Eun Yeon Kim

A new measurement tool for speech development based on Ling's stages of speech acquisition in pediatric cochlear implant recipients.

OBJECTIVES With the rapid increase of pediatric cochlear implantation (CI), there exists a need for a standardized assessment tool regarding speech and communication skills in children with CI. However, the current testing tools are not appropriate for the longitudinal evaluation of young children after CI. The aims of this study were to describe a progressive testing tool developed for the evaluation of speech acquisition and production in young children who have undergone CI and to examine its validity. METHODS Sixty children younger than six years of age with CI participated in this study. A Korean version of Lings stages (K-Ling) was developed based on the Ling speech teaching model to longitudinally assess phonologic and phonetic developments in young children after CI. The K-Ling, the Categories of Auditory Performance (CAP), and the Sequenced Language Scale for Infants (SELSI) were performed in the children with CI preoperatively and three, six, and 12 months postoperatively. Correlations among these three testing tools were analyzed. RESULTS Auditory, language, and speech skills assessed using the CAP, SELSI, and K-Ling improved continuously for 12 months in young children following CI. Strong correlations were obtained among K-Lings level, CAP scores, and the equivalent age of SELSI; correlation indices ranged from 0.540 to 0.800. CONCLUSIONS The K-Ling was a valid evaluation tool regarding speech development in young children who are using CI and who are in the early stages of speech development. Longitudinal assessments of phonetic and phonologic developments may be attainable in young children using the K-Ling.

The auditory and speech performance of children with intellectual disability after cochlear implantation

Abstract Conclusion: The results revealed that children with intellectual disability (ID) who underwent cochlear implantation (CI) showed gradual progress in their auditory perception and speech development. ID in children should not be considered a contraindication for CI, because they are able to obtain a chance to develop oral communication skills following CI. Objective: The purpose of this study was to assess the auditory and speech performance of 14 young deaf children with ID after CI. Methods: Fourteen children with ID who underwent CI between December 2002 and February 2010 were included. Improvement in auditory perception and speech production over time was evaluated longitudinally with the Categories of Auditory Performance (CAP) score and Korean version of Lings stages (K-Ling). The results were compared with those of age- and gender-matched implanted controls without additional disabilities. All tests were performed four times in each patient: before implantation and at 3, 6, and 12 months after implantation. Preoperative and postoperative communication modes were also assessed and compared between the two groups. Results: Auditory perception and speech production of deaf children with an ID improved consistently after CI. In addition, the communication mode also took a favorable turn from nonverbal to vocalizations or oral communication or from vocalizations to oral communication.

Clinical assessment of music perception in Korean cochlear implant listeners

Conclusion: The Korean version of the Clinical Assessment of Music Perception (K-CAMP) test is an efficient, self-administrable test for discrimination of a wide range of music perception ability in adult Korean cochlear implant (CI) users. Objectives: The aims of the study were the development of a clinically practical test of music perception for adult Korean CI lisetners and evaluation of its effectiveness. Methods: Twelve adult post-lingually deafened patients and 12 normal-hearing (NH) controls were tested with the K-CAMP test, comprising pitch direction discrimination, melody identification, and timbre identification tests. Results: Pitch discrimination, melody identification, and timbre identification in CI users showed a wide range of perceptual abilities. The mean pitch change discrimination difference limen (DL) for the base frequency of 262 Hz (middle C) was 2.7 ± 1.7 semitones: 4.4 ± 4.2 semitones for 330 Hz (E4) and 8.1 ± 3.0 semitones for 391 Hz (G4) in CI listeners. The DL widened as the base frequency increased. The melody identification test produced 21.1 ± 21.7% correct answers, and the timbre identification test recorded 25.7 ± 8.5% correct answers in CI listeners. Pitched percussion instruments (piano, guitar) were better for timbre identification. Speech performance scores had a positive correlation with the pitch discrimination DL (p < 0.05).

