Language development in Japanese children who receive cochlear implant and/or hearing aid

doi:10.1016/j.ijporl.2011.12.027

International Journal of Pediatric Otorhinolaryngology

Volume 76, Issue 3, March 2012, Pages 433-438

https://doi.org/10.1016/j.ijporl.2011.12.027 Get rights and content

Abstract

Objectives

This study aimed to investigate a wide variety of factors that influence auditory, speech, and language development following pediatric cochlear implantation (CI).

Study design

Prospective collection of language tested data in profound hearing-impaired children.

Hypothesis

Pediatric CI can potentially be effective to development of practical communication skills and early implantation is more effective.

Methods

We proposed a set of language tests (assessment package of the language development for Japanese hearing-impaired children; ALADJIN) consisting of communication skills testing (test for question–answer interaction development; TQAID), comprehensive (Peabody Picture Vocabulary Test-Revised; PVT-R and Standardized Comprehension Test for Abstract Words; SCTAW) and productive vocabulary (Word Fluency Test; WFT), and comprehensive and productive syntax (Syntactic processing Test for Aphasia; STA). Of 638 hearing-impaired children recruited for this study, 282 (44.2%) with >70 dB hearing impairment had undergone CI. After excluding children with low birth weight (<1800 g), those with >11 points on the Pervasive Developmental Disorder ASJ Rating Scale for the test of autistic tendency, and those <2 SD on Raven's Colored Progressive Matrices for the test of non-verbal intelligence, 190 children were subjected to this set of language tests.

Results

Sixty children (31.6%) were unilateral CI-only users, 128 (67.4%) were CI–hearing aid (HA) users, and 2 (1.1%) were bilateral CI users. Hearing loss level of CI users was significantly (p < 0.01) worse than that of HA-only users. However, the threshold level, maximum speech discrimination score, and speech intelligibility rating in CI users were significantly (p < 0.01) better than those in HA-only users. The scores for PVT-R (p < 0.01), SCTAW, and WFT in CI users were better than those in HA-only users. STA and TQAID scores in CI–HA users were significantly (p < 0.05) better than those in unilateral CI-only users. The high correlation (r = 0.52) has been found between the age of CI and maximum speech discrimination score. The scores of speech and language tests in the implanted children before 24 months of age have been better than those in the implanted children after 24 months of age.

Conclusions

We could indicate that CI was effective for language development in Japanese hearing-impaired children and early CI was more effective for productive vocabulary and syntax.

Introduction

Management of CI in infants and children is one of the most striking advances for congenital severe to profound hearing loss. Several studies have shown that early implantation can be beneficial not only for speech perception, but also for the development of speech and language [1], [2], [3]. Moreover, early intervention for children with hearing loss facilitates successful educational integration at the earliest possible age [4].

More than 20 years have passed since the first pediatric CI surgery was performed in Japan. Many hearing-impaired children are now benefiting from this device. However, the long-term benefits for Japanese CI users have rarely been reported. In particular, language development after CI among Japanese children has not often been investigated. Language development outcomes among children with prelingual hearing impairment have been studied in Indo-European languages, but language differences may have an effect on language development in children with CI. In addition, differences in national and local education systems may make a difference to language development. To determine the effect of CI, we examined language development in different language and/or social systems.

Language differences may add other difficulties; for example, interpretation of Japanese language test results may not be comparable with that of English or other European language tests. To reduce these difficulties, we have established the assessment package of the language development for Japanese hearing-impaired children (ALADJIN) as a language performance evaluation tool for hearing-impaired children. ALADJIN includes several Japanese language tests that are directly comparable with previously reported English tests, including the Peabody Picture Vocabulary Test-Revised (PVT-R) and Test for Reception of Grammar (TROG)-like syntax tests (e.g., the Syntactic processing Test for Aphasia; STA). These tests all have their own distinctive emphasis and evaluate different aspects or domains of language.

In 2010, we assessed the current status of hearing-impaired children in Japan through a project called Research on Sensory and Communicative Disorders (RSCD). ALADJIN was used in this nationwide research project. The RSCD was originally intended to assess the effectiveness of interventional methods for hearing-impaired children. As part of the RSCD survey, we evaluated the domain-specific language status of Japanese hearing-impaired children with CI, not only in selected institutes and schools that potentially yield biases, but in a wide variety of institutes in Japan.

Thus, the objective of this study was to evaluate the development of interpersonal communication skills (IPCS) in hearing-impaired children with CI using the ALADJIN data set from the RSCD nationwide research project.

