Outcomes after cochlear reimplantation in children.

OBJECTIVES: With cochlear implantation now a routine procedure, reimplantation is becoming more commonplace for medical/surgical complications or device malfunctions. This study investigated the indications for reimplantation and the auditory outcomes following reimplantation surgery in prelingually-deafened children. METHODS: Of the 539 prelingually deafened children implanted between 1990 and 2013, 45 were reimplanted (8.3% of implantations). Causes of reimplantation, type of device and angle of insertion at initial implantation were recorded, as well as type of implant reinserted, number of electrodes inserted and angle of insertion (calculated on cone beam computed tomography) on reimplantation, and finally any surgical findings. Speech perception test scores (phonetically balanced kindergarten (PBK) words, open-set sentence testing in quiet and in noise (S/N+ 10 dB SNR), and speech tracking scores) were obtained 1, 2 and 3 years after reimplantation, and compared against the best speech recognition score obtained with the first implant before failure. RESULTS: Medical reasons for reimplantation were found in 10 cases (22.2%). A malfunctioning device had occurred in 35 cases (77.7%) including hard failure in 24 and soft failure in 11. Complete insertion was achieved in the scala tympani in 42 cases and in the scala vestibuli in one case; partial insertion occurred in the remaining two cases. In two cases, one or two electrode rings snatched off from the electrode array during removal. The mean insertion angle was 330.5° before surgery and 311.8° after reimplantation (no statistical difference p=0.48). The postoperative speech perception outcome measures showed no significant difference to the best score before reimplantation. Angle of insertion, type of device and etiology of deafness did not influence the results. The PBK performance improved over 10% in 43.2% of children, was similar in 40.5%, and showed a more than 10% decrease in 16.2% of children after reimplantation. The latter decline in performance was explained for some children by a partial insertion. CONCLUSIONS: Reimplantation has no negative effect on auditory outcome. In rare cases, speech perception outcome may not improve, requiring a specific rehabilitation program.

Educational and employment achievements in prelingually deaf children who receive cochlear implants.

OBJECTIVE: To investigate the educational and employment achievements of prelingually deaf children who undergo cochlear implantation. DESIGN: Prospective study. Data were examined within groups defined by current age and additional disabilities. Multivariate analyses were used to identify variables influencing grade failure and communication mode. SETTING: Tertiary referral center. PARTICIPANTS: One hundred prelingually deaf children who received cochlear implants before 6 years of age and who also had at least 4 years of follow-up. INTERVENTION: Interview of parents using a standardized questionnaire. MAIN OUTCOME MEASURES: The type of schooling, form of communication, employment status, age at which the child learned to read and write, number of grade failures, and educational support required. RESULTS: Mainstream schooling, regardless of educational level, was the standard experience for children without additional disabilities (16 of 24 [67%] in the 12- to 15-year age group to 20 of 24 [83%] in the 8- to 11-year age group). Four of 8 participants older than 18 years (50%) had a university-level education; the remainder had vocational training. Delayed reading and writing skills were experienced by 19 of 74 participants (26%) and, depending on the age group, 42% to 61% of participants (10 of 24 in the 8- to 11-year age group to 11 of 18 in the 16- to 18-year age group) had failed a grade. The number of grade failures was associated with communication mode at the time of the survey. Age at implantation, preoperative communication mode, and educational support influenced the final communication mode. In children with additional disabilities, the level of academic achievement and employment status varied. CONCLUSIONS: Despite significant differences in the grade failure rate between the children with cochlear implants and the general population, the participants in the present study ultimately achieved educational and employment levels similar to those of their normal-hearing peers. To minimize these delays and improve academic success in mainstream education, early oral education and early cochlear implantation are important.

Impact of early cochlear implantation on the linguistic development of the deaf child.

