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PubMed2004

Modifying cochlear implant design: advantages of placing a return electrode in the modiolus.

HYPOTHESIS: A modiolar return electrode significantly increases the current flow across spiral ganglion cells into the modiolus, and may decrease the cochlear implant's power requirements. BACKGROUND: Ideal cochlear implants should maximize current flow into the modiolus to stimulate auditory neurons. Previous efforts to facilitate current flow through the modiolus included the fabrication and use of precurved electrodes designed to "hug" the modiolus and silastic positioners designed to place the electrodes closer to the modiolus. In contrast to earlier efforts, this study explores the effects of return electrode placement on current distributions in the modiolus. METHODS: The effects of return electrode positioning on current flow in the modiolus were studied in a Plexiglas model of the cochlea. Results of model measurements were confirmed by measurements in the modiolus of human temporal bones. The return electrode was placed either within the modiolus, or remotely, outside the temporal bone, simulating contemporary cochlear implant configurations using monopolar stimulation. RESULTS: Cochlear model results clearly show that modiolar current amplitudes can be influenced significantly by the location of the return electrode, being larger when placed into the modiolus. Temporal bone data show similar findings. Voltages recorded in the modiolus are, on average, 2.8 times higher with the return electrode in the modiolus compared with return electrode locations outside the temporal bone. CONCLUSION: Placing a cochlear implant's return electrode in the modiolus should significantly reduce its power consumption. Reducing power requirements should lead to improved efficiency, safer long-term use, and longer device life.

Cochlea↗

PubMed2004

How cochlear implants encode speech.

PURPOSE OF REVIEW: This review summarizes the history of cochlear implant signal processing and provides the rationale underlying current approaches. Present strategies are explained and recent research findings are summarized. It is suggested how these results may drive future advancements in signal processing. RECENT FINDINGS: Substantial advances have been made in our understanding of the spectral and temporal cues necessary for cochlear implant recipients to perceive music, speech in noise, and interaural timing. It is clear that higher levels of both spectral and temporal resolution, as well as better loudness and pitch coding are necessary for higher levels of performance. These factors are highly interrelated, however, and are beneficial for differing aspects of hearing. Signal processing algorithms incorporating these findings are under active development and some are currently undergoing clinical investigation. SUMMARY: Current implant devices, and those soon to be available, have substantial untapped potential to improve the auditory experience of their recipients. It is likely that in the near future, recent findings on pitch and loudness perception, as well as techniques to better emulate the normal functions of the cochlea will result in much higher levels of prosthetic hearing fidelity than are possible today. As the performance of these remarkable devices continues to improve, the population of hearing-impaired individuals who can benefit from implantation is likely to increase significantly.

Cochlear Implantation↗

PubMed2003

Residual speech perception and cochlear implant performance in postlingually deafened adults.

OBJECTIVE: This study aimed at testing the post-hoc validity of the previously reported predictive index for postoperative cochlear implant performance, based on preoperative duration of deafness, and speech reception. STUDY DESIGN: Adult patients with postlingual severe to profound hearing loss, who were implanted with Cochlear Corporation CI-22 and CI-24 devices were included in this study. We studied the relationship between their postoperative word recognition scores and preoperative factors, namely, duration of deafness, and sentence recognition. We used the same predictive index reported in the previous study to predict their postoperative scores and test the model's agreement with the actual performance. RESULTS: We found that postoperative performance as measured by CNC word scores had an inverse relationship with the duration of deafness, and a direct correlation with the preoperative performance on CID sentence recognition tests. A nonlinear term [Duration / (1+CID)] was shown to improve the correlation coefficient of our predictive index. CONCLUSION: Some predictability of cochlear implant outcome is possible depending on the preoperative duration of deafness and speech recognition abilities. Preoperative residual speech recognition acts as a "trophic factor" that protects the spiral ganglion and/ or the central auditory pathways from degeneration. In other words, it improves the expected postoperative word scores.

Cochlear Implantation↗

PubMed2005

[Oblique sagittal MRI of internal auditory canal applied before cochlear implantation].

