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To contact author Susan Zimmerman-Phillips, M.S., call 734/213-2276.

EARLY COCHLEAR IMPLANTATION HELPS DEAF CHILDREN ACQUIRE AGE-APPROPRIATE COMMUNICATION SKILLS

CHICAGO—Receiving a cochlear implant early in life helps children with profound hearing loss to acquire language and communication skills similar to their hearing peers, according to an article in the May issue of the Archives of Otolaryngology—Head & Neck Surgery, a theme issue on pediatric cochlear implants and one of the JAMA/Archives journals.

Cochlear implants are small electronic devices that are surgically implanted in the ear that allow profoundly deaf people to hear. According to the article, early identification of hearing problems and implantation of a cochlear device when appropriate have a positive effect on communication development in very young hearing-impaired children.

Amy McConkey Robbins, M.S., from the Communication Consulting Services, Indianapolis, and colleagues investigated the effect of age at cochlear implantation on the auditory development of children younger than three years, and compared the auditory development of these children with their peers with normal hearing.

The researchers followed 107 hearing-impaired children (age range, 12-36 months) who received a cochlear implant in North America. Listening skills were evaluated before implantation, and at three, six and 12 months after implantation. Evaluations were based on parental interviews regarding their child's listening behaviors in everyday situations, vocalizations associated with using the implant, and the child's ability to notice and interpret sounds.

The researchers found that "Infants and toddlers who receive implants show rapid improvement in auditory skills during the first year of device use regardless of age at implantation, although younger children achieve higher scores [on the listening skills evaluation]."

"Children who undergo implantation at a younger age acquire auditory skills nearer to those of their peers with normal hearing at a younger age. The mean [average] rate of acquisition of auditory skills is similar to that of infants and toddlers with normal hearing regardless of age at implantation."

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To contact Thomas P. Nikolopoulos, M.D., D.M., Ph.D., email: Thomas.Nikolopoulos{at}nottingham.ac.uk

COCHLEAR IMPLANTS ASSIST IN DEVELOPMENT OF LANGUAGE SKILLS IN DEAF CHILDREN

CHICAGO—Prelingually deaf children who receive a cochlear implant at a young age have a greater improvement in spoken language grammar skills, according to a study in the May issue of the Archives of Otolaryngology—Head & Neck Surgery, a theme issue on pediatric cochlear implants and one of the JAMA/Archives journals.

Children with profound congenital or prelingual deafness have been shown to experience substantial delays in their mastery of all aspects of the spoken language, according to background information in the article.

Thomas P. Nikolopoulos, M.D., D.M., Ph.D., of Athens University, Athens, Greece, and colleagues assessed the development of spoken language grammar comprehension by prelingually deaf children following cochlear implantation, and compared their grammatical abilities with those of their normal-hearing peers.

The study included 82 prelingually deaf children who were less than 7 years old at the time of cochlear implantation. All received the same multichannel cochlear implant system; there was up to 5 years of follow-up. The children were assessed using a multiple-choice test designed to measure the understanding of grammatical contrasts in the English language.

The researchers found that before implantation, only a small proportion (2 percent) of prelingually deaf children were above the first percentile of their normal-hearing peers. "This percentage increased to 40 percent and 67 percent, respectively, 3 and 5 years after implantation; and 5 years after implantation, 20 percent of the children performed between the 25th and the 75th percentile or better. In the subgroup of children who received their cochlear device before the age of 4 years, this percentage reached 36 percent," the authors write.

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To contact John B. Christiansen, Ph.D., call Darrick Nicholas at 202/448-7136.

OPPOSITION TO PEDIATRIC COCHLEAR IMPLANTATION FADING

CHICAGO—Opposition to cochlear implantation for children within the deaf community appears to be diminishing, according to an article in the May issue of the Archives of Otolaryngology—Head & Neck Surgery, a theme issue on pediatric cochlear implants and one of the JAMA/Archives journals.

