Australian families of deaf and hard of hearing children: Are they using sign?

BACKGROUND: Deaf and hard of hearing (DHH) children may experience communication delays, irrespective of early intervention and technology. Australian Sign Language (Auslan) is one approach in early intervention to address language delays. Current prevalence of Auslan use among Australian families with DHH children is unknown. AIMS: The first aim was to determine the proportion of families enrolled in an Australian statewide hearing loss databank who use Auslan with their DHH child. The second aim was to explore the relationships between indicators of child hearing loss (bilateral or unilateral hearing loss, degree of hearing loss, and device use: hearing aids and cochlear implants), family factors (maternal education, attendance at early intervention, family history of deafness, and socio-economic disadvantage) and the family's reported use of Auslan. METHODS: We analysed the enrolment data from 997 families who participated in an Australian statewide hearing loss databank between 2012 and 2021. We described the proportion of families who used Auslan with their DHH child at home. The association between indicators of child hearing loss and family factors, and the parental reports of communication approach were examined using correlation analyses. RESULTS: Eighty-seven of 997 parents (8.7%) reported using Auslan with their DHH child. Of these, 26 (2.6%) used Auslan as their primary language. The use of Auslan at home was associated with the following indicators of child hearing loss: bilateral hearing loss, profound compared to mild hearing loss, and cochlear implant and hearing aid use compared to no device use. The family factors associated with the use of Auslan were: referral or attendance at early intervention compared to those who did not attend, and a family history of deafness compared to those with none. No association was found between maternal education and socio-economic disadvantage and the use of Auslan. CONCLUSION: This Australian study found a low proportion (8.7%) of families with a DHH child who reported using Auslan. Seven child hearing loss and family factors were considered, and five were significantly associated with using Auslan at home. Children with a greater degree of hearing loss, attendance at early intervention and family history of deafness tended to use Auslan.

Speech Perception and Language Outcomes for Infants Receiving Cochlear Implants Before or After 9 Months of Age: Use of Category-Based Aggregation of Data in an Unselected Pediatric Cohort.

Purpose This retrospective study aimed to amass large data sets to enable statistical comparisons of communication outcomes for infants receiving cochlear implants (CIs) before 9 months of age compared to groups who received their first CI between 9 months and 3.5 years of age. Method Speech perception scores and experienced clinicians' observations were used to refine the Categories of Auditory Performance Index (CAPI), thus creating its revised version, namely, the CAPI-Revised (CAPI-R). Standardized and criterion-referenced language data were used to create the novel Categories of Linguistic Performance (CLIP). The association between CAPI-R and CLIP data at two time points post implant (at 2 years of device experience and at 5 years of age) was examined in a large unselected cohort stratified for age at first implant: before 9 months (Group 1), between 9 and 12 months (Group 2), between 13 and 18 months (Group 3), between 19 and 24 months (Group 4), between 25 and 30 months (Group 5), between 31 and 36 months (Group 6), and between 37 and 42 months (Group 7). Results CAPI-R medians were 5 at 2 years of device experience, and 6 at 5 years of age. At 2 years of device experience, there was no significant difference in CAPI-R medians for children who received their first CI before 9 months compared to all other age-at-implant groups. At 5 years of age, a significantly better CAPI-R median was demonstrated by Group 1 (CI before 9 months) compared to Groups 4, 5, 6, and 7. CLIP medians were 3 at 2 years of device experience, and at 5 years of age. At 2 years device experience, and at 5 years of age, the Group 1 CLIP medians were significantly better than later age-at-implant groups. Conclusion Median CAPI-R outcomes supported access to CIs before 18 months of age for speech perception, and median CLIP outcomes supported access to CIs before 9 months of age for optimum language development.

Wearable Technology to Support Early Child Language Experiences: What's Important to Parents and Clinicians?

