Current Trends in Pediatric Cochlear Implant Candidate Selection and Postoperative Follow-Up

2014 ◽  
Vol 23 (3) ◽  
pp. 309-325 ◽  
Author(s):  
Kristin Uhler ◽  
René H. Gifford
Keyword(s):  
Speech Perception ◽  
Cochlear Implant ◽  
The United States ◽  
Test Battery ◽  
Current Trends ◽  
Northwestern University ◽  
Auditory Integration ◽  
Scheduling Protocols ◽  
Selection Of

Purpose In this article, the authors describe current pediatric cochlear implant (CI) assessment and postoperative scheduling protocols in the United States. Method A survey was conducted in 2 phases. Results Response rates were similar between Phase I (10%) and Phase II (13%). Across phases, nearly all respondents reported assessing speech perception both preoperatively and postoperatively. The most frequently used parent questionnaires were the Infant–Toddler Meaningful Auditory Integration Scale (Robbins, Renshaw, & Berry, 1991), the Meaningful Auditory Integration Scale (Robbins et al., 1991), and LittlEARS (Kuehn-Inacken, Weichboldt, Tsiakpini, Coninx, & D'Haese, 2003). The most commonly used speech perception measure for children <23 months of age was the Early Speech Perception Test–Low Verbal (ESP-LV; Moog & Geers, 1990). The most commonly used measures for children 24–35 months of age were the ESP-LV, the Northwestern University of Children's Perception of Speech (Elliot & Katz, 1980), and the Mr. Potato Head task (Robbins, 1993). For children >36 months of age, there was a wide variety of speech perception tests utilized. Patient follow-up visits were weekly or biweekly immediately following CI activation, then every 3 months for the remainder of the 1st year. After the 1st year, most children were seen semiannually. Conclusions Although trends emerged, there is a lack of consistency in the selection of speech perception measures utilized across centers for children <36 months of age. The development of a working group to establish a standard minimum pediatric test battery (similar to the adult Minimum Speech Test Battery) would promote uniformity in clinical protocols used to assess children who receive CIs.

scholarly journals A Systematic Review to Define the Speech and Language Benefit of Early (<12 Months) Pediatric Cochlear Implantation

2016 ◽  
Vol 21 (2) ◽  
pp. 113-126 ◽  
Author(s):  
Hanneke Bruijnzeel ◽  
Fuat Ziylan ◽  
Inge Stegeman ◽  
Vedat Topsakal ◽  
Wilko Grolman
Keyword(s):  
Speech Perception ◽  
Speech Production ◽  
Cochlear Implantation ◽  
Receptive Language ◽  
Additional Benefit ◽  
Speech And Language ◽  
Language Outcome ◽  
Auditory Performance ◽  
Auditory Integration

Objective: This review aimed to evaluate the additional benefit of pediatric cochlear implantation before 12 months of age considering improved speech and language development and auditory performance. Materials and Methods: We conducted a search in PubMed, EMBASE and CINAHL databases and included studies comparing groups with different ages at implantation and assessing speech perception and speech production, receptive language and/or auditory performance. We included studies with a high directness of evidence (DoE). Results: We retrieved 3,360 articles. Ten studies with a high DoE were included. Four articles with medium DoE were discussed in addition. Six studies compared infants implanted before 12 months with children implanted between 12 and 24 months. Follow-up ranged from 6 months to 9 years. Cochlear implantation before the age of 2 years is beneficial according to one speech perception score (phonetically balanced kindergarten combined with consonant-nucleus-consonant) but not on Glendonald auditory screening procedure scores. Implantation before 12 months resulted in better speech production (diagnostic evaluation of articulation and phonology and infant-toddler meaningful auditory integration scale), auditory performance (Categories of Auditory Performance-II score) and receptive language scores (2 out of 5; Preschool Language Scale combined with oral and written language skills and Peabody Picture Vocabulary Test). Conclusions: The current best evidence lacks level 1 evidence studies and consists mainly of cohort studies with a moderate to high risk of bias. Included studies showed consistent evidence that cochlear implantation should be performed early in life, but evidence is inconsistent on all speech and language outcome measures regarding the additional benefit of implantation before the age of 12 months. Long-term follow-up studies are necessary to provide insight on additional benefits of early pediatric cochlear implantation.

