United Kingdom national paediatric bilateral audit.

South of England Cochlear Implant Centre, Institute of Sound and Vibration Research, University of Southampton, Southampton, UK.
Cochlear implants international 08/2011; 12 Suppl 2:S15-8. DOI: 10.1179/146701011X13074645127234
Source: PubMed

ABSTRACT Prior to 2009, UK public funding was mainly only available for children to receive unilateral cochlear implants. In 2009, the National Institute for Health and Clinical Excellence (NICE) published guidance for cochlear implantation following their review. According to these guidelines, all suitable children are eligible to have simultaneous bilateral cochlear implants or a sequential bilateral cochlear implant if they had received the first before the guidelines were published. NICE stated that they would review this decision in 2011. In preparation for this review, 13 UK cochlear implant centres formed a consortium, and the decision was made to carry out a multi-centre audit. The audit involves collecting data from simultaneously and sequentially implanted children at three intervals: before bilateral cochlear implants or before the sequential implant, 1 year after bilateral implants, and 2 years after bilateral implants. The measures include localization, speech recognition in quiet and background noise, speech production, listening, vocabulary, parental perception, quality of life, and surgical data including complications. The audit has now passed the 1-year point, and data have been received on more than 400 children. Preliminary results will be available a year later.

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    ABSTRACT: Objectives Since being approved in 2009, bilateral simultaneous cochlear implantation (CI) has been the standard treatment for children in the UK who meet the criteria for CI. The aim was to report surgical outcomes of bilateral CI in the UK. Methods Between January 2010 and December 2011, 14 UK CI centres collected data prospectively: demographics, aetiology, use of imaging, device type, surgery duration, use of intra-operative electrophysiology, length of stay, and post-operative complications. Results 1397 CI procedures in 961 CI recipients were included; 436 bilateral simultaneous, 394 bilateral sequential, and 131 unilateral. The majority (85%) were congenitally deaf. The commonest causes of acquired deafness were meningitis and cytomegalovirus infection. The median age for congenitally deaf bilateral simultaneous CI was 2.2 years, mean surgical duration 4.5 hours. 6.3% surgeries were day case procedures. Eight cases (2.0%) of planned bilateral CI had unilateral surgery. The overall major complication rate was 1.6% (0.9% excluding device failures), including explantation due to infection (0.2%), cerebrospinal fluid leak (0.2%), and meningitis (0.1%). There were no permanent facial nerve palsies and no deaths. Sixty-two (6.5%) immediate minor complications included 12 (1.3%) children with significant vestibular impairment. The complication rate was similar following bilateral CI compared to sequential and unilateral CI, and is comparable to other published series. Conclusion This prospective multi-centre audit provides evidence that bilateral paediatric CI is a safe procedure in the UK, thus endorsing its role as a major therapeutic intervention in childhood deafness.
    Cochlear implants international 01/2014; 14(S4). DOI:10.1179/1754762813Y.0000000041
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    ABSTRACT: To evaluate the sound localisation ability in children with sequential bilateral cochlear implants and the potential influence of age at the time of the first implantation, years of experience with the first implanted ear and the inter-implant interval (time between the first and the second cochlear implantation). Sixty-three prelingually deaf children (mean age, 11.03; range, 6.5-17 years; SD, 3.09) were tested after 12 and 24 months of using bilateral cochlear implants. Every child was tested with each ear alone and both ears together. Five loudspeakers were placed in a 180° horizontal arch with 45° of separation between each loudspeaker. The child was placed 1.5m from the speakers. For each test run, three stimuli were presented at 65dB (A) from each speaker for a total of 15 stimulus presentations. For each test run, we calculated the mean angular error (MAE) and the proportion of correct speakers identified (CSS: correct speaker score). Performance by chance for the MAE was 72° and for the CSS was 20% (1 of 5 speakers). After 12 months of using bilateral CIs, the added effect of the second CI in the MAE was minor, and there was no significant difference in CSS between listening in the unilateral condition and listening in bilateral condition. After 24 months, however, the added effect of the second CI in the MAE was significant (mean diff=12.2°; 95% CI; 4.5-20.0°, p=0.003). The mean bilateral CSS increased significantly to 38% (diff=7.7%; 95% CI; 1.4-14.0%; p=0.019) while the mean unilateral CSS remained at a similar level (27%). The influence of age at the time of the first implantation on CSS after 24 months was not significant (p=0.96). However, the inter-implant interval showed a significant decrease in score by 1.4% per year between the two implants (p=0.04). Sound localisation with two versus one CI in children with a sequential bilateral cochlear implantation was significantly improved 24 months (but not 12 months) after the second implantation. A shorter inter-implant interval showed a small but significant beneficial effect on sound localisation.
    International journal of pediatric otorhinolaryngology 06/2012; 76(9):1245-8. DOI:10.1016/j.ijporl.2012.05.013 · 1.32 Impact Factor
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    ABSTRACT: Objective: The Toy Discrimination Test measures children's ability to discriminate spoken words. Previous assessments of reliability tested children with normal hearing or mild hearing impairment, and most studies used a version of the test without a masking sound. We assessed test-retest reliability for children with hearing impairment using maskers of broadband noise and two-talker babble. Design: Stimuli were presented from a loudspeaker. The signal-to-noise ratio (SNR) was varied adaptively to estimate the speech-reception threshold (SRT) corresponding to 70.7% correct performance. Participants completed each masked condition twice. Study sample: Fifty-five children with permanent hearing impairment participated, aged 3.0 to 6.3 years. Thirty-four children used acoustic hearing aids; 21 children used cochlear implants. Results: For the noise masker, the within-subject standard deviation of SRTs was 2.4 dB, and the correlation between first and second SRT was + 0.73. For the babble masker, corresponding values were 2.7 dB and + 0.60. Reliability was similar for children with hearing aids and children with cochlear implants. Conclusions: The results can inform the interpretation of scores from individual children. If a child completes a condition twice in different listening situations (e.g. aided and unaided), a difference between scores ≥ 7.5 dB would be statistically significant (p <.05).
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