Cochlear Implants or Hearing Aids: Speech Perception, Language, and Executive Function Outcomes.

OBJECTIVES: We aimed to determine whether children with severe hearing loss (HL) who use hearing aids (HAs) may experience added value in the perception of speech, language development, and executive function (EF) compared to children who are hard of hearing (HH) or children who are deaf and who use cochlear implants (CIs) and would benefit from CIs over HAs. The results contribute to the ongoing debate concerning CI criteria. We addressed the following research question to achieve this aim: Do children who are HH or deaf with CIs perform better than children with severe HL with HAs with respect to auditory speech perception, and receptive vocabulary and/or EF? DESIGN: We compared two groups of children with severe HL, profound HL or deafness, with CIs or HAs, matched for gender, test age (range, 8 to 15 years), socioeconomic status, and nonverbal intelligence quotient. Forty-three children had CIs (pure-tone average at 2000 and 4000 Hz >85 dB HL), and 27 children had HAs (mean pure-tone average: 69 dB HL). We measured speech perception at the conversational level (65 dB SPL) and the soft speech perception level (45 dB SPL). We established receptive vocabulary using the Peabody Picture Vocabulary Test-III-NL. We tested EF using the Delis Kaplan Executive Function System battery and the Dutch Rey Auditory Verbal Learning Test. We employed the Mann-Whitney U test to compare data between the CI and HA groups. We used Chi-square goodness of fit tests to contrast the CI and HA group distributions with the norm data of children who are typically developing (TD). We harnessed Kendall's Tau-b to investigate relationships between the study variables. RESULTS: Both groups of children, with CIs and Has, obtained ceiling scores for perception of speech on a conversational level. However, the HA group exhibited significantly lower perception on a soft speech level scores (68 %) than the CI group (87%). No difference was present between the receptive vocabulary distributions of the CI and HA groups. The median receptive vocabulary standard scores for both groups were well within the normal range (CI group: 93; HA group: 96). In addition, we did not find any difference in EF between the CI and HA groups. For planning and verbal memory, the distributions of observed scores for children with CIs were different from the expected distributions of children who are TD. In both groups, a large proportion of children obtained below-average scores for planning (CI: 44%; HA: 33%) and for long-term verbal memory (CI: 44%; HA: 35%). In the HA group, perception at a soft speech level was associated with receptive vocabulary and planning. In the CI group, we did not find any associations. CONCLUSIONS: Both groups of children with severe and profound HL with HAs exhibit less favorable auditory perception on the soft speech level, but not at a conversational level, compared to children who are HH or deaf with CIs. Both groups, children with CIs and HAs, only exhibit more problems in planning and verbal memory than the norm groups of children who are TD. The results indicate that to obtain age-appropriate levels of receptive vocabulary and EF, the perception at the soft speech level is a necessary but not sufficient prerequisite.

Capability of Children with Hearing Devices: A Mixed Methods Study.

We investigated 34 deaf and hard-of-hearing children with hearing devices aged 8-12 years and 30 typical hearing peers. We used the capability approach to assess well-being in both groups through interviews. Capability is "the real freedom people have to do and to be what they have reason to value." Speech perception, phonology, and receptive vocabulary data of the deaf and hard-of-hearing children, that were used retrospectively, showed a large variability. The analysis of the relation between clinical quantitative outcome measures and qualitative capability interview outcomes suggests that at this age, differences in clinical performance do not appear to translate into considerable differences in capability, including capability did offer insight into the factors that appeared to ensure this equivalence of capability. We argue that capability outcomes should be used to determine the focus of (auditory) rehabilitation and support, in line with the United Nations Convention on the Rights of the Child.

Age-Related Changes in Listening Effort for Children and Teenagers With Normal Hearing and Cochlear Implants.

