Clark, Catherine; Scott, Larry
This brochure explains what a cochlear implant is, lists the types of individuals with deafness who may be helped by a cochlear implant, describes the process of evaluating people for cochlear implants, discusses the surgical process for implanting the aid, traces the path of sound through the cochlear implant to the brain, notes the costs of…
Ching, Teresa Y. C.; Psarros, Colleen; Incerti, Paula; Hill, Mandy
Four case studies identify six factors affecting successful use of a hearing aid with a cochlear implant: duration of hearing aid use prior to implantation, amount of residual hearing in the non-implanted ear, educational and listening demands, cosmetic issues, hearing aid rejection, and extended period of non-use of hearing aid. (Contains…
Seeber, Bernhard U.; Baumann, Uwe; Fastl, Hugo
After successful cochlear implantation in one ear, some patients continue to use a hearing aid at the contralateral ear. They report an improved reception of speech, especially in noise, as well as a better perception of music when the hearing aid and cochlear implant are used in this bimodal combination. Some individuals in this bimodal patient group also report the impression of an improved localization ability. Similar experiences are reported by the group of bilateral cochlear implantees. In this study, a survey of 11 bimodally and 4 bilaterally equipped cochlear implant users was carried out to assess localization ability. Individuals in the bimodal implant group were all provided with the same type of hearing aid in the opposite ear, and subjects in the bilateral implant group used cochlear implants of the same manufacturer on each ear. Subjects adjusted the spot of a computer-controlled laser-pointer to the perceived direction of sound incidence in the frontal horizontal plane by rotating a trackball. Two subjects of the bimodal group who had substantial residual hearing showed localization ability in the bimodal configuration, whereas using each single device only the subject with better residual hearing was able to discriminate the side of sound origin. Five other subjects with more pronounced hearing loss displayed an ability for side discrimination through the use of bimodal aids, while four of them were already able to discriminate the side with a single device. Of the bilateral cochlear implant group one subject showed localization accuracy close to that of normal hearing subjects. This subject was also able to discriminate the side of sound origin using the first implanted device alone. The other three bilaterally equipped subjects showed limited localization ability using both devices. Among them one subject demonstrated a side-discrimination ability using only the first implanted device.
Bittencourt, Aline Gomes; Torre, Ana Adelina Giantomassi Della; Bento, Ricardo Ferreira; Tsuji, Robinson Koji; Brito, Rubens de
Summary Introduction: The majority of patients with hearing loss, including those with severe hearing loss, benefits from the use of hearing aids. The cochlear implant is believed to achieve better results in a child with hearing loss in cases where the severity of disability renders hearing aids incapable of providing adequate sound information, as they require sufficient cochlear reserve so that acoustic detention occurs. Objective: To assess if cochlear implants provide more benefit than conventional hearing aids in prelingually deaf patients. Summary of the findings: The study was a systematic review of scientific papers selected by a search of the SciELO, Cochrane, MEDLINE, and LILACS-BIREME databases. Among the 2169 articles found, 12 studies proved relevant to the issue and presented an evidence strength rating of B. No publications rated evidence strength A. Seven of the studies analyzed were prospective cohorts and 5 were cross-sectional studies. Conclusion: Based on several studies, cochlear implants were demonstrated to be the best current alternative for bilateral severe or profound hearing loss, achieving better results in speech perception and development in prelingual children when compared to conventional hearing aids. PMID:25991962
... NIDCD A cochlear implant is a small, complex electronic device that can help to provide a sense ... are better able to hear, comprehend sound and music, and speak than their peers who receive implants ...
Bouccara, D; Mosnier, I; Bernardeschi, D; Ferrary, E; Sterkers, O
Cochlear implant in adults is a procedure, dedicated to rehabilitate severe to profound hearing loss. Because of technological progresses and their applications for signal strategies, new devices can improve hearing, even in noise conditions. Binaural stimulation, cochlear implant and hearing aid or bilateral cochlear implants are the best opportunities to access to better level of comprehension in all conditions and space localisation. By now minimally invasive surgery is possible to preserve residual hearing and use a double stimulation modality for the same ear: electrical for high frequencies and acoustic for low frequencies. In several conditions, cochlear implant is not possible due to cochlear nerve tumour or major malformations of the inner ear. In these cases, a brainstem implantation can be considered. Clinical data demonstrate that improvement in daily communication, for both cochlear and brainstem implants, is correlated with cerebral activation of auditory cortex.
Britt, Christopher J; Coughlin, Adam R; Gubbels, Samuel P
We describe a novel technique of scalp flap rearrangement for cochlear implant (CI) candidates who have previously undergone ipsilateral bone-anchored hearing aid (BAHA) placement. One patient with single-sided deafness (SSD) underwent removal of a BAHA with subsequent scalp rearrangement for coverage of the implant site. After adequate healing of the scalp rotational flap, he underwent uncomplicated cochlear implantation without soft tissue complications. With increasing utilization of CIs in SSD, there will be more patients undergoing cochlear implantation who have previously had a BAHA. We present a novel method for accomplishing this goal while minimizing the risk of soft tissue complications. Laryngoscope, 126:2601-2604, 2016.
Connell, Sarah S; Balkany, Thomas J
Cochlear implants are cost-effective auditory prostheses that safely provide a high-quality sensation of hearing to adults who are severely or profoundly deaf. In the past 5 years, progress has been made in hardware and software design, candidate selection, surgical techniques, device programming, education and rehabilitation,and, most importantly, outcomes. Cochlear implantation in the elderly is well tolerated and provides marked improvement in auditory performance and psychosocial functioning.
More than 60,000 people worldwide use cochlear implants as a means to restore functional hearing. Although individual performance variability is still high, an average implant user can talk on the phone in a quiet environment. Cochlear-implant research has also matured as a field, as evidenced by the exponential growth in both the patient population and scientific publication. The present report examines current issues related to audiologic, clinical, engineering, anatomic, and physiologic aspects of cochlear implants, focusing on their psychophysical, speech, music, and cognitive performance. This report also forecasts clinical and research trends related to presurgical evaluation, fitting protocols, signal processing, and postsurgical rehabilitation in cochlear implants. Finally, a future landscape in amplification is presented that requires a unique, yet complementary, contribution from hearing aids, middle ear implants, and cochlear implants to achieve a total solution to the entire spectrum of hearing loss treatment and management. PMID:15247993
Harris, Margaret; Terlektsi, Emmanouela
A total of 86 deaf children aged between 12 and 16 years were recruited from schools for the deaf, specialist units attached to a school, and mainstream schools. Approximately one-third used hearing aids, one-third had received a cochlear implant before 42 months, and one-third had been implanted later. The 3 subgroups were matched for age and…
Leuwer, R.; Müller, J.
Aim of this report is to explain the current concept of hearing restoration using hearing aids. At present the main issues of conventional hearing aids are the relative benefits of analogue versus digital devices and different strategies for the improvement of hearing in noise. Implantable hearing aids provide a better sound quality and less distortion. The lack of directional microphones is the major disadvantage of the partially implantable hearing aids commercially available. Two different clinical studies about fully implantable hearing aids have been started in 2004. One of the most-promising developments seems to be the electric-acoustic stimulation. PMID:22073051
Dunn, Camille C.; Tyler, Richard S.; Witt, Shelley A.
The purpose of this investigation was to document performance of participants wearing a cochlear implant and hearing aid in opposite ears on speech-perception and localization tests. Twelve individuals who wore a cochlear implant and a hearing aid on contralateral ears were tested on their abilities to understand words in quiet and sentences in…
Peterson, Candida C.
Background: In the context of the established finding that theory-of-mind (ToM) growth is seriously delayed in late-signing deaf children, and some evidence of equivalent delays in those learning speech with conventional hearing aids, this study's novel contribution was to explore ToM development in deaf children with cochlear implants. Implants…
Bajin, Münir Demir; Savaş, Özden; Aslan, Filiz; Sennaroğlu, Levent
Background: Neurobrucellosis is a disease consisting of a wide spectrum of complications such as peripheral neuropathy, cranial nerve involvement, ataxia, meningeal irritation, paraplegia, seizures, coma, and even death. The vestibulocochlear nerve seems to be the most commonly affected cranial nerve (10%). We present a patient with neurobrucellosis whose auditory perception and speech intelligibility skill performances improved after cochlear implantation. Case Report: A 35 year-old woman was admitted to another hospital 2 years ago with the symptoms of headache, nausea, and altered consciousness, who was finally diagnosed with neurobrucellosis. She developed bilateral profound sensorineural hearing loss during the following 6 months. There was no benefit of using hearing aids. After successful treatment of her illness, she was found to be suitable for cochlear implantation. After the operation, her auditory perception skills improved significantly with a Categories of Auditory Performance (CAP) score of 5. According to clinical observations and her family members’ statements, her Speech Intelligibility Rating (SIR) score was 3. Her speech intelligibility skills are still improving. Conclusion: Our case report represents the second case of hearing rehabilitation with cochlear implantation after neurobrucellosis. Cochlear implantation is a cost-effective and time-proven successful intervention in post-lingual adult patients with sensorineural hearing loss. Early timing of the surgery after appropriate treatment of meningitis helps the patient to achieve better postoperative results. PMID:26966626
Noble, Jack H.; Labadie, Robert F.; Wanna, George B.; Dawant, Benoit M.
It is widely believed that major factors in achieving atraumatic insertion of the electrode array into the cochlea in cochlear implant (CI) surgery include amount of tissue resection, selection of the entry point, and angle of insertion. Our group is interested in developing an image guidance (IG) system for electrode insertion if IG can improve outcomes. Thus, in this work we conducted the first study evaluating whether IG could aid atraumatic electrode insertion. To do this, we measured the performance of experienced surgeons when tasked to perform cochleostomy resection and to select CI insertion trajectories in virtual 3D surgical field-of-view simulation software. This software, which simulates views through the surgical microscope, was designed to allow a user to manually perform cochleostomy resection and to select a preferred insertion trajectory in one of two modes: (a) where the traditional approach is simulated and sub-surface anatomy is not visible; and (b) where an IG approach is simulated and the surgical view is augmented with rendering of subsurface intra-cochlear structures. We used this software to compare two surgeons' performance in selecting insertion trajectories with and without IG. Our results show that when using virtual IG, both surgeons could choose insertion trajectories with less variability, select higher quality insertion trajectories, and create the cochleostomy with substantially less tissue resection. These results suggest that IG could indeed aid performance of atraumatic cochlear implantation techniques.
Most, Tova; Rothem, Hilla; Luntz, Michal
The researchers evaluated the contribution of cochlear implants (CIs) to speech perception by a sample of prelingually deaf individuals implanted after age 8 years. This group was compared with a group with profound hearing impairment (HA-P), and with a group with severe hearing impairment (HA-S), both of which used hearing aids. Words and…
Most, Tova; Aviner, Chen
This study evaluated the benefits of cochlear implant (CI) with regard to emotion perception of participants differing in their age of implantation, in comparison to hearing aid users and adolescents with normal hearing (NH). Emotion perception was examined by having the participants identify happiness, anger, surprise, sadness, fear, and disgust.…
Background Speech production and speech phonetic features gradually improve in children by obtaining audio feedback after cochlear implantation or using hearing aids. The aim of this study was to develop and evaluate automated classification of voice disorder in children with cochlear implantation and hearing aids. Methods We considered 4 disorder categories in children's voice using the following definitions: Level_1: Children who produce spontaneous phonation and use words spontaneously and imitatively. Level_2: Children, who produce spontaneous phonation, use words spontaneously and make short sentences imitatively. Level_3: Children, who produce spontaneous phonations, use words and arbitrary sentences spontaneously. Level_4: Normal children without any hearing loss background. Thirty Persian children participated in the study, including six children in each level from one to three and 12 children in level four. Voice samples of five isolated Persian words "mashin", "mar", "moosh", "gav" and "mouz" were analyzed. Four levels of the voice quality were considered, the higher the level the less significant the speech disorder. "Frame-based" and "word-based" features were extracted from voice signals. The frame-based features include intensity, fundamental frequency, formants, nasality and approximate entropy and word-based features include phase space features and wavelet coefficients. For frame-based features, hidden Markov models were used as classifiers and for word-based features, neural network was used. Results After Classifiers fusion with three methods: Majority Voting Rule, Linear Combination and Stacked fusion, the best classification rates were obtained using frame-based and word-based features with MVR rule (level 1:100%, level 2: 93.75%, level 3: 100%, level 4: 94%). Conclusions Result of this study may help speech pathologists follow up voice disorder recovery in children with cochlear implantation or hearing aid who are in the same age range. PMID
... antenna. This part of the implant receives the sound, converts the sound into an electrical signal, and sends it to ... implants allow deaf people to receive and process sounds and speech. However, these devices do not restore ...
... outside of the body, behind the ear. A second part is surgically placed under the skin. An implant does not restore normal hearing. It can help a person understand speech. Children and adults can benefit from them. National Institute on Deafness and Other Communication Disorders
Vandam, Mark; Ide-Helvie, Dana; Moeller, Mary Pat
This work investigates the developmental aspects of the duration of point vowels in children with normal hearing compared with those with hearing aids and cochlear implants at 4 and 5 years of age. Younger children produced longer vowels than older children, and children with hearing loss (HL) produced longer and more variable vowels than their…
Bunta, Ferenc; Douglas, Michael; Dickson, Hanna; Cantu, Amy; Wickesberg, Jennifer; Gifford, René H.
Background: There is a critical need to understand better speech and language development in bilingual children learning two spoken languages who use cochlear implants (CIs) and hearing aids (HAs). The paucity of knowledge in this area poses a significant barrier to providing maximal communicative outcomes to a growing number of children who have…
Most, Tova; Shina-August, Ella; Meilijson, Sara
This study characterized the profile of pragmatic abilities among 24 children with hearing loss (HL) aged 6.3-9.4 years, 13 using hearing aids (HAs) and 11 using cochlear implants (CIs), in comparison to those of 13 hearing children with similar chronological and language ages. All the children with HL used spoken language, attended regular…
Most, Tova; Harel, Tamar; Shpak, Talma; Luntz, Michal
Purpose: The purpose of the study was to evaluate the contribution of acoustic hearing to the perception of suprasegmental features by adults who use a cochlear implant (CI) and a hearing aid (HA) in opposite ears. Method: 23 adults participated in this study. Perception of suprasegmental features--intonation, syllable stress, and word…
Kronenberg, Jona; Migirov, Lela; Taitelbaum-Swead, Rikey; Hildesheimer, Minka
Cochlear implant surgery became the standard of care in hearing rehabilitation of patients with severe to profound sensorineural hearing loss. This procedure may alter the lives of children and adults enabling them to integrate with the hearing population. In the past, implantation was performed only in one ear, despite the fact that binaural hearing is superior to unilateral, especially in noisy conditions. Cochlear implantation may be performed sequentially or simultaneously. The "sensitive period" of time between hearing loss and implantation and between the two implantations, when performed sequentially, significantly influences the results. Shorter time spans between implantations improve the hearing results after implantation. Hearing success after implantation is highly dependent on the rehabilitation process which includes mapping, implant adjustments and hearing training. Bilateral cochlear implantation in children is recommended as the proposed procedure in spite of the additional financial burden.
Stöver, T; Lenarz, T
Cochlear implants (CI) represent the "gold standard" for the treatment of congenitally deaf children and postlingually deafened adults. Thus, cochlear implantation is a success story of new bionic prosthesis development. Owing to routine application of cochlear implants in adults but also in very young children (below the age of one), high demands are placed on the implants. This is especially true for biocompatibility aspects of surface materials of implant parts which are in contact with the human body. In addition, there are various mechanical requirements which certain components of the implants must fulfil, such as flexibility of the electrode array and mechanical resistance of the implant housing. Due to the close contact of the implant to the middle ear mucosa and because the electrode array is positioned in the perilymphatic space via cochleostomy, there is a potential risk of bacterial transferral along the electrode array into the cochlea. Various requirements that have to be fulfilled by cochlear implants, such as biocompatibility, electrode micromechanics, and although a very high level of technical standards has been carried out there is still demand for the improvement of implants as well as of the materials used for manufacturing, ultimately leading to increased implant performance. General considerations of material aspects related to cochlear implants as well as potential future perspectives of implant development will be discussed.
Dincer D'Alessandro, H; Sennaroğlu, G; Yücel, E; Belgin, E; Mancini, P
The aim of this study was to investigate the amount of binaural squelch effect (BSE) and head shadow effect (HSE) in children who use unilateral cochlear implants (CI) and contralateral hearing aids (HA). The study group consisted of 19 CI recipient children who consistently wore a contralateral HA. Speech sounds were used to evaluate speech perception performance in noise. Testing was performed in three listening conditions: (1) bimodal listening with noise source on HA side; (2) CI only with noise source contralaterally (HA off); (3) CI only with noise source on the CI side. Statistical analysis revealed a significant difference between the three listening conditions and post hoc tests indicated significant differences for all pairwise comparisons (p < 0.001). The average BSE and HSE were 11.8% and 17.1% respectively. The majority of bimodal CI users showed BSE and HSE with significant speech perception improvement in the presence of noise.
Wang, Yifang; Su, Yanjie; Yan, Song
Facial expression recognition (FER) is an important aspect of effective interpersonal communication. In order to explore whether the development of FER was delayed in hearing impaired children, 44 child participants completed labeling, and matching tasks to identify four basic emotions (happiness, sadness, anger, and fear). Twenty-two participants had either a cochlear implant (CI) or a hearing aid (HA) while 22 had normal hearing and participants were matched across conditions by age and gender. The results showed that children with a CI or HA were developmentally delayed not only in their emotion-labeling (verbal) tasks but also in their emotion-matching (nonverbal) tasks. For all participants, the emotion-labeling task was more difficult than the emotion-matching task. Additionally, the relative difficulty of recognizing four different emotional expressions was similar between verbal and nonverbal tasks. PMID:28066306
Haumann, Sabine; Hohmann, Volker; Meis, Markus; Herzke, Tobias; Lenarz, Thomas; Büchner, Andreas
Owing to technological progress and a growing body of clinical experience, indication criteria for cochlear implants (CI) are being extended to less severe hearing impairments. It is, therefore, worth reconsidering these indication criteria by introducing novel testing procedures. The diagnostic evidence collected will be evaluated. The investigation includes postlingually deafened adults seeking a CI. Prior to surgery, speech perception tests [Freiburg Speech Test and Oldenburg sentence (OLSA) test] were performed unaided and aided using the Oldenburg Master Hearing Aid (MHA) system. Linguistic skills were assessed with the visual Text Reception Threshold (TRT) test, and general state of health, socio-economic status (SES) and subjective hearing were evaluated through questionnaires. After surgery, the speech tests were repeated aided with a CI. To date, 97 complete data sets are available for evaluation. Statistical analyses showed significant correlations between postsurgical speech reception threshold (SRT) measured with the adaptive OLSA test and pre-surgical data such as the TRT test (r=−0.29), SES (r=−0.22) and (if available) aided SRT (r=0.53). The results suggest that new measures and setups such as the TRT test, SES and speech perception with the MHA provide valuable extra information regarding indication for CI. PMID:26557327
Mauger, Stefan J; Arora, Komal; Dawson, Pam W
Noise-reduction methods have provided significant improvements in speech perception for cochlear implant recipients, where only quality improvements have been found in hearing aid recipients. Recent psychoacoustic studies have suggested changes to noise-reduction techniques specifically for cochlear implants, due to differences between hearing aid recipient and cochlear implant recipient hearing. An optimized noise-reduction method was developed with significantly increased temporal smoothing of the signal-to-noise ratio estimate and a more aggressive gain function compared to current noise-reduction methods. This optimized noise-reduction algorithm was tested with 12 cochlear implant recipients over four test sessions. Speech perception was assessed through speech in noise tests with three noise types; speech-weighted noise, 20-talker babble and 4-talker babble. A significant speech perception improvement using optimized noise reduction over standard processing was found in babble noise and speech-weighted noise and over a current noise-reduction method in speech-weighted noise. Speech perception in quiet was not degraded. Listening quality testing for noise annoyance and overall preference found significant improvements over the standard processing and over a current noise-reduction method in speech-weighted and babble noise types. This optimized method has shown significant speech perception and quality improvements compared to the standard processing and a current noise-reduction method.
Chun, Hyungi; Ma, Sunmi; Chun, Youngmyoung
Background and Objectives Not all impaired listeners may have the same speech perception ability although they will have similar pure-tone threshold and configuration. For this reason, the present study analyzes error patterns in the hearing-impaired compared to normal hearing (NH) listeners as a function of signal-to-noise ratio (SNR). Subjects and Methods Forty-four adults participated: 10 listeners with NH, 20 hearing aids (HA) users and 14 cochlear implants (CI) users. The Korean standardized monosyllables were presented as the stimuli in quiet and three different SNRs. Total error patterns were classified into types of substitution, omission, addition, fail, and no response, using stacked bar plots. Results Total error percent for the three groups significantly increased as the SNRs decreased. For error pattern analysis, the NH group showed substitution errors dominantly regardless of the SNRs compared to the other groups. Both the HA and CI groups had substitution errors that declined, while no response errors appeared as the SNRs increased. The CI group was characterized by lower substitution and higher fail errors than did the HA group. Substitutions of initial and final phonemes in the HA and CI groups were limited by place of articulation errors. However, the HA group had missed consonant place cues, such as formant transitions and stop consonant bursts, whereas the CI group usually had limited confusions of nasal consonants with low frequency characteristics. Interestingly, all three groups showed /k/ addition in the final phoneme, a trend that magnified as noise increased. Conclusions The HA and CI groups had their unique error patterns even though the aided thresholds of the two groups were similar. We expect that the results of this study will focus on high error patterns in auditory training of hearing-impaired listeners, resulting in reducing those errors and improving their speech perception ability. PMID:26771013
Deer, Maria Soledad
The auditory experience of using a hearing aid or a cochlear implant simultaneously with a cell phone is driven by a number of factors. These factors are: radiofrequency and baseband interference, speech intelligibility, sound quality, handset design, volume control and signal strength. The purpose of this study was to develop a tool to be used by hearing aid and cochlear implant users in retail stores as they try cell phones before buying them. This tool is meant to be an efficient, practical and systematic consumer selection tool that will capture and document information on all the domains that play a role in the auditory experience of using a cell phone with a hearing aid or cochlear implant. The development of this consumer tool involved three steps as follows: preparation, verification and measurement of success according to a predefined criterion. First, the consumer tool, consisting of a comparison chart and speech material, was prepared. Second, the consumer tool was evaluated by groups of subjects in a two-step verification process. Phase I was conducted in a controlled setting and it was followed by Phase II which took place in real world (field) conditions. In order to perform a systematic evaluation of the consumer tool two questionnaires were developed: one questionnaire for each phase. Both questionnaires involved five quantitative variables scored with the use of ratings scales. These ratings were averaged yielding an Overall Consumer Performance Score. A qualitative performance category corresponding to the Mean Opinion Score (MOS) was allocated to each final score within a scale ranging from 1 to 5 (where 5 = excellent and 1 = bad). Finally, the consumer tool development was determined to be successful if at least 80% of the participants in verification Phase II rated the comparison chart as excellent or good according to the qualitative MOS score. The results for verification Phase II (field conditions) indicated that the Overall Consumer
Saikawa, Etsuko; Takano, Kenichi; Ogasawara, Noriko; Tsubomatsu, Chieko; Takahashi, Nozomi; Shirasaki, Hideaki; Himi, Tetsuo
Cochlear implantation (CI) has proven to be an effective treatment for severe bilateral sensorineural hearing loss (SNHL). Inner ear malformation is a rare anomaly and occurs in approximately 20% of cases with congenital SNHL. In cases with cochlear malformation, CI can be successfully performed in nearly all patients, the exceptions being those with complete labyrinthine and cochlear aplasia. It is important to evaluate the severity of inner ear deformity and other associated anomalies during the preimplantation radiological assessment in order to identify any complication that may potentially occur during the surgery and subsequent patient management.
Most, Tova; Aviner, Chen
This study evaluated the benefits of cochlear implant (CI) with regard to emotion perception of participants differing in their age of implantation, in comparison to hearing aid users and adolescents with normal hearing (NH). Emotion perception was examined by having the participants identify happiness, anger, surprise, sadness, fear, and disgust. The emotional content was placed upon the same neutral sentence. The stimuli were presented in auditory, visual, and combined auditory-visual modes. The results revealed better auditory identification by the participants with NH in comparison to all groups of participants with hearing loss (HL). No differences were found among the groups with HL in each of the 3 modes. Although auditory-visual perception was better than visual-only perception for the participants with NH, no such differentiation was found among the participants with HL. The results question the efficiency of some currently used CIs in providing the acoustic cues required to identify the speaker's emotional state.
Werfel, Krystal L.; Douglas, Michael; Ackal, Leigh
This case report details a year-long phonological awareness (PA) intervention for pre-kindergarten children with hearing loss (CHL) who use listening and spoken language. All children wore cochlear implants and/or hearing aids. Intervention occurred for 15 min/day, 4 days per week across the pre-kindergarten school year and was delivered by…
Ahmad, R L; Lokman, S
Many children have benefited from cochlear implant device including those with congenital malformation of the inner ear. The results reported in children with malformed cochlea are very encouraging. We describe 2 cases of Mondini's malformation with severe sensorineural hearing loss. Cochlear implantation was performed and both of them underwent post-implantation speech rehabilitation. Post-implantation, both of them were noted to respond to external sound. But the second case developed facial twitching a few months after the device was switched on. It is important to evaluate the severity of the inner ear deformity and the other associated anomalies in pre-implantation radiological assessment in order to identify the problem that may complicate the surgery and subsequent patient management.
Merchán, Miguel A
In this review we analyse cochlear implantation in terms of the fundamental aspects of the functioning of the auditory system. Concepts concerning neuronal plasticity applied to electrical stimulation in perinatal and adult deep hypoacusis are reviewed, and the latest scientific bases that justify early implantation following screening for congenital deafness are discussed. Finally, this review aims to serve as an example of the importance of fostering the sub-specialty of neurotology in our milieu, with the aim of bridging some of the gaps between specialties and thus improving both the knowledge in the field of research on auditory pathologies and in the screening of patients. The objectives of this review, targeted above all towards specialists in the field of otorhinolaryngology, are to analyse some significant neurological foundations in order to reach a better understanding of the clinical events that condition the indications and the rehabilitation of patients with cochlear implants, as well as to use this means to foster the growth of the sub-specialty of neurotology.
Stöver, Timo; Lenarz, Thomas
The cochlear implant (CI) represents, for almost 25 years now, the gold standard in the treatment of children born deaf and for postlingually deafened adults. These devices thus constitute the greatest success story in the field of ‘neurobionic’ prostheses. Their (now routine) fitting in adults, and especially in young children and even babies, places exacting demands on these implants, particularly with regard to the biocompatibility of a CI’s surface components. Furthermore, certain parts of the implant face considerable mechanical challenges, such as the need for the electrode array to be flexible and resistant to breakage, and for the implant casing to be able to withstand external forces. As these implants are in the immediate vicinity of the middle-ear mucosa and of the junction to the perilymph of the cochlea, the risk exists – at least in principle – that bacteria may spread along the electrode array into the cochlea. The wide-ranging requirements made of the CI in terms of biocompatibility and the electrode mechanism mean that there is still further scope – despite the fact that CIs are already technically highly sophisticated – for ongoing improvements to the properties of these implants and their constituent materials, thus enhancing the effectiveness of these devices. This paper will therefore discuss fundamental material aspects of CIs as well as the potential for their future development. PMID:22073103
Horga, Damir; Liker, Marko
Patients with cochlear implants have the ability to exercise auditory control over their own speech production and over the speech of others, which is important for the development of speech control. In the present investigation three groups of 10 subjects were compared. The groups comprised: (1) cochlear implant users, (2) profoundly deaf using traditional hearing aids, and (3) hearing controls. The subjects in three groups were matched in age. While repeating after a model the subjects were recorded and the following linguistic voice variables were analysed: (1) vowel formant space, (2) voice vs. voiceless difference, (3) closure duration and VOT, (4) word accent production, (5) sentence stress production, (6) voice quality, (7) pronunciation quality. Acoustic analysis and perceptual assessment by phoneticians showed that in great majority of variables, subjects with cochlear implants performed better than the profoundly deaf subjects with traditional hearing-aids.
Saeed, Shahad; Mawman, Deborah; Green, Kevin
Cochlear implantation in patients with known central nervous system conditions can result in wide-ranging outcomes. The aim of this study is to report two cases of cochlear implantation outcomes in patients with acquired cerebellar ataxia following cerebellar surgery. The first is a female implanted with the Nucleus 24 implant in September 2000 and the second is a male implanted with a MED-EL Sonata Flexsoft electro-acoustic stimulation in July 2009. Programming these patients resulted in significant non-auditory stimulation which resulted in less than optimum map fittings. The patients did not gain any open set speech perception benefit although both of them gained an awareness of sound with the device. However, patient 2 elected to become a non-user because of the limited benefit.
This special issue contains a collection of 13 papers highlighting the collaborative research and engineering project entitled Advancing Binaural Cochlear Implant Technology—ABCIT—as well as research spin-offs from the project. In this introductory editorial, a brief history of the project is provided, alongside an overview of the studies. PMID:26721929
Zhang, Kaiyin; Guo, He; Wu, Shan; Wu, Yanning; Zhao, Shutao; Wang, Qiuling
Optical cochlear implant has been occuring as a new cochlear implant which utilizes laser pulses to stimulate hearing. Compared to electronic cochlear implant, it has demonstrated higher spatial selectivity and less radiation scattering, which could lead to higher fidelity cochlear prostheses. At present, most investigations have focused on experiments in vivo. Although a lot of exciting results have been obtained, the mechanisms of laser stimulation is still open. In this paper, a brief review on the recent new findings of optical cochlear implant is given, and possible mechanisms are discussed. In the end, new experimental proposals are suggested which could help to explore the mechanisms of laser-cochlea stimulation.
Data from our laboratory show that the auditory brain is highly malleable by experience. We establish a base of knowledge that describes the normal structure and workings at the initial stages of the central auditory system. This research is expanded to include the associated pathology in the auditory brain stem created by hearing loss. Utilizing the congenitally deaf white cat, we demonstrate the way that cells, synapses, and circuits are pathologically affected by sound deprivation. We further show that the restoration of auditory nerve activity via electrical stimulation through cochlear implants serves to correct key features of brain pathology caused by hearing loss. The data suggest that rigorous training with cochlear implants and/or hearing aids offers the promise of heretofore unattained benefits.
Kim, Chong-Sun; Song, Jae-Jun; Park, Min-Hyun; Kim, Young Ho; Koo, Ja-Won
Superficial siderosis (SS) of the central nervous system has been thought to be a rare condition that generates progressive hearing loss, ataxia, pyramidal signs, and dementia. The main cause of hearing loss by SS is thought to be neuronal. Because there is no histopathologic report of the human temporal bone in SS, there is a debate about the possibility of cochlear involvement. We present a 25-year-old man who was investigated for bilateral progressive sensorineural hearing loss and vestibular failure after head trauma. On brain MRI, SS of the central nervous system was detected. Distortion product otoacoustic emission (DPOAE) and auditory brainstem response (ABR) showed no response on both sides. However, integrity of the eighth nerve was proved by the electrical ABR test on the right side and the patient benefited significantly from cochlear implantation. The sensorineural hearing loss in SS seems to be related to cochlear damage as well as neuronal damage. So, cochlear implantation would be a hearing rehabilitation modality for the sensorineural hearing loss caused by SS.
Nishizaki, K; Fukushiama, K; Oda, Y; Masuda, A; Hayashi, S; Nagayasu, N; Yoshino, T; Kashihara, K; Takahashi, K; Masuda, Y
Recently, the effectiveness of cochlear implantation for hereditary deafness has been reported. We performed cochlear implantation for two patients with symptomatic hereditary deafness. Deafness in one patient was thought to be a result of albinism-deafness syndrome and in the other patient, a result of chronic progressive external ophthalmoplegia syndrome. Since their speech perception abilities improved dramatically, we believe that cochlear implantation should be actively performed for these two syndromes.
Imaging procedures are a mainstream tool in the daily ENT workflow. Cochlear Implant patients are representing a special population with specific demands for imaging. There are different imaging techniques available for pre-operative evaluation, surgery and postoperative controls with different indications and consequences. High-resolution computed tomography and magnetic resonance imaging are mainly used in the evaluation process. New procedures, as digital volume tomography, are increasingly used intra- and postoperatively. Especially the intracochlear positioning in malformations of the inner ear, eventually added with radiological assisted navigation, can be considered a standard of modern cochlear implant surgery. In addition, digital volume tomography may serve as a quality control tool focusing on the evaluation of the intracochlear electrode position. The range of applications, indications and current results are illustrated. PMID:22558057
Carmel, Eldar; Taitelbaum-Swead, Ricky; Migirov, Lela; Hildesheimer, Minka; Kronenberg, Jona
Cochlear implantation is a standard method of hearing rehabilitation among patients with severe to profound bilateral sensorineural hearing loss. In recent years there have been an increasing number of studies showing superior hearing with bilateral cochlear implantation in comparison with a unilateral procedure. In this study we present our experience with 15 patients, children and adults, who had bilateral cochlear implant surgery. Speech perception test results demonstrated a hearing benefit in bilateral cochlear implantation in comparison with a unilateral device, mainly by improvement in the identification of speech in noise tests.
