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Aim: To report the experience of an image-guided and navigation-based robot arm as an assistive surgical tool for cochlear implantation in a case with a labyrinthitis ossificans.Patient: A 55-years-old man with a history of childhood meningitis whose hearing deteriorated progressively to bilateral profound sensorineural hearing loss.Intervention: Robotic Assisted Cochlear Implant Surgery (RACIS) with a straight flexible lateral wall electrode. Primary outcome measures: Electrode cochlear insertion depth with RACIS with facial recess approach and autonomous inner ear access with full electrode insertion of a flexible straight cochlear implant array.Conclusions: Intra cochlear ossifications pose a challenge for entering the cochlea and full-length insertion of a cochlear implant. RACIS has shown that computations of radiological images combined with navigation-assisted robot arm drilling can provide efficient access to the inner ear.

With the introduction of newborn hearing screening, children with different degrees of hearing loss can receive hearing aids and cochlear implants in the early months after birth, which is also the case in the Netherlands and in Flanders, the Dutch speaking part of Belgium.This has intensified the need for a validated questionnaire in the Dutch language to assess the speech development of children under the age of two. The LittlEARS Early Speech Production Questionnaire® (LEESPQ®), which was originally developed and validated in German language, was translated and validated into the Dutch language. Questionnaires of 355 normal hearing children were analysed.Total score was highly correlated with age (The Dutch LittlEARS Early Speech Production Questionnaire®, was found to be a reliable and valid tool to assess and monitor the early speech and language production skills in children up to 18 months of age.

Type is a wonderful tool to represent speech visually. Therefore, it can provide deaf individuals the information that they miss auditorily. Still, type does not represent all the information available in speech: it misses an exact indication of prosody. Prosody is the motor of expressive speech through speech variations in loudness, duration, and pitch. The speech of deaf readersis often less expressive because deafness impedes the perception and production of prosody. Support can be provided by visual cues that provide information about prosody—visual prosody—supporting both the training of speech variations and expressive reading. We will describe the influence of visual prosody on the reading expressiveness of deaf readers between age 7 and 18 (in this study, ‘deaf readers’ means persons with any kind of hearing loss, with or without hearing devices, who still developed legible speech). A total of seven cues visualize speech variations: a thicker/thinner font corresponds with a louder/quieter voice; a wider/narrower font relates to a lower/faster speed; a font raised above/lowered below the baseline suggests a higher/lower pitch; wider spaces between words suggest longer pauses. We evaluated the seven cues with questionnaires and a reading aloud test. Deaf readers relate most cues to the intendedspeech variation and read most of them aloud correctly. Only the raised cue is di#cult to connect to the intended speech variation at first, and a faster speed and lower pitch prove challenging to vocalize. Despite those two difficulties, this approach to visual prosody is elective in supporting speech prosody. The applied materials can form an example for typographers, type designers, graphic designers, teachers, speech therapists, and researchers developing expressive reading materials.

Type enriched with visual prosody is a powerful tool to encourage expressive reading. Visual prosody adds cues to text to guide vocal variations in loud-ness, duration, and pitch. More vocal variations result in a less monotonous voice and thus more expression. A positive e!ect of visual prosody is known on the voice of normal hearing readers and of signed bilingual deaf readers who developed signed language and spoken language. These deaf readers rely on speech as well as sign language and both modalities can be used interchangeably to compensate each other. This preliminary study explores visual prosody in text in relation to Flemish Sign Language to see if sign language can be used to explain prosody. We asked deaf readers between 7 and 18 to relate prosodic cues to videos presenting prosodic components of Flemish Sign Language. We found that those readers connect the prosodic cues with the components in Flemish Sign Language as intended. Larger word-spacing cor-relates with a pause between signs, a wider font with a sign with ‘longer du-ration’, a thicker font with more ‘displacement’ in the sign, a raised font with a ‘faster velocity’ in the sign. However, some confusion occurred as participants seemed to extract only two prosodic components in the sign language: both the ‘faster velocity’ and ‘longer duration’ were referred to in terms of 'speed' and were not perceived as separate prosodic components. Participants were confused about why there were three cues in the text. Therefore, it is advised to re-evaluate and to re-design visual prosody for sign language with only ‘displacement’ and ‘speed’ in mind.

