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PubMed2003

[Contralateral electrically evoked reflex of the musculus stapedius in patients with cochlear implant].

Registration of electrically evoked reflex is widely applied in rehabilitation of patients by cochlear implantation. As a rule, visual assessment of the ipsilateral reflex is made intraoperatively for functional evaluation of surgical results. Of interest is use of contralateral electrically evoked reflex of the musculus stapedius in the course of adjustment of the speech processor. We studied the latter reflex in 20 patients with cochlear implants Cl24M and Cl22 made by 'Cochlear'. 13 patients used Sprint processors, 7 patients - Spectra ones. Zodiak impedansometer registered the reflex which was recorded in 12 patients. The threshold of the reflex registration correlated well with comfortable perception of loudness. Most of the patients evaluated threshold (for the reflex) sound perception as the sound of moderate loudness. The conclusion is made that registration and analysis of the contralateral electrically evoked reflex can assess a comfortable stimulation level in adjustment of speech processors in patients with cochlear implants.

Adolescent↗

PubMed1998

The Clarion Multi-Strategy Cochlear Implant--surgical technique, complications, and results: a single institutional experience.

OBJECTIVE: This study aimed to review a single institution's experience with Clarion Multi-Strategy Cochlear Implant with respect to surgical technique, surgical complications, and rehabilitative outcome. STUDY DESIGN: This study was a review of patients implanted with the Clarion Multi-Strategy Cochlear Implant. SETTING: The setting was a tertiary referral center with care delivered in the inpatient and outpatient environment. PATIENTS: The first 37 patients were implanted under an Investigational Device Exemption as part of the Food and Drug Administration (FDA) clinical trial of the Clarion implant. Subsequent patients were implanted after the device received FDA approval. Patients met the following criteria for implantation: 18 years of age or older, psychological and emotional stability, profound postlingual deafness without evidence of middle ear disease, one cochlea at least partially patent, and marginal or no benefit from conventional hearing aids. INTERVENTION: Patients received implantation with the Clarion Multi-Strategy Cochlear Implant. MAIN OUTCOME MEASURES: Measured were presence or absence of surgical complications and auditory performance with open- and closed-set word and sentence recognition testing. RESULTS: A total of 47 patients have been implanted. Three patients have suffered complications: two cases of delayed-onset facial palsy both resolved with steroid therapy and one case of internal cochlear stimulator migration required refixation. Significant improvement in speech understanding has been seen in the majority of patients who were implanted within the first 6 months of device use. Specifically, at 6 months, scores on CID (Central Institute for the Deaf) sentences (implant alone) improved from a preoperative mean of 9% to a mean of 72%, and scores on the NU-6 (Northwestern University) monosyllabic word test increased from a preoperative mean of 3% (range, 0-20%) to a mean of 32% (range, 0-70%). More than two thirds (68%) of the adults were able to understand at least 50% of sentences over the telephone, and half were able to understand at least 75% of the sentence material. CONCLUSIONS: The authors' institutional experience with the Clarion Multi-Strategy Cochlear Implant shows minimal surgical morbidity and significant improvement on all open-set test measures of sentence and word recognition.

Adult↗

PubMed2002

Cochlear implantation in children with inner ear malformations: report of two cases.

UNLABELLED: Cochlear implantation of congenitally deaf children with inner ear malformations is gaining special interest. Although the number of the reported cases is increasing, the decision for implantation needs thorough investigation. Preoperative evaluation, surgical approach and postoperative follow-up can be challenging. STUDY DESIGN: A retrospective analysis of two cases with inner ear malformations. PATIENTS: One patient was a 3-year-old-girl who had cochlear and cochleovestibular nerve aplasia on the left side and incomplete partition on the other side. The other patient was a 5-year-old-boy who had hypoplastic cochlea on both sides. Both of them also had vestibular anomalies. Cases were implanted by using multichannel cochlear implant. RESULTS: No complications were encountered. Both patients responded to acoustic stimuli, and their speech perception skills were improved. After 10 months of cochlear implant use, their results seem encouraging. CONCLUSION: Except cochlear or cochleovestibular nerve agenesis, inner ear malformations cannot be accepted as a contraindication for cochlear implantation. Although there can be difficulties during the surgery or in the postoperative period, patients with inner ear malformations can also benefit from cochlear implantation. It is essential that all possible complications and postoperative performance should be discussed with the parents.