Berrettini, S; Forli, F; De Vito, A; Bruschini, L; Quaranta, N
In this investigation, we report on 4 patients affected by incomplete partition type I submitted to cochlear implant at our institutions. Preoperative, surgical, mapping and follow-up issues as well as results in cases with this complex malformation are described. The cases reported in the present study confirm that cochlear implantation in patients with incomplete partition type I may be challenging for cochlear implant teams. The results are variable, but in many cases satisfactory, and are mainly related to the surgical placement of the electrode and residual neural nerve fibres. Moreover, in some cases the association of cochlear nerve abnormalities and other disabilities may significantly affect results.
Petersen, B.; Gjedde, A.; Wallentin, M.; Vuust, P.
The most dramatic progress in the restoration of hearing takes place in the first months after cochlear implantation. To map the brain activity underlying this process, we used positron emission tomography at three time points: within 14 days, three months, and six months after switch-on. Fifteen recently implanted adult implant recipients listened to running speech or speech-like noise in four sequential PET sessions at each milestone. CI listeners with postlingual hearing loss showed differential activation of left superior temporal gyrus during speech and speech-like stimuli, unlike CI listeners with prelingual hearing loss. Furthermore, Broca's area was activated as an effect of time, but only in CI listeners with postlingual hearing loss. The study demonstrates that adaptation to the cochlear implant is highly related to the history of hearing loss. Speech processing in patients whose hearing loss occurred after the acquisition of language involves brain areas associated with speech comprehension, which is not the case for patients whose hearing loss occurred before the acquisition of language. Finally, the findings confirm the key role of Broca's area in restoration of speech perception, but only in individuals in whom Broca's area has been active prior to the loss of hearing. PMID:24377050
Chute, Patricia M.; Nevins, Mary Ellen
This article addresses educational challenges for children with severe to profound hearing loss who receive cochlear implants. Despite the implants, these children face acoustic challenges, academic challenges, attention challenges, associative challenges, and adjustment challenges. (Contains references.) (Author/DB)
... systems Will have to be careful of static electricity. Static electricity may temporarily or permanently damage a cochlear implant. ... more details regarding how to deal with static electricity, contact the manufacturer or implant center. Have less ...
Pfingst, Bryan E; Zhou, Ning; Colesa, Deborah J; Watts, Melissa M; Strahl, Stefan B; Garadat, Soha N; Schvartz-Leyzac, Kara C; Budenz, Cameron L; Raphael, Yehoash; Zwolan, Teresa A
Amazing progress has been made in providing useful hearing to hearing-impaired individuals using cochlear implants, but challenges remain. One such challenge is understanding the effects of partial degeneration of the auditory nerve, the target of cochlear implant stimulation. Here we review studies from our human and animal laboratories aimed at characterizing the health of the implanted cochlea and the auditory nerve. We use the data on cochlear and neural health to guide rehabilitation strategies. The data also motivate the development of tissue-engineering procedures to preserve or build a healthy cochlea and improve performance obtained by cochlear implant recipients or eventually replace the need for a cochlear implant. This article is part of a Special Issue entitled
Yawn, Robert; Hunter, Jacob B.; Sweeney, Alex D.
Cochlear implants are a medical prosthesis used to treat sensorineural deafness, and one of the greatest advances in modern medicine. The following article is an overview of cochlear implant technology. The history of cochlear implantation and the development of modern implant technology will be discussed, as well as current surgical techniques. Research regarding expansion of candidacy, hearing preservation cochlear implantation, and implantation for unilateral deafness are described. Lastly, innovative technology is discussed, including the hybrid cochlear implant and the totally implantable cochlear implant. PMID:26097718
Välimaa, T T; Sorri, M J; Löppönen, H J
This study was done to investigate the effects of a multichannel cochlear implant on phoneme perception in Finnish-speaking postlingually deafened adults. Phoneme recognition was studied with 100 prerecorded nonsense syllables (open-set) presented at 70 dB SPL, auditorily only, in a free-field situation. Ten subjects were tested before implantation both with and without a hearing aid (HA), and 3, 6 and 12 months after switching on the implant. Before implantation without a HA, the subjects did not recognize vowels, consonants or syllables. Four of the subjects used a HA before implantation, and the mean recognition scores of these subjects were 34% for vowels, 28% for consonants and 13% for syllables. One year after switching on the implant, the mean recognition scores were 77% for vowels, 66% for consonants and 46% for syllables. According to phonological analysis vowels appear to be easier to perceive than consonants during the first stage after multichannel cochlear implantation.
Vishwakarma, Rajesh; Shawn, T Joseph
Post-lingual deafness is a stressful condition which is rendered even more painful by the sudden emotional isolation that the patient suffers. Cogan's syndrome is a rare autoimmune cause for post-lingual deafness characterized by non-syphilitic interstitial keratitis, bilateral audio vestibular deficiencies and systemic vasculitis. World over very few cases of Cogan's syndrome have been reported. Cochlear implant surgery in such a patient is a challenging but highly satisfactory experience due to the multitude of clinical problems the patient faces. This demands a proper work up, meticulous surgery and stringent post-operative follow-up. Here we present a patient with atypical Cogan's syndrome, diabetes mellitus and hypothyroidism. She went into a major depression with suicidal tendency following the complete loss of hearing. We performed cochlear implant surgery in this patient, but not before facing several clinical obstacles, helped by a dedicated team consisting of a rheumatologist, endocrinologist, neurophysician, psychiatrist, anaesthetists and audiologist. The results are extremely satisfying for the patient and all the people involved. This case underlines the prime importance of hearing in maintaining the psychological well being of a human being.
Gupta, Shweta; Singh, Shashi kumar; Dubey, Pratik Kumar
This research is based on neural prosthetic device. The oldest and most widely used of these electrical, and often computerized, devices is the cochlear implant, which has provided hearing to thousands of congenitally deaf people in this country. Recently, the use of the cochlear implant is expanding to the elderly, who frequently suffer major hearing loss. More cutting edge are artificial retinas, which are helping dozens of blind people see, and ìsmartî artificial arms and legs that amputees can maneuver by thoughts alone, and that feel more like real limbs.Research, which curiosity led to explore frog legs dancing during thunderstorms, a snail shapedorgan in the inner ear, and how various eye cells react to light, have fostered an understanding of how to ìtalkî to the nervous system. That understanding combined with the miniaturization of electronics and enhanced computer processing has enabled prosthetic devices that often can bridge the gap in nerve signaling that is caused by disease or injury.
Yuen, Kevin C P; Cao, Ke-Li; Wei, Chao-Gang; Luan, Lan; Li, Huan; Zhang, Zhi-Yong
The benefits of bimodal hearing (cochlear implant and hearing aid in opposite ears) in children are well documented in English-speaking populations (Ching et al., 2000; Holt et al., 2005) but not much evidence has been reported from populations using tonal languages. The lexical tones in tonal languages are heavily loaded with semantic and grammatical information, which are essentially represented by the fundamental frequency (F0) and low-order harmonics of the speech signal. This unique linguistic feature means that tonal language-speaking CI recipients may achieve more bimodal benefits than their non-tonal language peers may. Twenty Mandarin-speaking children using the Nucleus 24 cochlear implant system and a hearing aid on the non-implant ear were assigned to either one of the two groups to investigate the head-shadow and binaural redundancy effects. A computerized speech test - MAPPID-N (Yuen et al., 2007) was used to present Mandarin lexical tones in monosyllabic words, and disyllabic words with a four- and eight-alternative forced choice picture-identification task, respectively. Individualized signal-to-noise ratio was used to capture the speech scores in the 30%-70% range and was fixed throughout the CI alone and bimodal experimental conditions. Hearing aid fitting was optimized before the first test phase, which was followed by the second test phase after three months. Significant head shadow but not binaural redundancy benefits were observed, suggesting that subjects have not yet developed central binaural processing abilities to improve speech recognition when speech and noise are mixed, in the bimodal condition, in this group of Mandarin-speaking paediatric CI recipients. No subject experienced any degradation of performance in the bimodal versus the CI-only test condition. This may be the first study that demonstrated the bimodal benefits in CI paediatric recipients speaking tonal language, particularly in lexical tone perception. Hearing aid
James, Deborah; Rajput, Kaukab; Brown, Tracey; Sirimanna, Tony; Brinton, Julie; Goswami, Usha
A short-term longitudinal study was conducted to investigate possible benefits of cochlear implant (CI) use on the development of phonological awareness in deaf children. Nineteen CI users were tested on 2 occasions. Two groups of deaf children using hearing aids were tested once: 11 profoundly deaf and 10 severely deaf children. A battery of…
Pass, Lauren; Graber, Abraham D
While cochlear implantation is now considered routine in many parts of the world, the debate over how to ethically implement this technology continues. One's stance on implantation often hinges on one's understanding of deafness. On one end of the spectrum are those who see cochlear implants as a much needed cure for an otherwise intractable disability. On the other end of the spectrum are those who view the Deaf as members of a thriving culture and see the cochlear implant as an attempt to eliminate this culture. Rather than take a stance in this debate, we will argue that the informed consent process for cochlear implantation must include access to Deaf perspectives. Deaf individuals know best what it is like to be a member of the Deaf community; the reasonable person would put significant weight on the testimony of Deaf individuals when considering whether to undergo cochlear implantation. The reasonable person standard determines what information careproviders must present as part of the informed consent process; thus, informed consent for cochlear implantation requires access to the testimony of Deaf individuals.
Lin, Frank R; Chien, Wade W; Li, Lingsheng; Clarrett, Danisa M; Niparko, John K; Francis, Howard W
Cochlear implants allow individuals with severe to profound hearing loss access to sound and spoken language. The number of older adults in the United States who are potential candidates for cochlear implantation (CI) is approximately 150,000 and will continue to increase with the aging of the population. Should CI be routinely recommended for these older adults, and do these individuals benefit from CI? We reviewed our 12-year experience with CI in adults aged ≥60 years (n = 445) at Johns Hopkins Medical Institutions to investigate the impact of CI on speech understanding and to identify factors associated with speech performance. Complete data on speech outcomes at baseline and 1 year post-CI were available for 83 individuals. Our results demonstrate that CI in adults aged ≥60 years consistently improved speech understanding scores, with a mean increase of 60.0% (SD 24.1) on HINT (Hearing in Noise Test) sentences in quiet. The magnitude of the gain in speech scores was negatively associated with age at implantation, such that for every increasing year of age at CI the gain in speech scores was 1.3 percentage points less (95% confidence interval [95% CI], 0.6-1.9) after adjusting for age at hearing loss onset. Conversely, individuals with higher pre-CI speech scores (HINT scores between 40% and 60%) had significantly greater post-CI speech scores by a mean of 10.0 percentage points (95% CI, 0.4-19.6) than those with lower pre-CI speech scores (HINT <40%) after adjusting for age at CI and age at hearing loss onset. These results suggest that older adult CI candidates who are younger at implantation and with higher preoperative speech scores obtain the highest speech understanding scores after CI, with possible implications for current United States Medicare policy. Finally, we provide an extended discussion of the epidemiology and impact of hearing loss in older adults. Future research of CI in older adults should expand beyond simple speech outcomes to take
Bruns, Lisa; Mürbe, Dirk; Hahne, Anja
Direct stimulation of the auditory nerve via a Cochlear Implant (CI) enables profoundly hearing-impaired people to perceive sounds. Many CI users find language comprehension satisfactory, but music perception is generally considered difficult. However, music contains different dimensions which might be accessible in different ways. We aimed to highlight three main dimensions of music processing in CI users which rely on different processing mechanisms: (1) musical discrimination abilities, (2) access to meaning in music, and (3) subjective music appreciation. All three dimensions were investigated in two CI user groups (post- and prelingually deafened CI users, all implanted as adults) and a matched normal hearing control group. The meaning of music was studied by using event-related potentials (with the N400 component as marker) during a music-word priming task while music appreciation was gathered by a questionnaire. The results reveal a double dissociation between the three dimensions of music processing. Despite impaired discrimination abilities of both CI user groups compared to the control group, appreciation was reduced only in postlingual CI users. While musical meaning processing was restorable in postlingual CI users, as shown by a N400 effect, data of prelingual CI users lack the N400 effect and indicate previous dysfunctional concept building. PMID:27558546
Bille, Jesper; Fink-Jensen, Vibeke; Ovesen, Therese
The objective of the study was the evaluation of outcomes of cochlear implantation (CI) in children with cochlear malformations. A retrospective case-control study was conducted in a tertiary referral centre. The patients were children with inner ear malformation judged by high-resolution computed tomography and magnetic resonance imaging treated with uni- or bilateral CI and a follow-up period of at least 3 years. They were matched with a control group of children operated for other reasons. The patients were operated by one of two surgeons using similar techniques including a standard perimodiolar electrode in all cases. The intervention was therapeutic and rehabilitative. The main outcome measures were category of auditory performance (CAP) and speech intelligibility rating (SIR). Eighteen children were diagnosed with cochlear malformations (12 % of children receiving CI). No statistical differences regarding CAP and SIR scores were found between the two groups. Only one child was diagnosed with a common cavity and performed below average. Children with auditory neuropathy performed beyond average. Children with cochlear malformations performed equally to children without malformation in the long term. Standard perimodiolar electrodes can be used despite cochlear malformations. The most important factors determining the outcome is the age of the child at the time of implantation and duration of hearing loss before CI. Awareness towards an increased risk of complications in case of inner ear malformations is recommended.
Jeschke, Marcus; Moser, Tobias
Electrical cochlear implants are by far the most successful neuroprostheses and have been implanted in over 300,000 people worldwide. Cochlear implants enable open speech comprehension in most patients but are limited in providing music appreciation and speech understanding in noisy environments. This is generally considered to be due to low frequency resolution as a consequence of wide current spread from stimulation contacts. Accordingly, the number of independently usable stimulation channels is limited to less than a dozen. As light can be conveniently focused, optical stimulation might provide an alternative approach to cochlear implants with increased number of independent stimulation channels. Here, we focus on summarizing recent work on optogenetic stimulation as one way to develop optical cochlear implants. We conclude that proof of principle has been presented for optogenetic stimulation of the cochlea and central auditory neurons in rodents as well as for the technical realization of flexible μLED-based multichannel cochlear implants. Still, much remains to be done in order to advance the technique for auditory research and even more for eventual clinical translation. This article is part of a Special Issue entitled
Szyfter, W; Colletti, V; Pruszewicz, A; Kopeć, T; Szymiec, E; Kawczyński, M; Karlik, M
The inner part of cochlear implant is inserted into inner ear during surgery through mastoid and middle ear. It is a classical method, used in the majority cochlear centers in the world. This is not a suitable method in case of chronic otitis media and middle ear malformation. In these cases Colletti proposed the middle fossa approach and cochlear implant insertion omitting middle ear structures. In patient with bilateral chronic otitis media underwent a few ears operations without obtaining dry postoperative cavity. Cochlear implantation through the middle fossa approach was performed in this patient. The bone fenster was cut, temporal lobe was bent and petrosus pyramid upper surface was exposed. When the superficial petrosal greater nerve, facial nerve and arcuate eminence were localised, the cochlear was open in the basal turn and electrode were inserted. The patient achieves good results in the postoperative speech rehabilitation. It confirmed Colletti tesis that deeper electrode insertion in the cochlear implantation through the middle fossa approach enable use of low and middle frequencies, which are very important in speech understanding.
Bat-Chava, Yael; Deignan, Elizabeth
Qualitative and quantitative analysis of interviews with parents of children with cochlear implants found that, although implants have the potential to improve deaf children's relationships with hearing peers, these children still face communication obstacles which impede their social relationships. Results are discussed from the viewpoints of…
Miller, Douglas A.; Matin, Mohammad A.
Normal hearing persons are able to localize the direction of sounds better using both ears than when listening with only one ear. Localization ability is dependent on auditory system perception of interaural differences in time, intensity, and phase. Interaural timing differences (ITDs) provide information for locating direction of low and mid frequency sounds, while interaural level differences (ILDs), which occur because of the horizontal plane shadowing effect of the head, provide information for locating direction of higher frequency sounds. The head related transfer function (HRTF) contains characteristic information important for acoustic localization. Models based on HRTFs take into account head shadow, torso, and pinna effects, and their impact on interaural frequency, level, and timing differences. Cochlear implants (CIs) have proven a successful treatment for persons with bilateral severe to profound hearing loss. A problem is that only some ITD and ILD cues are maintained with CI sound processing, and the microphone position alters the acoustic cues. The relative impact of differences in physical cues received by the auditory system with bilateral CIs versus differences in the ability of the damaged auditory nervous system to process bilateral inputs is not yet clear. The model presented in this paper was constructed as a step toward answering this question, and is intended to serve as a tool for future development of more optimal signal processing algorithms that may provide better localization ability for persons with bilateral CIs.
Low Levels of Insurance Reimbursement Impede Access to Cochlear Implants Cochlear implants enable many severely to profoundly hearing-impaired...a cochlear implant device and required professional services, can cost more than $40,000. But studies by other organizations show that the benefits of...using the technology generally outweigh the treatment costs. About 3,000 people received cochlear implants in the United States in 1999—a number
Pedrett, Mariana dos Santos; Moreira, Sandra Costa
Summary Introduction: The cochlear implant is a device that is intended to substitute for the function of cochlear hair cells, electrically stimulate auditory nerve fibers, and contribute to the perception of speech sounds. However, the surgical procedure alone is not enough for the user to achieve favorable results in habilitation/rehabilitation. Objective: To characterize the patients from Manaus who have received cochlear implants based on the criteria for surgery. Methods: We conducted a retrospective cross-sectional study of 15 cases and recorded etiological aspects of deafness, age, gender, duration of implant use, use of hearing aids, and participation in individual therapy. Data were recorded in a protocol designed specifically for this purpose. All patients were natives of Manaus. Results: The leading etiological aspect was ototoxicity associated with prematurity in newborns undergoing treatment in the neonatal intensive care unit. The age at surgery is carefully observed in the evaluation of implant centers, as well as if the candidate is pre-or post-lingual. In this study, 73% of patients were pre-lingual and did not benefit from hearing aids. As to the degree and type of hearing loss, 93% had audiological reports indicating profound bilateral sensorineural hearing loss and 7% had severe bilateral sensorineural hearing loss. This latter finding confirmed one of the basic principles of implant placement. Conclusion: This study allowed us to verify that there are reduced number of cochlear implant recipients in Manaus, but they have met the criteria required by implant centers located in other states of Brazil. PMID:25991973
Aronoff, Justin M.; Stelmach, Julia; Padilla, Monica; Landsberger, David M.
Objective Cochlear implant patients have difficulty in noisy environments in part because of channel interaction. Interleaving the signal by sending every other channel to the opposite ear has the potential to reduce channel interaction by increasing the space between channels in each ear. Interleaving still potentially provides the same amount of spectral information when the two ears are combined. Although this method has been successful in other populations such as hearing aid users, interleaving with cochlear implant patients has not yielded consistent benefits. This may be because perceptual misalignment between the two ears and the spacing between stimulation locations must be taken into account before interleaving. Design Eight bilateral cochlear implant users were tested. After perceptually aligning the two ears, twelve channel maps were made that spanned the entire aligned portions of the array. Interleaved maps were created by removing every other channel from each ear. Participants' spectral resolution and localization abilities were measured with perceptually aligned processing strategies both with and without interleaving. Results There was a significant improvement in spectral resolution with interleaving. However, there was no significant effect of interleaving on localization abilities. Conclusions The results indicate that interleaving can improve cochlear implant users' spectral resolution. However, it may be necessary to perceptually align the two ears and/or use relatively large spacing between stimulation locations. PMID:26656190
Martins, Mariane Barreto Brandão; de Lima, Francis Vinicius Fontes; Santos, Ronaldo Carvalho; Santos, Arlete Cristina Granizo; Barreto, Valéria Maria Prado; de Jesus, Eduardo Passos Fiel
Summary Introduction: Cochlear Implants are important for individuals with severe to profound bilateral sensorineural hearing loss. Objective: Evaluate the experience of cochlear implant center of Otorhinolaryngology through the analysis of records of 9 patients who underwent cochlear implant surgery. Methods: This is a retrospective study performed with the patients records. Number 0191.0.107.000-11 ethics committee approval. We evaluated gender, etiology, age at surgery, duration of deafness, classification of deafness, unilateral or bilateral surgery, intraoperative and postoperative neural response and impedance of the electrodes in intraoperative and preoperative tests and found those that counter-indicated surgery. Results: There were 6 pediatric and 3 adult patients. Four male and 5 female. Etiologies: maternal rubella, cytomegalovirus, ototoxicity, meningitis, and sudden deafness. The age at surgery and duration of deafness ranged from 2–46 years and 2–18 years, respectively. Seven patients were pre-lingual. All had profound bilateral PA. There were 7 bilateral implants. Intraoperative complications: hemorrhage. Complications after surgery: vertigo and internal device failure. In 7 patients the electrodes were implanted through. Telemetry showed satisfactory neural response and impedance. CT and MRI was performed in all patients. We found enlargement of the vestibular aqueduct in a patient and incudomalleolar malformation. Conclusion: The cochlear implant as a form of auditory rehabilitation is well established and spreading to different centers specialized in otoaudiology. Thus, the need for structured services and trained professionals in this type of procedure is clear. PMID:25991976
Qian, Haifeng; Loizou, Philipos C; Dorman, Michael F
Hearing-impaired people, and particularly hearing-aid and cochlear-implant users, often have difficulty communicating over the telephone. The intelligibility of telephone speech is considerably lower than the intelligibility of face-to-face speech. This is partly because of lack of visual cues, limited telephone bandwidth, and background noise. In addition, cellphones may cause interference with the hearing aid or cochlear implant. To address these problems that hearing-impaired people experience with telephones, this paper proposes a wireless phone adapter that can be used to route the audio signal directly to the hearing aid or cochlear implant processor. This adapter is based on Bluetooth technology. The favorable features of this new wireless technology make the adapter superior to traditional assistive listening devices. A hardware prototype was built and software programs were written to implement the headset profile in the Bluetooth specification. Three cochlear implant users were tested with the proposed phone-adapter and reported good speech quality.
Yılmaz, İsmail; Akdoğan, M Volkan; Özer, Fulya; Yavuz, Haluk; Çadırcı, Cabbar; Özlüoğlu, Levent N N
In this article, we present four patients who underwent cochlear implantation due to far advanced otosclerosis. Preoperative evaluations, intraoperative findings, complications, and postoperative benefits were analyzed. Cochlear implantation is a treatment option providing excellent audiological results for rehabilitation of patients with far advanced otosclerosis. However, facial nerve stimulation after cochlear implantation is observed more frequently in patients with otosclerosis. Also, caution should be paid in patients with otosclerosis in terms of cochlear ossification and inconsistent results.
Gérard, Jean-Marc; Demanez, Laurent; Salmon, Caroline; Vanpoucke, Filiep; Walraevens, Joris; Plasmans, Anke; De Siati, Daniele; Lefèbvre, Philippe
This study aimed at evaluating the feasibility of an implanted microphone for cochlear implants (CI) by comparison of hearing outcomes, sound quality and patient satisfaction of a subcutaneous microphone to a standard external microphone of a behind-the-ear sound processor. In this prospective feasibility study with a within-subject repeated measures design comparing the microphone modalities, ten experienced adult unilateral CI users received an implantable contralateral subcutaneous microphone attached to a percutaneous plug. The signal was pre-processed and fed into their CI sound processor. Subjects compared listening modes at home for a period of up to 4 months. At the end of the study the microphone was explanted. Aided audiometric thresholds, speech understanding in quiet, and sound quality questionnaires were assessed. On average thresholds (250, 500, 750, 1k, 2k, 3k, 4k and 6 kHz) with the subcutaneous microphone were 44.9 dB, compared to 36.4 dB for the external mode. Speech understanding on sentences in quiet was high, within approximately 90% of performance levels compared to hearing with an external microphone. Body sounds were audible but not annoying to almost all subjects. This feasibility study with a research device shows significantly better results than previous studies with implanted microphones. This is attributed to technology enhancements and careful fitting. Listening effort was somewhat increased with an implanted microphone. Under good sound conditions, speech performance is nearly similar to that of external microphones demonstrating that an implanted microphone is feasible in a range of normal listening conditions.
Mikic, B; Miric, D; Nikolic-Mikic, M; Ostojic, S; Asanovic, M
Early cochlear implantation, before the age of 3 years, provides the best outcome regarding listening, speech, cognition an memory due to maximal central nervous system plasticity. Intensive postoperative training improves not only auditory performance and language, but affects auditory memory as well. The aim of this study was to discover if the age at implantation affects auditory memory function in cochlear implanted children. A total of 50 cochlear implanted children aged 4 to 8 years were enrolled in this study: early implanted (1-3y) n = 27 and late implanted (4-6y) n = 23. Two types of memory tests were used: Immediate Verbal Memory Test and Forward and Backward Digit Span Test. Early implanted children performed better on both verbal and numeric tasks of auditory memory. The difference was statistically significant, especially on the complex tasks. Early cochlear implantation, before the age of 3 years, significantly improve auditory memory and contribute to better cognitive and education outcomes.
Barker, Elizabeth J; Briggs, Robert Js
Three children with keratitis-ichthyosis-deafness (KID) syndrome received cochlear implants at the Royal Victorian Eye and Ear Hospital. KID syndrome is a rare genodermatosis associated with mutation of the connexin-26 gene with characteristics affecting skin, hair, vision and hearing. Ichthyotic involvement of the ear canal epithelium and associated non-erosive keratosis obturans complicate hearing assessment and aid fitting. The tendency to eczematous dermatitis and otitis media is an additional problem with cochlear implantation. All cases have required additional medical management, however the outcomes show that the cochlear implant can be effective in these patients.
Shafiro, Valeriy; Sheft, Stanley; Kuvadia, Sejal; Gygi, Brian
Purpose: The study investigated the effect of a short computer-based environmental sound training regimen on the perception of environmental sounds and speech in experienced cochlear implant (CI) patients. Method: Fourteen CI patients with the average of 5 years of CI experience participated. The protocol consisted of 2 pretests, 1 week apart,…
Kuang, Heide; Haversat, Heather H.; Michaelides, Elias M.
Purpose: This article seeks to review current literature on caloric function following cochlear implantation while analyzing any correlations of caloric function changes with vestibular symptoms. Method: This article is a systematic review of evidence-based literature. English language articles published between 1980 and 2014 that presented some…
In this essay, the hearing parents of a child with deafness explain why they have chosen not to seek a cochlear implant for their daughter. The essay concludes that deafness inspires and sustains a language and a culture that offer fulfilling participation in every important aspect of life and society. (CR)
Houston, Derek M.; Carter, Allyson K.; Pisoni, David B.; Kirk, Karen Iler; Ying, Elizabeth A.
An experimental procedure was developed to investigate word-learning skills of children who use cochlear implants (CIs). Using interactive play scenarios, 2- to 5-year olds were presented with sets of objects (Beanie Baby stuffed animals) and words for their names that corresponded to salient perceptual attributes (e.g., "horns" for a goat). Their…
Massida, Zoe; Marx, Mathieu; Belin, Pascal; James, Christopher; Fraysse, Bernard; Barone, Pascal; Deguine, Olivier
Purpose: In this study, the authors examined the ability of subjects with cochlear implants (CIs) to discriminate voice gender and how this ability evolved as a function of CI experience. Method: The authors presented a continuum of voice samples created by voice morphing, with 9 intermediate acoustic parameter steps between a typical male and a…
Dillier, N; Bögli, H; Spillmann, T
A rather general basic working hypothesis for cochlear implant research might be formulated as follows. Signal processing for cochlear implants should carefully select a subset of the total information contained in the sound signal and transform these elements into those physical stimulation parameters which can generate distinctive perceptions for the listener. Several new digital processing strategies have thus been implemented on a laboratory cochlear implant speech processor for the Nucleus 22-electrode system. One of the approaches (PES, pitch excited sampler) is based on the maximum peak channel vocoder concept whereby the spectral energy of a number of frequency bands is transformed into appropriate electrical stimulation parameters for up to 22 electrodes using a voice pitch synchronous pulse rate at any electrode. Another approach (CIS, continuous interleaved sampler) uses a maximally high pitch-independent stimulation pulse rate on a selected number of electrodes. As only one electrode can be stimulated at any instance of time, the rate of stimulation is limited by the required stimulus pulse widths (as determined individually for each subject) and some additional constraints and parameters which have to be optimized and fine tuned by psychophysical measurements. Evaluation experiments with 5 cochlear implant users resulted in significantly improved performance in consonant identification tests with the new processing strategies as compared with the subjects own wearable speech processors whereas improvements in vowel identification tasks were rarely observed. The pitch-synchronous coding (PES) resulted in worse performance compared to the coding without explicit pitch extraction (CIS).(ABSTRACT TRUNCATED AT 250 WORDS)
Pals, Carina; Sarampalis, Anastasios; Baskent, Deniz
Purpose: Fitting a cochlear implant (CI) for optimal speech perception does not necessarily optimize listening effort. This study aimed to show that listening effort may change between CI processing conditions for which speech intelligibility remains constant. Method: Nineteen normal-hearing participants listened to CI simulations with varying…
Mishra, Srikanta K.; Boddupally, Shiva P.; Rayapati, Deeksha
Purpose: The purpose of this study was to examine and characterize the training-induced changes in speech-in-noise perception in children with congenital deafness who have cochlear implants (CIs). Method: Twenty-seven children with congenital deafness who have CIs were studied. Eleven children with CIs were trained on a speech-in-noise task,…
Välimaa, T T; Sorri, M J; Löppönen, H J
This study was done to investigate the effect of a multichannel cochlear implant on speech perception and the functional benefit of cochlear implantation in Finnish-speaking postlingually deafened adults. Fourteen subjects were enrolled. Sentence and word recognition were studied with open-set tests auditorily only. One year after implantation, the listening performance was assessed by case histories and interviews. Before implantation for subjects with a hearing aid, the mean recognition score was 38% for sentences and 17% for words. One year after switching on the implant, the mean recognition score was 84% for sentences and 70% for words. Before implantation, the majority of the subjects were not aware of environmental sounds and only a few were able to recognize some environmental sounds. One year after switching on the implant, the majority of the subjects were able to use the telephone with a familiar speaker. All the subjects were able to recognize speech auditorily only and had thus gained good functional benefit from the implant.
Preisler, G.; Tvingstedt, A. -L.
Within the framework of a longitudinal study of deaf children with cochlear implants, 11 children with implants were interviewed. The objective was to shed light on what it is like for a child to use a cochlear implant, based on these children's own experience with implants, which ranged from 5.0 to 7.5 years. Six of the children were in schools…
CPI's human-implantable automatic implantable defibrillator (AID) is a heart assist system, derived from NASA's space circuitry technology, that can prevent erratic heart action known as arrhythmias. Implanted AID, consisting of microcomputer power source and two electrodes for sensing heart activity, recognizes onset of ventricular fibrillation (VF) and delivers corrective electrical countershock to restore rhythmic heartbeat.
Page, E L; Eby, T L
Although the potential for CSF leakage and subsequent meningitis after cochlear implantation in the malformed cochlea has been recognized, this complication has not been previously reported. We report a case of CSF otorhinorrhea and meningitis after minor head trauma developing 2 years after cochlear implantation in a child with Mondini malformation. Leakage of CSF was identified from the cochleostomy around the electrode of the implant, and this leak was sealed with a temporalis fascia and muscle plug. Although this complication appears to be rare, care must be taken to seal the cochleostomy in children with inner ear malformations at the initial surgery, and any episode of meningitis after surgery must be thoroughly investigated to rule out CSF leakage from the labyrinth.
Polizzi, Valeria; Formigoni, Patrizia; Russo, Carmela; Tribi, Lorenzo
Objective. To share our experience of cerebrospinal fluid gusher in cochlear implantation in patients with enlarged cochlear or vestibular aqueduct. Study Design. Case series with comparison and a review of the literature. Methods. A retrospective study was performed. Demographic and radiological results of patients with enlarged cochlear aqueduct or enlarged vestibular aqueduct in 278 consecutive cochlear implant recipients, including children and adults, were evaluated between January 2000 and December 2015. Results. Six patients with enlarged cochlear aqueduct and eight patients with enlarged vestibular aqueduct were identified. Cerebrospinal fluid gusher occurs in five subjects with enlarged cochlear aqueduct and in only one case of enlarged vestibular aqueduct. Conclusion. Based on these findings, enlarged cochlear aqueduct may be the best risk predictor of cerebrospinal fluid gusher at cochleostomy during cochlear implant surgery despite enlarged vestibular aqueduct. PMID:27847516
Guo, Rui; Zhang, HongLei; Chen, Wei; Zhu, XiaoQuan; Liu, Wei; Rask-Andersen, Helge
The patency of the inferior cochlear vein (ICV) may be challenged in cochlear implantation (CI) due to its location near the round window (RW). This may be essential to consider during selection of different trajectories for electrode insertion aiming at preserving residual hearing. Venous blood from the human cochlea is drained through the ICV. The vein also drains blood from the modiolus containing the spiral ganglion neurons. Surgical interference with this vein could cause neural damage influencing CI outcome. We analyzed the topographical relationship between the RW and ICV bony channel and cochlear aqueduct (CA) from a surgical standpoint. Archival human temporal bones were further microdissected to visualize the CA and its accessory canals (AC1 and AC2). This was combined with examinations of plastic and silicone molds of the human labyrinth. Metric analyses were made using photo stereomicroscopy documenting the proximal portion of the AC1, the internal aperture of the CA and the RW. The mean distance between the AC1 and the anterior rim of the RW was 0.81 mm in bone specimens and 0.67 mm assessed in corrosion casts. The AC1 runs from the floor of the scala tympani through the otic capsule passing parallel to the CA to the posterior cranial fossa. The mean distance between the CA and AC1 canal was 0.31 and 0.25 mm, respectively.