Performance Over Time of Congenitally Deaf and Postlingually Deafened Children Using a Multichannel Cochlear Implant

1992 ◽  
Vol 35 (4) ◽  
pp. 913-920 ◽  
Author(s):  
Holly Fryauf-Bertschy ◽  
Richard S. Tyler ◽  
Danielle M. Kelsay ◽  
Bruce J. Gantz
Keyword(s):  
Speech Perception ◽  
Word Recognition ◽  
Cochlear Implant ◽  
Deaf Children ◽  
Closed Set ◽  
Open Set ◽  
Northwestern University ◽  
Identification Test ◽  
Improved Performance ◽  
Over Time

The speech perception performance of 10 congenitally deaf and 3 postlingually deafened children who received the Cochlear Corporation multichannel cochlear implant was examined and compared. The children were tested preimplant and at 6-month intervals up to 2 years using the Monosyllable-Trochee-Spondee test (MTS), the Word Intelligibility by Picture Identification test (WIPI), and Phonetically Balanced Kindergarten (PB-K) or Northwestern University List 6 (NU-6) word lists. The postlingually deafened children exhibited significantly improved performance on open- and closed-set tests of word recognition after 6 months of implant use, a pattern similar to that of postlingually deafened adult implant users. In contrast, the congenitally deaf children did not exhibit measurably improved performance on speech perception tests until after 12 months or more of implant use. With as much as 18–24 months of use, however, some congenitally deaf children demonstrated limited open-set word recognition.

Population-Based Prediction of Fitting Levels for Individual Cochlear Implant Recipients

2014 ◽  
Vol 20 (1) ◽  
pp. 1-16 ◽  
Author(s):  
Feddo B. van der Beek ◽  
Jeroen J. Briaire ◽  
Johan H.M. Frijns
Keyword(s):  
Speech Perception ◽  
Cochlear Implant ◽  
Predictive Models ◽  
Linear Models ◽  
Dynamic Range ◽  
Population Based ◽  
Design Data ◽  
Data Set ◽  
Closed Set

Objectives: This study analyzed the predictability of fitting levels for cochlear implant recipients based on a review of the clinical levels of the recipients. Design: Data containing threshold levels (T-levels) and maximum comfort levels (M-levels) for 151 adult subjects using a CII/HiRes 90K cochlear implant with a HiFocus 1/1 J electrode were used. The 10th, 25th, 50th, 75th and 90th percentiles of the T- and M-levels are reported. Speech perception of the subjects, using a HiRes speech coding strategy, was measured during routine clinical follow-up. Results: T-levels for most subjects were between 20 and 35% of their M-levels and were rarely (<1/50) below 10% of the M-levels. Furthermore, both T- and M-levels showed an increase over the first year of follow-up. Interestingly, levels expressed in linear charge units showed a clear increase in dynamic range (DR) over 1 year (29.8 CU; SD 73.0), whereas the DR expressed in decibels remained stable. T-level and DR were the only fitting parameters for which a significant correlation with speech perception (r = 0.34, p < 0.01, and r = 0.33, p < 0.01, respectively) could be demonstrated. Additionally, analysis showed that T- and M-level profiles expressed in decibels were independent of the subjects' across-site mean levels. Using mixed linear models, predictive models were obtained for the T- and M-levels of all separate electrode contacts. Conclusions: On the basis of the data set from 151 subjects, clinically applicable predictive models for T- and M-levels have been obtained. Based on one psychophysical measurement and a population-based T- or M-level profile, individual recipients' T- and M-levels can be approximated with a closed-set formula. Additionally, the analyzed fitting level data can serve as a reference for future patients. i 2014 S. Karger AG, Basel

scholarly journals Cochlear Implant Practice Patterns: The U.S. Trends with Pediatric Patients