OBJECTIVES: A clinically viable measure of listening effort is crucial in safeguarding the educational success of hard-of-hearing students enrolled in mainstream schools. To this end, a novel behavioral paradigm of listening effort targeting school-age children has been designed and reported in Hsu et al. (2017). The current article consists of two follow-up experiments investigating the effects of noise, processing depth, and age in a similar paradigm, first in a group of participants with normal hearing (NH) followed by a sample of school-age cochlear implant (CI) users. Research objectives include the construction of normative values of listening effort and comparing outcomes between age-matched NH and CI participants. DESIGN: In Experiment 1, the listening effort dual-task paradigm was evaluated in a group of 90 NH participants with roughly even age distribution between 6 and 26 years. The primary task asked a participant to verbally repeat each of the target words presented in either quiet or noise, while the secondary task consisted of categorization true-or-false questions "animal" and "dangerous," representing two levels of semantic processing depth. Two outcome measures were obtained for each condition: a classic word recognition score (WRS) and an average response time (RT) measured during the secondary task. The RT was defined as the main listening effort metric throughout the study. Each NH participant's long-term memory retrieval speed and working memory capacity were also assessed through standardized tests. It was hypothesized that adding noise would negatively affect both WRS and RT, whereas an increase in age would see significant improvement in both measures. A subsequent Experiment 2 administered a shortened version of the paradigm to 14 school-age CI users between 5 and 14 years old at a university clinic. The patterns of results from the CI group were expected to approximate those of the NH group, except with larger between-subject variability. RESULTS: For NH participants, while WRS was significantly affected by age and noise levels, RT was significantly affected by age, noise levels, and depth of processing. RT was significantly correlated with long-term memory retrieval speed but not with working memory capacity. There was also a significant interaction effect between age and noise levels for both WRS and RT. The RT data set from the NH group served as a basis to establish age-dependent 95% prediction intervals for expected future observations. For CI participants, the effect of age on the two outcome measures was more visible when target words were presented in quiet. Depending on the condition, between 35.7% and 72.7% of the children with CI exhibited higher-than-norms listening effort as measured by categorization processing times. CONCLUSION: Listening effort appears to decrease with age from early school-age years to late teenage years. The effects of background noise and processing depth are comparable with those reported in Hsu et al. (2017). Future studies interested in expanding the paradigm's clinical viability should focus on the reduction of testing time while maintaining or increasing the sensitivity and external validity of its outcome measures.

Cochlear Implant Data Logs Predict Children's Receptive Vocabulary.

OBJECTIVES: The data logs of Cochlear Nucleus cochlear implant (CI) sound processors show large interindividual variation in children's daily CI use and auditory environments. This study explored whether these differences are associated with differences in the receptive vocabulary of young implanted children. DESIGN: Data of 52 prelingually deaf children, who had received a CI before 3 years of age, were obtained from their clinical records. In total, 73 Peabody Picture Vocabulary tests and CI data logs for 1 year preceding each test were collected. The data logs were used to determine the children's average daily amount of CI use and exposure to speech, speech in noise, noise, music, and quiet. In addition, information was collected about other potential predictors of language abilities, namely gender, age, age at implantation, etiology of deafness, educational placement, and implantation mode (unilateral, bilateral). Model selection with Akaike's information criterion was used to determine which data-logging metrics, other variables, and combinations of both best predict receptive vocabulary scores. RESULTS: The data showed a strong positive association between receptive vocabulary and daily CI use, and a negative association between receptive vocabulary and daily exposure to music. Associations with the data logs' speech and noise metrics were less clear. The most important other variable was educational placement. The best model performance was achieved when data logs and other information were combined. CONCLUSIONS: The results emphasize the importance of consistent CI use and a rich auditory environment for the early language development of young CI users. The study also shows that CI data logs capture information about children's environment and CI use that are related to language performance and can help to detect and address problems and improve the auditory rehabilitation after cochlear implantation.

Influence of hearing loss and cognitive abilities on language development in CHARGE Syndrome.