Black, F. O.; Lilly, D. J.; Fowler, L. P.; Stypulkowski, P. H.
The customary presentation of surgical procedures to patients in the United States consists of discussions on alternative treatment methods, risks of the procedure(s) under consideration, and potential benefits for the patient. Because the contents of the normal speech signal have not been defined in a way that permits a surgeon systematically to provide alternative auditory signals to a deaf patient, the burden is placed on the surgeon to make an arbitrary selection of candidates and available devices for cochlear prosthetic implantation. In an attempt to obtain some information regarding the ability of a deaf patient to use electrical signals to detect and understand speech, the Good Samaritan Hospital and Neurological Sciences Institute cochlear implant team has routinely performed tympanotomies using local anesthesia and has positioned temporary electrodes onto the round windows of implant candidates. The purpose of this paper is to review our experience with this procedure and to provide some observations that may be useful in a comprehensive preoperative evaluation for totally deaf patients who are being considered for cochlear implantation.
Searls, J. Matt, Comp.
Cochlear implants (CIs) are complex electronic devices surgically implanted under the skin behind the ear. These devices utilize electrodes placed in the inner ear (the cochlea) to stimulate the auditory nerve of individuals with significant permanent hearing loss. Cochlear implants may not be suitable for everyone. They are designed to provide…
Sandmann, Pascale; Eichele, Tom; Buechler, Michael; Debener, Stefan; Jancke, Lutz; Dillier, Norbert; Hugdahl, Kenneth; Meyer, Martin
Auditory evoked potentials are tools widely used to assess auditory cortex functions in clinical context. However, in cochlear implant users, electrophysiological measures are challenging due to implant-created artefacts in the EEG. Here, we used independent component analysis to reduce cochlear implant-related artefacts in event-related EEGs of…
Shape Optimization of Cochlear Implant Electrode Array using Genetic Algorithms Charles T.M. Choi, Ph.D., senior member, IEEE Department of...firstname.lastname@example.org Abstract−Finite element analysis is used to compute the current distribution of the human cochlea during cochlear implant electrical...stimulation. Genetic algorithms are then applied in conjunction with the finite element analysis to optimize the shape of cochlear implant electrode array
This paper uses the fictional case of the "Babel fish" to explore and illustrate the issues involved in the controversy about the use of cochlear implants in prelinguistically deaf children. Analysis of this controversy suggests that the development of genetic tests for deafness poses a serious threat to the continued flourishing of Deaf…
McDermott, Hugh J.
The acceptance of cochlear implantation as an effective and safe treatment for deafness has increased steadily over the past quarter century. The earliest devices were the first implanted prostheses found to be successful in compensating partially for lost sensory function by direct electrical stimulation of nerves. Initially, the main intention was to provide limited auditory sensations to people with profound or total sensorineural hearing impairment in both ears. Although the first cochlear implants aimed to provide patients with little more than awareness of environmental sounds and some cues to assist visual speech-reading, the technology has advanced rapidly. Currently, most people with modern cochlear implant systems can understand speech using the device alone, at least in favorable listening conditions. In recent years, an increasing research effort has been directed towards implant users’ perception of nonspeech sounds, especially music. This paper reviews that research, discusses the published experimental results in terms of both psychophysical observations and device function, and concludes with some practical suggestions about how perception of music might be enhanced for implant recipients in the future. The most significant findings of past research are: (1) On average, implant users perceive rhythm about as well as listeners with normal hearing; (2) Even with technically sophisticated multiple-channel sound processors, recognition of melodies, especially without rhythmic or verbal cues, is poor, with performance at little better than chance levels for many implant users; (3) Perception of timbre, which is usually evaluated by experimental procedures that require subjects to identify musical instrument sounds, is generally unsatisfactory; (4) Implant users tend to rate the quality of musical sounds as less pleasant than listeners with normal hearing; (5) Auditory training programs that have been devised specifically to provide implant users with
Rebscher, Stephen; Harrison, William V.; Sun, Xiaoan; Feng, Haihong
As the most successful neural prosthesis, cochlear implants have provided partial hearing to more than 120,000 persons worldwide; half of which being pediatric users who are able to develop nearly normal language. Biomedical engineers have played a central role in the design, integration and evaluation of the cochlear implant system, but the overall success is a result of collaborative work with physiologists, psychologists, physicians, educators, and entrepreneurs. This review presents broad yet in-depth academic and industrial perspectives on the underlying research and ongoing development of cochlear implants. The introduction accounts for major events and advances in cochlear implants, including dynamic interplays among engineers, scientists, physicians, and policy makers. The review takes a system approach to address critical issues from design and specifications to integration and evaluation. First, the cochlear implant system design and specifications are laid out. Second, the design goals, principles, and methods of the subsystem components are identified from the external speech processor and radio frequency transmission link to the internal receiver, stimulator and electrode arrays. Third, system integration and functional evaluation are presented with respect to safety, reliability, and challenges facing the present and future cochlear implant designers and users. Finally, issues beyond cochlear implants are discussed to address treatment options for the entire spectrum of hearing impairment as well as to use the cochlear implant as a model to design and evaluate other similar neural prostheses such as vestibular and retinal implants. PMID:19946565
Nadol, Joseph B; Eddington, Donald K
The most common forms of severe hearing loss and deafness are related to morphological changes in the cochlea. Many individuals with such forms of hearing disorders have received cochlear implants. It has been assumed that preservation of spiral ganglion cells is important for success of cochlear implants. Preservation of ganglion cells is negatively correlated with the duration of the hearing loss. It has, however, not been possible to reveal a relationship between the degree of survival of spiral ganglion cells and performance of cochlear implants. It is important to understand the histopathological changes that follow cochlear implantation. Insertion of cochlear implants may cause trauma to the basilar membrane, the spiral lamina, and the spiral ligament. Rupture of the basilar membrane may occur. Over time, new bone forms at the cochleostomy and along the implant track. Further investigation is necessary to evaluate the causes of variability of behavioral measures of performance.
Wilson, Blake S.; Finley, Charles C.; Lawson, Dewey T.; Wolford, Robert D.; Eddington, Donald K.; Rabinowitz, William M.
HIGH levels of speech recognition have been achieved with a new sound processing strategy for multielectrode cochlear implants. A cochlear implant system consists of one or more implanted elec-trodes for direct electrical activation of the auditory nerve, an external speech processor that transforms a microphone input into stimuli for each electrode, and a transcutaneous (rf-link) or per-cutaneous (direct) connection between the processor and the elec-trodes. We report here the comparison of the new strategy and a standard clinical processor. The standard compressed analogue (CA) processor1,2 presented analogue waveforms simultaneously to all electrodes, whereas the new continuous interleaved sampling (CIS) strategy presented brief pulses to each electrode in a nonover-lapping sequence. Seven experienced implant users, selected for their excellent performance with the CA processor, participated as subjects. The new strategy produced large improvements in the scores of speech reception tests for all subjects. These results have important implications for the treatment of deafness and for minimal representations of speech at the auditory periphery.
Ben-Itzhak, D.; Most, T.; Weisel, A.
The present study examined the relationships between teachers' and communication clinicians' self-reported knowledge on cochlear implants and their expectations of CIs. The authors also explored these professionals' views regarding the child's communication mode, educational setting, and social options following cochlear implantation. The…
Stith, Joanna L.; Drasgow, Erik
Cochlear implants can provide partial hearing to individuals with substantial hearing loss. Because of improvements in early identification and intervention, more children with cochlear implants will be included in elementary school general education classrooms. Thus, general education teachers should be prepared for teaching children with…
There has been much research conducted demonstrating the positive benefits of cochlear implantation (CI) in children who are deaf. Research on CI in children who are both deaf and blind, however, is lacking. The purpose of this article is to present a study of five congenitally deafblind children who received cochlear implants between 2.2 and 4.2…
Chin, Steven B.; Bergeson, Tonya R.; Phan, Jennifer
Objectives: The purpose of the current study was to examine the relation between speech intelligibility and prosody production in children who use cochlear implants. Methods: The Beginner's Intelligibility Test (BIT) and Prosodic Utterance Production (PUP) task were administered to 15 children who use cochlear implants and 10 children with normal…
Chin, Steven B.
This study examined variations in English complex onset realizations by children who use cochlear implants. Data consisted of 227 productions of two-segment onset clusters from 12 children. In general, onset cluster realizations of children with cochlear implants did not differ markedly from those reported for children with normal hearing: null…
Most, Tova; Zaidman-Zait, Anat
This study surveyed 35 mothers of cochlear implant (CI) candidates or current users on the relative importance of various topics in a parent-targeted intervention program preceding and/or following cochlear implantation. Suggestions for an optimal intervention include use of a multidisciplinary team, information on many topics and services, and…
Lund, Emily; Dinsmoor, Jessica
Purpose: The purpose of this study was to compare the taxonomic vocabulary knowledge and organization of children with cochlear implants to (a) children with normal hearing matched for age, and (b) children matched for vocabulary development. Method: Ten children with cochlear implants, 10 age-matched children with normal hearing, and 10…
Goehring, Jenny L.; Hughes, Michelle L.; Baudhuin, Jacquelyn L.
The use of remote technology to provide cochlear implant services has gained popularity in recent years. This article contains a review of research evaluating the feasibility of remote service delivery for recipients of cochlear implants. To date, published studies have determined that speech-processor programming levels and other objective tests…
Wiefferink, Carin H.; Rieffe, Carolien; Ketelaar, Lizet; De Raeve, Leo; Frijns, Johan H. M.
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…
Tang, Qing; Benítez, Raul; Zeng, Fan-Gang
The modern multi-channel cochlear implant is widely considered to be the most successful neural prosthesis owing to its ability to restore partial hearing to post-lingually deafened adults and to allow essentially normal language development in pre-lingually deafened children. However, the implant performance varies greatly in individuals and is still limited in background noise, tonal language understanding, and music perception. One main cause for the individual variability and the limited performance in cochlear implants is spatial channel interaction from the stimulating electrodes to the auditory nerve and brain. Here we systematically examined spatial channel interactions at the physical, physiological, and perceptual levels in the same five modern cochlear implant subjects. The physical interaction was examined using an electric field imaging technique, which measured the voltage distribution as a function of the electrode position in the cochlea in response to the stimulation of a single electrode. The physiological interaction was examined by recording electrically evoked compound action potentials as a function of the electrode position in response to the stimulation of the same single electrode position. The perceptual interactions were characterized by changes in detection threshold as well as loudness summation in response to in-phase or out-of-phase dual-electrode stimulation. To minimize potentially confounding effects of temporal factors on spatial channel interactions, stimulus rates were limited to 100 Hz or less in all measurements. Several quantitative channel interaction indexes were developed to define and compare the width, slope and symmetry of the spatial excitation patterns derived from these physical, physiological and perceptual measures. The electric field imaging data revealed a broad but uniformly asymmetrical intracochlear electric field pattern, with the apical side producing a wider half-width and shallower slope than the basal
Koyama, Hajime; Kashio, Akinori; Sakata, Aki; Tsutsumiuchi, Katsuhiro; Matsumoto, Yu; Karino, Shotaro; Kakigi, Akinobu; Iwasaki, Shinichi; Yamasoba, Tatsuya
Objectives. This study aimed to determine the feasibility of cochlear implantation for sensorineural hearing loss in patients with Waardenburg syndrome. Method. A retrospective chart review was performed on patients who underwent cochlear implantation at the University of Tokyo Hospital. Clinical classification, genetic mutation, clinical course, preoperative hearing threshold, high-resolution computed tomography of the temporal bone, and postoperative hearing outcome were assessed. Result. Five children with Waardenburg syndrome underwent cochlear implantation. The average age at implantation was 2 years 11 months (ranging from 1 year 9 months to 6 years 3 months). Four patients had congenital profound hearing loss and one patient had progressive hearing loss. Two patients had an inner ear malformation of cochlear incomplete partition type 2. No surgical complication or difficulty was seen in any patient. All patients showed good hearing outcome postoperatively. Conclusion. Cochlear implantation could be a good treatment option for Waardenburg syndrome. PMID:27376080
Varadarajan, Varun V; Dirain, Carolyn O; Antonelli, Patrick J
Objectives Cochlear implant infections may be refractory to medical management and require device removal with subsequent reimplantation. During device removal, the intracochlear electrode array is commonly left in place to prevent obliteration of the cochlear lumen. If the electrode is colonized with pathogens, this risks contaminating the replacement implant. In this study, we compare the microorganisms detected on infected cochlear implants against those on the retained electrode using culture and microbial gene-sequencing techniques. Study Design Prospective single-cohort study. Setting Tertiary medical center. Subjects and Methods Six patients with refractory cochlear implant infections had the receiver-stimulator and extracochlear electrode removed to facilitate treatment of the infection. The intracochlear electrode was removed at (delayed) reimplantation. Implant specimens were analyzed by microbial culture and 16S DNA gene sequencing. Results Staphylococcus aureus was the organism most commonly identified. None of the 6 patients' intracochlear electrodes yielded microbes by culture. Two intracochlear electrodes revealed bacterial species, and 1 revealed fungal species by gene sequencing. There was no correlation between the microbes on the infected extracochlear implants and the retained intracochlear electrodes. All subjects underwent reimplantation after resolution of their infections. One of 6 subjects developed a second infection after reimplantation, with S aureus in the primary and secondary infections. Conclusions The intracochlear electrodes of infected cochlear implants carry a low microbial burden. Preserving intracochlear electrodes upon removal of infected cochlear implants appears to carry a low risk of contaminating a replacement cochlear implant.
Over the last years, indications for cochlear implants (CIs) have changed dramatically. The benefits depend on the preconditions of the individual patient as well as on the subsequent (re)habilitation. Therefore, many variables influencing the hearing and speech perception of a CI user must be kept in mind. As an example, the special situation of children having Turkish as their mother tongue is described. The most convincing argument concerning (re)habilitation is its benefit. Indeed, this benefit represents the final standard of quality and serves as the yardstick for standard assessments of (re)habilitation quality. CI (re)habilitation includes medical, pedagogical, audiological, hearing and speech, and psychological therapeutic aspects.
Raine, Christopher; Atkinson, Helen; Strachan, David R; Martin, Jane M
Cochlear implant (CI) intervention is expensive and accessed mainly by developed countries. The introduction of Universal Newborn Hearing Screening and funding via a public health service give children better access to CIs. However for adults large disparities exist between utilization and estimated prevalence. In the UK CI selection criteria are restrictive compared with many other countries. Improved audiological awareness and screening programmes for adults would improve access to hearing technologies that would improve health and quality of life. Hearing loss itself has significant medical and financial burdens on society and by investing in early intervention and using best technology this would mitigate some of the rising associated medical costs.
Cochlear implants generated intense debate almost immediately following their introduction in the 1980s. Today, with a vast number of deaf individuals with cochlear implants, the debate about the cochlear implant device and mode of communication continues. Q-methodology was used in this study to explore cochlear implants and language acquisition…
Patrick, James F.; Busby, Peter A.; Gibson, Peter J.
Cochlear Limited (Cochlear™) released the fourth-generation cochlear implant system, Nucleus® Freedom™, in 2005. Freedom is based on 25 years of experience in cochlear implant research and development and incorporates advances in medicine, implantable materials, electronic technology, and sound coding. This article presents the development of Cochlear's implant systems, with an overview of the first 3 generations, and details of the Freedom system: the CI24RE receiver-stimulator, the Contour Advance™ electrode, the modular Freedom processor, the available speech coding strategies, the input processing options of SmartSound™ to improve the signal before coding as electrical signals, and the programming software. Preliminary results from multicenter studies with the Freedom system are reported, demonstrating better levels of performance compared with the previous systems. The final section presents the most recent implant reliability data, with the early findings at 18 months showing improved reliability of the Freedom implant compared with the earlier Nucleus 3 System. Also reported are some of the findings of Cochlear's collaborative research programs to improve recipient outcomes. Included are studies showing the benefits from bilateral implants, electroacoustic stimulation using an ipsilateral and/or contralateral hearing aid, advanced speech coding, and streamlined speech processor programming. PMID:17172547
Medrad utilized NASA's Apollo technology to develop a new device called the AID implantable automatic pulse generator which monitors the heart continuously, recognizes the onset of ventricular fibrillation and delivers a corrective electrical shock. AID pulse generator is, in effect, a miniaturized version of the defibrillator used by emergency squads and hospitals to restore rhythmic heartbeat after fibrillation, but has the unique advantage of being permanently available to the patient at risk. Once implanted, it needs no specially trained personnel or additional equipment. AID system consists of a microcomputer, a power source and two electrodes which sense heart activity.
Kloostra, Francka J J; Arnold, Rosemarie; Hofman, Rutger; Van Dijk, Pim
This study retrospectively assessed the prevalence of tinnitus in cochlear implant patients and the changes after implantation in 212 patients implanted between 2000 and 2009. Patients were included at least 6 months after implantation and received 2 sets of questionnaires, one about the situation before implantation and one about the situation after implantation. Mostly standardized questionnaires assessed tinnitus handicap (Tinnitus Handicap Inventory, THI, and Tinnitus Handicap Questionnaire, THQ), tinnitus characteristics, hearing loss (Abbreviated Profile of Hearing Aid Benefit) and anxiety/depression (Hospital Anxiety and Depression Scale). Of the approached patients, 117 completed the full sets of questionnaires and 35 completed a short version. Preoperative tinnitus was reported by 51.3% of these patients, of which 55.6% reported a reduction or cessation of their tinnitus after implantation. However, 8.2% of the patients with tinnitus reported a postoperative deterioration of their tinnitus. In addition, among the patients without preoperative tinnitus, 19.6% reported the start of tinnitus after implantation. The self-reported change of tinnitus correlated with the pre- and postoperative scores on the THI and THQ. The THQ showed slightly more changes in scores after cochlear implantation compared to the THI. Overall hearing handicap and feelings of anxiety and depression decreased after implantation. In conclusion, tinnitus is reduced after cochlear implantation in an important part of the patients, but in a small part implantation has a negative effect on tinnitus. When tinnitus starts after implantation, the tinnitus handicap is mild.
Turok, Rebecca L.; Labadie, Robert F.; Wanna, George B.; Dawant, Benoit M.; Noble, Jack H.
Cochlear Implant (CI) surgery is a procedure in which an electrode array is inserted into the cochlea. The electrode array is used to stimulate auditory nerve fibers and restore hearing for people with severe to profound hearing loss. The primary goals when placing the electrode array are to fully insert the array into the cochlea while minimizing trauma to the cochlea. Studying the relationship between surgical outcome and various surgical techniques has been difficult since trauma and electrode placement are generally unknown without histology. Our group has created a CI placement simulator that combines an interactive 3D visualization environment with a haptic-feedback-enabled controller. Surgical techniques and patient anatomy can be varied between simulations so that outcomes can be studied under varied conditions. With this system, we envision that through numerous trials we will be able to statistically analyze how outcomes relate to surgical techniques. As a first test of this system, in this work, we have designed an experiment in which we compare the spatial distribution of forces imparted to the cochlea in the array insertion procedure when using two different but commonly used surgical techniques for cochlear access, called round window and cochleostomy access. Our results suggest that CIs implanted using round window access may cause less trauma to deeper intracochlear structures than cochleostomy techniques. This result is of interest because it challenges traditional thinking in the otological community but might offer an explanation for recent anecdotal evidence that suggests that round window access techniques lead to better outcomes.
Hardonk, Stefan; Bosteels, Sigrid; Desnerck, Greetje; Loots, Gerrit; Van Hove, Geert; Van Kerschaver, Erwin; Vanroelen, Christophe; Louckx, Fred
Factors contributing to parents' decision when they choose between cochlear implantation (CI) and traditional hearing aids for their child were examined. The subjects were children with severe/profound hearing loss, born 1999-2001, registered in the universal neonatal hearing screening program in the Flanders region of Belgium. Qualitative data…
Schorr, Efrat A.; Roth, Froma P.; Fox, Nathan A.
Purpose: This study examined children's self-reported quality of life with a cochlear implant as related to children's actual perceptions of speech and the emotional information conveyed by sound. Effects of age at amplification with hearing aids and fitting of cochlear implants on perceived quality of life were also investigated. Method: A…
Cohen, Seth M.; Haynes, David S.
This article discusses the surgical management of children receiving cochlear implants. It identifies preoperative considerations to select patients likely to benefit, contraindications, some new surgical techniques, complications, special considerations (otitis media, meningitis, head growth, inner ear malformations, and cochlear obstruction).…
Eshraghi, Adrien A.; Nazarian, Ronen; Telischi, Fred F.; Martinez, Diane; Hodges, Annelle; Velandia, Sandra; Cejas-Cruz, Ivette; Balkany, Thomas J.; Lo, Kaming; Lang, Dustin
Objective To assess the outcome of cochlear implantation in children with Autism Spectrum Disorder Study Design Retrospective case review and survey Setting Tertiary referral center Patients Children who meet criteria for cochlear implantation and diagnosis of Autism Spectrum Disorder Main Outcome Measures Receptive and expressive language scores and parental survey data. Results 15 patients with history of ASD and cochlear implantation were analyzed and compared to 15 patients who received cochlear implant and have no other disability. Post-operatively, more than 67% of children with ASD significantly improved their speech perception skills and 60% significantly improved their speech expression skills while all patients in the control group showed significant improvement in both aspects. The top three reported improvements after cochlear implantation were name recognition, response to verbal requests, and enjoyment of music. Of all behavioral aspects, the use of eye contact was the least improved. Survey results in regards to improvements in patient interaction were more subtle when compared to those related to sound and speech perception. The most improved aspects in the ASD patients’ lives after cochlear implantation appeared to be attending to other people’s requests and conforming to family routines. Of note, awareness of the child’s environment is the most highly ranked improvement attributed to the cochlear implant. Conclusions Cochlear implants are effective and beneficial for hearing impaired members of the ASD population even though development of language may lag behind that of implanted children with no additional disabilities. Significant speech perception and overall behavior improvement are noted. PMID:25899551
Zhang, Hongzheng; Stark, Gemaine; Reiss, Lina
Hypothesis Gene expression changes occur in conjunction with hearing threshold changes after cochlear implantation. Background Between 30–50% of individuals who receive electro-acoustic stimulation (EAS) cochlear implants lose residual hearing after cochlear implantation, reducing the benefits of EAS. The mechanism underlying this hearing loss is unknown; potential pathways include mechanical damage, inflammation, or tissue remodeling changes. Methods Guinea pigs were implanted in one ear with cochlear implant electrode arrays, with non-implanted ears serving as controls, and allowed to recover for 1, 3, 7, or 14 days. Hearing threshold changes were measured over time. Cochlear ribonucleic acid was analyzed using real-time quantitative reverse transcription-polymerase chain reaction from the following gene families: cytokines, tight junction claudins, ion and water (aquaporin) transport channels, gap junction connexins, and tissue remodeling genes. Results Significant increases in expression were observed for cochlear inflammatory genes (Cxcl1, IL-1b, TNFα and Tnfrsf1a/b) and ion homeostasis genes (Scnn1γ, Aqp3 and Gjb3). Upregulation of tissue remodeling genes (TGF-β, MMP2, MMP9) as well as a paracrine gene (CTGF) was also observed. Hearing loss occurred rapidly, peaking at 3 days with some recovery at 7 and 14 days after implantation. MM9 exhibited extreme upregulation of expression and was qualitatively associated with changes in hearing thresholds. Conclusion Cochlear implantation induces similar changes as middle ear inflammation for genes involved in inflammation and ion and water transport function, whereas tissue remodeling changes differ markedly. The upregulation of MMP9 with hearing loss is consistent with previous findings linking stria vascularis vessel changes with cochlear implant-induced hearing loss. PMID:25970030
Chin, Steven B.; Oglesbee, Eric N.; Kirk, Andrew K.; Krug, Joseph E.
Although cochlear implants are primarily auditory prostheses, they have also demonstrated their usefulness as aids to speech production and the acquisition of spoken language in children. This presentation reports on research currently being conducted at the Indiana University Medical Center on the development of phonological systems by children with five or more years of cochlear implant use in English-speaking environments. Characteristics of the feature [voice] will be examined in children with cochlear implants and in two comparison groups: adults with normal hearing and children with normal hearing. Specific aspects of voicing to be discussed include characteristic error patterns, phonetic implementation of the voicing contrast, and phonetic implementation of neutralization of the voicing contrast. Much of the evidence obtained thus far indicates that voicing acquisition in children with cochlear implants is not radically different from that of children with normal hearing. Many differences between the systems of children with cochlear implants and the ambient system thus appear to reflect the children's age as much as their hearing status. [Work supported by grants from the National Institutes of Health to Indiana University: R01DC005594 and R03DC003852.
Lu, Thomas; Huang, Juan; Zeng, Fan-Gang
Modern cochlear implant (CI) users understand speech but find difficulty in music appreciation due to poor pitch perception. Still, some deaf musicians continue to perform with their CI. Here we show unexpected results that CI musicians can reliably tune a guitar by CI alone and, under controlled conditions, match simultaneously presented tones to <0.5 Hz. One subject had normal contralateral hearing and produced more accurate tuning with CI than his normal ear. To understand these counterintuitive findings, we presented tones sequentially and found that tuning error was larger at ∼30 Hz for both subjects. A third subject, a non-musician CI user with normal contralateral hearing, showed similar trends in performance between CI and normal hearing ears but with less precision. This difference, along with electric analysis, showed that accurate tuning was achieved by listening to beats rather than discriminating pitch, effectively turning a spectral task into a temporal discrimination task. PMID:24651081
Lu, Thomas; Huang, Juan; Zeng, Fan-Gang
Modern cochlear implant (CI) users understand speech but find difficulty in music appreciation due to poor pitch perception. Still, some deaf musicians continue to perform with their CI. Here we show unexpected results that CI musicians can reliably tune a guitar by CI alone and, under controlled conditions, match simultaneously presented tones to <0.5 Hz. One subject had normal contralateral hearing and produced more accurate tuning with CI than his normal ear. To understand these counterintuitive findings, we presented tones sequentially and found that tuning error was larger at ∼ 30 Hz for both subjects. A third subject, a non-musician CI user with normal contralateral hearing, showed similar trends in performance between CI and normal hearing ears but with less precision. This difference, along with electric analysis, showed that accurate tuning was achieved by listening to beats rather than discriminating pitch, effectively turning a spectral task into a temporal discrimination task.
Edwards, Alexandra; Edwards, Lindsey; Langdon, Dawn
Research has shown that cochlear implants give rise to improvements in speech recognition and production in children with profound hearing loss but very few studies have explored mathematical abilities in these children. The current study compared the mathematical abilities of 24 children with cochlear implants (mean age 10 years 1 month) to a control group of 22 hearing children (mean age 9 years 8 months). The math questions were categorized into questions that tapped into arithmetic or geometrical reasoning. It was predicted that the cochlear implant group would perform below the hearing group on the arithmetic questions but not the geometrical reasoning questions. Unexpectedly, the results showed that the cochlear implant group performed significantly below the hearing group on both types of math questions, but that this difference was mediated by language skill as assessed by vocabulary knowledge. The clinical implications of these results and possible future research results are considered.
Hedley-Williams, Andrea J.; Sladen, Douglas P.; Tharpe, Anne Marie
This article provides an overview of current cochlear implant technology, programming strategies, troubleshooting, and care techniques. It considers: device components, initial stimulation, speech coding strategies, use and care, troubleshooting, and the classroom environment. (Contains references.) (DB)
... Current Issue Past Issues Special Section: Focus on Communication Cochlear Implants Past Issues / Fall 2008 Table of ... from the National Institute on Deafness and Other Communication Disorders (NIDCD), he studies how the language skills ...
... based on this study include: Children should be up-to-date on vaccines at least 2 weeks before having a cochlear implant if they are not already up-to-date on these vaccinations. Parents of children who have ...
Munivrana, Boska; Mildner, Vesna
In some cochlear implant users, success is not achieved in spite of optimal clinical factors (including age at implantation, duration of rehabilitation and post-implant hearing level), which may be attributed to disorders at higher levels of the auditory pathway. We used cortical auditory evoked potentials to investigate the ability to perceive…
Bohnert, Andrea; Spitzlei, Vera; Lippert, Karl L.; Keilmann, Annerose
Between 2000 and 2006, the University Clinic for Ear Nose and Throat and Communication Disorders in Mainz, Germany, performed 41 bilateral cochlear implantations in children. This article addresses some of the factors to be considered in a decision to bilaterally implant a child, including the age of the child at the first implant, the length of…
Büchner, A; Gärtner, L
Twenty years ago, cochlear implants (CI) were indicated only in cases of profound hearing loss or complete deafness. While from today's perspective the technology was clumsy and provided patients with only limited speech comprehension in quiet scenarios, successive advances in CI technology and the consequent substantial hearing improvements over time have since then resulted in continuous relaxation of indication criteria toward residual hearing. While achievements in implant and processor electronics have been one key factor for the ever-improving hearing performance, development of electro-acoustic CI systems-together with atraumatic implantation concepts-has led to enormous improvements in patients with low-frequency residual hearing. Manufactures have designed special processors with integrated hearing aid components for this patient group, which are capable of conveying acoustic and electric stimulation. A further milestone in improvement of hearing in challenging listening environments was the adoption of signal enhancement algorithms and assistive listening devices from the hearing aid industry. This article gives an overview of the current state of the art in the abovementioned areas of CI technology.
Nicholas, Johanna Grant; Geers, Ann E.
Purpose: The authors examined the benefits of younger cochlear implantation, longer cochlear implant use, and greater pre-implant aided hearing to spoken language at 3.5 and 4.5 years of age. Method: Language samples were obtained at ages 3.5 and 4.5 years from 76 children who received an implant by their 3rd birthday. Hierarchical linear modeling…
Hsiao, Feilin; Gfeller, Kate
This review of literature presents a systematic analysis of the capabilities and limitations of cochlear implant recipients regarding music perception. Specifically, it a) analyzes individual components of music (e.g., rhythm, timbre, and pitch) as they interface with the technical characteristics of cochlear implants and the perceptual abilities of cochlear implant recipients; and b) describes accommodations for music instruction that support successful participation of children with cochlear implants. This article consolidates research studies from various disciplines (audiology, hearing science, speech-language pathology, cochlear implants, and music therapy) to provide practical recommendations for educators in fostering the musical growth of children with cochlear implants.
Macherey, Olivier; Carlyon, Robert P.
Pitch can be conveyed to cochlear implant (CI) listeners via both place of excitation and temporal cues. The transmission of place cues may be hampered by several factors including limitations on the insertion depth and number of implanted electrodes, and the broad current spread produced by monopolar stimulation. The following series of experiments investigate several methods to partially overcome these limitations. Experiment 1 compares two recently published techniques that aim to activate more apical fibers than produced by monopolar or bipolar stimulation of the most apical contacts. The first technique (phantom stimulation) manipulates the current spread by simultaneously stimulating two electrodes with opposite-polarity pulses of different amplitudes. The second technique manipulates the neural spread of excitation by using asymmetric pulses and exploiting the polarity-sensitive properties of auditory nerve fibers. The two techniques yielded similar results and were shown to produce lower place pitch percepts than stimulation of monopolar and bipolar symmetric pulses. Furthermore, combining these two techniques may be advantageous in a clinical setting. Experiment 2 proposes a novel method to create place pitches intermediate to those produced by physical electrodes by using charge-balanced asymmetric pulses in bipolar mode with different degrees of asymmetry. PMID:22423718
Zeng, Fan-Gang; Tang, Qing; Lu, Thomas
Contemporary cochlear implants with multiple electrode stimulation can produce good speech perception but poor music perception. Hindered by the lack of a gold standard to quantify electric pitch, relatively little is known about the nature and extent of the electric pitch abnormalities and their impact on cochlear implant performance. Here we overcame this obstacle by comparing acoustic and electric pitch perception in 3 unilateral cochlear-implant subjects who had functionally usable acoustic hearing throughout the audiometric frequency range in the non-implant ear. First, to establish a baseline, we measured and found slightly impaired pure tone frequency discrimination and nearly perfect melody recognition in all 3 subjects’ acoustic ear. Second, using pure tones in the acoustic ear to match electric pitch induced by an intra-cochlear electrode, we found that the frequency-electrode function was not only 1–2 octaves lower, but also 2 times more compressed in frequency range than the normal cochlear frequency-place function. Third, we derived frequency difference limens in electric pitch and found that the equivalent electric frequency discrimination was 24 times worse than normal-hearing controls. These 3 abnormalities are likely a result of a combination of broad electric field, distant intra-cochlear electrode placement, and non-uniform spiral ganglion cell distribution and survival, all of which are inherent to the electrode-nerve interface in contemporary cochlear implants. Previous studies emphasized on the “mean” shape of the frequency-electrode function, but the present study indicates that the large “variance” of this function, reflecting poor electric pitch discriminability, is the main factor limiting contemporary cochlear implant performance. PMID:24551131
Reiss, Lina A J; Ito, Rindy A; Eggleston, Jessica L; Wozny, David R
Bimodal stimulation, or stimulation of a cochlear implant (CI) together with a contralateral hearing aid (HA), can improve speech perception in noise However, this benefit is variable, and some individuals even experience interference with bimodal stimulation. One contributing factor to this variability may be differences in binaural spectral integration (BSI) due to abnormal auditory experience. CI programming introduces interaural pitch mismatches, in which the frequencies allocated to the electrodes (and contralateral HA) differ from the electrically stimulated cochlear frequencies. Previous studies have shown that some, but not all, CI users adapt pitch perception to reduce this mismatch. The purpose of this study was to determine whether broadened BSI may also reduce the perception of mismatch. Interaural pitch mismatches and dichotic pitch fusion ranges were measured in 21 bimodal CI users. Seventeen subjects with wide fusion ranges also conducted a task to pitch match various fused electrode-tone pairs. All subjects showed abnormally wide dichotic fusion frequency ranges of 1-4 octaves. The fusion range size was weakly correlated with the interaural pitch mismatch, suggesting a link between broad binaural pitch fusion and large interaural pitch mismatch. Dichotic pitch averaging was also observed, in which a new binaural pitch resulted from the fusion of the original monaural pitches, even when the pitches differed by as much as 3-4 octaves. These findings suggest that abnormal BSI, indicated by broadened fusion ranges and spectral averaging between ears, may account for speech perception interference and nonoptimal integration observed with bimodal compared with monaural hearing device use.
