Cochlear implantation in children

Cochlear implantation has revolutionized the treatment and prognosis of children with severe to profound sensorineural hearing loss who receive limited benefits from hearing aids. Children who receive cochlear implantation at young age, in particular before 2 years of age, can be expected to reach their normal age-equivalent developmental milestones and have higher chance to integrate into the mainstream educational settings. With the positive outcomes after cochlear implantation and the improvements in technology and surgical techniques, candidacy for cochlear implantation in children has been expanding to include hearing-impaired children with significant residual hearing, severe inner ear malformations, multiple handicaps such as mental retardation or visual impairment, and auditory neuropathy. Furthermore, there is growing interest in offering bilateral cochlear implantation to give children the benefits of binaural hearing. As the candidacy criteria expand, cochlear implant programs including preoperative evaluation, surgery, and habilitation have become more complex. Therefore, candidates should be selected prudently by multidisciplinary approach and cochlear implantation in children is much better to be provided by experienced cochlear implant team consisting of experts in relevant fields for the best results.

from Auris Nasus Larynx

An electrophysiological correlate of voice processing in 4- to 5-year-old children

Abstract
Cortical auditory evoked potentials were studied in responses to voice and environmental sounds in 4- to 5-year old children. A specific response to voice was dissociated from the response to environmental sounds. It appeared as a positive deflection recorded at right fronto-temporal sites and beginning within 60 ms of stimulus onset. We termed this response Fronto-Temporal Positivity to Voice (FTPV).

from

Effects of word frequency and phonological neighborhood characteristics on confrontation naming in children who stutter and normally fluent peers

In a prior study (Newman & Bernstein Ratner, 2007), we examined the effects of word frequency and phonological neighborhood characteristics on confrontation naming latency, accuracy and fluency in adults who stutter and typically-fluent speakers. A small difference in accuracy favoring fluent adults was noted, but no other patterns differentiated fluent speaker responses from those obtained from the adults who stutter. Because lexical organization or retrieval differences might be more easily observed in less mature language users, we replicated the experiment using 15 children who stutter (ages 4;10 16;2) and age-and gender-matched peers. Results replicated the earlier study: the two groups of participants showed strikingly similar patterns of responses based on word frequency and neighborhood characteristics. There were also no differences in naming accuracy overall between the two groups. Given our results and those of other researchers who have explored the impact of neighborhood variables on lexical retrieval in people who stutter, we suggest that differences between language production in PWS and fluent speakers are not likely to involve atypical phonological organization of lexical neighborhoods.

from Journal of Fluency Disorders

The impact of chronic suppurative otitis media on children’s and teenagers’ hearing

Results and conclusions
Air conduction, bone conduction thresholds and air-bone gaps in children and teenagers with CCOM are significantly greater. There were no significative differences between air-bone gaps in epitympanic and posterior mesotympanic cholesteatomas. In NCCOM, the gap value is positively correlated with the number of quadrants with tympanic perforation. There was no significative difference between the air-bone gaps in tympanic perforations affecting the posterior and anterior quadrants.

from the International Journal of Pediatric Otorhinolaryngology

Listening to children with communication impairment talking through their drawings

Including children as research participants is an important new direction in early childhood research. However, it is rare for such studies to include the voices of children with significant communication impairment. This article suggests that drawing may be an appropriate non-verbal method for ‘listening’ to these children’s ideas and recording their perspectives. Three areas of inquiry are reviewed: (1) the use of drawings as a method of listening respectfully to children; (2) approaches to the analysis of children’s drawings; and (3) the analysis of drawings completed by children with communication impairment. We identify six aspects of children’s drawings — facial expressions, accentuation of body features (e.g. mouth and ears), portrayal of talking/listening, colours used, conversational partners, and sense of self — that are potentially pertinent for children with communication impairment.

from the Journal of Early Childhood Research

The functional organization of trial-related activity in lexical processing after early left hemispheric brain lesions: An event-related fMRI study

