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      Language development in the pediatric cochlear implant patient

      review-article
      , MD 1 ,
      Laryngoscope Investigative Otolaryngology
      John Wiley and Sons Inc.
      cochlear implant, language outcome

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          Abstract

          Objective

          To access the long‐term outcomes of children implanted during most sensitive period for language development.

          Study design

          Literature review.

          Method

          An initial PubMed search was carried out using the search terms language development and cochlear implant resulted in 1149 citations. A second search was carried out on the initial citations using the criterion of implantation in the period of birth to 24 months, which identified 386 articles. These were analyzed to determine those studies in which linguistic outcome was measured at least three or more years following implantation.

          Results

          Twenty‐one reports published from 2004 to 2017 that met the criteria. The range of follow‐up was from 3 years to an excess of 10 years. Four => 10‐year follow‐up reports were consistent in showing that the earlier the subject is implanted the better the outcome. Many, but not all, of these children did obtain age‐appropriate language. There were 17 reports with follow‐up from 3 to less than 10 years. In 7 of the 11 studies, the children's expressive language was reported to have reached an age level of less than 80%. The results for receptive language showed that 4 of the 11 studies found that the children achieved a receptive language age level of less than 80%. There were 8 studies which documented the effect of implantation before 12 months of age and between 12 and 24 months of age and they all found that the earlier the implantation, the better the outcome for language.

          Conclusion

          The cochlear implant is efficacious in the amelioration of receptive and expressive language deficits in most congenitally deafened children implanted before the age of one. The language outcomes for those implanted after the age of one decline as the age of implantation increases.

          Level of Evidence

          N/A.

          Related collections

          Most cited references39

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          Spoken language development in children following cochlear implantation.

          Cochlear implantation is a surgical alternative to traditional amplification (hearing aids) that can facilitate spoken language development in young children with severe to profound sensorineural hearing loss (SNHL). To prospectively assess spoken language acquisition following cochlear implantation in young children. Prospective, longitudinal, and multidimensional assessment of spoken language development over a 3-year period in children who underwent cochlear implantation before 5 years of age (n = 188) from 6 US centers and hearing children of similar ages (n = 97) from 2 preschools recruited between November 2002 and December 2004. Follow-up completed between November 2005 and May 2008. Performance on measures of spoken language comprehension and expression (Reynell Developmental Language Scales). Children undergoing cochlear implantation showed greater improvement in spoken language performance (10.4; 95% confidence interval [CI], 9.6-11.2 points per year in comprehension; 8.4; 95% CI, 7.8-9.0 in expression) than would be predicted by their preimplantation baseline scores (5.4; 95% CI, 4.1-6.7, comprehension; 5.8; 95% CI, 4.6-7.0, expression), although mean scores were not restored to age-appropriate levels after 3 years. Younger age at cochlear implantation was associated with significantly steeper rate increases in comprehension (1.1; 95% CI, 0.5-1.7 points per year younger) and expression (1.0; 95% CI, 0.6-1.5 points per year younger). Similarly, each 1-year shorter history of hearing deficit was associated with steeper rate increases in comprehension (0.8; 95% CI, 0.2-1.2 points per year shorter) and expression (0.6; 95% CI, 0.2-1.0 points per year shorter). In multivariable analyses, greater residual hearing prior to cochlear implantation, higher ratings of parent-child interactions, and higher socioeconomic status were associated with greater rates of improvement in comprehension and expression. The use of cochlear implants in young children was associated with better spoken language learning than would be predicted from their preimplantation scores.
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            Long-term Communication Outcomes for Children Receiving Cochlear Implants Younger Than 12 Months: A Multicenter Study.

            Examine the influence of age at implant on speech perception, language, and speech production outcomes in a large unselected paediatric cohort.
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              Measures of digit span and verbal rehearsal speed in deaf children after more than 10 years of cochlear implantation.