Objective: To collect figures on the numbers of children and adults receiving cochlear implants across Europe, compare the figures for 2016 with those for 2010, and identify any trends. Materials and methods: In 2018 EURO-CIU invited their 23 member countries to conduct a survey collecting data on the number of CI recipients in 2016 and 2017. Data were received from 15 countries, representing more than 100 000 CI recipients in Europe. Results: For paediatric CI, there was an increase in nearly all European countries (except Denmark, the UK and Luxembourg) between 2010 and 2016. We found an annual figure of one CI per 1000 newborns common in most countries where reimbursement of paediatric CI's is available. Conversely the adult data reveals no increase between 2010 and 2016 and the data is less homogeneous than the paediatric data with huge differences across countries. Conclusion: There is little agreement on data on numbers of CI across Europe, which makes it difficult to plan public health policy, funding or services. In all European countries included in this study (except Germany) there needs to be work on raising more awareness of adult hearing loss and adult cochlear implantation to improve access.

In Belgium the majority of children with CI's are being educated in mainstream schools. In mainstream schools difficult listening situations occur (e.g. due to background noise) which may result in educational risks for children with CI's. A tool that identifies potential listening difficulties, the English Listen inventory for Education Revised (LIFE-R), was translated and validated into Dutch for elementary and secondary schools (LIFE-NL, LIFE2-NL respectively).Two forward-backward translations were performed followed by a linguistic evaluation and validation by a multidisciplinary committee. The LIFE-NL was further validated on content by pre-testing the questionnaire in 5 students with hearing loss (8-13 years). After minor cross-cultural adaptations normative data were assembled from 187 normal-hearing (NH) students enrolled in mainstream secondary education (1st to 4th grade). The normative data were further analysed based on grade and school type. Additionally, the internal consistency was evaluated by calculating Cronbach's alpha for 3 different scales of the LIFE2-NL: the LIFE total (situation 1-15), LIFE class (situation 1-10: listening situations in classroom) and LIFE social (situation 11-15: social listening situations in school).NH students scored on average 72.0 (SD = 19.9%) on the LIFE2-NL, indicating they experience some difficulties in secondary mainstream schools. The most difficult listening situations were those where fellow students are noisy or when students have to listen in large classrooms. NH students scored significantly higher on the LIFE class compared to the LIFE social (84.1 ± 14.7% vs. 68.1 ± 19.0%, p .000). Moreover the LIFE social tend to decrease from the 3rd grade on. The different subscales of the LIFE2-NL showed high internal consistency (Cronbach's alpha of 0.86, 0.89 and 0.75 for LIFE total, LIFE class and LIFE social respectively).The LIFE-NL and LIFE2-NL are valid Dutch translations of the original LIFE-R and are fully comprehensible for students with hearing loss. The normative data of the LIFE2-NL provide a representative framework for interpreting the results of mainstreamed students with hearing loss in secondary schools.

Item does not contain fulltext The aim of this study is to assess the role of bilateral/bimodal device use in auditory speech perception in complex listening situations and long-term verbal cognition in deaf children using cochlear implants (CIs). Two groups of children are compared (unilateral and bilateral device users) concerning vocabulary, speech perception at conversational level and in complex listening situations, and verbal cognition. In this retrospective study, we collected data of 37 deaf children with normal learning potential of whom 16 were unilateral CI users and 21 were bilateral device users (9 with a bimodal fitting and 12 with bilateral CIs). We came to the conclusion that deaf children who use bilateral devices have the opportunity to develop good speech perception skills in complex listening conditions. These abilities enable at least some of the children to develop age-equivalent verbal cognition skills.

BackgroundCochlear implantation is the major beneficial treatment of bilateral profound deafness in children and adults, but there are big differences in utilisation between European countries.Material and MethodStatistical data on the number of implanted persons are obtained each year by Euro-CIU (the European Association of Cochlear Implant Users). This study models the trends and gives an overview of the current number of cochlear implants in 16 European countries; our model predicts the future demand on cochlear implants in children and adults.ResultsThe degree of utilisation of cochlear implantation by suitable children and adults varies considerably between the European countries. Most less affluent East European countries focus on the implantation of children rather than adults. Although adult recipient numbers are growing, it has been estimated that less than 10% of adult candidates in Europe receive a CI. There is little to no scientific data available on late onset, or progressive, hearing loss in children or adults.ConclusionIt is possible to estimate the yearly number of CI candidates in a country, but we don’t yet have enough reliable data to put into our model. Because of the underutilisation of cochlear implants, especially in adults, we have to work on raising the general awareness of the benefits of cochlear implants, and its improvement in quality of life, based on cost-effectiveness data and on guidelines for good clinical practice.

