cochlear Implantation (CI) has become an important modality of treatment for children with severe to profoundpre-lingual sensorineural hearing loss who do not benefit from hearing aids (HAs). The final outcome is not totally predictable,as there are a large number of factors which either alone or in combination will play their roles in the final outcome of CI.Aim of the Study: This study aims to evaluate prospectively the relative impact of multiple pre-, peri-, and post-operative factorson the final outcome of the CI in pre-lingual hearing impaired children aged 5 years under “Sruthitharangam” free cochlearimplant program of Government of Kerala.Materials and Methods: This study was conducted at Government Medical College, Kozhikode (GMC-KKD), Kerala, fromJanuary 2014 to January 2015. The study group consisted of 60 patients screened from the patients who have attendedAuditory verbal habilitation (AVH) categories of Auditory Performance (CAP) test, Meaningful auditory integration scale (MAIS)and Speech intelligibility rating test (SIR) at GMC-KKD, Kerala. Counseling of parents was done regarding regular follow-upsand therapy/support to the child at home.Observations and Results: Pearson correlation test and Spearman correlation test were done to check the correlation betweenage at which HA was first fitted and MAIS scores. Correlation between the age at which HA first fitted and MAIS was negative.As the age at which HAs were fitted increases, the MAIS score decreases. This indicates the significance of using the residualhearing and stimulation of auditory nerve as early as possible. Pearson correlation and Spearman correlation tests were appliedto check the correlation between age of surgery and MAIS score and found that there was negative correlation existing betweenage of surgery and MAIS scores. This meant, as the age at which surgery was done increases, the MAIS score decreases.Pearson correlation test and Spearman correlation tests were applied to check the MAIS scores and duration of AVH with HAs.Conclusions: A Cochlear implant was not a passive sensory aid or sensory substitution device that simply replaces a damaged ordefective cochlea to restore normal hearing but requires prolonged period of aural rehabilitation that involves perceptual learning,adaptation, and readjustment of their attention. The various risk factors that affect the auditory gain and speech perception eitheracting singly or in combination and the statistical analysis of the present study showed are the age at implantation, duration ofauditory deprivation, and the residual hearing which have a direct impact on the outcome over a period of 1 year.

Long-term follow-up of auditory performance and speech perception and effects of age on cochlear implantation in children with pre-lingual deafness / 中华医学杂志(英文版)

Background@#The development of auditory and speech perception ability of children with hearing loss is affected by many factors after they undergo cochlear implantation (CI). Age at CI (CI age) appears to play an important role among these factors. This study aimed to evaluate the development of auditory and speech perception ability and explore the impact of CI age on children with prelingual deafness present before 3 years of age.@*Methods@#Two hundred and seventy-eight children with pre-lingual deafness (176 boys and 102 girls) were included in this study, and the CI age ranged from 6 to 36 months (mean age, 19 months). Categorical auditory performance (CAP) was assessed to evaluate auditory ability, and the speech intelligibility rating was used to evaluate speech intelligibility. The evaluations were performed before CI and 1, 3, 6, 12, 18, 24, 36, 48, and 60 months after CI.@*Results@#The auditory ability of the pre-lingually hearing-impaired children showed the fastest development within 6 months after CI (k = 0.524, t = 30.992, P < 0.05); then, the progress started to decelerate (k = 0.14, t = 3.704, P < 0.05) and entered a plateau at the 24th month (k = 0.03, t = 1.908, P < 0.05). Speech intelligibility showed the fastest improvement between the 12th and 24th months after CI (k = 0.138, t = 5.365, P < 0.05); then, the progress started to decelerate (k = 0.026, t = 1.465, P < 0.05) and entered a plateau at the 48th month (k = 0.012, t = 1.542, P < 0.05). The CI age had no statistical significant effect on the auditory and speech abilities starting at 2 years after CI (P < 0.05). The optimal cutoff age for CI was 15 months.@*Conclusions@#Within 5 years after CI, the auditory and speech ability of young hearing-impaired children continuously improved, although speech development lagged behind that of hearing. An earlier CI age is recommended; the optimal cutoff age for CI is at 15 months.

Early Linguistic Developments of Simultaneous Bilateral Cochlear Implantees / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The present study aimed to compare receptive and expressive language development in children who have undergone simultaneous bilateral cochlear implantation (SCI) and those who have undergone bimodal stimulation (unilateral CI+ hearing aid). SUBJECTS AND METHOD: In a retrospective analysis of clinical data, 15 pediatric patients who have received SCI and nine patients who have received bimodal stimulation (BM group) were enrolled. CI was performed for all patients at 24 months of age. Category of Auditory Performance (CAP) scores, Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS) scores, and developmental quotients (DQ) for expressive and receptive language were compared between the groups at 12 month of follow-up. The Percentage of Consonants Correct (PCC) of children evaluated at 4 years old was also compared. RESULTS: At 12 months of follow-up, significantly greater improvements in CAP scores (Δ4.25±0.5) were noted in the SCI group compared to the BM group (Δ3.56±0.88, p=0.041). Significantly greater improvements in IT-MAIS scores were also noted in the SCI group (Δ36.17±4.09) than in the BM group (Δ30.17±2.91, p=0.004). The DQ of receptive language was higher in the SCI group than in the BM group (87.6±15.4% vs. 75.5±12.0%, p=0.023) at 12 months of follow-up. Moreover, early SCI was associated with better receptive language skills. PCC index of children at 4 years old was higher in the SCI group than in the BM group (88.5±13.2% vs. 62±15.8%, p=0.014). Earlier SCI was associated with even greater improvements. CONCLUSION: Bilateral SCI is associated with significant improvements in language development when compared with bimodal stimulation. Earlier SCI was associated with better outcomes.