Emerging research evidence has demonstrated the potential for digital tools, such as automated language processing technology, to support parent-child interactions. Making use of digital tools can aid measurement of parent interaction metrics, additionally, providing contingent feedback to parents based on their language metrics can facilitate positive changes in their everyday input to their young children. Product innovation aside, there is a distinct lack of understanding about how best to integrate real-world, user design needs and preferences to improve deployment of technologies into routine clinical interventions. The present study explored salient requirements of a wearable language tracking device from the users' perspectives. Mothers of young children and clinicians with experience working in paediatric settings completed a written questionnaire and rated the importance of specific functions and features of a child-worn, language tracking device on a 10-point Likert scale. There was strong rating consensus across the participants that comfort, reliability and the provision of clear and useful results were of greater importance. The need for the wearable language tracking device to 'blend in' with different types of clothing was rated as less important. The extended Unified Theory of Acceptance and Use of Technology (UTAUT2) model was employed as a framework for addressing these importance ratings in this population of interest. This study highlighted the need to consider user-focused service design. Addressing user's preferences could facilitate greater technology adoption which ultimately enriches the language experiences for young children.

Speech Perception Outcomes for Adult Cochlear Implant Recipients Using a Lateral Wall or Perimodiolar Array.

AIM: To assess the speech perception outcomes of adult CI recipients with significant preimplant low frequency hearing, examining differences between perimodiolar and lateral wall electrode placement in order to provide clinical guidance for clinicians and surgeons. METHODS: A prospective cohort study was undertaken identifying all adults who received a thin straight electrode array (TSEA) at the Royal Victorian Eye & Ear Hospital (RVEEH) from 2010 to 2015 and who had a preimplant low frequency pure tone median ≤70 dB HL (n = 63). A retrospective review was completed of the RVEEH database to identify a comparison group who had been implanted with a perimodiolar electrode array, comprising adults implanted between 2004 and 2011 (PM Group) with preimplant hearing equivalent to the TSEA group (n = 70). The TSEA Group were further divided into subgroups in which n = 19 used EAS (TSEA-EAS) and n = 44 who used electric-only hearing (TSEA-Standard). RESULTS: There was no significant difference in median speech perception outcomes between the TSEA and PM Groups (TSEA 61.7%, PM 67.3%, p = 0.954). A significant difference was found between the TSEA-EAS and TSEA-Standard subgroups for median speech perception outcome (TSEA-EAS median 73.5%, TSEA-Standard median 58.3%, p = 0.043). CONCLUSIONS: Significant speech perception benefit following cochlear implantation was achieved with both the perimodiolar and lateral wall electrode arrays and no significant difference was found between outcomes with those array types in this population of adults with functional low frequency hearing pre-implant. Those that received a TSEA, had preserved hearing, and utilised an EAS sound processor performed better than their peers with a TSEA and electric-only hearing.

Talking to Toddlers: Drawing on Mothers' Perceptions of Using Wearable and Mobile Technology in the Home.

BACKGROUND: Mother-child interactions often give rise to opportunities for early language learning in the context of everyday life. Persuasive technology has the potential to influence maternal language behaviours in the home and promote mothers' active engagement in the development of their children's communication skills. AIM: This paper explored maternal perceptions regarding the use of a language tracking wearable (Language Environment Analysis; LENA) device and a parent education smartphone application in an 8-week trial with their young children. METHODS: Mother/child dyads were enrolled in a feasibility trial designed to obtain objective auditory and linguistic data from each child's naturalistic settings (Control Condition), provide feedback to mothers about their child's home language environment (LENA Feedback Condition), and to explore effectiveness of an app designed to promote meaningful parent/child interactions during daily routines (LENA Feedback and App Condition). RESULTS AND DISCUSSION: The majority of mothers (80%) who participated in the trial reported a preference for using the mobile app and/or LENA technology again. Maternal responses during this pilot informed the design of an ongoing, prospective language intervention study for parents and their young children with significant hearing loss.