Audiometry↗

PubMed1997

A model of educational resource use by children with cochlear implants.

We have tracked patterns of use of educational and rehabilitative resources as part of an initial assessment of cost-benefit ratios of cochlear implants in children. Forty-two children with cochlear implants in the Listening Center at Johns Hopkins program of aural rehabilitation have served as our study cohort to develop the measures to be assessed. An educational resource matrix stratifies school setting (residential vs special education vs non-specialized "mainstream" setting) and levels of rehabilitative support (speech and language therapy and interpreter use) to map past and current use of these services. Initial cost-benefit projections based on observed advancement toward educational independence in the educational resource matrix indicate an extremely favorable net present value of the implant (cost savings minus cost). These cost-benefit projections will need to be supplemented with measures of the impact on quality of life and future educational and vocational options to determine the overall cost-effectiveness of cochlear implants in children.

Baltimore↗

PubMed2004

Outcomes for cochlear implant users with significant residual hearing: implications for selection criteria in children.

OBJECTIVES: To develop an evidence-based technique for providing recommendations to candidates for cochlear implantation with significant residual hearing and to assess the efficacy of the approach. DESIGN: Modified selection criteria were derived from an analysis of the postoperative performance for a large group of adult cochlear implant users. In particular, the distributions of results for implant users with significant preoperative open-set speech perception were reviewed. This suggested that the candidates had a good chance (>75%) of overall improvement if they obtained open-set sentence scores in quiet of up to 70% in the best-aided condition and scores of up to 40% in the ear to undergo implantation. PATIENTS: A group of 45 adult implantation candidates who fit the modified criteria and who underwent preimplantation and postimplantation assessment to compare actual results with those predicted from the distributions. RESULTS: The speech perception results showed that 36 subjects (80%) had improved open-set sentence scores with the cochlear implant compared with their best-aided preoperative performance (mean improvement, 20.5%). Forty-four (98%) had improved open-set sentence scores for the ear undergoing implantation (mean improvement, 65.3%). CONCLUSIONS: The general concept of using the distribution of speech perception results to make evidence-based recommendations for candidates for cochlear implants is supported by this study. The approach can be used across different subpopulations, including older children with significant residual auditory skills, and for different outcome measures. It is important that the data used to provide recommendations and modify selection criteria are from an unselected sample of implant users of adequate size. This study highlights the continuing need to evaluate speech perception performance carefully before and after cochlear implantation.

Adult↗

PubMed1999

Intracochlear position of cochlear implant electrodes.

There are many different types of cochlear implants available on the market today and they are constantly being re-evaluated and changed. Knowledge of the exact position of the electrode within the cochlea is important in order to improve the electrical stimulation of the hearing nerve by the implants. The stimulating electrodes are usually located peripherally within the scala tympani, although several attempts have been made to develop peri-modiolar located electrode arrays. In this study, our goal was to evaluate the intracochlear positions of Nucleus, Combi 40/Combi 40 +, and newly developed peri-modiolar positioned electrodes by inserting them into fresh human temporal bones. After insertion, the bones were then histologically processed with the electrodes in situ, following perilymphatic formalin perfusion and methylmethacrylate embedding. Sections of the bones 80-100 microm thick were prepared using a sawing, grinding and polishing technique. This technique resulted in excellent preservation of the inner ear structures and clear identification of each electrode. The different types of electrodes were then evaluated as to their insertion depth, trauma to cochlear structures and location in relation to the scala tympani walls.

Cadaver↗

PubMed2002

Influence of age at implantation and of residual hearing on speech outcome measures after cochlear implantation: binary partitioning analysis.

The goal of this study was to evaluate speech understanding outcomes in prelingually deaf children who use a cochlear implant device. Specifically, we discuss investigations on 2 prognostic variables--age at implantation and degree of residual hearing--and use a novel method: binary partitioning analysis. Our outcome measures are standard speech perception evaluations, including the Word Intelligibility by Picture Identification (WIPI) test, the Phonetically Balanced-Kindergarten (PBK) test, and the Glendonald Auditory Screening Procedure (GASP). Regarding age at implantation, we definitely showed that growth rates of speech understanding do relate to age at implantation, but not in a simple fashion. We used binary partitioning in an attempt to find the age at implantation that best separates the performances of children with younger versus older ages at implantation. We found that there is no one "critical age"; much appears to depend on the nature and difficulty (eg, whether open- or closed-set) of the test used. Regarding residual hearing, binary partitioning analysis was unable to show that the amount of residual hearing (as shown by preimplantation audiometric data) has any significant bearing on speech outcome measures in congenitally or prelingually deaf children.

