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To examine spoken language outcomes in children undergoing bilateral cochlear implantation compared with matched peers undergoing unilateral implantation.
Case-control, frequency-matched, retrospective cross-sectional multicenter study.
Two Belgian and 3 Dutch cochlear implantation centers.
Twenty-five children with 1 cochlear implant matched with...
Contexts in source publication
Context 1
... dren with indications of intellectual disabilities were excluded from the study. An overview of all participants is given in Table 1 and Table 2. ...
Context 2
... match both subgroups on age at first fitting, children had to un- dergo implantation before 2.00 years of age. A group of 14 children undergoing sequential implantation (82%) (Seq in Table 1) met this criterion and did not differ sig- nificantly from the 8 children undergoing simultaneous implantation on age at first fitting (Mann-Whitney test, 32; P=.10) or additional disabilities (likelihood ratio, 1.1; df, 2; P =.59). One of these 14 children undergoing se- quential implantation received the second implant within the first year after the first implant. ...
Similar publications
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...
Citations
... Embora muitas crianças com implantes tenham conseguido desenvolver a oralidade, está bem documentado que muitas delas com este dispositivo usado unilateralmente apresentam atrasos no desenvolvimento da linguagem (Nittrouer et al., 2012), na produção da fala (Spencer et al., 2011), na alfabetização (Geers & Hayes, 2011, nas competências académicas (Mukari et al., 2007) e sociais (Hintermair, 2006). Ainda que não hajam evidências de que o melhor desempenho linguístico de crianças com implantes bilaterais se deva à dupla perceção auditiva ou a um efetivo processamento dos sons ao nível binaural 2 , o uso deste dispositivo, nestas condições, tem sido associado a um melhor desenvolvimento de competências linguísticas, comparativamente aos seus pares utilizadores de implante unilateral (Boons et al., 2012). ...
As competências de consciência fonológica devem ser desenvolvidas o mais precocemente possível, na medida em que, a partir destas, desenvolve-se a capacidade de decodificação de sons e letras, possibilitando um posterior acesso ao princípio alfabético. No entanto, no caso de crianças com perda auditiva, verifica-se uma escassez de estudos que permitam aferir a eficácia de práticas baseadas em evidências, na melhoria do processamento fonológico destas crianças. Assim, foi realizada uma revisão sistemática da literatura tendo em conta os estudos de intervenções que tenham como foco o desenvolvimento de competências fonológicas em crianças com perda auditiva. Os procedimentos de síntese e relato da pesquisa adotados seguiram as diretrizes do PRISMA. Esta revisão incorpora treze estudos publicados em revistas especializadas nas últimas duas décadas, envolvendo um total de 268 crianças com perda auditiva, com idades compreendidas entre os 57 meses e os 15 anos, de nove nacionalidades, sendo Israel e Estados Unidos os países mais representativos. Em termos de duração, as intervenções variaram entre as seis e as trinta e seis semanas, com uma frequência que variou entre as duas e as quatro sessões semanais, perfazendo, em média, 30 horas de intervenção. No que concerne ao uso de meios auxiliares de audição, a maioria das crianças usava dispositivos de amplificação tradicionais. As intervenções revisadas no presente estudo reportaram, sem exceção, melhorias significativas nas competências fonológicas das crianças com surdez que nelas participaram, ao nível do fonema, da sílaba e da rima, o que reforça a premência de uma abordagem destas competências tão precocemente quanto possível, de modo a assegurar o acesso à língua, nas suas vertentes oral e escrita, tendo em conta a educação bilingue. As limitações enfrentadas por alguns estudos durante suas intervenções devem ser vistas como uma melhoria para pesquisas futuras.
... Studies have shown that the bilateral implantations were better not only for sound localization and speech understanding in noise but also for the quality of life and language development. [5][6][7] As a result, bilateral CI is now strongly recommended for pediatric patients with bilateral severe-to-profound SNHL. [8][9][10] Simultaneous bilateral surgeries are ideal but sequential surgeries have also shown favorable outcomes. ...