What Can Long-Term Attendance at Programming Appointments Tell Us About Pediatric Cochlear Implant Recipients?

OBJECTIVE: This study sought to understand factors linked to long-term engagement with available post-implant "mapping" review services for individuals who received cochlear implants (CI)(s) as children. STUDY DESIGN: Demographics, communication outcomes, and appointment attendance records from an unselected group of 400 participants who received CI(s) between 1985 and 2009 were analyzed. RESULTS: After 5 years post-implant, 85.75% (n = 343) of participants attended the clinic for "mapping" appointments between March 2011 and March 2014, but 14.25% (n = 57) had not attended "mapping" for more than 3 years before March 2014. Findings showed that participants who did attend routine follow-up "mapping" appointments received their first implants at a significantly younger age (mean, 3.73 yr; standard deviation [SD], 3.39) and demonstrated better receptive language performance (mean standard score, 72; SD, 21.2) and better speech perception scores (mean open-set words, 54.1%; SD, 24.4; phonemes, 77.5%; SD, 15.8) suggesting they derived greater benefit from the technology than participants who did not attend (mean age at implant, 6.38 yr; SD, 4.85; mean receptive language standard score, 58.6; SD, 25.6; mean open-set-words, 34.5%; SD, 24.5; phonemes, 62.7.4%; SD, 23.4). CONCLUSIONS: The present study identified a profile of pediatric CI recipients who continue to attend follow-up review appointments after 5 years of device experience. Individuals who were non-attenders tended to include part-time and non-users of the technology. This could be due to a range of factors including the use of past speech processor technology (at first 12 months after switch-on), less overall benefit, and the presence of additional special needs.

Barriers to early cochlear implantation.

OBJECTIVE: Identify variables associated with paediatric access to cochlear implants (CIs). DESIGN: Part 1. Trends over time for age at CI surgery (N = 802) and age at hearing aid (HA) fitting (n = 487) were examined with regard to periods before, during, and after newborn hearing screening (NHS). Part 2. Demographic factors were explored for 417 children implanted under 3 years of age. Part 3. Pre-implant steps for the first 20 children to receive CIs under 12 months were examined. RESULTS: Part 1. Age at HA fitting and CI surgery reduced over time, and were associated with NHS implementation. Part 2. For children implanted under 3 years, earlier age at HA fitting and higher family socio-economic status were associated with earlier CI. Progressive hearing loss was associated with later CIs. Children with a Connexin 26 diagnosis received CIs earlier than children with a premature / low birth weight history. Part 3. The longest pre-CI steps were Step 1: Birth to diagnosis/identification of hearing loss (mean 16.43 weeks), and Step 11: MRI scans to implant surgery (mean 15.05 weeks) for the first 20 infants with CIs under 12 months. CONCLUSION: NHS implementation was associated with reductions in age at device intervention in this cohort.

Evidence-based guidelines for recommending cochlear implantation for young children: Audiological criteria and optimizing age at implantation.

OBJECTIVE: Establish up-to-date evidence-based guidelines for recommending cochlear implantation for young children. DESIGN: Speech perception results for early-implanted children were compared to children using traditional amplification. Equivalent pure-tone average (PTA) hearing loss for cochlear implant (CI) users was established. Language of early-implanted children was assessed over six years and compared to hearing peers. STUDY SAMPLE: Seventy-eight children using CIs and 62 children using traditional amplification with hearing losses ranging 25-120 dB HL PTA (speech perception study). Thirty-two children who received a CI before 2.5 years of age (language study). RESULTS: Speech perception outcomes suggested that children with a PTA greater than 60 dB HL have a 75% chance of benefit over traditional amplification. More conservative criteria applied to the data suggested that children with PTA greater than 82 dB HL have a 95% chance of benefit. Children implanted under 2.5 years with no significant cognitive deficits made normal language progress but retained a delay approximately equal to their age at implantation. CONCLUSIONS: Hearing-impaired children under three years of age may benefit from cochlear implantation if their PTA exceeds 60 dB HL bilaterally. Implantation as young as possible should minimize any language delay resulting from an initial period of auditory deprivation.