Section snippets

Materials and methods

All ALADJIN tests were conducted by trained audiologists, speech pathologists, or deaf school teachers in a noise-minimized compartment. Audiometry for evaluation of hearing level, pure-tone threshold, speech discrimination test, and speech intelligibility rating [5] were measured in a sound-attenuated room of the relevant hospital. The study design was approved by the ethics review board of the Association of Technical Aids.

Results

There were significant (p < 0.01) differences in the scores of average hearing loss level, average threshold level with hearing devices, maximum speech discrimination score, and speech intelligibility rating between CI users (unil CI-only or CI–HA users) and HA-only users (Fig. 4). Hearing loss level of CI users was significantly lower than that of HA-only users. However, the threshold level, maximum speech discrimination scores, and speech intelligibility rating of CI users were significantly

Discussion

To evaluate the language development in the typical hearing-impaired children, we have made exclusionary criteria to standardize the subjects in this study. We excluded the hearing-impaired children with birth weights <1800 g who scored >11 points on the PARS test and <2 SD on the RCPM. Very low birth weight children are at a high risk of neurosensory disability, including developmental delay, behavioral problems, and learning disabilities [14]. Long-term follow-up studies have also emphasized

Acknowledgments

We thank all participants of this study, including children, parents, and staff of the Research on Sensory and Communicative Disorders (RSCD) project who collaborated with the Association for Technical Aids (Tokyo, Japan). This work was supported by the Division of Hearing Impairment, RSCD of the Ministry of Health, Labour and Welfare, Tokyo, Japan.