Performance after timely cochlear implantation in prelingually deaf children with cerebral palsy

OBJECTIVES To investigate auditory perception, speech production, and language ability of prelingually deaf toddlers with cerebral palsy (CP) who were implanted within a sensitive period and who received proper speech therapy. Comparison of their outcomes with age- and sex-matched CI recipients without additional disabilities was also performed. METHODS We retrospectively reviewed a cohort of pediatric CI in Samsung Medical Center. Eight CP subjects who received CI before 3 years of age and age-sex matched control recipients who had no additional disabilities except idiopathic sensorineural hearing loss (SNHL) were included for the analysis. Preoperative evaluation included the Categories of Auditory Performance (CAP) score, Korean Version of the Lings Stage (K-Ling), Sequenced Language Scale for Infants (SELSI), Bailey Scales of Infant Development II assessment, Social Maturity Scale test, and grading of CP severity using severity level and Gross Motor Function Classification System for CP (GMFCS). To measure the outcome, the CAP scores, K-Ling, and SELSI were performed at 3, 6, 12, and 24 months after implantation. RESULTS Four CP children with outstanding performances showed comparable achievement with matched control recipients. These patients had less severe motor disabilities (mild-moderate severity, GMFCS level 1-3), better social quotient, and better cognitive abilities. Although the others showed poor language abilities and hardly produced meaningful speech, their CAP scores reached 1 or 2 in 24 months after implantation. CONCLUSIONS Deaf children with CP could have various ranges of benefits up to the levels of normal peers whose only disability was hearing loss, when CI was performed within a critical period. Especially, children with mild or moderate CP had a favorable outcome after CI, equivalent to that of normal peers.

The Clinical Significance of Preoperative Brain Magnetic Resonance Imaging in Pediatric Cochlear Implant Recipients

Although central nervous system abnormalities are incidentally detected in preoperative brain magnetic resonance imaging (MRI) studies in pediatric cochlear implant (CI) candidates, the clinical significance of the abnormalities remains unclear. We aimed to assess post-implantation auditory and speech performance in patients with brain lesions seen on MRI. Pediatric CI recipients (n = 177) who underwent preoperative MRI scans of the brain between January 2002 and June 2009 were included in this study. Patients with brain lesions on MRI were reviewed and categorized into the following groups: brain parenchymal lesions (focal vs. diffuse), ventriculomegaly, and extra-axial lesion. The main communication mode as well as progress in auditory perception and speech production were evaluated preoperatively and at 3, 6, 12, and 24 months postoperatively. Performance in patients with brain lesions was compared with the age- and sex-matched control group. Various brain lesions were found in 27 out of 177 patients. Children with brain lesions who received CIs showed gradual progress in auditory and speech outcomes for 2 years, though performance was reduced compared with the control group. In addition, there was a significant difference in the main communication mode between the two groups at 2 years following cochlear implantation. This difference was especially significant in patients with diffuse brain parenchymal lesions after further stratification of the brain lesion group. Preoperative brain MRI may have a role in improving the prediction of adverse outcomes in pediatric CI recipients. In particular, children with diffuse brain parenchymal lesions should be counseled regarding the poor prognosis preoperatively, and followed up with special attention.

Sound Localization and Speech Perception in Noise of Pediatric Cochlear Implant Recipients: Bimodal Fitting Versus Bilateral Cochlear Implants