Long-term Communication Outcomes for Children Receiving Cochlear Implants Younger Than 12 Months: A Multicenter Study.

OBJECTIVE: Examine the influence of age at implant on speech perception, language, and speech production outcomes in a large unselected paediatric cohort. STUDY DESIGN: This study pools available assessment data (collected prospectively and entered into respective databases from 1990 to 2014) from three Australian centers. PATIENTS: Children (n = 403) with congenital bilateral severe to profound hearing loss who received cochlear implants under 6 years of age (excluding those with acquired onset of profound hearing loss after 12 mo, those with progressive hearing loss and those with mild/moderate/severe additional cognitive delay/disability). MAIN OUTCOME MEASURE(S): Speech perception; open-set words (scored for words and phonemes correct) and sentence understanding at school entry and late primary school time points. Language; PLS and PPVT standard score equivalents at school entry, CELF standard scores. Speech Production; DEAP percentage accuracy of vowels, consonants, phonemes-total and clusters, and percentage word-intelligibility at school entry. RESULTS: Regression analysis indicated a significant effect for age-at-implant for all outcome measures. Cognitive skills also accounted for significant variance in all outcome measures except open-set phoneme scores. ANOVA with Tukey pairwise comparisons examined group differences for children implanted younger than 12 months (Group 1), between 13 and 18 months (Group 2), between 19 and 24 months (Group 3), between 25 and 42 months (Group 4), and between 43 and 72 months (Group 5). Open-set speech perception scores for Groups 1, 2, and 3 were significantly higher than Groups 4 and 5. Language standard scores for Group 1 were significantly higher than Groups 2, 3, 4, and 5. Speech production outcomes for Group 1 were significantly higher than scores obtained for Groups 2, 3, and 4 combined. Cross tabulation and χ2 tests supported the hypothesis that a greater percentage of Group 1 children (than Groups 2, 3, 4, or 5) demonstrated language performance within the normative range by school entry. CONCLUSIONS: Results support provision of cochlear implants younger than 12 months of age for children with severe to profound hearing loss to optimize speech perception and subsequent language acquisition and speech production accuracy.

Language outcomes for children with cochlear implants enrolled in different communication programs.

OBJECTIVES: The aims of this study were to (a) compare language outcomes in pediatric cochlear implant users enrolled in three different communication programs: sign and spoken language, auditory-oral, and auditory-verbal therapy, and (b) examine factors influencing language outcomes. METHODS: Post-implant standard scores on language assessments of receptive vocabulary, auditory comprehension, and expressive communication were collected from files of 42 children with prelingual hearing loss who were implanted by 3;6 years of age. Early intervention history, device details, and demographic information were obtained for each child. Family involvement was evaluated using a rating scale. RESULTS: After adjusting for potential covariates, there were no significant differences in language outcomes across the three groups. Overall, there was a large degree of variability with some children achieving below average scores and others achieving above average scores. Age at diagnosis of hearing loss and family involvement were significantly associated with language outcomes. CONCLUSION: Regardless of the type of communication approach received, children diagnosed with hearing loss at an early age and children with a high level of family involvement had better post-implant language scores than children diagnosed later and with lower levels of family involvement. These findings emphasize the importance of early diagnosis and highlight the contribution families make to the language outcomes of children with cochlear implants.

Communication outcomes for groups of children using cochlear implants enrolled in auditory-verbal, aural-oral, and bilingual-bicultural early intervention programs.