... Ear, Nose & Throat Journal 103 (7) (± 4.8), and 11.9 (± 6.6) years in Groups A to C, respectively, (P = .858). The inter-implant period was 7.1 (± 3.2) years in Group A, 6.3 (±2.3) years in Group B, and 7.8 (± 3.1) years in Group C, which was slightly longer in Group C; however, this difference was not significant (P = .495). ...
Objectives
When there is a difference in hearing on both ears, where to perform the first cochlear implantation (CI) becomes an important issue. The purpose of the study was to evaluate which ear should be chosen for the first implantation in sequential bilateral CI with a long inter-implant period.
Methods
The study population consisted of 34 severe-to-profound sensorineural hearing loss pediatrics with the inter-implant period of ≥3 years between the first CI (CI-1) and the second CI (CI-2) before the age of 19 (mean of inter-implant period: 7.1-year). The patients were classified into Group A (CI-1 was performed on the ear with better hearing), Group B (CI-1 on the ear with worse hearing), or Group C (symmetrical hearing in both ears). Speech intelligibility test results were compared between the groups.
Results
The monosyllabic word scores of CI-1 were excellent in Groups A (91.7±7.9%) and B (92.5±3.6%) but slightly lower in Group C (85.7±14.9%) before the second implantation (P = .487). At 3 years after the second implantation, all groups demonstrated excellent scores in the bilateral CI condition (95.9±3.0% in Group A; 99.1±.8% in Group B; 97.5±2.9% in Group C, P = .600). However, when the patients were tested in using CI-2 only in Groups A and B after using bilateral CI for 3 years, the scores were inconsistent in Group A (79.6±23.9%; range: 22.2-94.4%), while those were higher and more constant in Group B (92.9±4.8%; 86.8-100.0%).
Conclusions
The first CI is strongly recommended to perform on a worse hearing ear if they had different hearing levels between ears. Even with the first CI on a worse hearing ear, its performance never deteriorates. In addition, if they receive the second CI several years later, it will be likely that the second one functions better.
... Challenges in morphology, syntax (Boons et al., 2013;F. L. Halliday et al., 2017;Hammer & Coene, 2016;Koehlinger et al., 2013;Tomblin et al., 2015;Walker et al., 2015;Wie et al., 2020) and semantic skills (Boons et al., 2012;Geers et al., 2009;R. M. Mitchell et al., 2020;Niparko et al., 2010;Välimaa et al., 2022;Yoshinaga-Itano et al., 2010) are also common in HA and CI users. ...
... In addition, Yoshinaga-Itano et al. (2010) concluded from their study of DHH children with at least severe HL that CI users outperformed HAs users in expressive vocabulary and language comprehension. The results of Boons et al. (2012) showed that even though children implanted bilaterally performed better than children implanted unilaterally, 56% of bilaterally implanted children (first CI at the age of seven to 28 months) still had language comprehension below expectation after three years from the first CI activation. ...
... Results of previous studies have shown that there is considerably much variation in linguistic development among DHH children. Many of them are able to close the gap between them and TH children by the start of school, but there is evidence to show that some DHH children still have linguistic difficulties at school age (Boons et al., 2012(Boons et al., , 2013F. L. Halliday et al., 2017;van Wieringer & Wouters, 2015). ...
Children’s experiences in using language in variable social contexts contribute to their abilities to learn social-pragmatic skills. Offering adequate linguistic and social access for deaf and hard-of-hearing (DHH) children acquiring spoken language(s) often requires attention from parents and professionals. In this dissertation, the social-pragmatic development of children who use bilateral hearing aids (BiHAs) or bilateral cochlear implants (BiCIs) and that of typically hearing (TH) children was studied.
First, the views of parents and day care professionals on communication abilities, including linguistic and social-pragmatic skills, were analysed using the Children’s Communication Checklist -2 (CCC-2). Next, social-pragmatic development was analysed using the Pragma test, in which, answering socially and contextually demanding questions is required. Finally, associations between auditory, demographic, cognitive and linguistic factors and the Pragma test performance were explored.