Surgical and functional outcomes of cochlear implantation in post-lingual and cross-over patients: First 5-year review of the National Ministry of Health Malaysia cochlear implant programme

@#Introduction: There has been a paradigm shift in the management of acquired sensory neural deafness in the past 30years. This is due to the emergence of implantable hearing devices such as the cochlear implant. The objective of this study is to identify surgical and functional outcomes of post-lingual and cross-over patients implanted with a cochlear implant under the National Ministry of Heath Cochlear Implant (CI) Program between 2009-2013. Materials and Methods: We retrospectively reviewed all postlingual and cross-over recipients of cochlear implants under the National Ministry of Heath CI Programme from 2009 to 2013. The outcomes measured were surgical complications and functional outcome. Surgical complications were divided into major and minor complications. Functional outcomes were measured using Categorical Auditory Performances (CAP) scale. Results: A total of 41 post-lingual and 15 cross-over patients were implanted between 2009 and 2013. The age of implantees ranged from 3.6 years to 63.2 years old. There were two major complications (3.6%), one is a case of electrode migration at three months post implantation, and six months post second implantation. Another was a case of device failure at about one-year post implantation. Both patients were reimplanted in the same ear. There was no minor complication. The CAP score for both groups (overall) showed significant improvement with 96.4% achieved CAP score of five and above at 24 months after implantation (p<0.001). The CAP score showed marked improvement at the first 6 months post implantation and continued to improve with time in both groups. Conclusion: The Malaysian National Ministry of Health Cochlear implant (CI) Program between 2009-2013 has been a successful programme with good surgical and functional outcomes among the post lingual and cross-over patients.

Comparison of Auditory Performance and Speech Intelligibility in Children with Cochlear Implant Placed using Different Approaches.

Background: To demonstrate whether there are differences in the outcome of speech intelligibility in children with cochlear implantation (CI) using the techniques between mastoidectomy with posttympanotomy (MPTA) and varia, suprameatal approach (SMA). Materials and Methods: A total of 43 congenitally deaf children who underwent CI before the age of 7 years of age at community mental health center from 2013 to 2015 were included in this study. Children with severe mental retardation, cardiac problem or with cochlear malformations were excluded in the study. 17 patients were operated via SMA approach and 26 patients via posttympanotomy approach. All children were assessed before surgery and 3, 6, 9 and 12 months after surgery with categories of auditory performance (CAP) and speech intelligibility rating (SIR). Each assessment was given by the speech therapist at institute. A psychological evaluation was also carried out in all patients with developmental milestone assessment by pediatrician. At each interval, the CAP and SIR scores of each group were compared. Result: For both groups, CAP and SIR scores increased/improved with the time of CI usage during the follow-up period after implantation. There was no significant difference in scores of CAP and SIR at all the 4 time points between the MPTA versus SMA approach. Conclusion: Intelligible speech and auditory performance of children with CI using the SMA and MPTA were good. There were no differences between children implanted with the SMA technique versus the MPTA technique. All the children are doing well with speech rehabilitation.

The EvaIuation of Auditory and VerbaI AbiIity in 107 Pre-LinguaIIy Deaf ChiIdren with CochIear ImpIantation / 听力学及言语疾病杂志

Objective To evaluate the auditory and verbal abilities of cochlear implantees using question_naires ,to explore basic rules of the development of auditory and verbal abilities ,and to analyze their relationships with some influencing factors .Methods A retrospective analysis of 107 cases of pre-lingually deaf children with cochlear implantation was conducted with Infant-Toddler Meaningful Auditory Integration Scale/Meaningful Audi_tory Integration Scale (IT -MAIS/MAIS) ,categories of auditory performance (CAP) and speech intelligibility rat_ing (SIR) for the evaluation of auditory and verbal abilities .An analysis was performed to assess influencing fac_tors ,such as postoperative time ,age at implantation ,physical age at follow -up ,time with hearing aids before im_plantation .SAS 9 .1 .3 was used in statistical analysis .ResuIts A total of 107 pre-lingually deaf children (48 males and 59 females) participated in this study .The postoperative time ranged from 0 to 49 months ,with an average of 9 .0 ± 10 .9 months .The results showed the postoperative time and age at implantation had significant influences on the scores of IT -MAIS/MAIS ,and postoperative time and physical age at follow -up had significant influences on the scores of CAP/SIR (P0 .05) .ConcIusion The ages at implantation ,postoperative time and physical age had significant influences on the auditory and verbal abilities of pre-lingually deaf children with cochlear implanta_tion .Further studies are needed to explore their relationships with hearing aids usage before implantation .

