Cochlear implants in children

Cochlear implants are no longer considered new or experimental technology. Difficulty in evaluating the degree of hearing loss and response to traditional forms of amplification in young children makes pediatric cochlear implant candidacy a complex issue. Cochlear implantation and, in particular, pediatric cochlear implantation, requires a team commitment with contributions from surgeons, audiologists, speech pathologists, psychologists, and special educators. Elements discussed include assessment and candidacy issues, surgical technique, elements of a cochlear implant team, outcome assessment, and potential complications. The decision to perform pediatric cochlear implantation should not be undertaken without serious consideration to the enormous commitment required in both financial and personnel terms.     

Cochlear implants in children

Cochlear implants allow the rehabilitation of children with severe to profound hearing loss. They are beneficial for not only postlingual children with hearing loss but also for children with congenital or prelingual hearing loss. Issues regarding cochlear implant candidacy and surgery are discussed. The results of cochlear implants in children and the complications related to cochlear implant surgery in children are reviewed.     

A comparison of perceived- and computed-change measures over a three-year period.

Used longitudinal data, collected for 3 yrs from a large community general hospital, to assess the validity of retrospective reports of changes in job satisfaction, communication, and coordination. 90 registered nurses answered 2 questionnaires 3 yrs apart. Responses were assessed using correlational and contingency analyses. Although retrospective reports of change did to some extent measure before-after change, it is noted that retrospective measures are not accurate enough to be considered as substitutes for computed-change measures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Temporal generalization of treatment effects over a three-year period for a parent training program: Directive Parental Counseling (DPC).

Assessed the permanence of the treatment effects (temporal generalization) obtained by a parent-training program, Directive Parental Counseling (DPC), developed by the 2nd author (1983). 20 parents who participated in the program completed the Walker Problem Behavior Identification Checklist and the Missouri Children's Behavior Checklist at pretreatment, treatment termination, 3 mo posttreatment, and 3 yrs posttreatment. The parents were part of a larger treatment group of 36 Ss who demonstrated superiority in altering targeted behaviors of their children (mean age 6 yrs 11 mo), in contrast to a waiting-control group, at the completion of a 10-wk program. The positive changes noted on the behavior rating scales obtained from the parents in the treatment group at the posttreatment period were still evident at the 3-mo follow-up and continued to increase over the 3-yr interval. Results are discussed in light of the issues surrounding temporal generalization and the structure of the DPC program. (French abstract) (26 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cochlear implants: selection criteria and shifting borders

Cochlear implants have proven to be effective and reliable in postlingually deaf adults. This is also true for congenitally deaf and perilingually deaf children up to the age of six years. Due to the increasing experience, the improvement of implant technology and the proven reliability the selection criteria are broadened with shifting borders. The main extensions are related to age, additional handicaps, residual hearing and special etiologies of deafness. Increasing evidence shows that very early implantation results in better performance and better hearing and speech development. Near-normal language acquisition can be achieved in children implanted under the age of four. Additional handicaps do not automatically exclude a candidate from cochlear implantation. A case-to-case decision has to be made based on additional diagnostics and the experience of the implant centre. A list of suitable handicaps is provided. Severely hearing impaired patients may also be considered for cochlear implantation if their residual hearing provides no benefit for speech discrimination. The same holds true for children. Cochlear implantation in obliterated cochleae and inner ear malformation requires a special surgical technique and special electrode arrays. In this way even difficult cases can be managed with remarkable outcome. Over all, the selection criteria have been broadened with increasing experience and technological improvement. This development may continue and the borderline between hearing aids and cochlear implants will shift further towards severe hearing loss. However, the basis for success still remains good rehabilitation, a team approach and the willingness of the patient to undergo the whole process of cochlear implantation.     

A retrospective epidemiological analysis of non-accidental head injury in children in Scotland over a 15 year period

We have made a simple 15-year retrospective epidemiological study of a part of South Moravia, district Breclav, on the basis of genetic documentation of 245 congenital defects and 28 spontaneous abortions. The whole area was worked up by computer-geographical methods, and the occurrence of congenital defects was compared both in areas of severe chronic air pollution and in less contamined areas. There were three municipal areas, Mikulov, Breclav-Postorná, Velké Bilovice and their surroundings, in which an increased number of congenital defects was recorded. In the municipal area of Breclav-Postorná there was also a greater occurrence of organic solvents and phosphoric acid and a significantly higher occurrence of spontaneous abortions and at the same time a higher occurrence of heart defects.     

