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Objective To compare the communication outcomes between children with aided residual hearing and children with cochlear implants. Design Measures of speech recognition and language were administered to pediatric hearing aid users and cochlear implant users followed up longitudinally as part of an ongoing investigation on cochlear implant outcomes. The speech recognition measures included the Lexical Neighborhood Test, Phonetically Balanced–Kindergarten Word Lists, and the Hearing in Noise Test for Children presented in quiet and noise (+5 dB signal-to-noise ratio). Language measures included the Peabody Picture Vocabulary Test: Third Edition (PPVT-III), the Reynell Developmental Language Scales, and the Clinical Evaluation of Language Fundamentals–Revised. Subjects The experimental group was composed of 39 pediatric hearing aid users with a mean unaided pure-tone average threshold of 78.2 dB HL (hearing level). The comparison group was composed of 117 pediatric cochlear implant users with a mean unaided pure-tone average threshold of 110.2 dB HL. On average, both groups lost their hearing at younger than 1 year and were fitted with their respective sensory aids at 2 to 2.6 years of age. Not every child was administered every test for a variety of reasons. Results Between-group performance was equivalent on most speech recognition and language measures. The primary difference found between groups was on the PPVT-III, in which the hearing aid group had a significantly higher receptive vocabulary language quotient than the cochlear implant group. Notably, the cochlear implant group was substantially younger than the hearing aid group and had less experience with their sensory devices on this measure. Conclusion Data obtained from children with aided residual hearing can be useful in determining cochlear implant candidacy. [ABSTRACT FROM AUTHOR]

Much evidence suggests that, early in life, auditory input and communication are essential for the normal development of language, cognition, and behavior. Thus, deaf children, who experience significant disruptions in auditory input, are likely to show delays not only in the production of oral language but in other important aspects of development such as visual attention and behavioral control. Cochlear implants have shown tremendous promise in restoring auditory information to deaf children and concomitant improvements in speech recognition and production. However, little is known about how cochlear implants affect psychological variables. In this multisite trial, we assess the effects of cochlear implants on a range of developmental outcomes, including visual attention, problem-solving skills, symbolic play, and social adjustment. Measuring these constructs in young children, primarily younger than 2 years, has presented a number of unique challenges. In this article, we describe the methods used to assess these variables in young children and present preliminary findings comparing joint attention and symbolic play skills in a small sample of age-matched deaf and hearing children. As expected, deaf children performed more poorly than hearing children on measures of attention and symbolic play. As auditory input is restored via a cochlear implant, we predict that significant improvements in these variables will be observed. [ABSTRACT FROM AUTHOR]

Objective To measure the benefit (ie, sound localization and speech intelligibility in noise) of bilateral cochlear implants (CIs) in adults and in children. Design, Setting, and Patients Seventeen adults and 3 children underwent testing 3 months after activation of bilateral hearing. Adults received their devices in a simultaneous procedure and children in sequential procedures (3-8 years apart). Adults underwent testing of sound localization and speech intelligibility, with a single CI and bilaterally. Children underwent testing of sound localization, right/left discrimination, and speech intelligibility, with the first CI alone and bilaterally. We used computer games to attract the children's attention and engage them in the psychophysical tasks for long periods of time. Results Preliminary findings suggest that, for adults, bilateral hearing leads to better performance on the localization task, and on the speech task when the noise is near the poorer of the 2 ears. In children, localization and discrimination are slightly better under bilateral conditions, but not remarkably so. On the speech tasks, 1 child did not benefit from bilateral hearing. Two children showed consistent improvement with bilateral hearing when the noise was near the side that underwent implantation first. Conclusions Bilateral CIs may offer advantages to some listeners. The tasks described in this study might offer a powerful tool for measuring such advantages, especially in young children. The extent of the advantage, however, is difficult to ascertain after 3 months of bilateral listening experience, and might require a more prolonged period of adjustment and learning. Future work should be aimed at examining these issues. [ABSTRACT FROM AUTHOR]

Objective To examine changing parent and deaf community perspectives related to pediatric cochlear implantation. Design This research is based primarily on 2 nonrandom study designs. In the first study, conducted by the Gallaudet University Research Institute, Washington, DC, in the spring of 1999, a 12-page questionnaire was distributed to 1841 parents of children with cochlear implants; 439 questionnaires were returned. In the second study, we conducted 56 interviews with parents of 62 children with implants (and 1 without). Subjects Parents of children with cochlear implants; Gallaudet University faculty, staff, students, and alumni. Results While parents frequently receive conflicting information about educational and communication options for their child, they generally support signing before and after implantation. The parents of a child with an implant have a great interest in their child's spoken language development, and most would like to have had their child receive an implant earlier. Children with implants are educated in a variety of educational settings. Mainstreamed children with implants often continue to require classroom support services, and children with implants are frequently not isolated from both deaf and hearing peers. Parents have mixed experiences when getting information from persons in the deaf community. Comment Opposition to pediatric cochlear implantation within the deaf community is giving way to the perception that it is one of a continuum of possibilities for parents to consider. To ensure optimal use of the cochlear implant, parents need to remain involved in their child's social and educational development. [ABSTRACT FROM AUTHOR]