This paper reviews first what is known of outcomes from bilateral implantation, and the challenges of working with cochlear implant users after bilateral implantation, in particular after sequential bilateral implantation. Our investigation of the existing literature to date to determine the best rehabilitative methods and how they should vary for different groups of bilaterally implanted children suggests there is a lack of description of the therapy types and techniques and no attempt to correlate the methods used with the outcomes observed. As a result, a standard or optimal rehabilitative approach cannot be concluded from the literature to date. Based on clinical good practices it will give you some suggestions for maximizing the benefits from bilateral implantation, in therapy, at home and school.

Belgium, and especially the northern region called Flanders, has been a center of expertise in cochlear implants and early hearing screening for many years. Some of their surgeons and engineers were pioneers in the development of cochlear implants and in 1998 Flanders was the first region in Europe to implement a universal hearing screening program for all neonates. The Belgian National Institute for Health and Disability Insurance has reimbursed cochlear implants in children and adults since 1994 and bilateral implantation in children under the age of 12 years since February 2010. These deaf children, screened and implanted early, achieve higher auditory, speech and language outcomes and increasing numbers are going to regular schools using fewer interpreters. In 2010, 93% of severe-to-profound deaf preschool children in Flanders had received cochlear implants and 25% had bilateral implants. Although on average twice as many adults as children are implanted a year in Belgium, we have less research data available from this adult population. Also very little is published about the growth curves and minimal rehabilitation requirements (intensity, duration etc.) after implantation for both children and adults. So, there still remain many challenges for the future.

Auditory perception with cochlear implants (CIs) enables the majority of deaf children with normal learning potential to develop (near) age-appropriate spoken language. As a consequence, a large proportion of children now attend mainstream education from an early stage. The acoustical environment in kindergartens and schools, however, might be detrimental for children with hearing loss. This paper considers the progress and needs of children with CIs in mainstream education, using the Screening Instrument for Targeting Educational Risk and the assessment of mainstream progress. Academic skills develop quite swiftly, while on the other hand, communicative skills lag behind. The needs of children with CIs are rather subtle and their communicative abilities which show delay may be camouflaged by good speech, spoken language, and academic skills that are at a higher level than observed in the past. One reason for the delay in communicative difficulties may be the difficulty for deaf children with impl...

In the last decade the population of deaf children has changed dramatically in a lot of countries, especially in those where universal neonatal hearing screening, early multi-disciplinary support, digital hearing aids and cochlear implants are available. Most of these children can acquire intelligible spoken language and choose spoken language as their main means of communication and for access to education, because they go to mainstream schools in larger proportions, and fewer to schools for the deaf. Mainstream placement does not eliminate the need for services, which will vary depending upon the child's age, language modality, and other child specific factors. But there is also evidence that the outcomes after paediatric implantation are very heterogeneous. All this is a big change for the educational services. We must ensure that their staff have the skills to meet these challenges: to be flexible, continually updated with the technology and changing expectations (ongoing professional training), to provide an environment which will utilise the hearing while meeting the linguistic and curricular needs of the children, to meet the psycho-social needs of this group as they grow through adolescence, and to work with other professionals. Now, and looking ahead, the challenge for deaf education is also to embrace the diversity of this population and to appropriately address the specific needs of each child.

This paper reports the results of two studies of reading comprehension of Flemish children in Belgium. In the northern part of Belgium (Flanders), Dutch is the official language. The Dutch-speaking inhabitants of Flanders are called Flemish. Dutch is also the national language of the Netherlands. Despite both groups using Dutch, cultural differences between the groups are reflected in healthcare and education. Study 1 investigated the effect of these differences on the reading comprehension of deaf children. Reading levels of Flemish deaf children with cochlear implants (CI) (n = 30) or hearing aids (HA) (n = 44) were compared with reference data of Dutch deaf children with CI (n = 50) and HA (n = 500), and with a hearing norm group. Study 2 investigated sources of variability by examining the underlying processes of reading comprehension of good and poor Flemish deaf readers from the CI group in Study 1. Results of Study 1 showed significantly better reading levels for the two Flemish groups. The...