Hydroxyapatite-coated implants: a case for their use

The information on which this article is based comprises a small fraction of the large database compiled from the DICRG study. These results represent the early performance for HA implants (up to 36 months). The study has been ongoing for 6 years, and there are more than 2,000 implants with 4-year data and 1,500 with 5-year data. These data are similar to the 36-month data, and when they are eventually released, they are likely to reinforce the results reported here. Meanwhile, the evidence presented in this article, along with other corroborating studies cited in the introduction, are sufficient grounds to reach the following conclusion: The ideal implant design and material is one that is easy to use, requires average skills, involves minimal bone trauma, presents a biocompatible contact surface, and produces a high rate of survival in most patients. Based on 36-month survival in the DICRG study, HA-coated implants appeared to satisfy these basic requirements better than the other implants used in the study. HA-coated implants were placed in the most challenging bone types and jaw region, in patients with compromised medical histories, by dentists with different training, skills, and experience, under less than ideal clinical conditions, and still showed the highest survival rates of all implants at every point in the treatment up to 36 months.     

Referential communication and reading performance in learning disabled children over a 3-year period.

Examined the ability of 30 learning disabled (LD) and 30 non-LD (NLD) 6- and 7-yr-olds to understand a sequence of instructions, communicate the steps in a sequence to others, and rephrase their verbal messages across a 3-yr period using a referential communication task. In order to perform the puzzle-box task correctly, Ss had to execute 6 steps in an invariant sequence. After Ss demonstrated a perfect nonverbal enactment of the sequence, they were asked to communicate all information about how to open the box to a puppet. Upon completion, the puppet feigned poor memory and asked the Ss to explain the step-by-step process again. Subsequently, the puppet requested that Ss rephrase their explanation of each step by either a verbal or nonverbal rephrase request. Results reveal that LD children differed from NLD peers consistently on referential communication over the 3-yr period in terms of listener competence and speaker competence. For LD Ss, the ability to produce competent verbal messages was highly related to reading comprehension both concurrently and 3 yrs later. By the 3rd yr, NLD Ss were better able to rephrase information, indicating a growing awareness of the speaker's responsibility in communication. Findings suggest that the communication measures studied play very different roles for LD and NLD Ss with regard to reading achievement. (27 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological adjustment of children with sickle cell disease: Stability and change over a 10-month period.

Rates of poor psychological adjustment of children with sickle cell disease remained relatively constant over initial and follow-up assessment points. 50 children (aged 7–12 yrs) and their mothers completed the initial protocol. 30 children completed the follow-up plus 5 additional children and their mothers. These Ss were aged 7–24 yrs at follow-up. With initial levels of adjustment controlled, children's strategies for coping with pain accounted for a significant increment in child-reported symptoms and mother-reported internalizing behavior problems at follow-up beyond the contribution of illness and demographic parameters and follow-up interval. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An analysis of career enquiries made to a school of radiography over a five-year period

A follow-up enquiry form is described and results provided from a survey over a five-year period. The information gained has enabled a further and we hope more searching questionnaire to be designed. At the time of producing the pro-forma in 1969, career and salary prospects in radiography were not as good as at present. The Halsbury Report in May 1974 was a great advantage to the paramedical professions as a whole. It will be interesting to see how recruitment and job availability proceed over the ensuing five years.     

Cochlear implantation in children with inner ear malformations

We performed a case study and intervention study, with follow-up of 1 to 5 years, in 4 children with inner ear malformations who underwent implantation of a multichannel cochlear implant (Nucleus, Cochlear Corporation) at ages 3 to 12 years. Malformations included a common cavity deformity, 2 incomplete partitions, and 1 case of isolated bilateral vestibular aqueduct enlargement. One child had a single-channel implant placed at 3 years of age, and this was exchanged for a 22-channel implant at age 9. One child had her implant placed at age 4.5 years, but due to complications from a cerebrospinal fluid (CSF) leak had the initial implant removed and replaced at age 5 years during repair of the CSF leak. Intraoperative findings included a CSF leak at the time of surgery in 3 patients. One patient contracted bacterial meningitis 7 months postimplantation that was thought to be secondary to acute otitis media in the unoperated ear. Bilateral CSF leaks were noted in the middle ear by a lumbar puncture radionuclide and fluorescein dye study. Successful repair of the CSF leaks and reimplantation of the cochlear implant was carried out in this patient. Mapping and programming of the implant was found to be challenging in each of these patients. All patients demonstrated improved performance after implantation. Two patients demonstrated some open-set speech perception. One patient demonstrates improved use of temporal cues in a structured closed set. One patient has achieved no significant speech recognition at this time, but does have improved sound detection and awareness. Cochlear implantation in children with congenital inner ear abnormalities can be a successful method of rehabilitation. It should be recognized that the postoperative speech perception results may be highly variable among patients, and that intraoperative complications may occur.     

Test validity over a seventeen-year period.

