During 2007, there are 102 papers included in the literature review on child-specific cochlear implantation. The topics highlighted in the review are:
• Earlier implantation and outcomes
• More complex children
• Functional outcomes, including educational
• Psycho-social issues, including family issues
• Binaural hearing, including bilateral implantation.
Age at implantation has long been recognised as a significant factor in determining outcomes from implantation; during 2007 a number of papers have thrown further light on the issue, often comparing children to normally hearing peers, rather than those with hearing aids. For example, Dettman et al (1), looked at 19 infants implanted below age of one (mean age at implant 0.88) finding that implantation was safe in this group. They found that language growth was significantly greater in these infants than in a matched group implanted between 12 and 24 months, and their growth rates matched the growth rates of normally hearing infants. Nicholas and Geers (2) asked the question “Will they catch up?”, using the Pre-School Language Scale with 76 children aged 3.5 and 4.5 years of age, implanted below the age of three, and comparing them with hearing children of 4.5 years of age. Those implanted between 12 and 16 months were more likely to achieve age-appropriate spoken language. Two studies looked at the use of TAIT video analysis in exploring the developing communication skills of deaf infants with implants. Tait, De Raeve and Nikolopoulos (3) compared the pre-verbal communication skills of children implanted before the age of one, with normally hearing children: 10 implanted under one and 10 normally hearing infants. They were cautious because of the small numbers involved, but the development of vocal autonomy was close to that of normally hearing children as was the development of non-looking vocal turns. Normally hearing children progressed faster but the difference was not significant. Tait, Nikolopoulos and Lutman (4) found that vocal and auditory preverbal skills developed more rapidly in those implanted between one and two, and those implanted between two and three. Additionally, those implanted between the ages of one and two also were significantly more likely to develop auditory/oral communication more rapidly.
Looking at the area of early babbling and its relationship to speech and language outcomes Walker and Bass-Ringdahl (5) found that, recording the development of early babble, the phonetic complexity of babbling was significantly correlated with speech and language outcomes at four years of age, giving a useful early indication of progress.
An interesting paper by Desjardin et al (6) looks at maternal input in early implanted children and found that mothers’ involvement, self-efficacy, and linguistic input were significant factors in the progress of their children. Mothers’ MLU and language interactions were positively related to their children’s linguistic development. This has implications for those services working with parents and carers of children with implants, to ensure that they feel positively about the contributions they can make.
More complex children are now being considered for implantation: Edwards (7) reviewed the available research into children with complex needs and implants. The available literature is relatively sparse, and Edwards comments that appropriate measures are not available to enable progress to be monitored. She considers two groups – those who have additional difficulties identifiable before implantation and those whose difficulties can be identified after implantation. She recommends psychology involvement in assessment for implantation and in ongoing monitoring: each child should be assessed individually. Auditory neuropathy is an area of growing interest in the audiology field, and one paper by Jeong et al (8) explored outcomes in nine children with AN, finding their outcomes comparable to a group with SNHL, concluding that AN children can obtain considerable benefit from implantation. Connell et al (9) report encouraging progress in children with DFNB1. Children with CHARGE syndrome are another group being considered for implantation and Lanson et al (10) considered ten children with CHARGE who were implanted and who all showed, to varying degrees, benefit as measured by IT-MAIS.
Functional outcomes, including education in particular, were of interest in several studies. Lin et al (11) report the development of a communicative performance scale for use with paediatric patients. The FAPCI is the first validated instrument to assess real-world communicative performance of a child with an implant. It is a 23 item, parent-proxy scale which can be used with children between 2 and 5 years of age, giving a useful measure of the efficacy of implantation in real life.
Educational outcomes in children with implants have been considered an important area, with possible cost-savings and an increase in attainments. Three educational studies indicate that the area may not be straightforward: Mukari et al (12) explored the educational performance of children with implants in everyday life, using the SIFTER teacher rating scale, and found that children with implants were rated poorly in the SIFTER communication assessments. They conclude that children with implants continue to need specialist support in mainstream classes. Marschark et al’s (13) review of the effect of cochlear implantation on children’s reading and academic achievement shows that empirical results are variable and Vermuelen et al (14) in their study of reading attainments in 50 deaf children with at least three years of implant use found that those with implants had significantly better reading comprehension than those with hearing aids but remained substantially behind hearing peers.
