United Kingdom national paediatric bilateral cochlear implant audit: preliminary results.

Prior to 2009, United Kingdom (UK) public funding was mainly only available for children to receive unilateral cochlear implants. In 2009, the National Institute for Health and Care Excellence published guidance for cochlear implantation following their review. According to these guidelines, all suitable children are eligible to have simultaneous bilateral cochlear implants or a sequential bilateral cochlear implant if they had received the first before the guidelines were published. Fifteen UK cochlear implant centres formed a consortium to carry out a multi-centre audit. The audit involves collecting data from simultaneously and sequentially implanted children at four intervals: before bilateral cochlear implants or before the sequential implant, 1, 2, and 3 years after bilateral implants. The measures include localization, speech recognition in quiet and background noise, speech production, listening, vocabulary, parental perception, quality of life, and surgical data including complications. The audit has now passed the 2-year point, and data have been received on 850 children. This article provides a first view of some data received up until March 2012.

A framework for good practice: managing failures in a cochlear implant service.

Cochlear implants can provide the recipient and their family with wonderful outcomes in terms of their improved access to sound and to speech. However the experience of a cochlear implant failing is distressing for all concerned. Clinicians endeavour to ensure that the process of confirming the failure, re-implantation and subsequent rehabilitation is as smooth as possible. In order to benefit from each others experience, a working party of cochlear implant centre coordinators and representatives from the Ear Foundation met on a number of occasions to draw up a protocol which could be used widely throughout the British Cochlear Implant Group. The protocol indicates quality standards of clinical care to be used in the event of device failure.

Conversion of scores between Bamford, Kowal and Bench (BKB) sentences and Arthur Boothroyd (AB) words in quiet for cochlear implant patients.

This paper describes the relationship between the scores obtained in the Bamford, Kowal and Bench (BKB) sentence test and the Arthur Boothroyd (AB) word test in quiet for a group of 71 cochlear implant users. Each subject was tested at the same appointment and in the same environment during routine clinical appointments at the South of England Cochlear Implant Centre.Using rationalised arcsine transformation and a linear regression calculation, conversion tables were produced from BKB to AB and from AB to BKB scores. The relationship between scores obtained from the two tests was highly significant.These conversion tables may be of use in cochlear implant centres and by audiology clinics.

Bilateral sequential cochlear implantation in the congenitally deaf child: evidence to support the concept of a 'critical age' after which the second ear is less likely to provide an adequate level of speech perception on its own.

This study attempts to answer the question of whether there is a 'critical age' after which a second contralateral cochlear implant is less likely to provide enough speech perception to be of practical use. The study was not designed to predict factors that determine successful binaural implant use, but to see if there was evidence to help determine the latest age at which the second ear can usefully be implanted, should the first side fail and become unusable.Outcome data, in the form of speech perception test results, were collected from 11 cochlear implant programmes in the UK and one centre in Australia. Forty-seven congenitally bilaterally deaf subjects who received bilateral sequential implants were recruited to the study. The study also included four subjects with congenital unilateral profound deafness who had lost all hearing in their only hearing ear and received a cochlear implant in their unilaterally congenitally deaf ear. Of those 34 subjects for whom complete sets of data were available, the majority (72%) of those receiving their second (or unilateral) implant up to the age of 13 years scored 60 per cent or above in the Bamford Kowal Bench (BKB) sentence test, or equivalent. In contrast, of those nine receiving their second or unilateral implant at the age of 15 or above, none achieved adequate levels of speech perception on formal testing: two scored 29 per cent and 30 per cent, respectively, and the rest seven per cent or less.A discriminant function analysis performed on the data suggests that it is unlikely that a second contralateral implant received after the age of 16 to 18 years will, on its own, provide adequate levels of speech perception. As more children receive sequential bilateral cochlear implants and the pool of data enlarges the situation is likely to become clearer.The results provide support for the concept of a 'critical age' for implanting the second ear in successful congenitally deaf unilateral cochlear implant users. This would argue against 'preserving' the second ear beyond a certain age, in order to use newer models of cochlear implant or for the purpose of hair cell regeneration and similar procedures in the future. The results suggest a new and more absolute reason for bilateral implantation of congenitally deaf children at an early age.

Phonological awareness, vocabulary, and word reading in children who use cochlear implants: does age of implantation explain individual variability in performance outcomes and growth?

The phonological awareness (PA), vocabulary, and word reading abilities of 19 children with cochlear implants (CI) were assessed. Nine children had an implant early (between 2 and 3.6 years) and 10 had an implant later (between 5 and 7 years). Participants were tested twice over a 12-month period on syllable, rhyme, and phoneme awareness (see James et al., 2005). Performance of CI users was compared against younger hearing children matched for reading level. Two standardized assessments of vocabulary and single word reading were administered. As a group, the children fitted early had better performance outcomes on PA, vocabulary, and reading compared to hearing benchmark groups. The early group had significant growth on rhyme awareness, whereas the late group showed no significant gains in PA over time. There was wide individual variation in performance and growth in the CI users. Two participants with the best overall development were both fitted with an implant late in childhood.

Phonological awareness in deaf children who use cochlear implants.

A short-term longitudinal study was conducted to investigate possible benefits of cochlear implant (CI) use on the development of phonological awareness in deaf children. Nineteen CI users were tested on 2 occasions. Two groups of deaf children using hearing aids were tested once: 11 profoundly deaf and 10 severely deaf children. A battery of tests was designed to investigate syllable, rhyme, and phoneme awareness. Syllable awareness in the CI users was equivalent to that of the severely deaf group, and rhyme and phoneme awareness was similar to that of the profoundly deaf children using hearing aids. CI use affords some benefit to the development of phonological awareness. The results from this study indicate that this enhancement is first observable at the syllable level.

Speech intelligibility rating of cochlear implanted children: inter-rater reliability.

The Speech Intelligibility Rating (SIR) scale was designed to classify children's global speech production according to one of five hierarchical categories. Individuals rating the scale need to judge which category is appropriate, giving the possibility that different raters could use different scores in their assessments. The aim of this study was to determine the inter-rater reliability of the scale, i.e. whether judges agree as to the category membership for the assessed behaviour. Inexperienced ('naive') judges rated videotape excerpts of implanted children in communication with a known adult according to the scale. Each judge rated four children sequentially from one of four videos: there were two videos of different sets of children, each recorded with two different orders. Both subsets of subjects ranked children in the same order of intelligibility (Kendall's W = 0.86 and W = 0.98 respectively, both p < 0.01). There was agreement on the category membership for each child (Kappa's K = 0.45 and K = 0.68 respectively, both p < 0.001). The intra-class correlation coefficient showed that agreement between raters was high (ICC(2,1) values = 0.80 and 0.81, both p < 0.001), and that ratings were consistent (ICC(3,1) values = 0.82 and 0.97, both p < 0.001). This study indicated that the scale demonstrates good inter-rater reliability. It can be used confidently by cochlear implant teams to monitor the progress of implanted children's speech intelligibility.