Møller, Aage R
Cochlear implants bypass functions of the cochlea that have been regarded to be fundamental for discrimination of the frequency (or spectrum). Frequency discrimination is essential for discrimination of sounds, including speech sounds, and the normal auditory system is assumed to make use of both (power) spectral and temporal information for frequency discrimination. Spectral information is represented by the place on the basilar membrane that generates the largest amplitude of vibration on the basilar membrane. Evidence has been presented that the temporal representation of frequency is more robust than the place representation and thus regarded more important for speech discrimination. The fact that some cochlear implants provide good speech discrimination using only information about the energy in a few spectral bands seems to contradict these studies. In that way, frequency discrimination may be similar to trichromatic color vision, which is based on the energy in only three different spectral bands of light, accomplished by different color-sensitive pigments in the cones of the retina. Cochlear nucleus implants (ABIs) also bypass the auditory nerve, which does not perform any processing. Therefore, it may be expected that ABIs are equally efficient as cochlear implants. However, experience from the use of ABIs in patients with bilateral vestibular schwannoma has not been encouraging, but recent studies of the use of ABIs in patients with other causes of injuries to the auditory nerve have shown similar speech discrimination as achieved with modern cochlear implants. Cochlear implants and ABIs are successful in providing speech discrimination because of redundancy in the processing in the ear, redundancy of the speech signal and because the auditory nervous system has a high degree of plasticity. Expression of neural plasticity makes the auditory nervous system adapt to the change in demands of processing of the information provided by cochlear implants.
Biomedical engineering technologies such as brain-machine interfaces and neuroprosthetics are advancements which assist human beings in varied ways. There are exciting yet speculative visions of how the neurosciences and bioengineering may influence human nature. However, these could be preparing a possible pathway towards an enhanced and even posthuman future. This article seeks to investigate several ethical themes and wider questions of enhancement, transhumanism and posthumanism. Four themes of interest are: autonomy, identity, futures, and community. Three larger questions can be asked: will everyone be enhanced? Will we be "human" if we are not, one day, transhuman? Should we be enhanced or not? The article proceeds by concentrating on a widespread and sometimes controversial application: the cochlear implant, an auditory prosthesis implanted into Deaf patients. Cochlear implantation and its reception in both the deaf and hearing communities have a distinctive moral discourse, which can offer surprising insights. The paper begins with several points about the enhancement of human beings, transhumanism's reach beyond the human, and posthuman aspirations. Next it focuses on cochlear implants on two sides. Firstly, a shorter consideration of what technologies may do to humans in a transhumanist world. Secondly, a deeper analysis of cochlear implantation's unique socio-political movement, its ethical explanations and cultural experiences linked with pediatric cochlear implantation-and how those wary of being thrust towards posthumanism could marshal such ideas by analogy. As transhumanism approaches, the issues and questions merit continuing intense analysis.
Kokkinakis, Kostas; Azimi, Behnam; Hu, Yi; Friedland, David R
To restore hearing sensation, cochlear implants deliver electrical pulses to the auditory nerve by relying on sophisticated signal processing algorithms that convert acoustic inputs to electrical stimuli. Although individuals fitted with cochlear implants perform well in quiet, in the presence of background noise, the speech intelligibility of cochlear implant listeners is more susceptible to background noise than that of normal hearing listeners. Traditionally, to increase performance in noise, single-microphone noise reduction strategies have been used. More recently, a number of approaches have suggested that speech intelligibility in noise can be improved further by making use of two or more microphones, instead. Processing strategies based on multiple microphones can better exploit the spatial diversity of speech and noise because such strategies rely mostly on spatial information about the relative position of competing sound sources. In this article, we identify and elucidate the most significant theoretical aspects that underpin single- and multi-microphone noise reduction strategies for cochlear implants. More analytically, we focus on strategies of both types that have been shown to be promising for use in current-generation implant devices. We present data from past and more recent studies, and furthermore we outline the direction that future research in the area of noise reduction for cochlear implants could follow.
Blom, Helen C.; Marschark, Marc
This study was designed to evaluate the potential of simultaneous communication (sign and speech together) to support classroom learning by college students who use cochlear implants (CIs). Metacognitive awareness of learning also was evaluated. A within-subjects design involving 40 implant users indicated that the student participants learned…
Ertmer, David J.; Young, Nancy M.; Nathani, Suneeti
Purpose: The main purpose of this investigation was to examine the effects of cochlear implant experience on prelinguistic vocal development in young deaf children. Procedure: A prospective longitudinal research design was used to document the sequence and time course of vocal development in 7 children who were implanted between 10 and 36 months…
Ertmer, David J.
This epilogue to a forum on children with hearing impairments who have cochlear implants discusses innovation in implant technology and considers intervention issues. Key factors influencing outcomes are discussed, including educational programming, amount and length of communication intervention, and the targeting of both developmental and…
Gheysen, Freja; Loots, Gerrit; Van Waelvelde, Hilde
The purpose of this study was to investigate the impact of a cochlear implant (CI) on the motor development of deaf children. The study involved 36 mainstreamed deaf children (15 boys, 21 girls; 4- to 12-years old) without any developmental problems. Of these children, 20 had been implanted. Forty-three hearing children constituted a comparison…
Mayer, Connie; Watson, Linda; Archbold, Sue; Ng, Zheng Yen; Mulla, Imran
Thirty-three young people with cochlear implants, aged between 9 and 16 years, were assessed for use of their implant system, cognitive abilities, vocabulary, reading, and writing skills. The group came from throughout England and included 26 born deaf, six deafened by meningitis, one with auditory neuropathy, and five with additional needs.…
Parisier, S C; Chute, P M; Popp, A L; Hanson, M B
Early cochlear implantation to treat prelingually deafened children has been shown to improve speech perception and overall performance. The current age limit for implantation is 24 months in accordance with US Food and Drug Administration guidelines, but it is believed that earlier implantation is possible and may result in better performance. Implantation in children younger than 36 months, however, is complicated by the altered anatomy of the temporal bone in this young age group. We have developed specific modifications in the cochlear implantation technique for this young age group. This technique was used in implantation for 17 children younger than 36 months. The ages ranged from 16 to 36 months and averaged 30 months. All patients except one had complete electrode insertion without complication. The technique of cochlear implantation must be modified not only for differences in anatomy in these young children but also for the expected continued growth of the temporal bone and related structures. Cochlear implantation can be safely performed on children as young as 16 months.
Geers, Anne E.; Nicholas, Johanna G.
Purpose: In this article, the authors sought to determine whether the precise age of implantation (AOI) remains an important predictor of spoken language outcomes in later childhood for those who received a cochlear implant (CI) between 12 and 38 months of age. Relative advantages of receiving a bilateral CI after age 4.5 years, better…
Bento, Ricardo Ferreira; Monteiro, Tatiana Alves; Bittencourt, Aline Gomes; Goffi-Gomez, Maria Valeria Schmidt; de Brito, Rubens
Summary Introduction: Few cases of cochlear implantation (CI) in neurofibromatosis type 2 (NF2) patients had been reported in the literature. The approaches described were translabyrinthine, retrosigmoid or middle cranial fossa. Objectives: To describe a case of a NF2- deafened-patient who underwent to vestibular schwannoma resection via RLA with cochlear nerve preservation and CI through the round window, at the same surgical time. Resumed Report: A 36-year-old woman with severe bilateral hearing loss due to NF2 was submitted to vestibular schwannoma resection and simultaneous CI. Functional assessment of cochlear nerve was performed by electrical promontory stimulation. Complete tumor removal was accomplishment via RLA with anatomic and functional cochlear and facial nerve preservation. Cochlear electrode array was partially inserted via round window. Sound field hearing threshold improvement was achieved. Mean tonal threshold was 46.2 dB HL. The patient could only detect environmental sounds and human voice but cannot discriminate vowels, words nor do sentences at 2 years of follow-up. Conclusion: Cochlear implantation is a feasible auditory restoration option in NF2 when cochlear anatomic and functional nerve preservation is achieved. The RLA is adequate for this purpose and features as an option for hearing preservation in NF2 patients. PMID:25992034
Cochlear implants are electronic prosthetic devices that restores partial hearing in patients with severe to profound hearing loss. Although most coding strategies have significantly improved the perception of speech in quite listening conditions, there remains limitations on speech perception under adverse environments such as in background noise, reverberation and band-limited channels, and we propose strategies that improve the intelligibility of speech transmitted over the telephone networks, reverberated speech and speech in the presence of background noise. For telephone processed speech, we propose to examine the effects of adding low-frequency and high- frequency information to the band-limited telephone speech. Four listening conditions were designed to simulate the receiving frequency characteristics of telephone handsets. Results indicated improvement in cochlear implant and bimodal listening when telephone speech was augmented with high frequency information and therefore this study provides support for design of algorithms to extend the bandwidth towards higher frequencies. The results also indicated added benefit from hearing aids for bimodal listeners in all four types of listening conditions. Speech understanding in acoustically reverberant environments is always a difficult task for hearing impaired listeners. Reverberated sounds consists of direct sound, early reflections and late reflections. Late reflections are known to be detrimental to speech intelligibility. In this study, we propose a reverberation suppression strategy based on spectral subtraction to suppress the reverberant energies from late reflections. Results from listening tests for two reverberant conditions (RT60 = 0.3s and 1.0s) indicated significant improvement when stimuli was processed with SS strategy. The proposed strategy operates with little to no prior information on the signal and the room characteristics and therefore, can potentially be implemented in real-time CI
Sheft, Stanley; Kuvadia, Sejal; Gygi, Brian
Purpose The study investigated the effect of a short computer-based environmental sound training regimen on the perception of environmental sounds and speech in experienced cochlear implant (CI) patients. Method Fourteen CI patients with the average of 5 years of CI experience participated. The protocol consisted of 2 pretests, 1 week apart, followed by 4 environmental sound training sessions conducted on separate days in 1 week, and concluded with 2 posttest sessions, separated by another week without training. Each testing session included an environmental sound test, which consisted of 40 familiar everyday sounds, each represented by 4 different tokens, as well as the Consonant Nucleus Consonant (CNC) word test, and Revised Speech Perception in Noise (SPIN-R) sentence test. Results Environmental sounds scores were lower than for either of the speech tests. Following training, there was a significant average improvement of 15.8 points in environmental sound perception, which persisted 1 week later after training was discontinued. No significant improvements were observed for either speech test. Conclusions The findings demonstrate that environmental sound perception, which remains problematic even for experienced CI patients, can be improved with a home-based computer training regimen. Such computer-based training may thus provide an effective low-cost approach to rehabilitation for CI users, and potentially, other hearing impaired populations. PMID:25633579
Heman-Ackah, Selena E; Roland, J Thomas; Haynes, David S; Waltzman, Susan B
Since the first cochlear implant approved by the US Food and Drug Administration in the early 1980s, great advances have occurred in cochlear implant technology. With these advances, patient selection, preoperative evaluation, and rehabilitation consideration continue to evolve. This article describes the current practice in pediatric candidacy evaluation, reviews the medical and surgical considerations in pediatric cochlear implantation, and explores the expanding criteria for cochlear implantation within the pediatric population.
Goehring, Jenny L; Hughes, Michelle L; Baudhuin, Jacquelyn L
The use of remote technology to provide cochlear implant services has gained popularity in recent years. This article contains a review of research evaluating the feasibility of remote service delivery for recipients of cochlear implants. To date, published studies have determined that speech-processor programming levels and other objective tests (electrode impedance and electrically evoked compound action potentials) are equivalent to those obtained in the face-to-face condition. Despite these promising findings, speech perception using remote technology has proven to be more challenging. Previous investigations have evaluated speech perception with recipients of cochlear implants using videoconference (Polycom) equipment in nonsound-treated rooms (due to lack of access to audiological sound booths in rural areas). Results have revealed poorer speech perception scores using remote technology compared to face-to-face results. Additionally, it has been shown that Polycom transmission of a speech stimulus does not cause significant compression for adequate evaluation; rather, poorer results are due to testing performed in nonsound-treated environments. Based on the literature, telepractice is a feasible option for cochlear implant service delivery. Barriers to the wide-spread use of remote services for recipients of cochlear implants include a uniform system for the evaluation of speech perception, validation of services for pediatric recipients and initial activations, license reciprocity, and reimbursement for services.
Miyamoto, R T; Robbins, A J; Myres, W A; Pope, M L
We report the case of a profoundly deaf 4-year-old boy with congenital deafness as a result of Mondini's dysplasia. The Mondini inner ear malformation is the result of arrested labyrinthine development during embryogenesis and is characterized by both bony and membranous anomalies of the inner ear. The dysplastic cochlear anatomy does not preclude successful cochlear implantation, and electrical threshold measurements are similar to those recorded in pediatric subjects deafened as a result of other causes.
Baumhoff, Peter; Kral, Andrej
Electroacoustic stimulation in subjects with residual hearing is becoming more widely used in clinical practice. However, little is known about the properties of electrically induced responses in the hearing cochlea. In the present study, normal-hearing guinea pig cochleae underwent cochlear implantation through a cochleostomy without significant loss of hearing. Using recordings of unit activity in the midbrain, we were able to investigate the excitation patterns throughout the tonotopic field determined by acoustic stimulation. With the cochlear implant and the midbrain multielectrode arrays left in place, the ears were pharmacologically deafened and electrical stimulation was repeated in the deafened condition. The results demonstrate that, in addition to direct neuronal (electroneuronal) stimulation, in the hearing cochlea excitation of the hair cells occurs (“electrophonic responses”) at the cochlear site corresponding to the dominant temporal frequency components of the electrical stimulus, provided these are < 12 kHz. The slope of the rate–level functions of the neurons in the deafened condition was steeper and the firing rate was higher than in the hearing condition at those sites that were activated in the two conditions. Finally, in a monopolar stimulation configuration, the differences between hearing status conditions were smaller than in the narrower (bipolar) configurations. SIGNIFICANCE STATEMENT Stimulation with cochlear implants and hearing aids is becoming more widely clinically used in subjects with residual hearing. The neurophysiological characteristics underlying electroacoustic stimulation and the mechanism of its benefit remain unclear. The present study directly demonstrates that cochlear implantation does not interfere with the normal mechanical and physiological function of the cochlea. For the first time, it double-dissociates the electrical responses of hair cells (electrophonic responses) from responses of the auditory nerve
Fagan, Mary K.; Pisoni, David B.
This study investigated receptive vocabulary delay in deaf children with cochlear implants. Participants were 23 children with profound hearing loss, ages 6-14 years, who received a cochlear implant between ages 1.4 and 6 years. Duration of cochlear implant use ranged from 3.7 to 11.8 years. "Peabody Picture Vocabulary Test, Third…
Sampaio, André L. L.; Araújo, Mercêdes F. S.; Oliveira, Carlos A. C. P.
Numerous changes continue to occur in cochlear implant candidacy. In general, these have been accompanied by concomitant and satisfactory changes in surgical techniques. Together, this has advanced the utility and safety of cochlear implantation. Most devices are now approved for use in patients with severe to profound unilateral hearing loss rather then the prior requirement of a bilateral profound loss. Furthermore, studies have begun utilizing short electrode arrays for shallow insertion in patients with considerable low-frequency residual hearing. This technique will allow the recipient to continue to use acoustically amplified hearing for the low frequencies simultaneously with a cochlear implant for the high frequencies. The advances in design of, and indications for, cochlear implants have been matched by improvements in surgical techniques and decrease in complications. The resulting improvements in safety and efficacy have further encouraged the use of these devices. This paper will review the new concepts in the candidacy of cochlear implant. Medline data base was used to search articles dealing with the following topics: cochlear implant in younger children, cochlear implant and hearing preservation, cochlear implant for unilateral deafness and tinnitus, genetic hearing loss and cochlear implant, bilateral cochlear implant, neuropathy and cochlear implant and neural plasticity, and the selection of patients for cochlear implant. PMID:22013448
Reeder, Ruth M.; Firszt, Jill B.; Cadieux, Jamie H.; Strube, Michael J.
Purpose: Whether, and if so when, a second-ear cochlear implant should be provided to older, unilaterally implanted children is an ongoing clinical question. This study evaluated rate of speech recognition progress for the second implanted ear and with bilateral cochlear implants in older sequentially implanted children and evaluated localization…
Yuan, Meng; Sun, Yang; Feng, Haihong; Lee, Tan
This paper discusses a single-channel speech enhancement method for cochlear implant listeners. It is assumed that the Fourier Transform coefficients of speech and background noise have different statistical distributions. A statistical-model-based method is adopted to update the signal-to-noise ratio and estimate the background noise so that the musical noise and speech distortion induced by traditional spectral subtraction method can be effectively reduced. This enhancement method was evaluated on seven postlingually deaf Chinese cochlear implant listeners in comparison with other two speech enhancement methods. Test materials were Mandarin sentences corrupted by three different types of background noise. Experimental results showed that the proposed speech enhancement method could benefit the speech intelligibility of Chinese cochlear implant listeners. The results suggest that different noise types may affect the performance of different speech enhancement algorithms.
Corrales, C. Eduardo
Early identification and management of disabilities in children are essential to reduce long-term developmental sequelae. Many of the causes of hearing loss also produce cognitive delays resulting in a large number of children with both deafness and developmental disabilities. Children who have hearing loss and additional disabilities require complex, individualized therapy to maximize their long-term quality of life. Hearing loss is often detected early because of widespread newborn hearing screening programs and the decision for cochlear implantation in children presenting with multiple medical and developmental disorders is still evolving. This article will review the literature regarding cochlear implant considerations in children with additional developmental disabilities in areas of family perception, speech and language development, cognitive development including adaptive behavior and intelligence, communication and functional skills, auditory outcomes, quality of life outcomes, predictors of outcomes and realistic expectations after cochlear implantation. PMID:23772353
Vivero, Richard J.; Fan, Kenneth; Angeli, Simon; Balkany, Thomas J; Liu, Xue Z
Genetic factors are among the main etiologies of severe to profound hearing loss and may play an important role in cochlear implantation (CI) outcomes. While genes for common forms of deafness have been cloned, efforts to correlate the functional outcome of CIs with a genetic form of deafness carried by the patient have been largely anecdotal to date. It has been suggested that the differences in auditory performance may be explained by differences in the number of surviving spiral ganglion cells, etiology of hearing loss, and other factors. Knowledge of the specific loci and mutations involved in patients who receive cochlear implants may elucidate other factors related to CI performance. In this review article, current knowledge of cochlear implants for hereditary hearing loss will be discussed with an emphasis on relevant clinical genotype-phenotype correlations. PMID:20655117
Vivero, Richard J; Fan, Kenneth; Angeli, Simon; Balkany, Thomas J; Liu, Xue Z
Genetic factors are among the main etiologies of severe to profound hearing loss and may play an important role in cochlear implantation (CI) outcomes. While genes for common forms of deafness have been cloned, efforts to correlate the functional outcome of CIs with a genetic form of deafness carried by the patient have been largely anecdotal to date. It has been suggested that the differences in auditory performance may be explained by differences in the number of surviving spiral ganglion cells, etiology of hearing loss, and other factors. Knowledge of the specific loci and mutations involved in patients who receive cochlear implants may elucidate other factors related to CI performance. In this review article, current knowledge of cochlear implants for hereditary hearing loss will be discussed with an emphasis on relevant clinical genotype-phenotype correlations.
Mitterbacher, A; Lampacher, P; Zierhofer, C; Hochmair, E
CILab is a computer-based versatile laboratory system for the implementation and evaluation of innovative stimulation strategies for cochlear implants. In contrast to existing laboratory systems the entire signal processing from the input signal to the creation of the data word for the implant is effected with the aid of a personal computer (PC). This permits rapid implementation of new stimulation strategies or psycho-acoustic tests. Real-time audio processing is also possible by using the CILab as a cochlear implant speech processor. The laboratory system has been employed with success for the evaluation of new strategies and numerous psycho-acoustic tests.
Aldhafeeri, Ahmad M.; Alsanosi, Abdulrahman A.
Objectives: To determine the prevalence of inner ear anomalies and the frequency of different anomaly types among cochlear implant recipients. Methods: This study included a retrospective chart review of all patients who received cochlear implants between January 2009 and January 2013 in King Abdulaziz University Hospital cochlear implant program in Riyadh, Saudi Arabia. All subjects underwent thin-cut CT of the temporal bone and MRI. The collected data included age, gender, and CT and MRI findings regarding temporal bone anomalies. Patients with any identified congenital inner ear anomalies were included in the study. Results: In total, 316 patients’ cases were reviewed. Inner ear malformations were identified in 24 patients, which represented a prevalence of 7.5%. Among these 24 patients, 8 (33.3%) presented with a large vestibular aqueduct (LVA), 8 (33.3%) semicircular canal (SCC) dysplasia, 7 (29.1%) classical Mondini deformity, and one (4.1%) cochlear hypoplasia. Conclusion: The prevalence of inner ear anomalies among cochlear implant recipients was 7.5%. This result is consistent with findings worldwide. The most common anomalies were LVA and SCC hypoplasia; by contrast, in other regions, the most common anomaly is either the Mondini deformity, or LVA. PMID:27652360
Ebrahimi, Amir-Abbas; Movallali, Guita; Jamshidi, Ali-Ashraf; Haghgoo, Hojjat Allah; Rahgozar, Mehdi
The aim of this study was to compare the static and dynamic balance performance of deaf children with and without cochlear implants. This is a cross-sectional study of 145 school children, aged between 7 and 12 years comprising 85 children with congenital or early acquired bilateral profound sensorineural hearing loss (the hearing loss group) and 60 normal hearing aged-matched control counterparts were assessed using the balance subtest of Bruininks-Oseretsky test of Motor Proficiency (BOTMP). The hearing loss group, 50 without cochlear implants (the non-implant group) and 35 of them with unilateral cochlear implants (the implant group) were recruited from schools for the deaf and normal hearing children (the control group) randomly selected from two randomly selected elementary schools of Tehran city. The scores were analyzed using one-way ANOVA. The total score of deaf children especially the implant group were significantly lower than the control group )P<0.001). The balance performance of the control group was better than the implant group in all of the items as well as the non-implant group except the fourth tested item (walking forward on a line) (P<0.05). The balance score of the implant group was significantly lower than the non-implant group except for the third tested item (standing on the preferred leg on a balance beam with eyes closed). The findings suggested that deaf children, specifically those with cochlear implants are at risk for motor and balance deficits. Thus, vestibular and motor evaluations, as well as interventions to improve balance and motor skills, should be prioritized for this population.
Carlson, Matthew L.; Driscoll, Colin L. W.; Gifford, René H.; Service, Geoffrey J.; Tombers, Nicole M.; Hughes-Borst, Becky J.; Neff, Brian A.; Beatty, Charles W.
Objective To describe the relationship between implantation-associated trauma and postoperative speech perception scores among adult and pediatric patients undergoing cochlear implantation using conventional length electrodes and minimally traumatic surgical techniques. Study Design Retrospective chart review (2002–2010). Setting Tertiary academic referral center. Patients All subjects with significant preoperative low-frequency hearing (≤70 dB HL at 250 Hz) who underwent cochlear implantation with a newer generation implant electrode (Nucleus Contour Advance, Advanced Bionics HR90K [1J and Helix], and Med El Sonata standard H array) were reviewed. Intervention(s) Preimplant and postimplant audiometric thresholds and speech recognition scores were recorded using the electronic medical record. Main Outcome Measure(s) Postimplantation pure tone threshold shifts were used as a surrogate measure for extent of intracochlear injury and correlated with postoperative speech perception scores. Results Between 2002 and 2010, 703 cochlear implant (CI) operations were performed. Data from 126 implants were included in the analysis. The mean preoperative low-frequency pure-tone average was 55.4 dB HL. Hearing preservation was observed in 55% of patients. Patients with hearing preservation were found to have significantly higher postoperative speech perception performance in the cochlear implantation-only condition than those who lost all residual hearing. Conclusion Conservation of acoustic hearing after conventional length cochlear implantation is unpredictable but remains a realistic goal. The combination of improved technology and refined surgical technique may allow for conservation of some residual hearing in more than 50% of patients. Germane to the conventional length CI recipient with substantial hearing loss, minimizing trauma allows for improved speech perception in the electric condition. These findings support the use of minimally traumatic techniques in all CI
Caldwell, Amanda; Nittrouer, Susan
Purpose Common wisdom suggests that listening in noise poses disproportionately greater difficulty for listeners with cochlear implants (CIs) than for peers with normal hearing (NH). The purpose of this study was to examine phonological, language, and cognitive skills that might help explain speech-in-noise abilities for children with CIs. Method Three groups of kindergartners (NH, hearing aid wearers, and CI users) were tested on speech recognition in quiet and noise and on tasks thought to underlie the abilities that fit into the domains of phonological awareness, general language, and cognitive skills. These last measures were used as predictor variables in regression analyses with speech-in-noise scores as dependent variables. Results Compared to children with NH, children with CIs did not perform as well on speech recognition in noise or on most other measures, including recognition in quiet. Two surprising results were that (a) noise effects were consistent across groups and (b) scores on other measures did not explain any group differences in speech recognition. Conclusions Limitations of implant processing take their primary toll on recognition in quiet and account for poor speech recognition and language/phonological deficits in children with CIs. Implications are that teachers/clinicians need to teach language/phonology directly and maximize signal-to-noise levels in the classroom. PMID:22744138
Briggs, Robert J S
It has been over 50 years since Djourno and Eyries first attempted electric stimulation in a patient with deafness. Over this time, the Cochlear Implant (CI) has become not only remarkably successful, but increasingly complex. Although the basic components of the system still comprise an implanted receiver stimulator and electrode, externally worn speech processor, microphone, control system, and power source, there are now several alternative designs of these components with different attributes that can be variably combined to meet the needs of specific patient groups. Development by the manufacturers has been driven both by these various patient needs, and also by the desire to achieve technological superiority, or at least differentiation, ultimately in pursuit of market share. Assessment of benefit is the responsibility of clinicians. It is incumbent on both industry and clinicians to ensure appropriate, safe, and affordable introduction of new technology. For example, experience with the totally implanted cochlear implant (TIKI) has demonstrated that quality of hearing is the over-riding consideration for CI users. To date, improved hearing outcomes have been achieved by improvements in: speech processing strategies; microphone technology; pre-processing strategies; electrode placement; bilateral implantation; use of a hearing aid in the opposite ear (bimodal stimulation); and the combination of electric and acoustic stimulation in the same ear. The resulting expansion of CI candidacy, with more residual hearing, further improves the outcomes achieved. Largely facilitated by advances in electronic capability and computerization, it can be expected that these improvements will continue. However, marked variability of results still occurs and we cannot assure any individual patient of their outcome. Realistic goals for implementation of new technology include: improved hearing in noise and music perception; effective invisible hearing (no external apparatus
Shim, Hyun Joon; Won, Jong Ho; Moon, Il Joon; Anderson, Elizabeth S.; Drennan, Ward R.; McIntosh, Nancy E.; Weaver, Edward M.; Rubinstein, Jay T.
Objective To determine if unaided, non-linguistic psychoacoustic measures can be effective in evaluating cochlear implant (CI) candidacy. Study Design Prospective split-cohort study including predictor development subgroup and independent predictor validation subgroup. Setting Tertiary referral center. Subjects Fifteen subjects (28 ears) with hearing loss were recruited from patients visiting the University of Washington Medical Center for CI evaluation. Methods Spectral-ripple discrimination (using a 13-dB modulation depth) and temporal modulation detection using 10- and 100-Hz modulation frequencies were assessed with stimuli presented through insert earphones. Correlations between performance for psychoacoustic tasks and speech perception tasks were assessed. Receiver operating characteristic (ROC) curve analysis was performed to estimate the optimal psychoacoustic score for CI candidacy evaluation in the development subgroup and then tested in an independent sample. Results Strong correlations were observed between spectral-ripple thresholds and both aided sentence recognition and unaided word recognition. Weaker relationships were found between temporal modulation detection and speech tests. ROC curve analysis demonstrated that the unaided spectral ripple discrimination shows a good sensitivity, specificity, positive predictive value, and negative predictive value compared to the current gold standard, aided sentence recognition. Conclusions Results demonstrated that the unaided spectral-ripple discrimination test could be a promising tool for evaluating CI candidacy. PMID:24901669
Connor, Carol McDonald
The purpose of this longitudinal case study was to closely examine one deaf child's experience with a cochlear implant and his speech, language, and communication skills from kindergarten through middle and high school using both developmental and sociocultural frameworks. The target child was one of the first children to receive a cochlear implant in the United States in 1988, when he was 5 years of age. The developmental analysis revealed that prior to receiving a cochlear implant the child demonstrated profound delays in speech and language skill development. His speech and language skills grew slowly during the first 3-4 years following implantation, very rapidly from about 5 through 7 years postimplantation, then slowed to rates that were highly similar to same-age peers with normal hearing. The sociocultural analysis revealed that the child's communicative competence improved; that he used sign language but use of sign language decreased as his oral communication skills improved; that as his oral communication skills improved, the adults talked and directed the topic of conversation less frequently; and that topics became less concrete and more personal over time. The results of this study indicate that we may learn more about how to support children who use cochlear implants by examining what they are saying as well as how they are saying it.
Brookes, James T; Kanis, Adam B; Tan, Lih Yeen; Tranebjaerg, Lisbeth; Vore, Abram; Smith, Richard J H
To report the results of the first known cochlear implantation in a patient with deafness-dystonia-optic neuronopathy (DDON) syndrome (Mohr-Tranebaerg syndrome, DFN-1). DDON syndrome is an X-linked condition characterized by postlingual sensorineural hearing loss in early childhood followed by dystonia, psychosis, and optic atrophy in adolescence and adulthood. The gene responsible for the condition maps to Xq22 adjacent to the gene causally related to X-linked agammaglobulinemia. The audiometric characteristics of DDON syndrome are typical of auditory neuropathy, with spiral ganglion cells being the suspected site of pathology. Performance following cochlear implantation in auditory neuropathy patients is variable and has yet to be reported in any patients with DDON syndrome. The reported case describes a male initially diagnosed with X-linked agammaglobulinemia due to recurrent infections. Speech, language and hearing were typical of a child in the first year of life; however profound hearing loss developed and cochlear implantation was performed at age 4. Following implantation, further genetic workup determined that the patient carries a deletion that includes BTK and DDP1/TIMM8a, consistent with the diagnosis of X-linked agammaglobulinemia and DDON syndrome. The patient's performance with the cochlear implant was marginal even after 2 years of use, with continued poor scores in standardized speech, language and audiometric tests. Additionally, his most-comfortable-level implant setting requires higher-than-normal current applied to the electrode array. This case report supports other studies showing that DDON syndrome results in an auditory neuropathy. Further investigation is required to determine the efficacy of cochlear implantation in this patient population. DDON syndrome should be considered in patients with X-linked agammaglobulinemia and hearing loss.
Chung, King; Nelson, Lance; Teske, Melissa
The purpose of this study was to investigate whether a multichannel adaptive directional microphone and a modulation-based noise reduction algorithm could enhance cochlear implant performance in reverberant noise fields. A hearing aid was modified to output electrical signals (ePreprocessor) and a cochlear implant speech processor was modified to receive electrical signals (eProcessor). The ePreprocessor was programmed to flat frequency response and linear amplification. Cochlear implant listeners wore the ePreprocessor-eProcessor system in three reverberant noise fields: 1) one noise source with variable locations; 2) three noise sources with variable locations; and 3) eight evenly spaced noise sources from 0° to 360°. Listeners' speech recognition scores were tested when the ePreprocessor was programmed to omnidirectional microphone (OMNI), omnidirectional microphone plus noise reduction algorithm (OMNI + NR), and adaptive directional microphone plus noise reduction algorithm (ADM + NR). They were also tested with their own cochlear implant speech processor (CI_OMNI) in the three noise fields. Additionally, listeners rated overall sound quality preferences on recordings made in the noise fields. Results indicated that ADM+NR produced the highest speech recognition scores and the most preferable rating in all noise fields. Factors requiring attention in the hearing aid-cochlear implant integration process are discussed.