OBJECTIVE: To explore practical value of oblique sagittal MRI of internal auditory canal (IAC) before cochlear implantation. METHOD: Fifteen patients(30 ears) with sensorineural hearing loss who prepared to receive cochlear implantation were examined by oblique sagittal MRI (three dimensional T2-weighted fast spin echo) of IAC. RESULT: All patients have successfully completed oblique sagittal magnetic resonance imaging of IAC. The nerves in internal auditory canal were displayed distinctly. Thirteen patients with normal cochlear nerve had CI successfully, while 2 cases didn't receive CI due to abnormality of cochlear nerve. CONCLUSION: Oblique sagittal magnetic resonance imaging of internal auditory canal is a good method for evaluating development of cochlear nerve before cochlear implantation.

Adolescent↗

PubMed2004

Consonant production and language skills in Mandarin-speaking children with cochlear implants.

OBJECTIVES: To investigate the phonemic inventories of syllable-initial consonants in Mandarin-speaking children with cochlear implants, assessing the relationship between the children's mastery levels of consonant production and their receptive and expressive language skills. DESIGN: Descriptive study. SETTING: Chi-Mei Medical Center, Tainan, Taiwan. PATIENTS: The 30 prelingually deaf children with cochlear implants who participated in the study ranged in age from 6 years to 12 years 6 months, and their age at implantation ranged from 2 years 3 months to 10 years 3 months. The average length of device experience was 3 years 7 months (range, 1 year 7 months to 6 years 5 months). None of the children was identified with concomitant learning disabilities. OUTCOME MEASURES: The 21 Mandarin syllable-initial consonants were elicited using a set of 105 pictures. Two language assessment tools were used to evaluate the children's receptive vocabulary skills as well as their overall receptive and expressive language development. RESULTS: The mean +/- SD score for correct consonant production was 57.9% +/- 19.5%. Regarding the manner of articulation, plosives received the highest average correct percentage whereas nasals, affricates, fricatives, and the lateral approximant /l/ were less frequently correct. The children's overall percentage of correct scores for consonant production and receptive vocabulary measure were significantly correlated (r = 0.51; P =.005). Additionally, correlation coefficients were significant between the overall score for correct consonant production and both the scores for receptive language measure (r = 0.65; P<.001) and expressive language measure (r = 0.76; P<.001). The participants' consonant production skills were negatively correlated with age at implantation (r = - 0.46; P =.01) and positively correlated with length of experience with cochlear implant (r = 0.45; P =.02). CONCLUSIONS: Mastery levels of Mandarin syllable-initial consonants remained moderately low in prelingually deaf children with cochlear implants. The present results suggest a significant association between consonant production skills and language development in these children.

Asian People↗

PubMed2003

Monosyllable speech perception of Japanese hearing aid users with prelingual hearing loss: implications for surgical indication of cochlear implant.

OBJECTIVE: The monosyllable speech perception ability after years of educational intervention was compared between prelingually deafened pediatric hearing aid users and their cochlear implant counterparts. DESIGN: An open-set monosyllabic speech perception test was conducted on all subjects. The test required subjects to indicate a corresponding Japanese character to that spoken by the examiner. Fifty-two subjects with prelingual hearing impairment (47 hearing aid users and 5 cochlear implant users) were examined. RESULTS: Hearing aid users with average pure-tone thresholds less than 90 dB HL demonstrated generally better monosyllable perception than 70%, which was equivalent or better performance than that of the cochlear implant group. Widely dispersed speech perception was observed within the 90-99 dB HL hearing-aid user group with most subjects demonstrating less than 50% speech perception. In the cluster of >100 dB HL, few cases demonstrated more than 50% in speech perception. The perception ability of the vowel part of each mora within the cochlear implant group was 100% and corresponding to that of hearing aid users with moderate and severe hearing loss. CONCLUSION: Hearing ability among cochlear implant users can be comparable with that of hearing aid users with average unaided pure-tone thresholds of 90 dB HL, after monosyllabic speech perception testing was performed.

Adolescent↗

PubMed2005

Medical and surgical complications of the second 100 adult cochlear implant patients in Birmingham.