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The effects of narrative-based language intervention (NBLI) on spoken narrative structures in Persian-speaking cochlear implanted children: A prospective randomized control trial
2018, International Journal of Pediatric Otorhinolaryngology
Citation Excerpt :
Traditionally, language evaluation and intervention programs for hearing-impaired children (especially those with cochlear implants) have predominantly focused on reinforcement of early-developing language skills, such as specific language forms, unique vocabulary items, word-order rules, phonological training and subject-verb agreement [16]. A number of studies have reported that receptive and expressive vocabulary [17], mean length of utterances [18], morpho-syntactic complexity [19], auditory perception of speech [20] and speech intelligibility [21] in children with cochlear implants (CI) could be improved using traditional procedures. It can be said that CIs have had considerable positive influence on verbal language development and simple sentence production in deaf children that allows them to satisfactorily pass through the early-developing language period [6], yet they are inevitably classified as having delayed language [22].
Previous research has shown that narrative-based language intervention (NBLI) is a feasible approach increasing the narrative skills of hearing-impaired children.
In the present study, the efficacy of NBLI on the macrostructure and microstructure components of the spoken narrative of children with cochlear implants (CI) was evaluated in an experimental study.
Thirty-six CI children between the ages of 5.5 and 7 years were randomly divided in three groups of equal size. Group 1 attended 24 1-h sessions of NBLI group therapy. Group 2 participants each attended 24 1-h private sessions of NBLI instruction. Group 3 attended 24 1-h conventional speech therapy (CST) sessions. The subjects' storytelling skills were prompted using pictures from the Persian version of the Language Sample Analysis test. The results were assessed before treatment (T0), after treatment (T1) and two months after treatment (T2) as follow-up.
Groups 1 and 2 showed significantly better results over Group 3 on all microstructure components of spoken narrative at the T1 (p ≤ 0.04) and T2 (p ≤ 0.04) levels in comparison with T0, but no differences were observed between the NBLI approaches (p > 0.05). All three intervention programs significantly improved the macrostructure of the spoken narrative in CI children.
Improvements in spoken narrative structures were observed in CI children that support the efficacy of NBLI over CST for the hearing-impaired population.
Laser-capture micro dissection combined with next-generation sequencing analysis of cell type-specific deafness gene expression in the mouse cochlea
2017, Hearing Research
Citation Excerpt :
Many factors, medical, educational, and environmental, are presumed to affect CI performance. With regard to the medical factors affecting CI outcomes, diagnostic age, pre-operative hearing thresholds, duration of pre-operative hearing loss, implantation timing, associated mental retardation or other complex symptoms have been reported (Artières et al., 2009; Kasai et al., 2012; Forli et al., 2011; Iwasaki et al., 2012; Beadle et al., 2005; Calmels et al., 2004 Birman et al., 2015). Recent advances in genetic analysis technology using Massively Parallel DNA Sequencing have accelerated the exploration of novel genes involved in deafness (Walsh et al., 2010; Rehman et al., 2010; Brownstein et al., 2011; Schraders et al., 2011; Azaiez et al., 2015) and also have made possible the comprehensive genetic testing of all known deafness-causing genes in a shorter period (Shearer et al., 2010; Lin et al., 2012; Yan et al., 2013; Mutai et al., 2013; Nishio and Usami, 2015, Nishio et al., 2015a).
Cochlear implantation (CI), which directly stimulates the cochlear nerves, is the most effective and widely used medical intervention for patients with severe to profound sensorineural hearing loss. The etiology of the hearing loss is speculated to have a major influence of CI outcomes, particularly in cases resulting from mutations in genes preferentially expressed in the spiral ganglion region.
To elucidate precise gene expression levels in each part of the cochlea, we performed laser-capture micro dissection in combination with next-generation sequencing analysis and determined the expression levels of all known deafness-associated genes in the organ of Corti, spiral ganglion, lateral wall, and spiral limbs. The results were generally consistent with previous reports based on immunocytochemistry or in situ hybridization. As a notable result, the genes associated with many kinds of syndromic hearing loss (such as Clpp, Hars2, Hsd17b4, Lars2 for Perrault syndrome, Polr1c and Polr1d for Treacher Collins syndrome, Ndp for Norrie Disease, Kal for Kallmann syndrome, Edn3 and Snai2 for Waardenburg Syndrome, Col4a3 for Alport syndrome, Sema3e for CHARGE syndrome, Col9a1 for Sticker syndrome, Cdh23, Cib2, Clrn1, Pcdh15, Ush1c, Ush2a, Whrn for Usher syndrome and Wfs1 for Wolfram syndrome) showed higher levels of expression in the spiral ganglion than in other parts of the cochlea.
This dataset will provide a base for more detailed analysis in order to clarify gene functions in the cochlea as well as predict CI outcomes based on gene expression data.
Impact of early intervention on comprehensive language and academic achievement in Japanese hearing-impaired children with cochlear implants
2015, International Journal of Pediatric Otorhinolaryngology
Citation Excerpt :
They have now grown to school age, and many are attending mainstream schools and able to perform several language tests. There are reports suggesting good efficacy of CI [4] on language development in Japanese children with hearing impairment, but there are few reports concerning prognostic factors for language development and academic achievement by implanted children. In this study, we identified factors contributing to language development and academic achievement among CI users.
Early hearing detection and intervention (EHDI) is critical for achievement of age-appropriate speech perception and language development in hearing-impaired children. It has been 15 years since newborn hearing screening (NHS) was introduced in Japan, and its effectiveness for language development in hearing-impaired children has been extensively studied. Moreover, after over 20 years of cochlear implantation in Japan, many of the prelingual cochlear implant (CI) users have reached school age, and the effect of CI on language development have also been assessed. To identify prognostic factors for language development, audiological/language test scores and demographic factors were compared among prelingual severe-to-profound hearing-impaired children with CI divided into subgroups according to age at first hearing aid (HA) use and whether they received NHS.