McKinnon, Brian J; Watts, Tamara
We conducted a retrospective case review at a tertiary academic medical center for the complications of pneumolabyrinth with pneumocephalus and subcutaneous emphysema after surgery for middle ear and cochlear implants. Charts of 76 cochlear implant and 2 middle ear implant patients from January 2001 through June 2009 were reviewed. We identified 1 cochlear implant recipient with pneumolabyrinth and pneumocephalus, and 1 middle ear implant recipient with subcutaneous emphysema. Surgical exploration was performed for the pneumolabyrinth with pneumocephalus; the subcutaneous emphysema was managed conservatively. The patient with the cochlear implant, who had had a ventriculoperitoneal shunt placed, experienced pneumolabyrinth with pneumocephalus 6 years after uneventful surgery. Middle ear exploration revealed no residual fibrous tissue seal at the cochleostomy. The middle ear and cochleostomy were obliterated with muscle, fat, and fibrin glue. The ventriculoperitoneal shunt was deactivated, with clinical and radiographic resolution. On postoperative day 5, the patient who had undergone the middle ear implant reported crepitance over the mastoid and implant device site after repeated Valsalva maneuvers. Computed tomography showed air surrounding the internal processor. A mastoid pressure dressing was applied and the subcutaneous emphysema resolved. These 2 cases support the importance of recognizing the clinical presentation of pneumolabyrinth with associated pneumocephalus, as well as subcutaneous emphysema. Securing the internal processor, adequately sealing the cochleostomy, and providing preoperative counseling regarding Valsalva maneuvers and the potential risk of cochlear implantation in the presence of a ventriculoperitoneal shunt may prevent adverse sequelae.
Boisvert, Isabelle; McMahon, Catherine M; Dowell, Richard C; Lyxell, Björn
In many countries, a single cochlear implant is offered as a treatment for a bilateral hearing loss. In cases where there is asymmetry in the amount of sound deprivation between the ears, there is a dilemma in choosing which ear should be implanted. In many clinics, the choice of ear has been guided by an assumption that the reorganisation of the auditory pathways caused by longer duration of deafness in one ear is associated with poorer implantation outcomes for that ear. This assumption, however, is mainly derived from studies of early childhood deafness. This study compared outcomes following implantation of the better or poorer ear in cases of long-term hearing asymmetries. Audiological records of 146 adults with bilateral hearing loss using a single hearing aid were reviewed. The unaided ear had 15 to 72 years of unaided severe to profound hearing loss before unilateral cochlear implantation. 98 received the implant in their long-term sound-deprived ear. A multiple regression analysis was conducted to assess the relative contribution of potential predictors to speech recognition performance after implantation. Duration of bilateral significant hearing loss and the presence of a prelingual hearing loss explained the majority of variance in speech recognition performance following cochlear implantation. For participants with postlingual hearing loss, similar outcomes were obtained by implanting either ear. With prelingual hearing loss, poorer outcomes were obtained when implanting the long-term sound-deprived ear, but the duration of the sound deprivation in the implanted ear did not reliably predict outcomes. Contrary to an apparent clinical consensus, duration of sound deprivation in one ear has limited value in predicting speech recognition outcomes of cochlear implantation in that ear. Outcomes of cochlear implantation are more closely related to the period of time for which the brain is deprived of auditory stimulation from both ears.
Smiljanic, Rajka; Sladen, Douglas
Purpose: In this study, the authors examined how signal clarity interacts with the use of sentence context information in determining speech-in-noise recognition for children with cochlear implants and children with normal hearing. Method: One hundred and twenty sentences in which the final word varied in predictability (high vs. low semantic…
Ibertsson, Tina; Hansson, Kristina; Maki-Torkko, Elina; Willstedt-Svensson, Ursula; Sahlen, Birgitta
Background: This study investigates the use of requests for clarification in conversations between teenagers with a cochlear implant (CI) and hearing peers. So far very few studies have focused on conversational abilities in children with CI. Aims: The aim was to explore co-construction of dialogue in a referential communication task and the…
Caldwell, Amanda; Nittrouer, Susan
Purpose: Common wisdom suggests that listening in noise poses disproportionately greater difficulty for listeners with cochlear implants (CIs) than for peers with normal hearing (NH). The purpose of this study was to examine phonological, language, and cognitive skills that might help explain speech-in-noise abilities for children with CIs.…
Moreno-Torres, Ignacio; Madrid-Canovas, Sonia; Blanco-Montanez, Gema
This study explores the hypothesis that the existence of a short sensitive period for lower-level speech perception/articulation skills, and a long one for higher-level language skills, may partly explain the language outcomes of children with cochlear implants (CIs). The participants were fourteen children fitted with a CI before their second…
Wechsler-Kashi, Deena; Schwartz, Richard G.; Cleary, Miranda
Purpose: In the present study, the authors examined lexical naming in children with cochlear implants (CIs). The goal was to determine whether children with CIs have deficits in lexical access and organization as revealed through reaction time in picture-naming and verbal fluency (VF) experiments. Method: Children with CIs (n = 20, ages 7-10) were…
Walker, Elizabeth A.; McGregor, Karla K.
Purpose: To determine whether 3 aspects of the word learning process--fast mapping, retention, and extension--are problematic for children with cochlear implants (CIs). Method: The authors compared responses of 24 children with CIs, 24 age-matched hearing children, and 23 vocabulary-matched hearing children to a novel object noun training episode.…
Conway, Christopher M.; Pisoni, David B.; Anaya, Esperanza M.; Karpicke, Jennifer; Henning, Shirley C.
Deaf children with cochlear implants (CIs) represent an intriguing opportunity to study neurocognitive plasticity and reorganization when sound is introduced following a period of auditory deprivation early in development. Although it is common to consider deafness as affecting hearing alone, it may be the case that auditory deprivation leads to…
Khwaileh, Fadwa A.; Flipsen, Peter, Jr.
This study examined the intelligibility of speech produced by 17 children (aged 4-11 years) with cochlear implants. Stimulus items included sentences from the Beginners' Intelligibility Test (BIT) and words from the Children Speech Intelligibility Measure (CSIM). Naive listeners responded by writing sentences heard or with two types of responses…
Cochlear implant specialists daily observe patients and families grapple with a wide range of emotions. As nonprofessional counsellors, we can help patients address those emotions by providing more opportunities to talk about their thoughts and feelings. This paper will review some familiar counselling challenges, such as the disappointment that…
Spencer, Linda J.; Tomblin, J. Bruce; Gantz, Bruce J.
The long-term educational/vocational, affiliation, and quality-of-life outcomes of the first and second cohorts of children with bilateral, profound hearing loss who received cochlear implants under a large National Institutes of Health-funded study was investigated in 41 of 61 eligible participants. Educational and vocational outcomes were…
Vermeulen, Anneke M.; van Bon, Wim; Schreuder, Rob; Knoors, Harry; Snik, Ad
The reading comprehension and visual word recognition in 50 deaf children and adolescents with at least 3 years of cochlear implant (CI) use were evaluated. Their skills were contrasted with reference data of 500 deaf children without CIs. The reading comprehension level in children with CIs was expected to surpass that in deaf children without…
Jachova, Zora; Kovacevic, Jasmina
This article presents a case study of a child aged 12 years with a cochlear implant who is attending a mainstream educational setting in Skopje, FYR Macedonia. The study, which uses both qualitative and quantitative data, took place over a period of 12 months. It illustrates the importance of professional development and training of teachers and a…
Stith, Joanna; Stredler-Brown, Arlene; Greenway, Pat; Kahn, Gary
What might bring the efforts of a physician, a speech-language pathologist, a teacher of the deaf and hard of hearing, and a nurse together? The answer is the innovative use of telepractice to deliver high quality, family-centered early intervention to infants and toddlers with hearing loss. TeleCITE: Telehealth--A Cochlear Implant Therapy…
Robbins, Amy McConkey
This article presents a framework for modifying traditional auditory therapy techniques to address the needs of hearing-impaired children with cochlear implants. Emphasis is on activities that encourage carry-over of skills from structured to unstructured settings resembling listening in a natural environment. (DB)
Grieco-Calub, Tina M.; Saffran, Jenny R.; Litovsky, Ruth Y.
Purpose: The purpose of this study was to assess the time course of spoken word recognition in 2-year-old children who use cochlear implants (CIs) in quiet and in the presence of speech competitors. Method: Children who use CIs and age-matched peers with normal acoustic hearing listened to familiar auditory labels, in quiet or in the presence of…
Rinaldi, Pasquale; Baruffaldi, Francesca; Burdo, Sandro; Caselli, Maria Cristina
Background: An increasing number of deaf children received cochlear implants (CI) in the first years of life, but no study has focused on linguistic and pragmatic skills in children with CI younger than 3 years of age. Aims: To estimate the percentage of children who had received a CI before 2 years of age whose linguistic skills were within the…
Almeida-Verdu, Ana Claudia; Huziwara, Edson M.; de Souza, Deisy G.; de Rose, Julio C.; Bevilacqua, Maria Cecilia; Lopes, Jair, Jr.; Alves, Cristiane O.; McIlvane, William J.
This four-experiment series sought to evaluate the potential of children with neurosensory deafness and cochlear implants to exhibit auditory-visual and visual-visual stimulus equivalence relations within a matching-to-sample format. Twelve children who became deaf prior to acquiring language (prelingual) and four who became deaf afterwards…
Hayes, Heather; Kessler, Brett; Treiman, Rebecca
The spellings of 39 profoundly deaf users of cochlear implants, aged 6 to 12 years, were compared with those of 39 hearing peers. When controlled for age and reading ability, the error rates of the 2 groups were not significantly different. Both groups evinced phonological spelling strategies, performing better on words with more typical…
Connor, Carol McDonald
The purpose of this longitudinal case study was to closely examine one deaf child's experience with a cochlear implant and his speech, language, and communication skills from kindergarten through middle and high school using both developmental and sociocultural frameworks. The target child was one of the first children to receive a cochlear…
The cochlear implant has restored partial hearing to more than 100
Kwon, Bomjun J.; Perry, Trevor T.
Purpose: The present study examined cochlear implant (CI) users' perception of vowels presented concurrently (i.e., "double vowels") to further our understanding of auditory grouping in electric hearing. Method: Identification of double vowels and single vowels was measured with 10 CI subjects. Fundamental frequencies (F0s) of…
Schraer-Joiner, Lyn; Prause-Weber, Manuela
According to the National Institute on Deafness and Other Communication Disorders, 23,000 individuals in the United States, including 10,000 children, have a cochlear implant. This biomedical electronic device has been a breakthrough in the auditory rehabilitation of individuals diagnosed with severe or profound sensorineural hearing losses who…
Plyler, Patrick N.; Bahng, Junghwa; von Hapsburg, Deborah
Purpose: The purpose of this study was to determine (a) if acceptable noise levels (ANLs) are different in cochlear implant (CI) users than in listeners with normal hearing, (b) if ANLs are related to sentence reception thresholds in noise in CI users, and (c) if ANLs and subjective outcome measures are related in CI users. Method: ANLs and the…
Remmel, Ethan; Peters, Kimberly
Thirty children with cochlear implants (CI children), age range 3-12 years, and 30 children with normal hearing (NH children), age range 4-6 years, were tested on theory of mind and language measures. The CI children showed little to no delay on either theory of mind, relative to the NH children, or spoken language, relative to hearing norms. The…
Bouchard, Marie-Eve Gaul; Le Normand, Marie-Therese; Cohen, Henri
Consonant production following the sensory restoration of audition was investigated in 22 prelinguistically deaf French children who received cochlear implants. Spontaneous speech productions were recorded at 6, 12, and 18 months post-surgery and consonant inventories were derived from both glossable and non-glossable phones using two acquisition…
Chang, Yi-ping; Fu, Qian-Jie
Purpose: To investigate the effects of talker variability on vowel recognition by cochlear implant (CI) users and by normal-hearing (NH) participants listening to 4-channel acoustic CI simulations. Method: CI users were tested with their clinically assigned speech processors. For NH participants, 3 CI processors were simulated, using different…
Archbold, Sue; Sach, Tracey; O'Neill, Ciaran; Lutman, Mark; Gregory, Susan
While cochlear implantation is an increasingly routine provision for profoundly deaf children in many countries, parents still require information about the procedure and likely outcomes in order to make an informed decision. Other parents can provide them with the insights of those who have undergone the process themselves and observed outcomes…
Castellanos, Irina; Kronenberger, William G.; Beer, Jessica; Colson, Bethany G.; Henning, Shirley C.; Ditmars, Allison; Pisoni, David B.
This study investigated if a period of auditory sensory deprivation followed by degraded auditory input and related language delays affects visual concept formation skills in long-term prelingually deaf cochlear implant (CI) users. We also examined if concept formation skills are mediated or moderated by other neurocognitive domains (i.e.,…
This article examined a database of Australian daily newspapers on the terms cochlear implant and deaf children to investigate how journalists and columnists report competing models of deafness: as either "medical" (deafness is a condition to be cured) or "sociocultural" (deafness provides a way of life to be lived). The…
Chikar, Jennifer A.; Batts, Shelley A.; Pfingst, Bryan E.; Raphael, Yehoash
Current cochlear histology methods do not allow in situ processing of cochlear implants. The metal components of the implant preclude standard embedding and mid-modiolar sectioning, and whole mounts do not have the spatial resolution needed to view the implant within the scala tympani. One focus of recent auditory research is the regeneration of structures within the cochlea, particularly the ganglion cells and their processes, and there are multiple potential benefits to cochlear implant users from this work. To facilitate experimental investigations of auditory nerve regeneration performed in conjunction with cochlear implantation, it is critical to visualize the cochlear tissue and the implant together to determine if the nerve has made contact with the implant. This paper presents a novel histological technique that enables simultaneous visualization of the in situ cochlear implant and neurofilament – labeled nerve processes within the scala tympani, and the spatial relationship between them. PMID:19428528
Flipsen, Peter, Jr.
This study examines use of the Goldman-Fristoe Test of Articulation-Second Edition (GFTA-2) with children who use cochlear implants to evaluate whether or not it would be appropriate to use this test with this population. Participants included 15 children with cochlear implants who ranged in age of implantation and amount of implant experience.…
Marschark, Marc; Rhoten, Cathy; Fabich, Megan
This article presents a critical analysis of empirical studies assessing literacy and other domains of academic achievement among children with cochlear implants. A variety of recent studies have demonstrated benefits to hearing, language, and speech from implants, leading to assumptions that early implantation and longer periods of implant should be associated with higher reading and academic achievement. This review, however, reveals that although there are clear benefits of cochlear implantation to achievement in young deaf children, empirical results have been somewhat variable. Examination of the literature with regard to reading achievement suggests that the lack of consistent findings might be the result of frequent failures to control potentially confounding variables such as age of implantation, language skills prior to implantation, reading ability prior to implantation, and consistency of implant use. Studies of academic achievement beyond reading are relatively rare, and the extent to which performance in such domains is mediated by reading abilities or directly influenced by hearing, language, and speech remains unclear. Considerations of methodological shortcomings in existing research as well as theoretical and practical questions yet to be addressed provide direction for future research.
Orzan, E; Muzzi, E; Marchi, R; Falzone, C; Battelino, S; Ciciriello, E
Cochlear implantation (CI) is a viable option for providing access to auditory stimulation in severe-to-profound hearing loss/impairment of cochlear origin. It has been demonstrated that CI is safe and effective for deaf children. Younger age at activation after CI is linked with better outcomes. It is important to study variables and issues that can interfere with an early fitting and access to sound after CI. They range from patient characteristics, family compliance and support, to technical, medical or organisational problems. A SWOT analysis and a subsequent TOWS matrix was conducted to discuss issues and propose recommendations to be considered when operating an early switch on of the CI.
Galvin, John J.; Fu, Qian-Jie
Combined use of a hearing aid (HA) and cochlear implant (CI) has been shown to improve CI users’ speech and music performance. However, different hearing devices, test stimuli, and listening tasks may interact and obscure bimodal benefits. In this study, speech and music perception were measured in bimodal listeners for CI-only, HA-only, and CI + HA conditions, using the Sung Speech Corpus, a database of monosyllabic words produced at different fundamental frequencies. Sentence recognition was measured using sung speech in which pitch was held constant or varied across words, as well as for spoken speech. Melodic contour identification (MCI) was measured using sung speech in which the words were held constant or varied across notes. Results showed that sentence recognition was poorer with sung speech relative to spoken, with little difference between sung speech with a constant or variable pitch; mean performance was better with CI-only relative to HA-only, and best with CI + HA. MCI performance was better with constant words versus variable words; mean performance was better with HA-only than with CI-only and was best with CI + HA. Relative to CI-only, a strong bimodal benefit was observed for speech and music perception. Relative to the better ear, bimodal benefits remained strong for sentence recognition but were marginal for MCI. While variations in pitch and timbre may negatively affect CI users’ speech and music perception, bimodal listening may partially compensate for these deficits. PMID:27837051
Crew, Joseph D; Galvin, John J; Fu, Qian-Jie
Combined use of a hearing aid (HA) and cochlear implant (CI) has been shown to improve CI users' speech and music performance. However, different hearing devices, test stimuli, and listening tasks may interact and obscure bimodal benefits. In this study, speech and music perception were measured in bimodal listeners for CI-only, HA-only, and CI + HA conditions, using the Sung Speech Corpus, a database of monosyllabic words produced at different fundamental frequencies. Sentence recognition was measured using sung speech in which pitch was held constant or varied across words, as well as for spoken speech. Melodic contour identification (MCI) was measured using sung speech in which the words were held constant or varied across notes. Results showed that sentence recognition was poorer with sung speech relative to spoken, with little difference between sung speech with a constant or variable pitch; mean performance was better with CI-only relative to HA-only, and best with CI + HA. MCI performance was better with constant words versus variable words; mean performance was better with HA-only than with CI-only and was best with CI + HA. Relative to CI-only, a strong bimodal benefit was observed for speech and music perception. Relative to the better ear, bimodal benefits remained strong for sentence recognition but were marginal for MCI. While variations in pitch and timbre may negatively affect CI users' speech and music perception, bimodal listening may partially compensate for these deficits.
Zhou, Ning; Pfingst, Bryan E
Comparisons of performance with cochlear implants and postmortem conditions in the cochlea in humans have shown mixed results. The limitations in those studies favor the use of within-subject designs and non-invasive measures to estimate cochlear conditions. One non-invasive correlate of cochlear health is multipulse integration, established in an animal model. The present study used this measure to relate neural health in human cochlear implant users to their speech recognition performance. The multipulse-integration slopes were derived based on psychophysical detection thresholds measured for two pulse rates (80 and 640 pulses per second). A within-subject design was used in eight subjects with bilateral implants where the direction and magnitude of ear differences in the multipulse-integration slopes were compared with those of the speech-recognition results. The speech measures included speech reception threshold for sentences and phoneme recognition in noise. The magnitude of ear difference in the integration slopes was significantly correlated with the magnitude of ear difference in speech reception thresholds, consonant recognition in noise, and transmission of place of articulation of consonants. These results suggest that multipulse integration predicts speech recognition in noise and perception of features that use dynamic spectral cues.
Cohen, N L; Waltzman, S B; Shapiro, W H
The reported telephone usage by cochlear implant recipients has become a major issue of controversy. Although patients and clinicians report good communication skills via the telephone, no standardized tests have been used and no quantifiable results have been reported. In an effort to determine the extent to which our better-performing patients can use the telephone, we established a clinical protocol to assess their ability to recognize speech, taking into consideration the problems inherent in telephone testing. Eight cochlear implant recipients were administered the NU-6 Monosyllabic Word Test and the City University of New York Topic Related Sentences under the following listening conditions: soundfield in a soundproof suite and via telephone within the hospital, locally, and long-distance. Twenty-three percent of the patients implanted at New York University Medical Center demonstrated a significant degree of telephone communication ability.
van Nierop, Josephine W.I.; Snabel, Rebecca R.; Langereis, Margreet; Pennings, Ronald J.E.; Admiraal, Ronald J.C.; Mylanus, Emmanuel A.M.; Kunst, Henricus P.M.
Objective To analyse the benefit of cochlear implantation in young deaf children with Waardenburg syndrome (WS) compared to a reference group of young deaf children without additional disabilities. Method A retrospective study was conducted on children with WS who underwent cochlear implantation at the age of 2 years or younger. The post-operative results for speech perception (phonetically balanced standard Dutch consonant-vocal-consonant word lists) and language comprehension (the Reynell Developmental Language Scales, RDLS), expressed as a language quotient (LQ), were compared between the WS group and the reference group by using multiple linear regression analysis. Results A total of 14 children were diagnosed with WS, and 6 of them had additional disabilities. The WS children were implanted at a mean age of 1.6 years and the 48 children of the reference group at a mean age of 1.3 years. The WS children had a mean phoneme score of 80% and a mean LQ of 0.74 at 3 years post-implantation, and these results were comparable to those of the reference group. Only the factor additional disabilities had a significant negative influence on auditory perception and language comprehension. Conclusions Children with WS performed similarly to the reference group in the present study, and these outcomes are in line with the previous literature. Although good counselling about additional disabilities concomitant to the syndrome is relevant, cochlear implantation is a good rehabilitation method for children with WS. PMID:27245679
Mârţu, D; Rădulescu, Luminiţa; Cozma, S; Curcă, A I
This paper presents our Cochlear Implant Departments results from the beginning until present time. Our implant list contains 161 candidates. The enlisted was made based on the criteria's for implant candidates' selection and we have implanted already 17 of them (11 children and 6 adults). Surgical interventions were done according to standard procedure - the approach being through mastoidectomy and posterior tympanotomy. We discuss the results obtained with cochlear implantation in each case. The outline idea is that the cochlear implant was a good choice in all our implanted cases and the patients had achieved at least the performances predicted before implantation for every particular situation.
Svirsky, Mario A; Fitzgerald, Matthew B; Neuman, Arlene; Sagi, Elad; Tan, Chin-Tuan; Ketten, Darlene; Martin, Brett
The Laboratory of Translational Auditory Research (LTAR/NYUSM) is part of the Department of Otolaryngology at the New York University School of Medicine and has close ties to the New York University Cochlear Implant Center. LTAR investigators have expertise in multiple related disciplines including speech and hearing science, audiology, engineering, and physiology. The lines of research in the laboratory deal mostly with speech perception by hearing impaired listeners, and particularly those who use cochlear implants (CIs) or hearing aids (HAs). Although the laboratory's research interests are diverse, there are common threads that permeate and tie all of its work. In particular, a strong interest in translational research underlies even the most basic studies carried out in the laboratory. Another important element is the development of engineering and computational tools, which range from mathematical models of speech perception to software and hardware that bypass clinical speech processors and stimulate cochlear implants directly, to novel ways of analyzing clinical outcomes data. If the appropriate tool to conduct an important experiment does not exist, we may work to develop it, either in house or in collaboration with academic or industrial partners. Another notable characteristic of the laboratory is its interdisciplinary nature where, for example, an audiologist and an engineer might work closely to develop an approach that would not have been feasible if each had worked singly on the project. Similarly, investigators with expertise in hearing aids and cochlear implants might join forces to study how human listeners integrate information provided by a CI and a HA. The following pages provide a flavor of the diversity and the commonalities of our research interests.
Amirsalari, Susan; Ajallouyean, Mohammad; Saburi, Amin; Haddadi Fard, Adel; Abed, Maryam; Ghazavi, Yasaman
Waardenburg syndrome (WS) is an autosomal dominant disease, characterized by dystopia canthorum, hyperplasia of the eyebrows, heterochromia iridis, white forelock, and congenital sensori-neural hearing loss (SNHL). The aim of this study was to evaluate the outcome of cochlear implantation in children with WS and compare it with children with pure SNHL. In a prospective study we evaluated 336 cochlear implanted children from 2008 to 2010. The WS was diagnosed by its established criteria and for control group children without any dysmorphic features, anatomical, behavioral, and developmental disorders were also enrolled. We evaluated children of both groups 1 year after cochlear implantation by categories of auditory performance (CAP) and speech intelligibility rating (SIR) tests. Eighty-one children out of the total 336 who had SNHL were included in study. Out of these 75 (22.3%) were healthy and six (1.78%) had WS. Of the 75 healthy children 40 (53.3%) were girls, while of the six children with WS, three (50%) were girls. There was a significant difference in SIR between WS and cases with pure SNHL (2.67 ± 1.03 vs. 3.79 ± 1.11, p = 021) however, the difference was not significant in CAP (4 ± 1.26 vs. 5.13 ± 1.13, p = 0.082). Prevalence of WS was 1.78% at Baqiyatallah Cochlear Implant Center. One year after implantation there was no significant difference in auditory outcome; however, the difference in speech outcome was significant between WS and cases with pure SNHL.
Seo, Young Joon; Kim, Hyun Ji
Objectives: Tinnitus is a very common symptom in patients with hearing loss. Several studies have confirmed that hearing restoration using hearing aids or cochlear implants (CIs) has a suppressive effect on tinnitus in users. The aim of this study was to analyze the effect of other hearing restoration devices, specifically the middle ear implant (MEI), on changes in tinnitus severity. Design: From 2012 to October 2014, 11 adults with tinnitus and hearing loss underwent MEI surgery. Pure-tone audiometry, tinnitus handicap inventory (THI), and visual analog scale scores for loudness, awareness, and annoyance and psychosocial instruments were measured before, immediately after, and 6 months after surgery. Changes in hearing thresholds and THI scores were analyzed and compared with those of 16 CI recipients. Results: In both MEI and CI groups, significant improvements in tinnitus were found after the surgery. The THI scores improved in 91% of patients in the MEI group and in 56% of those in the CI group. Visual analog scale scores and psychosocial scale scores also decreased after surgery, but there were no statistical differences between the groups. Conclusions: The results indicate that the MEI may be as beneficial as the CI in relieving tinnitus in subjects with unilateral tinnitus accompanying hearing loss. Furthermore, this improvement may manifest as hearing restoration or habituation rather than a direct electrical nerve stimulation, which was previously considered as the main mechanism underlying tinnitus suppression by auditory implants. PMID:26107004
Young, N M; Grohne, K M; Carrasco, V N; Brown, C
This study compares the auditory perceptual skill development of 23 congenitally deaf children who received the Nucleus 22-channel cochlear implant with the SPEAK speech coding strategy, and 20 children who received the CLARION Multi-Strategy Cochlear Implant with the Continuous Interleaved Sampler (CIS) speech coding strategy. All were under 5 years old at implantation. Preimplantation, there were no significant differences between the groups in age, length of hearing aid use, or communication mode. Auditory skills were assessed at 6 months and 12 months after implantation. Postimplantation, the mean scores on all speech perception tests were higher for the Clarion group. These differences were statistically significant for the pattern perception and monosyllable subtests of the Early Speech Perception battery at 6 months, and for the Glendonald Auditory Screening Procedure at 12 months. Multiple regression analysis revealed that device type accounted for the greatest variance in performance after 12 months of implant use. We conclude that children using the CIS strategy implemented in the Clarion implant may develop better auditory perceptual skills during the first year postimplantation than children using the SPEAK strategy with the Nucleus device.
Barnes, Judith M., Ed.; And Others
This collection of 10 papers is intended as a resource book integrating information on pediatric cochlear implants for educators, parents, implant teams, and rehabilitation specialists. The papers focus on the importance of providing an oral educational environment to maximize cochlear implant success. An introduction notes controversies in the…
Buell, Thomas J.; Ksendzovsky, Alexander; Shah, Binit B.; Kesser, Bradley W.; Elias, W. Jeffrey
Background/Aims As technology continues to advance for our aging population, an increasing number of DBS candidates will have preexisting implanted electrical devices. In this article, we discuss safe and successful DBS in a patient with Parkinson's disease (PD) and bilateral cochlear implants. Methods A 70 year-old male with PD and bilateral cochlear implants underwent successful microelectrode-guided DBS implantation into bilateral subthalamic nuclei (STN). The patient's cochlear implant magnets were removed and replaced in outpatient clinic for pre-operative MRI and stereotactic targeting. The cochlear implants were turned off intraoperatively for STN microelectrode recordings. Results Precise, MRI-guided stereotactic DBS implantation was possible. Intraoperative high-fidelity microelectrode recordings confirmed STN neurons with the cochlear implants turned off. These recordings were not possible with active cochlear implant devices. Our literature review describes the other approaches/techniques that have been used to manage DBS surgery in the setting of cochlear implants. Conclusions Despite the risk of electrical interference between implanted medical devices, DBS and cochlear implants may be safe and compatible in the same patient if necessary precautions are taken. PMID:25998722
Melton, Julie; Higbee, Renee
Since the early 1990s, when the U.S. Food and Drug Administration approved cochlear implants for deaf and hard of hearing children, the number of children who have cochlear implants has increased in mainstream settings. Recent research suggests that these students, like their deaf and hard of hearing peers without implants who use sign language,…
1 Implementation of Spectral Maxima Sound processing for cochlear implants by using Bark scale Frequency band partition Han xianhua1 Nie...new method on the basis of Bark scale frequency-band partition was presented to improve the recognition performance of cochlear implants . In the...nature of physics, it consists with human’s cochlea filter properties. Also the mechanism of a cochlear implant and its spectral maxima sound
Barriat, Sebastien; Poirrier, Annelise; Malgrange, Brigitte; Lefebvre, Philippe
Insertion of an electrode array into the cochlea produces immediate damage to the inner ear, which is responsible for a hearing loss. In addition, a delayed hearing loss can be observed. In order to maximize hearing preservation after insertion of an electrode and to enhance the performance of the cochlear implant, it has been proposed to deliver pharmacological agents to the inner ear. Molecules can be administered locally to the inner ear through a direct perilymphatic perfusion or through the round window membrane. These modalities of treatment have already been successfully applied to some patients with inner ear diseases. In this paper, we will review some basic aspects of drug delivery to the inner ear to prevent the degeneration of the neurosensory hair cells and auditory neurons, and the actual applicability to humans in order to maintain hearing function after the insertion of electrodes of a cochlear implant.
Aschendorff, A; Laszig, R; Maier, W; Beck, R; Schild, C; Birkenhäger, R; Wesarg, T; Kröger, S; Arndt, S
The radiologic evaluation of the temporal bone in cochlear implant candidates can detect malformations of the inner ear in up to 20% of cases. The aim of our study was to analyze and classify malformations of the inner ear in patients with cochlear implants carried out from 2001 to 2009. Malformations of the inner ear, including malformations of the internal auditory canal were detected in 12.7% of children and 3.4% of adults. Mondini dysplasia was most common and occurred in 45% of cases. The surgical procedure had to be adapted according to the individual malformation. Modification of surgical access, management of intraoperative CSF gusher, choice of electrode array, intraoperative imaging and the use of navigation were the most important factors. Rehabilitation results were generally very positive and corresponded to the expectation depending on the duration of deafness, if no additional handicaps were present.
Paniagua, Lauren Medeiros; Dorfman, Maria Elza Kazumi Yamaguti; Lavinsky, Luiz; Sleifer, Pricila
Background Harboyan syndrome, defined as congenital corneal dystrophy associated with progressive sensorineural hearing loss, was first described by Harboyan in 1971. It is a hereditary disease manifested by eye lesions consistent with corneal endothelial dystrophy and progressive sensorineural hearing loss. There is bilateral symmetric progressive hearing loss, which may be either dominant or recessive. Objective To report a case of a patient with a diagnosis of Harboyan syndrome. Case Report A 25-year-old woman with profound bilateral sensorineural hearing loss, showing poor hearing performance while using a personal sound amplification device, underwent hearing rehabilitation with a cochlear implant. Conclusion Rehabilitation was imperative in this case. The cochlear implant has proven to be the best therapeutic option, providing the patient with a better quality of life. PMID:25992045
Lee, Dong Soo; Lee, Jae Sung; Oh, Seung Ha; Kim, Seok-Ki; Kim, Jeung-Whoon; Chung, June-Key; Lee, Myung Chul; Kim, Chong Sun
Hearing in profoundly deaf people can be helped by inserting an implant into the inner ear to stimulate the cochlear nerve. This also boosts the low metabolic activity of the auditory cortex, the region of the brain normally used for hearing. Other sensory modalities, such as sign language, can also activate the auditory cortex, a phenomenon known as cross-modal plasticity. Here we show that when metabolism in the auditory cortex of prelingually deaf children (whose hearing was lost before they learned to talk) has been restored by cross-modal plasticity, the auditory cortex can no longer respond to signals from a cochlear implant installed afterwards. Neural substrates in the auditory cortex might therefore be routed permanently to other cognitive processes in prelingually deaf patients.
Human children with cochlear implants represent a unique population of individuals who have undergone variable amounts of auditory deprivation prior to being able to hear. Even more unique are children who received bilateral cochlear implants (BICIs), in sequential surgical procedures, several years apart. Auditory deprivation in these individuals consists of a two-stage process, whereby complete deafness is experienced initially, followed by deafness in one ear. We studied the effects of post-implant experience on the ability of deaf children to localize sounds and to understand speech in noise. These are two of the most important functions that are known to depend on binaural hearing. Children were tested at time intervals ranging from 3-months to 24-months following implantation of the second ear, while listening with either implant alone or bilaterally. Our findings suggest that the period during which plasticity occurs in human binaural system is protracted, extending into middle-to-late childhood. The rate at which benefits from bilateral hearing abilities are attained following deprivation is faster for speech intelligibility in noise compared with sound localization. Finally, the age at which the second implant was received may play an important role in the acquisition of binaural abilities. [Work supported by NIH-NIDCD.