Adolescent↗

PubMed2002

Better speech performance in cochlear implant patients with GJB2-related deafness.

OBJECTIVE: We applied mutation screening in seven cochlear implant users to identify those persons with GJB2-related deafness to determine whether etiology of deafness was predictive of speech performance after implantation. METHODS: Direct sequence of GJB2 was conducted over seven cochlear implant users with prelingual hearing impairment and their speech, language and cognitive performance was examined. RESULTS: The three persons with GJB2-related deafness had a mean vocabulary of 1243 words compared to a mean vocabulary of 195 words in the four children with GJB2-unrelated deafness, although the number of patients examined here was limited. The developmental quotient (DQ) of cognitive ability also was higher in those children with GJB2-related deafness. CONCLUSIONS: These preliminary results suggest that better speech performance after cochlear implantation may be observed in persons with GJB2-related deafness. In the future, detailed phenotypic studies and mutation screening for non-syndromic hearing loss may play an important role in the preoperative assessment of prelingually-deafened children.

Audiometry↗

PubMed2000

The influence of residual high-frequency hearing on the outcome in congenitally deaf cochlear implant recipients.

OBJECTIVE: To show that congenitally deaf children who receive a cochlear implant between 10 and 15 years of age find it significantly more difficult to learn the new signal, and that a history of sound detection at high frequencies with hearing aids is predictive of better outcomes in these children. STUDY DESIGN: A retrospective study using a within-subjects design. SETTING: Children's Cochlear Implant Centre, Sydney (CCIC), Royal Prince Alfred Hospital, and the New Children's Hospital in Westmead are tertiary referral centers. PATIENTS: Forty-five congenitally deaf patients were grouped according to their age (in years) at implantation into group 1 (aged 10-15), group 2 (aged <10), group 2a (aged 6-9), and group 2b (aged 3-5). Within each group, individuals with previous hearing between 2 and 4 kHz before receiving a cochlear implant were identified, and their mean results were compared with those in their respective age-matched groups. INTERVENTIONS: Surgical implantation, intensive weekly habilitation at the CCIC. MAIN OUTCOME MEASURES: Speech perception, speech production, and language measures were compared. Questionnaires and telephone interviews were conducted. RESULTS: Group 2 (age <10 years) consistently outperformed group 1 (10-15 years) on all outcome measures, and most of them learned to converse without lipreading. In group 1, children with previous aided hearing at high frequencies displayed exceptional gains in speech perception and speech production, with reduced dependence on lipreading. Previous high-frequency hearing does not benefit group 2. CONCLUSIONS: Implant recipients aged 10 to 15 years experience more difficulty than younger children during the initial periods of device use. A history of high-frequency hearing before implantation in these individuals correlates with more rapid improvement.

Adolescent↗

PubMed2004

Prospective evaluation of intraoperative cochlear implant radiographs.

OBJECTIVE: To investigate the clinical utility of intraoperative plain radiographs in cochlear implant surgery. STUDY DESIGN: Prospective. SETTING: Tertiary referral center. PATIENTS: Eighty consecutive adult and pediatric cochlear implant operations at a facility capable of intraoperative radiographs were evaluated over 12 months. INTERVENTIONS: Intraoperative plain radiographs to assess implant location and surgeon questionnaire. MAIN OUTCOME MEASURES: Plain radiographic image interpretation and surgeon questionnaire. RESULTS: In one revision surgery, the intraoperative plain radiograph was useful for confirming the cochleostomy site. In the remaining 79 operations, no changes in the electrode arrays were made on the basis of the information provided by intra-operative plain radiographs. CONCLUSIONS: In this cohort, intraoperative plain radiographs were not useful for uncomplicated implant operations; however, they may be useful for complicated operations. These results may have implications for surgical cost and patient radiation exposure.

Adult↗

PubMed1993

A comparison of speech discrimination with cochlear implants and tactile aids.