2018 ◽  
Vol 29 (08) ◽  
pp. 722-733 ◽  
Author(s):  
Carly Hemmingson ◽  
Jessica J. Messersmith
Keyword(s):  
Cochlear Implant ◽  
Online Survey ◽  
Practice Patterns ◽  
Pediatric Population ◽  
The United States ◽  
Practice Research ◽  
Clinical Practices ◽  
Cross Sectional Survey ◽  
Follow Up Care

AbstractMany factors affect an individual’s outcomes with a cochlear implant (CI); however, quality of device programming and consistency of follow-up appointments have been shown to be crucial contributors. As audiologists’ CI caseloads increase, time constraints on appointments also increase, thus fueling the need for efficient and effective programming strategies. Currently, there are no standardized guidelines describing what methods should be used during programming, nor are there standardized schedules that delineate what procedures should be performed at specific appointment intervals. Without standardized programming guidelines, clinical practices may be variable and may not align with best practice research; thus, outcomes with a CI, particularly for pediatrics, may not be reflective of the actual potential available.The purpose of this study was to identify the clinical practice patterns used by U.S. audiologists when programming and providing follow-up care to children who use CIs. This study aimed to determine the following: common programming approaches, provision intervals for these procedures, common validation assessments, typical follow-up care schedules, and source(s) of CI training. In addition, this study sought to evaluate if training and/or follow-up care differed between small and large CI centers.A cross-sectional survey design was used.Target population included practicing audiologists working with pediatric CI users throughout the United States. Participation was voluntary, thus random selection could not be used. A total of 167 participants opened and began the online survey and 113 successfully completed the survey instrument (23.99% return rate).Potential participants were identified using the “find a clinic” function on three CI manufacturers' websites. Potential participants were asked to complete an online survey seeking information about practices they employ in their clinical setting. Survey responses were analyzed for trends.Overall, a common follow-up schedule was determined, which included an average of 6.8 appointments within the first year. Minor differences in training and programming practices between small and large CI centers emerged; however, no statistically significant results were noted. Results did reveal trends in the use of certain clinical practices. This was particularly evident in the limited use of objective measures.Overall, the findings support other recent studies that suggest the development of CI guidelines that may standardize programming and follow-up practices of CI audiologists. This could prove valuable for the continual improvement of CI outcomes, particularly in the pediatric population.

scholarly journals Rates, Indications, and Speech Perception Outcomes of Revision Cochlear Implantations

2021 ◽  
Vol 10 (15) ◽  
pp. 3215
Author(s):  
Doron Sagiv ◽  
Yifat Yaar-Soffer ◽  
Ziva Yakir ◽  
Yael Henkin ◽  
Yisgav Shapira
Keyword(s):  
Speech Perception ◽  
Cochlear Implant ◽  
Outcome Analysis ◽  
Tertiary Referral Center ◽  
Patient Demographics ◽  
Included Patient ◽  
Decision Making Processes ◽  
Surgical Failure ◽  
Improved Performance

Revision cochlear implant (RCI) is a growing burden on cochlear implant programs. While reports on RCI rate are frequent, outcome measures are limited. The objectives of the current study were to: (1) evaluate RCI rate, (2) classify indications, (3) delineate the pre-RCI clinical course, and (4) measure surgical and speech perception outcomes, in a large cohort of patients implanted in a tertiary referral center between 1989–2018. Retrospective data review was performed and included patient demographics, medical records, and audiologic outcomes. Results indicated that RCI rate was 11.7% (172/1465), with a trend of increased RCI load over the years. The main indications for RCI were device-related failures (soft-45.4%, hard-23.8%), medical failure (14%), trauma (8.1%), and surgical failure (6.4%). Success rate was 98.8%. Children comprised 78% (134) of the cohort and were more likely than adults to undergo RCI. Most (70%) of the RCIs were performed within 10 years from primary implantation. Speech perception outcome analysis revealed unchanged or improved performance in 85% of the cases and declined performance in 15%. Current findings confirm that RCI is a safe with high clinical efficacy; however, the non-negligible percentage of patients that exhibited declined performance post-RCI should be considered in decision-making processes regarding RCI. Routine follow-up during their first years post-implantation is warranted.

