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The purpose of this study was to determine the prevalence of ceiling effects for commonly used speech perception tests in a large population of children who received a cochlear implant (CI) before the age of four. A secondary goal was to determine the demographic factors that were relevant for predicting which children were more likely to reach ceiling level performance. We hypothesize that ceiling effects are highly prevalent for most tests. Retrospective chart review of children receiving a CI between 2002 and 2014. 165 children were included. Median scores were above ceiling levels (≥90% correct) for the majority of speech perception tests and all distributions of scores were highly skewed. Children who were implanted earlier, received two implants, and were oral communicators were more likely to reach ceiling-level performance. Age and years of CI listening experience at time of test were negatively correlated with performance, suggesting a non-random assignment of tests. Many children were re-tested on tests for which they had already scored at ceiling. Commonly used speech perception tests for children with CIs are prone to ceiling effects and may not accurately reflect how a child performs in everyday listening situations. [ABSTRACT FROM AUTHOR]

Cochlear implants (CIs) provide access to sound for children and adults who do not receive adequate benefit from hearing aids. Age at implantation is known to affect outcomes across the lifespan. The effects of age on CI outcomes are examined for infants, children, adolescents, and older adults. A variety of outcome measures are considered, including speech perception, language, cognition, and quality of life measures. For those meeting candidacy criteria, CIs are beneficial at any age. In general, younger age is related to greater benefit when considering pre-lingual deafness. Other factors such as additional disabilities, may mitigate this effect. Post-lingually deafened adults demonstrate similar benefit regardless of age, though the oldest individuals (80+) may see smaller degrees of improvement from preoperative scores. Benefit can be measured in many ways, and the areas of greatest benefit may vary based on age: young children appear to see the greatest effects of age at implantation on language measures, whereas scores on cognitive measures appear to be most impacted for the oldest population. Future research should consider implantation at extreme ages (5–9 months or > 90 years), unconventional measures of CI benefit including qualitative assessments, and longitudinal designs. [ABSTRACT FROM AUTHOR]

The current study aimed to identify and map the available evidence surrounding cochlear implantation (CI) in older adults. Five outcomes were evaluated: speech perception scores, perioperative complications, neurocognitive outcomes, quality of life outcomes and vestibular dysfunction and fall rates after surgery. A scoping review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews and included patients over the age of 60. Ninety-seven studies met inclusion criteria, encompassing 7,182 patients. Mean (SD) speech perception scores in quiet and in noise pre-and postoperatively were 7.9% (6.7) and 52.8% (14.3) and 8.0% (68.1) and 68.1% (15.9) respectively. Postoperative cardiac arrhythmias, urinary retention, and delirium occurred slightly more frequently in older adults. In terms of cognition, most studies noted stability or improvement one year after implantation. A majority of studies indicated better quality of life post-CI. Rates of fall after surgery were rarely reported, and there was a general paucity of data surrounding vestibular function changes after CI. This scoping review identifies many positive outcomes linked to CI in older adults. No findings suggest a single patient characteristic that would warrant refusal to consider evaluation for cochlear implantation. [ABSTRACT FROM AUTHOR]

Untreated hearing loss is risk factor for dementia, depression and falls in the elderly population. The present study evaluated the outcomes of cochlear implantation in adults over age 85, including surgical outcomes, speech perception, and implant use. Retrospective chart review of 78 patients implanted at a tertiary academic medical center. Co-morbidities, pre-operative hearing thresholds and speech perception scores at 4 time points (pre-operative, and 3 months, 1, 2, and 3 years post-operatively) were collected from charts. Linear mixed models were used to account for missing data points. Medical comorbidities such as hypertension (56%) and heart disease (53%) were common. Surgical complications were rare (5% or less) and minor. Local anesthesia was used for 71% of study patients implanted in the last three years. Significant improvements were seen for speech perception scores on monosyllabic words (37 percentage points), sentences in quiet (45 percentage points) and sentences in noise (28 percentage points). These improvements remained stable to at least two years post-activation. Seventy-one percent of patients wore their implant full time. Cochlear implantation is safe and effective for very elderly adults. The use of local anesthesia may increase adoption of cochlear implantation and thus improve the quality of life for this population. [ABSTRACT FROM AUTHOR]