OBJECTIVES:: In this study, procedures for measuring sound localization, sound lateralization, and binaural masking level differences (BMLDs) in young children were developed. Sensitivity for these tasks was assessed in large groups of children between 4 and 9 yr of age to investigate potential developmental trends. DESIGN:: Sound localization was measured in the sound field, with a broadband bell-ring presented from one of nine loudspeakers positioned in the frontal horizontal field. A group of 33 children between 4 and 6 yr of age and 5 adults took part in this experiment. Sound lateralization based on interaural time differences was measured with headphones in 49 children between 4 and 9 yr of age and 10 adults. A low-frequency stimulus containing harmonics 2 to 5 from a click train with a rate of 160 Hz was used. In the BMLD test, the same filtered click train was presented diotically or dichotically (phase reversed or time delayed) in a broadband (200 to 1000 Hz) frozen noise to 23 children between 4 and 6 yr of age and 10 adults. For comparison with literature, additional measurements with a 500-Hz sinusoid were administered to adults. All tasks were adapted to the interest and attention span of young children. RESULTS:: Children of 5 yr of age did not perform significantly different from adults on the sound localization task, but mean absolute errors were larger for the 4 yr olds. Also on the BMLD task, 5-yr-old children performed at the adult level, whereas the 4-yr-old children obtained significantly less binaural unmasking compared with the adults. Concerning sound lateralization, a small but significant difference between adults and children existed, but no age effects were apparent in the 4- to 9-yr-old group. Overall, the variation was relatively large in the 4-yr-old group, with some of the children performing at adult level, in all three tasks. CONCLUSIONS:: The results of this study show that the modified procedures are suitable for testing children from the age of 4 to 5 yr. Furthermore, it seems that binaural hearing capacities of the 5-yr-old group are similar to those of adults. Several observations led to the hypothesis that the observed age differences between those 4 yr of age and older subjects on localization and BMLD or between those 4- to 9 yr old and adults on lateralization were attributable to both a development in binaural hearing and to nonauditory factors, such as task comprehension, attention, and testing conditions. It is possible that the developmental process is more obvious and prolonged in other aspects of binaural hearing, which require more dynamic or more central processing.

The purpose of this study was to examine several behavioral problems in school-aged hearing-impaired children with hearing aids or cochlear implants, compared to normally hearing children. Additionally, we wanted to investigate which sociodemographic, linguistic, and medical factors contributed to the level of behavioral problems, to pinpoint where targeted interventions can take place. This large, retrospective study included a sample of 261 school-aged children (mean age = 11.8 years, SD = 1.6), that consisted of three age- and gender-matched subgroups: 75 with hearing aids, 57 with cochlear implants, and 129 normally hearing controls. Self- and parent-reports concerning reactive and proactive aggression, delinquency, and symptoms of psychopathy, attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder were used. In addition, several language and intelligence tests were administered. Hearing-impaired children showed significantly more proactive aggression, symptoms of psychopathy, attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder than their normally hearing peers. More behavioral problems were associated with special schools for the deaf, sign (-supported) language, hearing aids (in contrast to cochlear implants), higher age, male gender, lower socioeconomic status, lower intelligence, and delayed language development. Hearing-impaired children face multiple problems regarding their behavior. The outcomes implicate that professionals should be aware of the higher risk of developing behavioral problems, in order to screen, detect, and treat in time. Furthermore, the associated risk and protective factors emphasize that clinicians must always consider the heterogeneity of the group of hearing-impaired children, in order to help and support the individual patient.

(2010). Changing Candidature: Do We Know How to Support These Children and Their Families in Short and Long Term? Cochlear Implants International: Vol. 11, Proceedings of the 9th European Symposium on Paediatric Cochlear Implantation, Warsaw, 2009, pp. 228-230.

It is still largely unknown how receiving a cochlear implant affects the emotion understanding in deaf children. We examined indices for emotion understanding and their associations with communication skills in children aged 2.5-5 years, both hearing children (n = 52) and deaf children with a cochlear implant (n = 57). 2 aspects of emotion understanding were examined: (a) emotion recognition in facial expressions and (b) emotion attribution in a situational context. On all emotion-understanding tasks, children with a cochlear implant were less proficient than children with normal hearing. In children with normal hearing, performance and language skills were positively associated. In children with cochlear implants, language was positively associated only with tasks in which a verbal demand was made on children. These findings indicate that hearing loss in children, despite a cochlear implant, affects all aspects of emotion understanding measured in this study, including their nonverbal emotion-understanding skills.