Hearing loss and cognitive delay are frequently occurring features in CHARGE syndrome that may contribute to impaired language development. However, not much is known about language development in patients with CHARGE syndrome. In this retrospective study, hearing loss, cognitive abilities, and language development are described in 50 patients with CHARGE syndrome. After informed consent was given, data were collected from local medical files. Most patients (38.3%; 18/47 patients) had moderate hearing loss (41-70 dB) and 58.5% (24/41 patients) had an IQ below 70. The mean language quotients of the receptive and expressive language were more than one standard deviation below the norm. Both hearing loss and cognitive delay had an influence on language development. Language and cognitive data were not available for all patients, which may have resulted in a pre-selection of patients with a delay. In conclusion, while hearing thresholds, cognitive abilities and language development vary widely in CHARGE syndrome, they are mostly below average. Hearing loss and cognitive delay have a significant influence on language development in children with CHARGE syndrome. To improve our knowledge about and the quality of care we can provide to CHARGE patients, hearing and developmental tests should be performed regularly in order to differentiate between the contributions of hearing loss and cognitive delay to delays in language development, and to provide adequate hearing amplification in the case of hearing loss. © 2016 Wiley Periodicals, Inc.

Paediatric Cochlear Implantation in Patients with Waardenburg Syndrome.

OBJECTIVE: To analyse the benefit of cochlear implantation in young deaf children with Waardenburg syndrome (WS) compared to a reference group of young deaf children without additional disabilities. METHOD: A retrospective study was conducted on children with WS who underwent cochlear implantation at the age of 2 years or younger. The post-operative results for speech perception (phonetically balanced standard Dutch consonant-vocal-consonant word lists) and language comprehension (the Reynell Developmental Language Scales, RDLS), expressed as a language quotient (LQ), were compared between the WS group and the reference group by using multiple linear regression analysis. RESULTS: A total of 14 children were diagnosed with WS, and 6 of them had additional disabilities. The WS children were implanted at a mean age of 1.6 years and the 48 children of the reference group at a mean age of 1.3 years. The WS children had a mean phoneme score of 80% and a mean LQ of 0.74 at 3 years post-implantation, and these results were comparable to those of the reference group. Only the factor additional disabilities had a significant negative influence on auditory perception and language comprehension. CONCLUSIONS: Children with WS performed similarly to the reference group in the present study, and these outcomes are in line with the previous literature. Although good counselling about additional disabilities concomitant to the syndrome is relevant, cochlear implantation is a good rehabilitation method for children with WS.

Linguistic profiles of children with CI as compared with children with hearing or specific language impairment.

BACKGROUND: The spoken language difficulties of children with moderate or severe to profound hearing loss are mainly related to limited auditory speech perception. However, degraded or filtered auditory input as evidenced in children with cochlear implants (CIs) may result in less efficient or slower language processing as well. To provide insight into the underlying nature of the spoken language difficulties in children with CIs, linguistic profiles of children with CIs are compared with those of hard-of-hearing (HoH) children with conventional hearing aids and children with specific language impairment (SLI). AIMS: To examine differences in linguistic abilities and profiles of children with CIs as compared with HoH children and children with SLI, and whether the spoken language difficulties of children with CIs mainly lie in limited auditory perception or in language processing problems. METHODS & PROCEDURE: Differences in linguistic abilities and differential linguistic profiles of 47 children with CI, 66 HoH children with moderate to severe hearing loss, and 127 children with SLI are compared, divided into two age cohorts. Standardized Dutch tests were administered. Factor analyses and cluster analyses were conducted to find homogeneous linguistic profiles of the children. OUTCOMES & RESULTS: The children with CIs were outperformed by their HoH peers and peers with SLI on most linguistic abilities. Concerning the linguistic profiles, the largest group of children with CIs and HoH children shared similar profiles. The profiles observed for most of the children with SLI were different from those of their peers with hearing loss in both age cohorts. CONCLUSIONS & IMPLICATIONS: Results suggest that the underlying nature of spoken language problems in most children with CIs manifests in limited auditory perception instead of language processing difficulties. However, there appears to be a subgroup of children with CIs whose linguistic profiles resemble those of children with SLI.

Wellbeing as Capability: Findings in Hearing-Impaired Adolescents and Young Adults With a Hearing Aid or Cochlear Implant.

