Outcomes of Paediatric Cochlear Implantation

Presented in February, 2005

Optimising Outcome from Cochlear Implants: Our Experience

Agnes A Allen
Head of Department
Scottish Cochlear Implant Programme for Adults and Children

Scottish Cochlear Implant Programme for Adults & Children

Crosshouse Hospital, Kilmarnock

Purpose of Measuring Outcome

Monitor Progress

Test for Reception of Grammar

Measure Effectiveness

Perceptions / Expectations

• Implant Team
  Purpose Statement
• to enable profoundly deaf individuals to acquire or retain functional spoken language.   
• Child
• Parents
• Local Team
• Health Economists
• Benchmarking
• Predict CI outcome and ‘shape’ Selection Criteria

Selection Criteria

Puretone Audiometry
Average Thresholds (1, 2 & 4KHz) greater than 95dB HL

Puretone Thresholds

Aided Thresholds
Aided Thresholds greater than 55dB @ 2&4 KHz

Aided Thresholds

Evaluating HA Benefit

• Aided Thresholds
• Hearing Aid Fitting
• Speech Perception Tests
• Quality of Sound
• Anecdotal Evidence

Functional Hearing

• Will a cochlear implant improve speech understanding (c.f. a conventional hearing-aid) ?

Speech Perception Tests

• Lings Sounds
• Nonsense Syllables
• Monosyllabic Words
• Sentence Lists (BKB, CUNY, CID) – HA alone, LR alone, HA+LR
• McCormick Toy Test / Manchester Picture Test (PARROT System)

Other Considerations

• the cochlea and inner-ear

MRI Imaging

• integrity of auditory system

• age and duration of deafness

Children who have acquired spoken language

• No upper age limit

Congenitally Deaf Children

• communication skills

• general health

• ability to participate in ‘mapping’

• expectations

• commitment

• spoken language

Outcome Measures

• Aided Thresholds
• Sound Detection / Discrimination / Recognition
• Speech Perception
• Spoken Language
• Educational (Accessing Curriculum etc.)
• Observational Outcome Measures
• Quality of Life

Observational Outcome Measures
CHILDREN

1. Displays no awareness of sound. 0%

2. Is aware of environmental sound. 100%

3. Responds to speech sounds. 100%

4. Recognises environmental sounds. 99%

5. Discriminates at least two speech sounds. 99%

6. Discriminates reliably among five speech sounds. 96%

7. Understands common phrases without lip-reading. 78%

8. Understands conversation without lip-reading with a familiar talker. 45%

9. Can use the telephone with a familiar talker. 24%

Achieving a Successful Outcome

• Must wear external equipment
• Commitment / Home Support
• Spoken language exposure
• Mode of Communication
• No significant behaviour / learning difficulties

Outcomes of Paediatric Cochlear Implantation