Cochlear implants have a significant positive effect on spoken language development in severely hearing impaired children. Previous work in this population has focused mostly on the emergence of early-developing language skills, such as vocabulary. The current study aims at comparing narratives, which are more complex and later-developing spoken language skills, of a contemporary group of profoundly deaf school-aged children using cochlear implants ( n = 66, median age = 8 years 3 months) with matched normal hearing peers. Results show that children with cochlear implants demonstrate good results on quantity and coherence of the utterances, but problematic outcomes on quality, content and efficiency of retold stories. However, for a subgroup ( n = 20, median age = 8 years 1 month) of deaf children without additional disabilities who receive cochlear implantation before the age of 2 years, use two implants, and are raised with one spoken language, age-adequate spoken narrative skills at school-age are feasible. This is the first study to set the goals regarding spoken narrative skills for deaf children using cochlear implants.

Practical experience and research reveal generic spoken language benefits after cochlear implantation. However, systematic research on specific language domains and error analyses are required to probe sub-skills. Moreover, the effect of predictive factors on distinct language domains is unknown. In this study, outcomes of 70 school-aged children with cochlear implants were compared with hearing peers. Approximately half of the children with cochlear implants achieved age-adequate language levels. Results did not reveal systematic strong or weak language domains. Error analyses showed difficulties with morphological and syntactic rules and inefficient narrative skills. Children without additional disabilities who received early intervention were raised with one spoken language, and used a second cochlear implant or contralateral hearing aid were more likely to present good language skills.

Objectives/Hypothesis: The objectives of this study were to examine the levels of anxiety in hearing-impaired children with hearing aids or cochlear implants compared to normally hearing children, and to identify individual variables that were associated with differences in the level of anxiety. Study Design: Large retrospective cohort study. Methods: Self-reports and parent-reports concerning general anxiety, social anxiety, and generalized anxiety disorder were used. The study group (mean age, 11.8 years) consisted of three age-matched subgroups: 32 children with cochlear implants, 51 children with conventional hearing aids, and 127 children without hearing loss. Results: Levels of anxiety in children with cochlear implants and normally hearing children were similar. Early implantation was associated with lower levels of general and social anxiety. Remarkably, children with conventional hearing aids had higher levels of social anxiety, and their parents also reported more generalized anxiety disorder. Conclusions: The outcomes demonstrate that in their level of anxiety, children with cochlear implants might be more comparable to normally hearing children than to children with hearing aids. This positive finding can be the consequence of audiological factors or other aspects of the cochlear implant rehabilitation program.

Objectives/Hypothesis: To evaluate the impact of a newborn hearing screening program on the management and outcome of deaf children and to identify underlying factors that may be responsible for the differences between high and low performing implanted children. Study Design: Retrospective cohort study of 391 implanted children in Flanders (Belgium). Methods: First, implanted children were sorted into two groups on account of screening age (early screened, n = 195 vs. late screened, n = 196). Both groups were compared with respect to several variables. Second, outcome of cochlear implantation was measured in terms of the child's speech perception and production skills (n = 355). A subgroup of high performing cochlear implant (CI) users was compared with low performing CI users with regard to several variables. Results: Early screened children differ significantly from late screened children with respect to age of hearing loss detection and age at cochlear implantation. Furthermore, early screening and implantation is associated with better auditory receptive skills and speech intelligibility. Additional impairments negatively influence both receptive and productive skills. In addition, children who communicate orally and wear bilateral cochlear implants perform better on speech production, whereas a better speech perception was found in children who became progressively deaf as opposed to congenitally deaf children. Conclusions: The results of this extensive study of profoundly deaf children with CIs in Flanders indicate that a newborn hearing screening program results in earlier intervention in deaf children, which beneficially influences the auditory receptive skills and speech intelligibility.

Objective To examine the effects of sequential bilateral cochlear implantation (CI) on the life of young children after 36 months of bilateral implant use. Method Thirty-five children were assessed prior to and 3 until 36 months after activation of the second CI. Main outcome measures were: the Categories of Auditory Performance (CAP), Speech Intelligibility Rating (SIR), communication mode, classroom placement, parent reports and the Würzburg questionnaire. Results were analysed separately for children younger and older than 6 years at the time of the second implantation. Results At the 3-year test interval, 80% of the younger children attended mainstream schools and were comprehensible for all listeners. They all used oral communication and almost 70% of them could have a conversation over the telephone. After 3 years of bilateral implant use less than 50% of the older children obtained the highest score on the SIR and CAP. Approximately 70% of them was integrated in mainstream schools and used oral communication. All parents reported a more natural communication and an improved quality of life. Conclusions Sequential bilateral implantation seems to offer a wide range of participation benefits to all children and facilitates the social intercourse with their hearing environment.

