[Early language performance in the ELFRA questionnaire : Analysis of multicentre data from children with bilateral cochlear implants]. / Frühe Sprachleistungen im Fragebogen ELFRA : Auswertung multizentrischer Daten von Kindern nach bilateraler Cochleaimplantatversorgung.

BACKGROUND: Very early bilateral cochlear implant (CI) provision is today's established standard for children. Therefore, the assessment of preverbal and verbal performance in very early stages of development is becoming increasingly important. Performance data from cohorts of children were evaluated and presented based on diagnostic assessment using chronological age (CA) and hearing age (HA). METHODS: The present study, as part of a retrospective multicentre study, included 4 cohorts (N = 72-233) of children with bilateral CI without additional disabilities. Their results in the German parent questionnaires Elternfragebögen zur Früherkennung von Risikokindern(ELFRA­1 and ELFRA-2) subdivided for CA and HA were statistically analysed. The data were also analysed in terms of mono-/bilingualism and age at CI provision. RESULTS: Overall, verbal performance in relation to CA was lower than in relation to HA. Preverbal skills were largely CA appropriate. Children with bi-/multilingual language acquisition performed significantly lower. Verbal performance in ELFRA­2 referenced to CA was negatively correlated with age at CI provision. CONCLUSION: In the case of early CI provision, CA should be the preferred reference mark in preverbal and verbal assessment in order to obtain exact individual performance levels and avoid bias in results. The percentiles determined are of limited use as generally valid reference values to which the individual performance of bilaterally implanted children could be compared. Further multicentre studies should be initiated.

Health-related quality of life and associated developmental domains of children provided early with cochlear implants.

OBJECTIVES: Quality of life plays an important place in the psychosocial development of children with Cochlear Implants (CI). We assesd health-related quality of life (HRQoL) in children with CI and in hearing children and determined relationships between HRQoL and other developmental characteristics (social-emotional development, Theory of Mind (ToM), spoken language skills). METHODS: A longitudinal study was conducted including children with CI and hearing children. We used instruments that are widely employed and have been validated for research. At time 1 social-emotional development, ToM and spoken language skills were assessed.HRQoL was assessed using the generic KINDL questionnaire, as was social-emotional development, 2.5 years later (time 2). RESULTS: No significant difference was seen in HRQoL between hearing children and children with CI. We show that the age of detection, the age of hearing care, and the start of early intervention are not related to HRQoL of children with CI, but relationships with some domains of social-emotional development are evident. CONCLUSIONS: This study highlights the importance of targeted intervention not only to improve spoken language skills at preschool age, but also strengthen social-emotional and social-cognitive competences.

Cochlear Implantation in Children With Congenital Unilateral Deafness: A Case Series.

OBJECTIVES: Cochlear implant is regarded as a treatment option for hearing rehabilitation of adults with unilateral sensorineural hearing loss. A clear benefit has been experienced in regard to speech comprehension in noise, localization, and quality of life. The aim of this study was to investigate the benefit of cochlear implantation for children with congenital unilateral hearing loss. STUDY DESIGN: Retrospective case series. SETTING: Tertiary referral center; cochlear implant program. PATIENTS: Ten children with congenital unilateral hearing loss. INTERVENTION: After extensive consultation with the families and intensive counseling, the children received a cochlear implant. MAIN OUTCOME MEASURES: Categories of auditory performance, speech discrimination in open set, subjective assessment by Speech, Spatial and Qualities scale questionnaire. CONCLUSION: Eight of ten children use their cochlear implant consistently on a daily basis. Two children who were equipped with an implanted device at a later age tend to nonuse of the device. The evaluation of binaural hearing in small children is still difficult and methods have to be developed to allow objective assessment.

Mental health problems in adolescents with cochlear implants: peer problems persist after controlling for additional handicaps.

The aims of the present multi-center study were to investigate the extent of mental health problems in adolescents with a hearing loss and cochlear implants (CIs) in comparison to normal hearing (NH) peers and to investigate possible relations between the extent of mental health problems of young CI users and hearing variables, such as age at implantation, or functional gain of CI. The survey included 140 adolescents with CI (mean age = 14.7, SD = 1.5 years) and 140 NH adolescents (mean age = 14.8, SD = 1.4 years), their parents and teachers. Participants were matched by age, gender and social background. Within the CI group, 35 adolescents were identified as "risk cases" due to possible and manifest additional handicaps, and 11 adolescents were non-classifiable. Mental health problems were assessed with the Strengths and Difficulties Questionnaire (SDQ) in the versions "Self," "Parent," and "Teacher." The CI group showed significantly more "Peer Problems" than the NH group. When the CI group was split into a "risk-group" (35 "risk cases" and 11 non-classifiable persons) and a "non-risk group" (n = 94), increased peer problems were perceived in both CI subgroups by adolescents themselves. However, no further differences between the CI non-risk group and the NH group were observed in any rater. The CI risk-group showed significantly more hyperactivity compared to the NH group and more hyperactivity and conduct problems compared to the CI non-risk group. Cluster analyses confirmed that there were significantly more adolescents with high problems in the CI risk-group compared to the CI non-risk group and the NH group. Adolescents with CI, who were able to understand speech in noise had significantly less difficulties compared to constricted CI users. Parents, teachers, and clinicians should be aware that CI users with additionally special needs may have mental health problems. However, peer problems were also experienced by CI adolescents without additional handicaps.

Unilateral deafness in children: audiologic and subjective assessment of hearing ability after cochlear implantation.

OBJECTIVES: Recently, several studies have shown that a cochlear implant is a suitable treatment for hearing rehabilitation of adults with unilateral sensorineural hearing loss (UHL), and benefits for speech comprehension in noise and localization have been demonstrated. The aim of this clinical study was to evaluate the benefit of cochlear implantation in children with UHL in comparison to their unaided listening situation. STUDY DESIGN: Prospective repeated measures single subject design. SETTING: Tertiary referral center; cochlear implant (CI) program PATIENTS: Three children (4, 10, and 11 yr) with noncongenital UHL resulting from different causes were enrolled in the study. INTERVENTION: After extensive consultation with each family and confirming CI-candidacy, each child received a cochlear implant. MAIN OUTCOME MEASURES: Open set speech recognition measures in competing background noise and tests of sound localization were performed for unaided preoperative and CI-aided postimplant intervals after 6 and 12 months. The parent and child versions of the Speech, Spatial and Qualities scale (SSQ) were used for subjective evaluation of hearing at preimplant and 12-month postimplant intervals. CONCLUSION: All children consistently use their CI 1 year postimplant. Our preliminary results suggest binaural hearing benefits for speech understanding in noise, localization ability and subjectively perceived hearing ability for school-aged children with UHL. Trends for CI-benefits in younger preschoolaged children are confirmed through subjective assessment reported by the parents. The benefits in hearing performance suggest binaural integration and processing of electric and acoustic stimulation arriving at 2 different ears is possible for children with UHL.