Language profile of children with cochlear implants: comparative study about the effect of age of cochlear implantation and the duration of rehabilitation.

PURPOSE: The analysis of different language domains and exploration of variables that affect the outcomes of cochlear implantation would help to document the efficacy of cochlear implantation and intervention programs. The aim of this work was to examine the language profile of children with Cochlear Implants (CI) and to assess the effect of age at the time of cochlear implantation and the impact of duration of rehabilitation on the development of linguistic abilities for cochlear implanted children. METHODS: The study was conducted on 46 Arabic speaking children using unilateral CI who are receiving regular post-cochlear auditory and language rehabilitation in the phoniatrics unit, Kasr Alaini hospital. A Proficient Preschooler Language Evaluation (APPEL TOOL) was applied for the assessment of different language domains. RESULTS: Children who received post implant rehabilitation for ≥ 2 years showed significant improvement in all subtests' scores of APPEL tool than children who received same rehabilitation for ≤ 1 year. There was no significant difference of language scores between children who have received CI before age of 3 years and those who have been implanted after age of 3 years. CONCLUSION: This study showed that the language profile of CI children was beneficially affected by the longer duration of therapy post implantation.

[Frankfurt concept of early inpatient rehabilitation after cochlear implant treatment : Feasibility for aftercare. German version]. / Frankfurter Konzept einer stationären Cochleaimplantat-Frührehabilitation : Untersuchung zur Durchführbarkeit als Anschlussheilbehandlung.

BACKGROUND: The Association of the Scientific Medical Societies in Germany (AWMF) clinical practice guideline on cochlear implant (CI) treatment, which was updated in 2020, defined the entire process of CI care for the first time. In the present study, the feasibility and results of very early rehabilitation were examined. MATERIALS AND METHODS: The intervention group (IG) comprised 54 patients in whom rehabilitation was initiated within 14 (maximally 28) days after implantation. Patients with a significantly longer waiting time were included in the control group (CG, n = 21). In addition to the start and duration of rehabilitation, the speech intelligibility achieved with CI was recorded at different timepoints within a 12-month period. In addition, questionnaires were used to assess the effort of fitting the CI processor and the patients' satisfaction with the outcome as well as the timing of the start of rehabilitation. RESULTS: Median waiting time between implantation and start of rehabilitation was 14 days in the IG and 106 days in the CG; 92.6% of IG patients were able to start rehabilitation within 14 days. The effect of rehabilitation in the IG was 35 and in the CG 25 percentage points (Freiburg monosyllabic test). After 6 and 12 months of CI use, both groups showed comparable results in the test condition in quiet (IG/CG 6 months: 70%/70%; 12 months: 70%/60%, Freiburg monosyllabic test) and in noise (IG/CG 6 months: -1.1-0.85 dB SNR; 12 months: -0.65 dB SNR/0.3 dB SNR, Oldenburg sentence test). Hearing quality assessment scores collected by SSQ (Speech, Spatial and Qualities of Hearing Scale) questionnaire showed better scores in the IG at 6 months, which converged to CG scores at 12 months. The IG was significantly more satisfied with the timing of the start of rehab than the CG. All other data obtained from questionnaires showed no differences between the two groups. CONCLUSION: A very early start of inpatient rehabilitation after cochlear implantation was successfully implemented. The rehabilitation was completed within 7 weeks of CI surgery. Comparison of speech recognition test results before and after rehabilitation showed a significant improvement. A clear rehabilitation effect can therefore be demonstrated. Inclusion of CI rehabilitation in the German catalog of follow-up treatments is thus scientifically justified and therefore strongly recommended.

Prognostic factors in cochlear implantation in adults: Determining central process integrity.