Abstract
Children with congenital left hemisphere damage due to perinatal stroke are capable of acquiring relatively normal language functions despite experiencing a cortical insult that in adults often leads to devastating lifetime disabilities. Although this observed phenomenon is accepted, its neurobiological mechanisms are not well characterized. In this paper we examined the functional neuroanatomy of lexical processing in 13 children/adolescents with perinatal left hemispheric damage. In contrast to many previous perinatal infarct fMRI studies, we used an event-related design, which allowed us to isolate trial-related activity and examine correct and error trials separately. Using both group and single subject analysis techniques we attempt to address several methodological factors that may contribute to some discrepancies in the perinatal lesion literature. These methodological factors include making direct statistical comparisons, using common stereotactic space, using both single subject and group analyses, and accounting for performance differences. Our group analysis, investigating correct trial-related activity (separately from error trials), showed very few statistical differences in the non-involved right hemisphere between patients and performance matched controls. The single subject analysis revealed atypical regional activation patterns in several patients; however, the location of these regions identified in individual patients often varied across subjects. These results are consistent with the idea that alternative functional organization of trial-related activity after left hemisphere lesions is in large part unique to the individual. In addition, reported differences between results obtained with event-related designs and blocked designs may suggest diverging organizing principles for sustained and trial-related activity after early childhood brain injuries.

from Brain and Language

The functional organization of trial-related activity in lexical processing after early left hemispheric brain lesions: An event-related fMRI study

Children with congenital left hemisphere damage due to perinatal stroke are capable of acquiring relatively normal language functions despite experiencing a cortical insult that in adults often leads to devastating lifetime disabilities. Although this observed phenomenon is accepted, its neurobiological mechanisms are not well characterized. In this paper we examined the functional neuroanatomy of lexical processing in 13 children/adolescents with perinatal left hemispheric damage. In contrast to many previous perinatal infarct fMRI studies, we used an event-related design, which allowed us to isolate trial-related activity and examine correct and error trials separately. Using both group and single subject analysis techniques we attempt to address several methodological factors that may contribute to some discrepancies in the perinatal lesion literature. These methodological factors include making direct statistical comparisons, using common stereotactic space, using both single subject and group analyses, and accounting for performance differences. Our group analysis, investigating correct trial-related activity (separately from error trials), showed very few statistical differences in the non-involved right hemisphere between patients and performance matched controls. The single subject analysis revealed atypical regional activation patterns in several patients; however, the location of these regions identified in individual patients often varied across subjects. These results are consistent with the idea that alternative functional organization of trial-related activity after left hemisphere lesions is in large part unique to the individual. In addition, reported differences between results obtained with event-related designs and blocked designs may suggest diverging organizing principles for sustained and trial-related activity after early childhood brain injuries.

from Brain and Language

Speech Disruptions in Relation to Language Growth in Children Who Stutter: An Exploratory Study

Young children with typical fluency demonstrate a range of disfluencies, or speech disruptions. One type of disruption, revision, appears to increase in frequency as syntactic skills develop. To date, this phenomenon has not been studied in children who stutter (CWS). Rispoli and colleagues (2008) suggest a schema for categorizing speech disruptions in terms of revisions and stalls. The purpose of this exploratory study was to use this schema to evaluate whether CWS show a pattern over time in their production of stuttering, revisions, and stalls. Nine CWS, ages 2;1 to 4;11, participated in the study, producing language samples each month for 10 months. MLU and vocd analyses were performed for samples across three time periods. Active declarative sentences within these samples were examined for the presence of disruptions. Results indicated that the proportion of sentences containing revisions increased over time, but proportions for stalls and stuttering did not. Visual inspection revealed that more stuttering and stalls occurred on longer utterances than on shorter utterances. Upon examination of individual children’s language, it appears two-thirds of the children showed a pattern in which, as MLU increased, revisions increased as well. Findings are similar to studies of children with typical fluency, suggesting that, despite the fact that CWS display more (and different) disfluencies relative to typically fluent peers, revisions appear to increase over time and correspond to increases in MLU, just as is the case with peers.

from Journal of Fluency Disorders

Acoustic analysis of voice in cochlear implant recipients with post-meningitic hearing loss

