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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]

Multichannel cochlear implants appear to be more effective than single channel implants in improving the ability of patients with hearing impairment to understand speech without reading lips. Cochlear implants are electronic devices that stimulate remaining nerves in the inner ears of patients with hearing loss. Of 80 adults with postlingual deafness who had not been helped by hearing aids, 30 received an Ineraid multichannel implant (implant 1), 30 received a Nucleus multichannel implant (implant 2) and 20 received the 3M/Vienna single channel implant before it was withdrawn by its manufacturer. All patients could hear with their implants, but 63% of those with implant 2 and 60% of those with implant 1 could understand some words and sentences compared with only 5% of those who received implant 3. Twenty-four patients with implant 2 were given a model with an improved speech processor, which furthered their ability to recognize words and sentences without lip reading.

Objective: To assess bimodal auditory performance in children with a cochlear implant (CI) and contralateral auditory brainstem implant (ABI).Methods: This is a retrospective case review performed at a tertiary referral center. Four patients with cochlear nerve deficiency initially underwent cochlear implantation but were not benefiting from their devices and underwent ABI in the contralateral ear. The main outcome measures included age-appropriate speech perception and production assessments.Results: Three subjects performed better on their auditory perception assessments using both of their devices than with either device alone. One subject had only preliminary outcomes, but subjectively performed best with both devices.Conclusions: We observed continued improvement in CI performance over time, even if no benefit was evident before the decision for ABI. This could suggest that ABI and CI have a synergistic effect, or it could simply be the adaptive ability of the developing brain to utilize the signals coming from these devices. There is preliminary evidence to support choosing the ear contralateral to the CI for an ABI in a pediatric patient with bilateral cochlear nerve deficiency. [ABSTRACT FROM AUTHOR]

Background: Prior studies have shown an advantage for electro-acoustic stimulation (EAS) in cochlear implant (CI) patients with residual hearing, but the degree of benefit can vary. The objective was to explore which factors relate to performance with and acceptance of EAS for CI users with conventional-length electrodes. Methods: A retrospective chart review was conducted for adults with an average threshold of 75 dB hearing loss or better across 250 and 500 Hz preoperatively (n = 83). All patients underwent cochlear implantation with a conventional-length electrode. Low-frequency audiometric thresholds were measured at initial activation as well as 3 and 12 months postoperatively to determine who met the criteria for EAS. Speech perception for CNC words and AzBio sentences in quiet and +10 dB SNR noise was evaluated 3 and 12 months after activation. Results: Speech perception in quiet and noise was similar regardless of whether or not the patient was eligible for EAS. Less than half of the patients who met the EAS criteria chose to use it, citing reasons such as physical discomfort or lack of perceived benefit. EAS users performed better on CNC words but not sentence recognition than EAS nonusers. Conclusions: EAS use is dependent on audiologic and nonaudiologic issues. Hearing preservation is possible with conventional electrodes, but hearing preservation alone does not guarantee superior speech perception. [ABSTRACT FROM AUTHOR]

Objective: To describe our experience with children undergoing unilateral cochlear implantation (CI) for treatment of single-sided deafness (SSD).Study Design: Retrospective case series.Methods: A retrospective case review from a tertiary referral center involving 14 pediatric patients (<18 years) with SSD who underwent unilateral CI. Speech perception testing in quiet and noise in the CI-only and bimodal conditions with at least 1 year of device use and device usage from data logs represent the main outcome measures.Results: The mean age at CI was 5.0 years (median 4.4, range 1.0-11.8 years). The mean duration of deafness was 3.0 years (median 2.4, range 0.6-7.0 years). Mean follow-up was 3.4 years. Speech perception testing with a minimum of 1 year post-CI was available in eight patients. The mean word recognition scores (WRS) in the CI-only condition was 56%; a significant improvement from baseline. Testing in background noise with spatially separated speech and noise revealed that patients scored as well or better with the CI-on versus CI-off in all conditions and in no cases was interference from the CI noted. Data logs were reviewed for device usage which revealed an average use of 6.5 hr/d.Conclusion: Cochlear implantation is a viable treatment option for pediatric SSD in this self-selected cohort. Open-set speech and improvement in background noise can be achieved. Careful patient selection and thorough counseling on expectations is paramount to achieving successful outcomes.Level Of Evidence: IV Laryngoscope, 131:E271-E277, 2021. [ABSTRACT FROM AUTHOR]

Background: The purpose of a cochlear implant is to provide the recipient who has a severe-to-profound hearing loss with direct stimulation of the auditory nerve. A hearing aid, appropriate for lesser levels of hearing impairment, amplifies sound while a cochlear implant replaces a function lost by the cochlea. Cochlear implants have been in use for more than 20 years, but there is a degree of lack of awareness of the advances in the field. This includes the degree of benefit which has been obtained in children, even those born profoundly deaf. This study reports on an experience with 285 children who have received cochlear implants at our center. Methods: Since 1987 we have placed multichannel cochlear implants in 285 children ranging in age from 14 months to 17 years. These children were all evaluated using a battery of age-appropriate tests to determine their degree of hearing loss. All underwent a trial with hearing aids which demonstrated lack of significant benefit. Evaluation included parental interviews, detailed histories, evaluation for evidence of syndromal hearing loss, physical examination and high resolution CT scans of the temporal bone. These were supplemented by MRI (without Gadolinium) where necessary. Successful candidates received one of the two FDA approved multichannel cochlear implants during an operation which generally lasted approximately three hours. There were no perioperative complications and postoperative complications were minimal. The children were evaluated at 1,3,6 and 12 months post initial stimulation, and annually thereafter. Results: All children received an auditory percept when using the device. Post-lingually deaf children derived significant and immediate benefit when implanted relatively soon after losing hearing. Congenitally and pre-lingually deaf children also did very well, especially when implanted prior to the age of five years. The younger children received more immediate benefit than did those slightly older. The overwhelming majority of these children developed language and speech and were able to enter mainstream schools rather than schools for the deaf. Conclusions: The use of multichannel cochlear implants in appropriately selected deaf children as young as 14 months produces significant benefit in terms of allowing them to hear, speak, read and attend mainstream schools even when they were born deaf. A careful evaluation process, expert surgery, ongoing programming and rehabilitation are necessary in order to ensure optimal benefit. (The senior author is a member of the Medical Advisory Boards of Cochlear Corp. and the Advanced Bionics Corp.), Neil H. Cohen, MD, FACS; Susan B. Waltzman, Ph.D; and J. Thomas Roland, Jr., MD; Department of Otolaryngology, NYU School of Medicine, New York, [...]