Evidence-based guidelines for recommending cochlear implantation for young children: Audiological criteria and optimizing age at implantation.

OBJECTIVE: Establish up-to-date evidence-based guidelines for recommending cochlear implantation for young children. DESIGN: Speech perception results for early-implanted children were compared to children using traditional amplification. Equivalent pure-tone average (PTA) hearing loss for cochlear implant (CI) users was established. Language of early-implanted children was assessed over six years and compared to hearing peers. STUDY SAMPLE: Seventy-eight children using CIs and 62 children using traditional amplification with hearing losses ranging 25-120 dB HL PTA (speech perception study). Thirty-two children who received a CI before 2.5 years of age (language study). RESULTS: Speech perception outcomes suggested that children with a PTA greater than 60 dB HL have a 75% chance of benefit over traditional amplification. More conservative criteria applied to the data suggested that children with PTA greater than 82 dB HL have a 95% chance of benefit. Children implanted under 2.5 years with no significant cognitive deficits made normal language progress but retained a delay approximately equal to their age at implantation. CONCLUSIONS: Hearing-impaired children under three years of age may benefit from cochlear implantation if their PTA exceeds 60 dB HL bilaterally. Implantation as young as possible should minimize any language delay resulting from an initial period of auditory deprivation.

Language outcomes for children with cochlear implants enrolled in different communication programs.

OBJECTIVES: The aims of this study were to (a) compare language outcomes in pediatric cochlear implant users enrolled in three different communication programs: sign and spoken language, auditory-oral, and auditory-verbal therapy, and (b) examine factors influencing language outcomes. METHODS: Post-implant standard scores on language assessments of receptive vocabulary, auditory comprehension, and expressive communication were collected from files of 42 children with prelingual hearing loss who were implanted by 3;6 years of age. Early intervention history, device details, and demographic information were obtained for each child. Family involvement was evaluated using a rating scale. RESULTS: After adjusting for potential covariates, there were no significant differences in language outcomes across the three groups. Overall, there was a large degree of variability with some children achieving below average scores and others achieving above average scores. Age at diagnosis of hearing loss and family involvement were significantly associated with language outcomes. CONCLUSION: Regardless of the type of communication approach received, children diagnosed with hearing loss at an early age and children with a high level of family involvement had better post-implant language scores than children diagnosed later and with lower levels of family involvement. These findings emphasize the importance of early diagnosis and highlight the contribution families make to the language outcomes of children with cochlear implants.

Communication development in children who receive the cochlear implant younger than 12 months: risks versus benefits.

BACKGROUND: The advent of universal neonatal hearing screening in some countries and the availability of screening programs for at-risk infants in other countries has facilitated earlier referral, diagnosis, and intervention for infants with hearing loss. Improvements in device technology, two decades of pediatric clinical experience, a growing recognition of the efficacy of cochlear implants for young children, and the recent change in the U.S. Food and Drug Administration's age criteria to include children as young as 12 mo has led to increasing numbers of young children receiving cochlear implants. Evidence to support provision for infants younger than 12 mo is extrapolated from physiological studies, studies of children using hearing aids, and studies of children older than 12 mo of age with implants. To date, however, there are few published research findings regarding communication development in children between 6 and 12 mo of age who receive implants. The current study hypothesized that earlier implantation would lead to increased rates of language acquisition as the children were still in the critical period for their development. METHOD: A retrospective review was completed for 19 infants (mean age at implantation, 0.88 yr; range, 0.61-1.07, SD 0.15) and 87 toddlers (mean age at implantation, 1.60 yr; range, 1.13-2.00, SD 0.24) who received the multichannel implant in Melbourne, Australia. Preimplantation audiological assessments for these children included aided and unaided audiograms, auditory brain stem response, auditory steady state response (ASSR), and otoacoustic emission and indicated profound to total bilateral hearing loss in all cases. Communication assessment included completion of the Rossetti Infant-Toddler Language Scale and educational psychologists' cognitive and motor assessment. Computed tomography scan, magnetic resonance imaging, and surgical records for all cases were reviewed. Postimplantation language assessments were reported in terms of the rate of growth over time on the language comprehension and language expression subscales of the Rossetti Infant-Toddler Language Scale. RESULTS: Results demonstrated that cochlear implantation may be performed safely in very young children with excellent language outcomes. The mean rates of receptive (1.12) and expressive (1.01) language growth for children receiving implants before the age of 12 mo were significantly greater than the rates achieved by children receiving implants between 12 and 24 mo, and matched growth rates achieved by normally hearing peers. These preliminary results support the provision of cochlear implants for children younger than 12 mo of age within experienced pediatric implantation centers.

