Auditory performance of cochlear implant children aged 2-5 years.

OBJECTIVE: To assess the categories of auditory performance in prelingual deaf children after implantation. STUDY DESIGN: Prospective study MATERIAL AND METHOD: The present study consisted of one boy and four girls aged between 2 and 5 years old at the time of implantation. All subjects had bilateral profound sensorineural hearing loss and received no substantial benefit from amplification. Three subjects were implanted with Med-El combi 40+ with CIS strategy and two subjects received multichanal monopolar Nucleus 24 cochlear implant with ACE strategy. After implantation, all subjects undertook a program ofhabilitation at the Speech and Hearing Clinic Ramathibodi Hospital. The Categories of Auditory Performance (CAP) score was determined at regular intervals prior to implantation, immediately at the initial mapping (0) and 3, 6, 12 and 18 months after the implantation. RESULTS: The results showed that before implantation, only three children showed awareness of environment sounds, CAP score level 1, and that immediately after mapping, all of the children demonstrated awareness of the environmental sounds. Moreover, two of these children showed awareness of speech sounds, CAP score level 2. The CAP scores were gradually increased over a 12-month period. At the 12-month assessment interval, four children could discriminate two speech sounds, CAP score level 4 and one child understood phrases without lip reading, CAP score level 5. 18 months after of implantation, the CAP score for four children increased to level 5. One child understood conversation without lip reading with a familiar talker, CAP score level 6. Furthermore, children with congenital hearing loss who underwent implantation at a younger age received more benefit from the implantation. CONCLUSION: The CAP score was found to be a useful and sensitive tool to evaluate the outcome of auditory receptive abilities in young congenital deaf children who underwent cochlear implantation. The accessible outcome measurement will provide information for parents and professionals to obtain a hierarchical scale on which the children's auditory ability with other more formal measures may be inappropriate.

Indication and surgical consideration of cochlear implantation at Ramathibodi Hospital.

OBJECTIVES: To demonstrate selection criteria for cochlear implant candidates as well as the outcome of quality of life (QoL) after cochlear implant surgery. MATERIAL AND METHOD: Retrospective review was performed of all cochlear implants at Ramathibodi Hospital. A total number of 33 cochlear implantations were performed during the period of 10 years from December 1995 to December 2005. Inclusion criteria were established and the audiological criteria were then evaluated using the electrical promontory stimulation test. The etiology of severe sensory neural hearing loss was detected. The CT scan and MRI of the inner ear were studied in the different causes of deafness. RESULTS: The main cause of deafness in the present study (16 adults and 17 children) was suffering from pregnancy rubella. The second one was familial congenital deafness. The CT scan studied in the rubella cases showed anatomical normal cochlea and the hereditary cause of deafness showed abnormal cochlea that caused a strong perilymphatic gusher in a 14 year- old boy. There were 16 cases of adolescent and adult patients who all had good response in the promontory stimulation test. The QoL post implantation was evaluated in regards to improvement in education and communication. CONCLUSION: Multi-channel cochlear implantation in severe profound hearing loss patients could improve the hearing in both normal and abnormal cochlea, congenital rubella deafness and the familial cause of deafness. The outcomes of the QoL after surgery were better in hearing detection, speech perception, school performance, communication and return to work.

Aural rehabilitation for deaf children: a northeastern Thailand experience.

Aural rehabilitation for deaf children (hearing loss > 90 dB) has been established since World War II. Many developed countries such as USA, Canada, United Kingdom, Netherlands and Australia have famous institutes providing aural rehabilitation for these children so that they are able to communicate with other people in the hearing society. Teaching programs include auditory training, speech stimulation, speech correction and developing language skills by using natural conversation and real models. In Thailand, the most common mode of communication for deaf children is total communication which focuses on sign language, thus, limiting the ability to communicate with other people. With the realization of this problem, the preschool program for deaf children was set up in 1993 by an audiologist and a speech pathologist at the speech and hearing clinic, Department of Otolaryngology, Faculty of Medicine, Khon Kaen University. A study of 31 deaf children with the average better ear hearing threshold of 103 dB (103.5 +/- 7.01), who visited the program regularly showed that it took an average of 277 days or approximately 9 months (9.25 +/- 4.1) after hearing aid fitting, in acquiring spontaneous meaningful single words or 638 days or approximately 21 months (21.3 +/- 4.3) in acquiring simple conversation or sentences of more than three words. The limitation and problems of the program will be discussed.