Although deaf children with cochlear implants (CIs) are able to develop good language skills, the large variability in outcomes remains a significant concern. The first aim of this study was to evaluate language skills in children with CIs to establish benchmarks. The second aim was to make an estimation of the optimal age at implantation to provide maximal opportunities for the child to achieve good language skills afterward. The third aim was to gain more insight into the causes of variability to set recommendations for optimizing the rehabilitation process of prelingually deaf children with CIs. Receptive and expressive language development of 288 children who received CIs by age five was analyzed in a retrospective multicenter study. Outcome measures were language quotients (LQs) on the Reynell Developmental Language Scales and Schlichting Expressive Language Test at 1, 2, and 3 years after implantation. Independent predictive variables were nine child-related, environmental, and auditory factors. A series of multiple regression analyses determined the amount of variance in expressive and receptive language outcomes attributable to each predictor when controlling for the other variables. Simple linear regressions with age at first fitting and independent samples t tests demonstrated that children implanted before the age of two performed significantly better on all tests than children who were implanted at an older age. The mean LQ was 0.78 with an SD of 0.18. A child with an LQ lower than 0.60 (= 0.78-0.18) within 3 years after implantation was labeled as a weak performer compared with other deaf children implanted before the age of two. Contralateral stimulation with a second CI or a hearing aid and the absence of additional disabilities were related to better language outcomes. The effect of environmental factors, comprising multilingualism, parental involvement, and communication mode increased over time. Three years after implantation, the total multiple regression model accounted for 52% of the variance in receptive language scores and 58% of the variance in expressive language scores. On the basis of language test scores of this large group of children, an LQ of 0.60 or lower was considered a risk criterion for problematic language development compared with other deaf children using CIs. Children attaining LQs below 0.60 should be monitored more closely and perhaps their rehabilitation programs should be reconsidered. Improved language outcomes were related to implantation under the age of two, contralateral stimulation, monolingualism, sufficient involvement of the parents, and oral communication by the parents. The presence of an additional learning disability had a negative influence on language development. Understanding these causes of variation can help clinicians and parents to create the best possible circumstances for children with CIs to acquire language.

A Dutch sentence test (LIST) and a Dutch number test (LINT) have been developed and validated for the accurate measurement of speech reception thresholds (SRT) in quiet and in noise with severely hearing-impaired individuals and cochlear implant recipients in Flanders and the Netherlands. The LIST consists of 35 lists of 10 sentences of equal known difficulty uttered by a female speaker; while the LINT consists of 400 numbers (1–100) by two male and two female speakers. Normative values were determined at fixed S/N ratios and using the adaptive method (Plomp & Mimpen, ), yielding identical results for SRT and slope. For the LIST, average fitted SRTs were 27.1 (0.9) dB SPL in quiet and −7.8 dB (0.2) SNR in noise. In addition, the LIST in noise displayed a steep discrimination function (17%/dB) and good reliability (within-subject standard deviation=1.2 dB). For the LINT average fitted SRTs in quiet were 20.7 (0.9) dB SPL and about −9.0 dB SNR in noise. Again, the slopes of the performance intensity functions were relatively steep, i.e. 8.5%/dB in quiet and 15.2%/dB in noise, suggesting that the LINT is accurate and efficient and thus capable of reflecting subtle changes in performance. First data with cochlear implanted subjects show that both LIST and LINT are feasible and are capable of mapping a large range of hearing disabilities.

This paper evaluates the benefit of the two-microphone adaptive beamformer BEAM™ in the Nucleus Freedom™ cochlear implant (CI) system for speech understanding in background noise by CI users. A double-blind evaluation of the two-microphone adaptive beamformer BEAM and a hardware directional microphone was carried out with five adult Nucleus CI users. The test procedure consisted of a pre- and post-test in the lab and a 2-wk trial period at home. In the pre- and post-test, the speech reception threshold (SRT) with sentences and the percentage correct phoneme scores for CVC words were measured in quiet and background noise at different signal-to-noise ratios. Performance was assessed for two different noise configurations (with a single noise source and with three noise sources) and two different noise materials (stationary speech-weighted noise and multitalker babble). During the 2-wk trial period at home, the CI users evaluated the noise reduction performance in different listening conditions by means of the SSQ questionnaire. In addition to the perceptual evaluation, the noise reduction performance of the beamformer was measured physically as a function of the direction of the noise source. Significant improvements of both the SRT in noise (average improvement of 5–16 dB) and the percentage correct phoneme scores (average improvement of 10–41%) were observed with BEAM compared to the standard hardware directional microphone. In addition, the SSQ questionnaire and subjective evaluation in controlled and real-life scenarios suggested a possible preference for the beamformer in noisy environments. The evaluation demonstrates that the adaptive noise reduction algorithm BEAM in the Nucleus Freedom CI-system may significantly increase the speech perception by cochlear implantees in noisy listening conditions. This is the first monolateral (adaptive) noise reduction strategy actually implemented in a mainstream commercial CI.