OBJECTIVE: The relative impact of early intervention approach on speech perception and language skills was examined in these 3 well-matched groups of children using cochlear implants. STUDY DESIGN: Eight children from an auditory verbal intervention program were identified. From a pediatric database, researchers blind to the outcome data, identified 23 children from auditory oral programs and 8 children from bilingual-bicultural programs with the same inclusion criteria and equivalent demographic factors. PATIENTS: All child participants were male, had congenital profound hearing loss (pure tone average >80 dBHL), no additional disabilities, were within the normal IQ range, were monolingual English speakers, had no unusual findings on computed tomography/magnetic resonance imaging, and received hearing aids and cochlear implants at a similar age and before 4 years of age. MAIN OUTCOME MEASURES: Open-set speech perception (consonant-nucleus-consonant [CNC] words and Bamford-Kowal-Bench [BKB] sentences) and the Peabody Picture Vocabulary Test (PPVT) were administered. RESULTS: The mean age at cochlear implant was 1.7 years (range, 0.8-3.9; SD, 0.7), mean test age was 5.4 years (range, 2.5-10.1; SD, 1.7), and mean device experience was 3.7 years (range, 0.7-7.9; SD, 1.8). Results indicate mean CNC scores of 60%, 43%, and 24% and BKB scores of 77%, 77%, and 56% for the auditory-verbal (AV), aural-oral (AO), and bilingual-bicultural (BB) groups, respectively. The mean PPVT delay was 13, 19, and 26 months for AV, AO, and BB groups, respectively. CONCLUSION: Despite equivalent child demographic characteristics at the outset of this study, by 3 years postimplant, there were significant differences in AV, AO, and BB groups. Results support consistent emphasis on oral/aural input to achieve optimum spoken communication outcomes for children using cochlear implants.

Communication development in children who receive a cochlear implant by 12 months of age.

OBJECTIVE: Describe the long-term benefits of early cochlear implantation. Provide a comprehensive description of outcomes, including: language, speech production, and speech perception. Compare the communication outcomes for the early implanted children to those of normally hearing children and children who received a cochlear implant at a comparatively older age. METHOD: Retrospective review of the communication development of 35 children implanted between 6 and 12 months of age and 85 children implanted between 13 and 24 months of age. Audiologic assessments included unaided and aided audiograms, auditory brainstem response (ABR), auditory steady state response (ASSR), and otoacoustic emissons (OAEs). Formal language, speech production, and speech perception measures were administered, preimplant and at 1, 2, 3, and 5 years postimplant. RESULTS: The children who received their cochlear implant by 12 months of age demonstrated language growth rates equivalent to their normally hearing peers and achieved age appropriate receptive language scores 3 years postimplant. The children who received their cochlear implant between 13 and 24 months demonstrated a significant language delay at 3 years postimplant. Speech production development followed a similar pattern to that of normal-hearing children, although was delayed, for both groups of children. Mean open-set speech perception scores were comparable with previous reports for children and adults who use cochlear implants. CONCLUSION: Children implanted by 12 months of age demonstrate better language development compared with children who receive their cochlear implant between 13 and 24 months. This supports the provision of a cochlear implant within the first year of life to enhance the likelihood that a child with severe-to-profound hearing impairment will commence elementary school with age-appropriate language skills.

Evidence-based approach for making cochlear implant recommendations for infants with residual hearing.