To examine whether age at cochlear implantation or duration of implant use is associated with speech, language, and reading skills exhibited at age 8 to 9 years in children who underwent implantation by age 5 years. Design Performance outcomes in speech perception, speech production, language, and reading were examined in terms of the age at which children first received a cochlear implant (2, 3, or 4 years), the age they received an updated (Spectra) processor, and the duration of use of an implant and an updated processor. Setting Data collection was conducted at summer research camps held over 4 consecutive years to maximize the number of children available at a specific age (8-9 years). Children were tested individually by experienced examiners, and their parents and therapists provided background and educational history information. Participants A total of 181 children from 33 different states and 5 Canadian provinces who received a cochlear implant by age 5 years were tested. A subsample of 133 children with performance IQ scores of 80 or greater and onset of deafness at birth were selected for the age-at-implantation analysis. Another subsample of 39 children with deafness acquired by age 3 years was also examined. Outcome Measures A battery of tests of speech perception, speech production, language, and reading was administered to each child and reduced to a single factor score for each skill. Results Correlation coefficients between age at implantation and duration of use did not reach significance for any of the outcome skills measured. Age at which the updated speech processor (Spectra) was fitted was significantly related to speech production outcome (earlier use of an updated processor was associated with greater speech intelligibility) but not to any other skill area. However, more of the children who underwent implantation at age 2 years (43%) achieved combined speech and language skills commensurate with their age-matched peers with normal hearing than did children who underwent implantation at age 4 years (16%). Furthermore, normal speech and language skills were documented in 80% of children who lost hearing after birth and who underwent implantation within a year of onset of deafness. Conclusions For children who receive a cochlear implant between the ages of 2 and 4 years, early cochlear implantation does not ensure better speech perception, speech production, language, or reading skills. However, greater speech and language proficiency may be expected from children who exhibit normal hearing for even a brief period after birth and receive a cochlear implant shortly after losing their hearing. Further research examining the benefits of cochlear implantation before age 2 years will help families and clinicians better understand the time-sensitive nature of the decision to conduct cochlear implant surgery. [ABSTRACT FROM AUTHOR]

Objective To test the feasibility of using the deaf white cat model of early-onset deafness. We studied the neuronal effects of prosthetic intervention with a clinical, "off-the-shelf" multichannel cochlear implant. Methods We placed cochlear implants in 5 deaf white kittens at age 12 and 24 weeks. The devices were activated and stimulated in the laboratory using a clinical speech processor programmed with a high-resolution continuous interleaved sampling (CIS) strategy for 8 to 24 weeks. Stimulus parameters were guided by electrically evoked brainstem responses and intracochlear-evoked potentials. Kittens were assessed with respect to their tolerance and general behavior in response to speech, music, and environmental sounds. Results Surgical complications were minimal, and kittens tolerated the experimental procedures well. Subjects were able to detect and respond to a specific sound played from a computer speaker. Electrophysiologic responses were reliably attainable and showed consistency with observed behavioral responses to sound. This experimental paradigm, using clinical devices, can be used in a practical research setting in cats. Conclusions Deafness and other variations in neural activity result in many distinct changes to the central auditory pathways. Animal models will facilitate assessment of the reversibility of deafness-associated changes at the level of the neuron and its connections. Our observations of the feasibility of using clinical devices in animal models will enable us to simulate clinical conditions in addressing questions about the effects of "replacement" activity on the structure and function within the central auditory pathways in deafness. [ABSTRACT FROM AUTHOR]

Objectives To investigate the effect of age at cochlear implantation on the auditory development of children younger than 3 years and to compare these children's auditory development with that of peers with normal hearing. Design Using a repeated-measures paradigm, auditory skill development was evaluated before and 3, 6, and 12 months after implantation. Data were compared with previously published data from cohorts with normal hearing. Participants One hundred seven hearing-impaired children (age range, 12-36 months) who received a cochlear implant during clinical trials in North America. Main Outcome Measure Auditory skill development was assessed using the Infant-Toddler Meaningful Auditory Integration Scale, a tool that provides a quantitative measure in children as young as newborns. Results Infants and toddlers who receive implants show rapid improvement in auditory skills during the first year of device use regardless of age at implantation, although younger children achieve higher scores. Children who undergo implantation at a younger age acquire auditory skills nearer to those of their peers with normal hearing at a younger age. The mean rate of acquisition of auditory skills is similar to that of infants and toddlers with normal hearing regardless of age at implantation. Conclusion Performing implantation in children with profound hearing loss at the youngest age possible allows the best opportunity for them to acquire communication skills that approximate those of their peers with normal hearing. [ABSTRACT FROM AUTHOR]