A Matched-Pairs Comparison of Single and

Multichannel Cochlear Implants in Childre11

Patricia M. Chute, MA; Sharon A. Hellman, MS; Simon C. Parisier, MD; Samuel H. Selesnick, MD

Auditory capabilities of Nucleus 22® multichannel co- improved by at least two levels or one perceptual
chlear implant users were compared to those of matched category. 2 Comparisons have been made between chil-
3M/House® single-channel users. Six children who received dren using vibrotactile and single-channel cochlear
either the 3M/House or Nucleus 22 cochlear implants were implants, 3 ,4 but no attempt has been made to compare
separated into three matched pairs. Group 1 consisted of benefits between multichannel versus single-channel
two postlinguistically deafened adolescents, group 2 con-
cochlear implants.
sisted of two prelinguistically deafened school-age chil-
dren, and group 3 consisted of two perilinguistically deaf- The Children's Hearing Institute at Manhattan
ened preschoolers. Eye, Ear & Throat Hospital has been involved with
Participants were evaluated using auditory comprehen- the implantation of cochlear prostheses in 42 patients
sion and discrimination tasks as indicated by the 3M/House since 1981. Of the 28 patients who are children, 18
and Nucleus 22 protocols. However, only tasks common to have received single-channel devices, and 10 have
both were included here. While the 3M/House single-chan- received multichannel devices (it should be noted that
nel device has been under an IDE for children under the age all children using the Nucleus 22 multichannel device
of 18 years since 1984, the Nucleus 22 multichannel implant have full insertion of the electrode array).
only recently became available for this age group. Thus,
short-term evaluations at 6 months and 1 year postimplanta- MATERIALS AND METHODS
tion have been used for comparison.
To compare the children's performances with these devices,
Two of the three groups indicated that the multichannel children receiving multichannel units were matched to their single-
users performed as early as the 6-month level; the children channel counterparts. The criteria for matching included age of
in the third group performed equally. These results indicate onset of deafness, duration of deafness prior to implantation, educa-
that multichannel cochlear implants show great promise in tional setting, and communication mode. Furthermore, all children
deaf children. had normal intelligence quotients and no secondary handicapping
conditions.
INTRODUCTION Six children (three matched pairs) fulfilled these requirements.
Performance on the DAT and TAC were used as measures of
Children using the 3M/House® single-channel co- comparison, since these are the only tests that both device test
chlear implant have exhibited increases in the detec- protocols have in common.
tion of sound, discrimination of suprasegmental fea- The DAT was developed for use in prelinguistically deafened
tures, and identification of environmental sounds. 1 adults. 1 This test is based on a hierarchy of perceptual skills that
Although the Nucleus 22® multichannel device has range from a simple lip reading task (level 1), to a sound-detection
only recently been implanted in children, perfor- task (level 2), to identification of three and four spondees using
hearing alone (levels 11 and 12). Although this test is not stan-
mances on the Discrimination After Training (DAT)
test and Test of Auditory Comprehension (TAC) reflect
improvements in the same areas. After only 6 months TABLE I.
of use, 68% of the children evaluated with the DAT DAT/TAC Scores Classified into
Categories of Speech Perception.
Category of DAT Level TAC Level
Speech Perception Passed Passed
Presented at the Meeting of the Eastern Section of the American
Laryngological, Rhinological and Otological Society, Inc., Toronto, January 1. No pattern perception 0-2 0
27, 1989. 2. Pattern perception 3-8 1
From The Children's Hearing Institute of Manhattan Eye, Ear & Throat 3. Some word recognition 9-11 2-3
Hospital, New York. 4. Consistent word recognition 12 4-7
Send Reprint Requests to Patricia M. Chute, MA, The Children's Hear- 5. Open set recognition with 8-10
ing Institute of Manhattan Eye, Ear & Throat Hospital, 210 East 64th contextual clues
Street, New York, NY 10021.

Laryngoscope 100: January 1990 Chute, et al.: Cochlear Implants

25
 TABLE II.
Raw DAT/TAC' Scores for All Patients.
Patient
Name Device Test Pre- 6 Mo 1 Yr 18 Mo 2 Yr 3 Yr 4 Yr
MBA Nucleus DAT 1 11
TAC 0 2
NM 3M/House DAT 1 6 7 6
TAC 0 0 1 1
DB Nucleus DAT 4 4 12
TAC 0 0 1
TL 3M/House DAT 0 4 12 12 12 12 12
TAC 0 0 1 ONT 2 3 5
JB Nucleus DAT 5 9 12
TAC 0 3 4
cs 3M/House DAT 0 7 9
TAC 0 1 2
'All pre- DAT and TAC scores for patients using the Nucleus 22 device were obtained with a Tactald II vlbrotactlle device.
ONT = Did not test.