The purpose of this study is to examine various preoperative factors that can play a role in the auditory rehabilitation outcome of cochlear implant (CI) recipients. In order to determine the level of integrity of central processing preoperatively, special attention was given to residual hearing, duration of deafness, and cochlear nerve diameter as prognostic factors. A cohort of 232 (272 CI implantations) postlingually deafened adults was evaluated in this study. Hearing results at 1, 2 and up to 3 years postoperatively were compared with various preoperative factors: promontory stimulation testing, residual hearing, duration of deafness, and magnetic resonance imaging of the cochlear nerve. Postoperative hearing performance was measured based on the German Freiburg monosyllabic word test and the Oldenburg sentence test. Postoperative hearing performance showed a significant improvement in each consecutive year after implantation. Duration of deafness showed a negative correlation to word recognition and a positive correlation to increased signal-to-noise-ratio in sentence testing. A significant decline in hearing outcome was shown starting around the second decade of deafness corresponding to 66% of life spent in deafness. MR imaging of cochlear nerve diameter shows a positive correlation of larger nerve diameter to better speech understanding. Promontory stimulation testing did not show any prognostic value. In this retrospective review it could be shown that there is an intricate interaction in the preoperative variables: duration of deafness - as well as the ratio of life spent in deafness; residual hearing; and cochlear nerve diameter.

Long-term effects of cochlear implantation on the intelligibility of speech in French-speaking children.

Our study compares the intelligibility of French-speaking children with a cochlear implant (N = 13) and age-matched children with typical hearing (N = 13) in a narrative task. This contrasts with previous studies in which speech intelligibility of children with cochlear implants is most often tested using repetition or reading tasks. Languages other than English are seldom considered. Their productions were graded by naive and expert listeners. The results show that (1) children with CIs have lower intelligibility, (2) early implantation is a predictor of good intelligibility, and (3) late implantation after two years of age does not prevent the children from eventually reaching good intelligibility.

[Quality of cochlear implant rehabilitation under COVID-19 conditions. German version]. / Qualität der Cochleaimplantat-Rehabilitation unter COVID-19-Bedingungen.

BACKGROUND: The rehabilitation process following cochlear implant (CI) surgery is carried out in a multimodal therapy according to German national guidelines and includes technical and medical aftercare. In times of the corona pandemic surgery and rehabilitation appointments were cancelled or delayed leading to a more difficult access to auditory rehabilitation. Newly implemented hygiene modalities due to the SARS-CoV­2 pandemic have changed medical aftercare and the rehabilitation process. The aim of this study was to evaluate the quality of rehabilitation under corona conditions. MATERIAL AND METHODS: An anonymous survey of adult cochlear implant patients was carried out by a non-standardized questionnaire. Demographics were analyzed and the quality of medical aftercare, speech therapy, technical aftercare, psychological support and the hygiene modalities were compared to previous rehabilitation stays. RESULTS: In total 109 patients completed the questionnaire. The quality of rehabilitation and individual therapy were rated as qualitatively similar or improved. The threat of the pandemic and fear of corona were rated unexpectedly high with 68% and 50%, respectively. The hygiene measures during the rehabilitation stay eased subjective fears at the same time. The majority of patients were annoyed by wearing face masks but visors, protection shields and social distancing were more tolerated. CONCLUSION: The implementation of the new hygiene modalities within the therapeutic rehabilitation setting was well-accepted by patients allowing access to auditory rehabilitation. A successful rehabilitation should ensure a fear-free environment by adhering to the necessary hygiene modalities.

Investigating the Effects of Vestibular Rehabilitation on Balance Function in Cochlear Implant Recipients.

