Eighty-seven primary-school children with impaired hearing were evaluated using speech perception, production, and language measures over a 3-year period. Forty-seven children with a mean unaided pure-tone-average hearing loss of 106 dB HL used a 22-electrode cochlear implant, and 40 with a mean unaided pure-tone-average hearing loss of 78 dB HL were fitted with hearing aids. All children were enrolled in oral/aural habilitation programs, and most attended integrated classes with normally hearing children for part of the time at school. Multiple linear regression was used to describe the relationships among the speech perception, production, and language measures, and the trends over time. Little difference in the level of performance and trends was found for the two groups of children, so the perceptual effect of the implant is equivalent, on average, to an improvement of about 28 dB in hearing thresholds. Scores on the Peabody Picture Vocabulary Test (PPVT) and the Clinical Evaluation of Language Fundamentals showed an upward trend at about 60% of the rate for normally hearing children. Rates of improvement for individual children were not correlated significantly with degree of hearing loss. The children showed a wide scatter about the average speech production score of 40% of words correctly produced in spontaneous conversations, with no significant upward trend with age. Scores on the open-set Consonant-Nucleus-Consonant (CNC) monosyllabic word test and the Bench-Kowal-Bamford (BKB) sentence test were strongly related to language level (as measured by an equivalent age on the PPVT) and speech production scores for both auditory-visual and auditory test conditions. After allowing for differences in language, speech perception scores in the auditory test condition showed a slight downward trend over time, which is consistent with the known biological effects of hearing loss on the auditory periphery and brainstem. Speech perception scores in the auditory condition also decreased significantly by about 5% for every 10 dB of hearing loss in the hearing aid group. The regression analysis model allows separation of the effects of language, speech production, and hearing levels on speech perception scores so that the effects of habilitation and training in these areas can be observed and/or predicted. The model suggests that most of the children in the study will reach a level of over 90% sentence recognition in the auditory-visual condition when their language becomes equivalent to that of a normally hearing 7-year-old, but they will enter secondary school at age 12 with an average language delay of about 4 or 5 years unless they receive concentrated and effective language training.

Hearing aids for children who also use cochlear implants can be selected using the NAL-RP prescription. Adjustment of hearing aid gain to match loudness in the implanted ear can facilitate integration of signals from both ears, leading to better speech perception. Given that there are binaural advantages from using cochlear implants with hearing aids in opposite ears, clinicians should advise parents and other professionals about these potential advantages, and facilitate bilateral amplification by adjusting hearing aids after stable cochlear implant MAPs are established.

The cumulative revision rate for primary implants suggests an ongoing linear relationship between the time of postprimary implantation and the need for revision surgery. We have formed an evidence base that characterizes the nature and frequency of revision surgery in a high-volume setting, allowing clinicians to effectively counsel prospective patients and clinics to understand the burden of revision surgery and device failure.

Despite differences in research design, there was remarkably close agreement in the pattern of group mean scores for the three strategies for CNC words and CUNY sentences in noise between the present study and the Conversion study (Arndt, Staller, Arcaroli, Hines, & Ebinger, Reference Note 1). In addition, essentially the same percentage of subjects preferred each strategy. For both studies, the strategy with which subjects had the highest score on the CUNY sentences in noise evaluation was strongly related to the preferred strategy; this relation was not strong for CNC words, CNC phonemes, vowels or consonants (Skinner, Arndt, & Staller, 2002). These results must be considered within the following context. For each strategy, programming parameters preferred for use in everyday life were determined before speech recognition was evaluated. In addition, implant recipients had experience listening with all three strategies in many situations in everyday life before choosing a preferred strategy. Finally, 11 of the 12 subjects strongly preferred one of the three strategies. Given the results and research design, it is recommended that clinicians fit each strategy sequentially starting with the ACE strategy so that the preferred programming parameters are determined for each strategy before recipients compare pairs of strategies. The goal is to provide the best opportunity for individuals to hear in everyday life within a clinically acceptable time period (e.g., 6 wk).

There was an ADRO benefit for this group of children in quiet and in noise. These findings suggest that young children would benefit from the ADRO programming option being locked in along with other processor settings in the SPrint processor once their MAP levels have stabilized. Some older children and teenagers may choose to use ADRO selectively for specific listening situations.

: Slower ECAP recovery, at equal loudness, is associated with larger neural populations. The collective results suggest that this neural population view of the recovery function explains the observed association between slower ECAP recovery and greater temporal responsiveness.

The scaled ECAP threshold profile method provides a clinically significant enhancement to ECAP-based fitting methods, confirming the value of the ECAP threshold profile to cochlear implant fitting.

AutoNRT provides comparable accuracy to an average clinician but with the added benefit of significant time savings over manual recordings. This makes it a valuable tool for clinical measurement of ECAP threshold in cochlear implant recipients.