Data are presented for 692 employees between scores on LOMA-1 (a 15-minute general mental ability test) on the one hand, and attained job class (7 to 17 years later) and current job performance on the other. LOMA test scores correlated .60 with attained job class, and .29-.48 with current performance in four departments as measured by a production criterion. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trend of bacterial meningitis in children over a 14 year period (1981 through 1994) in Japan--an analysis based on studies in 27 institutions]

We observed 266 children with purulent meningitis in 27 institutions in Japan during the 14 years from 1981 on dividing these years into 3 periods, 1981-1985, 1986-1990 and 1991-1994, and studied the trend of causative organisms identified in 254 among the 266 patients. Their ages were less than 3 months after birth in 50 children and 3 months or older in 216: there were 141 boys and 125 girls. The causative organisms were H. influenzae in 134 patients and S. pneumoniae in 50, most of them being aged 3 months or older. Next to the above bacteria ranked S. agalactiae in 29 and E. coli in 12, many of the patients were aged less than 3 months. Staphylococcus spp. was found in 7 patients and about 70% of them were aged 3 months or older. L. monocytogenes was found in 4 patients and N. meningitidis in 3 and they were aged 3 months or older in both patient groups. S. pyogenes, Enterococcus spp., Peptostreptococcus spp., P. Mirabilis and Enterobacter spp. were detected each in 1 patient. The causative organism was unknown in 21 patients and there was no double infection. H. influenzae were detected in 18 patients in 1981-1985 period (36.7%), in 56 in 1986-1990 (54.9%) and in 60 in 1991-1994 (63.8%) showing an increasing tendency, but S. pneumoniae exhibited neither an increasing nor decreasing tendency. There was a decreasing tendency with S. agalactiae and E. coli, but the details were not clear because there were few patients aged less than 3 months. Although the period of coexistence of 4 main bacterial species was not made clear in this study. Listeria is considered to develop mainly in the early childhood, and we believe that the conventional way of using a cephem preparation and ampicillin combined for patients under 6 years need not be altered. However, panipenem (phonetic) is likely to be effective for insensible S. pneumoniae for the time being.     

Deafness in childhood: 3. Cochlear implants: who, why and what are the results?

Some profound or totally deaf children cannot benefit from a hearing aid. In some cases a cochlear implant may be successful. The system compromises a small cable implanted into the inner ear, and externally-worn devices to collect and transmit the sounds to the ear. The cable consists of electrodes that respond to different frequencies of speech, imitating the action of the inner ear. It is not possible to predict the outcome in individual cases. At best, the child may subsequently be able to speak fluently and hear without lip-reading. At least, the child should be able to hear some background noise such as traffic, and be able to improve his or her lip-reading skills. It may take up to a year before improvements begin to show. The implant is intended to be permanent. Cochlear implants are still at a relatively early stage of development. Progress is cautious but the results so far are very encouraging. The entry gate is widening and the number of children being accepted for treatment is increasing.     

The community hospital: a three-year study

In a three-year period a community hospital of 40 beds discharged 2086 patients, their mean length of stay being 14.8 days. Some 68% of the patients treated were over 65, and 8.9% died in hospital. While the most common diagnosis on admission was disease of the respiratory tract, this does not indicate the actual cause of admission. For 142 patients from one practice this was acute illness in 44% of the cases, assessment in 20%, and a need for nursing care in 36%. If the community hospital had not been available about half these patients would have been admitted to the general hospital.     

Long-term efficacy of total SILASTIC implants: a subjective analysis

A retrospective analysis of the long-term efficacy of total SILASTIC implant arthroplasty performed before 1986 is presented. A total of 50 patients responded to subjective questionnaires regarding pain, function, complications, and overall patient satisfaction. The average age of the patients at the time of surgery was 55.1 years with an average follow-up of 13.4 years (range 10.7 to 16.9 years). Ninety-seven percent of patients reported relief from pain, and the overall success rating was 90.7%. Results were calculated based on a modification of the American Orthopaedic Foot and Ankle Society clinical rating system; the mean rating was 87.3. Attention must be directed at realigning the joint via appropriate osteotomies and soft tissue balancing procedures for increased success. Although radiographic deterioration of the implant was demonstrated in all implants, this deterioration did not correlate with patient satisfaction and should not be the sole criterion for implant removal. We conclude that total implant arthroplasty is a proven procedure for long-term relief of pain in selected patients with degenerative joint disease of the first metatarsophalangeal joint.     

Cochlear implantation in children younger than 2 years old

PURPOSE: This study recorded and compared the flexural elastic moduli and moduli of rupture of four materials (Provipont DC resin, Triad provisional restorative material, Jet acrylic resin, and a 50:50 mixture of Jet acrylic resin and orthodontic resin) used to make provisional restorations. MATERIAL AND METHODS: Thirty-nine identical 63 x 10 x 3 mm specimens were made from each of the four materials. After 24 hours, 30 days, and 60 days of water storage at 37 degrees C (13 specimens each), standard three-point bend tests were conducted on an Instron universal testing machine at a crosshead speed of 0.5 cm/minute. Stress strain curves were generated, and values for the flexural elastic moduli and moduli of rupture were calculated. Data were subjected to two-way and one-way analyses of variance (alpha = 0.05). RESULTS: Provipont DC resin exhibited significantly higher flexural elastic moduli and moduli of rupture values at the 24-hour test time. However, Provipont DC resin exhibited the greatest decrease in these values over time.