The study objective was to quantify abilities of children with unilateral hearing loss (UHL) on measures that address known deficits for this population, i.e. speech understanding in quiet and noise, and sound localisation. Noise conditions varied by noise type and source location. Parent reports of real-world abilities were also obtained. Performance was compared to gender- and age-matched normal hearing (NH) peers. UHL performance was poorer and more varied compared to NH peers. Among the findings, age correlated with localisation ability for UHL but not NH participants. Low-frequency hearing in the better ear of UHL children was associated with performance in noise; however, there was no relation for NH children. Considerable variability was evident in the outcomes of children with UHL and needs to be understood as future treatment options are considered.

Objective This study is designed to test the hypothesis that preservation of residual hearing in a pediatric population is possible using standard electrode arrays with full length insertions. Surgical technique during implantation is also described. Study Design Retrospective review of patient medical records. Setting Academic tertiary care center. Patients Thirty-one severely to profoundly hearing impaired pediatric patients with some residual hearing pre-cochlear implantation. Intervention Cochlear implantation using a modified “soft surgery” protocol. Main Outcome Measures Pre-implant and post-implant pure tone thresholds and pure tone average (PTA) were calculated from unaided pre- and post-operative audiograms from 250, 500, and 1000 Hz. Hearing preservation rates were determined to be either: complete (loss of ≤10 dB), moderate (loss of 11-20 dB), marginal (loss of 21-40 dB), or none (loss of >40 dB or no response at the limits of the audiometer.) Functional residual hearing rates (defined in this study as at least one threshold better than or equal to 75 dB HL for 250, 500, or 1000 Hz) were calculated. Results Complete hearing preservation was achieved in 14/31 patients (45.2%), while 28/31 (90.3%) had at least partial hearing preservation (loss of ≤40 dB). The pre- to post-operative low frequency PTA had a mean change of 18.5 dB and median change of 20 dB. Of the patients who had pre-operative functional hearing, 9/18 (50.0%) maintained functional residual hearing post-operatively for at least one pitch. Conclusion Preservation of residual hearing is feasible in pediatric cochlear implant patients using standard length electrode arrays with full insertions. These data have implications for cochlear implantation in pediatric patients who are at higher risk of progressive hearing loss than adults.

Objective Traditionally, children are cochlear implant (CI) candidates if bilateral severe to profound hearing loss is present and amplification benefit is limited. The current study investigated abilities of adolescents with asymmetric hearing loss (one ear with severe to profound hearing loss and better hearing contralaterally), where the poorer ear received a CI and the better ear maintained amplification. Study Design Within-subject case study Setting Pediatric hospital, outpatient clinic Patients Participants were five adolescents who had not met traditional CI candidacy due to one better hearing ear, but did have one ear that met criteria and was implanted. All maintained hearing aid (HA) use in the contralateral ear. In the poorer ear pre-implant, three participants had used amplification and the other two had no HA experience. Main Outcome Measure Participants were assessed in three listening conditions: HA alone, CI alone, and both devices together (bimodal) for speech recognition in quiet and noise, and sound localization. Results Three participants had CI open-set speech recognition and significant bimodal improvement for speech recognition and localization compared with the HA or CI alone. Two participants had no CI speech recognition and limited bimodal improvement. Conclusions Some adolescents with asymmetric hearing loss who are not typical CI candidates can benefit from a CI in the poorer ear, compared to a HA in the better ear alone. Additional study is needed to determine outcomes for this population, especially those who have early onset profound hearing loss in one ear and limited HA experience.