BACKGROUND: Cochlear Implantation (CI) is an effective surgical approach to rehabilitate the severe to profound hearing-impaired patients. However, the insertion of CI electrodes into the cochlea may adversely affect vestibular receptors, resulting in vertigo or dizziness. The present study aimed to investigate the impacts of Vestibular Rehabilitation Therapy (VRT) exercises on dizziness symptoms of patients who underwent CI. METHODS: A total of 21 consecutive patients (age range: 28 to 61 years) with profound sensorineural hearing loss undergoing CI operation participated. The VRT therapy plan consisted of a habituation and adaptation exercises in combination with gait and balance exercises. The handicapping influences of dizziness was measured using a Dizziness Handicap Inventory (DHI) scale to measure the level of respondent's performance on physical, emotional, and functional dimensions. Visual Analogue Scale (VAS) was also conducted to assess the severity of dizziness symptoms. The DHI and VAS scales were conducted before VRT and at "oneweek", "two-week", and "four-week" following the last rehabilitation session. RESULTS: A repeated-measure analysis of variance demonstrated a significant decrement and a consequent improvement in DHI scores after vestibular exercises in all emotional, physical and functional domains (p < 0.001). We also found that the influence of implanted ear (p=0.076) and gender (p=0.094) variables on DHI scores were not statistically significant. The mean VAS score was 5.87 ± 2.27 at baseline stage and it reduced significantly during the course of the therapy (second week, 2.02 ±1.75, p < 0.001; and forth week, 1.51 ± 1.29, p < 0.001). CONCLUSION: The findings of this study showed that vestibular rehabilitation therapy has a positive impact on the symptoms of the patients who underwent CI surgery. These exercises lead to an improvement in balance and postural stability, and a reduction in the self-report measure of handicaps. These findings provide the basis for better pre-operative counseling and postoperative vestibular rehabilitation to CI recipients.

Development and validation of a spectro-temporal processing test for cochlear-implant listeners.

Psychophysical tests of spectro-temporal resolution may aid the evaluation of methods for improving hearing by cochlear implant (CI) listeners. Here the STRIPES (Spectro-Temporal Ripple for Investigating Processor EffectivenesS) test is described and validated. Like speech, the test requires both spectral and temporal processing to perform well. Listeners discriminate between complexes of sine sweeps which increase or decrease in frequency; difficulty is controlled by changing the stimulus spectro-temporal density. Care was taken to minimize extraneous cues, forcing listeners to perform the task only on the direction of the sweeps. Vocoder simulations with normal hearing listeners showed that the STRIPES test was sensitive to the number of channels and temporal information fidelity. An evaluation with CI listeners compared a standard processing strategy with one having very wide filters, thereby spectrally blurring the stimulus. Psychometric functions were monotonic for both strategies and five of six participants performed better with the standard strategy. An adaptive procedure revealed significant differences, all in favour of the standard strategy, at the individual listener level for six of eight CI listeners. Subsequent measures validated a faster version of the test, and showed that STRIPES could be performed by recently implanted listeners having no experience of psychophysical testing.

[Multicentric analysis of the use behavior of cochlear implant users]. / Multizentrische Analyse des Nutzerverhaltens von Cochlea-Implantat-Trägern.

INTRODUCTION: Novel cochlear implant speech processors are capable of storing data logs. With the help of this information a more individualized patient care can be provided. However, standard data are missing to a greater extent to the individual usage behavior. MATERIALS AND METHODS: In a retrospective study, the use data of 2687 patients were evaluated. All patients had the Nucleus 6 system from Cochlear Ltd. RESULTS: The data allow a normal range to be defined for the duration of use of cochlear implant speech processors. Likewise, the identification of conspicuous usage behavior is possible.

[Evoked potentials in the rehabilitation of the patients after cochlear implantation]. / Vyzvannye potentsialy v reabilitatsii patsientov posle kokhlearnoi implantatsii.

The objective methods for the hearing examination of the patients after cochlear implantation provide an important tool for the speech processor fitting. The aim of the present study was to evaluate the possibilities and the informative value of the electrically evoked compound action potential (ECAP) and electrically evoked auditory brainstem response (EABR) combined recording technique. For this reason, the comparison of the ECAP and EABR thresholds with comfortable levels of stimulation, obtained on the basis of subjective response and psychophysical testing of the patients with good results after cochlear implantation was performed. 19 patients with the CI experience from 1 to 5 years were included in our study. The combined registration of ECAP and EABR can be used to evaluate the functional capacity of the central auditory pathways and for the fitting of the complicated patients, especially those in whom the registration proved impossible with the use of other objective techniques. The ECAP and EABR threshold values were well correlated with the individual stimulation map profiles in the patients with the CI experience of less than two years (p<0.05). The results obtained in the present study allow us to conclude that combined registration of ECAP and EABR could be used for the determination of stimulation comfort level parameters and individual stimulation map profiles, especially in combination with the minimum amount of psychoacoustic information received from the patient.