OBJECTIVE: The purpose of this study was to examine prognostic factors of cochlear implantation and to evaluate the impact of early implantation on linguistic development in deaf children. STUDY DESIGN: Retrospective study. SETTING: Tertiary referral center. PATIENTS: Seventy-four prelingually deafened children implanted before the age of 5 years. INTERVENTION: Annual follow-up after cochlear implantation. MAIN OUTCOME MEASURES: Speech perception, intelligibility, and expressive and receptive language scores from age 3 to 8 years were globally compared between 4 subgroups of children. Significant differences were further explored by intergroup comparisons. Stepwise logistic linear regression was performed using the following variables: age at implantation, duration of cochlear implant (CI) use, preoperative hearing levels, age of hearing aid (HA) fitting, and age at time of the evaluation. Preoperative data were not available. RESULTS: Between group comparisons displayed significant differences according to age at implantation. Multivariate analysis demonstrated the positive impact of early implantation on receptive language. Moreover, duration of CI use and preoperative hearing levels were statistically correlated with performance on speech perception, intelligibility, and expressive and receptive language. Age of HA fitting was associated with speech intelligibility. CONCLUSION: Age at implantation, duration of CI, preoperative hearing levels, and age of HA fitting may each be useful in predicting linguistic success after cochlear implantation. Other factors such as preoperative linguistic development may also influence postoperative outcomes, but the lack of tests suitable for use with very young children makes such a hypothesis difficult to confirm.

Ten-year follow-up of a consecutive series of children with multichannel cochlear implants.

OBJECTIVES: To assess a group of children who consecutively received implants more than 10 years after implantation with regard to speech perception, speech intelligibility, receptive language level, and academic/occupational status. STUDY DESIGN: A prospective longitudinal study. SETTING: Pediatric referral center for cochlear implantation. PATIENTS: Eighty-two prelingually deafened children received the Nucleus multichannel cochlear implant. INTERVENTIONS: Cochlear implantation with Cochlear Nucleus CI22 implant. MAIN OUTCOME MEASURES: The main outcome measures were open-set Phonetically Balanced Kindergarten word test, discrimination of sentences in noise, connective discourse tracking (CDT) using voice and telephone, speech intelligibility rating (SIR), vocabulary knowledge measured using the Peabody Picture Vocabulary Test (Revised), academic performance on French language, foreign language, and mathematics, and academic/occupational status. RESULTS: After 10 years of implant experience, 79 children (96%) reported that they always wear the device; 79% (65 of 82 children) could use the telephone. The mean scores were 72% for the Phonetically Balanced Kindergarten word test, 44% for word recognition in noise, 55.3 words per minute for the CDT, and 33 words per minute for the CDT via telephone. Thirty-three children (40%) developed speech intelligible to the average listener (SIR 5), and 22 (27%) developed speech intelligible to a listener with little experience of deaf person's speech (SIR 4). The measures of vocabulary showed that most (76%) of children who received implants scored below the median value of their normally hearing peers. The age at implantation was the most important factor that may influence the postimplant outcomes. Regarding educational/vocational status, 6 subjects attend universities, 3 already have a professional activity, 14 are currently at high school level, 32 are at junior high school level, 6 additional children are enrolled in a special unit for children with disability, and 3 children are still attending elementary schools. Seventeen are in further noncompulsory education studying a range of subjects at vocational level. CONCLUSION: This long-term report shows that many profoundly hearing-impaired children using cochlear implants can develop functional levels of speech perception and production, attain age-appropriate oral language, develop competency level in a language other than their primary language, and achieve satisfactory academic performance.

Cochlear implantation in prelingually deafened children with residual hearing.

OBJECTIVE: The purpose of this study was to examine the speech perception skills of prelingually deafened French children with preoperative residual hearing who received multichannel cochlear implants. DESIGN: The design of the study incorporated a within-subject, repeated measures design for assessing speech perception skills. SETTING: Montpellier, Toulouse and Lyon Pediatric Cochlear Implant Centers. SUBJECTS: Seven prelingually deafened children demonstrating marginal benefit from conventional amplification prior to implantation with a Nucleus multichannel cochlear implant, served as subjects for the speech perception assessment (a speech recognition score less than 30% defines marginal benefit from acoustic amplification on open set materials). The mean age at implantation was 7 years, 9 months. OUTCOME MEASURES: Speech perception skills were assessed using open set materials and the MUSS and MAIS questionnaires. RESULTS: Open-set speech recognition averaged 21.4% before implantation, and 83.6% after 1 year's cochlear implant experience. All children demonstrated an open-set score over 60% after 12 months of CI use. MAIS test scores averaged 18.1/40 before implantation and 35.1/40 after 9 months of CI use. MUSS test scores averaged 24.4/40 before implantation and 34.1/40 after 9 months of CI use. CONCLUSIONS: Cochlear implantation should be considered for prelingually hearing impaired children demonstrating marginal benefit from hearing aids, with a speech recognition score less than 30% on open set materials, in order to improve their speech discrimination skills.