Download PDF
J Am Acad Audiol 2024; 35(03/04): 065-074
DOI: 10.1055/a-2224-7941
Research Article

Working Memory, Attention Skills, and Language Proficiency in Children with Unilateral and Bilateral Cochlear Implants

Cagla Dikderi 
1   Department of Audiology Faculty of Health Sciences, Baskent University, Ankara, Türkiye
,
Hilal B. Ozkan Atak 
2   Department of Audiology, Faculty of Health Sciences, Hacettepe University, Ankara, Türkiye
,
Esra Yucel 
2   Department of Audiology, Faculty of Health Sciences, Hacettepe University, Ankara, Türkiye
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Background Previous studies observed that children with cochlear implants (CIs) have poor language, working memory, and attention skills. The ability to perform cognitive tasks, such as attention and memory, plays a crucial role in the academic achievement and everyday life of children with hearing impairment.

Purpose This study aimed to evaluate and compare the effects of age at the time of implantation and bilateral hearing on cognitive skills, such as language development, working memory, and selective attention, among children with CIs.

Research Design Language skills were assessed using the Test of Language Development-Primary: Fourth Edition (TOLD-P:4), working memory using the Visual-Aural Digit Span Test-Revised Form (VADS-R), and selective attention skills using the Stroop Test TBAG Form.

Study Sample A total of 58 participants, comprised of 21 children with early unilateral CIs (before 2 years), 18 children with late unilateral CIs (after 2 years), and 19 children with bilateral CIs, between the ages of 6 and 9 years, were included in the study.

Data Collection and Analysis According to the age at the time of implantation and whether or not the participant was unilaterally or bilaterally implanted, the mean scores, percentage values, and resultant scores of the participants were calculated using the Mann–Whitney U test. The number of repeated backward digit spans for the VADS-R test, completion times, number of errors and corrections for the Stroop test, raw scores, scaled scores corresponding to raw scores at the relevant age, descriptive terms for the TOLD-P:4 test, and within-group comparisons for all tests were examined.

Results There were significant differences in language, working memory, and attention skills between individuals with early and late unilateral cochlear implantation, whereas there were no significant differences in many subtests between individuals with early unilateral and bilateral cochlear implantation.

Conclusion These findings demonstrate the importance of early cochlear implantation and bilateral hearing on the development of cognitive processes, such as language development, selective attention, and memory skills, which are important factors that may contribute to children's academic performance and overall success.

Keywords

cochlear implant - language - attention - working memory - child

Consent to Participate and Publication

This study was conducted at the Hacettepe University Department of Otorhinolaryngology and Audiology. Patients routinely signed a form consenting to the use of personal data for scientific and research purposes prior to enrollment.


Authors' Contributions

All the authors contributed to the study conception, analysis, and design. Material preparation, data collection, and analysis were performed by Cagla Dikderi and Hilal Burcu Ozkan Atak. The first draft of the manuscript was written by Cagla Dikderi, Hilal Burcu Ozkan Atak, and Esra Yucel. All the authors read and approved the final manuscript.


Ethical Approval

All the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. We initiated the data collection process after obtaining the approval of the Ethical Committee for Non-Interventional Clinical Research of Hacettepe University (issue no. 16969557-585, decision no. GO 18/156-21).