Hassepass, Frederike; Arndt, Susan; Aschendorff, Antje; Laszig, Roland; Wesarg, Thomas
The aim of the study was to investigate the option of cochlear implantation (CI) in resultant single-sided deafness associated with unilateral translabyrinthine resection of sporadic vestibular schwannoma (VS). This is a retrospective study performed at Tertiary Care Academic Centre. Following extensive counselling regarding the potential for delayed CI, translabyrinthine VS resection was performed and an intracochlear placeholder was inserted to allow later CI in 11 patients who showed intraoperative microscopic confirmation of preserved cochlear nerve anatomy. Follow-up magnetic resonance imaging (MRI) and promontory testing were performed 1 year after surgery to confirm the absence of VS recurrence and viable cochlea. Confirmed CI candidates underwent a second procedure where the placeholder was removed and the CI inserted (4/11). Preimplant unaided and CI-aided evaluations at 12 and 24 months were performed for subjective and objective hearing outcomes. Tinnitus suppression was also measured for implant on and off effects. Available audiological data for three patients demonstrated significant hearing benefits for 'speech from deaf/implanted side, noise from the normal-hearing side' in all three patients and localisation ability improved for 2/3 patients. Subjective findings presented similar results. For the two patients with preimplant tinnitus, complete suppression occurred during active CI. CI is beneficial for hearing rehabilitation and tinnitus reduction in SSD patients with remaining viable cochlear nerve after translabyrinthine VS surgery. Counselling on the risks of intracochlear placeholder insertion and the inherent limitations for ongoing MRI investigations of VS recurrence is essential.
Hainarosie, M; Zainea, V; Hainarosie, R
The article presents a brief history of the development of the cochlear implant, from its beginnings to the present day. After a short description of the device, it describes the evolution of the technology for three of the top manufacturing companies, from the first model marketed, to the latest. It presents the technological advancements from one model to the next, taking into account the exterior design, processing capabilities and functionality. PMID:25870662
Almeida-Verdu, Ana Claudia; Huziwara, Edson M; de Souza, Deisy G; de Rose, Julio C; Bevilacqua, Maria CecÍlia; Lopes, Jair; Alves, Cristiane O; McIlvane, William J
This four-experiment series sought to evaluate the potential of children with neurosensory deafness and cochlear implants to exhibit auditory–visual and visual–visual stimulus equivalence relations within a matching-to-sample format. Twelve children who became deaf prior to acquiring language (prelingual) and four who became deaf afterwards (postlingual) were studied. All children learned auditory–visual conditional discriminations and nearly all showed emergent equivalence relations. Naming tests, conducted with a subset of the children, showed no consistent relationship to the equivalence-test outcomes. This study makes several contributions to the literature on stimulus equivalence. First, it demonstrates that both pre- and postlingually deaf children can acquire auditory–visual equivalence relations after cochlear implantation, thus demonstrating symbolic functioning. Second, it directs attention to a population that may be especially interesting for researchers seeking to analyze the relationship between speaker and listener repertoires. Third, it demonstrates the feasibility of conducting experimental studies of stimulus control processes within the limitations of a hospital, which these children must visit routinely for the maintenance of their cochlear implants. PMID:18540222
Spencer, Linda J; Tomblin, J Bruce; Gantz, Bruce J
The long-term educational/vocational, affiliation, and quality-of-life outcomes of the first and second cohorts of children with bilateral, profound hearing loss who received cochlear implants under a large National Institutes of Health-funded study was investigated in 41 of 61 eligible participants. Educational and vocational outcomes were collected from user survey data. Affiliation and quality-of-life data were collected from the Satisfaction-with-Life scale and the Deaf Identity Scale. Qualitative results indicated that compared with their hearing, adult-age peers, this group obtained high educational achievement, and they reported a very high satisfaction of life. With respect to forming an identity in these first 2 cohorts of cochlear implant users, we found that most of the individuals endorsed a dual identity, which indicates they feel just as comfortable with Deaf individuals as they do with hearing individuals. Quantitative results revealed a significant relationship between ability to hear and ability to speak, in addition to consistency of device use. Additional relationships were found between mother's and the individual's educational statuses, hearing scores, and communication system used. Younger individuals scored higher on satisfaction-with-life measures, and they also tended to endorse a dual identity more often. Taken together, these findings diminish concerns that profoundly deaf individuals growing up with cochlear implants will become culturally bereft and unable to function in the hearing world.
Guevara, Nicolas; Gérard, Anaïs; Dupré, Jeanne; Goursonnet, Delphine; Hoen, Michel; Gnansia, Dan; Angellier, Gaëlle; Thariat, Juliette
The purpose of the present study was to test the behavior of two different generations of cochlear implant systems subjected to a clinical radiotherapy scheme and to determine the maximal acceptable cumulative radiation levels at which the devices show out-of-specification behaviors. Using stereotactic irradiation (Cyberknife, 6 MV photon beam), three Digisonic SP and three Neuro devices were submitted to 5 Gy doses that cumulated to 60 Gy (12 sessions) and 80 Gy (16 sessions), respectively. A follow-up series of irradiation was then applied, in which Digisonic SP devices received two additional fractions of 50 Gy each, cumulating to 160 Gy, and Neuro devices three additional fractions of 20, 40, and 150 Gy, cumulating to 290 Gy. Output current values were monitored during the treatment. At clinical doses, with 60 or 80 Gy cumulative radiation exposure, no single measurement showed more than 10% divergence from the reference measure. The cochlear implants tested in this study showed high resistance to clinically relevant cumulative radiation doses and showed no out-of-bounds behavior up to cumulative doses of 140 or 160 Gy. These observations suggest that cochlear implant users can undergo radiotherapy up to cumulative doses well above those currently used in clinical situations without risk of failure.
Hersbach, Adam A; Grayden, David B; Fallon, James B; McDermott, Hugh J
Cochlear implant users have limited ability to understand speech in noisy conditions. Signal processing methods to address this issue that use multiple microphones typically use beamforming to perform noise reduction. However, the effectiveness of the beamformer is diminished as the number of interfering noises increases and the acoustic environment becomes more diffuse. A multi-microphone noise reduction algorithm that aims to address this issue is presented in this study. The algorithm uses spatial filtering to estimate the signal-to-noise ratio (SNR) and attenuates time-frequency elements that have poor SNR. The algorithm was evaluated by measuring intelligibility of speech embedded in 4-talker babble where the interfering talkers were spatially separated and changed location during the test. Twelve cochlear implant users took part in the evaluation, which demonstrated a significant mean improvement of 4.6 dB (standard error 0.4, P < 0.001) in speech reception threshold compared to an adaptive beamformer. The results suggest that a substantial improvement in performance can be gained for cochlear implant users in noisy environments where the noise is spatially separated from the target speech.
Li, Enbang; Yao, Jianquan
Cochlear implantation has been proved as a great success in treating profound sensorineural deafness in both children and adults. Cochlear electrode array implantation is a complex and delicate surgical process. Surgically induced damage to the inner wall of the scala tympani could happen if the insertion angle of the electrode is incorrect and an excessive insertion force is applied to the electrode. This damage could lead to severe degeneration of the remaining neural elements. It is therefore of vital importance to monitor the shape and position of the electrode during the implantation surgery. In this paper, we report a fiber-optic bending sensor which can be integrated with the electrode and used to guide the implantation process. The sensor consists of a piece of optical fiber. The end of the fiber is coated with aluminum layer to form a mirror. Bending the fiber with the electrode introduces loss to the light transmitting in the fiber. By detecting the power of the reflected light, we can detennine the bending happened to the fiber, and consequently measure the curved shape of the electrode. Experimental results show that the proposed fiber sensor is a promising technique to make in-situ monitoring of the shape and position of the electrode during the implantation process.
Cardoso, Carolina Costa; Sales de Meneses, Michelle; Silva, Isabella Monteiro de Castro; Alves, Angela Maria Vaccaro Silva
Introduction The CHARGE association (coloboma of the eyes; heart disease; atresia of the choanae; retarded growth and development; genital hypoplasia/genitourinary anomalies; ear anomalies and/or hearing loss) was first described in 1979 by Hall, and among its main features is hearing loss. This study presents a case aiming to establish relationships between performance on Infant Toddler Meaningful Auditory Integration Scale (IT-MAIS) and Meaningful Use of Speech Scales (MUSS) tests and the analysis of hearing and language categories of a patient diagnosed with CHARGE syndrome, before and after cochlear implant (CI) surgery. Case Report A 7-year-old girl was diagnosed with CHARGE. She had severe sensorineural hearing loss and was a prelingual unilateral CI user. We analyzed data from the patient's medical records regarding therapies and video recordings. Results The patient showed positive results in all evaluations after CI. IT-MAIS rose from 5 to 90% following the use of CI. MUSS also rose, from 75 to 72.5%, after use of CI. Classification of Auditory Skills changed from category 1 before use of CI to category 6 after use of CI. Classification of Language Skills changed from category 1 before use of CI to category 3 after use of CI. The CI is an aid but there are many factors in the therapeutic process, and great heterogeneity in individuals diagnosed with CHARGE should be investigated. Conclusion The development of listening and language skills after CI use was demonstrated by IT-MAIS and MUSS tests, and categorization of speech and hearing in this child with a diagnosis of CHARGE syndrome shows that CI can be an effective technological resource to provide information on hearing as one source for language construction. PMID:25992052
Strenger, T; Stark, T
Over the last decade, bone conducting hearing aids, cochlear implants and implantable hearing aids have come to represent additional treatment options in clinical routine-alongside conventional hearing aids-for hearing impaired patients. Thanks to experience gained in recent years with implantable hearing aids and the consistent evaluation of functional results, the original spectrum of indications has been progressively extended. Today, implantable hearing aids are available for the hearing (re)habilitation of various forms of middle ear pathology as well as sensorineural hearing loss within the audiological criteria. With CE certification for children, the treatment of younger patients with implantable hearing aids has also become possible. Using the Vibrant Soundbridge as an example, the function, indications and contraindications of implantable hearing aids are described and the surgical procedure and post-operative care discussed.
Just, T.; Lankenau, E.; Hüttmann, G.; Pau, H. W.
To assess the potential use of optical coherence tomography (OCT) in cochlear implant surgery, OCT was applied in human temporal bones before cochleostomy. The question was whether OCT might provide information about the cochlear topography, especially about the site of the scala tympani. OCT was carried out on human temporal bone preparations, in which the cochleostomy was performed leaving the membranous labyrinth and the fluid-filled inner ear intact. A specially equipped operating microscope with integrated OCT prototype was used. Spectral-domain (SD)-OCT was used for all investigations. On all scans, OCT supplied information about inner ear structures, such as scala tympani, scala vestibuli while the membranous labyrinth was still intact. In the fresh temporal bone the scala media, basilar membrane and the Reissner's membrane were identified. This OCT study clearly documents the possibility to identify inner ear structures, especially the scala tympani without opening its enveloping membranes. These findings may have an impact on cochlear implant surgery, especially as an orientation guide to localize the scala tympani precisely before opening the fluid filled inner ear.
Ali, Hussnain; Ahmad, Talha J; Ajaz, Asim; Khan, Shoab A
This paper presents design overview of a low cost prototype of Cochlear Implant developed from commercial off-the-shelf components. Design scope includes speech processing module implemented on a commercial digital signal processor, transcutaneous data and power transceiver developed from a single pair of inductive coils and finally a stimulator circuitry for cochlear stimulation. Different speech processing strategies such as CIS, SMSP and F0/F1 have been implemented and tested using a novel, indigenously developed speech processing research module which evaluates the performance of speech processing strategies in software, hardware and practical scenarios. Design overview, simulations and practical results of an optimized inductive link using Class E Power Amplifier are presented. Link was designed at a carrier frequency of 2.5MHz for 100mW output power. Receiver logic design and stimulator circuitry was implemented using a PIC microcontroller and off-the-shelf electronic components. Results indicate 40% link efficiency with 128kbps data transfer rate. This low cost prototype can be used for undertaking cochlear implant research in laboratories.
Aronoff, Justin M.; Freed, Daniel J.; Fisher, Laurel M.; Pal, Ivan; Soli, Sigfrid D.
directional microphone when the speech and masker were spatially separated, emphasizing the importance of measuring binaural benefits separately for each HRTF. Evaluation of binaural benefits indicated that binaural squelch and spatial release from masking were found for all HRTFs and binaural summation was found for all but one HRTF, although binaural summation was less robust than the other types of binaural benefits. Additionally, the results indicated that neither interaural time nor level cues dominated binaural benefits for the normal hearing participants. Conclusions This study provides a means to measure the degree to which cochlear implant microphones affect acoustic hearing with respect to speech perception in noise. It also provides measures that can be used to evaluate the independent contributions of interaural time and level cues. These measures provide tools that can aid researchers in understanding and improving binaural benefits in acoustic hearing individuals listening via cochlear implant microphones. PMID:21412155
Meinzen-Derr, Jareen; Wiley, Susan; Grether, Sandra; Choo, Daniel I.
The number of children receiving cochlear implants (CIs) with significant disabilities in addition to their deafness has increased substantially. Unfortunately, children with additional disabilities receiving CIs have largely been excluded from studies on cochlear implant outcomes. Thus limited data exists on outcomes in this population to guide…
Patton, Kristin L.
The purpose of this qualitative research, which utilized a narrative design strategy, was to describe the process of self-regulation of a child who has bilateral cochlear implants within the social environment of school. The study investigated the use of self-regulatory strategies by the cochlear implant recipient. It also examined how the child…
Isarin, Jet; van Zadelhoff, Ilse; Wolters-Leermakers, Nina; Speksnijder-Bregman, Marjon; Hannink, Mariën; Knoors, Harry
An increasing number of deaf children with additional disabilities receive a cochlear implant (CI). International studies on cochlear implantation in deaf children with additional disabilities show less and slower speech and language gains, but improvement in overall quality of life. In order to qualify the concept of quality of life this study…
Punch, Renee; Hyde, Merv
This Australian study examined the communication, academic, and social outcomes of pediatric cochlear implantation from the perspectives of teachers working with children with cochlear implants. The children were aged from 1 to 18 years and attended a range of educational settings in early intervention, primary, and secondary schooling. One…
Ambrose, Sophie E.; Fey, Marc E.; Eisenberg, Laurie S.
Purpose: To determine whether preschool-age children with cochlear implants have age-appropriate phonological awareness and print knowledge and to examine the relationships of these skills with related speech and language abilities. Method: The sample comprised 24 children with cochlear implants (CIs) and 23 peers with normal hearing (NH), ages 36…
Pascoe, Michelle; Randall-Pieterse, Candice; Geiger, Martha
This single case study describes the speech, phonological awareness and literacy of a 6;0-year-old girl with a cochlear implant. NG, a child with a congenital bilateral severe/profound hearing loss, received a monaural cochlear implant at the age of 3;0, three years prior to the study. Using a psycholinguistic framework to investigate her single…
Holt, Rachael Frush; Beer, Jessica; Kronenberger, William G.; Pisoni, David B.; Lalonde, Kaylah
Purpose: To evaluate the family environments of children with cochlear implants and to examine relationships between family environment and postimplant language development and executive function. Method: Forty-five families of children with cochlear implants completed a self-report family environment questionnaire (Family Environment Scale-Fourth…
Valente, Joseph Michael
The author, who was raised oral deaf himself, recounts a visit to a school for young deaf children and discovers that young d/Deaf children and their rights are subverted by the cochlear implantation empire. The hypercapitalist, techno-manic times of cochlear implantation has wreaked havoc to the lives of not only young children with deafness but…
Straley, Sara G.; Werfel, Krystal L.; Hendricks, Alison Eisel
This study evaluated the spelling of 3rd to 6th grade children with cochlear implants in written stories. Spelling was analysed using traditional correct/incorrect scoring as well as the Spelling Sensitivity Score, which provides linguistic information about spelling attempts. Children with cochlear implants spelled 86 per cent of words in stories…
Zaidman-Zait, Anat; Jamieson, Janet R.
The present study has three purposes: (a) to determine who disseminates information on cochlear implants on the Web; (b) to describe a representative sample of Web sites that disseminate information on cochlear implants, with a focus on the content topics and their relevance to parents of deaf children; and (c) to discuss the practical issues of…
Bruin, Marieke; Ohna, Stein Erik
This study presents an analysis of parental experiences on follow-up after cochlear implantation. Data were constructed in semi-structured, individual interviews with the parents of 14 children who use cochlear implants. Drawing on narrative analysis, the study explores parental responses to insecurity concerning children's learning and…
Geers, Ann E.; Nicholas, Johanna; Tobey, Emily; Davidson, Lisa
Purpose: The purpose of the present investigation is to differentiate children using cochlear implants (CIs) who did or did not achieve age-appropriate language scores by mid-elementary grades and to identify risk factors for persistent language delay following early cochlear implantation. Materials and Method: Children receiving unilateral CIs at…
Zaidman-Zait, Anat; Curle, Deirdre; Jamieson, Janet R.; Chia, Ruth; Kozak, Frederick K.
Although increasing numbers of children with additional disabilities are receiving cochlear implants (CIs), little is known about family perspectives of the benefits and the challenges of cochlear implantation in this pediatric population. This study examines perceptions among parents of deaf children with additional disabilities regarding…
Reich, Rebecca D.; Eddington, Donald
Signal processing in a cochlear implant (CI) is primarily designed to convey speech and environmental sounds, and can cause distortion of musical timbre. Systematic investigation of musical instrument identification through a CI has not yet revealed how timbre is affected by the implant's processing. In this experiment, the bandpass filtering, rectification, and low-pass filtering of an implant are simulated in MATLAB. Synthesized signals representing 12 common instruments, each performing a major scale, are processed by simulations using up to 8 analysis channels. The unprocessed recordings, together with the 8 simulation conditions for 12 instruments, are presented in random order to each of the subjects. The subject's task is to identify the instrument represented by each item. The subjects also subjectively score each item based on similarity and pleasantness. We anticipate performance using the simulation will be worse than the unprocessed condition because of the limited information delivered by the envelopes of the analysis channels. These results will be analyzed as a confusion matrix and provide a basis for contrasting the information used by subjects listening to the unprocessed and processed materials. Understanding these differences should aid in the development of new processing strategies to better represent music for cochlear implant users.
Perreau, Ann E.; Ou, Hua; Tyler, Richard; Dunn, Camille
Purpose The goal of this study was to determine how self-reported spatial hearing abilities differ across various cochlear implant (CI) profiles and to examine the degree of subjective benefit following cochlear implantation across different groups of CI users. Method This was a retrospective study of subjective spatial hearing ability of CI recipients. The subjects consisted of 99 unilateral CI users, 49 bilateral CI users, 32 subjects with a CI and contralateral hearing aid (bimodal users), and 37 short-electrode CI users. All subjects completed the Spatial Hearing Questionnaire (Tyler, Perreau, & Ji, 2009), a questionnaire assessing spatial hearing ability, after implantation, and a subset of the subjects completed the questionnaire pre- and postimplantation. Results Subjective spatial hearing ability was rated higher for the bilateral and short electrode CI users compared to the unilateral and bimodal users. There was no significant difference in subjective spatial hearing performance between the bilateral and short electrode CI users and the unilateral CI and bimodal users. A separate analysis of pre- and postimplant performance revealed that all CI groups reported significant improvements in spatial hearing ability after implantation. Conclusion This study suggests that there are substantial differences in perceived spatial hearing ability among unilateral and bimodal CI users compared with bilateral and short electrode CI users. PMID:25093507
Hopyan, Talar; Peretz, Isabelle; Chan, Lisa P.; Papsin, Blake C.; Gordon, Karen A.
Cochlear implants (CIs) electrically stimulate the auditory nerve providing children who are deaf with access to speech and music. Because of device limitations, it was hypothesized that children using CIs develop abnormal perception of musical cues. Perception of pitch and rhythm as well as memory for music was measured by the children’s version of the Montreal Battery of Evaluation of Amusia (MBEA) in 23 unilateral CI users and 22 age-matched children with normal hearing. Children with CIs were less accurate than their normal hearing peers (p < 0.05). CI users were best able to discern rhythm changes (p < 0.01) and to remember musical pieces (p < 0.01). Contrary to expectations, abilities to hear cues in music improved as the age at implantation increased (p < 0.01). Because the children implanted at older ages also had better low frequency hearing prior to cochlear implantation and were able to use this hearing by wearing hearing aids. Access to early acoustical hearing in the lower frequency ranges appears to establish a base for music perception, which can be accessed with later electrical CI hearing. PMID:23133430
Pinyon, Jeremy L; Tadros, Sherif F; Froud, Kristina E; Y Wong, Ann C; Tompson, Isabella T; Crawford, Edward N; Ko, Myungseo; Morris, Renée; Klugmann, Matthias; Housley, Gary D
The cochlear implant is the most successful bionic prosthesis and has transformed the lives of people with profound hearing loss. However, the performance of the "bionic ear" is still largely constrained by the neural interface itself. Current spread inherent to broad monopolar stimulation of the spiral ganglion neuron somata obviates the intrinsic tonotopic mapping of the cochlear nerve. We show in the guinea pig that neurotrophin gene therapy integrated into the cochlear implant improves its performance by stimulating spiral ganglion neurite regeneration. We used the cochlear implant electrode array for novel "close-field" electroporation to transduce mesenchymal cells lining the cochlear perilymphatic canals with a naked complementary DNA gene construct driving expression of brain-derived neurotrophic factor (BDNF) and a green fluorescent protein (GFP) reporter. The focusing of electric fields by particular cochlear implant electrode configurations led to surprisingly efficient gene delivery to adjacent mesenchymal cells. The resulting BDNF expression stimulated regeneration of spiral ganglion neurites, which had atrophied 2 weeks after ototoxic treatment, in a bilateral sensorineural deafness model. In this model, delivery of a control GFP-only vector failed to restore neuron structure, with atrophied neurons indistinguishable from unimplanted cochleae. With BDNF therapy, the regenerated spiral ganglion neurites extended close to the cochlear implant electrodes, with localized ectopic branching. This neural remodeling enabled bipolar stimulation via the cochlear implant array, with low stimulus thresholds and expanded dynamic range of the cochlear nerve, determined via electrically evoked auditory brainstem responses. This development may broadly improve neural interfaces and extend molecular medicine applications.
Accoto, D; Calvano, M; Campolo, D; Salvinelli, F; Guglielmelli, E
Cochlear implants (CIs) are used for compensating the so-called deep sensorineural deafness. CIs are usually powered by rechargeable or long-lasting batteries. In this paper, the feasibility of a fully implanted stand-alone device able to provide the electric power required for stimulating the auditory nerve, without external recharging, is investigated. At first, we demonstrate that the sound wave entering the ear is not a sufficient power source. Then, we propose a solution exploiting the mechanical energy associated to head vibration during walking. The energetic feasibility of this approach is demonstrated based on experimental measurements of head motions. Preliminary considerations on the technical feasibility of a fully implanted energy harvester are finally presented.
Vermeulen, Anneke M; van Bon, Wim; Schreuder, Rob; Knoors, Harry; Snik, Ad
The reading comprehension and visual word recognition in 50 deaf children and adolescents with at least 3 years of cochlear implant (CI) use were evaluated. Their skills were contrasted with reference data of 500 deaf children without CIs. The reading comprehension level in children with CIs was expected to surpass that in deaf children without implants, partly via improved visual word recognition. Reading comprehension scores of children with implants were significantly better than those of deaf children without implants, although the performance in implant users was substantially lagging behind that in hearing children. Visual word recognition was better in children with CIs than in children without implants, in secondary education only. No difference in visual word recognition was found between the children with CIs and the hearing children, whereas the deaf children without implants showed a slightly poorer performance. The difference in reading comprehension performance of the deaf children with and without CIs remained present when visual word recognition was controlled for. This indicates that other reading-related skills were also contributing to the improved reading comprehension skills of deaf children with CIs.
Cochlear implants generated intense debate almost immediately following their introduction in the 1980s. Today, with a vast number of deaf individuals with cochlear implants, the debate about the cochlear implant device and mode of communication continues. Q-methodology was used in this study to explore cochlear implants and language acquisition perspectives within the deaf community. Thirty respondents sorted 33 statements, which were collected from professional literature and mainstream media, into a forced-choice, quasi-normal template. A by-person factor analysis of the Q-sorts revealed 5 model viewpoints: (a) American Sign Language advocate, (b) bilingual advocate, (c) cochlear implant advocate, (d) diverse options advocate, and (e) English visually advocate. Even though the results indicate 5 distinct perspectives, the Q-method also revealed similarities among them. The results also show that there seems to be some agreement on using a bilingual approach, although the perspectives seem to disagree on which language should be acquired first.
Spencer, Linda J.; Guo, Ling-Yu
This study provided a yearly record of consonant development for the initial 4 years of cochlear implant (CI) use and established a precedent for using a standardized articulation test, the "Goldman-Fristoe Test of Articulation--2" (Goldman, R., & Fristoe, M. . Goldman-Fristoe Test of Articulation--2. Circle Pines, MN: American…
Dettman, Shani; Sadeghi-Barzalighi, Ana; Ambett, Ranjeeta; Dowell, Richard; Trotter, Matthew; Briggs, Robert
CT and MRI scans for 48 children with cochlear and/or vestibular abnormality were classified in decreasing severity; common cavity, Mondini plus enlarged vestibular aqueduct, Mondini dysplasia alone and enlarged vestibular aqueduct alone. No significant relationship between degree of cochlea abnormality and surgical issues (cerebrospinal fluid gusher, depth of insertion, number of electrodes) or speech perception/language outcomes was found. A significant relationship was observed between cerebrospinal fluid gusher and partial electrode insertion, fewer active electrodes and poorer sentence understanding. Optimum language outcomes were associated with younger age at implant.
Tanaka, Chiemi; Nguyen-Huynh, Anh; Loera, Katherine; Stark, Gemaine; Reiss, Lina
The Hybrid cochlear implant (CI), also known as Electro- Acoustic Stimulation (EAS), is a new type of CI that preserves residual acoustic hearing and enables combined cochlear implant and hearing aid use in the same ear. However, 30-55% of patients experience acoustic hearing loss within days to months after activation, suggesting that both surgical trauma and electrical stimulation may cause hearing loss. The goals of this study were to: 1) determine the contributions of both implantation surgery and EAS to hearing loss in a normal-hearing guinea pig model; 2) determine which cochlear structural changes are associated with hearing loss after surgery and EAS. Two groups of animals were implanted (n=6 per group), with one group receiving chronic acoustic and electric stimulation for 10 weeks, and the other group receiving no direct acoustic or electric stimulation during this time frame. A third group (n=6) was not implanted, but received chronic acoustic stimulation. Auditory brainstem response thresholds were followed over time at 1, 2, 6, and 16 kHz. At the end of the study, the following cochlear measures were quantified: hair cells, spiral ganglion neuron density, fibrous tissue density, and stria vascularis blood vessel density; the presence or absence of ossification around the electrode entry was also noted. After surgery, implanted animals experienced a range of 0-55 dB of threshold shifts in the vicinity of the electrode at 6 and 16 kHz. The degree of hearing loss was significantly correlated with reduced stria vascularis vessel density and with the presence of ossification, but not with hair cell counts, spiral ganglion neuron density, or fibrosis area. After 10 weeks of stimulation, 67% of implanted, stimulated animals had more than 10 dB of additional threshold shift at 1 kHz, compared to 17% of implanted, non-stimulated animals and 0% of non-implanted animals. This 1-kHz hearing loss was not associated with changes in any of the cochlear measures
Tanaka, Chiemi; Nguyen-Huynh, Anh; Loera, Katherine; Stark, Gemaine; Reiss, Lina
The Hybrid cochlear implant (CI), also known as Electro-Acoustic Stimulation (EAS), is a new type of CI that preserves residual acoustic hearing and enables combined cochlear implant and hearing aid use in the same ear. However, 30-55% of patients experience acoustic hearing loss within days to months after activation, suggesting that both surgical trauma and electrical stimulation may cause hearing loss. The goals of this study were to: 1) determine the contributions of both implantation surgery and EAS to hearing loss in a normal-hearing guinea pig model; 2) determine which cochlear structural changes are associated with hearing loss after surgery and EAS. Two groups of animals were implanted (n = 6 per group), with one group receiving chronic acoustic and electric stimulation for 10 weeks, and the other group receiving no direct acoustic or electric stimulation during this time frame. A third group (n = 6) was not implanted, but received chronic acoustic stimulation. Auditory brainstem response thresholds were followed over time at 1, 2, 6, and 16 kHz. At the end of the study, the following cochlear measures were quantified: hair cells, spiral ganglion neuron density, fibrous tissue density, and stria vascularis blood vessel density; the presence or absence of ossification around the electrode entry was also noted. After surgery, implanted animals experienced a range of 0-55 dB of threshold shifts in the vicinity of the electrode at 6 and 16 kHz. The degree of hearing loss was significantly correlated with reduced stria vascularis vessel density and with the presence of ossification, but not with hair cell counts, spiral ganglion neuron density, or fibrosis area. After 10 weeks of stimulation, 67% of implanted, stimulated animals had more than 10 dB of additional threshold shift at 1 kHz, compared to 17% of implanted, non-stimulated animals and 0% of non-implanted animals. This 1-kHz hearing loss was not associated with changes in any of the cochlear measures
Myung, Nam-Suk; Lee, Il-Woo; Goh, Eui-Kyung; Kong, Soo-Keun
Lightning strike can produce an array of clinical symptoms and injuries. It may damage multiple organs and cause auditory injuries ranging from transient hearing loss and vertigo to complete disruption of the auditory system. Tympanic-membrane rupture is relatively common in patients with lightning injury. The exact pathogenetic mechanisms of auditory lesions in lightning survivors have not been fully elucidated. We report the case of a 45-year-old woman with bilateral profound sensorineural hearing loss caused by a lightning strike, who was successfully rehabilitated after a cochlear implantation.
Padilla, Monica; Landsberger, David M
Channel interaction from a broad spread of excitation is likely to be a limiting factor in performance by cochlear implant users. Although partial tripolar stimulation has been shown to reduce spread of excitation, the magnitude of the reduction is highly variable across subjects. Because the reduction in spread of excitation is typically only measured at one electrode for a given subject, the degree of variability across cochlear locations is unknown. The first goal of the present study was to determine if the reduction in spread of excitation observed from partial tripolar current focusing systematically varies across the cochlea. The second goal was to measure the variability in reduction of spread of excitation relative to monopolar stimulation across the cochlea. The third goal was to expand upon previous results that suggest that scaling of verbal descriptors can be used to predict the reduction in spread of excitation, by increasing the limited number of sites previously evaluated and verify the relationships remain with the larger dataset. The spread of excitation for monopolar and partial tripolar stimulation was measured at 5 cochlear locations using a psychophysical forward masking task. Results of the present study suggest that although partial tripolar stimulation typically reduces spread of excitation, the degree of reduction in spread of excitation was found to be highly variable and no effect of cochlear location was found. Additionally, subjective scaling of certain verbal descriptors (Clean/Dirty, Pure/Noisy) correlated with the reduction in spread of excitation suggesting sound quality scaling might be used as a quick clinical estimate of channels providing a reduction in spread of excitation. This quick scaling technique might help clinicians determine which patients would be most likely to benefit from a focused strategy.
Padilla, Monica; Landsberger, David M.
Channel interaction from a broad spread of excitation is likely to be a limiting factor in performance by cochlear implant users. Although partial tripolar stimulation has been shown to reduce spread of excitation, the magnitude of the reduction is highly variable across subjects. Because the reduction in spread of excitation is typically only measured at one electrode for a given subject, the degree of variability across cochlear locations is unknown. The first goal of the present study was to determine if the reduction in spread of excitation observed from partial tripolar current focusing systematically varies across the cochlea. The second goal was to measure the variability in reduction of spread of excitation relative to monopolar stimulation across the cochlea. The third goal was to expand upon previous results that suggest that scaling of verbal descriptors can be used to predict the reduction in spread of excitation, by increasing the limited number of sites previously evaluated and verify the relationships remain with the larger dataset. The spread of excitation for monopolar and partial tripolar stimulation was measured at 5 cochlear locations using a psychophysical forward masking task. Results of the present study suggest that although partial tripolar stimulation typically reduces spread of excitation, the degree of reduction in spread of excitation was found to be highly variable and no effect of cochlear location was found. Additionally, subjective scaling of certain verbal descriptors (Clean/Dirty, Pure/Noisy) correlated with the reduction in spread of excitation suggesting sound quality scaling might be used as a quick clinical estimate of channels providing a reduction in spread of excitation. This quick scaling technique might help clinicians determine which patients would be most likely to benefit from a focused strategy. PMID:26778546
Inner ear malformations constitute about 20% of congenital sensorineural hearing loss. In this review article an updated classification of cochlear malformations is provided. Incomplete partition and cochlear hypoplasia cases are each divided further into three groups. There are two main difficulties in the surgery of inner ear malformations; gusher and facial nerve abnormalities. Radiological features of malformations necessary to identify these problems preoperatively are discussed. Facial nerve abnormalities that may occur are described. Two different types of cerebrospinal fluid leakage are defined and necessary measures to prevent leakage are described. Standard and modified surgical approaches to overcome the described problems are described with literature findings. Finally meningitis which may occur with and without cochlear implantation in this special group of patients is emphasized. This is common in incomplete partition type I patients and is usually due to a fistula in one of the windows (usually oval window) which occurs as a result of cerebrospinal fluid pressure. This is a medical emergency leading to potential meningitis and measures that should be taken to stop the leak as soon as possible are described.