OBJECTIVES: The aim of this study was to develop guidelines, based on the unaided pure-tone audiogram, for recommending a cochlear implant (CI) for infants and young children with residual hearing. As awareness of the benefits of early implantation increases and age at diagnosis decreases, an increasing number of infants are presenting for consideration of implantation with significant residual hearing in one or both ears. Determining the likelihood that these infants will have an improved speech and language outcome if they receive a CI is a challenge. DESIGN: Subjects were 142 hearing impaired children (ages 4.6 to 16.2 yrs) with unaided three-frequency pure-tone average (PTA; at 500, 1000, and 2000 Hz) ranging from 28 to 125 dB HL: 62 used conventional amplification (analog or digital hearing aids [HAs]) and the remaining 80 used a Nucleus 24 (N24) or Freedom CI. Open-set monosyllabic word (Phonetically Balanced Kindergarten or Consonant-Nucleus-Consonant words) and sentence (Bamford-Kowal-Bench sentences) testing was administered audition alone to both groups of children. RESULTS: Comparison of means for sentence testing showed that the children using CIs performed significantly better than their peers with profound hearing loss (PTA >90 dB HL) using HAs and not significantly differently to those with severe (PTA 66 to 90 dB HL) or moderate (PTA <66 dB HL) hearing loss. Comparison of means for monosyllabic word testing showed that the children using CIs performed significantly better than their peers with severe and profound hearing loss and not significantly differently to those with moderate hearing loss. Regression analysis was used to determine the equivalent unaided PTA values that corresponded to the median and first quartile scores for the children using CIs on speech perception testing. For open-set words, scored for phonemes correct, the equivalent unaided PTAs were 46 and 56 dB HL, respectively. For sentence testing, the equivalent unaided PTAs were 63 and 72 dB HL, respectively. CONCLUSIONS: Results suggest that recommendation for implantation can be made confidently for children presenting with bilateral profound hearing loss. For children with unaided PTA hearing levels in the range of 75 to 90 dB HL, a recommendation for implantation can also be made, provided that a 75% chance of improvement in hearing outcome is an acceptable level of benefit to the family and clinician. Children presenting with PTA hearing levels better than 75 dB HL should be encouraged to continue with binaural HA use.

Cochlear implants in forty-eight children with cochlear and/or vestibular abnormality.

CT and MRI scans for 48 children with cochlear and/or vestibular abnormality were classified in decreasing severity; common cavity, Mondini plus enlarged vestibular aqueduct, Mondini dysplasia alone and enlarged vestibular aqueduct alone. No significant relationship between degree of cochlea abnormality and surgical issues (cerebrospinal fluid gusher, depth of insertion, number of electrodes) or speech perception/language outcomes was found. A significant relationship was observed between cerebrospinal fluid gusher and partial electrode insertion, fewer active electrodes and poorer sentence understanding. Optimum language outcomes were associated with younger age at implant.

Communication development in children who receive the cochlear implant younger than 12 months: risks versus benefits.

BACKGROUND: The advent of universal neonatal hearing screening in some countries and the availability of screening programs for at-risk infants in other countries has facilitated earlier referral, diagnosis, and intervention for infants with hearing loss. Improvements in device technology, two decades of pediatric clinical experience, a growing recognition of the efficacy of cochlear implants for young children, and the recent change in the U.S. Food and Drug Administration's age criteria to include children as young as 12 mo has led to increasing numbers of young children receiving cochlear implants. Evidence to support provision for infants younger than 12 mo is extrapolated from physiological studies, studies of children using hearing aids, and studies of children older than 12 mo of age with implants. To date, however, there are few published research findings regarding communication development in children between 6 and 12 mo of age who receive implants. The current study hypothesized that earlier implantation would lead to increased rates of language acquisition as the children were still in the critical period for their development. METHOD: A retrospective review was completed for 19 infants (mean age at implantation, 0.88 yr; range, 0.61-1.07, SD 0.15) and 87 toddlers (mean age at implantation, 1.60 yr; range, 1.13-2.00, SD 0.24) who received the multichannel implant in Melbourne, Australia. Preimplantation audiological assessments for these children included aided and unaided audiograms, auditory brain stem response, auditory steady state response (ASSR), and otoacoustic emission and indicated profound to total bilateral hearing loss in all cases. Communication assessment included completion of the Rossetti Infant-Toddler Language Scale and educational psychologists' cognitive and motor assessment. Computed tomography scan, magnetic resonance imaging, and surgical records for all cases were reviewed. Postimplantation language assessments were reported in terms of the rate of growth over time on the language comprehension and language expression subscales of the Rossetti Infant-Toddler Language Scale. RESULTS: Results demonstrated that cochlear implantation may be performed safely in very young children with excellent language outcomes. The mean rates of receptive (1.12) and expressive (1.01) language growth for children receiving implants before the age of 12 mo were significantly greater than the rates achieved by children receiving implants between 12 and 24 mo, and matched growth rates achieved by normally hearing peers. These preliminary results support the provision of cochlear implants for children younger than 12 mo of age within experienced pediatric implantation centers.