One hundred consecutive adult cochlear implant patients, numbered 101 to 200 in an ongoing series, were prospectively monitored and data collected using the same protocol as for the first 100 patients. The study period was 1999 to 2001. The total number of procedures was 122. Changes in practice following the first 100 implants included a standard surgical technique with a smaller incision and lesser flap mobilization, and routine facial nerve monitoring. As far as was practicable, the same commercial type of implant was used. There were 111 (91 per cent) implantation episodes, five (4 per cent) explantation episodes, four (3.3 per cent) reimplantation episodes and two (1.6 per cent) revision procedures. Eighty-nine patients underwent unilateral implantation and 11 underwent bilateral implantation. Major complications included flap breakdown (1.6 per cent), extrusion of electrode array (0.8 per cent) and device failure (0.8 per cent). The overall major complication rate was 3.2 per cent (4/122). The overall minor complication rate was 18 per cent. In addition, 7.3 per cent experienced transient vertigo and 5.7 per cent experienced local discomfort lasting three days on average with complete resolution. The overall complication rate in the second 100 implant patients was lower than in the first 100. Smaller incision and lesser flap mobilization reduced the minor complication rate.

Adolescent↗

PubMed1994

The mechanism of speech perception in patients with a multichannel cochlear implant.

The mechanism of speech perception in patients with a multichannel cochlear implant was investigated by administering vowel, consonant, and speech recognition tests, and comparing sound spectrograms with the activities recorded from the cochlear implant electrodes. Vowel recognition was found to be adequate, but consonant recognition was poor. Although the cochlear hair cells of such patients are known to be functionally damaged, the cochlear nerve was found to have the capacity to characterize frequency. The signals from the implanted device were very simple compared with those from the normal cochlea; however, the patients could nevertheless understand speech well after cochlear implantation.

Adult↗

PubMed2004

Benefits of bilateral electrical stimulation with the nucleus cochlear implant in adults: 6-month postoperative results.

OBJECTIVE: To evaluate the benefits of bilateral electrical stimulation for hearing-impaired adult subjects using the Nucleus 24 cochlear implant in a multicenter study, and to compare and quantify performance on speech perception measures in quiet and in noise and localization ability for unilateral and bilateral cochlear implant use. DESIGN: : Repeated single subject measures were carried out for each subject, with each subject serving as their own control. Assessment of unilateral and bilateral listening conditions for performance on tests of speech comprehension and sound localization were performed. Speech comprehension measures were performed in quiet at 0 degree azimuth and in the presence of background noise simultaneously presented from the same speaker and spatially separated by 90 degrees, at S+45 degrees N45 degrees and at S-45 degrees N+45 degrees . Test materials included Freiburger monosyllabic words, Oldenburger sentences, and the Hochmair-Schulz-Moser sentences. Tests of localization were performed in the horizontal plane with 12 speaker locations 30 degrees apart using a shortened sentence stimulus from the Hochmair-Schulz-Moser sentences at two possible presentation levels of 55 and 70 dB sound pressure level for assessment of directionality. The binaural advantage provided by bilateral stimulation was calculated with respect to each ear separately, classified as either the better or poorer performing ear for each speech material in quiet and in noise test conditions. For localization of sound, the binaural advantage was compared with left and right ears separately. Paired comparisons for performance data in all conditions were carried out by considering measurements for each subject in different conditions as paired observations and applying the Student's t test to determine the statistical difference between the data sets. SETTING: Tertiary referral centers with a cochlear implant program. PATIENTS: Thirty-seven profoundly hearing-impaired adults were enrolled in the study, 22 simultaneously and 15 sequentially bilaterally implanted. All patients received the Nucleus 24 cochlear implant and used the Nucleus SPrint or ESPrit 3G speech processor, with the vast majority using the ACE speech coding strategy. RESULTS: For spatially separated speech in noise conditions, an interaural performance advantage for the ear closest to the speech source (i.e., with a superior signal to noise ratio) compared with that for the ear closest to the noise source (i.e., with an inferior signal to noise ratio) is consistently demonstrated regardless of whether it is the better or poorer performing ear closest to the speech signal. This is referred to as a significant binaural head-shadow benefit, resulting in a mean improvement between -10 dB and -11.4 dB in the critical signal to noise ratio required for 50% speech comprehension for the Olden-burger sentences and a mean improvement in the maximum score of 42% to 55% for the ear closest to the speech signal over the ear farthest away for the Hochmair-Schulz-Moser sentences. Bilateral stimulation is always observed to provide a performance advantage over the unilateral listening condition for either ear when ipsilateral to the noise source. In addition, as demonstrated by approximately half the subjects tested in noise with the Hochmair-Schulz-Moser sentences, a performance advantage of bilateral stimulation may be observed over the better ear alone when positioned ipsilateral to the speech signal, which is referred to as a binaural squelch effect. On average, for the group, this resulted in a statistically significant improvement in speech comprehension scores of 8% in the bilateral listening condition compared with the scores for the better ear alone. Through assessment of comprehension of coincidental speech in noise and speech in quiet, a significant benefit of binaural redundancy was noted for the group for Oldenburger sentence scores in noise and in quiet compared with unilateral scores for either ear and for the Freiburger monosyllabic words in quiet in comparison with the better ear alone scores. Binaural stimulation also led to a significant improvement in localization ability over either monaural condition, with the root mean square degrees of error reduced by 38 degrees compared with that observed for unilateral stimulation. CONCLUSION: Similar to what has been observed for bilateral acoustic stimulation in the past, bilateral electrical stimulation provides the foundation for the potential advantages of the head-shadow effect, providing a binaural head-shadow benefit and binaural auditory processing such as binaural redundancy and binaural squelch effects, all of which combine to lead to improved speech comprehension over unilateral listening conditions. The combination of improved speech comprehension and improved localization ability made available through bilateral electrical stimulation provides the necessary foundation to further assist the hearing-impaired listener to better cope with communication in the everyday listening situation both in noise and in quiet.