In the Western world, for deaf and hard-of-hearing children, hearing aids or cochlear implants are available to provide access to sound, with the overall goal of increasing their wellbeing. If and how this goal is achieved becomes increasingly multifarious when these children reach adolescence and young adulthood and start to participate in society in other ways. An approach to wellbeing that includes personal differences and the relative advantages and disadvantages that people have, is the capability approach, as developed by Nobel Prize laureate Amartya Sen. Capability is the set of real opportunities people have to do and be things they have reason to value. We interviewed 59 young people, aged 13 through 25, with cochlear implants (37) or hearing aids (22) to capture their capability. We found that their hearing devices enabled them to actively participate in a predominantly hearing society, with few differences between cochlear implant and hearing aid recipients. They did, however, report challenges associated with prejudices and expectations, and with feeling poorly understood, all of which appeared to impact their capability. Through the lens of capability, alleged differences between hearing aid and cochlear implant recipients began to fade. We discuss the implications for initiatives focused on the long-term support young recipients of hearing devices to meet their specific requirements over time.

Self-concept of children and adolescents with cochlear implants.

OBJECTIVES: Communicative disorders can complicate social interactions and may be detrimental for one's self-concept. This study aims to assess the self-concept of children with Cochlear Implants (CI). Results of educational peer groups (special needs or typical) were compared. Correlations amongst speech perception, language comprehension, self-concept and other study variables are determined. METHODS: This retrospectively patient file study contained 53 CI participants with a mean age of 14.2 (SD = 2.8). Self-concept was measured with the Dutch language version of the Self-Perception Profile for Children and Adolescents. Proportions of low, normal and high competence scores were compared to a normative sample. Outcomes were analyzed for the total CI group and for the two educational peer groups. RESULTS: In the Scholastic Competence, Athletic Competence, Physical Appearance and Behavioral Conduct domains larger proportions of high perceived competence levels were found in the CI Total group compared to the hearing normative sample. Children with CIs in the Mainstream educational subgroup were found to have larger proportions of high levels on these domains. Remarkably, children with CI in the Special hearing impaired educational subgroup reported comparable self-concept scores as their hearing peers. Speech perception and language comprehension were positively correlated to Scholastic Competence. CONCLUSION: This study has shown that self-concept levels of profoundly hearing impaired children with CI are comparable to those of hearing peers. They are generally satisfied with their functioning in various domains. Better speech perception and language comprehension levels are related to higher outcomes in the Scholastic Competence domain.

Capability of deaf children with a cochlear implant.

INTRODUCTION: The main idea underlying this paper is that impairments such as deafness are particularly relevant to the extent that they lead to deprivation of capability. Likewise, the impact of healthcare services such as cochlear implants and subsequent rehabilitation can best be inferred from the extent that they protect or restore capability of those affected. METHODS: To explore children's post-implant capabilities, we tested two newly developed digital, adaptive child self-report and parent-report questionnaires in 19 deaf children (aged 8-12 years) and their parents during rehabilitation, as well as in 23 age peers with normal hearing. RESULTS: Despite the impressive speech-language results that were recorded with cochlear implants, the post-implant capabilities of the deaf children we evaluated differed from those of their hearing peers, with the cochlear implant group appearing particularly disadvantaged in areas such as accessing information, communication, social participation, and participation in school. CONCLUSION: Deaf children with cochlear implants who are performing well on linguistic and auditory tests can still experience serious limitations in desired functioning. Our findings suggest that a capability approach may reveal aspects of what is being achieved through rehabilitation that might otherwise remain unnoticed, and that could help to further improve the well-being of our patients.IMPLICATIONS FOR REHABILITATIONOverall, children with cochlear implants appeared disadvantaged in certain capability areas, like accessing information, communication, social participation, and participation in school.It may be worthwhile to also ascertain capabilities in these children, representing a domain not covered by clinical measures, tapping directly into areas that are valuable to the patient.

Frequencies of Behavioral Problems Reported by Parents and Teachers of Hearing-Impaired Children With Cochlear Implants.

