Julia Z. Sarant

Variation in speech perception scores among children with cochlear implants.

Objective The objective of this study was to identify common factors affecting speech perception scores in children with cochlear implants. Design Speech perception data for 167 implanted children were collected at two cochlear implant centres in Melbourne and Sydney. The data comprised audition-alone scores on open-set word and sentence tests. Children were selected on the basis that they had a Nucleus 22-electrode cochlear implant. The average age of the children was 5 yr. Information was also collected about 12 factors that may have influenced speech perception scores for each child. Analysis of covariance was used to identify factors that significantly affected speech perception scores. Pearson pairwise correlation coefficients were also calculated for all factors analyzed. Results The analyses in this study identified factors that accounted for 51%, 34%, and 45% of the variance in phoneme, word and sentence perception scores. Scores decreased by 1.4 to 2.4% per year of profound deafness prior to implantation. Children who normally use oral communication scored significantly higher than children normally using sign or simultaneous oral and sign communication. Children implanted in Sydney scored higher on average than children implanted in Melbourne. Conclusions The results show that a significant part of the variation in speech perception scores is systematically related to audiological and environmental factors for each child. The reasons for significant differences between children using different communication modes or from different clinics were not identified.

Spoken Language Development in Oral Preschool Children With Permanent Childhood Deafness

This article documented spoken language outcomes for preschool children with hearing loss and examined the relationships between language abilities and characteristics of children such as degree of hearing loss, cognitive abilities, age at entry to early intervention, and parent involvement in childrens intervention programs. Participants were evaluated using a combination of the Child Development Inventory, the Peabody Picture Vocabulary Test, and the Preschool Clinical Evaluation of Language Fundamentals depending on their age at the time of assessment. Maternal education, cognitive ability, and family involvement were also measured. Over half of the children who participated in this study had poor language outcomes overall. No significant differences were found in language outcomes on any of the measures for children who were diagnosed early and those diagnosed later. Multiple regression analyses showed that family participation, degree of hearing loss, and cognitive ability significantly predicted language outcomes and together accounted for almost 60% of the variance in scores. This article highlights the importance of family participation in intervention programs to enable children to achieve optimal language outcomes. Further work may clarify the effects of early diagnosis on language outcomes for preschool children.

The development of speech production following cochlear implantation

Conversational speech samples were analysed over a six-year period postoperatively for nine profoundly deaf children implanted with the Cochlear Limited 22-electrode cochlear implant between ages 2-5 years. Four years post-implant, at least 90% of all syllables produced by each child were intelligible, although only one of the children (who had suffered a progressive hearing loss) had over 10% intelligible syllables prior to implantation. Over the 6-year period, the mean number of intelligible words per utterance increased from 0.15 to 4.2 and the mean number of syllables (counting both intelligible and unintelligible syllables) increased from 1.7 to 5.2, indicating an increase in complexity as well as intelligibility. The speech samples were transcribed phonetically and percentage correct analyses were conducted on the transcripts. These analyses showed a steady improvement in the percentage of correctly produced monophthongs, diphthongs and consonants. There was a corresponding rise in the percentage of words that were produced without phonetic errors. Following six years of implantation, the speech acquisition process was incomplete, although there was no evidence to suggest a plateau in performance.

Receptive language and speech production in children with auditory neuropathy/dyssynchrony type hearing loss

Objective: The purpose of this study was to characterize the receptive language and speech production abilities of school-aged children with auditory neuropathy/dyssynchrony (AN/AD) and to compare those abilities to children with sensorineural (SN) hearing loss of similar age and degree of hearing loss. Design: Standardized speech and language tests were carried out on 12 AN/AD children, aged between 57 and 167 mo. Each of these subjects was a full-time hearing aid user or had been just before testing. Receptive language skills were assessed using the Peabody Picture Vocabulary Test (PPVT) and speech production ability was measured using the Diagnostic Evaluation of Articulation and Phonology (DEAP) and a Speech Intelligibility Rating Scale. Data from a matched cohort of children with sensorineural hearing loss were also obtained. Results: Receptive vocabulary and speech production were delayed (to varying degrees) in each of the AN/AD subjects (relative to normally hearing children). The group PPVT Language Quotient score was 0.65 ± 0.19 and the average number of pronunciation errors was 11 ± 8.4% higher than expected for age. Results for the AN/AD group were however similar to those obtained for a matched group of children with sensorineural hearing loss on both language and speech production measures. Conclusions: The findings of this study indicate that while AN/AD type hearing loss can pose a significant developmental risk, at least some children fit with conventional amplification can develop reasonable speech and language abilities.