[The effectiveness of the speech therapist and audiologist collaboration during speech processor fitting]. / Éffektivnost' sovmestnoi raboty surdopedagoga i surdologa v khode nastroek rechevogo protsessora.

The aim of the study was to present the first clinical experience of clinical trials of new methodology of the CI speech processor fitting with the new software Nucleus Fitting Software - NFS. At all 4 fittings sessions there were 15 children. During the fitting sessions 2 techniques were used - with the new NFS software and classical technique were used. The efficiency and need of collaboration of the speech therapist and the audiologist in the CI fitting sessions is proved. Results of inspection have shown that in 76.6% parents have established emotional cooperation with the children. Most of children have begun to seize the spontaneous speech in natural communication (60% - words, 23.3% - simple phrases). The results received by us allow to recommend the offered technique of the facilitated speech processor fitting technique for widespread introduction in clinical practice.

[The rehabilitation of the children with a cochlear implant as a way to the promotion of the natural development of the auditory perception, communication, and speech]. / Reabilitatsiia detei s kokhlearnym imalantom kak perevod na put' estestvennogo razvitiia slukhovogo vospriiatiia, kommunikatsii i rechi.

The objective of the present study was to substantiate and present the new approach to the rehabilitation of the children with cochlear implants (CI), the so-called ZP-rehabilitation, with special reference to its principal systemic differences from the 'hearing-speech' rehabilitation. The new method was tested in the course of rehabilitation of 90 deaf and dumb children having cochlear implants since the early and preschool age with the participation of 152 members of their families. As a result of the rehabilitative treatment, all the children included in the study were put on the way of the natural (normal) development of the auditory perception, communication, and speech while all the adults could communicate with the children on the natural sensory basis. It is concluded that the ZP-rehabilitation enables the child with a cochlear implant to embark on the path of the natural (normal) development and to pass (on the new natural sensory basis) through those early stages of ontogenesis that the deaf and dumb child and his relatives had gone through during the preceding period; moreover it helps to rearrange the relations between the child and his family on this new sensory basis.

[Preoperative auditory evaluation and postoperative follow-up in cochlear implantees : The role of objective measures]. / Präoperative audiologische Evaluation und postoperative Verlaufsdiagnostik bei Cochleaimplantatversorgung : Bedeutung objektiver Testverfahren.

The primary diagnostic aim prior to cochlear implantation is establishment of a comprehensive and multidisciplinary diagnosis, in order to subsequently begin therapy as early as possible. Audiological evaluation prior to implantation employs a test battery-approach, including subjective and objective procedures. Objective measures show high reliability and therefore play a major role in the diagnosis of difficult-to-test subjects such as infants and young children. During postoperative follow-up, objective measures offer a valid method for analyzing the effects of different stimuli on the auditory system. Particularly in infants, children, and uncooperative patients, the results of these tests enable the speech processor settings to be optimized, the hearing benefit to be assessed, and treatment to be adapted accordingly. Auditory brainstem responses (ABR) offer an excellent test/retest and inter-/intrarater reliability and validity, and are the most commonly used method for objective hearing threshold estimation and evaluation of the functional integrity of the lower auditory pathway. The use of narrow-band stimuli allows frequency-specific threshold estimation; analysis of stationary auditory steady state potentials (ASSR) adds the advantages of automated objective detection. Electrocochleography and electrically evoked ABR give valuable information in special cases. The use of cortical potentials (CAEP) in response to speech stimuli is quite promising, although the high response variability currently limits this method's clinical application. An audiological test-battery approach combining the results of subjective and objective measures leads to significantly increased reliability of preoperative diagnosis and postoperative follow-up in cochlear implantees.

[Intra- and postoperative electrophysiological diagnostics]. / Intra- und postoperative elektrophysiologische Diagnostik.