Cochlear implants are small electronic devices that are surgically implanted in the ear that allow profoundly deaf people not helped by traditional hearing aids to hear better. According to information in the article, the topic of cochlear implants for children has been debated among deaf and hard-of-hearing persons, educators, and parents of deaf children and others. There has been disagreement over the appropriateness of cochlear implants for children, especially if they are too young to decide if they want the procedure for themselves. Additionally, approximately 90 percent of parents who have deaf children are not deaf, and generally have had little, if any, experience with deaf persons or understanding of deafness. However, perceptions may be changing, partially due to new research on the implants, the article states.

John B. Christiansen, Ph.D., and Irene W. Leigh, Ph.D., of Gallaudet University, Washington, D.C., investigated the changing attitudes of parents of the deaf community and parents of deaf children regarding pediatric cochlear implantation.

The researchers combined the data from two studies: the first study (by the Gallaudet University Research Institute - the GRI survey) was conducted in the spring of 1999 and included the results of 439 questionnaires filled out by parents of children with cochlear implants. The second study consisted of 56 interviews with parents of 62 children with implants (and one without). The children represented by the studies ranged in age from two to 20 years old, and were between 15 months and 17 years when implanted.

Overall, the researchers found "While parents frequently receive conflicting information about educational and communication options for their child, they generally support signing [sign language] before and after implantation." About 50 percent of the children signed after getting their implant, both at home and at school.

According to the GRI survey, 62 percent of parents said they would have liked their child to receive an implant earlier because they believed it would have better facilitated the development of spoken language. One year after implantation, 54 percent of these parents were very satisfied with their child's progress.

Children with cochlear implants were educated in a variety of educational settings, with 34 percent of children represented in the questionnaire survey in mainstream classrooms for all activities with hearing children. Twenty-four percent were partially mainstreamed, and 13 percent were in classes for deaf or hard-of-hearing children. "Mainstreamed children with implants often continue to require classroom support services, and children with implants are frequently not isolated from deaf and hearing peers," the authors write.

CHILDREN WITH COCHLEAR IMPLANTS CAN LEARN MORE THAN ONE LANGUAGE

Researchers studied oral language skills in twelve deaf children between the ages of 20 months and 15 years who had received a cochlear implant before the age of three years. Based on assessment of first and second language skills at two yearly intervals after implantation, the researchers found that average scores in the first language were within the average range of normal hearing children and second language skills showed steady improvement. "…the children most proficient in two languages were those whose parents spoke the second language at home, who had opportunities to use the language outside of home, and who had been wearing their CI (cochlear implant) for an extended time," the researchers note.

COCHLEAR IMPLANT SURGERY MAY BE TIME SENSITIVE

Researchers collected data over a four-year period on testing from 181 children from 33 different states and five Canadian provinces who received a cochlear implant by age five. "For children who receive a cochlear implant between the ages of two and four years, early cochlear implantation does not ensure better speech perception, speech production, language, or reading skills," the researchers found. "However, greater speech and language proficiency may be expected from children who exhibit normal hearing for even a brief period after birth and receive a cochlear implant shortly after losing their hearing."

CLASSROOM PLACEMENT AND COMMUNICATION METHODS IMPACT CHILDREN WITH COCHLEAR IMPLANTS

This study included 131 congenitally deafened children between the ages of eight and nine years who received a multichannel cochlear implant before the age of five years. Researchers examined speech intelligibility scores and classroom environments. "Higher speech intelligibility scores at eight to nine years of age were associated with classroom exposure to normal-hearing peers in full or partial mainstream placements than in self-contained, special education placements," the researchers report. They also note the importance of educational settings that emphasize oral communication development.

COMMUNICATION ABILITIES OF CHILDREN WITH AIDED RESIDUAL HEARING VS. COCHLEAR IMPLANTS

Measures of speech recognition and language were administered to 39 pediatric hearing aid users and 117 cochlear implant users as part of an ongoing investigation on cochlear implant outcomes. On average, both groups lost their hearing at younger than one year and were fitted with their respective sensory aids at 2 to 2.6 years of age. "Between-group performance was equivalent on most speech recognition and language measures," the researchers state. "…the results from this study provide evidence to support implantation of CIs (cochlear implants) in children with significant aided residual hearing who, for whatever reason, may not be achieving performance levels comparable to the average performance of CI children."

Editor's Note: Please see the Archives of Otolaryngology—Head & Neck Surgery studies for full detailed information on these studies, the researchers, and the funding.