a Purpose: Whether, and if so when, a second-ear cochlear implant should be provided to older, unilaterally implanted children is an ongoing clinical question. This study evaluated rate of speech recognition progress for the second implanted ear and with bilateral cochlear implants in older sequentially implanted children and evaluated localization abilities. Method: A prospective longitudinal study included 24 bilaterally implanted children (mean ear surgeries at 5.11 and 14.25 years). Test intervals were every 3-6 months through 24 months postbilateral. Test conditions were each ear and bilaterally for speech recognition and localization.Results: Overall, the rate of progress for the second implanted ear was gradual. Improvements in quiet continued through the second year of bilateral use. Improvements in noise were more modest and leveled off during the second year. On all measures, results from the second ear were poorer than the first. Bilateral scores were better than either ear alone for all measures except sentences in quiet and localization. Conclusions: Older sequentially implanted children with several years between surgeries may obtain speech understanding in the second implanted ear; however, performance may be limited and rate of progress gradual. Continued contralateral ear hearing aid use and reduced time between surgeries may enhance outcomes. Bilateral cochlear implantation in children has become more prevalent (Peters, Wyss, & Manrique, 2010) with sequential implantation more common than simultaneous procedures. The dominance of sequential implantation has been driven by the many unilateral pediatric cochlear implant (CI) recipients who were implanted before bilateral implantation was considered and the fact that worldwide, the majority of children continue to be implanted unilaterally (Cullington, Bele, Brinton, & Lutman, 2013;Peters et al., 2010). During the decision process for individual children about second-side implantation, clinicians and families must consider the type and extent of benefit to be expected, for both the second implanted ear and bilaterally, and the rate of improvement to expect after varied years of unilateral CI experience.Pediatric studies have focused on bilateral compared with unilateral performance in the same individual using one of three study designs: bilateral compared with the first implanted (CI1) ear, bilateral compared to the better performing ear (Galvin, Mok, & Dowell, 2007;Kim et al., 2009;Kühn-Inacker, Shehata-Dieler, Müller, & Helms, 2004;Wolfe et al., 2007), or bilateral compared with each ear individually (Galvin, Hughes, & Mok, 2010;Galvin, Mok, Dowell, & Briggs, 2008;Peters, Litovsky, Parkinson, & Lake, 2007;Steffens et al., 2008; for reviews of pediatric sequential bilateral studies, see Dowell et al., 2011;Johnston, Durieux-Smith, Angus, O'Connor, & Fitzpatrick, 2009;Lammers, Venekamp, Grolman, & van der Heijden, 2014;Sparreboom et al., 2010). Most published studies report results from a single time point with participants having varied amounts ...

Background Cochlear implants provide access to soft intensity sounds and therefore improved audibility for children with severe-to-profound hearing loss. Speech processor programming parameters, such as threshold or T-level, Input Dynamic Range (IDR) and microphone sensitivity, contribute to the recipient’s program and influence audibility. When soundfield thresholds obtained through the speech processor are elevated, programming parameters can be modified to improve soft sound detection. Adult recipients show improved detection for low-level sounds when T-levels are set at raised levels, and show better speech understanding in quiet when wider IDRs are used. Little is known about the effects of parameter settings on detection and speech recognition in children using today’s cochlear implant technology. Purpose The overall study aim was to assess optimal T-level, IDR and sensitivity settings in pediatric recipients of the Advanced Bionics cochlear implant. Research Design Two experiments were conducted. Experiment 1 examined the effects of two T-level settings on soundfield thresholds and detection of the Ling 6 Sounds. One program set Ts at 10% of M-levels and another at 10 current units (CUs) below the level judged as “soft”. Experiment 2 examined the effects of IDR and sensitivity settings on speech recognition in quiet and noise. Study Sample Participants were eleven children 7 to 17 years of age (mean 11.3) implanted with the Advanced Bionics High Resolution 90K or CII cochlear implant system and had speech recognition scores of 20% or greater on a monosyllabic word test. Data Collection and Analysis Two T-level programs were compared for detection of the Ling Sounds and frequency modulated (FM) tones. Differing IDR/sensitivity programs (50/0, 50/10, 70/0, 70/10) were compared using Ling and FM-tone detection thresholds, CNC words at 50 dB SPL, and HINT-C sentences at 65 dB SPL in the presence of four talker babble (+8 signal-to-noise ratio). Outcomes were analyzed using a paired t-test and a mixed-model repeated measures analysis of variance (ANOVA). Results T-levels set 10 CUs below “soft” resulted in significantly lower detection thresholds for all six Ling sounds and FM-tones at 250, 1000, 3000, 4000 and 6000 Hz. When comparing programs differing by IDR and sensitivity, a 50 dB IDR with a 0 sensitivity setting showed significantly poorer thresholds for low frequency FM-tones and voiced Ling sounds. Analysis of group mean scores for CNC words in quiet or HINT-C sentences in noise indicated no significant differences across IDR/sensitivity settings. Individual data, however showed significant differences between IDR/sensitivity programs in noise; the optimal program differed across participants. Conclusions In pediatric recipients of the Advanced Bionics cochlear implant device, manually setting T-levels with ascending loudness judgments should be considered when possible or when low-level sounds are inaudible. Study findings confirm the need to determine program settings on an individual bas...