scholarly journals Preimplant Hearing Aid Fittings and Aided Audibility for Pediatric Cochlear Implant Recipients

2019 ◽  
Vol 30 (08) ◽  
pp. 703-711 ◽  
Author(s):  
Alissa Nickerson ◽  
Lisa S. Davidson ◽  
Rosalie M. Uchanski
Keyword(s):  
Speech Recognition ◽  
Speech Perception ◽  
Cochlear Implant ◽  
Hearing Aids ◽  
Speech Intelligibility ◽  
Recognition Performance ◽  
Demographic Data ◽  
The United States ◽  
Mean Deviation ◽  
The Relationship

AbstractAudibility of speech for children with hearing loss (HL) depends on the degree of HL and the fitting of the hearing aids (HAs) themselves. Many studies on cochlear implant (CI) users have demonstrated that preimplant hearing is associated with postimplant outcomes, but there have been very few reports on the fitting of HAs before surgery.The aims of this study were to characterize HA fittings and aided audibility of speech for pediatric HA users with severe to profound HL and to examine the relation between preimplant aided audibility and postimplant speech perception.A descriptive/observational and correlational study. Audiologic records of pediatric CI participants involved in a larger study examining the effects of early acoustic hearing were analyzed retrospectively; when available, these records included HA verification and speech recognition performance.The CI participants were enrolled in audiology centers and oral schools for the deaf across the United States.To determine whether deviations from prescribed DSL target were significantly greater than zero, 95% confidence intervals of the mean deviation were calculated for each frequency (250, 500, 1000, 2000, and 4000 Hz). Correlational analyses were used to examine the relationship between preimplant aided Speech Intelligibility Indices (SIIs) and postimplant speech perception in noise. Correlational analyses were also used to explore the relationship between preimplant aided SIIs and demographic data. T-tests were used to compare preimplant-aided SIIs of HAs of listeners who later became users of either sequential CIs, simultaneous CIs, or bimodal devices.Preimplant fittings of HAs were generally very close to prescriptive targets, except at 4000 Hz for those HAs with active frequency-lowering processing, and preimplant SIIs, albeit low, were correlated with postimplant speech recognition performance in noise. These results suggest that aided audibility should be maximized throughout the HA trial for later speech recognition purposes.It is recommended that HA fittings be optimized to support speech audibility even when considering implantation. In addition to the age at which HA use begins, the aided audibility itself is important in determining CI candidacy and decisions regarding bimodal HA use.

Cochlear Implant Users with Otosclerosis: Are Hearing and Quality of Life Outcomes Worse than in Cochlear Implant Users without Otosclerosis?

2018 ◽  
Vol 23 (6) ◽  
pp. 345-355 ◽  
Author(s):  
Miryam  Calvino ◽  
Isabel  Sánchez-Cuadrado ◽  
Javier Gavilán ◽  
Luis Lassaletta
Keyword(s):  
Speech Perception ◽  
Cochlear Implant ◽  
Electrode Array ◽  
Pure Tone Audiometry ◽  
Intergroup Difference ◽  
Profound Hearing Loss ◽  
Significant Intergroup Difference ◽  
Glasgow Benefit Inventory ◽  
Subjective Outcomes