Background: Internalizing and externalizing behavioral problems were frequently reported in profoundly hearing-impaired (HI) children with hearing aids. Due to the positive effect of cochlear implants (CIs) on hearing and language development, a positive effect on behavioral problems was expected. However, there is no consensus about the frequency of behavioral problems in CI children, and studies are often based on one informant with the risk of missing behavioral problems in other contexts. Aims: The first aim of this study was to investigate the frequency of behavioral problems in children with CIs as compared to a hearing normative sample. The second aim was to measure the agreement between the parents' and teachers' rates on the behavioral problem scales. And the third aim was to investigate the relation between speech perception, language skills and the frequencies of reported behavioral problems. Methods: Of 71 CI children, 51% were girls and 49% were boys, and the mean age was 8.6 (SD = 3.3). Behavior was reported by parents using the Child Behavior Checklist (CBCL) and by teachers using the Teacher Report Form (TRF). Frequencies of behavioral problems of CI children (6-16 years) were compared to a normative sample with the chi square test. Parent-teacher agreement was measured with the intraclass correlation coefficient (ICC 2,1). Next CI children were divided into four ability level categories regarding speech perception and language skills. Frequencies of behavioral problems were compared between the categories with the chi square test. Results: Parents and teachers of CI children reported similar frequencies of behavioral problems to the normative sample. Fair to low parent-teacher agreements were found on the behavioral problem scales. A significantly higher frequency of behavioral problems was reported in children with low speech perception and receptive vocabulary at school. Conclusion: Parents and teachers report similar frequencies of behavioral problems children with CIs compared to a hearing normative sample. Children with lower speech perception and language levels are more at risk of developing behavioral problems at school. Adequate speech perception and language levels are found to be protective factors for the development of behavior.

Personality Traits of Profoundly Hearing Impaired Adolescents with Cochlear Implants - A Comparison with Normal Hearing Peers.

The aim of this study was to compare the personality traits of adolescents with cochlear implants (CIs) to a reference group (normal-hearing peers). In the past, the personality development of hearing impaired adolescents was severely compromised. Improved speech perception with CI significantly increased their perspectives. In addition, differences between the reference group and CI users were investigated on personality traits according to level of speech perception skills (high/low) and level of language comprehension (adequate/poor). A cohort of 59 adolescents was assessed 10 years after CI implantation. Personality traits were measured using the standardized Dutch Personality Questionnaire, which consists of 5 scales: Inadequacy, Social Inadequacy, Recalcitrance (RE), Perseverance, and Dominance. Speech perception and language comprehension were tested with standardized tests. The distributions of personality scores, in the clinical or non-clinical range, for the CI group were compared to the reference group using the Chi-Square test for Goodness of Fit. Adolescents with CI showed normal or favorable distributions on all personality scales except for the RE scale. There was a significant influence of speech perception and language comprehension on this scale. Consequently, adolescents with CI who demonstrated high speech perception and adequate language comprehension scores showed similar distribution patterns as the reference group on all personality scales. In conclusion; personality traits that reflect social relations, self-conscience, and school- and task orientation in adolescents with CI are similar to those in normal-hearing peers. This holds, despite variations in speech perception ability and language comprehension levels, for the CI group. On the RE scale, the adolescents with CI with low speech perception and poor language comprehension scores are more likely to score in the clinical deviant range and are at risk.

Classroom performance and language development of CI students placed in mainstream elementary school.

OBJECTIVE: Investigation of the relation between classroom performance and language development of cochlear implant (CI) students in mainstream education. Structural analyses of assessment of mainstream performance (AMP) and Screening Instrument For Targeting Educational Risk (SIFTER) instruments. STUDY DESIGN: Cross-sectional instrument and language development analyses. SETTING: Tertiary university medical center. PATIENTS: Twenty-six CI children in elementary school with congenital or prelingual deafness were included. At the time of this study, mean period of multichannel CI use was 5.3 years, and children's ages ranged from 6.5 to 12.8 years. MAIN OUTCOME MEASURE: Assessment of mainstream performance and SIFTER instruments measured classroom performance and language development were measured by means of Reynell and Schlichting tests. RESULTS: Assessment of mainstream performance and SIFTER domains showed good reliability (Cronbach alpha >0.6), but factor analyses only showed the expected instrument structure in the AMP. In both questionnaires and within all domains, individual variability is detected. Spearman's correlation analyses showed the probable explanation of individual questionnaire variability by language test results (p value mostly <0.01). The AMP and SIFTER instruments showed a predictive capacity for language development, based upon general linear model univariate and linear regression analyses. CONCLUSION: Individual classroom performance, measured by AMP and SIFTER questionnaires, of CI children in mainstream education varies. Correlation analyses showed strong significant relation between questionnaire results (classroom performance) and both expressive and receptive language test results (Schlichting and Reynell tests). Structural questionnaire analyses of the AMP and SIFTER demonstrated good reliability. The predictive value of the AMP can monitor the actual linguistic functioning of the child.