Within the context of treatment with cochlear implants (CIs), different electrical and electrophysiological diagnostic procedures are applied both intra- and postoperatively. These assess electrical measures from the CI and electrophysiological measures from CI patients, respectively. The electrophysiological diagnostic procedures comprise measurement of electrically evoked compound action potentials of the auditory nerve, the registration of electrically evoked auditory brainstem potentials and the assessment of electrically evoked auditory cortical potentials. These potentials reflect auditory nerve excitation and stimulus processing in different parts of the ascending auditory pathway for intracochlear electrical stimulation via a CI. For current CIs, assessment of electrode position and examination of the implant's coupling to the auditory nerve are important domains of application for electrophysiological diagnostic procedures. Another substantial application area is the examination of stimulus processing in the auditory pathway. However, the main field of application of these procedures is supporting the fitting of CI speech processors in infants and toddlers on the basis of electrophysiological thresholds.

Delayed-onset hearing loss in pediatric candidates for cochlear implantation.

The objective of this study was to evaluate the clinical significance of delayed-onset hearing loss in children. Seventy-three children who underwent cochlear implantation (CI) were included. They were divided into a congenital hearing loss group (n = 50) and a delayed-onset hearing loss group (n = 23). The age at diagnosis of hearing loss, age at the beginning of auditory habilitation, the age at CI, and the postimplant speech perception abilities were compared between the two groups. Children in the congenital hearing loss group were confirmed to have hearing loss at a mean age of 0.3 years, and those in the delayed-onset hearing loss group were diagnosed with hearing loss at a mean age of 2.0 years. Auditory habilitation began at a mean age of 0.4 and 2.0 years, and CI was performed at a mean age of 1.4 and 2.6 years, respectively. Children in the congenital hearing loss group had better scores on speech perception tests than those in the delayed-onset hearing loss group, but the differences were not significant. About half of the children with delayed-onset hearing loss (57 %) had risk factors associated with delayed-onset hearing loss. A high prevalence of delayed-onset hearing loss was noted in the group of children who underwent CI. Risk factors for hearing loss were not found in 43 % of children with delayed-onset hearing loss. Universal screening for delayed-onset hearing loss needs to be performed during early childhood.

Cochlear implantation in patients with inner ear bone malformations with posterior labyrinth involvement: an exploratory study.

Inner ear bone malformations are one cause of profound sensorineural hearing loss. This investigation focused on those affecting the posterior labyrinth, especially enlarged vestibular aqueduct syndrome, which is associated with fluctuating and progressive hearing loss. The objectives of this study were to analyze the behavior of the electrical stimulation, auditory functionality and linguistic development in patients with inner ear malformations involving the posterior labyrinth. The study included ten patients undergoing cochlear implantation (cases: five with enlarged vestibular aqueduct, two with vestibular aqueduct stenosis/aplasia, and three with semicircular canal disorders). Post-implantation, data were gathered on the electrical stimulation threshold and maximum comfort levels and on the number of functioning electrodes. Evaluation of Auditory Responses to Speech (EARS) subtests were used to assess auditory functionality and language acquisition at 6, 12, and 24 months post-implantation. Results were compared with findings in a control group of 28 cochlear implantation patients without these malformations. No significant differences were found between case and control groups in electrical stimulation parameters; auditory functionality subtest scores were lower in cases than controls, although the difference was only statistically significant for some subtests. In conclusion, cochlear implantation patients with posterior labyrinth bone malformations and profound hearing loss, including those with enlarged vestibular aqueduct syndrome, showed no significant difference in electrical stimulation threshold with controls. Although some auditory functionality test results were lower in cases than in controls, cochlear implantation appears to be beneficial for all patients with these malformations.

The impact of input quality on early sign development in native and non-native language learners.

There is debate about how input variation influences child language. Most deaf children are exposed to a sign language from their non-fluent hearing parents and experience a delay in exposure to accessible language. A small number of children receive language input from their deaf parents who are fluent signers. Thus it is possible to document the impact of quality of input on early sign acquisition. The current study explores the outcomes of differential input in two groups of children aged two to five years: deaf children of hearing parents (DCHP) and deaf children of deaf parents (DCDP). Analysis of child sign language revealed DCDP had a more developed vocabulary and more phonological handshape types compared with DCHP. In naturalistic conversations deaf parents used more sign tokens and more phonological types than hearing parents. Results are discussed in terms of the effects of early input on subsequent language abilities.

