Nonrepaired communication breakdown (silence and minimal response) and the use of communication strategies (nonspecific repair, confirmation repair, wh-question) were studied in children with cochlear implant (s)(CI). Methods: A total of 14 subjects aged between five and eight years old, who had received cochlear implants by five years of age were included. As the control group, age-matched children with normal hearing (NH) were enrolled. The ratios of nonrepaired communication breakdown to the use of repair strategies were determined based on the free conversation between the tester and each individual. The relationship between nonrepaired communication breakdown and use of repair strategies were analyzed using some individual factors such as speech perception, age at the time of cochlear implant surgery, language intelligence (VIQ), and mean length of utterance (MLU). Results: A higher frequency nonrepaired communication breakdown as compared with that of NH, especially the silence type, was observed in the children with CIs. No correlations were observed between nonrepaired communication breakdown and individual factors. As for the communication strategies, both groups used them equally. However, nonspecific repair was used more frequently by the CI group as compared to the NH group. In regard to the correlation between the confirmation repair strategies and individual factors, the VIQ was related to the confirmation repair strategies, the age at implantation and speech perception were not. Conclusion: The results indicated that the use of confirmation repair strategies with improvement of the VIQ might help in maintaining conversation in children with CIs.
The Research on Sensory and Communicative Disorders (RSCD) was originally planned as a nationwide research project to assess the effectiveness of interventional methods for hearing-impaired children. Of the 638 hearing-impaired children who participated in the RSCD project in 2009, 282 (44.2%) were cochlear implant users. Of these, 196 (69.5%) were both cochlear implant plus hearing aid (bimodal stimulation) users, 84 (29.8%) were unilateral-cochlear implant only users, and 2 children (0.7%) were bilateral cochlear implant users. The average hearing loss level was 109.7dB. However, good outcomes of the hearing threshold (35.9dB) and maximum speech discrimination score (80.3%) were observed. A high correlation (r=0.52) was found between the age at cochlear implantation and the maximum speech discrimination score. The scores on the speech and language tests in the children who were under 24 months of age at the time of the cochlear implant surgery were better than those in the children who were over 24 months of age at the time of the surgery. The results of our study indicate that early implantation is beneficial for speech and language development.
After a revision of the Medical Act in 2001, it has become possible for even students with severe hearing impairment to become medical doctors in Japan. Consequently, a student with profound hearing impairment was accepted into the University of Tsukuba School of Medicine. He was the third medical student with hearing impairment to be enrolled in Japan. However, there is as yet no established educational method designed for students with hearing impairment. Our student had refused to undergo cochlear implantation, instead using hearing aids, sign language and lip reading for daily communication. He needed various supports to comprehend the vast amount of medical information. Abstract writing on a personal computer served as an appropriate support for medical lectures. Handout of the lecture was essential for accurate translation by the abstract writers. The sign language was very effective for clinical clerkship. The hearing impaired student and sign language translators were kindly accepted by the majority of the patients. Appropriate intervention is critical for hearing impaired students. We need to continuously accumulate and share such experiences to offer better medical education to such students in Japanese medical schools.
We evaluated the postoperative results in terms of the audiological charasteritics, speech discrimination, language development and speech intelligibility in 11 children with inner ear malformations who underwent cochlear implantation surgery. Two of the 11 patients had common cavity deformity (CC), two had incomplete partition type I (IP-I), five had incomplete partition type II (IP-II), one had cochleo- vestibular hypoplasia with cochlear nerve deficiency (CVH/CND), and one had internal auditory canal stenosis and cochlear nerve deficiency. Aided thresholds with cochlear implants were 33.3dB-45.0dB. Among the four patients with CC and IP-I, two showed good postoperative results and used auditory verbal communication. The speech perception and production performances of the remaining two patients were poor and they used total communication. All of the five patients with IP-II showed good improvement of all the parameters and used auditory-only approach. The two patients with CND exhibited the poorest performances in all postoperative evaluations, using sign language to develop their language skills. Sennaroglu's classification and evaluation of the cochlear nerve by MRI are useful for selecting the appropriate surgical and postoperative rehabilitation methods for pediatric patients with inner ear malformations scheduled for cochlear implantation.