This study investigates patterns of speech discrimination in profoundly hearing-impaired children who have received cochlear implants or tactile aids. The change/no change procedure was used to assess speech discrimination in these children. Three groups of subjects were tested: the first group used 3M/House single-channel cochlear implants; the second group used Nucleus 22-channel cochlear implants; and the third group used two-channel Tactaid II+ vibrotactile aids. Nine contrasts were constructed that assessed discrimination of suprasegmental and segmental speech features. Subjects were presented with stimulus trials in which stimuli changed during the trial or in which stimuli remained the same. Hits, misses, false alarms, and correct rejections were tallied and d' values were calculated for individual subjects for each contrast. Results indicated that different patterns of speech discrimination are provided by the three sensory prosthetic devices. For all contrasts, mean discrimination performance with the Nucleus device was better than that observed for the other two devices, despite the shorter duration of subject experience with this cochlear implant. In addition, interactions between device and speech contrast were not observed. Examination of individual subject performance revealed that each device group had a distribution of good to poor performers. The results suggest that the change/no change procedure is able to provide information regarding speech perception through sensory prosthetic devices despite existing differences in vocabulary and language skills of subjects.

Acoustic Stimulation↗

PubMed2000

Fixation of the electrode array with bone paté in cochlear implant surgery.

The aims of this study are to report on our experiences using a bone paté (a mixture of bone dust and fibrin glue) fixation technique of the Combi 40/Combi 40+ electrode array during cochlear implant surgery. A retrospective study involving 57 patients implanted with Combi 40/Combi 40+ cochlear implants over 31 months fixated with bone paté was performed, utilizing our electrical fitting data as well as re-operation and X-ray findings. We found no signs of electrode retraction in any of the 57 patients. Electrical fitting data showed no reduction in the number of active channels between the first and last times patients were evaluated (a period of 4-31 months). Furthermore, a comparison of X-rays performed within the first week following cochlear implant surgery and again 7-27 months later showed no signs of electrode retraction in 10 patients. Three patients who required re-operations after implantation allowed us the opportunity to examine the effectiveness of the bone paté fixation and revealed new bone growth with the electrode fixed in place. Histological examinations of the newly built bone showed laminar and compact bone structures. The use of bone paté was thus found to be a suitable method of electrode fixation in cochlear implant surgery. Compared with other fixation methods, it is inexpensive and uses no foreign materials.

Adult↗

PubMed2005

Preservation of hearing in cochlear implant surgery: advantages of combined electrical and acoustical speech processing.

OBJECTIVES/HYPOTHESIS: This study documents the importance of preserving residual low-frequency acoustic hearing as those with more residual hearing are selected for cochlear implantation. Surgical strategies used for hearing preservation with a short hybrid cochlear implant are outlined. The benefits of preserved residual low-frequency hearing, improved word understanding in noise, and music appreciation are described. STUDY DESIGN: Multicenter, prospective, single-subject design. METHODS: Records were reviewed of 21 individuals participating in an Food and Drug Administration (FDA) feasibility clinical trial who have received an Iowa/Nucleus 10 mm electrode. A second group of subjects receiving implants at the University of Iowa that have used the 10 mm device between 2 years and 6 months were also reviewed. Outcome measures included standardized tests of monosyllabic word understanding, spondees in noise, and common melody recognition. RESULTS: Low-frequency hearing was maintained in all individuals immediately postoperative. One subject lost hearing at 2.5 months postoperative after a viral infection. The group has averaged a loss of -9 dB low-frequency acoustic hearing between 125 and 1,000 Hz. Monosyllabic word understanding scores at 6 months for a group being followed for an FDA clinical trial using the implant plus hearing aids was 69% correct. For the long-term group receiving implants at Iowa, monosyllabic word understanding in those who have used the device between 6 months and 2 years is 79%. Other important findings include improved recognition of speech in noise (9 dB improvement) as compared with standard cochlear implant recipients who were matched for speech recognition in quiet and near normal recognition of common melodies. CONCLUSION: The surgical strategies outlined have been successful in preservation of low-frequency hearing in 96% of individuals. Combined electrical and acoustical speech processing has enabled this group of volunteers to gain improved word understanding as compared with their preoperative hearing with bilateral hearing aids and a group of individuals receiving a standard cochlear implant with similar experience with their device. The improvement of speech in noise and melody recognition is attributed to the ability to distinguish fine pitch differences as the result of preserved residual low-frequency acoustic hearing. Preservation of low-frequency acoustic hearing is important for improving speech in noise and music appreciation for the hearing impaired, both of which are important in real-life situations.

