Audiology and Speech Pathology - Research Publications
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ItemBilateral cochlear implants in children(Georg Thieme Verlag KG, 2011-02-28)
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ItemHow we do it: clinical management of the child receiving a second, bilateral cochlear implant.(Informa UK Limited, 2009-06)For children to gain maximum benefit from a second, bilateral cochlear implant clinicians need to be aware of the special needs of the family and child, and to adapt their clinical management appropriately. This article describes how the situation of the family considering a second implant is different, and how the decision to be made differs from that for a first implant. The information specific to sequential implants that should be provided so families can make an informed decision is reviewed. Programming issues unique to sequential bilateral cochlear implants are discussed. Finally, information is provided on how children may respond post-operatively, and what can be done to promote bilateral device use and the development of listening skills with the new implant.
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ItemCan adolescents and young adults with prelingual hearing loss benefit from a second, sequential cochlear implant?(TAYLOR & FRANCIS LTD, 2010-05)This study aimed to determine if adolescents/young adults gained additional perceptual benefit from sequential bilateral cochlear implants within 12 months, and to document adaptation to the second implant. Assessments comprised a pediatric version of The Speech, Spatial and Qualities of Hearing Scale (SSQ), anecdotal reports of device use and daily listening, and the Adaptive Spondee Discrimination Test (AdSpon). All nine participants achieved full-time use of, a preference for, and superior daily listening with, bilateral implants. Eight participants were comfortable using the second implant alone, and two achieved similar daily listening with either implant alone. SSQ ratings were higher post-operatively for the majority of participants. AdSpon performance was superior bilaterally for five participants with noise ipsilateral to the first implant, but not contralateral. Unilateral performance with either implant was similar for one participant. A second implant may provide additional benefit up to 19 years of age, even with congenital hearing loss and >16 years between implants. Families and clinicians should understand the aspects of second-implant candidacy and post-operative use that are unique to adolescents/young adults.
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ItemPerformance of Toddlers, Children and Young Adults Using Unilateral or Bilateral Cochlear Implants on a Left versus Right Loudspeaker Identification Task(KARGER, 2011)Thirty-six participants with bilateral cochlear implants aged 1–19 years completed a left versus right loudspeaker identification task. The majority performed at chance in the unilateral condition (n = 24) and significantly above chance in the bilateral condition (n = 28). Cluster analysis identified three groups; one group performed above chance in both conditions and was older at second implant and older at testing, with longer delay between implants. There were no such differences between the group performing at chance in both conditions and the group which scored highly in the bilateral condition only, thus demonstrating a bilateral benefit. Unilateral, but not bilateral, scores were correlated with age at second and at first implant, time between implants, and age at testing. Bilateral benefit was negatively correlated with age at second implant, time between implants and age at testing. Co-linearity made it difficult to isolate the relationships with demographic factors, though age at testing may have had the most influence on unilateral scores. Spatial hearing skills with bilateral implants cannot be predicted for individuals.
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ItemAdapting to bilateral cochlear implants: early post-operative device use by children receiving sequential or simultaneous implants at or before 3.5 years.(Informa UK Limited, 2012-05)OBJECTIVE: To classify adaptation difficulties, or lack thereof, experienced by a clinical population of young bilateral cochlear implant recipients. METHOD: Forty-six of the first 48 children sequentially or simultaneously implanted at ≤3.5 years at the Melbourne Clinic participated. Classification into categories was based on daily use of both implants at 2 months post-switch-on, with follow-up information obtained at 12 months. RESULTS: The 37 Category 1 children wore both implants full time at 2 months, and 35 still did so at 12 months. The two Category 2 children used both implants 4 hours daily at 2 months, but achieved full-time use within 12 months. The five Category 3 children used both implants for ≤1 hour, with only three achieving full-time use within 12 months. The two Category 4 children did not use two implants at 2 months, and one still did not wear both implants at 12 months. There were weak/modest but significant relationships between category and each of time between implants and age at bilateral implantation. DISCUSSION: Ninety-five percent of simultaneously and 70% of sequentially implanted children demonstrated full-time use within 2 months, and nearly all continued to do so at 12 months. Full-time use maximizes opportunities to develop listening skills. Monitoring device use is necessary for all children, especially when significant change occurs. For those experiencing difficulty in adapting, bilateral implant use usually increased over 12 months. Pre-operative counselling must include discussion of possible adaptation difficulties and raise the potential negative influence of age at bilateral implantation and time between implants.