dardized on the population of cochlear implant users, it has been
shown to be clinically useful in determining progress via categori-
cal changes in speech perception with implant users as defined by
Geers and Moog. 6
The TAC, developed by the Los Angeles School District, also uses
a hierarchy of performances, beginning with differentiation of
linguistic versus nonlinguistic sounds and progressing to the recall
of five details of a story presented in the presence of a competing
message.
The recategorization of DAT and TAC scores into categories of
speech perception is shown in Table I. (Please note a category 5 has
been added to encompass a level of open set recognition.)
The DAT primarily assesses the perception of the durational and
stress patterns of speech. Allsman and Tonokawa 6 reported that
the mean DAT score for 21 participants at the 6-month evaluation
was 6.7; at the 3-year evaluation, the score was 9.2. The TAC
evaluates the recognition and identification of environmenta l
sounds and speech. Allsman and Tonokawa found only slight im-
provement over time for 23 children implanted with the 3M/House
single-channel device. The mean TAC score was 1.0 at the 6-month
level and 1.4 at the 3-year level. Thus, it appears that the TAC is a
much more difficult test for children.
This premise holds true in analyzing the present data. Gener-
ally, patients appear to "top out" quickly on the DAT, while slowly
progressing on the TAC. Thus, the TAC may be the more sensitive of
the two tests.
The duration of time under study in the present investigation
compares three matched pairs preoperatively, 6 months after im-
plant stimulation, and 1 year after implant stimulation. Since the
multichannel device has been available to children for less than 2
years, performance measures are not available for longer durations
of usage.
PATIENTS
Groupl
Patient MBR lost her hearing secondary to men-
ingitis at age 9 months. NM was diagnosed at age 9
months following head trauma and seizures; however,
because it is possible that this loss was congenital,
NM's age of onset has been classified as at birth. Both
children were implanted approximately 8 years later
and are enrolled in regular elementary school classes
with support services, including cued-speech inter-
preters. MBR and NM use oral communication with
the addition of cued speech. MBR received a multi-
channel device. NM received a single-channel device.
Group2
Patients DB and TL lost their hearing secondary to
meningitis at approximately age 2 years, up to which
point both children were developing normal speech
and language. They were implanted approximately 2
years after their hearing loss, DB with a multichannel
device and TL with a single-channel device. At the
time interval under study, both were mainstream ed
into regular kindergarte n classes. TL has had her
single-channel implant for 5 years and attends regu-
lar elementary school.
Group8
JB and CS lost their hearing secondary to men-
ingitis, JB at age 6 years 3 months and CS at age 5
years. JB received a multichannel device 10 years
later; CS received a single-channel device 11 years
later. At the time interval under study, both were fully
mainstream ed in their local high schools and commu-
nicating orally as well as through sign language.
RESULTS
Table II shows the DAT and TAC speech perception
scores for the six participants . It should be noted that
the preimplant scores reported for children using the
Nucleus device on both the DAT and TAC tests reflect
the best scores obtained with the ·use of vibrotactile
aid (Tactaid II). However, when tested preoperatively
with a conventional hearing aid alone, they scored at
the Olevel (no auditory detection).
In group 1, DAT and TAC scores are equivalent at
the preimplant interval. At the 6-month postimplan t
interval, the child using the multichann el device

Laryngoscope 100: January 1990 Chute, et al.: Cochlear Implants

26
 4
c
0 c
4
00

~
u
C
3 t
u
C
3

.Q 0
',i:l
i5.
Q)
2 C. 2
~ ~
Q)
&. ♦ JB - Nucleus
0..
♦ MBR - Nucleus
..c 1 ..c
u
Q) ~ ■ CS - 3M/House
QJ
C.
■ NM - 3M/House QJ
C.
Vl Vl
0 0
Pre-Op 6 Mo 1 Yr 18 Mo 2 Yr 3 Yr Pre-Op 6 Mo 1 Yr 18 Mo
Time Interval Time Interval
Fig. 1. Speech perception scores over time for group 1. Fig. 3. Speech perception scores over time for group 3.