Objectives: The aim of this study was to compare binaural performance of auditory localization task and speech perception in babble measure between children who use a cochlear implant (CI) in one ear and a hearing aid (HA) in the other (bimodal fitting) and those who use bilateral CIs. Design: Thirteen children (mean age ± SD = 10 ± 2.9 years) with bilateral CIs and 19 children with bimodal fitting were recruited to participate. Sound localization was assessed using a 13-loudspeaker array in a quiet sound-treated booth. Speakers were placed in an arc from −90° azimuth to +90° azimuth (15° interval) in horizontal plane. To assess the accuracy of sound location identification, we calculated the absolute error in degrees between the target speaker and the response speaker during each trial. The mean absolute error was computed by dividing the sum of absolute errors by the total number of trials. We also calculated the hemifield identification score to reflect the accuracy of right/left discrimination. Speech-in-babble perception was also measured in the sound field using target speech presented from the front speaker. Eight-talker babble was presented in the following four different listening conditions: from the front speaker (0°), from one of the two side speakers (+90° or −90°), from both side speakers (±90°). Speech, spatial, and quality questionnaire was administered. Results: When the two groups of children were directly compared with each other, there was no significant difference in localization accuracy ability or hemifield identification score under binaural condition. Performance in speech perception test was also similar to each other under most babble conditions. However, when the babble was from the first device side (CI side for children with bimodal stimulation or first CI side for children with bilateral CIs), speech understanding in babble by bilateral CI users was significantly better than that by bimodal listeners. Speech, spatial, and quality scores were comparable with each other between the two groups. Conclusions: Overall, the binaural performance was similar to each other between children who are fit with two CIs (CI + CI) and those who use bimodal stimulation (HA + CI) in most conditions. However, the bilateral CI group showed better speech perception than the bimodal CI group when babble was from the first device side (first CI side for bilateral CI users or CI side for bimodal listeners). Therefore, if bimodal performance is significantly below the mean bilateral CI performance on speech perception in babble, these results suggest that a child should be considered to transit from bimodal stimulation to bilateral CIs.

Can young adolescents with cochlear implants perceive different timbral cues

Abstract Objective This study aimed to compare the timbre recognition and preferences of young adolescents with cochlear implants (CIs) to that of adolescents with normal hearing (NH). Methods Nine Korean adolescents with CIs and 25 adolescents with NH participated in this study. After listening to each of four Western instruments and five traditional Korean instruments, participants were asked to identify presented instruments and rate how much they liked the timbres. Results The results showed that the CI group recognized instruments significantly less often than the NH group. They also tended to show a relatively higher recognition of the instruments bearing a rapid and strong attack time. With regard to timbre preferences, no significant differences were found between the groups. Discussion Young adolescents with CIs show potential for detecting salient features in sound information, especially instrumental timbre. This study indicates what can be considered to incorporate more sounds with varying origins and tone qualities into music perception and education for this population.

Social skills and developmental delay: importance in predicting the auditory and speech outcomes after cochlear implantation in children

Abstract Conclusion: Preoperative evaluation of social interaction and global development levels using the Vineland Social Maturity Scale (VSMS) and Bayley Scales of Infant Development–2nd edition (BSID-II) may be beneficial in predicting the postoperative outcome in pediatric cochlear implant recipients. In particular, cautious preoperative counseling regarding the poor postoperative prognosis may be necessary in children with low social skills and developmental status. Objective: To determine the clinical benefit of preoperative evaluation of social interaction and global development levels using VSMS and BSID-II in predicting the postoperative outcome in pediatric cochlear implant recipients. Patients: A total of 65 deaf children who underwent cochlear implantation (CI) were included in this study. Age at the time of implantation ranged from 12 to 76 months. All of the children underwent a comprehensive preimplant psychological assessment by a clinical psychologist. The VSMS and BSID-II were used for evaluating social skills and a child’s development preoperatively. A social quotient (SQ) was calculated by using the VSMS for each subject using the following formula: (social age/chronological age) × 100. The auditory perception and speech production abilities were evaluated using the Categories of Auditory Performance (CAP) scale and the Korean version of the Ling’s stage (K-Ling), respectively, at 1 year after CI. The associations between the preoperative SQ/developmental levels and the postoperative auditory/speech outcomes were evaluated. Results: The mean SQ was significantly decreased in the enrolled children (90.6 ± 26.1). The improvement in CAP score at 1 year after CI was correlated with preoperative SQ. The improvements in phonemic and phonologic levels of K-Ling were correlated with preoperative VSMS and BSID-II scores.