The objective of this study was to evaluate the critical time period between the onset of sensorineural hearing loss and cochlear implantation with respect to normal voice production in children with post-meningitic hearing loss. Acoustic measures of voice production were obtained from ten paediatric cochlear implant recipients with post-meningitic hearing loss. Acoustic measures were obtained utilising the Multi-Dimensional Voice Program and Computerized Speech Laboratory (Kay Elemetrics Corp.). Measures were based on sustained phonation of the vowel /a/. Acoustic parameters included fundamental frequency, short- and long-term frequency perturbation, and short- and long-term amplitude perturbation. Measures of fundamental frequency and short-term frequency and amplitude perturbation were comparable to values of children with normal hearing. Long-term control of frequency was within normal limits for subjects with a period of auditory deprivation of less than four months. Measures of long-term amplitude perturbation were normal for all patients except those with cochlear ossification. Early restoration of auditory feedback with cochlear implantation, the absence of cochlear ossification, residual aided hearing following meningitis, and auditory-verbal therapy were identified as factors in preserving the long-term control of frequency and amplitude in the setting of post-meningitic hearing loss. Copyright © 2009 John Wiley & Sons, Ltd.

from Cochlear Implants International

Assessing speech perception in young children and relationships with language skills

Few materials are available to assess speech perceptual skills in young children without hearing impairments. However, children with a range of developmental conditions are at risk of speech discrimination deficits. Tasks that reliably assess speech perception skills are thus necessary for research and clinical practice. The development and application of two speech perception tests are described. Data were collected from 105 children, aged 4-5 years, attending mainstream schools, on two tasks, mispronunciation detection and non-word XAB, in quiet and in a background of multi-talker babble. Children’s receptive language skills were also measured. Performance on mispronunciation detection was significantly better than on the XAB non-word task, and significantly better in quiet than in babble. Performance significantly improved with age, and speech discrimination was significantly related to receptive language abilities. Scores obtained in quiet and in babble were highly correlated and findings suggest there may be no advantage to testing in noise, except to avoid ceiling effects on performance. These tasks prove useful in the assessment of young children who may have speech discrimination deficits.

from the International Journal of Audiology

Effects of It Takes Two to Talk—The Hanen Program for Parents of Preschool Children With Cerebral Palsy: Findings From an Exploratory Study

Purpose: To investigate whether It Takes Two to Talk—The Hanen Program for Parents of Preschool Children With Cerebral Palsy is associated with change in interaction between children who have motor disorders and their parents.

Method: Eleven children aged 19–36 months who had nonprogressive motor disorders that affected their communication, and their mothers, were observed 4 months and 1 month before mothers attended It Takes Two to Talk training, and 1 month and 4 months after its completion.

Results: Interaction patterns were stable prior to training. After training, mothers initiated less and produced more responses and fewer requests. Children produced more initiations, as well as more requests and provisions of information, after training. Mothers’ linguistic input did not change in amount or complexity. Changes were maintained 4 months later. Mothers’ views of parenting did not change.

Conclusions: It Takes Two to Talk may be associated with positive communication change for this group. Further investigation of its clinical effectiveness is warranted.

from the Journal of Speech, Language, and Hearing Research

Epidemiology of Speech and Language Impairment in a Nationally Representative Sample of 4- to 5-Year-Old Children

Results: Parent-reported prevalence: 25.2% had concerns about how their child talked and made speech sounds (11.8% “concerned”; 13.4% “a little concerned”), and 9.5% had concerns about how their child understood language (4.4% “concerned”; 5.1% “a little concerned”). Parents who reported concerns identified “speech not clear to others” as the most frequent area of difficulty (12.0%). Teacher-reported prevalence: 22.3% of children were considered to be less competent than others in their expressive language ability (6.7% “much less competent”; 15.6% “less competent”); 16.9% were considered to be less competent than others in their receptive language ability (4.0% “much less competent”; 12.9% “less competent”). The match between parent and teacher identification was higher for expressive speech and language concern than for receptive language. Direct assessment: 13.0% of children were 1–2 SDs below the mean on the Adapted Peabody Picture Vocabulary Test–III (S. Rothman, 2003), and a further 1.7% were > 2 SDs below the mean. Parent and teacher reports were significantly correlated with scores obtained via direct assessment. Period prevalence: Parents and teachers reported that 14.5% of children had accessed speech-language pathologist (SLP) services. 2.2% indicated that they needed but could not access an SLP.

