Title: 'The Effect of Hearing Modality on Communication Outcomes: Bimodal Hearing versus Bilateral Cochlear Implantation'
Track: 2 - Audiological Services
Keyword(s): Pediatric Language Development, Hearing Modality
Learning Objectives:
  1. How devices, such as hearing aids and cochlear implants, can effect speech and/or language development in children with hearing loss
  2. How cochlear implantation can potentially impact future academic, occupational, and psychosocial needs
  3. Possible changes to standard of care counseling and treatment for families who choose to have their child implanted


There is a plethora of literature describing the negative academic and psychosocial effects of unilateral or minimal bilateral hearing loss on children with acoustic hearing. Bimodal listeners, however, may also be negatively affected, representing a special case of “minimal hearing loss”. Cochlear implants provide audibility in the range of normal to near-normal hearing from 250 to 6000 Hz, generally yielding higher levels of speech recognition than observed for non-implanted ears. Therefore, children with bilateral cochlear implants may be less likely to suffer from negative academic, speech, language and psychosocial consequences. Though most major insurers recognize bilateral cochlear implantation as standard of care treatment for children with profound sensorineural hearing loss, families with children who have asymmetric or less severe hearing losses are often counseled toward bimodal hearing. Such recommendations are based on adult clinical research demonstrating equivalent speech recognition for bimodal and bilateral listeners. To date, limited pediatric data exist on speech and language outcomes in bimodal and bilateral populations. Thus the purpose of this study was to assess speech and language outcomes for bimodal and bilateral preschoolers enrolled in an auditory-oral program focusing on listening and spoken language. This study included a cross-sectional model of bimodal and bilateral children enrolled at the Mama Lere Hearing School at Vanderbilt - between 48 and 60 months of age - using observational and norm-referenced assessments for speech and language development. A linear regression model was used with hearing modality as the independent variable; age at testing and hearing age (in months) were covariates. Our results indicated that children with bilateral cochlear implants have higher articulation, expressive and receptive vocabulary and language than children with bimodal hearing. These findings have potentially significant implications for a child’s future academic and psychosocial performance and may influence caregivers’ decision to pursue cochlear implantation over bimodal hearing.
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Megan Roberts - Author
Northwestern University
     Credentials: Ph.D, CCC-SLP
      Megan Roberts, Ph.D., CCC-SLP, is an assistant professor in the Department of Communication Sciences and Disorders at Northwestern University. Her research focuses on preliguistic and linguistic development in infants with hearing loss as well as family-centered early intervention strategies for children with language delays.

Financial - No relevant financial relationship exist.

Nonfinancial - No relevant nonfinancial relationship exist.
Tamala Bradham - Author
Vanderbilt University School of Medicine
     Credentials: Ph.D. in Speech and Hearing Sciences, University of South Carolina, 1998 CCC-A, ASHA since 1995
     Other Affiliations: NCHAM Consultant for Special Projects
      Tamala S. Bradham, Ph.D., CCC-A is a Assistant Professor at the Vanderbilt Bill Wilkerson Center in Nashville, TN and the Associate Director of Quality, Protocols, and Risk Management. She is the Coordinator for the Steering Committee of the American Speech-Language-Hearing Association (ASHA) Special Interest Division 9: Hearing and Hearing Disorders in Childhood. She is the former director of the MUSC Cochlear Implant Center in Charleston, S.C. and the past President of the South Carolina Academy of Audiology and the South Carolina Chapter of A.G. Bell. Dr. Bradham also served as the Vice-Chairman of the First Sound Universal Newborn Hearing Screening Program in South Carolina. She received her doctorate in Speech and Hearing Sciences and her Master in Audiology at the University of South Carolina.

Financial - Receives Other financial benefit for Consulting from NCHAM.  

Nonfinancial - No relevant nonfinancial relationship exist.
Rene Gifford - Author
      René Gifford, Ph.D., is an Assistant Professor at Vanderbilt University and Director of the Cochlear Implant Program and Associate Director of Pediatric Audiology at the Vanderbilt Bill Wilkerson Center. Her NIH-funded research focuses on electric and acoustic hearing, speech perception, speech and language development, binaural hearing with cochlear implants, and pre-implant prediction of postoperative outcomes.

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Devon Brunson - Primary Presenter,Author
      Devon Brunson is a Magna Cum Laude graduate with a Bachelor of Arts degree in Hearing and Speech Sciences from the University of Maryland, College Park. She will go on to pursue graduate school for speech-language pathology during the coming fall. Ms. Brunson has been involved in research for the past two years, completing three child literacy projects under the guidance of Dr. Nan Bernstein Ratner and Dr. Rochelle Newman at the University of Maryland, in addition to taking part in a child hearing modality project at Vanderbilt University with mentoring from Dr. Megan Roberts, Dr. Tamala Bradham, and Dr. René Gifford. Ms. Brunson’s primary research interests include child literacy in relation to language development, autism, and speech-language development in children with hearing loss.

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