Audiometry, Pure-Tone↗

PubMed2000

Monaural and binaural loudness measures in cochlear implant users with contralateral residual hearing.

OBJECTIVE: The aim was to measure the loudness of monaural and binaural stimuli in a group of cochlear implant users who had residual hearing in the nonimplanted ear, and to consider the implications of these measures for a binaural fitting consisting of a hearing aid and an implant in opposite ears. Three independent hypotheses were addressed: that the shapes of the electric and acoustic loudness growth functions would be similar, although the dynamic ranges would differ; that standard implant and hearing aid fittings would result in substantial loudness mismatches between the acoustic and electric signals; and that loudness summation would occur for binaural combinations of electric and acoustic signals. DESIGN: A modified version of the "Loudness Growth in 1/2-Octave Bands" method (Allen, Hall, & Jeng, 1990) was used to measure loudness growth for each ear of nine subjects. At the time of the experiment, the subject group included all implant users in Melbourne and Denver who were available for research and who also had sufficient residual hearing to use a hearing aid in the nonimplanted ear. Five acoustic frequencies and five electrodes were measured for each subject. The same subjects also estimated the loudness of a set of stimuli including monaural and binaural signals chosen to cover the loudness range from very soft to loud. RESULTS: The shapes of the averaged loudness growth functions were similar in impaired and electrically stimulated ears, although the shapes of iso-loudness curves were quite different in the two ears, and dynamic ranges varied considerably. Calculations based on the psychophysical data demonstrated that standard fitting procedures for cochlear implants and hearing aids lead to a complex pattern of loudness differences between the ears. A substantial amount of loudness summation was observed for the binaural stimuli, with most summation occurring when the acoustic and electric components were of equal loudness. This is consistent with observations for subjects with normal hearing and subjects with bilaterally impaired hearing. CONCLUSIONS: These experiments provide data on which criteria and methods for the binaural fitting of cochlear implants and hearing aids may be based. It is unlikely that standard monaural fitting methods for cochlear implants and hearing aids will result in balanced loudness between the two ears across a reasonably broad range of frequencies and levels. It is also likely that output levels of both devices will need to be reduced relative to a monaural fitting to compensate for the binaural summation of loudness in some listeners.

Adult↗

PubMed2006

Residual hearing conservation and electroacoustic stimulation with the nucleus 24 contour advance cochlear implant.

OBJECTIVE: To assess the conservation of residual hearing in recipients of the Nucleus 24 Contour Advance cochlear implant (CI) and the benefits of combined electrical and acoustic stimulation. STUDY DESIGN: Prospective multicenter study. SETTING: CI clinics in Western Europe. PATIENTS: Adult candidates for conventional cochlear implantation with a minimum preoperative word recognition score of 10% in the ear to be implanted. INTERVENTION: "Soft-surgery" protocol, including a 1- to 1.2-mm anterior and inferior cochleostomy hole with the electrode array, inserted 17 mm using the "advance-off-stylet" technique. Patients with postoperative pure-tone hearing threshold levels (HTLs) of 80 dB hearing loss or less at 125 and 250 Hz and 90 dB hearing loss or less at 500 Hz were refitted with an in-the-ear hearing aid for combined ipsilateral electrical and acoustic (El-Ac) stimulation. MAIN OUTCOME MEASURES: A questionnaire to collect information regarding surgery. Pure-tone HTLs measured at intervals. Word recognition tested in quiet and sentence recognition tested in noise at 10 and 5 dB signal-to-noise ratio (SNR). HEARING CONSERVATION RESULTS: HTL data were available for 27 patients. HTLs were conserved within 20 dB of preoperative levels for 33, 26, and 19% of patients for 125, 250, and 500 Hz, respectively. However, the recommended soft-surgery protocol was strictly followed in only 12 of 27 patients. For these 12 patients, hearing thresholds were conserved within 20 dB for 50, 50, and 33% of patients. Median threshold increases were 40 dB (range, 250-500 Hz) for the whole group and 23 dB for the strict surgery group. Ten patients retained sufficient HTLs to enter the El-Ac user group. SPEECH RECOGNITION RESULTS: Group mean recognition scores for nine El-Ac users for words presented at 65 dB sound pressure level were 45% for CI alone and 55% for CI + ipsilateral hearing aid (p < 0.05, paired t). For sentences presented in noise at 5 dB SNR, mean word scores were 46% CI alone and 56% CI + ipsilateral hearing aid (p < 0.01, paired t). CONCLUSION: Hearing was conserved for conventional candidates for cochlear implantation where the recommended soft-surgery protocol was strictly adhered. Combined ipsilateral electrical and acoustic stimulation provided considerable benefits for speech recognition in noise, equivalent to between 3 and 5 dB SNR, compared with CI alone.