Sources of variability in language development of children with cochlear implants: age at implantation, parental language, and early features of children's language construction.

The aim of the present study was to analyze the relative influence of age at implantation, parental expansions, and child language internal factors on grammatical progress in children with cochlear implants (CI). Data analyses used two longitudinal corpora of spontaneous speech samples, one with twenty-two and one with twenty-six children, implanted between 0;6 and 3;10. Analyses were performed on the combined and separate samples. Regression analyses indicate that early child MLU is the strongest predictor of child MLU two and two-and-a-half years later, followed by parental expansions and age at implantation. Associations between earliest MLU gains and MLU two years later point to stability of individual differences. Early type and token frequencies of determiners predict MLU two years later more strongly than early frequency of lexical words. We conclude that features of CI children's very early language have considerable predictive value for later language outcomes.

[Music therapy in adults with cochlear implants : Effects on music perception and subjective sound quality]. / Musiktherapie bei erwachsenen CI-Trägern : Effekte auf die Musikwahrnehmung und die subjektive Klangqualität.

BACKGROUND: People with severe hearing impairments and deafness can achieve good speech comprehension using a cochlear implant (CI), although music perception often remains impaired. A novel concept of music therapy for adults with CI was developed and evaluated in this study. METHODS: This study included 30 adults with a unilateral CI following postlingual deafness. The subjective sound quality of the CI was rated using the hearing implant sound quality index (HISQUI) and musical tests for pitch discrimination, melody recognition and timbre identification were applied. As a control 55 normally hearing persons also completed the musical tests. RESULTS: In comparison to normally hearing subjects CI users showed deficits in the perception of pitch, melody and timbre. Specific effects of therapy were observed in the subjective sound quality of the CI, in pitch discrimination into a high and low pitch range and in timbre identification, while general learning effects were found in melody recognition. CONCLUSION: Music perception shows deficits in CI users compared to normally hearing persons. After individual music therapy in the rehabilitation process, improvements in this delicate area could be achieved.

[Phoneme discrimination training with experienced cochlear implant listeners]. / Training der Phonemdiskrimination mit erfahrenen Cochleaimplantatträgern.

BACKGROUND: Computer-based auditory training programmes seem to be a useful tool in the process of auditory rehabilitation after cochlear implantation (CI). Currently, little is known about the learning mechanism and efficiency of such programs. The aim of the study was to evaluate a specific auditory training programme for phoneme discrimination in experienced CI listeners. MATERIALS AND METHODS: A total of 15 CI adult listeners with more than 2 years' CI experience participated in the auditory training. Over a period of 3 weeks they were instructed to train their phoneme discrimination via computer twice a week. Training material consisted of special syllables for consonants (vCv) and vowels (cVc) discrimination. RESULTS: The discrimination abilities for consonants and vowels improved significantly over the training period for training group participants, whereas the changes for the consonants were higher. In addition, the improvement for voiced and unvoiced consonants was significant. CONCLUSION: Computerised auditory training with phonemes improves CI listeners' discrimination abilities for consonants and vowels.

Sensitive periods and language in cochlear implant users.

This study explores the hypothesis that the existence of a short sensitive period for lower-level speech perception/articulation skills, and a long one for higher-level language skills, may partly explain the language outcomes of children with cochlear implants (CIs). The participants were fourteen children fitted with a CI before their second birthday. Data about their language skills and the environmental conditions (e.g. Family Involvement in rehabilitation) were obtained over a period of three years. Age at implantation correlated exclusively with the ratio of errors of place of articulation, a phonological feature for which CIs provide insufficient information. The degree of Family Involvement was significantly correlated with the remaining language measures. We conclude that small plasticity reductions affecting lower-level skills may partly explain the difficulties of some CI users in developing language.