Adolescent↗

PubMed2003

Choice of ear for cochlear implantation: the effect of history and residual hearing on predicted postoperative performance.

OBJECTIVE: This study used mathematical formulas predicting cochlear implant outcomes to investigate the effects of implantation in the poorer ear on postoperative speech recognition. DESIGN: Retrospective cohort study with mathematical and statistical analyses. This study used the University of Iowa formula for predicting outcomes derived from implantation of the better ear on the basis of duration of deafness and preoperative speech understanding, applying this predictive model to a cohort of patients undergoing implantation in the poorer ear at The Johns Hopkins Medical Center. SETTING: Tertiary referral center with active cochlear implant program. PATIENTS: Postlingually deafened adults (n = 58) with preoperative Central Institute for the Deaf sentence scores less than or equal to 40%. INTERVENTION: Cochlear implantation with all three Food and Drug Administration-approved devices. MAIN OUTCOME MEASURE: Postoperative monosyllabic word recognition scores and correlations between actual and predicted results. RESULTS: There was good statistical correlation between the predicted postoperative performance using the University of Iowa formula and the actual performance of our cohort of patients undergoing implantation in the poorer ear (r = 0.50, p < 0.0001). In addition, as a population, our cohort had a mean postoperative consonant-nucleus-consonant word score of 41.8%, which was statistically the same as that predicted by the University of Iowa formula (43.6%). CONCLUSIONS: The postoperative performance of cochlear implant patients is most closely correlated with duration of deafness. However, our results indicate that this measure may not be ear specific and is more reflective of the total auditory receptivity of the patient. These observations help to form guidelines for choice of ear for implantation.

Adolescent↗

PubMed1999

The development of auditory perception in children following cochlear implantation.

The time course for the development of auditory perception in prelingually deaf children following cochlear implantation may extend over many years, thus making long-term studies necessary to evaluate any such outcome. However, few such studies exist in the literature. We prospectively followed-up a consecutive group of 133 prelingually deaf children up to 6 years following implantation. All children were prelingually deaf with age at onset of deafness < 3 years and age at implantation < 8 years. The aetiology of deafness was meningitis for 45 children (34%), congenital deafness for 77 children (58%) and other causes for 11 children (8%). All were implanted with a Nucleus-22 multi-channel cochlear implant and followed the same rehabilitation programme. No child was lost to follow-up and there were no exclusions from the study. Prelingually deaf children showed significant improvement in the auditory perception with implant experience. 82% of children who reached the 6-year interval could understand conversation without lip-reading. The respective percentage in the 4-year interval was 70%. The long-term results of cochlear implantation reveal that the majority of prelingually deaf children, when implanted before the age of 8 years, will develop significant auditory perception.

Auditory Perception↗

PubMed2000

Congenital malformations of the ear and cochlear implantation in children: review and temporal bone report of common cavity.