Auditory and speech performance in deaf children with deaf parents after cochlear implant.

Objective To evaluate the auditory and speech outcome in deaf children with deaf parents (CDP) after cochlear implantation (CI), emphasizing both the presence of additional caregiver and patients’ main communication mode. Study Design Retrospective case review. Setting Cochlear implant center at a tertiary referral hospital. Patients Fourteen CDP and 14 age- and sex-matched deaf children with normal-hearing parents (CNH). Main Outcome Measure(s) The Korean version of Ling’s stage (K-Ling) and Category of Auditory Perception (CAP) were administered to the children to assess the speech production and auditory perception abilities, preoperatively and 3, 6, 12, and 24 months after CI. To elucidate the effects of the additional caregiver and main communication mode of the implanted child, the patients were divided into the following groups: with additional caregiver(s) who have normal hearing (n = 11) versus without additional caregiver (n = 3); sign language plus oral communication (S+O) group (n = 9) versus oral communication only (O) group (n = 5). Results CAP scores and K-Ling stages improved remarkably in both CDP and CNH, and no significant differences were found between the 2 groups. Within the CDP group, CAP scores and K-Ling stages improved significantly in CDP with an additional caregiver than those without. Auditory perception and speech production performances in the S+O group were similar to those in the O group. Conclusion CDP can develop similarly to CNH in auditory perception and speech production, if an additional caregiver with normal hearing provides sufficient support and speech input. In addition, using sign language in addition to oral language might not be harmful, and these children can be a communication bridge between their deaf parents and society.

Contents Vol. 17, 2012

Maurizio Barbara, Rome Olivier Bertrand, Bron F. Owen Black, Portland Th omas Brandt, München Barbara Canlon, Stockholm John P. Carey, Baltimore Douglas A. Cotanche, Boston Cor W.R.J. Cremers, Nijmegen Norbert Dillier, Zürich Robert Dobie, Sacramento Manuel Don, Los Angeles Jill B. Firszt, St. Louis Andrew Forge, London Bernard Fraysse, Toulouse Rick Friedman, Los Angeles Bruce J. Gantz, Iowa City Pablo Gil-Loyzaga, Madrid Anthony W. Gummer, Tübingen James W. Hall III, Gainesville Joseph W. Hall III, Chapel Hill Michael Halmagyi, Camperdown Rudolf Häusler, Bern Vicente Honrubia, Los Angeles Gary D. Housley, Auckland Karl-Bernd Hüttenbrink, Köln Pawel J. Jastreboff , Atlanta Margaret A. Kenna, Boston Philippe P. Lefebvre, Liège Bernd Lütkenhöner, Münster Linda L. Luxon, London Geoff rey A. Manley, Oldenburg Alessandro Martini, Padova Jennifer R. Melcher, Boston Brian C.J. Moore, Cambridge David R. Moore, Nottingham Cynthia C. Morton, Boston Donata Oertel, Madison Kaoru Ogawa, Tokyo Stephen J. O’Leary, Parkville Alan R. Palmer, Nottingham Lorne S. Parnes, London, Ont. Jean-Luc Puel, Montpellier Ramesh Rajan, Monash Yehoash Raphael, Ann Arbor J. Th omas Roland, Jr., New York John J. Rosowski, Boston Rudolf Rübsamen, Leipzig Mario A. Ruggero, Evanston Leonard P. Rybak, Springfi eld Richard J. Salvi, Buff alo Robert V. Shannon, Los Angeles Guido F. Smoorenburg, Besse sur Issole Haim Sohmer, Jerusalem Olivier Sterkers, Clichy Istvan Sziklai, Debrecen Peter R. Th orne, Auckland Shin-ichi Usami, Matsumoto P. Ashley Wackym, Portland Tatsuya Yamasoba, Tokyo Fan-Gang Zeng, Irvine The Science of Hearing and Balance