Spoken Language Skills in Children With Bilateral Hearing Aids or Bilateral Cochlear Implants at the Age of Three Years

Abstract

Objectives: Early hearing aid (HA) fitting and cochlear implants (CIs) aim to reduce the effects of hearing loss (HL) on spoken language development. The goals of this study were (1) to examine spoken language skills of children with bilateral HAs and children with bilateral CIs; (2) to compare their language skills to the age-norms of peers with normal hearing (NH); and (3) to investigate factors associated with spoken language outcomes. Design: Spoken language results of 56 Finnish children with HL were obtained from a nationwide prospective multicenter study. Children with HL comprised two groups: children with mild-to-severe HL who used bilateral HAs (BiHA group, n = 28) and children with profound HL who used bilateral CIs (BiCI group, n = 28). Children’s spoken language comprehension, expressive and receptive vocabulary, and phonological skills were compared with normative values of children with NH at the age of three years. Odds ratio (OR) was calculated to compare proportions of children below age-norms in BiHA and BiCI groups. Factors associated with spoken language outcomes were modeled with analysis of covariance. Results: At the age of 3 years, 50%–96% of children with HL performed 1 SD or more below the mean of the normative sample of age-peers with NH in spoken language skills, depending on the language domain. Receptive vocabulary and phonological skills were the most vulnerable language domains. In receptive vocabulary, 82% of the children in the BiHA group and 50% of the children in the BiCI group scored 1 SD or more below the normative mean. The BiHA group was 4.4 times more likely to have poorer receptive vocabulary than the BiCI group. In phonological skills, 96% of children in the BiHA group and 60% of the children in the BiCI group scored 1 SD or more below the normative mean. The BiHA group was 18.0 times more likely to have poorer phonological skills than the BiCI group. The analysis of covariance models showed that unaided pure-tone average, PTA 0.5–4 kHz , had a significant effect on spoken language comprehension in the BiHA group. For the BiCI group, age at HL diagnosis and age at CI activation had a significant effect on expressive vocabulary. High maternal level of education had a significant effect on language comprehension and expressive vocabulary and female gender on phonological skills. Conclusions: At the age of 3 years, especially receptive vocabulary and phonological skills caused difficulties for children with HL showing also considerable individual variation. Children with bilateral HAs seemed to be more likely to have poorer receptive vocabulary and phonological skills than children with bilateral CIs. A variety of factors was associated with outcomes in both groups. Close monitoring of spoken language skills of children with HL is important for ensuring similar opportunities for all children with HL and timely intervention, when needed.

Hearing Thresholds, Speech Recognition, and Audibility as Indicators for Modifying Intervention in Children With Hearing Aids

“…First, we identified language scores that were below scores of age- and SES-matched CTH at clinically significant levels 1.5 SDs below mean of the CTH. Various values have been used as a criterion for disordered or delayed communication in the research on language disorders and on children who are deaf and hard of hearing, ranging from >1 to 2 SD below the normative mean of a given test (Tomblin et al 1996; Ramus et al 2013; Bishop 2014; Reilly et al 2014; Geers et al 2016; Norbury et al 2016; Hansson et al 2018; Välimaa et al 2022). We chose to set 1.5 SD as the threshold for language delay in this analysis to capture the median of this range of definitions.…”

Long-Term Device Satisfaction and Safety after Cochlear Implantation in Children

“…Nicholas et al also analyzed vocabulary, expressive and receptive language at 4.5 years of age and showed that children implanted between 6 and 11 months ( n = 27) achieved higher scores on all measures compared to those implanted between 12 and 18 months ( n = 42) [ 39 ]. Numerous studies demonstrated similar results regarding improved language trajectories among infants implanted <12 months [ 27 , 38 , 40 , 41 , 42 , 43 ]. However, Leigh et al showed no significant difference in the rate of receptive language growth between children implanted <12 months compared to those implanted between 13 and 24 months [ 44 ].…”

Delays in receptive vocabulary and verbal IQ in deaf children and adolescents

“…Nevertheless, even after the improvements that early intervention can produce, language development still supposes a challenge for deaf or hard of hearing (DHH) children (Välimaa et al, 2022). Some authors mention the existence of developmental sensitive periods, related to environmental experiences, although it is difficult to determine the exact time where the development of a certain function is at its pike (Gabard-Durnam & McLaughlin, 2020;Gariépy et al, 2019).…”