Cochlear implants for children with significant residual hearing.

BACKGROUND: Previous research suggests that children with pure-tone averages of greater than 90 dB hearing level and/or open-set sentence perception of less than 30% may derive significant benefit from cochlear implantation. OBJECTIVE: To evaluate postoperative speech perception benefit and bilateral-bimodal benefit for 16 children whose preimplant speech perception scores exceeded conservative candidacy guidelines. STUDY DESIGN: Preimplant and postimplant repeated-measure design. METHODS: Sixteen child subjects who obtained 30% or greater on preimplant open-set sentence material, presented live voice audition alone, were selected for this study. Preimplant pure-tone averages ranged from 73 to 110 dB in the better aided ear. Preimplant and postimplant open-set word and sentence testing was completed in quiet and with competing background noise for separate ear and binaural conditions. RESULTS: Fourteen of 16 subjects had improved speech perception scores across all test materials after implantation. Group means were significantly higher for all test materials. Results in the bimodal-bilateral condition were significantly higher than implant alone for open-set word tests (scored for phonemes) and open-set sentences in quiet. CONCLUSION: The results of this study suggest that, with appropriate counseling and management, some children with significant residual hearing benefit from cochlear implantation, in particular improved speech understanding due to bimodal-bilateral hearing.

Speech perception outcomes in older children who use multichannel cochlear implants: older is not always poorer.

Speech perception outcomes for early-deafened children who undergo implantation as teenagers or young adults are generally reported to be poorer than results for young children. It is important to provide appropriate expectations when counseling adolescents and their families to help them make an informed choice regarding cochlear implant surgery. The considerable variation of results in this group makes this process more difficult. This study considered a number of factors in a group of 25 children who underwent implantation in Melbourne between the ages of 8 and 18 years. Each subject completed open-set speech perception testing with Bamford-Kowal-Bench sentences before and after implantation and preoperative language testing with the Peabody Picture Vocabulary Test. Data were collected regarding the type of hearing loss, age at implantation, age at hearing aid fitting, audiometric details, and preoperative and postoperative communication mode. Results were submitted to a stepwise multiple linear regression analysis with postoperative open-set sentence scores as the dependent variables. The analysis suggested that 3 factors have a significant predictive value for speech perception after implantation: preoperative open-set sentence score, duration of profound hearing loss, and equivalent language age. These 3 factors accounted for 66% of the variance in this group. The results of this study suggest that children who have useful speech perception before implantation, and higher age-equivalent scores on language measures, would be expected to do well with a cochlear implant. Consistent with other studies, a shorter duration of profound hearing loss is also advantageous. The mean sentence score for this group, 47%, was not significantly different from the mean result across all children in the Melbourne program.

Speech perception in children using cochlear implants: prediction of long-term outcomes.

A group of 102 children using the Nucleus multichannel cochlear implant were assessed for open-set speech perception abilities at six-monthly intervals following implant surgery. The group included a wide range of ages, types of hearing loss, ages at onset of hearing loss, experience with implant use and communication modes. Multivariate analysis indicated that a shorter duration of profound hearing loss, later onset of profound hearing loss, exclusively oral/aural communication and greater experience with the implant were associated with better open-set speech perception. Developmental delay was associated with poorer speech perception and the SPEAK signal coding scheme was shown to provide better speech perception performance than previous signal processors. Results indicated that postoperative speech perception outcomes could be predicted with an accuracy that is clinically useful.