Bilateral versus unilateral cochlear implants in children: a study of spoken language outcomes

Objectives: Although it has been established that bilateral cochlear implants (CIs) offer additional speech perception and localization benefits to many children with severe to profound hearing loss, whether these improved perceptual abilities facilitate significantly better language development has not yet been clearly established. The aims of this study were to compare language abilities of children having unilateral and bilateral CIs to quantify the rate of any improvement in language attributable to bilateral CIs and to document other predictors of language development in children with CIs. Design: The receptive vocabulary and language development of 91 children was assessed when they were aged either 5 or 8 years old by using the Peabody Picture Vocabulary Test (fourth edition), and either the Preschool Language Scales (fourth edition) or the Clinical Evaluation of Language Fundamentals (fourth edition), respectively. Cognitive ability, parent involvement in children’s intervention or education programs, and family reading habits were also evaluated. Language outcomes were examined by using linear regression analyses. The influence of elements of parenting style, child characteristics, and family background as predictors of outcomes were examined. Results: Children using bilateral CIs achieved significantly better vocabulary outcomes and significantly higher scores on the Core and Expressive Language subscales of the Clinical Evaluation of Language Fundamentals (fourth edition) than did comparable children with unilateral CIs. Scores on the Preschool Language Scales (fourth edition) did not differ significantly between children with unilateral and bilateral CIs. Bilateral CI use was found to predict significantly faster rates of vocabulary and language development than unilateral CI use; the magnitude of this effect was moderated by child age at activation of the bilateral CI. In terms of parenting style, high levels of parental involvement, low amounts of screen time, and more time spent by adults reading to children facilitated significantly better vocabulary and language outcomes. In terms of child characteristics, higher cognitive ability and female sex were predictive of significantly better language outcomes. When family background factors were examined, having tertiary-educated primary caregivers and a family history of hearing loss were significantly predictive of better outcomes. Birth order was also found to have a significant negative effect on both vocabulary and language outcomes, with each older sibling predicting a 5 to 10% decrease in scores. Conclusions: Children with bilateral CIs achieved significantly better vocabulary outcomes, and 8-year-old children with bilateral CIs had significantly better language outcomes than did children with unilateral CIs. These improvements were moderated by children’s ages at both first and second CIs. The outcomes were also significantly predicted by a number of factors related to parenting, child characteristics, and family background. Fifty-one percent of the variance in vocabulary outcomes and between 59 to 69% of the variance in language outcomes was predicted by the regression models.

Language and speech perception outcomes in hearing-impaired children with and without connexin 26 mutations.

This study addressed the question of whether a hearing loss caused by mutations in the connexin 26 gene had a significant effect on language and speech perception outcomes in children using cochlear implants or hearing aids. The families of children who had participated in two previous studies of language development were invited to participate in this genetic study. From the 52 children whose families agreed to participate, 15 children with connexin 26 mutations in both chromosomes were identified. After taking into account other factors which are known to affect language development and speech perception in children with impaired hearing, no significant differences were found between the 15 children where connexin 26 was known to be the cause of deafness and the other 37 children in the study.

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.

Cognitive processing in children using cochlear implants: the relationship between visual memory, attention, and executive functions and developing language skills

We performed this study to determine whether children using a cochlear implant performed differently from age- and gender-matched hearing aid users on 8 neuropsychological measures of visual memory, attention, and executive functioning. The study also examined whether differences in cognitive skills could account for some of the observed variance in speech perception, vocabulary, and language abilities of hearing-impaired children. In contrast to previous studies, our results revealed no significant cognitive differences between children who use a cochlear implant and children who use hearing aids. Partial correlation analysis indicated that the childrens visual memory skills, ie, their recognition memory, delayed recall, and paired associative learning memory skills, correlated significantly with their language skills. When examined at a significance level of.01, attention and executive functioning skills did not relate to the childrens developing speech perception, vocabulary, or language skills. The results suggested that differences in visual memory skills may account for some of the variance seen in the language abilities of children using implants and children using hearing aids.

Parenting Stress in Parents of Children With Cochlear Implants: Relationships Among Parent Stress, Child Language, and Unilateral Versus Bilateral Implants

Little attention has been focused on stress levels of parents of children with cochlear implants (CIs). This study examined the stress experience of 70 parents of children with CIs by comparing stress levels in this group of parents to those in parents of children without disabilities, identifying primary stressors, examining the relationship between parent stress and child language, and comparing stress in parents of children with bilateral and unilateral CIs. Parents completed a parent stress questionnaire, and the receptive vocabulary and language abilities of the children were evaluated. Results indicated that these parents had a higher incidence of stress than the normative population. Parent stress levels and child language outcomes were negatively correlated. Child behavior and lack of spousal and social support were the prime causes of parent stress. Parents of children with bilateral CIs were significantly less stressed than were parents of children with unilateral CIs.

Speech Perception and Language Criteria for Paediatric Cochlear Implant Candidature

Existing criteria for cochlear implantation of children with impaired hearing aim to select children who will eventually achieve better speech perception scores with an implant than with a hearing aid. It is difficult to predict the eventual outcomes with hearing aid and implant because speech perception scores typically increase with age, and because the distribution of scores for implant and hearing aid users overlap considerably at all ages. This paper shows how speech perception scores can be combined with spoken language measures to arrive at an objective criterion for implant selection. The method also allows estimation of the likely increase in speech perception score within a few months of implantation and estimation of the probability that the child will perform better with the implant than the hearing aid. The criteria were based on data from 135 evaluations of 50 children using cochlear implants with monosyllabic words, open-set sentences, the Clinical Evaluation of Language Fundamentals, and the Peabody Picture Vocabulary Test. Data from 114 evaluations of 43 children using hearing aids were used to illustrate the sensitivity of the criteria.