(MBR) surpassed the performance of her single-chan- demonstrating Category 3 speech perception abilities,
nel counterpart (NM). while her single-channel counterpart is at the Catego-
ry 2 level. It should be noted that the single-channel
The group 2 children seem to be performing at the user (NM) has appeared to plateau at the 1-year and
same level. This is interesting because the single- 18-month intervals. It is possible that MBR will
channel user in this group (TL) is a superior user of plateau in a similar manner; however, since MBR has
this device. Her TAC scores at the 3-year level indi- gone beyond using suprasegmenta l cues to perceive
cated her to be two levels above the average single- speech and has begun to use segmental features, it is
channel user. Her performance on a modified version not felt that a similar plateau will occur given the
of the Glendonald Auditory Screening Procedure 7 processing scheme of the Nucleus 22 multichannel
showed her to have correctly identified 8 of 10 sen- device.
tences and 8 of12 words; 1.5% of the total 126 subjects
sampled with this test did so. 1 However, it should also In group 2, an interesting trend is noted. It can
be noted that the multichannel user in this group clearly be seen in Figure 2 that the performances of
(DB) is not a "star performer:' His performance is the two children is overlapping. Although all criteria
typical of perilinguistically deafened children using a regarding these children are similar, there remains
multichannel device. one significant difference: TL is an atypical user of the
single-channel system. TL is a star performer who
In group 3, postlinguistically deafened adolescents' has been shown to outperform most other children
performance with the Nucleus 22 multichannel device using the 3M/House unit. TL is continually improving
surpasses that of the 3M/House single-channel device and shows no indication of reaching a plateau in her
at all time intervals sampled. abilities. To DB's credit, he is typical of perilinguis-
In Figures 1 to 3, each group's speech perception tically deafened children who use a multichannel
capabilities as reflected by its performance on the device. Thus, the fact that the performance of these
TAC are shown as a function of time. Figure 1 displays two children is similar is exciting.
the results for the prelinguistic children. At the In group 3 (Fig. 3), the adolescent implanted with
6-month interval, the multichannel user (MBR) is the multichannel device is performing better at 6
months and 1 year after initial stimulation than the
adolescent with the single-channel device.
4
c
0
CONCLUSIONS
1 Several patterns have emerged:
a
C:
3
1. Postlinguistic ally deafened children tend to
.Q
i5. 2
show the most rapid growth. Although there is a
QJ
similar pattern over time between the multichannel
...u
QJ
♦ DB - Nucleus and single-channel devices, the multichannel user
0..
..c shows greater achievement in speech perception skills
u
QJ
QJ ■ TL - 3M/House following implantation at all time intervals sampled.
C.
Vl
0 2. The perilinguistically deafened children show a
Pre-Op 6 Mo 1 Yr 2 Yr 3 Yr 4 Yr similar rate pattern between the two devices, al-
Time Interval though they are both still slower than either of the
Fig . 2. Speech perception scores over time for group 2. postlinguistically deafened children.

Laryngoscope 100: January 1990 Chute, et al.: Cochlear Implants

27
 3. The prelinguistically deafened children show a
very different pattern. The single-channel device user
appears to have plateaued at about 1 year. The child
using the Nucleus device may similarly plateau, but
the likelihood of this is small given our experience
BIBLIOGRAPHY
1. Thielemeir, M.A., 'lbnokawa, L.L., Petersen, B., et al.: Audiologi-
cal Results in Children With a Cochlear Implant. Ear Hear.,
6:27S-35S, 1985.
2. Staller, S.J., Beiter, A.L., Brimacombe, J.A., et al.: Clinical
Trials of a Cochlear Implant in Children. Hearing Instru-
ments, 39(11):22-27, 1988.
3. Miyamoto, R.T., Meyers, W.A. and Punch, J.L.: Tactile Aids in
the Evaluation Procedure for Cochlear Implant Candidacy.
Hearing Instruments , 38:33-37, 1987.
4. Pickett, J.M. and McFarland, W.: Auditory Implants and Tactile
Aids for the Profoundly Deaf. J. Speech Hear. Res., 28:134-
Rhinoplasty 1990 Symposium Set
The American Academy of Facial Plastic Surgery
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The symposium will include a course, Basic Rhino-
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Subject matter will include Facial Esthetic Anato-
my, Nasal Septoplasty, Osteotomies, and Post-Opera-
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explorations of Facial Esthetic Considerations in Rhi-
noplasty, Surgical Modifications of the Nasal Tip,
Temporal Bone Course Set
The NYU Medical Center, Post-Graduate Medical
School, is sponsoring a course on Temporal Bone
Dissection, March 26-30, at the Medical Center.
The course will be Monday through Friday, 5 pm to
10pm.
The course is designed for practicing otolaryngolo-
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tions and surgical techniques.
Laryngoscope 100: January 1990
28
with the other two groups over time.
These data are recognized as preliminary and form
a very small subset of the cochlear implant popula-
tion. These children will continue to be followed, and
other pairs of children will be matched when possible.
150, 1985.
5. Geers, A.E. and Moog, J.S. : Predicting Spoken Language Ac-
quisition of Profoundly Hearing-Impaired Children. J.
Speech Hear. Disord., 52:84-94, 1985.
6. Allsman, C.S. and 'lbnokawa, L.L.: Single-Channel Cochlear
Implants in Children: A Three-Year Follow-up. In: Cochlear
Implants in Young Deaf Children. E. Owens and D. Kessler
(Eds.). College-Hill, Boston, pp. 183-227, 1989.
7. Erber, N.P.: Auditory Training. Alexander Graham Bell Asso-
ciation for the Deaf, Washington, DC, 1982.
Naso-Labial Complex Surgery and Naso-Frontal An-
gle Considerations, among other topics.
The meeting will be held at the Portland Marriot
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pared.
A spouse and family program is available.
For more information, contact Ted A. Cook, MD,
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Lectures and videotapes during a buffet supper will
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More information on the course is available from the
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Chute, et al. : Cochlear Implants