              Conventional assessments of outcomes in deaf children with cochlear implants (CIs) have focused primarily on endpoint or product measures of speech and language. Little attention has been devoted to understanding the basic underlying core neurocognitive factors involved in the development and processing of speech and language. In this study, we examined the development of factors related to the quality of phonological information in immediate verbal memory, including immediate memory capacity and verbal rehearsal speed, in a sample of deaf children after >10 yrs of CI use and assessed the correlations between these two process measures and a set of speech and language outcomes. Of an initial sample of 180 prelingually deaf children with CIs assessed at ages 8 to 9 yrs after 3 to 7 yrs of CI use, 112 returned for testing again in adolescence after 10 more years of CI experience. In addition to completing a battery of conventional speech and language outcome measures, subjects were administered the Wechsler Intelligence Scale for Children-III Digit Span subtest to measure immediate verbal memory capacity. Sentence durations obtained from the McGarr speech intelligibility test were used as a measure of verbal rehearsal speed. Relative to norms for normal-hearing children, Digit Span scores were well below average for children with CIs at both elementary and high school ages. Improvement was observed over the 8-yr period in the mean longest digit span forward score but not in the mean longest digit span backward score. Longest digit span forward scores at ages 8 to 9 yrs were significantly correlated with all speech and language outcomes in adolescence, but backward digit spans correlated significantly only with measures of higher-order language functioning over that time period. While verbal rehearsal speed increased for almost all subjects between elementary grades and high school, it was still slower than the rehearsal speed obtained from a control group of normal-hearing adolescents. Verbal rehearsal speed at ages 8 to 9 yrs was also found to be strongly correlated with speech and language outcomes and Digit Span scores in adolescence. Despite improvement after 8 additional years of CI use, measures of immediate verbal memory capacity and verbal rehearsal speed, which reflect core fundamental information processing skills associated with representational efficiency and information processing capacity, continue to be delayed in children with CIs relative to NH peers. Furthermore, immediate verbal memory capacity and verbal rehearsal speed at 8 to 9 yrs of age were both found to predict speech and language outcomes in adolescence, demonstrating the important contribution of these processing measures for speech-language development in children with CIs. Understanding the relations between these core underlying processes and speech-language outcomes in children with CIs may help researchers to develop new approaches to intervention and treatment of deaf children who perform poorly with their CIs. Moreover, this knowledge could be used for early identification of deaf children who may be at high risk for poor speech and language outcomes after cochlear implantation as well as for the development of novel targeted interventions that focus selectively on these core elementary information processing variables.
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                Author and article information

                Contributors
                robert.ruben@einstein.yu.edu
                Journal
                Laryngoscope Investig Otolaryngol
                Laryngoscope Investig Otolaryngol
                10.1002/(ISSN)2378-8038
                LIO2
                Laryngoscope Investigative Otolaryngology
                John Wiley and Sons Inc. (Hoboken )
                0023-852X
                2378-8038
                19 April 2018
                June 2018
                : 3
                : 3 ( doiID: 10.1002/lio2.v3.3 )
                : 209-213
                Affiliations
                [ 1 ] Departments of Otorhinolaryngology–Head and Neck Surgery and Pediatrics Albert Einstein College of Medicine, Montefiore Medical Center Bronx New York U.S.A.
                Author notes
                [*] [* ]Send correspondence to Robert J. Ruben, MD, Departments of Otorhinolaryngology–Head and Neck Surgery and Pediatrics, Albert Einstein College of Medicine, Montefiore Medical Center, Greene Medical Arts Pavilion, 3400 Bainbridge Avenue, 3rd Floor, Bronx, NY 10467. Email: robert.ruben@ 123456einstein.yu.edu .
                Author information
                http://orcid.org/0000-0001-7404-2498
                Article
                LIO2156
                10.1002/lio2.156
                6057214
                30062136
                3d80375b-93b2-48c6-bb35-e74df1f2bc63
                © 2018 The Authors Laryngoscope Investigative Otolaryngology published by Wiley Periodicals, Inc. on behalf of The Triological Society

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 18 January 2018
                : 27 February 2018
                : 12 March 2018
                Page count
                Figures: 2, Tables: 2, Pages: 5, Words: 3394
                Categories
                Otology, Neurotology, and Neuroscience
                Otology, Neurotology, and Neuroscience
                Review
                Custom metadata
                2.0
                lio2156
                June 2018
                Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.4.4 mode:remove_FC converted:24.07.2018

                cochlear implant,language outcome
                cochlear implant, language outcome

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