The results of the CCC-2 indicated that children in the BiHA and BiCI groups had on average poorer communication skills than TH children. Difficulties were more common and more large-scale in the BiCI group than in the BiHA group, including social-pragmatics in addition to linguistic skills. However, the results of the Pragma test showed that most BiHA and BiCI users still had difficulties in social-pragmatic skills at the age of six years, despite their accelerated development between the ages of five and six years. In the BiHA group, social-pragmatic skills were associated with the degree of hearing loss. In both groups of DHH children, social-pragmatic skills were associated with the level of maternal education and with visual inferencing skills. Furthermore, social-pragmatic skills were associated with linguistic skills in both DHH and TH children.
The results of this dissertation indicated that hearing habilitation practices should be improved to offer DHH children learning spoken language the best possible linguistic and social access, since they are crucial for the social-pragmatic development.
... Some studies have reported that simultaneous bilateral cochlear implantation in children with bilateral deafness may provide better postoperative speech outcomes than sequential implantation [7][8][9]. The disadvantages of sequential bilateral cochlear implantation may be attributed to a long inter-implant interval. ...
... Many auditory functions, such as sound localization and speech perception in noise, rely on normal bilateral listening [25][26][27]. Therefore, we infer that the asymmetric development of bilateral auditory systems may contribute to deficient auditory and speech processing in CI children [8,9,28]. Furthermore, there is evidence demonstrating that, compared with sequential bilateral implantation, simultaneous bilateral implantation could bring shorter hospital stays, fewer postoperative complications or better cost effectiveness to the patients [29,30]. ...
Purpose
To investigate the effect of the interval between bilateral cochlear implantation on the development of bilateral peripheral auditory pathways as revealed by the electrically evoked auditory brainstem response (EABR).
Methods
Fifty-eight children with profound bilateral sensorineural hearing loss were recruited. Among them, 33 children received sequential bilateral cochlear implants (CIs), and 25 children received simultaneous bilateral CIs. The bilateral EABRs evoked by electrical stimulation from the CI electrode were recorded on the day of second-side CI activation.
Results
The latencies of wave III (eIII) and wave V (eV) were significantly shorter on the first CI side than on the second CI side in children with sequential bilateral CIs but were similar between the two sides in children with simultaneous bilateral CIs. Furthermore, the latencies were prolonged from apical to basal channels along the cochlea in the two groups. In children with sequential CIs, the inter-implant interval was negatively correlated with the eV latency on the first CI side and was positively correlated with bilateral differences in the eIII and eV latencies.
Conclusions
Unilateral CI use promotes the maturation of ipsilateral auditory conduction function. However, a longer inter-implant interval results in more unbalanced development of bilateral auditory brainstem pathways. Bilateral cochlear implantation with no or a short interval is recommended.
... Early activation offers the potential for earlier hearing experience and rehabilitation, making it an attractive option for some CI patients [18,20]. However, the benefits of simultaneous BiCI have been proven in pediatric populations in terms of safety, efficacy, and speech outcomes, and the procedure requires fewer resources for rehabilitation compared to sequential BiCI [8,[22][23][24][25][26][27]. There is still a lack of evidence regarding the surgical and clinical outcomes of simultaneous BiCI in adults in achieving faster rehabilitation. ...
The objective of this study is to review our experience with simultaneous bilateral cochlear implantation (BiCI) in adults, and assess its feasibility. This could shorten the time required to regain binaural hearing, prevent social isolation, and potentially eliminate the need for hearing aids, as seen with sequential BiCI. A retrospective study was conducted involving adult patients who received simultaneous BiCI at our center between 2010 and 2023. The feasibility of simultaneous BiCI was assessed through postoperative clinical evaluations, outpatient visits, discharge status, and the acceptance of device fitting. Twenty-seven patients underwent simultaneous BiCIs. Their mean age was 37 years, comprising 59.3% males and 40.7% females. Out of the included patients, 51.9% had childhood-onset hearing loss, while 29.6% developed hearing loss later in life. Causes of hearing loss included meningitis 7.4%, trauma 11.1%, non-specific high-grade fever 11.1%, and Brucellosis infection 3.7%. Labyrinthine ossificans (LO) was present in 7.4%, and retrofenestral otospongiosis in 3.7%. The post-operative period and initial outpatient visit were uneventful for 88.8% and 81.5% of patients, respectively. Intraoperative complications were absent in 96.2% of cases. Simultaneous BiCI is feasible in adults without major intraoperative complications or troublesome recovery periods, offering potential benefits by reducing the number of surgeries and hospital admissions compared to the sequential method.