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To contact Zoe Arvanitakis, M.D., call Chris Martin at 312/942-7820.

DIABETES MAY BE ASSOCIATED WITH INCREASED RISK OF ALZHEIMER DISEASE

CHICAGO—Diabetes mellitus may affect a person's cognitive abilities, and may increase the risk of developing Alzheimer disease (AD), according to an article in the May issue of the Archives of Neurology, one of the JAMA/Archives journals.

According to information in the article, diabetes mellitus is a common condition, affecting about 20 percent of people older than 65 years. Diabetes mellitus has been associated with several other disorders, including cognitive impairment, however, few studies have examined a possible link between diabetes mellitus and AD, the study states.

Zoe Arvanitakis, M.D., of Rush University Medical Center, Chicago, and colleagues evaluated the association between diabetes mellitus and risk of AD and change in cognitive functioning in 824 Catholic nuns, priests, and brothers older than 55 years who underwent annual clinical evaluations. The participants were followed for up to nine years; 127 (15.4 percent) had diabetes mellitus.

During an average of 5.5 years of observation, 151 participants developed AD of whom 31 had diabetes. Among those with diabetes mellitus, there was a 65 percent increase in risk of developing AD compared to those without diabetes mellitus. Participants with diabetes mellitus also had lower levels of cognition and had more memory problems.

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To contact corresponding author Moses Rodriguez, M.D., call Robert Nellis at 507/284-5005.

MANY PATIENTS WITH MULTIPLE SCLEROSIS REPORT GOOD QUALITY OF LIFE

CHICAGO—Although multiple sclerosis (MS, an autoimmune disease affecting the nervous system) can be disabling, many patients who have MS report a good quality of life, according to an article in the May issue of the Archives of Neurology, one of the JAMA/Archives journals.

According to information in the article, quality of life (QOL) is an increasingly important measurement of disease impact. QOL refers to a person's perceived physical and mental well-being.

Sean J. Pittock, M.D., of the Mayo Clinic, Rochester, Minn., and colleagues studied the QOL of 201 patients with MS living in Olmstead County, Minn., on December 1, 2000. Questionnaires regarding quality of life were completed by 185 participants. The questionnaire included sections on pain, vitality, tiredness, social functioning, emotional well-being, mental health and ability to perform activities of daily life. The scores of these questionnaires were compared to scores from people in the general U.S. population without MS.

The researchers found that compared to people without MS in the general U.S. population, participants with MS had worse scores with respect to physical functioning, vitality and general health. Other areas related to QOL (pain, mental health and social functioning) were similar for patients with MS compared to the general U.S. population. "The majority of patients with MS (77 percent) were mostly satisfied or delighted with their QOL," according to the study.

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To contact Daniel G. Federman, M.D., call Pamela Redmond at 203/937-3824.

MOST PATIENTS WILLING TO UNDERGO FULL BODY SKIN EXAMINATIONS

CHICAGO—Many patients are comfortable with having their physician perform a full-body skin examination (FBSE) to screen for skin cancers, according to an article in the May issue of the Archives of Dermatology, one of the JAMA/Archives journals.

According to the article, skin cancer accounts for nearly half of all cancers in the United States. The American Cancer Society recommends skin cancer screenings as part of a cancer-related checkup every three years for people aged 20 to 40 years old, and annually for people older than 40 years. Skin cancer screening is easy, inexpensive and noninvasive, the article states.

Daniel G. Federman, M.D., from the Veterans Affairs Connecticut Health Care System, West Haven, and colleagues determined the rates of FBSE among 251 patients (97 percent male, average age 66 years) awaiting appointments at either dermatology clinics (n=102) or general medicine clinics (n=149).

Patients were surveyed about whether they had regular FBSE, their attitudes about this procedure and their risks for developing cancer.

The researchers found that 32 percent of patients reported undergoing regular FBSE by their primary care practitioner (PCP), while 55 percent of patients with a history of skin cancer reported undergoing FBSE. Eight percent of patients felt embarrassed by FBSE, and 87 percent of patients surveyed said they would like their PCP to perform FBSE regularly. Only two percent of patients said they would refuse FBSE if their PCP were of the opposite sex, whereas 8 percent would be more willing to be examined.