The objective of this review is to analyze aspects of congenital malformation of the ear in relation to cochlear implantation in children. Having briefly described the in utero development of the ear and the classification of types of external, middle and inner ear malformation, five practical aspects of these malformations are discussed. It seems likely that the combination of bilateral profound sensorineural deafness with bilateral microtia severe enough to make a surgical approach to the cochlea difficult will be extremely uncommon. No such cases have been reported, although Klippel-Feil deformity seems the syndrome most likely to produce this set of circumstances. Abnormalities in the intratympanic course of the facial nerve have been associated with cochlear malformation, emphasizing the benefit of intra-operative facial nerve monitoring, and a technique suggested for safely avoiding an abnormally placed nerve. Fistulae of cerebrospinal fluid (CSF) and perilymph can complicate surgery and are relatively common in common cavity and Mondini malformations. Strategies for facilitating surgery in the presence of 'gushers', for measuring the pressure of a gusher and for placement of the cochlear implant electrode array are reviewed, with reports of fluctuating levels of electric current when implants lie in dysplastic cochleas. The relationship of implant performance to VIIIth nerve tissue in malformed cochleas is discussed, with a description of the histological findings in a common cavity cochlea. Techniques for identifying the absence of the cochlear nerve are reviewed. Stimulation of the facial nerve by cochlear implants has been described in cases of congenital malformation of the labyrinth but is relatively uncommon. Case reports of the benefit received by implanted children with congenital cochlear malformation have appeared since 1988. Most cases reported have not yet been followed for long enough to establish a clear picture of the outcome following cochlear implantation in such children; no centre has yet built up a large series of cases, but there have been two multicentre postal surveys. It seems likely that in cochlear malformation the range of potential outcomes in terms of hearing threshold and the development of speech perception and production will be similar to the range found in implanted children without cochlear dysplasia. However there is, as yet, no clear picture of the mean level of performance within this range.

Adolescent↗

PubMed2004

Bilingual oral language proficiency in children with cochlear implants.

OBJECTIVE: To document oral language proficiency in a group of prelingually deaf bilingual children with a cochlear implant. DESIGN: Using a repeated-measures paradigm, oral language skills in the first and second language were evaluated at 2 yearly intervals after implantation. Language data were compared with normative data from children with normal hearing. SUBJECTS: Twelve deaf children between the ages of 20 months and 15 years who had received a cochlear implant before the age of 3 years. OUTCOME MEASURE: First-language skills were assessed using 1 of 2 standardized tests, either the Oral and Written Language Scales or the Reynell Developmental Language Scales, depending on the child's age. Second-language proficiency was assessed using the Student Oral Language Observation Matrix. RESULTS: Average standard scores in the first language fell solidly within the average range of normal-hearing peers. Second-language skills showed steady improvement from year 1 to year 2, along a continuum that reflected the amount and intensity of exposure of the child to the second language and the length of experience with the implant. CONCLUSION: A cochlear implant can make oral proficiency in more than 1 language possible for prelingually deaf children.

Adolescent↗

PubMed2003

Preoperative high resolution CT and MR imaging in cochlear implantation.

INTRODUCTION: Accurate preoperative imaging of the temporal bone in patients receiving cochlear implants is important. High resolution computed tomography (HRCT) and magnetic resonance (MR) imaging are the 2 preoperative imaging modalities that provide critical information on abnormalities of the otic capsule, pneumatisation of the mastoid, middle ear abnormalities, cochlear ducts patency and presence of cochlear nerve. MATERIALS AND METHODS: The HRCT and MR imaging in 46 cochlear implant patients in our department were reviewed. RESULTS: Majority of our patients [34 patients (73.9%)] showed normal HRCT of the temporal bone; 5 (10.9%) patients had labyrinthitis ossificans, 2 (4.3%) had Mondini's abnormality and 2 (4.3%) had middle ear effusion. One patient each had high jugular bulb, hypoplasia of the internal auditory canal and single cochlear cavity, respectively. CONCLUSION: The above findings contribute significantly to our surgical decisions regarding candidacy for surgery, side selection and surgical technique in cochlear implantation.

Cochlear Diseases↗

PubMed2001

Relationship between NRT measurements and behavioral levels in children with the Nucleus 24 cochlear implant may change over time: preliminary report.

