United Kingdom national paediatric bilateral project: Demographics and results of localization and speech perception testing

Abstract

Objectives: To assess longitudinal outcomes in a large and varied population of children receiving bilateral cochlear implants both simultaneously and sequentially.

Methods: This observational non-randomized service evaluation collected localization and speech recognition in noise data from simultaneously and sequentially implanted children at four time points: before bilateral cochlear implants or before the sequential implant, 1 year, 2 years, and 3 years after bilateral implants. No inclusion criteria were applied, so children with additional difficulties, cochleovestibular anomalies, varying educational placements, 23 different home languages, a full range of outcomes and varying device use were included.

Results: 1001 children were included: 465 implanted simultaneously and 536 sequentially, representing just over 50% of children receiving bilateral implants in the UK in this period. In simultaneously implanted children the median age at implant was 2.1 years; 7% were implanted at less than 1 year of age. In sequentially implanted children the interval between implants ranged from 0.1 to 14.5 years. Children with simultaneous bilateral implants localized better than those with one implant. On average children receiving a second (sequential) cochlear implant showed improvement in localization and listening in background noise after 1 year of bilateral listening. The interval between sequential implants had no effect on localization improvement although a smaller interval gave more improvement in speech recognition in noise. Children with sequential implants on average were able to use their second device to obtain spatial release from masking after 2 years of bilateral listening. Although ranges were large, bilateral cochlear implants on average offered an improvement in localization and speech perception in noise over unilateral implants.

Conclusion: These data represent the diverse population of children with bilateral cochlear implants in the UK from 2010 to 2012. Predictions of outcomes for individual patients are not possible from these data. However, there are no indications to preclude children with long inter-implant interval having the chance of a second cochlear implant.

Keywords:

• Cochlear implant
• Bilateral cochlear implant
• Binaural hearing
• Localization
• Paediatric service evaluation

Acknowledgments

The authors wholeheartedly express thanks to clinicians and patients at the following cochlear implant centres: Belfast Regional Cochlear Implant Centre; The Midlands Children's Hearing Implant Programme, Birmingham; West of England Paediatric Hearing Implant Programme, Bristol; Emmeline Centre, Cambridge; Cardiff Paediatric Cochlear Implant Programme; Great Ormond Street Cochlear Implant Programme, London; St Thomas’ Hospital Hearing Implant Centre, London; The Richard Ramsden Centre for Hearing Implants, Manchester; North East Cochlear Implant Programme, Middlesbrough; Nottingham Auditory Implant Programme; The Oxford Cochlear Implant Programme; Royal National Throat Nose and Ear Cochlear Implant Programme, London; University of Southampton Auditory Implant Service and St George's Hospital Auditory Implant Service, London. The authors gratefully acknowledge the support and contributions of Tricia Kemp, Cochlear Implanted Children's Support group Coordinator and Erasmus students Ellen Joos and Robin Gransier. Daniel Rowan and Stefan Bleeck provided helpful input on localization and speech perception.

Disclaimer statements

Contributors All authors contributed to the project design, planning, data collection and final report. Cullington takes responsibility for the data analysis.

Funding The project was supported by the Healthcare Quality Improvement Partnership (HQIP).

Conflicts of interest H. E. Cullington undertakes paid consulting work for Cochlear Europe. Advanced Bionics pay money to University of Southampton for research projects. H. E. Cullington is the second applicant on a successful grant from the Oticon Foundation with John Culling, Cardiff. No money comes to University of Southampton. Julie Brinton undertakes paid consulting work for Advanced Bionics. Gerard O'Donoghue receives occasional non-financial support from Cochlear, MED-EL and Advanced Bionics.

Ethics approval The purpose of this project was to record outcomes of paediatric bilateral cochlear implantation in the UK using performance measures, professional rating scales and parent questionnaires. It was not hypothesis-driven. This project was designed and conducted solely to judge the current care of children receiving two cochlear implants in the UK. The project was considered a service evaluation and did not require review by the National Health Service Research Ethics Committee. A letter was provided to all participating cochlear implant centres to give to the families, detailing the scope and purpose of the service evaluation.

ORCID

H. E. Cullington http://orcid.org/0000-0002-5093-2020