... Advances in CI technology have also led to better spoken language development outcomes for DHH children, although there is still variability [5]. Some DHH children catch up with peers quickly, some progress more slowly, and a proportion have persistent and severe delays [6][7][8][9][10][11][12][13][14]. For example in the Geers, Nicholas, Tobey and Davidson [9] sample, a third of children presented with persistent language delay. ...
... Considerable variation in spoken language outcomes is common in DHH children who receive a CI [7][8][9][10][11][12][13]. Persistent language difficulties are evident among some DHH children, but research and practice has not yet been able to determine if this is DLD. ...
(1) Background: While spoken language learning delays are assumed for deaf and hard of hearing (DHH) children after cochlear implant (CI), many catch up with their hearing peers. Some DHH children with CIs, however, show persistent delays in language, despite protective factors being in place. This suggests a developmental language disorder (DLD). However, at present there is little consensus on how to diagnose DLD in DHH children. (2) Methods: Given the lack of consensus in this area, a set of case studies provides an appropriate first step. The goal of this paper is to show the plausibility of a DLD diagnosis, following careful analysis of protective and risk factors. A retrospective case study review was conducted for three children. Their long-term language outcomes up to four years after CI were considered in the context of access to sound, speech sound discrimination, social skills and non-verbal cognition. (3) Results: It was possible to posit DLD in one child who had experienced good access to sound, alongside good speech discrimination abilities and social development, and normal non-verbal cognition, but who presented with severe language learning difficulties. (4) Conclusions: Finding markers for DLD in DHH children is important for diagnosis and intervention. The implications for clinical practice are discussed.
... Thus, we cannot clearly associate this difference between the groups with language skills. However, there are many studies in the literature that have associated bilateral cochlear implant use with better speech and language skills (Boons et al., 2012;Johnston et al., 2009). One such study showed that children with bilateral implants had better semantic and syntactic skills than unilateral users (Boons et al., 2012). ...
... However, there are many studies in the literature that have associated bilateral cochlear implant use with better speech and language skills (Boons et al., 2012;Johnston et al., 2009). One such study showed that children with bilateral implants had better semantic and syntactic skills than unilateral users (Boons et al., 2012). Another study showed that children with bilateral cochlear implants had larger vocabularies than unilateral users (Sarant et al., 2014). ...
Introduction: The preschool period is the most critical time for the development of social skills. Children with cochlear implants experience challenges in many domains, particularly including communication skills. This study aimed to compare the social skills (initiation, academic support, friendship, and emotion regulation skills) of preschool-age children with cochlear implants to those of their hearing peers. The second aim was investigate the influence of unilateral/bilateral cochlear implant use and preschool attendance on social skills. Method: Thirty-four children (16 girls, 18 boys) with cochlear implants with a mean age of 53.18 months and 36 hearing children (21 girls, 15 boys) with a mean age of 53.92 months were included in this study. The social skills of the hearing children and the children with cochlear implants were compared using the Preschool Social Skills Evaluation Scale. The influence of unilateral/bilateral cochlear implant use and the effect of preschool attendance on social skills were also investigated. Findings: The performances of children with cochlear implants were significantly lower than those of their hearing peers in terms of initiation skills, academic support skills, friendship skills, and emotion regulation skills (p < .05). Bilateral cochlear implant users had significantly higher initiation skills than unilateral cochlear implant users, and cochlear implant users who attended preschool had significantly higher academic support skills than cochlear implant users who did not attend preschool. Discussion: Preschool-age children with cochlear implants were behind their hearing age-mates in social skills and required increased educational support to promote their social skills. Being a bilateral cochlear implant user and attending preschool education had positive effects on social skills.