Psycho-social issues are an emerging area of interest and the focus of ten papers: both with families and with young people themselves. Anagostou et al (15) considered parental emotions following implantation: they found that parents experience grief before and up to two years after implantation, and are generally less satisfied than the parents of children implanted over two years. Kushalnagar et al (16) also looked at parental feelings – they considered the behaviour of children with implants in relation to non verbal intelligence and parental depression. They found that the child’s adaptive behaviour showed a strong relationship with intelligence, and moderate correlations were found in the younger group between parental depression and adaptive behaviour. Again, they recommend that family-centred interventions are required for promoting early communication and language development. Mothers’ stress and expectations were again investigated by Weisel et al (17); they found no change in stress levels before and after implantation, and found that expectations in communication and academic attainments decreased as time after implantation increased. Damen et al (18) evaluated the Parental Perspectives questionnaire and developed a short version; they found the questionnaire to be an important tool, with the short form usable and with internal consistency.
Another study, by Lin et al (19) considered the use of speech and language measures in relation to parental perceptions of development in those with early implantation: they found that all outcome measures were positively associated with parental perceptions of development. Parents’ views were also solicited by Watson et al (20) who sent a questionnaire to families of children who had received implants at least five years previously, asking if their child had changed communication mode, if so in which direction, and why. The children had changed markedly towards oral communication, and parents’ views were that the change was largely driven by the change in audition and was a child led change.
Thinking about young people, a study by Most et al (21) looked at adolescent attitudes to implantation, concluding that those with stronger Deaf identity were more likely to have less positive attitudes to cochlear implantation. The study by Wheeler et al (22) interviewing young people with implants about their views, revealed a positive attitude to their implants, that most were using spoken language, that their implants were helping them a great deal in education, and that they did not criticise their parents for making the decision but rather respected them for it and felt that it was now their decision.
The area with the highest number of papers is the area of binaural hearing and, in particular, bilateral implantation. A number of papers looked at binaural hearing: Dorman et al (23) looked at the benefits of combining acoustic and electrical stimulation, finding that proportionally more of those with a hearing aid in one ear and implant in other achieved very high scores on tests of speech recognition than those with unilateral implants. Luntz et al (24) investigated those with bimodal-binaural hearing aid users (unilateral implants and contra lateral hearing aid) over three years after implantation, and found that those with cochlear implant and hearing aid consistently achieved higher scores on sentence identification in background noise than those with implant alone. Mok et al (25) also compared those with two implants, those with hearing aid and implant, and those with normal hearing, finding that those with two implants showed a greater headshadow effect than those with hearing aid and implant. A test battery to monitor progress with hearing aid and implant was developed by Ullauri et al (26) and they found that all children had improved speech perception scores when wearing implant and aid, although on subjective measures of benefit results were mixed.
Sequential implantation is a major topic and whether it is effective. Galvin et al (27) looked at six children aged between 5 and 15 years who had received a second implant, assessing them 12 months later. Outcomes varied between no benefit and significant benefit, but success did not correlate with hearing aid use, age, time between implants or second implant experience. Galvin, Mok and Dowell (28) also looked at 11 subjects with sequential bilateral implants: the children were aged between 4 and 15 with 6 to 13 months experience with the second implant. While they found that these children could gain additional benefit with improved speech perception in noise, they found no evidence of to suggest gain in binaural listening skills in the first six months, and could not identify factors influencing benefit. Gordon et al (29) investigated auditory brainstem activity in children with 9-30 months of bilateral implant use, reporting that their findings suggested a negative impact of unilateral implant use on bilateral auditory brainstem activity. Peters et al (30) looked at a larger group of children, 30, with sequential implantation, and found that sequential implantation in these children, aged 3 to 13 years, showed improved speech perception abilities in the second ear and gave access to the ability to use binaural mechanisms. They found the benefit developed in the second six months after implantation and while the younger children demonstrated higher open-set speech perception scores, the older ones demonstrated bilateral benefit in noise. Steffens et al (31) studied another group of 20 children who were sequentially bilaterally implanted and concluded that sequential bilateral implantation gave advantages in listening in noise and for lateralization. Another study looking at sequentially implanted bilateral users was that of Wolfe et al (32) finding improved speech perception in noise compared with unilateral performance. Those who received bilateral implants below the age of four achieved better speech perception compared with those receiving the second implant after the age of four. The study of Scherf et al (33) indicated beneficial outcomes from implantation for those who received the second implant by the age of six, especially in noisy conditions; they looked at the progress of 33 children after 18 months of second implant use, with improved speech recognition scores for all children in quiet.