Classroom performance of children with cochlear implants in mainstream education.

OBJECTIVES: We compared classroom performance of children with a cochlear implant (CI) with that of their normal-hearing peers in mainstream education. METHODS: Thirty-two CI children in mainstream education, congenitally or prelingually deaf, participated in this study, as did 37 hearing classmates. Their teachers filled out 2 questionnaires: the Assessment of Mainstream Performance (AMP) and the Screening Instrument for Targeting Educational Risk (SIFTER). A high Fletcher index and open-set speech perception scores were obtained. RESULTS: The children with CIs scored above average on the AMP and sufficiently well in all but one area (communication) of the SIFTER questionnaire. Class rankings did not differ significantly between the CI students and their normal-hearing peers. Overall, the normal-hearing group outperformed the CI group. The classroom performance of CI children correlated negatively with duration of deafness and age at implantation. All longitudinal audiological data of the CI children showed improvement in open-set speech recognition. CONCLUSIONS: Although the results are encouraging, the CI group scored significantly less well than their normal-hearing peers on most questionnaire domains of both the AMP and the SIFTER. The most important variables for the outcome in this study were age at implantation and duration of deafness.

Auditory and verbal memory predictors of spoken language skills in children with cochlear implants.

BACKGROUND: Large variability in individual spoken language outcomes remains a persistent finding in the group of children with cochlear implants (CIs), particularly in their grammatical development. AIMS: In the present study, we examined the extent of delay in lexical and morphosyntactic spoken language levels of children with CIs as compared to those of a normative sample of age-matched children with normal hearing. Furthermore, the predictive value of auditory and verbal memory factors in the spoken language performance of implanted children was analyzed. METHODS & PROCEDURES: Thirty-nine profoundly deaf children with CIs were assessed using a test battery including measures of lexical, grammatical, auditory and verbal memory tests. Furthermore, child-related demographic characteristics were taken into account. OUTCOMES & RESULTS: The majority of the children with CIs did not reach age-equivalent lexical and morphosyntactic language skills. Multiple linear regression analyses revealed that lexical spoken language performance in children with CIs was best predicted by age at testing, phoneme perception, and auditory word closure. The morphosyntactic language outcomes of the CI group were best predicted by lexicon, auditory word closure, and auditory memory for words. CONCLUSIONS: Qualitatively good speech perception skills appear to be crucial for lexical and grammatical development in children with CIs. Furthermore, strongly developed vocabulary skills and verbal memory abilities predict morphosyntactic language skills.

Suggestions for a Guideline for Cochlear Implantation in CHARGE Syndrome.

OBJECTIVE: Identifying aspects for establishing cochlear implantation guidelines for patients with ocular coloboma, heart defects, atresia of the choanae, retardation (of growth and/or of development), genital anomalies, and ear anomalies (CHARGE) syndrome (CS). STUDY DESIGN: Explorative retrospective study. SETTING: Cochlear implant (CI)-centers of tertiary referral centers in The Netherlands. PATIENTS: Ten patients with CS who received a CI between 2002 and 2012. INTERVENTIONS: Describing the challenges and benefits of cochlear implantation in CS. MAIN OUTCOME MEASURES: Imaging and surgical findings, language development, and Quality-of-life (QoL), compared with two control groups: 1) 34 non-syndromic CI-users and 2) 13 patients with CS without CI because of sufficient hearing. RESULTS: Subjective and objective audiometry and magnetic resonance imaging were necessary to confirm the presence of the cochlear nerve. Surgery in CS was challenging because of enlarged emissary veins, semi-circular-canal aplasia, aberrant facial nerve, and dysplastic cochlear windows, making computed tomography indispensable in surgical preparations. No major intraoperative complications occurred. Despite additional handicaps, all patients showed auditory benefit and improvement in disease-specific QoL. Patients implanted at a relatively young age (≤37 months) followed by a long period of CI-use (>5 years) and with minor additional problems, developed spoken language at a basic level comparable to that of the control group of CS patients. CONCLUSION: A CI should be considered in all patients with CS and severe sensorineural hearing loss. A careful work-up is required, comprising computed tomography, magnetic resonance imaging, objective, and subjective audiometry and assessment by a specialized multidisciplinary team. Cochlear implantation in CS might be complicated by syndrome-related temporal-bone anatomy, and the outcome of the CI is more individually determined. Early implantation should be aimed for.