... Children with CIs form a very diverse population with many variables to consider. Boons et al. [22] divided the predictive factors into three groups: child-related factors (aetiology, cognitive skills, and additional disabilities), auditory factors (age diagnosis, age of CI, unilateral or bilateral CI, and fitting), and environmental factors (multilingualism, communication mode, family environment, rehabilitation, and education). Rehabilitation appears as an essential factor in predicting the outcomes of these children [22][23][24], but it is not clear yet how to optimally involve parents and how much and what kind of support a child with one or two CIs needs. ...
... Boons et al. [22] divided the predictive factors into three groups: child-related factors (aetiology, cognitive skills, and additional disabilities), auditory factors (age diagnosis, age of CI, unilateral or bilateral CI, and fitting), and environmental factors (multilingualism, communication mode, family environment, rehabilitation, and education). Rehabilitation appears as an essential factor in predicting the outcomes of these children [22][23][24], but it is not clear yet how to optimally involve parents and how much and what kind of support a child with one or two CIs needs. ...
Background and objectives: More and more children with severe-to-profound hearing loss are receiving cochlear implants (CIs) at an early age to improve their hearing and listening abilities, speech recognition, speech intelligibility, and other aspects of spoken language development. Despite this, the rehabilitation outcomes can be very heterogeneous in this population, not only because of issues related to surgery and fitting or the specific characteristics of the child with his/her additional disabilities but also because of huge differences in the quality of the support and rehabilitation offered by the therapist and the family. These quality standards for the rehabilitation of young deaf children receiving CIs are developed within the European KA202 Erasmus+ project “VOICE”—vocational education and training for speech and language therapists and parents for the rehabilitation of children with CIs, Ref. No.: 2020-1-RO01-KA202-080059. Material and methods: To develop these quality standards, we used the input from the face-to-face interviews of 11 local rehabilitation experts in CIs from the four partner countries of the project and the outcomes of the bibliographic analysis of 848 publications retrieved from six databases: Pub Med, Psych Info, CINAHL, Scopus, Eric, and Cochrane. Based on all this information, we created a first set of 32 quality standards over four domains: general, fitting, rehabilitation, and for professionals. Further on, the Delphi method was used by 18 international rehabilitation experts to discuss and agree on these standards. Results: The results from the literature analysis and the interviews show us that more than 90% of the consulted international experts agreed on 29 quality standards. They focus on different aspects of rehabilitation: the multidisciplinary team, their expertise and knowledge, important rehabilitation topics to focus on, and programming issues related to rehabilitation. Conclusions: These quality standards aim to optimize the activity of speech rehabilitation specialists so that they reach the optimal level of expertise. Also presented is the necessary equipment for the IC team to carry out the rehabilitation sessions in good conditions. This set of quality standards can be useful to ensure the appropriate postoperative care of these children. As a result, the rehabilitation process will be more relaxed, and therapists will have the opportunity to focus more on the specific needs of each child, with the provision of quality services, which will result in better results. This theme is particularly complex and dependent on multifactorial aspects of medicine, education, speech therapy, social work, and psychology that are very intricate and interdependent.
... In fact, some research indicates that bilaterally implanted child CI users may have higher scores in voice perception tasks and speech perception tasks with speech maskers than adult CI users, supporting such an advantage (Nagels et al. 2023). Furthermore, previous research has indicated that use of a CI facilitates native language acquisition in children, especially when implantation is done at an early age (see a recent review by Sharma et al. 2020, and for other demographic factors, see Boons et al. 2012aBoons et al. , 2012b. That is, the receptive and expressive native language skills in children have been shown to improve after implantation and may even reach age-appropriate levels for early implanted child CI users (Ruben 2018). ...