Objectives: We report on the auditory abilities and speech performance in quiet and noise of 35 children with sequential bilateral cochlear implantation after 3 years of bilateral implant use. Methods: Testing was done in bilateral and both unilateral listening conditions. The assessments took place before the second implantation and at several time intervals after fitting. As different auditory tests were used, the children were categorized by their age at the second implantation: Younger or older than 6 years. Results: The pure tone averages for the bilateral condition were significantly better than those for either unilateral condition after 12 months of bilateral implant use and remained so from that test interval onward. The speech recognition outcomes in quiet and noise also improved significantly for almost all children after 36 months, although a linear regression analysis showed a beneficial effect of younger age at first implantation on the speech-in-noise results. Conclusions: Bilateral cochlear implantation offered advantages to all children in comparison with the first implant — Even the children who received the second implant after the age of 6 years. Compared to the younger children, the older children needed a longer adjustment period to gain bilateral benefit. However, they obtained similar results after 2 years of bilateral implant use.

Bilateral cochlear implants (CIs) may offer deaf children a range of advantages compared to unilateral CIs. However, speech perception in noise is mainly facilitated by better-ear effects and much less by interaural comparisons or true ‘binaural’ hearing. Little is known about the development of the binaural auditory system with CIs provided at a young age. It is possible that, as with adults, binaural sensitivity exists but is not accessed due to technical limitations in electrical stimulation methods. In this paper, we present results on binaural hearing in children with bilateral CIs. Binaural masking level differences (BMLDs) were measured for a 180-degree phase shift in a 125-Hz sinusoid, presented in a 50-Hz-wide noise band and modulating a 1000-pps carrier pulse train. Stimuli were presented to a single electrode in the middle of the electrode array at both ears. Eight children between 6 and 15 years of age participated in this study. Six children had a significantly better detection threshold when the signal was out of phase (dichotic) between two ears than when it was in phase (diotic), with a mean difference (BMLD) of 6.4 dB. The present results show that children with bilateral CIs are sensitive to binaural cues in electrical stimuli, similar to adults, even when implants are provided at a later age and with a longer delay between implantations.

Objective: To investigate the subjective benefits of bilateral cochlear implantation in 33 young children after 18 months of second implant use. Method: The Würzburg questionnaire inquiring into a range of hearing functions was filled out by the parents. Additional data concerning the daily life and well-being of the children were gathered with an open-ended questionnaire and the Categories of Auditory Performance. Results were analyzed separately for children younger and older than 6 years at the time of the second implantation. Results: After 18 months of bilateral implant use 30% of the younger and 6% of the older children made the transition to an auditory-oral communication. In this period, 15% of all children switched to mainstream schools. The parents reported an evolution of their children’s auditory abilities, which included a better sound and speech perception. Multiregression analysis revealed that early hearing aid fitting and the age at the second cochlear implantation significantly contributed to the variance of the Würzburg results. Conclusions: The results indicate a wide range of positive subjective changes associated with bilateral cochlear implantation, even in older children. This progress led to a better and easier communication and a better integration in the normal-hearing world.

To investigate the additional bilateral benefits of a second cochlear implant (CI) in a group of young children (6 years of age) and a group of older children (6 years of age).This is a Belgian tertiary multi-centre study in which 33 CI-children with a second implant between the age of 2 and 12 participated. Assessments took place pre-second implant and at several time intervals post-fitting on pure tone audiometry and speech recognition in quiet and noise (+10 dBSNR). Testing was done with the first and second implant alone and bilaterally. Results were analysed separately for children younger and older than 6 years at the time of implantation of the 2nd CI.After 18 months of bilateral implant use all children obtained significantly higher hearing thresholds in the bilateral condition in comparison to both the unilateral conditions (p(CI1)=0.035/p(CI2)=0.042 for the younger children and p(CI1)=0.021/p(CI2)=0.007 for the older children). The speech recognition scores in quiet were for all children superior in the bilateral condition (p(CI2)=0.011 for the younger children and p(CI1)=0.016/p(CI2)=0.003 for the older children). In the noisy condition only significant bilateral better results were obtained in the group of younger children (p(CI1)=0.028/p(CI2)=0.034).Bilateral cochlear implantation offers advantages to all children. Even for the children who received a second implant after the age of 6 a progress is determined after 18 months. However, the data appear to show a beneficial performance for those children who received their second implant before the age of 6, especially in the more challenging conditions.