Benefits of simultaneous bilateral cochlear implantation on verbal reasoning skills in prelingually deaf children.

BACKGROUND: Impaired auditory speech perception abilities in deaf children with hearing aids compromised their verbal intelligence enormously. The availability of unilateral cochlear implantation (CI) auditory speech perception and spoken vocabulary enabled them to reach near ageappropriate levels. This holds especially for children in spoken language environments. However, speech perception in complex listening situations and the acquisition of complex verbal skills remains difficult. Bilateral CI was expected to enhance the acquisition of verbal intelligence by improved understanding of speech in noise. METHODS: This study examined the effect of bilateral CI on verbal intelligence of 49 deaf children (3;5-8;0 years). Relations between speech perception in noise, auditory short-term memory and verbal intelligence were analysed with multiple linear regressions. In addition, the interaction of educational setting, mainstream or special, on these relations was analysed. RESULTS: Children with bilateral CI obtained higher scores on verbal intelligence. Significant associations were present between speech perception in noise, auditory short-term memory and verbal intelligence. CONCLUSION: Children with simultaneous bilateral CIs showed better speech perception in noise than children with unilateral CIs, which mediated by the auditory short-term memory capacity, enhanced the ability to acquire more complex verbal skills for BICI children in mainstream education.

School performance and wellbeing of children with CI in different communicative-educational environments.

OBJECTIVES: This study aimed to evaluate the long term effects of CI on auditory, language, educational and social-emotional development of deaf children in different educational-communicative settings. METHODS: The outcomes of 58 children with profound hearing loss and normal non-verbal cognition, after 60 months of CI use have been analyzed. At testing the children were enrolled in three different educational settings; in mainstream education, where spoken language is used or in hard-of-hearing education where sign supported spoken language is used and in bilingual deaf education, with Sign Language of the Netherlands and Sign Supported Dutch. Children were assessed on auditory speech perception, receptive language, educational attainment and wellbeing. RESULTS: Auditory speech perception of children with CI in mainstream education enable them to acquire language and educational levels that are comparable to those of their normal hearing peers. Although the children in mainstream and hard-of-hearing settings show similar speech perception abilities, language development in children in hard-of-hearing settings lags significantly behind. Speech perception, language and educational attainments of children in deaf education remained extremely poor. Furthermore more children in mainstream and hard-of-hearing environments are resilient than in deaf educational settings. Regression analyses showed an important influence of educational setting. CONCLUSIONS: Children with CI who are placed in early intervention environments that facilitate auditory development are able to achieve good auditory speech perception, language and educational levels on the long term. Most parents of these children report no social-emotional concerns.

Lexical access in children with hearing loss or specific language impairment, using the cross-modal picture-word interference paradigm.

In this study we compared lexical access to spoken words in 25 deaf children with cochlear implants (CIs), 13 hard-of-hearing (HoH) children and 20 children with specific language impairment (SLI). Twenty-one age-matched typically developing children served as controls. The children with CIs and the HoH children in the present study had good speech perception abilities. We used a cross-modal picture-word interference paradigm to examine lexical access. Results showed that children with SLI revealed overall slower reaction times and produced more errors than the children with CIs, the HoH children, and the control children. Reaction times of children with CIs and the HoH children did not differ from those of the control children. Thus, problems with spoken language processing, as is the case in children with SLI, seem to affect lexical access more than limitations in auditory perception, as is the fundamental problem in children with hearing loss. We recommend that improvement of lexical access in children with SLI deserves specific attention in therapy and education.