Bilateral Cochlear Implantation for Hearing-Impaired Children

Lovett, Rosemary; Vickers, Deborah; Summerfield, A. Quentin

doi:10.1097/aud.0000000000000087

Cited by 43 publications

(47 citation statements)

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“…Thus, with the minimum age for CI surgery at 12 months or younger, pure-tone average (PTA) hearing levels are often utilized to guide device recommendations. Empirically driven hearing level (i.e., PTAs) guidelines for CI candidacy, for unilateral CIs (Blamey et al, 2001;Boothroyd & Eran, 1994;Davidson, 2006), and more recently for BCI versus bilateral HAs (Lovett, Vickers, & Summerfield, 2015) have been developed by examining the relationship between hearing level (i.e., unaided PTA) and speech perception scores in a group of children with HAs and comparing these scores to a group of children with CIs. Typically, regression models are used to determine a PTA cutoff level for recommending a CI (or CIs) or an HA (or HAs).…”

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confidence: 99%

“…The authors acknowledge that these models do not take into account possible benefits provided by use of a CI and HA combined (i.e., bimodal devices) and recommend that caution should be exercised when using this model to make recommendations regarding BCIs. A recent study by Lovett et al (2015) in the United Kingdom developed audiometric candidacy guidelines by comparing speech perception scores of 28 children with bilateral CIs to 43 children with bilateral HAs (age 3-7 years). The authors suggest that children with a four-frequency (average of 0.5, 1, 2, and 4 kHz) PTA of ≥ 80 dB HL should be considered for BCIs.…”

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confidence: 99%

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Effects of Early Acoustic Hearing on Speech Perception and Language for Pediatric Cochlear Implant Recipients

Davidson

Geers

Uchanski

et al. 2019

J Speech Lang Hear Res

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Purpose The overall goal of the current study was to identify an optimal level and duration of acoustic experience that facilitates language development for pediatric cochlear implant (CI) recipients—specifically, to determine whether there is an optimal duration of hearing aid (HA) use and unaided threshold levels that should be considered before proceeding to bilateral CIs. Method A total of 117 pediatric CI recipients (ages 5–9 years) were given speech perception and standardized tests of receptive vocabulary and language. The speech perception battery included tests of segmental perception (e.g., word recognition in quiet and noise, and vowels and consonants in quiet) and of suprasegmental perception (e.g., talker and stress discrimination, and emotion identification). Hierarchical regression analyses were used to determine the effects of speech perception on language scores, and the effects of residual hearing level (unaided pure-tone average [PTA]) and duration of HA use on speech perception. Results A continuum of residual hearing levels and the length of HA use were represented by calculating the unaided PTA of the ear with the longest duration of HA use for each child. All children wore 2 devices: Some wore bimodal devices, while others received their 2nd CI either simultaneously or sequentially, representing a wide range of HA use (0.03–9.05 years). Regression analyses indicate that suprasegmental perception contributes unique variance to receptive language scores and that both segmental and suprasegmental skills each contribute independently to receptive vocabulary scores. Also, analyses revealed an optimal duration of HA use for each of 3 ranges of hearing loss severity (with mean PTAs of 73, 92, and 111 dB HL) that maximizes suprasegmental perception. Conclusions For children with the most profound losses, early bilateral CIs provide the greatest opportunity for developing good spoken language skills. For those with moderate-to-severe losses, however, a prescribed period of bimodal use may be more advantageous for developing good spoken language skills.

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confidence: 99%

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confidence: 99%

Effects of Early Acoustic Hearing on Speech Perception and Language for Pediatric Cochlear Implant Recipients

Davidson

Geers

Uchanski

et al. 2019

J Speech Lang Hear Res

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“…Before embarking on the main test, listeners performed a threshold test that allowed us to match difficulty across listeners such that listeners’ performance fell above chance and below ceiling. Previous investigations that have measured spatial listening abilities in hearing-impaired children have often struggled to draw meaningful conclusions due to floor and ceiling effects ( Lovett, Vickers, & Summerfield, 2015 ). By including this threshold stage, we were therefore able to ensure that listeners were operating at the same point on the psychometric function and therefore allowed us to measure differences in performance across auditory space in both speech identification and sound discrimination tasks.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous Assessment of Speech Identification and Spatial Discrimination

et al. 2015

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With increasing numbers of children and adults receiving bilateral cochlear implants, there is an urgent need for assessment tools that enable testing of binaural hearing abilities. Current test batteries are either limited in scope or are of an impractical duration for routine testing. Here, we report a behavioral test that enables combined testing of speech identification and spatial discrimination in noise. In this task, multitalker babble was presented from all speakers, and pairs of speech tokens were sequentially presented from two adjacent speakers. Listeners were required to identify both words from a closed set of four possibilities and to determine whether the second token was presented to the left or right of the first. In Experiment 1, normal-hearing adult listeners were tested at 15° intervals throughout the frontal hemifield. Listeners showed highest spatial discrimination performance in and around the frontal midline, with a decline at more eccentric locations. In contrast, speech identification abilities were least accurate near the midline and showed an improvement in performance at more lateral locations. In Experiment 2, normal-hearing listeners were assessed using a restricted range of speaker locations designed to match those found in clinical testing environments. Here, speakers were separated by 15° around the midline and 30° at more lateral locations. This resulted in a similar pattern of behavioral results as in Experiment 1. We conclude, this test offers the potential to assess both spatial discrimination and the ability to use spatial information for unmasking in clinical populations.

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“…Since it is tricky to measure a four-frequency PTA in young children, recent observational studies recommend a two-frequency PTA, which can easily measure 85 dB HL or less in both ears as the criterion for bilateral implant in children. [9]…”

Section: Introductionmentioning

confidence: 99%