Kang, Dong Hoon; Lee, Myoung Jin; Lee, Kyu-Yup; Lee, Sang Heun; Jang, Jeong Hun
Objectives. To evaluate the factors that limit post-cochlear implantation (CI) speech perception in prelingually deaf children. Methods. Patients with CI were divided into two groups according to Category of Auditory Performance (CAP) scores 3 years post-CI: the poor performance group (poor performance group, CAP scores≤4, n=41) and the good performance group (good performance group, CAP scores≥5, n=85). The distribution and contribution of the potential limiting factors related to post-CI speech perception was compared. Results. Perinatal problems, inner ear anomalies, narrow bony cochlear nerve canal (BCNC), and intraoperative problems was significantly higher in the poor performance group than the good performance group (P=0.010, P=0.003, P=0.001, and P=0.045, respectively). The mean number of limiting factors was significantly higher in the poor performance group (1.98±1.04) than the good performance group (1.25±1.11, P=0.001). The odds ratios for perinatal problems and narrow bony cochlear nerve canal in the poor performance group in comparison with the good performance group were 4.878 (95% confidence interval, 0.067 to 0.625; P=0.005) and 4.785 (95% confidence interval, 0.045 to 0.972; P=0.046). Conclusion. This study highlights the comprehensive prediction of speech perception after CI and provides otologic surgeons with useful information for individualized preoperative counseling of CI candidates. PMID:27337951
Koitschev, Assen; Stingl, Katarina; Bartz-Schmidt, Karl Ulrich; Braun, Angelika; Gekeler, Florian; Greppmaier, Udo; Sachs, Helmut; Peters, Tobias; Wilhelm, Barbara; Zrenner, Eberhart; Besch, Dorothea
In hereditary retinal diseases photoreceptors progressively degenerate, often causing blindness without therapy being available. Newly developed subretinal implants can substitute functions of photoreceptors. Retina implant extraocular surgical technique relies strongly on cochlear-implant know-how. However, a completely new surgical approach providing safe handling of the photosensor array had to be developed. The Retina Implant Alpha IMS consisting of a subretinal microphotodiode array and cable linked to a cochlear-implant-like ceramic housing was introduced via a retroauricular incision through a subperiosteal tunnel above the zygoma into the orbit using a specially designed trocar. Implant housing was fixed in a bony bed within a tight subperiosteal pocket in all patients. Primary outcomes were patient short term safety as well as effectiveness. Nine patients participated in the first part of the multicenter trial and received the subretinal visual implant in one eye. In all cases microphotodiode array pull-through procedure and stable positioning were possible without affecting the device function. No intraoperative complications were encountered. The minimally invasive suprazygomatic tunneling technique for the sensor unit as well as a subperiosteal pocket fixation of the implant housing provides a safe extraocular implantation approach of a subretinal device with a transcutaneous extracorporeal power supply. PMID:26783453
Wilson, Blake S.; Dorman, Michael F.
The aims of this paper are to (i) provide a brief history of cochlear implants; (ii) present a status report on the current state of implant engineering and the levels of speech understanding enabled by that engineering; (iii) describe limitations of current signal processing strategies and (iv) suggest new directions for research. With current technology the “average” implant patient, when listening to predictable conversations in quiet, is able to communicate with relative ease. However, in an environment typical of a workplace the average patient has a great deal of difficulty. Patients who are “above average” in terms of speech understanding, can achieve 100% correct scores on the most difficult tests of speech understanding in quiet but also have significant difficulty when signals are presented in noise. The major factors in these outcomes appear to be (i) a loss of low-frequency, fine structure information possibly due to the envelope extraction algorithms common to cochlear implant signal processing; (ii) a limitation in the number of effective channels of stimulation due to overlap in electric fields from electrodes, and (iii) central processing deficits, especially for patients with poor speech understanding. Two recent developments, bilateral implants and combined electric and acoustic stimulation, have promise to remediate some of the difficulties experienced by patients in noise and to reinstate low-frequency fine structure information. If other possibilities are realized, e.g., electrodes that emit drugs to inhibit cell death following trauma and to induce the growth of neurites toward electrodes, then the future is very bright indeed. PMID:18616994
Connor, C M; Hieber, S; Arts, H A; Zwolan, T A
This study examines the relationship between the teaching method, oral or total communication, used at children's schools and children's consonant-production accuracy and vocabulary development over time. Children who participated in the study (N = 147) demonstrated profound sensorineural hearing loss and had used cochlear implants for between 6 months and 10 years. Educational programs that used an oral communication (OC) approach focused on the development of spoken language, whereas educational programs that used a total communication (TC) approach focused on the development of language using both signed and spoken language. Using Hierarchical Linear Modeling (HLM) we compared the consonant-production accuracy, receptive spoken vocabulary, and expressive spoken and/or signed vocabulary skills, over time, of children who were enrolled in schools that used either OC or TC approaches, while controlling for a number of variables. These variables included age at implantation, preoperative aided speech detection thresholds, type of cochlear implant device used, and whether a complete or incomplete active electrode array was implanted. The results of this study indicated that as they used their implants the children demonstrated improved consonant-production accuracy and expressive and receptive vocabulary over time, regardless of whether their school employed a TC or OC teaching method. Furthermore, there appeared to be a complex relationship among children's performance with the cochlear implant, age at implantation, and communication/teaching strategy employed by the school. Controlling for all variables, children in OC programs demonstrated, on average, superior consonant-production accuracy, with significantly greater rates of improvement in consonant-production accuracy scores over time compared to children in TC programs. However, there was no significant difference between OC and TC groups in performance or rate of growth in consonant-production accuracy when
Nicholas, Johanna; Tobey, Emily; Davidson, Lisa
Purpose The purpose of the present investigation is to differentiate children using cochlear implants (CIs) who did or did not achieve age-appropriate language scores by midelementary grades and to identify risk factors for persistent language delay following early cochlear implantation. Materials and Method Children receiving unilateral CIs at young ages (12–38 months) were tested longitudinally and classified with normal language emergence (n = 19), late language emergence (n = 22), or persistent language delay (n = 19) on the basis of their test scores at 4.5 and 10.5 years of age. Relative effects of demographic, audiological, linguistic, and academic characteristics on language emergence were determined. Results Age at CI was associated with normal language emergence but did not differentiate late emergence from persistent delay. Children with persistent delay were more likely to use left-ear implants and older speech processor technology. They experienced higher aided thresholds and lower speech perception scores. Persistent delay was foreshadowed by low morphosyntactic and phonological diversity in preschool. Logistic regression analysis predicted normal language emergence with 84% accuracy and persistent language delay with 74% accuracy. Conclusion CI characteristics had a strong effect on persistent versus resolving language delay, suggesting that right-ear (or bilateral) devices, technology upgrades, and improved audibility may positively influence long-term language outcomes. PMID:26501740
Majdani, Omid; Schuman, Theodore A.; Haynes, David S.; Dietrich, Mary S.; Leinung, Martin; Lenarz, Thomas
OBJECTIVE Establish time required to perform cochlear implantation (CI) in academic settings. STUDY DESIGN Historical cohort study. SETTING German and American academic centers. PATIENTS 2,639 patients underwent CI (1997–2007), excluding patients receiving experimental device or technique with abnormal cochlear anatomy or incomplete charts, leaving 2,253 for analysis. INTERVENTION Unilateral, bilateral and revision CI with devices approved in USA and Europe. MAIN OUTCOME MEASURES Mean surgical time (ST) and total OR time (TORT). RESULTS Mixed model analysis was employed; estimated marginal means given in minutes after adjusting for random effect of individual surgeon. No differences between unilateral (ST=171, TORT=245) and revision CI (ST=160, TORT=232), but bilateral procedures were longer than (ST=295, TORT=377, p=0.000). Unilateral surgeries - Cochlear Limited (CL) devices were implanted faster (ST=165, TORT=225) than Advanced Bionics (ABC) (ST=183, p=0.001, TORT=240, p=0.023) or MedEl (ST=193, p=0.000, TORT=253, p=0.002). No differences for unilateral CI between ABC and MedEl. For revision CI, ABC (ST=141, TORT=219) was faster than CL (ST=181, p=0.001, TORT=266, p=0.000). No differences by age group or between Germany and the USA. ST and TORT were shorter for 575 CI performed in the final two years of the study (unilateral CI: ST=145, TORT=209; bilateral CI: ST=259, TORT=330; revision CI: ST=138, TORT=205). For unilateral CI, ST and TORT decreased yearly (linear regression, p<0.001) and inversely correlated with surgeon experience (linear regression, p<0.01). CONCLUSIONS We report time required to perform CI in academic settings, data vital for cost-benefit analyses and assessing new CI techniques. PMID:20115984
Bergeson, Tonya R.; Pisoni, David B.; Kirk, Karen Iler
Speech feature discrimination is a fundamental perceptual skill that is often assumed to underlie word recognition and sentence comprehension performance. To investigate the development of speech feature discrimination in deaf children with cochlear implants, we conducted a retrospective analysis of results from the Minimal Pairs Test (Robbins et al., 1988) selected from patients enrolled in a longitudinal study of speech perception and language development. The MP test uses a 2AFC procedure in which children hear a word and select one of two pictures (bat-pat). All 43 children were prelingually deafened, received a cochlear implant before 6 years of age or between ages 6 and 9, and used either oral or total communication. Children were tested once every 6 months to 1 year for 7 years; not all children were tested at each interval. By 2 years postimplant, the majority of these children achieved near-ceiling levels of discrimination performance for vowel height, vowel place, and consonant manner. Most of the children also achieved plateaus but did not reach ceiling performance for consonant place and voicing. The relationship between speech feature discrimination, spoken word recognition, and sentence comprehension will be discussed. [Work supported by NIH/NIDCD Research Grant No. R01DC00064 and NIH/NIDCD Training Grant No. T32DC00012.
Välimaa, Taina T; Määttä, Taisto K; Löppönen, Heikki J; Sorri, Martti J
The aim of this study was to investigate how postlingually severely or profoundly hearing-impaired adults relearn to recognize consonants after receiving multichannel cochlear implants. Consonant recognition of 19 Finnish-speaking subjects was studied for a minimum of 6 months and a maximum of 24 months using an open-set nonsense-syllable test in a prospective repeated-measure design. Responses were coded for phoneme errors, and proportions of correct responses and 95% confidence intervals were calculated for recognition and confusions. Two years after the switch-on, the mean recognition of consonants was 71% (95% confidence interval = 68-73%). The manner of articulation was easier to classify than the place of articulation, and the consonants [s], [r], [k], [t], [p], [n], and [j] were easier to recognize than [h], [m], [l], and [v]. Adaptation to electrical hearing with a multichannel cochlear implant was successful, but consonants with alveolar, palatal, or velar transitions (high F2) were better recognized than consonants with labial transitions (low F2). The locus of the F2 transitions of the consonants with better recognition was at the frequencies 1.5-2 kHz, whereas the locus of the F2 transitions of the consonants with poorer recognition was at 1.2-1.4 kHz. A tendency to confuse consonants with the closest consonant with higher F2 transition was also noted.
Välimaa, Taina T; Määttä, Taisto K; Löppönen, Heikki J; Sorri, Martti J
The aim of this study was to investigate how postlingually severely or profoundly hearing-impaired adults relearn to recognize vowels after receiving multichannel cochlear implants. Vowel recognition of 19 Finnish-speaking subjects was studied for a minimum of 6 months and a maximum of 24 months using an open-set nonsense-syllable test in a prospective repeated-measure design. The responses were coded for phoneme errors, and 95% confidence intervals for recognition and confusions were calculated. The average vowel recognition was 68% (95% confidence interval = 66-70%) 6 months after switch-on and 80% (95% confidence interval = 78-82%) 24 months after switch-on. The vowels [ae], [u], [i], [o], and [a] were the easiest to recognize, and the vowels [y], [e], and [ø] were the most difficult. In conclusion, adaptation to electrical hearing using a multichannel cochlear implant was achieved well; but for at least 2 years, given two vowels with either F1 or F2 at roughly the some frequencies, confusions were drawn more towards the closest vowel with the next highest F1 or F2.
Mosca, F; Grassia, R; Leone, C A
In patients with a cochlear implant (CI), the first critical point in processing auditory information from sound stimuli that leads to comprehension is the interface between the electrode and the cochlear nerve, which is dependent on providing appropriate current input. The purpose of this work was to evaluate the longitudinal differences in psychoacoustic fitting parameters in CI users. We studied 26 profoundly deaf adults, aged between 18 and 58 years, who had been implanted in our department between 2009 and 2011. The lowest current levels that evoked an auditory sensation (T-level) and the highest current levels that did not elicit an uncomfortable loud sensation (C-level) were recorded at the time of activation, approximately 30 days after implantation (mean 28.5 days) (T0), after one month (T1), 3 months (T3), 6 months (T6) and one year (T12). Impedance values were calculated for electrode groups: basal, middle and apical. In all cases, the same model of perimodiolar implant (Cochlear™ Nucleus(®) CI24RE) and the same surgical technique (cochleostomy) were used. The values of T-level and C-level showed significant incremental changes between T0 and T1 and between T1 and T3. T-levels in the basal regions of the cochlea were higher than in other sites. T-levels in the basal turn exhibited higher values consistent with a greater amount of fibrosis, as reported in other studies. Our findings suggest that fitting sessions should be scheduled more frequently during the first three months as indicated by the greater slope of T- and C- level variations during that time frame.
Young, Joseph Y; Ryan, Maura E; Young, Nancy M
Cochlear implantation is the only U.S. Food and Drug Administration-approved treatment for children with marked bilateral sensorineural hearing loss. It provides auditory benefits that range from simple sound detection to substantial word understanding. Improved hearing through cochlear implantation has been demonstrated to enhance the rate of language acquisition, enable development of spoken language, and advance literacy in deaf children. Magnetic resonance imaging and computed tomography both have roles in the preoperative assessment of inner-ear abnormalities, cochlear nerve deficiency, and variant anatomy that may affect the decision to implant and the prognosis for auditory improvement and increase the risk for complications. Most cochlear abnormalities may be successfully treated with cochlear implantation, but the presence of a cochlear malformation may increase the risk for intraoperative cerebrospinal fluid leakage and postoperative bacterial meningitis. Eighth-nerve deficiency correlates with poor auditory outcomes and may affect eligibility for cochlear implantation. Another important consideration for implantation is the presence of labyrinthitis ossificans in some children with deafness resulting from bacterial meningitis, which may cause obstruction that limits electrode insertion. Anatomic variations of the facial nerve or middle-ear cavity, which are more common in syndromic patients, may also affect the surgical approach and make implantation difficult.
Cochlear implants are the first device to successfully restore neural function. They have instigated a popular but controversial revolution in the treatment of deafness, and they serve as a model for research in neuroscience and biomedical engineering. In this talk the physiology of natural hearing will be reviewed from the perspective of a physicist, and the function of cochlear implants will be described in the context of historical treatments, electrical engineering, psychophysics, clinical evaluation of efficacy and personal experience. The social implications of cochlear implantation and the future outlook for auditory prostheses will also be discussed.
Cochlear implants are the first device to successfully restore neural function. They have instigated a popular but controversial revolution in the treatment of deafness and they serve as a model for research in neuroscience and biomedical engineering. In this talk the physiology of natural hearing will be reviewed from the perspective of a physicist, and the function of cochlear implants will be described in the context of historical treatments, electrical engineering, psychophysics, clinical evaluation of efficacy and personal experience. The social implications of cochlear implantation and the future outlook for auditory prostheses will also be discussed.
Zanetti, D; Nassif, N; Redaelli de Zinis, L O
The likelihood of residual hearing preservation in cochlear implantation (CI) is related to surgical factors such as type of cochleostomy (trans-fenestral vs. promontorial), use of lubricants and protective drugs, and device-related factors such as shape, length and flexibility of the array. We investigated the impact of these factors on the hearing preservation rate in adults and children with conventional audiological indications to CI. Eighty-two children aged 1-9 years and 73 adults (16-79 years) received a CI in the right (59%) or left ear (41%). An anterior-inferior promontorial cochleostomy was performed in 143 ears (92%); a trans-fenestral approach was used in 12 (8%). A perimodiolar electrode was implanted in 144 ears (93%), and a straight electrode in the remaining 11 (7%). Overall, some post-operative hearing was retained in 39% of ears. The rate of preservation was higher at the low than at the high frequencies. When correlated with age, side of implant, implant model and type of cochleostomy, the mean threshold variations did not reach statistical significance for any of these variables. A slight trend in favour of better residual hearing preservation in children vs. adults was seen, especially at lower frequencies.
Kerber, S; Seeber, B U
Cochlear implant (CI) users frequently report listening difficulties in reverberant and noisy spaces. While it is common to assess speech understanding with implants in background noise, binaural hearing performance has rarely been quantified in the presence of other sources, although the binaural system is a major contributor to the robustness of speech understanding in noisy situations with normal hearing. Here, a pointing task was used to measure horizontal localization ability of a bilateral CI user in quiet and in a continuous diffuse noise interferer at a signal-to-noise ratio of 0 dB. Results were compared to localization performance of six normal hearing listeners. The average localization error of the normal hearing listeners was within normal ranges reported previously and only increased by 1.8° when the interfering noise was introduced. In contrast, the bilateral CI user showed a localization error of 22° in quiet which rose to 31° in noise. This increase was partly due to target sounds being inaudible when presented from frontal locations between -20° and +20°. With the noise present, the implant user was only able to reliably hear target sounds presented from locations well off the median plane. The results give support to the informal complaints raised by CI users and can help to define targets for the design of, e.g., noise reduction algorithms for implant processors.
Rejali, Darius; Lee, Valerie A; Abrashkin, Karen A; Humayun, Nousheen; Swiderski, Donald L; Raphael, Yehoash
Spiral ganglion neurons often degenerate in the deaf ear, compromising the function of cochlear implants. Cochlear implant function can be improved by good preservation of the spiral ganglion neurons, which are the target of electrical stimulation by the implant. Brain derived neurotrophic factor (BDNF) has previously been shown to enhance spiral ganglion survival in experimentally deafened ears. Providing enhanced levels of BDNF in human ears may be accomplished by one of several different methods. The goal of these experiments was to test a modified design of the cochlear implant electrode that includes a coating of fibroblast cells transduced by a viral vector with a BDNF gene insert. To accomplish this type of ex vivo gene transfer, we transduced guinea pig fibroblasts with an adenovirus with a BDNF gene cassette insert, and determined that these cells secreted BDNF. We then attached BDNF-secreting cells to the cochlear implant electrode via an agarose gel, and implanted the electrode in the scala tympani. We determined that the BDNF expressing electrodes were able to preserve significantly more spiral ganglion neurons in the basal turns of the cochlea after 48 days of implantation when compared to control electrodes. This protective effect decreased in the higher cochlear turns. The data demonstrate the feasibility of combining cochlear implant therapy with ex vivo gene transfer for enhancing spiral ganglion neuron survival.
Távora-Vieira, Dayse; Boisvert, Isabelle; McMahon, Catherine M; Maric, Vesna; Rajan, Gunesh P
To investigate the implications of duration of deafness in the rehabilitation of unilateral deafness utilizing cochlear implantation. From the ongoing prospective cochlear implantation in unilateral deafness study, we looked at five adults who received a cochlear implant for long-term unilateral deafness. Speech perception in noise and subjective evaluation of the benefits of cochlear implantation were measured at 3, 6, and 12 months after implantation. The results were analyzed and compared with published data from normal hearing individuals and adults using cochlear implants bilaterally. Analysis of speech perception in noise showed significant improvement for three spatial configurations: speech and noise from the front (S0/N0; P=0.003), speech from the front and noise from the normal hearing ear (S0/NHE; P=0.001), speech from the implanted ear, and noise from the normal hearing ear (SCI/NHE; P<0.001). The scores obtained at 12 months after surgery improved to values similar to those obtained by individuals with normal hearing. The results of subjective measures showed significant improvement in hearing over time to the scores obtained by individuals with a bilateral cochlear implants and those with normal hearing. In this study, older adults with more than 25 years of unilateral deafness obtained scores in speech perception testing and in subjective evaluation that are similar to those attained by individuals with normal hearing and/or those with bilateral cochlear implants. Therefore, patients with postlingual unilateral deafness should not be excluded as cochlear implant candidates on the basis of a long duration of deafness.
Liu, J F; Dai, J S; Wang, N Y
The aim of this review was to examine the current literature regarding application of cochlear implantation on patients with unilateral sensorineural hearing loss (USNHL) for improvement on sound localization. The literature were searched in the PubMed database with 'cochlear implantation AND single-sided deafness' or 'cochlear implantation AND unilateral deafness' as keywords. The publication date of the articles was up to 2015-2-12. A total of 12 articles were included. The results show that the ability of sound localization for most of the USNHL subjects (90%) with cochlear implantation was significantly improved than that without CI, which suggests that CI is a superior auditory rehabilitation treatment than BAHA and CROS hearing aids for patients with USNHL, because of the re-establishment of the benefits of binaural hearing. In addition, the benefit of CI for USNHL requires a period of auditory experience or training. About 30% subjects showed significantly improvement on sound localization ability after CI worked for three months. For most of the patients (90%), the sound localization ability improved after CI worked for six months. When CI worked for nine months, all the subjects would show improvement on sound localization ability. Sound localization of the USNHL subjects with a CI is based primarily on interaural level differences (ILD) while interaural time differences (ITD) provide little advantage or probably not perceptible at all. The younger subject suffers from USNHL, the stronger the plasticity of the auditory center shows, which results in more obvious degeneration of the affected side and adaptive enhancement of the contralateral side of the auditory pathway. Similarly, the longer duration of USNHL lead to more obvious degeneration of the affected side and adaptive enhancement of the contralateral side. An adaptive enhancement of auditory pathway corresponding to the healthy ear will rely more on the monaural spatial cues that available to the
Szagun, Gisela; Stumper, Barbara
Purpose: The authors investigated the influence of social environmental variables and age at implantation on language development in children with cochlear implants. Method: Participants were 25 children with cochlear implants and their parents. Age at implantation ranged from 6 months to 42 months (M[subscript age] = 20.4 months, SD = 22.0…
Cabbarzade, Cavid; Sennaroglu, Levent; Süslü, Nilda
Intraoperative cerebrospinal fluid (CSF) leakages from the cochleostomy site - known as gushers - are a serious complication of cochlear implantation surgery in cases of congenital deafness. They occur as the result of abnormal communication between CSF in the internal auditory canal and perilymph in the cochlea. Gushers are well recognized as occurring in a proportion of cases in which there is a clearly visible congenital malformation of the cochlea. In this report, we describe two cases in which pre-operative computed tomography (CT) scanning of the cochlea was initially reported as normal but gushers occurred during cochlear implant surgery. In both cases, more detailed review of the CT scans (peroperatively in the first case, pre-operatively in the second case) showed a defect at the cochlear base, in the absence of any other cochlear malformation. The aim of this paper is to draw attention to the risk of missing this abnormality and to encourage careful inspection of the cochlear base on CT scans in all cases, even when the rest of the cochlear appears normal.
Granna, Josephine; Rau, Thomas S.; Nguyen, Thien-Dang; Lenarz, Thomas; Majdani, Omid; Burgner-Kahrs, Jessica
During manual cochlear implant electrode insertion the surgeon is at risk to damage the intracochlear fine-structure, as the electrode array is inserted through a small opening in the cochlea blindly with little force-feedback. This paper addresses a novel concept for cochlear electrode insertion using tubular manipulators to reduce risks of causing trauma during insertion and to automate the insertion process. We propose a tubular manipulator incorporated into the electrode array composed of an inner wire within a tube, both elastic and helically shaped. It is our vision to use this manipulator to actuate the initially straight electrode array during insertion into the cochlea by actuation of the wire and tube, i.e. translation and slight axial rotation. In this paper, we evaluate the geometry of the human cochlea in 22 patient datasets in order to derive design requirements for the manipulator. We propose an optimization algorithm to automatically determine the tube set parameters (curvature, torsion, diameter, length) for an ideal final position within the cochlea. To prove our concept, we demonstrate that insertion can be realized in a follow-the-leader fashion for 19 out of 22 cochleas. This is possible with only 4 different tube/wire sets.
Warner-Czyz, Andrea D.; Loy, Betty; Roland, Peter S.; Tong, Liyue; Tobey, Emily A.
Objective Children with hearing loss who use cochlear implants have lower quality of life (QoL) in social situations and lower self-esteem than hearing peers. The child’s QoL has been assessed primarily by asking the parent rather than asking the child. This poses a problem because parents have difficulty judging less observable aspects like self-esteem and socio-emotional functioning, the domains most affected by hearing loss. Methods This case-control study evaluated QoL in 50 preschoolers using a cochlear implant and their parents with the Kiddy KINDLR, an established QoL measure. Children’s responses were compared to a hearing control group and correlated with demographic variables. We used a questionnaire for parents and a face-to-face interview with children. T-tests were used to compare (a) paired parent-child ratings and (b) children with cochlear implants versus normal hearing. Spearman rank correlations were used to compare QoL with demographic variables. Results Children using cochlear implants rated overall QoL significantly more positively than their parents (MD = 4.22, p=.03). Child rating of QoL did not differ significantly by auditory status (cochlear implant (82.8) vs. hearing (80.8), p=0.42). Overall QoL correlated inversely with cochlear implant experience and chronologic age, but did not correlate with implantation age. Conclusions Preschool children using cochlear implants can assess adequately their own QoL, but parents afford valuable complementary perspective on the child’s socio-emotional and physical well-being. Preschool children using cochlear implants rate overall QoL measures similar to hearing peers. A constellation of QoL measures should be collected to yield a better understanding of general QoL as well as specific domains centered on hearing loss. PMID:19674798
Suzuki, Mitsuya; Goto, Takio; Kashio, Akinori; Yasui, Takuya; Sakamoto, Takashi; Ito, Ken; Yamasoba, Tatsuya
A 58-year-old man, in whom the cochlear implant (CI) had been inserted into the left ear, had right middle-ear cancer. The CI was removed immediately before receiving subtotal removal of right temporal bone. Four months later, the CI was again inserted in his left cochlea. Because of obliterated scala tympani, the 22 active electrodes of the CI were placed into the scala vestibuli. After the surgery, the patient complained that he experienced rotary vertigo and "jumbling of vertical direction" of objects on walking. Using rotation test, we evaluated vestibular function of remaining left ear. Numerous horizontal nystagmus beats were induced during earth-vertical axis rotation, whereas vertical downbeat nystagmus was scarcely induced during off-vertical axis rotation. The horizontal vestibulo-ocular reflex (VOR) was almost normally induced by sinusoidal stimulation at 0.8Hz. These data suggest that the scala vestibuli insertion of CI would be not so invasive against the lateral semicircular canal.
CHIN, STEVEN B.; PISONI, DAVID B.
This report is a description of a developing phonological system as manifested in the productions of a prelingually deafened child approximately 2 years after fitting with a Nucleus 22-Channel Multi-Electrode Cochlear Implant. A probe list consisting of 23 proper nouns familiar to the child was used to elicit samples of her speech; stimulus materials consisted of photographs of those persons (friends and family members) whose names were included in the probe list. Analysis of the child's productions addressed the composition of the phonetic inventory of consonants and vowels and the presence of syllable structure and other phonotactic constraints. Results indicated a rich inventory of speech sound segments (among both consonants and vowels) and a lack of stringent constraints on syllable structure and consonants permitted in specified word positions. A further comparative analysis of correspondences with the ambient language showed a number of patterns that are also common in the speech of children with normal hearing. PMID:22091697
Matsuda, Keiji; Okuda, Takumi; Tono, Tetsuya; Takaki, Minoru; Hayashi, Tamon; Hanamure, Yutaka
Atlantoaxial rotatory fixation (AARF) is a relatively rare condition and is mainly seen in children. We report of a 7-year-old girl suffering from AARF after cochlear implantation (CI). Fortunately, early diagnosis based on three-dimensional computed tomography (3DCT) was made, and the patient was cured with conservative therapy. Nontraumatic AARF, which is also known as Grisel's syndrome and occurs subsequent to neck infections or ear, nose, and throat (ENT) surgery, represents only a small fraction of AARF cases. Two factors are mainly thought to contribute to the pathogenesis of the condition estimated, namely, (i) neck immaturity in children and (ii) infiltration by inflammatory mediators around the upper neck joint, easily permitted by the neck vasculature. AARF should be suspected in case of torticollis developing after ENT surgery. PMID:27340580
Pakdaman, Michael N; Herrmann, Barbara S; Curtin, Hugh D; Van Beek-King, Jessica; Lee, Daniel J
Our aim was to determine the influence of inner-ear anomalies on surgical difficulty and postoperative audiologic outcomes among pediatric cochlear implant (CI) recipients at our institution. We reviewed medical and audiologic records from 78 consecutive pediatric CI cases between 1985 and June 2009. Thirty patients had high-resolution temporal bone computed tomography imaging available for retrospective interpretation. Seven of these 30 patients (23%) had cochleovestibular dysplasia. Fifty percent of patients with severe dysplasia had a cerebrospinal fluid gusher intraoperatively, compared with 13% of patients with no dysplasia. Of patients with available audiologic outcome data, 17 of 26 patients with normal/mild/moderate dysplasia were able to complete CNC testing, whereas neither of the 2 patients with severe dysplasia could complete the open set test. Our experience suggests that surgical difficulty and audiologic outcomes in pediatric CI recipients may be affected by the presence and severity of a cochleovestibular anomaly.
Nogueira, Waldo; Kátai, András; Harczos, Tamás; Klefenz, Frank; Buechner, Andreas; Edler, Bernd
A physiological and computational model of the human auditory system has been fitted in a signal processing strategy for cochlear implants (CIs). The aim of the new strategy is to obtain more natural sound in CIs by better mimicking the human auditory system. The new strategy was built in three independent stages as proposed in . First a basilar membrane motion model was substituted by the filterbank commonly used in commercial strategies. Second, an inner hair cell model was included in a commercial strategy while maintaining the original filterbank. Third, both the basilar membrane motion and the inner-hair cell model were included in the commercial strategy. This paper analyses the properties and presents results obtained with CI recipients for each algorithm designed.
Sreedevi, N; Lepcha, Anjali; Mathew, John
Objectives Speech intelligibility is severely affected in children with congenital profound hearing loss. Hypernasality is a problem commonly encountered in their speech. Auditory information received from cochlear implants is expected to be far superior to that from hearing aids. Our study aimed at comparing the percentages of nasality in the speech of the cochlear implantees with hearing aid users and also with children with normal hearing. Methods Three groups of subjects took part in the study. Groups I and II comprised 12 children each, in the age range of 4-10 years, with prelingual bilateral profound hearing loss, using multichannel cochlear implants and digital hearing aids respectively. Both groups had received at least one year of speech therapy intervention since cochlear implant surgery and hearing aid fitting respectively. The third group consisted of age-matched and sex-matched children with normal hearing. The subjects were asked to say a sentence which consisted of only oral sounds and no nasal sounds ("Buy baby a bib"). The nasalance score as a percentage was calculated. Results Statistical analysis revealed that the children using hearing aids showed a high percentage of nasalance in their speech. The cochlear implantees showed a lower percentage of nasalance compared to children using hearing aids, but did not match with their normal hearing peers. Conclusion The quality of speech of the cochlear implantees was superior to that of the hearing aid users, but did not match with the normal controls. The study suggests that acoustic variables still exist after cochlear implantation in children, with hearing impairments at deviant levels, which needs attention. Further research needs to be carried out to explore the effect of the age at implantation as a variable in reducing nasality in the speech and attaining normative values in cochlear implantees, and also between unilateral versus bilateral implantees. PMID:26330912
Punch, Renée; Hyde, Merv
This Australian study examined the communication, academic, and social outcomes of pediatric cochlear implantation from the perspectives of teachers working with children with cochlear implants. The children were aged from 1 to 18 years and attended a range of educational settings in early intervention, primary, and secondary schooling. One hundred and fifty-one teachers completed a survey on one child with a cochlear implant and 15 of these teachers were interviewed. Teachers reported their perceptions of children's functional outcomes in a range of communication, academic, social, independence, and identity areas. Reported achievements in literacy, numeracy, and social development were below class levels. Implications for educational authorities and professionals working with children with cochlear implants are discussed.
Justice, Ellie C.; Swanson, Lori A.; Buebler, Velvet
A study was conducted to examine the use of narrative-based language intervention (NBLI) with 3 children who have cochlear implants. Findings reveal that NBLI is effective intervention to increase the narrative skills of children with specific language impairment.
This text presents an overview of the bioethical debate on pediatric cochlear implants and pays particular attention to the analysis of the Deaf critique of implantation. It dismisses the idea that Deaf concerns are primarily about the upholding of Deaf culture and sign language. Instead it is argued that Deaf skepticism about child rehabilitation after cochlear surgery is well founded. Many Deaf people have lived experiences as subjects undergoing rehabilitation. It is not the cochlear technology in itself they view as problematic, but rather the subsequent rehabilitation process. Because they themselves have experienced what they describe as harmful effects which relate above all to the idea of normalization, they have articulated worries for the new generations of deaf children in need of rehabilitation following cochlear implant surgery. These insights have attracted little attention, but could represent relevant ethical questions of which both practitioners and researchers in the field of implantation might be aware.
Cabral Junior, Francisco; Pinna, Mariana Hausen; Alves, Ricardo Dourado; Malerbi, Andrea Felice Dos Santos; Bento, Ricardo Ferreira
Introduction Current data show that binaural hearing is superior to unilateral hearing, specifically in the understanding of speech in noisy environments. Furthermore, unilateral hearing reduce onés ability to localize sound. Objectives This study provides a systematic review of recent studies to evaluate the outcomes of cochlear implantation in patients with single-sided deafness (SSD) with regards to speech discrimination, sound localization and tinnitus suppression. Data Synthesis We performed a search in the PubMed, Cochrane Library and Lilacs databases to assess studies related to cochlear implantation in patients with unilateral deafness. After critical appraisal, eleven studies were selected for data extraction and analysis of demographic, study design and outcome data. Conclusion Although some studies have shown encouraging results on cochlear implantation and SSD, all fail to provide a high level of evidence. Larger studies are necessary to define the tangible benefits of cochlear implantation in patients with SSD.