OBJECTIVE: Response from spiral ganglion cells to electrical stimulation via the Nucleus 24 cochlear implant can be measured using the neural response telemetry system. The purpose of this study was to assess, in children, the correlation between the neural response threshold and the behavioral levels used for cochlear implant programming process. METHODS: The neural response telemetry test was administered to 23 children (mean age at implantation: 4 years) with the Nucleus 24 cochlear implant. Four intra-cochlear electrodes (electrodes 5, 10, 15 and 20) were tested. The neural response threshold at 3, 6, 9 and 12 months post-implantation was compared with the behavioral threshold and the maximum comfort level estimated during the same periods: a Pearson's correlation test was performed for each tested electrode. RESULTS: On apical electrodes, the correlation with the behavioral threshold remained significant from 3 to 12 months post-implantation (r ranging from 0.696 to 0.909, P<0.05), and the correlation with the maximum comfort level was also significant throughout the study period, except on electrode 15 at 9 months (tendency to significance). On basal and intermediate electrodes, statistical correlations were found only at some points of time; nonetheless, at 12 months post-implantation, a significant correlation with behavioral levels could be clearly demonstrated both on electrode 15 (r=0.914--0.778, P<0.05) and on electrode 10 (r=0.845--0.720, P<0.05). CONCLUSIONS: This preliminary study suggests that the correlation between the neural response threshold and behavioral levels may improve from the base towards the apex of the cochlea. However, a significant correlation can be demonstrated for all tested electrodes at 12 months post-implantation. During the first months post-implantation care must be exercised when interpreting neural response telemetry measurements: a positive test does not necessarily mean that the stimulus delivered to the acoustic nerve will be centrally processed with the result of an auditory perception.

Action Potentials↗

PubMed2000

[Rehabilitation of hearing-impaired patients with cochlear implants: a review].

The aim of this paper is to provide an overview of the cochlear implant. The history of this entity is traced from the early development of implants, involving the stimulation of the hearing nerve, up to the currently available standard multichannel implants. The physiological background is also elucidated. A cochlear implant consists of an implantable portion which lies within the ear, and of parts that are worn externally on the body. Differences between the first implants and those now in use are as follows: transcutaneous information and energy transmission, the position of the electrode in the ear, and the configuration of the electrode. Differences between the currently available implants mainly concern the number of electrodes, speech coding strategies and the mode of electrode stimulation. Almost all of the most recent implants are equipped with electrodes that are implanted in the tympanic scale of the cochlea.

Acoustics↗

PubMed2005

Behavioral assessment of prelingually deaf children before cochlear implantation.

OBJECTIVES/HYPOTHESIS: To determine whether scores from a behavioral assessment of prelingually deafened children who present for cochlear implant surgery are predictive of audiological outcomes. STUDY DESIGN: Retrospective review of longitudinal data collected from 42 children with prelingual hearing loss who presented for a cochlear implant before age 5 years. METHODS: The Vineland Adaptive Behavioral Scales (VABS) was administered during the preimplant workup. Standardized scores reflect daily living skills, socialization, and motor development compared with a normative sample. Regression analyses were conducted to determine whether any subject variables were related to VABS scores. Mixed-model analyses were computed to determine whether preimplant VABS scores were predictive of longitudinal spoken-language data obtained after cochlear implant surgery. RESULTS: Motor scores tended to be higher than nonmotor scores. Nonmotor scores were significantly lower than the normative mean and decreased with testing age. Children with acquired deafness demonstrated lower motor scores than children with congenital causes. Children with higher motor scores demonstrated significantly higher performance on language, vocabulary, and word recognition tests than children with lower motor scores. Nonmotor domains were not as robustly related to spoken-language measures, although similar trends were observed. CONCLUSION: Profound deafness and language delay may confound the assessment of daily living skills and socialization in the population studied. Motor development appears to proceed normally in prelingually deafened children and is a preimplant predictor of spoken-language outcome in young infants and children with cochlear implants, a finding consistent with the large body of work establishing links between perceptual-motor and language development.

Activities of Daily Living↗

PubMed2001

Measuring language development in deaf children with cochlear implants.

For the past ten years profoundly deaf children in the UK have been able to receive cochlear implants as an alternative to conventional hearing aids. The South of England Cochlear Implant Centre (SOECIC) has implanted 78 profoundly deaf children. As cochlear implantation is still a relatively new procedure it is important to record progress comprehensively. One of the main aims of implantation is to give the recipient access to sound so that, in the case of a child, they can acquire speech and language. There is a need for a test that assesses a wide range of language abilities and which is also sensitive to change. The Preschool Language Scales-3 (UK) (PLS-3)(Zimmerman et al. 1997) has been standardised on a British population and was chosen to be part of a test battery at SOECIC. The test assesses skills from birth to seven years of age and has been administered at regular intervals to the clinic population. The outcome results show that average scores improve with use following implantation.

Child↗