outcomes of paediatric cochlear implantation in single ......1 dept audiology & speech...

1 Dept Audiology & Speech Pathology, The University of Melbourne, Australia 2 Cochlear Implant Clinic, Royal Victorian Eye and Ear Hospital, Melbourne, Australia 3 HEARing CRC, Melbourne, Australia 4 Dept Surgery, The University of Melbourne, Australia

Outcomes of Paediatric Cochlear implantation in Single-Sided Deafness or very Asymmetrical Hearing Loss (SSD/AHL)

Karyn Galvin1, Michelle Todorov1, Rebecca Farrell2, Robert Briggs1,2,3,4, Markus Dahm2, Jaime Leigh2

•  the work reported here involves off-label use of the Nucleus CI

Off-label declaration

ACI Alliance CI2017 San Francisco July 27-29 2017

•  Karyn Galvin: University of Melbourne Department of Audiology & Speech Pathology received project-based funding from Cochlear Ltd.

•  Michelle Todorov: University of Melbourne Department of Audiology & Speech Pathology received project-based funding from Cochlear Ltd.

•  Rebecca Farrell: none •  Robert Briggs: University of Melbourne Department of Audiology & Speech Pathology

received project-based funding from Cochlear Ltd.; A/Prof Briggs acts as a consultant to Cochlear Ltd.

•  Markus Dahm: none •  Jaime Leigh: none

Disclosures


•  document families’ preoperative expectations & postoperative experiences •  conduct a broad assessment of CI benefit •  consider impact of child demographics

Project aims


•  profound hearing loss in one ear (onset <12y age) •  contralateral ear does not fulfil current CI criteria

Selection criteria


P1: Preoperative Audiogram


Frequency (Hz)

0 10 20 30 40 50 60 70 80

250 500 1000 2000 4000

Hearing Level

(dB HL)

90 100 110 120

8000

AGE AT CI: 10y4m

HL Detected 2y9m

LVAS (progressive)

Left HA worn full time

Time point Parent report From switch-on •  adapted easily to CI •  usage full-time

At 6m •  significantly reduced reliance on lipreading, FM system, and positioning speaker on “good” side

At 12m •  improved ability to follow group conversation & locate speaker within the home

At 21m •  very reliant on CI (preferred over HA)

P1 Results: Functional outcomes


Speech perception test setup

speech

Better ear

CI noise

speech

Better ear

CI

noise

noise centre Co-incident speech & noise:

noise contra Speech at 00 & noise 900 contralateral to CI:


P1 Results: Speech perception (4AFC spondees)


•  1800 8-loudspeaker array

Spatial hearing test setup: Localisation


P1 Results: 8-loudspeaker localisation

8

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1 2 3 4 5 6 7

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•  parent rates child’s performance in everyday listening situations •  three separate areas of assessment

•  speech •  spatial hearing •  qualities of hearing

Speech, Spatial & Qualities of Hearing Scale


P1 Results: SSQ-Parent


Similar pattern of results with child self-report version

* p<0.05

Participant & Postoperative time point

P1 24m

Usage √ Functional reports √ Speech perception in noise testing X Spatial hearing testing √ Everyday listening (SSQ) √ Quality of life √ Classroom engagement X Classroom participation √

Summary of Results




CMV; premature

AGE AT CI: 6y11m

HL Detected 2y9m

Right HA worn full time

Frequency (Hz)

0 10 20 30 40 50 60 70 80

250 500 1000 2000 4000

Hearing Level

(dB HL)

90 100 110 120

8000

V V V V

Time point Parent report By 3m •  usage 70%

At 12m •  child generally wearing CI without prompting

•  no evident CI benefit


Clinician report Early months •  data logging 1.5hr/day

•  increase in usage over time; may be due to

better tolerance of lower level maps trialed to promote usage


P1 & P2: Summary of Results


P1 24m

P2 12m

Usage √ √ ?? Functional reports √ X Speech perception in noise testing X X

Spatial hearing testing √ X Everyday listening (SSQ) √ X Quality of life √ - Classroom engagement X - Classroom participation √ -




Meningitis at 6wks

AGE AT CI: 3m (ossification evident)

Frequency (Hz)

0 10 20 30 40 50 60 70 80

250 500 1000 2000 4000

Hearing Level

(dB HL)

90 100 110 120

8000

X

Time point Parent report From switch-on •  adapted easily to CI use

At 6m •  usage 6hr/day WITH CI ON: •  more content & engaged •  increased frequency & variety of babbling •  better able to identify sound direction

By 12m •  full-time use of HA+CI (HA fitted 7m) •  speech & language progressing well



P1 to P3: Results Summary


P1 24m

P2 12m

P3 12m

Usage √ √ ?? √ Functional reports √ X √ Speech in noise testing X X - Spatial hearing testing √ X √ (LvsR) Everyday listening (SSQ) √ X - Quality of life √ - - Classroom engagement X - - Classroom participation √ - -




Family Hx

HL Detected 3y6m

AGE AT CI: 10y4m

Frequency (Hz)

0 10 20 30 40 50 60 70 80

250 500 1000 2000 4000

Hearing Level

(dB HL)

90 100 110 120

8000

Time point Parent report From switch-on •  usage 8.5hr/day •  happy to wear CI but hides it with

hoodie

By 6m •  usage full-time •  takes responsibility for CI

•  no evident CI benefit

P4: Functional outcomes


P4 Results: 8-loudspeaker localisation

8

1

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3

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5

6

7

8

1 2 3 4 5 6 7

P

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N .potsopshtnom6H

8

1

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8

1 2 3 4 5 6 7

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P1 to P4: Results Summary Participant &

Postoperative time point P1

24m P2

12m P3

12m P4 6m

Usage √ √ ?? √ √ Functional reports √ X √ X Speech in noise testing X X - X Spatial hearing testing √ X √ X Everyday listening (SSQ) √ X - X Quality of life √ - - - Classroom engagement X - - - Classroom participation √ - - -


P5 5m

P6 6m

P7 7m

Etiology Family Hx Meningitis LVA

Onset Assumed cong (diag 7y) 2y10m 6y

Age at CI 11y10m 6y0m 15y5m

Usage √ √ X

P1 to P7: Results Summary

Participant & Postop time point

P1 24m

P2 12m

P3 12m

P4 12m

Usage √ √ ? √ √ Functional reports √ X √ X Speech in noise testing X X - X Spatial hearing testing √ X √ X Everyday listening (SSQ) √ X - X Quality of life √ - - - Classroom engagement X - - - Classroom participation √ - - -


•  CI for SSD/AHL presents challenges and opportunities

•  careful research is required to: –  evaluate benefit (administer broad assessment protocol) –  track progress longer term (usage) –  determine influential factors

•  end result of research must be evidence-based pre and postoperative counselling and clinical management practices

In conclusion


•  contribution of: –  participating children and their families –  Staff of the Royal Victorian Eye & Ear Hospital Cochlear Implant Clinic, Melbourne

•  financial supporters of the work reported: –  University of Melbourne Department of Audiology & Speech Pathology –  Royal Victorian Eye and Ear Hospital –  William Angliss Charitable Fund –  Collier Charitable Fund

THANK YOU!

Acknowledgements


outcomes of paediatric cochlear implantation in single ......1 dept audiology & speech...

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