Cochlear implants for children with significant residual hearing.

BACKGROUND: Previous research suggests that children with pure-tone averages of greater than 90 dB hearing level and/or open-set sentence perception of less than 30% may derive significant benefit from cochlear implantation. OBJECTIVE: To evaluate postoperative speech perception benefit and bilateral-bimodal benefit for 16 children whose preimplant speech perception scores exceeded conservative candidacy guidelines. STUDY DESIGN: Preimplant and postimplant repeated-measure design. METHODS: Sixteen child subjects who obtained 30% or greater on preimplant open-set sentence material, presented live voice audition alone, were selected for this study. Preimplant pure-tone averages ranged from 73 to 110 dB in the better aided ear. Preimplant and postimplant open-set word and sentence testing was completed in quiet and with competing background noise for separate ear and binaural conditions. RESULTS: Fourteen of 16 subjects had improved speech perception scores across all test materials after implantation. Group means were significantly higher for all test materials. Results in the bimodal-bilateral condition were significantly higher than implant alone for open-set word tests (scored for phonemes) and open-set sentences in quiet. CONCLUSION: The results of this study suggest that, with appropriate counseling and management, some children with significant residual hearing benefit from cochlear implantation, in particular improved speech understanding due to bimodal-bilateral hearing.

Speech perception outcomes in older children who use multichannel cochlear implants: older is not always poorer.

Speech perception outcomes for early-deafened children who undergo implantation as teenagers or young adults are generally reported to be poorer than results for young children. It is important to provide appropriate expectations when counseling adolescents and their families to help them make an informed choice regarding cochlear implant surgery. The considerable variation of results in this group makes this process more difficult. This study considered a number of factors in a group of 25 children who underwent implantation in Melbourne between the ages of 8 and 18 years. Each subject completed open-set speech perception testing with Bamford-Kowal-Bench sentences before and after implantation and preoperative language testing with the Peabody Picture Vocabulary Test. Data were collected regarding the type of hearing loss, age at implantation, age at hearing aid fitting, audiometric details, and preoperative and postoperative communication mode. Results were submitted to a stepwise multiple linear regression analysis with postoperative open-set sentence scores as the dependent variables. The analysis suggested that 3 factors have a significant predictive value for speech perception after implantation: preoperative open-set sentence score, duration of profound hearing loss, and equivalent language age. These 3 factors accounted for 66% of the variance in this group. The results of this study suggest that children who have useful speech perception before implantation, and higher age-equivalent scores on language measures, would be expected to do well with a cochlear implant. Consistent with other studies, a shorter duration of profound hearing loss is also advantageous. The mean sentence score for this group, 47%, was not significantly different from the mean result across all children in the Melbourne program.

Speech perception in children using cochlear implants: prediction of long-term outcomes.

A group of 102 children using the Nucleus multichannel cochlear implant were assessed for open-set speech perception abilities at six-monthly intervals following implant surgery. The group included a wide range of ages, types of hearing loss, ages at onset of hearing loss, experience with implant use and communication modes. Multivariate analysis indicated that a shorter duration of profound hearing loss, later onset of profound hearing loss, exclusively oral/aural communication and greater experience with the implant were associated with better open-set speech perception. Developmental delay was associated with poorer speech perception and the SPEAK signal coding scheme was shown to provide better speech perception performance than previous signal processors. Results indicated that postoperative speech perception outcomes could be predicted with an accuracy that is clinically useful.