Introduction: While cochlear implants (CI) prior to 12 months of age have become common, the prevalence and impact of issues that either arise or were not evident prior to implantation is unknown. Methods: Retrospective chart review of children implanted under 12 months of age with minimum 3 years follow up. The children were divided into three groups: those with no identified additional disabilities, those with no known disabilities at time of implantation but diagnosed with additional disabilities following implantation, and those that had known anticipated additional disabilities at time of implantation. Results: 108 children under the age of 12 months were implanted at our Center between 2000 and 2013 with an average age of 9 months at time of implantation and n = 93 met inclusion criteria. In 79.6% (74/93) of children, there were no additional issues detected. In 11.8% (11/93), additional issues were known at the time of implantation while in 8.6% (8/93) of the children were diagnosed with additional issues that were not evident prior to implantation. The auditory and linguistic benefits vary commensurate with the severity of their disabilities. Those with anticipated issues preoperatively did not perform as well. Conclusions: Children implanted below one year of age but diagnosed with additional disabilities following implantation obtained substantial though varying degrees of benefit. In none of these cases would knowledge of the disability have altered the decision to offer early CI. It is important to address these potential issues when counseling families about outcomes. [ABSTRACT FROM AUTHOR]

Objective: Preservation of residual low-frequency hearing has become a priority in cochlear implantation. The purpose of this study was to compare rates of hearing preservation and effects on performance of loss of low-frequency acoustic hearing with two different length electrodes.Study Design: Retrospective chart review.Setting: Tertiary Care Hospital.Patients: Twelve patients were implanted with the CI422 a slim-straight electrode; the second group consisted of 10 patients implanted with the Hybrid-L, a shorter hearing preservation electrode.Main Outcome Measure: Audiometric thresholds and speech perception measures.Results: At 1 year, 3/10 (30%) patients with the Hybrid-L and 7/12 (58%) patients with the CI422 lost residual acoustic hearing resulting in a profound hearing loss in the implanted ear. In comparing these patients in particular, mean CNC words in the implanted ear were 72% in the CI422 electrode group and 15% in the Hybrid-L electrode group at 1 year (P = 0.03). While hearing preservation rates with the Hybrid-L tended to be better, among recipients who lost residual hearing, speech perception was better in those with the longer CI422 electrode.Conclusions: With emphasis on preservation of residual hearing, patients need to be counseled regarding possible outcomes and options should loss of residual hearing occur following implantation. While shorter electrodes may have better rates of hearing preservation, the patients with the longer straight electrode in our study had significantly better speech understanding following the loss of residual hearing. [ABSTRACT FROM AUTHOR]

Objectives To determine which demographic or performance variables are associated with inconsistent use of a second implant in pediatric recipients of sequential bilateral cochlear implants (CIs). Methods A retrospective chart review was conducted on pediatric recipients of sequential bilateral CIs. Children were divided into two age groups, 5-9 and 10-17 years of age. For each group, we examined whether inconsistent use of the second implant (CI-2) was associated with a variety of demographic variables, or speech-perception scores. Results In children aged 5-9 years, inconsistent use of CI-2 was not significantly associated with any demographic variable, but was related to both the word-recognition score with CI-2, and the difference in word-recognition scores between the first implant (CI-1) and CI-2. In children aged 10-17 years, these relationships were not significant due to smaller number of subjects. Finally, CI-2 word-recognition scores across all children were significantly correlated with the age of implantation for both CI-1 and CI-2, and the time between CI-1 and CI-2 surgeries. Discussion Speech-recognition scores obtained with CI-2, and the extent to which it differs from CI-1, are most closely related with inconsistent use of CI-2 in pediatric sequential implantees. These results are consistent with similar data previously reported by other investigators. While children implanted with CI-2 at a later age generally perform more poorly, most children still use both implants, and benefit from CI-2 even when receiving the implant as an adolescent. Conclusion In pediatric recipients of sequential bilateral CIs, inconsistent use of CI-2 is related to the speech recognition scores with CI-2, and the difference in speech-recognition scores between CI-1 and CI-2. In addition, speech-recognition scores with CI-2 are related to the amount of time between CI-1 and CI-2 surgeries, and the age of implantation for both CI-1 and CI-2. [ABSTRACT FROM AUTHOR]

The article informs on the cochlear implantation in deaf individuals and focuses on sensitive period for cochlear implantation in congenitally and prelingually deaf children. It reports that adolescents who had undergone cochlear implantation at an early childhood had developed strong social skills and high self-esteem. It concludes that though early implantation yields best results in deaf children, they also prove to be beneficial for those who have been implanted at a later age.

This article reviews the current status of cochlear implantation in both adults and children, including expanding candidacy groups, bilateral implantation, advances in speech processing software, internal and external device hardware, surgical techniques and outcomes. Promising advances, novel therapies and evolving concepts are also highlighted in terms of their future impact on clinical outcomes. INSET: Key issues. [ABSTRACT FROM AUTHOR]

This article reviews the current and evolving status of cochlear implants, including technology, design, candidacy, outcomes and future directions. It examines these variables in terms of their present and future impact on clinical outcomes in pediatric and adult populations. [ABSTRACT FROM AUTHOR]