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ItemMeasuring listening effort expended by adolescents and young adults with unilateral or bilateral cochlear implants or normal hearing.(Informa UK Limited, 2013-06)OBJECTIVES: To compare the listening effort expended by adolescents and young adults using implants versus their peers with normal hearing when these two groups are achieving similar speech perception scores. The study also aimed to compare listening effort expended by adolescents and young adults with bilateral cochlear implants when using two implants versus one. METHODS: Eight participants with bilateral cochlear implants and eight with normal hearing aged 10-22 years were included. Using a dual-task paradigm, participants repeated consonant-nucleus-consonant (CNC) words presented in noise and performed a visual matching task. Signal-to-noise ratios were set individually to ensure the word perception task was challenging but manageable for all. Reduced performance on the visual task in the dual-task condition relative to the single-task condition was indicative of the effort expended on the listening task. RESULTS: The cochlear implant group, when using bilateral implants, expended similar levels of listening effort to the normal hearing group when the two groups were achieving similar speech perception scores. For three individuals with cochlear implants, and the group, listening effort was significantly reduced with bilateral compared to unilateral implants. DISCUSSION: The similar amount of listening effort expended by the two groups indicated that a higher signal-to-noise ratio overcame limitations in the auditory information received or processed by the participants with implants. This study is the first to objectively compare listening effort using two versus one cochlear implant. The results provide objective evidence that reduced listening effort is a benefit that some individuals gain from bilateral cochlear implants.
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ItemLonger-Term Functional Outcomes and Everyday Listening Performance for Young Children Through to Young Adults Using Bilateral Implants(LIPPINCOTT WILLIAMS & WILKINS, 2014)OBJECTIVES: First, to document a broad range of functional outcomes of bilateral implantation for young children through young adults at a postoperative point at which stable outcomes could be expected. Second, to evaluate the relationship between functional outcomes and age at bilateral implantation and time between implants. DESIGN: A study-specific questionnaire was administered to parents in an interview 3.5 years or more after sequential (n = 50) or simultaneous (n = 7) implants were received by their child. Median age at bilateral implantation was 4.1 years (range 0.7 to 19.8) and time between implants was 2.7 years (range 0.0 to 16.7). RESULTS: On the basis of parent report, 72% of the sequentially implanted children and young adults found it easy/only "a bit difficult" to adapt to the second implant, and were "happily wearing both implants together most of the time" by 6 months or before; 26% had not adapted, with both implants not worn most of the time or worn as a parental requirement. Seventy-two percent of sequentially implanted children and young adults had a positive attitude toward the second implant, including 9 whose early postoperative attitude was negative or neutral. The majority of children and young adults preferred bilateral implants (70%) and used the two full time (72%), while around half demonstrated similar performance with each implant alone. The proportion of nonusers or very minimal users of the second implant was just 9%. Eighty-eight percent of parents reported superior performance with bilateral versus a unilateral implant (n = 40), or that only bilateral implants were worn (n = 10) so performance could not be compared. The most commonly identified areas of superiority were localization, less need for repetition, and increased responsiveness. In balancing risks and costs with benefits, most parents (86%) considered the second implant worthwhile. Regarding the relationship between outcomes and demographic factors, the group achieving similar performance with each implant alone was younger at bilateral implantation and had less time between implants, and the group bilaterally implanted before 3.5 years of age (who also had less than 2 years between implants) had a higher proportion of positive outcomes on all functional outcome measures. CONCLUSION: Overall, the results indicate primarily positive functional outcomes for children and young adults receiving bilateral implants at all ages, including when the delay between implants is long. The results are important for evidence-based preoperative counseling, which helps families to make informed decisions and develop appropriate expectations. The results are also important for the development of clinical management practices that support and encourage the minority of recipients who have difficulty adapting to bilateral implants or achieving full-time use.