Sound Opportunities: Factors That Impact Referral for Pediatric Cochlear Implant Evaluation.

OBJECTIVES/HYPOTHESIS: To identify barriers to and opportunities for referral among children who could be considered for cochlear implantation. STUDY DESIGN: Retrospective review. METHODS: Audiological and medical records were reviewed on all children who had diagnostic or hearing aid care through a statewide healthcare system over 5-year span to identify children who met newly established clinical cochlear implant (CI) referral criteria. Data were collected for 869 potential CI candidates regarding demographic, socio-economic, audiological, medical, and family factors that may influence referral. A binomial logistic regression was completed to investigate the potential contributions of these predictors toward referral for a CI evaluation. RESULTS: Children who met traditional candidacy criteria of severe-to-profound bilateral hearing loss were referred at very high rates, while nontraditional candidates were referred less frequently. Factors influencing referral included race, age, insurance source, hearing thresholds, audiologist, physician, and family request. CONCLUSIONS: Results suggest that bilateral traditional candidates are being referred at high percentages; however, current practices and trends in pediatric cochlear implantation should be shared with families and providers to increase referral rates for nontraditional candidates. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:E2904-E2910, 2021.

The Impact of Cumulative Cochlear Implant Wear Time on Spoken Language Outcomes at Age 3 Years.

Purpose The purpose of this study was to analyze the impact of cumulative hearing hour percentage (HHP) on pediatric cochlear implant users' speech and language development at age 3 years and to determine an evidence-based wear time recommendation that yields typical spoken language standard scores. Method A retrospective chart review of 40 pediatric cochlear implant recipients was completed. Children met the following criteria: prelingually deafened, implanted at age 2 years or younger, utilized a speech processor with datalogging capabilities, a minimum of 1 year of cochlear implant use, and language testing completed at approximately age 3 years. Exclusion criteria included significant inner ear malformation (i.e., common cavity) or developmental delay that would preclude spoken language development. Results Multiple regression analysis revealed that age and implantation and HHP were predictive of spoken language skills at age 3 years. Further analysis yielded wear time recommendations associated with age-appropriate spoken language based on the age at implantation. Conclusions When the goal is age-appropriate spoken language, wear time recommendations should reflect a child's current age, age at implantation, and the comparative daily sound access of age-matched normal-hearing peers. The HHP measurement can help provide that information. The minimum wear time recommendation should be set to 80% HHP with the ultimate goal of 100% HHP to give pediatric cochlear implant recipients enough access to sound and language to achieve their spoken language goals.

The impact of unilateral, simultaneous, or sequential cochlear implantation on pediatric language outcomes.

OBJECTIVES: The purpose of this study was to determine the impact of unilateral versus bilateral cochlear implantation on receptive and expressive spoken language outcomes. Secondary aims were to investigate factors timing of first and second implant placement and reliance on government funded health plans on language outcome. METHODS: This was a retrospective chart review of spoken language users with bilateral severe-to-profound hearing loss. A total of 204 children were included, 105 in the bilateral group and 99 in the unilateral group. Multiple regression analyses were completed to investigate factors that influence language outcomes at age 5. RESULTS: Recipients who received bilateral CIs performed significantly higher on measures of receptive and expressive language than those with unilateral implants. DISCUSSION: This study demonstrates that bilateral implantation has a significant impact on receptive and expressive aspects of language development, and should be strongly considered as standard practice for children with bilateral severe to profound hearing loss. CONCLUSION: These results indicate that families should be counseled that language outcomes are better with bilateral cochlear implantation than unilateral implantation. Cochlear implant teams should continue to consider the impact of socioeconomic status on outcomes and explore new methods to reduce the impacts and barriers of poverty to language development.

Pediatric cochlear implant wear time and early language development.

Objectives: The purpose of this study is to analyze spoken language development in the first year of cochlear implant device use for pediatric recipients under five, and to determine the impact of device wear time on receptive and expressive spoken language outcomes using objective datalogging measures.Methods: Retrospective review of 37 children utilizing Cochlear™ processors capable of datalogging, who had completed speech and language testing before implantation and one year post. Hearing Hour Percentage (HHP) was created from datalogging results and two multiple regression analysis were performed including HHP and standard language scores.Results: HHP was found to be a predictor for receptive language outcomes one year after cochlear implant use. HHP was not found to be predictive of expressive language outcomes one year after cochlear implant use.Discussion: Datalogging is a vital objective measure that yields powerful data regarding a child's device use and early receptive spoken language development.Conclusion: In the first year of cochlear implant use, datalogging using the HHP significantly predicted receptive language scores. Increased HHP yielded higher receptive language standard scores. Continued research is needed to see if HHP is predictive of expressive language outcomes after a longer period of cochlear implant use.

Considerations for Pediatric Cochlear Implant Recipients With Unilateral or Asymmetric Hearing Loss: Assessment, Device Fitting, and Habilitation.

PURPOSE: The purpose of this clinical report is to present case studies of children who are nontraditional candidates for cochlear implantation because they have significant residual hearing in 1 ear and to describe outcomes and considerations for their audiological management and habilitation. METHOD: Case information is presented for 5 children with profound hearing loss in 1 ear and normal or mild-to-moderate hearing loss in the opposite ear and who have undergone unilateral cochlear implantation. Pre- and postoperative assessments were performed per typical clinic routines with modifications described. Postimplant habilitation was customized for each recipient using a combination of traditional methods, newer technologies, and commercial materials. RESULTS: The 5 children included in this report are consistent users of their cochlear implants and demonstrate speech recognition in the implanted ear when isolated from the better hearing ear. CONCLUSIONS: Candidacy criteria for cochlear implantation are evolving. Children with single-sided deafness or asymmetric hearing loss who have traditionally not been considered candidates for cochlear implantation should be evaluated on a case-by-case basis. Audiological management of these recipients is not vastly different compared with children who are traditional cochlear implant recipients. Assessment and habilitation techniques must be modified to isolate the implanted ear to obtain accurate results and to provide meaningful therapeutic intervention.