Acoustic Stimulation↗

PubMed1991

[The "Ineraid" multichannel cochlear implant].

In Geneva from 1985 to November 1990, we have implanted 21 Ineraid TM multichannel-cochlear implants in 18 totally deaf patients. On the basis of our experience we have divided the patients in 2 categories: optimal cases and difficult cases. Optimal cases had post lingual deafness and adequate anatomical conditions for implantation. They all recovered understanding of free running speech without lip-reading. Difficult cases had ossified cochlea or pre-and-perilingual deafness: results are variable and less predictable. The cochlear implant is both an artificial sense organ and a prosthetic device. With the aid of the prothesis the patient can hear. When the processor stops functionning the patient is again totally deaf. Implanted deaf patients require life-long technical and medical support.

Cochlear Implants↗

PubMed2001

Use of the telephone in prelingually deaf children with a multichannel cochlear implant.

OBJECTIVE: To assess progress in the use of the telephone in a group of prelingually deaf children after cochlear implantation. SETTING: Tertiary referral pediatric cochlear implant center in the U. K. STUDY DESIGN: A prospective study was undertaken on a consecutive group of 150 congenital and prelingually deaf children up to 5 years after implantation. The study group was confined to prelingually deaf children aged less than 7 years at the time of implantation. No child was lost to follow-up, and there were no exclusions from the study. At the time of the study, 129 children had reached the 1-year stage, and 91, 68, 40, and 23 had reached the 2-, 3-, 4-, and 5-year intervals, respectively. METHODS: A specifically designed profile was used to assess the telephone use of the implanted children. Regression analysis was used to assess the correlation between the results of the telephone profile with the outcomes of the Iowa sentence test and connected discourse tracking. RESULTS: After implantation, prelingually deaf children showed significant progress in telephone use over time, not reaching a plateau at the 5-year interval (median score 27 with maximum score available 34). The results of the telephone profile showed significant correlations with the other tests of speech perception (correlation coefficients from 0.47 to 0.79, all statistically significant p < 0.0001). CONCLUSION: The telephone profile provided a useful method of monitoring children's telephone use. The profile was easily administered, and it was sensitive in assessing the progress of prelingually deaf children with cochlear implants. Outcomes from the profile were highly correlated with results from other widely used closed- and open-set tests.

Child↗

PubMed2006

[Model oriented assessment of literacy performance in children with cochlear implants].

BACKGROUND: Although most hearing-impaired children lag behind normally hearing children in literacy acquisition, this aspect has hardly been addressed in the evaluation of language acquisition after cochlear implantation. The present study investigated written language abilities in 8 school-age children with cochlear implants. Neurolinguistic dual-route-models of written language processing indicate that literacy acquisition leads to the establishment of two distinct reading and writing strategies: a lexical one for the quick processing of known words and a sublexical one for decoding unfamiliar words or nonwords letter by letter. PATIENTS: 8 school-aged children were investigated, a very heterogeneous group concerning age of onset of hearing impairment, educational placement, and competences in sign language. However, this range is typical of the group of CI-children. METHODS: The aim was to investigate if children with cochlear implants are able to establish both strategies or if they need to find a differential and individual access to written language. Performance within the Salzburger Lese-Rechtschreib-Test was evaluated. Individual performance of each subject was analysed. RESULTS: Performance varied substantially ranging from only rudimentary spoken and written language abilities in two children to age-equivalent performance in three of them. Severe qualitative differences in written language processing were shown in the remaining three subjects. Suggestions for remediation were made and a re-test was carried out after 12 months. Their individual profiles of performance are described in detail. CONCLUSIONS: The present study stresses the importance of a thorough investigation of written language performance in the evaluation of language acquisition after cochlear implantation. The results draw a very heterogeneous picture of performance. Model-oriented testing and analysis of performance prove to be sensible in at least a subpopulation of children with cochlear implants. Based on a better understanding of their acquired word-processing strategies, remediation programs meeting the needs of each individual child can be derived.

Age Factors↗