Background: The otosclerotic process may influence the performance of the cochlear implant (CI). Difficulty in inserting the electrode array due to potential ossification of the cochlea, facial nerve stimulation, and instability of the results are potential challenges for the CI team. Objectives: To evaluate hearing results and subjective outcomes of CI users with otosclerosis and to compare them with those of CI users without otosclerosis. Method: Retrospective review of 239 adults with bilateral profound postlingual deafness who underwent unilateral cochlear implantation between 1992 and 2017. Hearing and speech understanding were assessed via pure-tone audiometry and speech perception tests. Subjective outcomes were assessed via the Nijmegen Cochlear Implant Questionnaire (NCIQ), the Glasgow Benefit Inventory (GBI), and the Hearing Implant Sound Quality Index (HISQUI19) at 6 months, 12 months, and at the last follow-up. Results: Subjects were 22 CI users with otosclerosis and 217 without otosclerosis. Both groups had a similar duration of deafness and age at CI implantation. Results did not significantly differ according to group: no significant intergroup difference was found regarding the frequency of complete electrode insertion, facial stimulation, reimplantation, or PTA4 scores at the last follow-up. Regarding speech perception, no significant intergroup difference was found on any test or at any interval. Further, subjective outcomes, as measured by the GBI, NCIQ, and HISQUI19, did not significantly differ between groups. Conclusions: Adults with otosclerosis and profound hearing loss derive significant benefit from CI use. Audiological and self-reported outcomes are not significantly different from that of other CI users with postlingual deafness.

scholarly journals One-year follow up of auditory performance in post-lingually deafened adults implanted with the Neurelec Digisonic® SP/Saphyr® Neo cochlear implant system

2015 ◽  
Vol 5 (2) ◽  
Author(s):  
Déborah Borger ◽  
Geneviève Lina-Granade ◽  
Stéphanie Verneyre ◽  
Hung Thai-Van ◽  
Sonia Saaï ◽  
...  
Keyword(s):  
Speech Perception ◽  
Cochlear Implant ◽  
Auditory Performance ◽  
Preliminary Study ◽  
One Year ◽  
Implant System ◽  
Technological Improvements ◽  
Sound Processor ◽  
Made In

This study aimed to quantify outcomes in a group of patients who were implanted with an Oticon Medical Neurelec (Vallauris, France) cochlear implant system, the Digisonic® SP/Saphyr® Neo. Ten participants took part in this preliminary study. Their speech perception capacities were evaluated at 3, 6, and 12-months after cochlear implant activation and compared to pre-implantation scores and to scores observed with former versions of the sound processor. Compared to former versions of the sound processor, patients using the Saphyr® Neo processor obtained better speech perception scores for sentences in silence at each tests session (3 months: 79%, 6 months: 82% and 12 months: 94%) compared to Digisonic® users (respectively: 58%, 69% and 75%) and Convex sound processor users (resp. 39%, 59% and 51%). These observations confirm that the technological improvements made in the Saphyr® Neo sound processor coupled with the Digisonic® implant, provided quantifiable benefits in speech perception in Quiet compared to former versions of the processor Convex and Digisonic® SP.

scholarly journals Electric and Acoustic Stimulation in Cochlear Implant Recipients with Hearing Preservation

2018 ◽  
Vol 39 (04) ◽  
pp. 414-427 ◽  
Author(s):  
Christopher Welch ◽  
Margaret Dillon ◽  
Harold Pillsbury
Keyword(s):  
Hearing Loss ◽  
Speech Perception ◽  
Cochlear Implant ◽  
Hearing Aids ◽  
High Frequency ◽  
Low Frequency ◽  
Hearing Preservation ◽  
The United States ◽  
Acoustic Stimulation ◽  
Electric Hearing

AbstractHearing loss affects 30 million people in the United States, and a subset of these patients have normal low-frequency hearing and ski-sloped high-frequency hearing loss. For these patients, hearing aids alone may not provide adequate benefit. Cochlear implantation alone has been utilized to improve speech perception. The addition of high-frequency electric hearing to low-frequency acoustic hearing in these patients is beneficial. Technical improvements have allowed preservation of low-frequency hearing in cochlear implant recipients, allowing for electric and acoustic stimulation in the same ear with significant improvements in speech perception, sound localization, music appreciation, and quality of life.

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