Rendimiento auditivo en pacientes menores de 2 años comparado con pacientes entre 2 y 5 años con implante coclear / Auditory performance in patients younger than 2 years old and patients between two and five years old who were intervened with cochlear implant

Objetivos: Conocer y comparar la evolución del rendimiento auditivo de los pacientes menores de 2 años (prelinguales) y entre 2 a 5 años (perilinguales) con hipoacusia neurosensorial severa a profunda que fueron intervenidos con la colocación del implante coclear. Materiales y métodos: Estudio descriptivo de pacientes del programa de implante coclear del Hospital Militar Central y el Hospital Universitario Clínica San Rafael. Se incluyeron pacientes prelinguales y perilinguales a los cuales se les realizó seguimiento del rendimiento auditivo con las pruebas de IT-MAIS y otthingham durante 3, 6 y 12 meses posimplante durante los años 2001 a 2008. Resultados: La población blanco fueron 84 pacientes de los cuales 53 pacientes cumplieron con los criterios de inclusión, 13 fueron prelinguales y 40 en proceso de adquisición del lenguaje o perilinguales, las dos pruebas alcanzaron un valor estadísticamente significativo con p menor de 0.05, a favor del grupo de pacientes prelinguales, es decir, que la intervención con el implante coclear en los pacientes prelinguales tiene mejor resultado que en los pacientes perilinguales. Conclusión: los pacientes prelinguales con implante coclear tienen mejor rendimiento auditivo que los pacientes perilinguales al año de seguimiento.

Objectives: To get to know and compare the evolution of auditory performance of children younger tan 2 years old (prelingual) and children between two and five years old (perilingual) with severe to profound sensorineural hearing loss that were implanted with a cochlear implant. Material and Methods: A descriptive study of patients that are part of the cochlear implant program at Hospital Militar central and at Hospital Universitario Clínica San Rafael. Prelingual and perilingual patients were included for follow - up of the auditory performance with the following tests IT-MAIS and Nottingham for 3, 6 and 12 months after the implant from 2001 to 2008. Results: The target population was 84 patients out of which 53 patients complied with the inclusion criteria, 13 of which were prelingual and 40 were in the process of acquiring the language or perilingual. Both tests reached a statistically significant value with p lower than 0.05, in favor of the prelingual group of patients. That is, the surgery with a cochlear implant has a better result in prelingual patients than it does in perilingual patients. Conclusion: perilingual patients with cochlear implants have a better auditory performance than perilingual patients after a follow-up of a year.

Long Term Outcomes of Early Cochlear Implantation in Korea

OBJECTIVES: The objective of this study was to compare the long-term auditory performance and language skill depending on the age of cochlear implantation in the Korean population. We especially tried to separate the effect of maturation/development from that of the age at implantation. METHODS: Eighty-six pre-lingual children with profound hearing loss who underwent a cochlear implantation before the age of six and had been followed for more than 3 yr were included in this study prospectively. Categories of Auditory Performance (CAP) and Korean Picture Vocabulary Test (K-PVT) were serially followed up. In order to separate the age at implantation effect, K-PVT results were readjusted to the child's chronological age in the normal hearing population. RESULTS: When the CAP and K-PVT scores were directly compared without chronological readjustment, we failed to show a significant difference for improvements according to the age at implantation. Early cochlear implantation was associated with better language development, only when the K-PVT scores were readjusted to percentile scores of their chronological age. CONCLUSION: Early cochlear implantation was associated with better language development even within the critical period. This advantage may be recognized only when the effect of the age at implantation is separated from the effect of maturation/development.

Long-Term Development of Auditory Performance in Children with Cochlear Implants / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study focused on the long-term development of auditory performance evaluated by CAP for children with cochlear implants. MATERIALS AND METHOD: The subjects for this study were 39 children who received the Nucleus multichannel cochlear implants. All children were prelingually deaf and the mean age for these children at the time of implantation was 4 years 5 months (range from 23 months to 10 years 9 months). All children were categorized by means of CAP prior to implantation, and at 6 and 12 months following implantation, and annually thereafter. Thirty children had reached the 1-year stage whereas 24, 21, 14 children, and 8 were in the 2, 3, 4, and 5-year stages, respectively. RESULTS: Eighty-three percent could discriminate speech sounds at 12 months. Their auditory performances gradually developed over 5-year period. Sixty-seven percent of the children who reached the 3-year stage could understand common phrases without lip-reading. Fifty-seven percent of the children who reached the 5-year stage could understand conversation without lip-reading. It is important to consider that the respective percentages at the 3-year stage and the 5-year stage are much higher (93% and 80%), when the eleven children with additional disabilities and/or children who received implants after the age of 7 are excluded. CONCLUSION: The long-term results of this study indicate that the majority of prelingually deaf children, who their cochlear implants before the age of 7 and/or without additional problems, can develop significant auditory performance.