Objectives
This study explores to what degree adolescent cochlear implant (CI) users can learn a foreign language in a school setting similar to their normal-hearing (NH) peers despite the degraded auditory input.
Design
A group of native Dutch adolescent CI users (age range 13 to 17 years) learning English as a foreign language at secondary school and a group of NH controls (age range 12 to 15 years) were assessed on their Dutch and English language skills using various language tasks that either relied on the processing of auditory information (i.e., listening task) or on the processing of orthographic information (i.e., reading and/or gap-fill task). The test battery also included various auditory and cognitive tasks to assess whether the auditory and cognitive functioning of the learners could explain the potential variation in language skills.
Results
Results showed that adolescent CI users can learn English as a foreign language, as the English language skills of the CI users and their NH peers were comparable when assessed with reading or gap-fill tasks. However, the performance of the adolescent CI users was lower for English listening tasks. This discrepancy between task performance was not observed in their native language Dutch. The auditory tasks confirmed that the adolescent CI users had coarser temporal and spectral resolution than their NH peers, supporting the notion that the difference in foreign language listening skills may be due to a difference in auditory functioning. No differences in the cognitive functioning of the CI users and their NH peers were found that could explain the variation in the foreign language listening tasks.
Conclusions
In short, acquiring a foreign language with degraded auditory input appears to affect foreign language listening skills, yet does not appear to impact foreign language skills when assessed with tasks that rely on the processing of orthographic information. CI users could take advantage of orthographic information to facilitate foreign language acquisition and potentially support the development of listening-based foreign language skills.
... However, the CI group performed significantly weaker on every language test, including vocabulary, morphology, syntax, and narratives, than their NH peers (Boons et al., 2013). In addition, Boons, Brokx, Frijns, et al. (2012) showed large variability in spoken language comprehension of children with CIs, ranging from two standard deviations below the norm for NH children to as high as one standard deviation (SD) above this norm. They showed that children with monaural implantation had significantly worse language comprehension skills than children with bilateral implantation (Boons, Brokx, Dhooge, et al., 2012) and that the presence of additional disabilities enlarged the odds of poor vocabulary skills (Boons et al., 2013). ...
... Our study investigated the feasibility of the DTT and a monosyllabic, word-in-noise task, the Lilliput, to investigate the auditory aspects of SPIN understanding of young children with CIs, a population that is characterized by the large variability in cognitive and language skills (AuBuchon et al., 2015;Boons, Brokx, Dhooge, et al., 2012;Kenett et al., 2013;Kronenberger et al., 2013Kronenberger et al., , 2018Moberly, Pisoni, et al., 2017;Wass et al., 2008;Yehudai et al., 2011), whether or not related to specific demographics (Boons, Brokx, Frijns, et al., 2012;Choi et al., 2017;Dettman et al., 2013Dettman et al., , 2016Sarant et al., 2001;Tajudeen et al., 2010). ...
The use of two types of speech-in-noise (SPIN) assessment, namely digits-in-noise self-tests and open-set, monosyllabic word tests, to assess the SPIN understanding performance of children with cochlear implants (CI) in mainstream and special education, was investigated. The tests' feasibility and reliability and the influence of specific cognitive abilities on their results were studied. The results of 30 children with CIs in mainstream and special education were compared to those of 60 normal-hearing children in elementary school. Results indicate that the digit triplet test (DTT) was feasible for all children tested in this study, as seen by the familiarity of all the digits, the high stability of the test results (<3 dB SNR), and a small measurement error (≤2 dB SNR). Remembering full triplets did not form a problem and results did not show systematic attention loss. For children with CIs, the performance on the DTT was strongly related to the performance on the open-set monosyllabic word-in-noise task. However, small but significant differences were observed in the performance of children with CIs in mainstream and special education on the monosyllabic word test. Both tests showed little influence of cognitive abilities, making them both useful in situations where the bottom-up auditory aspect of SPIN performance needs to be investigated or in situations where sentence-in-noise tests are too challenging.