Conclusion: Multiple indicators of speech and language impairment in diverse contexts confirmed the high prevalence of this condition in early childhood and a concomitant need for SLP services.

from the Journal of Speech, Language, and Hearing Research

The Effects of Bilateral Electric and Bimodal Electric—Acoustic Stimulation on Language Development

There is no doubt that cochlear implants have improved the spoken language abilities of children with hearing loss, but delays persist. Consequently, it is imperative that new treatment options be explored. This study evaluated one aspect of treatment that might be modified, that having to do with bilateral implants and bimodal stimulation. A total of 58 children with at least one implant were tested at 42 months of age on four language measures spanning a continuum from basic to generative in nature. When children were grouped by the kind of stimulation they had at 42 months (one implant, bilateral implants, or bimodal stimulation), no differences across groups were observed. This was true even when groups were constrained to only children who had at least 12 months to acclimatize to their stimulation configuration. However, when children were grouped according to whether or not they had spent any time with bimodal stimulation (either consistently since their first implant or as an interlude to receiving a second) advantages were found for children who had some bimodal experience, but those advantages were restricted to language abilities that are generative in nature. Thus, previously reported benefits of simultaneous bilateral implantation early in a child’s life may not extend to generative language. In fact, children may benefit from a period of bimodal stimulation early in childhood because low-frequency speech signals provide prosody and serve as an aid in learning how to perceptually organize the signal that is received through a cochlear implant.

from Trends in Amplification

Management of children with otitis media: A summary of evidence from recent systematic reviews

Health-care professionals who manage children are regularly confronted with clinical questions regarding the management of the full spectrum of otitis media: acute otitis media; otitis media with effusion; and chronic suppurative otitis media. Given the variety of potential therapies available, the wide spectrum of middle ear disorders, and the lack of consensus about management strategies, clinicians are in a difficult position when managing these children. In this review, we seek to summarise the current best evidence for answering otitis media management questions by collating existing systematic reviews.

from the Journal of Paediatrics and Child Health

Random Gap Detection Test and Random Gap Detection Test-Expanded results in children with auditory neuropathy

In this study, RGDT was applied to five children with auditory neuropathy between ages of 7 and 13 years (study group) (3 male, 2 female). As a control group, RGDT was applied to 10 normal hearing children who had not auditory processing problem between ages of 7 and 16 years (5 male, 5 female). In the first test, all children were applied to RGDT and RGDT-EXP. Each child responded whether he/she heard one or two tones. Their responses were taken as verbally and/or hold up one finger or two fingers. In the second test, they were applied speech discrimination test in quiet environment and in noise. Gap detection thresholds (GDTs) were detected at 500–4000 Hz; and composite GDTs (CGDTs) were found for the study and control groups. GDT/CGDT >20 ms was considered as abnormal for temporal processing disorder.

Results
Any of the children with AN who has no HAs; with HAs; and CI, could not be able to perform RGDT. Therefore the RGDT-EXP was applied in this group. In the study group, GDTs was all over 50 ms at 500–4000 Hz; and CGDTs were all over 50 ms for all children included into the study group with AN. In control group, except child 9 (GDTs were 25 ms at 3000 and 4000 Hz); and child 10 (GDT was 25 ms at 500 Hz); GDTs were all in normal limits for 500–4000 Hz for all children included into the study as control group. CGDTs were all in normal limits for the control group, except child 9 (CGDTs were 22.50, slightly higher than normal limits). In the study group with AN, mean of the GDTs was all over the normal limits; and in control group, mean of GDTs were all in normal limits. The difference between the mean GDTs of the study group was significantly higher than the control groups at all frequencies of 500–4000. In AN group, CGDT (97.5 ± 9.57 ms) was significantly higher than that of the control group (10.35 ± 0.65 ms).

Conclusion
We concluded that these results may only not be explained by auditory processing performance or temporal aspects of audition of each child. Their gap detection was much worse for short duration stimuli than for longer duration stimuli. The present study showed that temporal processing, auditory timing and gap detection skills of the children with AN were found as delayed in advanced degree. These findings may indicate that the AN children cannot perform temporal asynchrony. Our results may help to understand why the children with AN cannot manage the speech perception; and why they understand the speech after a few repeats.

from the International Journal of Pediatric Otorhinolaryngology