Publication History

Received: 14 December 2022

Accepted: 05 December 2023

Accepted Manuscript online:
08 December 2023

Article published online:
29 November 2024

© 2024. American Academy of Audiology. This article is published by Thieme.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Yoshinaga-Itano C, Sedey AL, Coulter DK, Mehl AL. Language of early- and later-identified children with hearing loss. Pediatrics 1998; 102 (05) 1161-1171
    CrossrefPubMedSearch in Google Scholar
  • 2 Geers AE, Nicholas JG, Moog JS. Estimating the influence of cochlear implantation on language development in children. Audiol Med 2007; 5 (04) 262-273
    CrossrefPubMedSearch in Google Scholar
  • 3 Moeller MP, Carr G, Seaver L, Stredler-Brown A, Holzinger D. Best practices in family-centered early intervention for children who are deaf or hard of hearing: an international consensus statement. J Deaf Stud Deaf Educ 2013; 18 (04) 429-445
    CrossrefPubMedSearch in Google Scholar
  • 4 Nikolopoulos TP, O'Donoghue GM, Archbold S. Age at implantation: its importance in pediatric cochlear implantation. Laryngoscope 1999; 109 (04) 595-599
    CrossrefPubMedSearch in Google Scholar
  • 5 Fernald A, Mazzie C. Prosody and focus in speech to infants and adults. Dev Psychol 1991; 27 (02) 209
    CrossrefSearch in Google Scholar
  • 6 Tomblin JB, Harrison M, Ambrose SE, Walker EA, Oleson JJ, Moeller MP. Language outcomes in young children with mild to severe hearing loss. Ear Hear 2015; 36 (01) 76S-91S
    CrossrefPubMedSearch in Google Scholar
  • 7 Kronenberger WG, Xu H, Pisoni DB. Longitudinal development of executive functioning and spoken language skills in preschool-aged children with cochlear implants. J Speech Lang Hear Res 2020; 63 (04) 1128-1147
    CrossrefPubMedSearch in Google Scholar
  • 8 Davidson LS, Geers AE, Hale S, Sommers MM, Brenner C, Spehar B. Effects of early auditory deprivation on working memory and reasoning abilities in verbal and visuospatial domains for pediatric cochlear implant recipients. Ear Hear 2019; 40 (03) 517-528
    CrossrefPubMedSearch in Google Scholar
  • 9 Litovsky RY, Johnstone PM, Godar SP. Benefits of bilateral cochlear implants and/or hearing aids in children: beneficios de los implantes cocleares bilaterales y/o auxiliares auditivos en niños. Int J Audiol 2006; 45 (Suppl. 01) 78-91
    CrossrefPubMedSearch in Google Scholar
  • 10 Dettman SJ, Dowell RC, Choo D. et al. Long-term communication outcomes for children receiving cochlear implants younger than 12 months: a multicenter study. Otol Neurotol 2016; 37 (02) e82-e95
    CrossrefPubMedSearch in Google Scholar
  • 11 Pisoni DB, Cleary M. Measures of working memory span and verbal rehearsal speed in deaf children after cochlear implantation. Ear Hear 2003; 24 (1, Suppl) 106S-120S
    CrossrefPubMedSearch in Google Scholar
  • 12 Geers AE, Sedey AL. Language and verbal reasoning skills in adolescents with 10 or more years of cochlear implant experience. Ear Hear 2011; 32 (1, Suppl) 39S-48S
    CrossrefPubMedSearch in Google Scholar
  • 13 Pisoni DB, Conway CM, Kronenberger WG, Horn DL, Karpicke J, Henning SC. Efficacy and effectiveness of cochlear implants in deaf children. Deaf Cognition: Foundations and Outcomes. 2008; 52: 101
    Search in Google Scholar
  • 14 Kral A, Sharma A. Developmental neuroplasticity after cochlear implantation. Trends Neurosci 2012; 35 (02) 111-122
    CrossrefPubMedSearch in Google Scholar
  • 15 Davidson MC, Amso D, Anderson LC, Diamond A. Development of cognitive control and executive functions from 4 to 13 years: evidence from manipulations of memory, inhibition, and task switching. Neuropsychologia 2006; 44 (11) 2037-2078