While new areas of interest in the cochlear implant field continue to emerge for study, there were two papers during the year which looked at long-term device use and outcomes, which are so important. The paper by Archbold and O’Donoghue (34) emphasised the importance of engaging local professionals in the long-term care of children with implants and recommending ways of ensuring that the local community is informed and engaged, to optimise long-term use and to be cost-effective. Uziel et al (35) provided ten year follow up of 82 children, looking at a range of outcomes. They concluded that children with implants can attain functional levels of speech perception and production, the majority were continuing to wear them and were achieving satisfactory academic performance.
Cochlear implantation in children continues to be an area under study with large numbers of papers published: this summary includes only a selection: the entire collection can be reviewed through the full annual evidence update of the Specialist Library for ENT and Audiology.
References
1. Dettman SJ, Pinder D, Briggs RJ, Dowell RC, Leigh JR. Communication development in children who receive the cochlear implant younger than 12 months: risks versus benefits. Ear Hear. 2007;28:11S-18S. [Link to abstract]
2. Nicholas JG, Geers AE. Will they catch up? The role of age at cochlear implantation in the spoken language development of children with severe to profound hearing loss. J Speech Lang Hear Res. 2007;50:1048-1062. [Link to abstract]
3. Tait M, De R, Nikolopoulos TP. Deaf children with cochlear implants before the age of 1 year: comparison of preverbal communication with normally hearing children. International journal of pediatric otorhinolaryngology. 2007;71:1605-1611. [Link to abstract]
4. Tait ME, Nikolopoulos TP, Lutman ME. Age at implantation and development of vocal and auditory preverbal skills in implanted deaf children. International journal of pediatric otorhinolaryngology. 2007;71:603-610. [Link to abstract]
5. Walker EA, Bass-Ringdahl S. Babbling Complexity and Its Relationship to Speech and Language Outcomes in Children With Cochlear Implants. Otol Neurotol. 2007. [Link to abstract]
6. Desjardin JL, Eisenberg LS. Maternal contributions: supporting language development in young children with cochlear implants. Ear Hear. 2007;28:456-469. [Link to abstract]
7. Edwards LC. Children with cochlear implants and complex needs: a review of outcome research and psychological practice. J Deaf Stud Deaf Educ. 2007;12:258-268. [Link to abstract]
8. Jeong SW, Kim LS, Kim BY, Bae WY, Kim JR. Cochlear implantation in children with auditory neuropathy: outcomes and rationale. Acta Otolaryngol Suppl. 2007;36-43. [Link to abstract]
9. Connell S, Angeli S, I, Suarez H, Hodges A, V, Balkany T, Liu X. Performance after cochlear implantation in DFNB1 patients. Otolaryngology--head and neck surgery : official journal of AmericanAcademy of Otolaryngology-Head and Neck Surgery. 2007;137:596-602. [Link to abstract]
10. Lanson B, Green J, Roland J, Lalwani A, Waltzman S. Cochlear implantation in Children with CHARGE syndrome: therapeutic decisions and outcomes. The Laryngoscope. 2007;117:1260-1266. [Link to abstract]
11. Lin FR, Ceh K, Bervinchak D, Riley A, Miech R, Niparko JK. Development of a communicative performance scale for pediatric cochlear implantation. Ear Hear. 2007;28:703-712. [Link to abstract]
12. Mukari S, Ling L, Ghani H. Educational performance of pediatric cochlear implant recipients in mainstream classes. International journal of pediatric otorhinolaryngology. 2007;71:231-240. [Link to abstract]
13. Marschark M, Rhoten C, Fabich M. Effects of cochlear implants on children's reading and academic achievement. J Deaf Stud Deaf Educ. 2007;12:269-282. [Link to abstract]
14. Vermeulen AM, van BW, Schreuder R, Knoors H, Snik A. Reading comprehension of deaf children with cochlear implants. J Deaf Stud Deaf Educ. 2007;12:283-302. [Link to abstract]
15. Anagnostou F, Graham J, Crocker S. A preliminary study looking at parental emotions following cochlear implantation. Cochlear implants international. 2007;8:68-86. [Link to abstract]