Prelingual severe-to-profound deafened children from the Research on Sensory and Communicative Disorders (RSCD) project who met the inclusion criteria were divided into groups according to the age (in months) of HA commencement (before 6 months: group A, after 7 months: group B), and the presence or absence of NHS (groups C and D). Language development and socio-economic data were obtained from audiological/language tests and a questionnaire completed by caregivers, respectively.
In total, 210 children from the RSCD project participated in this study. Group A (n = 49) showed significantly higher scores on comprehensive vocabulary and academic achievement (p < 0.05) than group B (n = 161), with no difference in demographics except for significantly older age in group B. No differences in language scores were observed between group C (n = 71) and group D (n = 129), although participants of group D was significantly older and had used CIs longer (p < 0.05).
Early use of HAs until the CI operation may result in better language perception and academic achievement among CI users with prelingual deafness. A long-term follow-up is required to assess the usefulness of NHS for language development.
Noun plural production in preschoolers with early cochlear implantation: An experimental study of Dutch and German
2015, International Journal of Pediatric Otorhinolaryngology
Citation Excerpt :
These elements are often/mostly unstressed, perceptually less salient, and hence, less easily identifiable for children with a hearing impairment. Most studies thus far have presented a very broad picture of language development in the CI population, presenting general measures of expressive/receptive vocabulary and grammar [3,13–17]. There have been relatively few attempts to trace the development of specific language phenomena, such as the acquisition of noun, verb, or adjective morphology [7,8,18–20].
Studies investigating language skills of children after cochlear implantation usually present general measures of expressive/receptive vocabulary and grammar and rarely tackle the acquisition of specific language phenomena (word classes, grammatical constructions, word forms, etc.). Furthermore, research is largely restricted to children acquiring English. Cross-linguistic comparisons among children acquiring different languages are almost inexistent. The present study targets the acquisition of noun plurals (e.g., dogs, balls) by Dutch- and German-speaking children implanted before their second birthday. Given its structural complexity and irregularity, noun plural formation is a good indicator of grammatical proficiency in children at risk for a developmental delay.
The study sample consisted of 14 cochlear-implanted (CI) children (M = 55 months of age), 80 age-matched normally hearing (NH) controls, and 40 normally hearing controls matched by Hearing Age (HA). The children were administered an elicitation task in which they had to provide plural forms to a set of singular nouns. The analysis focussed on the following variables: Hearing status (CI, NH), Language (Dutch, German), and Suffix Predictability/Stem Transparency of the plural words.
There was no significant difference between children with CI and their NH peers in correct plural production. In both child groups, plural responses followed the predicted pattern of Suffix Predictability/Stem Transparency. However, children with CI significantly more frequently replied to the test item with a recast of the singular noun instead of the plural, and the probability of these responses increased with later age of CI implantation. Furthermore, Dutch-speaking children showed an overall better performance than German-speaking children.
The findings suggest that after 3 years of implant use, preschoolers with early cochlear implantation show age-appropriate patterns of noun plural formation, but still have to catch up with respect to associating a particular singular with its plural form.
Mandarin lexical tones identification among children with cochlear implants or hearing aids
2014, International Journal of Pediatric Otorhinolaryngology
Mandarin Chinese is a lexical tone language that has four tones, with a change in tone denoting a change in lexical meaning. There are few studies regarding lexical tone identification abilities in deafened children using either cochlear implants (CIs) or hearing aids (HAs). Furthermore, no study has compared the lexical tone identification abilities of deafened children with their hearing devices turned on and off. The present study aimed to investigate the lexical tone identification abilities of deafened children with CIs or HAs.
Forty prelingually deafened children (20 with CIs and 20 with HAs) participated in the study. In the HA group, 20 children were binaurally aided. In the CI group, all of the children were unilaterally implanted. All of the subjects completed a computerized lexical tone pairs test with their hearing devices turned on and off. The correct answers of all items were recorded as the total score and the correct answers of the tone pairs were recorded as subtotal scores.
No significant differences in the tone pair identification scores were found between the CI group and HA group either with the devices turned on or off (t = 1.62, p = 0.11; t = 1.863, p = 0.07, respectively). The scores in the aided condition were higher than in the unaided condition regardless of the device used (t = 22.09, p < 0.001, in the HA group; t = 20.20, p < 0.001, in the CI group). Significantly higher scores were found in the tone pairs that contained tone 4. Age at fitting of the devices was correlated with tone identification abilities in both the CI and HA groups. Other demographic factors were not correlated with tone identification ability.
The hearing device, whether a hearing aid or cochlear implant, is beneficial for tone identification. The lexical tone identification abilities were similar regardless of whether the subjects wore a HA or CI. Lexical tone pairs with different durations and dissimilar tone contour patterns are more easily identified. Receiving devices at earlier age tends to produce better lexical tone identification abilities in prelingually deafened children.
Very young age at implantation and eight nerve deficiency: Two important and controversial issues in pediatric cochlear implantation
2013, International Journal of Pediatric Otorhinolaryngology

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Language development in Japanese children who receive cochlear implant and/or hearing aid

Abstract

Objectives

Study design

Hypothesis

Methods

Results

Conclusions

Introduction

Section snippets

Materials and methods

Results

Discussion

Acknowledgments

Int. J. Pediatr. Otorhinolaryngol.

Brain Lang.

Arch. Clin. Neuropsychol.

Int. J. Pediatr. Otorhinolaryngol.

Int. J. Pediatr. Otorhinolaryngol.

Early Hum. Dev.

Effects of age at implantation in young children

Ann. Otol. Rhinol. Laryngol. Suppl.

Assessing cochlear implant benefit in very young children

Ann. Otol. Rhinol. Laryngol. Suppl.

Estimating the influence of cochlear implantation on language development in children

Audiol Med