    CrossrefPubMedSearch in Google Scholar
  • 16 Diamond A. Normal development of prefrontal cortex from birth to young adulthood: cognitive functions, anatomy, and biochemistry. In: Principles of Frontal Lobe Function. Oxford University Press; 2002: 466-503
    Search in Google Scholar
  • 17 Cowan N. Attention and Memory: An Integrated Framework. Oxford University Press; 1998
    CrossrefSearch in Google Scholar
  • 18 Kirk KI, Miyamoto RT, Lento CL, Ying E, O'Neill T, Fears B. Effects of age at implantation in young children. Ann Otol Rhinol Laryngol Suppl 2002; 189 (5, suppl): 69-73
    CrossrefPubMedSearch in Google Scholar
  • 19 Harris MS, Kronenberger WG, Gao S, Hoen HM, Miyamoto RT, Pisoni DB. Verbal short-term memory development and spoken language outcomes in deaf children with cochlear implants. Ear Hear 2013; 34 (02) 179-192
    CrossrefPubMedSearch in Google Scholar
  • 20 Seyhun Topbaş SG. Türkçe Okul Çağı Dil Gelişimi Testi Kullanım Kılavuzu. Ankara, Türkiye: Detay Publishing; 2017
    Search in Google Scholar
  • 21 Koppitz EM. The Visual Aural Digit Span Test. Psychological Corp; 1977
    Search in Google Scholar
  • 22 Stroop JR. Studies of interference in serial verbal reactions. J Exp Psychol 1935; 18 (06) 643
    CrossrefSearch in Google Scholar
  • 23 Troyer AK, Leach L, Strauss E. Aging and response inhibition: normative data for the Victoria Stroop Test. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2006; 13 (01) 20-35
    CrossrefPubMedSearch in Google Scholar
  • 24 Molina M, Huarte A, Cervera-Paz FJ, Manrique M, Garcia-Tapia R. Development of speech in 2-year-old children with cochlear implant. Int J Pediatr Otorhinolaryngol 1999; 47 (02) 177-179
    CrossrefPubMedSearch in Google Scholar
  • 25 Waltzman SB, Cohen NL. Cochlear implantation in children younger than 2 years old. Am J Otol 1998; 19 (02) 158-162
    PubMedSearch in Google Scholar
  • 26 Mok M, Galvin KL, Dowell RC, McKay CM. Speech perception benefit for children with a cochlear implant and a hearing aid in opposite ears and children with bilateral cochlear implants. Audiol Neurotol 2010; 15 (01) 44-56
    CrossrefPubMedSearch in Google Scholar
  • 27 Cleary M, Pisoni DB, Geers AE. Some measures of verbal and spatial working memory in eight- and nine-year-old hearing-impaired children with cochlear implants. Ear Hear 2001; 22 (05) 395-411
    CrossrefPubMedSearch in Google Scholar
  • 28 Soleymani Z, Amidfar M, Dadgar H, Jalaie S. Working memory in Farsi-speaking children with normal development and cochlear implant. Int J Pediatr Otorhinolaryngol 2014; 78 (04) 674-678
    CrossrefPubMedSearch in Google Scholar
  • 29 Mikic B, Miric D, Nikolic-Mikic M, Ostojic S, Asanovic M. Age at implantation and auditory memory in cochlear implanted children. Cochlear Implants Int 2014; 15 (sup1) S33-S35
    CrossrefPubMedSearch in Google Scholar
  • 30 Sharma A, Dorman MF, Kral A. The influence of a sensitive period on central auditory development in children with unilateral and bilateral cochlear implants. Hear Res 2005; 203 (1-2): 134-143
    CrossrefPubMedSearch in Google Scholar
  • 31 Dye MWG, Hauser PC. Sustained attention, selective attention and cognitive control in deaf and hearing children. Hear Res 2014; 309: 94-102
    CrossrefPubMedSearch in Google Scholar
  • 32 Thorpe AM, Ashmead DH, Rothpletz AM. Visual attention in children with normal hearing, children with hearing aids, and children with cochlear implants. J Speech Lang Hear Res 2002; 45 (02) 403-413
    CrossrefPubMedSearch in Google Scholar