16. Kushalnagar P, Krull K, Hannay J, Mehta P, Caudle S, Oghalai J. Intelligence, parental depression, and behavior adaptability in deaf children being considered for cochlear implantation. J Deaf Stud Deaf Educ. 2007;12:335-349. [Link to abstract]
17. Weisel A, Most T, Michael R. Mothers' stress and expectations as a function of time since child's cochlear implantation. J Deaf Stud Deaf Educ. 2007;12:55-64. [Link to abstract]
18. Damen G, Krabbe P, Archbold S, Mylanus E. Evaluation of the Parental Perspective instrument for pediatric cochlear implantation to arrive at a short version. International journal of pediatric otorhinolaryngology. 2007;71:425-433. [Link to abstract]
19. Lin FR, Wang NY, Fink NE et al. Assessing the Use of Speech and Language Measures in Relation to Parental Perceptions of Development After Early Cochlear Implantation. Otol Neurotol. 2007;Publish Ahead of Print. [Link to abstract]
20. Watson LM, Hardie T, Archbold SM, Wheeler A. Parents' Views on Changing Communication After Cochlear Implantation. J Deaf Stud Deaf Educ. 2007. [Link to abstract]
21. Most T, Wiesel A, Blitzer T. Identity and attitudes towards cochlear implant among deaf and hard of hearing adolescents. Deafness Education International. 2007;9:68-82. [Link to abstract]
23. Dorman MF, Gifford RH, Spahr AJ, McKarns SA. The Benefits of Combining Acoustic and Electric Stimulation for the Recognition of Speech, Voice and Melodies. Audiol Neurootol. 2007;13:105-112. [Link to abstract]
24. Luntz M, Yehudai N, Shpak T. Hearing progress and fluctuations in bimodal-binaural hearing users (unilateral cochlear implants and contralateral hearing aid). Acta Otolaryngol. 2007;1-6. [Link to abstract]
25. Mok M, Galvin KL, Dowell RC, McKay CM. Spatial unmasking and binaural advantage for children with normal hearing, a cochlear implant and a hearing aid, and bilateral implants. Audiol Neurootol. 2007;12:295-306. [Link to abstract]
26. Ullauri A, Crofts H, Wilson K, Titley S. Bimodal benefits of cochlear implant and hearing aid on the non-implanted ear: a pilot study to develop a protocol and a test battery. Cochlear implants international. 2007;8:29-37. [Link to abstract]
27. Galvin K, Mok M, Dowell R, Briggs R. 12-month post-operative results for older children using sequential bilateral implants. Ear and hearing. 2007;28:19S-21S. [Link to abstract]
28. Galvin K, Mok M, Dowell R. Perceptual benefit and functional outcomes for children using sequential bilateral cochlear implants. Ear and hearing. 2007;28:470-482. [Link to abstract]
29. Gordon KA, Valero J, Papsin BC. Auditory brainstem activity in children with 9-30 months of bilateral cochlear implant use. Hearing research. 2007;233:97-107. [Link to abstract]
30. Peters B, Litovsky R, Parkinson A, Lake J. Importance of age and postimplantation experience on speech perception measures in children with sequential bilateral cochlear implants. Otology & neurotology : official publication of the AmericanOtological Society American Neurotology Society (and) European Academyof Otology and Neurotology. 2007;28:649-657. [Link to abstract]
31. Steffens T, Lesinski-Schiedat A, Strutz J et al. The benefits of sequential bilateral cochlear implantation for hearing-impaired children. Acta Otolaryngol. 2007;1-13. [Link to abstract]
32. Wolfe J, Baker S, Caraway T et al. 1-year postactivation results for sequentially implanted bilateral cochlear implant users. Otol Neurotol. 2007;28:589-596. [Link to abstract]
33. Scherf F, van DL, van WA et al. Hearing benefits of second-side cochlear implantation in two groups of children. Int J Pediatr Otorhinolaryngol. 2007;71:1855-1863. [Link to abstract]
34. Archbold S, O'Donoghue GM. Ensuring the long-term use of cochlear implants in children: the importance of engaging local resources and expertise. Ear Hear. 2007;28:3S-6S. [Link to abstract]
35. Uziel AS, Sillon M, Vieu A et al. Ten-year follow-up of a consecutive series of children with multichannel cochlear implants. Otol Neurotol. 2007;28:615-628. [Link to abstract]
