Prognostic factors in pediatric cochlear implant: an outcome-based study.

OBJECTIVE: To determine the prognostic factors in the pediatric cochlear implant (CI) outcome. MATERIALS AND METHODS: This prospective cohort study was conducted on 289 pediatric cases with prelingual hearing loss who received cochlear implantation. Several possible salient factors have been recorded. Auditory and speech evaluations were performed before CI, as well as 6 and 12 months after surgery, using Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) tests. RESULTS: According to univariate analysis, age at the time of surgery was a statistically significant factor. Neurological problems in the child, history of newborn infectious diseases, history of hearing aid use, proper parental cooperation, and round window approach were all significantly related to better auditory or speech outcomes. On the other hand, good parental cooperation and age (for CAP) and good parental cooperation, age, history of infectious disease, and hearing aids use (for SIR) are the significant factors in the multivariate setting. CONCLUSION: As evidenced by the obtained results, age, background diseases, history of rehabilitation with hearing aids, and surgical details are essential factors to be taken into account in the case-selection process.

Classification of voice disorder in children with cochlear implantation and hearing aid using multiple classifier fusion.

BACKGROUND: Speech production and speech phonetic features gradually improve in children by obtaining audio feedback after cochlear implantation or using hearing aids. The aim of this study was to develop and evaluate automated classification of voice disorder in children with cochlear implantation and hearing aids. METHODS: We considered 4 disorder categories in children's voice using the following definitions: Level_1: Children who produce spontaneous phonation and use words spontaneously and imitatively. Level_2: Children, who produce spontaneous phonation, use words spontaneously and make short sentences imitatively. Level_3: Children, who produce spontaneous phonations, use words and arbitrary sentences spontaneously. Level_4: Normal children without any hearing loss background. Thirty Persian children participated in the study, including six children in each level from one to three and 12 children in level four. Voice samples of five isolated Persian words "mashin", "mar", "moosh", "gav" and "mouz" were analyzed. Four levels of the voice quality were considered, the higher the level the less significant the speech disorder. "Frame-based" and "word-based" features were extracted from voice signals. The frame-based features include intensity, fundamental frequency, formants, nasality and approximate entropy and word-based features include phase space features and wavelet coefficients. For frame-based features, hidden Markov models were used as classifiers and for word-based features, neural network was used. RESULTS: After Classifiers fusion with three methods: Majority Voting Rule, Linear Combination and Stacked fusion, the best classification rates were obtained using frame-based and word-based features with MVR rule (level 1:100%, level 2: 93.75%, level 3: 100%, level 4: 94%). CONCLUSIONS: Result of this study may help speech pathologists follow up voice disorder recovery in children with cochlear implantation or hearing aid who are in the same age range.

Ophthalmic disturbances in children with sensorineural hearing loss.

Co-incidence of sensorineural hearing loss and ophthalmic abnormalities has a tremendous influence on development of children. This study was done to determine the nature and prevalence of ophthalmic disturbances in children with congenital sensorineural hearing loss. In a descriptive cross-sectional study, complete ophthalmologic examinations such as assessment of visual acuity, cycloplegic refraction, ocular motility examination, slit lamp examination and indirect funduscopy on 50 children with sensorineural hearing loss (determined by ABR), were performed. Thirty-two percent of cases had at least one kind of ophthalmic disturbances. Refractive errors were the most common abnormalities (28%), including astigmatism (12%), myopia and astigmatism (8%), and hyperopia (8%). Three (6%) cases had ocular motility disturbance including one case of esotropia, one case of exophoria and one case of exotropia. Twenty-four percent of cases had retinal abnormalities, including suspected Rubella retinopathy (6%), pigmentary changes suspect to retinitis pigmentosa (4%), optic nerve hypoplasia (4%), and finally poor fovea reflex (10%).

Speech development in children after cochlear implantation.

We evaluated the long-term speech intelligibility of young deaf children after cochlear implantation (CI). A prospective study on 47 consecutively implanted deaf children with up to 5 years cochlear implant use was performed. The study was conducted at a pediatric tertiary referral center for CI. All children in the study were deaf prelingually. They each receive implant before the program of auditory verbal therapy. A speech intelligibility rating scale evaluated the spontaneous speech of each child before and at frequent interval for 5 years after implantation. After cochlear implantation, the difference between the speech intelligibility, rating increased significantly each year for 3 years (P < 0.05). For the first year, the average rating remained "prerecognizable words" or "unintelligible speech". After 2 year of implantation the children had intelligible speech if someone concentrates and lip-reads (category 3). At the 4- and 5-year interval, 71.5 and 78% of children had intelligible speech to all listeners (category 5), respectively. So, 5 years after rehabilitation mode and median of speech intelligibility rating was five. Congenital and prelingually deaf children gradually develop intelligible speech that does not plateau 5 years after implantation.

Effect of stylet removal on neural response telemetry and stapedial reflex thresholds during cochlear implantation.

OBJECTIVE: The purpose of this study was to analyze changes in neural response telemetry (NRT) and electrically evoked stapedial reflex thresholds (ESRT) before and after stylet withdrawal during cochlear implant surgery. METHODS: Thirty children (21-92 months old) who were candidates for cochlear implantation took part in this study. In all of them Nucleus Contour Advance was implanted. NRT and ESRT responses were recorded initially with the stylet in and then when the stylet was taken out during the implant procedure. The recordings were performed in the basal, middle, and apical areas of the electrode array. RESULTS: The threshold levels required to obtain NRT and ESRT responses after stylet removal were lower. This decrease was observed in all parts of the cochlea. It was statistically significant in all areas with the exception of the basal ESRT measurements. CONCLUSION: Withdrawing the stylet results in better NRT and ESRT responses, most probably due to a favorable position change of the electrode array within the scala tympani.