International Journal of Pediatric Otorhinolaryngology, 1999
Previous animal research and clinical experiences in humans suggest the existence of an auditory ... more Previous animal research and clinical experiences in humans suggest the existence of an auditory critical period in language acquisition. We review the literature and present the changes within the cochlear nuclei in bilaterally deafferentated adult non-human primates. We also present and analyse the results of 98 prelingually deaf children and teenagers who underwent a cochlear implantation at the University of Navarra. Patients received a Nucleus 22 or 24 multichannel cochlear implant (CI). They were grouped in five categories according to their age at surgery. Performance is compared with a control group of 58 postlinguals. Only early-implanted prelingual children (before 6 years of age) achieved a complete open-set speech recognition, even with better performance than postlinguals. These results clearly demonstrate the existence of a period of high neural auditory plasticity within the first 6 years of life. The introduction of auditory stimulation with a CI can not restore the loss of neural plasticity out of this period. Prelingual children under 6 years of age should receive a CI as soon as there is a reliable diagnosis of bilateral sensorineural hearing loss.
The objectives of this study were to report the long-term auditory results of prelinguistically d... more The objectives of this study were to report the long-term auditory results of prelinguistically deafened children with bilateral profound hearing impairment treated with a cochlear implant (CI); to analyze the role of auditory stimulation in the development of communicating abilities in early implanted children; and to define the limits of the auditory critical period. It was designed as a prospective cohort single-subject repeated-measures study of children with bilateral profound hearing impairment treated with a CI at a tertiary referral center with a pediatric CI program since 1991. A total of 182 children with bilateral prelinguistic hearing impairment of profound degree treated with a Nucleus CI were enrolled in the study. Eighty-six children received a Nucleus 22 CI and 74 received a Nucleus 24. For data analyses the children were categorized by ages: 0-3 years of age (n = 94); 4-6 years (n = 36); 7-10 years (n = 30); 11-14 years (n = 22). The children were evaluated with a protocol that included tests of audition and speech perception, with closed-set (Vowel Confusion test, Series of Daily Words) and open-set tests (e.g. bisyllables, CID Sentences, CID Sentences adapted for children). Pure-tone averages significantly improved for all children in all groups with the CI compared with preoperative values. Nevertheless, only children implanted before the age of 6 years developed a high ability for recognition of bisyllables and sentences in an open-set. Results show that the earlier the implantation is undertaken, the better the performance outcome. Children implanted outside of the auditory critical period demonstrated significantly poorer performance, suggesting the occurrence of irreversible changes in the central auditory system. In conclusion, eligible children should receive a CI as soon as bilateral profound hearing impairment is diagnosed. This usually permits them to achieve high-performance levels on speech and language measures and potentially integration into an oral communication environment.
This study is aimed to analyze the current indications and counterindications of cochlear implant... more This study is aimed to analyze the current indications and counterindications of cochlear implantation (CI) in children. This study reviews the children implanted in our institution looking specifically at the following aspects: 1) auditory criteria for candidate selection; 2) age at implantation; 3) educational environment; and 4) associated handicapping conditions. Tertiary referral center with experience in CI since 1989 with inpatient and outpatient care. All children received a Mini Nucleus 22 CI device (Cochlear Limited, Australia) in a standard surgical procedure. Regarding auditory criteria, children with average hearing level of 100-105 dB HL are more likely to obtain benefit from a CI than from a hearing aid. The minimum age for CI should be as soon as there is a reliable diagnosis of bilateral profound hearing loss, while the maximum age for CI depends on strict selection criteria of candidates. The educational environment is of a great importance in the rehabilitation pr...
International Journal of Pediatric Otorhinolaryngology, 1999
Previous animal research and clinical experiences in humans suggest the existence of an auditory ... more Previous animal research and clinical experiences in humans suggest the existence of an auditory critical period in language acquisition. We review the literature and present the changes within the cochlear nuclei in bilaterally deafferentated adult non-human primates. We also present and analyse the results of 98 prelingually deaf children and teenagers who underwent a cochlear implantation at the University of Navarra. Patients received a Nucleus 22 or 24 multichannel cochlear implant (CI). They were grouped in five categories according to their age at surgery. Performance is compared with a control group of 58 postlinguals. Only early-implanted prelingual children (before 6 years of age) achieved a complete open-set speech recognition, even with better performance than postlinguals. These results clearly demonstrate the existence of a period of high neural auditory plasticity within the first 6 years of life. The introduction of auditory stimulation with a CI can not restore the loss of neural plasticity out of this period. Prelingual children under 6 years of age should receive a CI as soon as there is a reliable diagnosis of bilateral sensorineural hearing loss.
The objectives of this study were to report the long-term auditory results of prelinguistically d... more The objectives of this study were to report the long-term auditory results of prelinguistically deafened children with bilateral profound hearing impairment treated with a cochlear implant (CI); to analyze the role of auditory stimulation in the development of communicating abilities in early implanted children; and to define the limits of the auditory critical period. It was designed as a prospective cohort single-subject repeated-measures study of children with bilateral profound hearing impairment treated with a CI at a tertiary referral center with a pediatric CI program since 1991. A total of 182 children with bilateral prelinguistic hearing impairment of profound degree treated with a Nucleus CI were enrolled in the study. Eighty-six children received a Nucleus 22 CI and 74 received a Nucleus 24. For data analyses the children were categorized by ages: 0-3 years of age (n = 94); 4-6 years (n = 36); 7-10 years (n = 30); 11-14 years (n = 22). The children were evaluated with a protocol that included tests of audition and speech perception, with closed-set (Vowel Confusion test, Series of Daily Words) and open-set tests (e.g. bisyllables, CID Sentences, CID Sentences adapted for children). Pure-tone averages significantly improved for all children in all groups with the CI compared with preoperative values. Nevertheless, only children implanted before the age of 6 years developed a high ability for recognition of bisyllables and sentences in an open-set. Results show that the earlier the implantation is undertaken, the better the performance outcome. Children implanted outside of the auditory critical period demonstrated significantly poorer performance, suggesting the occurrence of irreversible changes in the central auditory system. In conclusion, eligible children should receive a CI as soon as bilateral profound hearing impairment is diagnosed. This usually permits them to achieve high-performance levels on speech and language measures and potentially integration into an oral communication environment.
This study is aimed to analyze the current indications and counterindications of cochlear implant... more This study is aimed to analyze the current indications and counterindications of cochlear implantation (CI) in children. This study reviews the children implanted in our institution looking specifically at the following aspects: 1) auditory criteria for candidate selection; 2) age at implantation; 3) educational environment; and 4) associated handicapping conditions. Tertiary referral center with experience in CI since 1989 with inpatient and outpatient care. All children received a Mini Nucleus 22 CI device (Cochlear Limited, Australia) in a standard surgical procedure. Regarding auditory criteria, children with average hearing level of 100-105 dB HL are more likely to obtain benefit from a CI than from a hearing aid. The minimum age for CI should be as soon as there is a reliable diagnosis of bilateral profound hearing loss, while the maximum age for CI depends on strict selection criteria of candidates. The educational environment is of a great importance in the rehabilitation pr...
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