Eshraghi, Adrien A.; Nazarian, Ronen; Telischi, Fred F.; Rajguru, Suhrud M.; Truy, Eric; Gupta, Chhavi
The cochlear implant (CI) is the first effective treatment for deafness and severe losses in hearing. As such, the CI is now widely regarded as one of the great advances in modern medicine. This paper reviews the key events and discoveries that led up to the current CI systems, and we review and present some among the many possibilities for further improvements in device design and performance. The past achievements include: (1) development of reliable devices that can be used over the lifetime of a patient; (2) development of arrays of implanted electrodes that can stimulate more than one site in the cochlea; and (3) progressive and large improvements in sound processing strategies for CIs. In addition, cooperation between research organizations and companies greatly accelerated the widespread availability and use of safe and effective devices. Possibilities for the future include: (1) use of otoprotective drugs; (2) further improvements in electrode designs and placements; (3) further improvements in sound processing strategies; (4) use of stem cells to replace lost sensory hair cells and neural structures in the cochlea; (5) gene therapy; (6) further reductions in the trauma caused by insertions of electrodes and other manipulations during implant surgeries; and (7) optical rather electrical stimulation of the auditory nerve. Each of these possibilities is the subject of active research. Although great progress has been made to date in the development of the CI, including the first substantial restoration of a human sense, much more progress seems likely and certainly would not be a surprise. PMID:23044644
Johnson, Carol; Goswami, Usha
Purpose: To explore the phonological awareness skills of deaf children with cochlear implants (CIs) and relationships with vocabulary and reading development. Method: Forty-three deaf children with implants who were between 5 and 15 years of age were tested; 21 had been implanted at around 2.5 years of age (Early CI group), and 22 had been…
Mather, Julie; Gregory, Sue; Archbold, Sue
Fifteen young people who had received sequential bilateral cochlear implants were interviewed about their experiences. The majority had become full-time users, and all found improvements in listening with the second implant, including those who did not continue to wear it. All would recommend sequential bilateral implantation to their peers. For…
Buhler, Helen C.; DeThomasis, Betty; Chute, Pat; DeCora, Anne
Phonological process use was investigated in five children who used Nucleus 24 cochlear implants (CIs). All participants were less than 3 years of age at the time of cochlear implantation and ranged from 4;2 to 4;7 years of age at onset of study. Speech samples obtained from the GFTA-2 were analyzed using the KLPA-2 to evaluate participants'…
Kileny, Paul R
Evoked potential measures are integral to the treatment of patients with cochlear implants. In particular, these techniques are useful in the management of the pediatric patient. This brief report describes three categories of evoked potentials including clinical and research examples: electrically evoked auditory brain stem responses with transtympanic stimulation, middle-latency responses with cochlear implant stimulation, and cognitive evoked potentials elicited by speech stimuli.
Hsiao, Fei-Lin; Gfeller, Kate
This paper outlines the skills required for participation in structured music programs and possible adaptations to facilitate successful participation by pediatric cochlear implant recipients. Common curricular components that present the structural features of music and the implications for perceptual and music production skills are discussed. A checklist of practical recommendations for clinicians, educators, and parents is provided to ensure success in integrating cochlear implant recipients into early childhood music programs.
Di Nardo, Walter; Giannantonio, Sara; Schinaia, Lorenzo; De Corso, Eugenio; Paludetti, Gaetano
MRI is a widespread and greatly helpful diagnostic tool, yet its use on cochlear implant patients is restricted by the presence of an inner magnet. We report on a case of magnet dislodgment after 1.5T MRI in a 31-year-old female with a Hi-Res 90K cochlear implant. In this case, it was possible to implement an alternative, totally noninvasive approach based on an external manual repositioning rather than a surgical procedure of the displaced magnet.
Marsella, P; Giannantonio, S; Scorpecci, A; Pianesi, F; Micardi, M; Resca, A
This is a prospective randomised study that evaluated the differences arising from a bimodal stimulation compared to a monaural electrical stimulation in deaf children, particularly in terms of auditory-perceptual skills development. We enrolled 39 children aged 12 to 36 months, suffering from severe-to-profound bilateral sensorineural hearing loss with residual hearing on at least one side. All were unilaterally implanted: 21 wore only the cochlear implant (CI) (unilateral CI group), while the other 18 used the CI and a contralateral hearing aid at the same time (bimodal group). They were assessed with a test battery designed to appraise preverbal and verbal auditory-perceptual skills immediately before and 6 and 12 months after implantation. No statistically significant differences were observed between groups at time 0, while at 6 and 12 months children in the bimodal group had better scores in each test than peers in the unilateral CI group. Therefore, although unilateral deafness/hearing does not undermine hearing acuity in normal listening, the simultaneous use of a CI and a contralateral hearing aid (binaural hearing through a bimodal stimulation) provides an advantage in terms of acquisition of auditory-perceptual skills, allowing children to achieve the basic milestones of auditory perception faster and in greater number than children with only one CI. Thus, "keeping awake" the contralateral auditory pathway, albeit not crucial in determining auditory acuity, guarantees benefits compared with the use of the implant alone. These findings provide initial evidence to establish shared guidelines for better rehabilitation of patients undergoing unilateral cochlear implantation, and add more evidence regarding the correct indications for bilateral cochlear implantation.
Svirsky, Mario; Holt, Rachael
Evidence shows that early implantation of congenitally deaf children is beneficial. However, infants as young as 6 months of age have started to receive cochlear implants (CIs) in the USA. Such early implantation may be associated with higher risks, including anesthetic risk as well as the increased possibility of a false positive in the diagnosis of profound deafness. On the other hand, delaying implantation may be associated with the risk of missing windows of opportunity or sensitive periods for the development of communication skills. In this study, speech perception and language skills in children who received CIs in the first, second, third, or fourth year of life were compared. Participants were tested at regular 6-month intervals after implantation. The effects of several potential confounds were considered. In general, children implanted earlier outperformed those implanted later, with one exception: infants implanted at 6-12 months showed similar outcomes to children implanted at 12-24 months, at least through 2 to 2-1/2 years of age. This preliminary result may be associated with the difficulty of choosing appropriate stimulation parameters for infants, and its potential influence on the quality of the stimulation patterns delivered by the CI.
Mauger, Stefan J; Dawson, Pam W; Hersbach, Adam A
Noise reduction in cochlear implants has achieved significant speech perception improvements through spectral subtraction and signal-to-noise ratio based noise reduction techniques. Current methods use gain functions derived through mathematical optimization or motivated by normal listening psychoacoustic experiments. Although these gain functions have been able to improve speech perception, recent studies have indicated that they are not optimal for cochlear implant noise reduction. This study systematically investigates cochlear implant recipients' speech perception and listening preference of noise reduction with a range of gain functions. Results suggest an advantageous gain function and show that gain functions currently used for noise reduction are not optimal for cochlear implant recipients. Using the cochlear implant optimised gain function, a 27% improvement over the current advanced combination encoder (ACE) stimulation strategy in speech weighted noise and a 7% improvement over current noise reduction strategies were observed in babble noise conditions. The optimized gain function was also most preferred by cochlear implant recipients. The CI specific gain function derived from this study can be easily incorporated into existing noise reduction strategies, to further improve listening performance for CI recipients in challenging environments.
Qadeer, Sadaf; Junaid, Montasir; Sobani, Zainul Abedeen; Nadeem, Naila; Awans, Mohammad Sohail
Autosomal-recessive genes account for about 80% of the patients of non-syndromic deafness, and a major portion of those lead to cochlear pathology. Given the strong cultural practice of consanguineous marriages and the lack of awareness regarding screening modalities, a high prevalence of hereditary pre-lingual deafness is seen in Pakistan. Considering the situation, cochlear implant surgery was introduced by Aga Khan University Hospital (AKUH), Karachi, Pakistan, in 2003. Recently we decided to expand the profile and services available and conducted the first ever cochlear implant on an anatomically-challenged cochlea. The case report relates to the experience of our pilot patient who was suffering from Mondini's deformity.
Choi, Ji Eun; Hong, Sung Hwa; Won, Jong Ho; Park, Hee-Sung; Cho, Young Sang; Chung, Won-Ho; Cho, Yang-Sun; Moon, Il Joon
Adults who score 50% correct or less in open-set sentence recognition test under the best aided listening condition may be considered as candidates for cochlear implant (CI). However, the requirement for ‘the best aided listening condition’ needs significant time and clinical resources to ensure such condition. As speech signals are composed of dynamic spectral and temporal modulations, psychoacoustic sensitivity to the combinations of spectral and temporal modulation cues may be a strong predictor for aided speech recognition. In this study, we tested 27 adults with moderately severe to profound hearing loss to explore the possibility that a non-linguistic unaided spectrotemporal modulation (STM) detection test might be a viable option as a surrogate measure to evaluate CI candidacy. Our results showed that STM detection thresholds were significantly correlated with aided sentence recognition scores for the 27 hearing impaired listeners. The receiver operator characteristic (ROC) curve analysis demonstrated that the CI candidacy evaluation by both unaided STM detection test and the traditional best-aided sentence recognition test was fairly consistent. More specifically, our results demonstrated that the STM detection test using a low spectral and temporal modulation rate might provide an efficient process for CI candidacy evaluation. PMID:27731425
Saxena, Rajeev C.; Lehmann, Ashton E.; Hight, A. Ed; Darrow, Keith; Remenschneider, Aaron; Kozin, Elliott D.; Lee, Daniel J.
Background More than 200,000 individuals worldwide have received a cochlear implant (CI). Social media Websites may provide a paramedical community for those who possess or are interested in a CI. The utilization patterns of social media by the CI community, however, have not been thoroughly investigated. Purpose The purpose of this study was to investigate participation of the CI community in social media Websites. Research Design We conducted a systematic survey of online CI-related social media sources. Using standard search engines, the search terms cochlear implant, auditory implant, forum, and blog identified relevant social media platforms and Websites. Social media participation was quantified by indices of membership and posts. Study Sample Social media sources included Facebook, Twitter, YouTube, blogs, and online forums. Each source was assigned one of six functional categories based on its description. Intervention No intervention was performed. Data Collection and Analysis We conducted all online searches in February 2014. Total counts of each CI-related social media source were summed, and descriptive statistics were calculated. Results More than 350 sources were identified, including 60 Facebook groups, 36 Facebook pages, 48 Twitter accounts, 121 YouTube videos, 13 forums, and 95 blogs. The most active online communities were Twitter accounts, which totaled 35,577 members, and Facebook groups, which totaled 17,971 members. CI users participated in Facebook groups primarily for general information/support (68%). Online forums were the next most active online communities by membership. The largest forum contained approximately 9,500 topics with roughly 127,000 posts. CI users primarily shared personal stories through blogs (92%), Twitter (71%), and YouTube (62%). Conclusions The CI community engages in the use of a wide range of online social media sources. The CI community uses social media for support, advocacy, rehabilitation information, research
Kim, Eunoak; Lee, Hyo-Jeong
Objectives Although the cochlear implant (CI) is successful for understanding speech in patients with severe to profound hearing loss, listening to music is a challenging task to most CI listeners. The purpose of this study was to assess music perception ability and to provide clinically useful information regarding CI rehabilitation. Methods Ten normal hearing and ten CI listeners with implant experience, ranging 2 to 6 years, participated in the subtests of pitch, rhythm, melody, and instrument. A synthesized piano tone was used as musical stimuli. Participants were asked to discriminate two different tones during the pitch subtest. The rhythm subtest was constructed with sets of five, six, and seven intervals. The melody & instrument subtests assessed recognition of eight familiar melodies and five musical instruments from a closed set, respectively. Results CI listeners performed significantly poorer than normal hearing listeners in pitch, melody, and instrument identification tasks. No significant differences were observed in rhythm recognition between groups. Correlations were not found between music perception ability and word recognition scores. Conclusion The results are consistent with previous studies that have shown that pitch, melody, and instrument identifications are difficult to identify for CI users. Our results can provide fundamental information concerning the development of CI rehabilitation tools. PMID:22701773
Castellanos, Irina; Kronenberger, William G.; Beer, Jessica; Colson, Bethany G.; Henning, Shirley C.; Ditmars, Allison; Pisoni, David B.
This study investigated if a period of auditory sensory deprivation followed by degraded auditory input and related language delays affects visual concept formation skills in long-term prelingually deaf cochlear implant (CI) users. We also examined if concept formation skills are mediated or moderated by other neurocognitive domains (i.e., language, working memory, and executive control). Relative to normally hearing (NH) peers, CI users displayed significantly poorer performance in several specific areas of concept formation, especially when multiple comparisons and relational concepts were components of the task. Differences in concept formation between CI users and NH peers were fully explained by differences in language and inhibition–concentration skills. Language skills were also found to be more strongly related to concept formation in CI users than in NH peers. The present findings suggest that complex relational concepts may be adversely affected by a period of early prelingual deafness followed by access to underspecified and degraded sound patterns and spoken language transmitted by a CI. Investigating a unique clinical population such as early-implanted prelingually deaf children with CIs can provide new insights into foundational brain–behavior relations and developmental processes. PMID:25583706
Castellanos, Irina; Kronenberger, William G; Beer, Jessica; Colson, Bethany G; Henning, Shirley C; Ditmars, Allison; Pisoni, David B
This study investigated if a period of auditory sensory deprivation followed by degraded auditory input and related language delays affects visual concept formation skills in long-term prelingually deaf cochlear implant (CI) users. We also examined if concept formation skills are mediated or moderated by other neurocognitive domains (i.e., language, working memory, and executive control). Relative to normally hearing (NH) peers, CI users displayed significantly poorer performance in several specific areas of concept formation, especially when multiple comparisons and relational concepts were components of the task. Differences in concept formation between CI users and NH peers were fully explained by differences in language and inhibition-concentration skills. Language skills were also found to be more strongly related to concept formation in CI users than in NH peers. The present findings suggest that complex relational concepts may be adversely affected by a period of early prelingual deafness followed by access to underspecified and degraded sound patterns and spoken language transmitted by a CI. Investigating a unique clinical population such as early-implanted prelingually deaf children with CIs can provide new insights into foundational brain-behavior relations and developmental processes.
This version of "Serving Deaf Students Who Have Cochlear Implants. PEPNet Tipsheet," written in Spanish, describes how cochlear implants (CIs) work. CIs are complex electronic devices surgically implanted under the skin behind the ear. These devices utilize electrodes placed in the inner ear (the cochlea) to stimulate the auditory nerve of…
George, Shefin S.; Shivdasani, Mohit N.; Wise, Andrew K.; Shepherd, Robert K.; Fallon, James B.
Objective. Speech intelligibility with existing multichannel cochlear implants (CIs) is thought to be limited by poor spatial selectivity and interactions between CI channels caused by overlapping activation with monopolar (MP) stimulation. Our previous studies have shown that focused multipolar (FMP) and tripolar (TP) stimulation produce more restricted neural activation in the inferior colliculus (IC), compared to MP stimulation. Approach. This study explored interactions in the IC produced by simultaneous stimulation of two CI channels. We recorded multi-unit neural activity in the IC of anaesthetized cats with normal and severely degenerated spiral ganglion neuron populations in response to FMP, TP and MP stimulation from a 14 channel CI. Stimuli were applied to a ‘fixed’ CI channel, chosen toward the middle of the cochlear electrode array, and the effects of simultaneously stimulating a more apical ‘test’ CI channel were measured as a function of spatial separation between the two stimulation channels and stimulus level of the fixed channel. Channel interactions were quantified by changes in neural responses and IC threshold (i.e., threshold shift) elicited by simultaneous stimulation of two CI channels, compared to stimulation of the test channel alone. Main results. Channel interactions were significantly lower for FMP and TP than for MP stimulation (p < 0.001), whereas no significant difference was observed between FMP and TP stimulation. With MP stimulation, threshold shifts increased with decreased inter-electrode spacing and increased stimulus levels of the fixed channel. For FMP and TP stimulation, channel interactions were found to be similar for different inter-electrode spacing and stimulus levels of the fixed channel. Significance. The present study demonstrates how the degree of channel interactions in a CI can be controlled using stimulation configurations such as FMP and TP; such knowledge is essential in enhancing CI function in complex
Lesser, Juan Carlos Cisneros; Brito Neto, Rubens Vuono de; Martins, Graziela de Souza Queiroz; Bento, Ricardo Ferreira
Introduction Middle fossa approach has been suggested as an alternative for patients in whom other routes of electrode insertion are contraindicated. Even though there are temporal bone studies about the feasibility of introducing the cochlear implant through the middle fossa, until now, very few studies have described results when cochlear implant surgery is done through this approach. Objective The objective of this study is to review a series of temporal bone studies related to cochlear implantation through the middle fossa and the results obtained by different surgical groups after cochlear implantation through this approach. Data Sources PubMed, MD consult and Ovid-SP databases. Data Synthesis A total of 8 human cadaveric temporal bone studies and 6 studies reporting cochlear implant surgery through the middle fossa approach met the inclusion criteria. Temporal bone studies show that it is feasible to perform cochlear implantation through this route. So far, only two surgical groups have performed cochlear implantation through the middle fossa with a total of 15 implanted patients. One group entered the cochlea in the most upper part of the basal turn, inserting the implant in the direction of the middle and apical turns; meanwhile, the other group inserted the implant in the apical turn directed in a retrograde fashion to the middle and basal turns. Results obtained in both groups were similar. Conclusions The middle fossa approach is a good alternative for cochlear implantation when other routes of electrode insertion are contraindicated. PMID:28050216
Lesser, Juan Carlos Cisneros; Brito Neto, Rubens Vuono de; Martins, Graziela de Souza Queiroz; Bento, Ricardo Ferreira
Introduction Middle fossa approach has been suggested as an alternative for patients in whom other routes of electrode insertion are contraindicated. Even though there are temporal bone studies about the feasibility of introducing the cochlear implant through the middle fossa, until now, very few studies have described results when cochlear implant surgery is done through this approach. Objective The objective of this study is to review a series of temporal bone studies related to cochlear implantation through the middle fossa and the results obtained by different surgical groups after cochlear implantation through this approach. Data Sources PubMed, MD consult and Ovid-SP databases. Data Synthesis A total of 8 human cadaveric temporal bone studies and 6 studies reporting cochlear implant surgery through the middle fossa approach met the inclusion criteria. Temporal bone studies show that it is feasible to perform cochlear implantation through this route. So far, only two surgical groups have performed cochlear implantation through the middle fossa with a total of 15 implanted patients. One group entered the cochlea in the most upper part of the basal turn, inserting the implant in the direction of the middle and apical turns; meanwhile, the other group inserted the implant in the apical turn directed in a retrograde fashion to the middle and basal turns. Results obtained in both groups were similar. Conclusions The middle fossa approach is a good alternative for cochlear implantation when other routes of electrode insertion are contraindicated.
Background Visual cross-modal re-organization is a neurophysiological process that occurs in deafness. The intact sensory modality of vision recruits cortical areas from the deprived sensory modality of audition. Such compensatory plasticity is documented in deaf adults and animals, and is related to deficits in speech perception performance in cochlear-implanted adults. However, it is unclear whether visual cross-modal re-organization takes place in cochlear-implanted children and whether it may be a source of variability contributing to speech and language outcomes. Thus, the aim of this study was to determine if visual cross-modal re-organization occurs in cochlear-implanted children, and whether it is related to deficits in speech perception performance. Methods Visual evoked potentials (VEPs) were recorded via high-density EEG in 41 normal hearing children and 14 cochlear-implanted children, aged 5–15 years, in response to apparent motion and form change. Comparisons of VEP amplitude and latency, as well as source localization results, were conducted between the groups in order to view evidence of visual cross-modal re-organization. Finally, speech perception in background noise performance was correlated to the visual response in the implanted children. Results Distinct VEP morphological patterns were observed in both the normal hearing and cochlear-implanted children. However, the cochlear-implanted children demonstrated larger VEP amplitudes and earlier latency, concurrent with activation of right temporal cortex including auditory regions, suggestive of visual cross-modal re-organization. The VEP N1 latency was negatively related to speech perception in background noise for children with cochlear implants. Conclusion Our results are among the first to describe cross modal re-organization of auditory cortex by the visual modality in deaf children fitted with cochlear implants. Our findings suggest that, as a group, children with cochlear implants show
Shafiro, Valeriy; Gygi, Brian; Cheng, Min-Yu; Vachhani, Jay; Mulvey, Megan
Objectives Environmental sound perception serves an important ecological function by providing listeners with information about objects and events in their immediate environment. Environmental sounds such as car horns, baby cries or chirping birds can alert listeners to imminent dangers as well as contribute to one's sense of awareness and well being. Perception of environmental sounds as acoustically and semantically complex stimuli, may also involve some factors common to the processing of speech. However, very limited research has investigated the abilities of cochlear implant (CI) patients to identify common environmental sounds, despite patients' general enthusiasm about them. This project (1) investigated the ability of patients with modern-day CIs to perceive environmental sounds, (2) explored associations among speech, environmental sounds and basic auditory abilities, and (3) examined acoustic factors that might be involved in environmental sound perception. Design Seventeen experienced postlingually-deafened CI patients participated in the study. Environmental sound perception was assessed with a large-item test composed of 40 sound sources, each represented by four different tokens. The relationship between speech and environmental sound perception, and the role of working memory and some basic auditory abilities were examined based on patient performance on a battery of speech tests (HINT, CNC, and individual consonant and vowel tests), tests of basic auditory abilities (audiometric thresholds, gap detection, temporal pattern and temporal order for tones tests) and a backward digit recall test. Results The results indicated substantially reduced ability to identify common environmental sounds in CI patients (45.3%). Except for vowels, all speech test scores significantly correlated with the environmental sound test scores: r = 0.73 for HINT in quiet, r = 0.69 for HINT in noise, r = 0.70 for CNC, r = 0.64 for consonants and r = 0.48 for vowels. HINT and
Holt, Rachael Frush; Beer, Jessica; Kronenberger, William G.; Pisoni, David B.; Lalonde, Kaylah
Purpose To evaluate the family environments of children with cochlear implants and to examine relationships between family environment and post-implant language development and executive function. Method Forty-five families of children with cochlear implants completed a self-report family environment questionnaire (FES) and an inventory of executive function (BRIEF/BRIEF-P). Children’s receptive vocabulary (PPVT-4) and global language skills (PLS-4/CELF-4) were also evaluated. Results The family environments of children with cochlear implants differed from those of normal-hearing children, but not in clinically significant ways. Language development and executive function were found to be atypical, but not uncharacteristic of this clinical population. Families with higher levels of self-reported control had children with smaller vocabularies. Families reporting a higher emphasis on achievement had children with fewer executive function and working memory problems. Finally, families reporting a higher emphasis on organization had children with fewer problems related to inhibition. Conclusions Some of the variability in cochlear implantation outcomes that have protracted periods of development is related to family environment. Because family environment can be modified and enhanced by therapy or education, these preliminary findings hold promise for future work in helping families to create robust language-learning environments that can maximize their child’s potential with a cochlear implant. PMID:22232387
Loy, Betty; Warner-Czyz, Andrea D.; Tong, Liyue; Tobey, Emily A.; Roland, Peter S.
Objective To examine the results of health-related quality of life questionnaire scores from profoundly deaf children fitted with at least one cochlear implant and compare responses to normal hearing age mates and to their parents. Study design Cross sectional study utilizing a generic quality of life questionnaire designed to be completed by both parents and children independently of each other. Setting Questionnaires completed at various summer camps designed for children with cochlear implants in Texas and Colorado. Subjects and Methods Eighty-eight families from 16 states were divided in to two subgroups by age of cochlear implantation: an 8–11 year old group and one 12–16 year old group. The KINDLR Questionnaire for Measuring Health-Related Quality of Life in Children and Adolescents was distributed and participants completed the questionnaire independently from their participating family member. Results CI users in both age groups scored similarly to their normal hearing peers and their parents. Younger CI users scored their family domain lower than their normal hearing peers. Teen CI users scored the school domain lower than their parents. Among CI participants, earlier implantation and longer cochlear implant use resulted in higher Quality of Life scores. Conclusion Children with cochlear implants experience similar quality of life as normal hearing peers. Parents are reliable reporters on the status of their child’s overall quality of life. PMID:20115983
Reda, Fitsum A.; Dawant, Benoit M.; McRackan, Theodore R.; Labadie, Robert F.; Noble, Jack H.
A cochlear implant (CI) is a neural prosthetic device that restores hearing by directly stimulating the auditory nerve with an electrode array. In CI surgery, the surgeon threads the electrode array into the cochlea, blind to internal structures. We have recently developed algorithms for determining the position of CI electrodes relative to intra-cochlear anatomy using pre- and post-implantation CT. We are currently using this approach to develop a CI programming assistance system that uses knowledge of electrode position to determine a patient-customized CI sound processing strategy. However, this approach cannot be used for the majority of CI users because the cochlea is obscured by image artifacts produced by CI electrodes and acquisition of pre-implantation CT is not universal. In this study we propose an approach that extends our techniques so that intra-cochlear anatomy can be segmented for CI users for which pre-implantation CT was not acquired. The approach achieves automatic segmentation of intra-cochlear anatomy in post-implantation CT by exploiting intra-subject symmetry in cochlear anatomy across ears. We validated our approach on a dataset of 10 ears in which both pre- and post-implantation CTs were available. Our approach results in mean and maximum segmentation errors of 0.27 and 0.62 mm, respectively. This result suggests that our automatic segmentation approach is accurate enough for developing customized CI sound processing strategies for unilateral CI patients based solely on postimplantation CT scans.
Hudson, V E; Elniel, A; Ughratdar, I; Zebian, B; Selway, R; Lin, J P
Cochlear implants for sensorineural deafness in children is one of the most successful neuromodulation techniques known to relieve early chronic neurodisability, improving activity and participation. In 2012 there were 324,000 recipients of cochlear implants globally.
Öztürk, Erkan; Doruk, Can; Orhan, Kadir Serkan; Çelik, Mehmet; Polat, Beldan; Güldiken, Yahya
Cochlear implants are mechanical devices used for patients with severe sensory-neural hearing loss, which has an inner magnet. It is proven that 1.5 Tesla magnetic resonance imaging (MRI) scanners are safe to use in patients with cochlear implant. In our patient, the authors aim to introduce a rare complication caused after a 1.5 Tesla MRI scanning and the management of this situation; the reversion of the magnet of the implant without displacement and significance of surgery in management.
Snow, David P.; Ertmer, David J.
This article describes the development of intonation in 12 cochlear implant (CI) recipients. In a previously reported study of the first year of CI use, children who were implanted late (after 24 months) acquired intonation more rapidly than the younger participants. The older children's advantage is plausibly owing to their greater maturity.…
Martin, Daniela; Bat-Chava, Yael; Lalwani, Anil; Waltzman, Susan B.
This study investigated factors that affect the development of positive peer relationships among deaf children with cochlear implants. Ten 5- to 6-year-old deaf children with implants were observed under conditions varying peer context difficulty in a Peer Entry task. Results revealed better outcomes for deaf children interacting in one-on-one…
Schraer-Joiner, Lyn E.; Chen-Hafteck, Lily
The purpose of this study was to investigate the musical experiences of preschool cochlear implant users. Research objectives were to examine: (1) musical, social and emotional responses to activities; and (2) whether length of experience with the implant influenced responses. Participants were three prelingually deafened children, age 4,…
Hyde, Merv; Punch, Renee; Komesaroff, Linda
Findings of a study that investigated parents' expectations and experiences of their children's outcomes with cochlear implants are presented. A survey completed by 247 parents whose children had received implants in eastern Australia compared parents' reports of their preimplant expectations with their experiences of postimplant outcomes on…
Snow, David P.; Ertmer, David J.
This article describes the longitudinal development of intonation in 18 deaf children who received cochlear implants (CIs) before the age of 3 years and 12 infants with typical development (TD) who served as controls. At the time their implants were activated, the children with CIs ranged in age from 9 to 36 months. Cross-group comparisons were…
Mather, Julie; Archbold, Sue; Gregory, Sue
A semi-structured interview format was used to explore the experiences and attitudes of twelve parents and twelve teachers of young people, aged 11-18 years, who had received sequential bilateral cochlear implants. The parents stressed the importance of involving the young person in the decision to go ahead with the second implant. Although all…
Goffman, Lisa; Ertmer, David J.; Erdle, Christa
A method is presented for examining change in motor patterns used to produce linguistic contrasts. In this case study, the method is applied to a child who experienced hearing loss at age 3 and received a multi-channel cochlear implant at 7. Post-implant, acoustic durations showed a maturational change. (Contains references.) (Author/CR)
Vecchiato, G; Maglione, A G; Scorpecci, A; Malerba, P; Marsella, P; Di Francesco, G; Vitiello, S; Colosimo, A; Babiloni, Fabio
Interestingly, the international debate about the quality of music fruition for cochlear implanted users does not take into account the hypothesis that bilateral users could perceive music in a more pleasant way with respect to monolateral users. In this scenario, the aim of the present study was to investigate if cerebral signs of pleasantness during music perception in healthy child are similar to those observed in monolateral and in bilateral cochlear implanted users. In fact, previous observations in literature on healthy subjects have indicated that variations of the frontal EEG alpha activity are correlated with the perceived pleasantness of the sensory stimulation received (approach-withdrawal theory). In particular, here we described differences between cortical activities estimated in the alpha frequency band for a healthy child and in patients having a monolateral or a bilateral cochlear implant during the fruition of a musical cartoon. The results of the present analysis showed that the alpha EEG asymmetry patterns observed in a healthy child and that of a bilateral cochlear implanted patient are congruent with the approach-withdrawal theory. Conversely, the scalp topographic distribution of EEG power spectra in the alpha band resulting from the monolateral cochlear user presents a different EEG pattern from the normal and bilateral implanted patients. Such differences could be explained at the light of the approach-withdrawal theory. In fact, the present findings support the hypothesis that a monolateral cochlear implanted user could perceive the music in a less pleasant way when compared to a healthy subject or to a bilateral cochlear user.
Agrawal, Vinamra; Newbold, Carrie
In the last few decades, cochlear implants have experienced major developments with intensive studies carried out through experimental and computational analysis. With the rapid increase in computational resources available and the development of efficient computational techniques, computer models of the cochlea and the cochlear implant have become more sophisticated. It is now possible to analyze the micromechanics of the cochlea and the transient response of tissue to external stimulation. This study reviews the major developments in cochlear models, summarizes, and categorizes features of models used in different studies and makes recommendations for future development. The paper is classified into four sections detailing features of the cochlear models, electrodes, electrical stimulation, and software used in different studies. The paper highlights unexplored areas in the model design and suggests additions to develop a better computer model.
Sousa, Aline Faria de; Carvalho, Ana Claudia Martinho de; Couto, Maria Ines Vieira; Tsuji, Robinson Koji; Goffi-Gomez, Maria Valéria Schmidt; Bento, Ricardo Ferreira; Matas, Carla Gentile; Befi-Lopes, Debora Maria
Introduction Difficulties with telephone use by adult users of cochlear implants (CIs) are reported as a limitation in daily life. Studies to improve the speech understanding of CI users on the telephone are scarce in the Brazilian scientific literature. Objective To develop and evaluate the effectiveness of a training program of auditory abilities on the telephone for an adult CI user. Resumed Report The subject was a 55-year-old woman with a degree in accounting who used a CI for 24 months. The program consisted of three stages: pretraining evaluation, eight sessions of advanced auditory abilities training, and post-training evaluation. Auditory abilities with CI were evaluated before and after training in three conditions: sound field, telephone with the speech processor in the microphone function, and telephone with the speech processor in the telecoil function. Speech recognition was assessed by three different lists: one with monosyllabic and dissyllabic words, another with nonsense syllables, and another one with sentences. The Client Oriented Scale of Improvement (COSI) was used to assess whether the needs established by the CI user in everyday telephone use situations improved after training. The auditory abilities training resulted in a relevant improvement in the percentage of correct answers in speech tests both in the telephone use conditions and in the sound field condition. Conclusion The results obtained with the COSI inventory indicated a performance improvement in all situations presented at the beginning of the program. PMID:26157504
Looi, Valerie; Gfeller, Kate; Driscoll, Virginia
In recent years, there has been increasing interest in music perception of cochlear implant (CI) recipients, and a growing body of research conducted in this area. The majority of these studies have examined perceptual accuracy for pitch, rhythm, and timbre. Another important, but less commonly studied aspect of music listening is appreciation, or appraisal. Despite the ongoing research into potential technological improvements that may improve music perception for recipients, both perceptual accuracy and appreciation generally remain poor for most recipients. Whilst perceptual accuracy for music is important, appreciation and enjoyment also warrants research as it also contributes to clinical outcomes and perceived benefits. Music training is being shown to offer excellent potential for improving music perception and appreciation for recipients. Therefore, the primary topics of this review are music appreciation and training. However, a brief overview of the psychoacoustic, technical, and physiological factors associated with a recipient’s perception of music is provided, as these are important factors in understanding the listening experience for CI recipients. The purpose of this review is to summarize key papers that have investigated these issues, in order to demonstrate that i) music enjoyment and appraisal is an important and valid consideration in evaluating music outcomes for recipients, and ii) that music training can improve music listening for many recipients, and is something that can be offered to persons using current technology. PMID:23459244
van Hoesel, Richard J M
Various measures of binaural timing sensitivity were made in three bilateral cochlear implant users, who had demonstrated moderate-to-good interaural time delay (ITD) sensitivity at 100 pulses-per-second (pps). Overall, ITD thresholds increased at higher pulse rates, lower levels, and shorter durations, although intersubject differences were evident. Monaural rate-discrimination thresholds, using the same stimulation parameters, showed more substantial elevation than ITDs with increased rate. ITD sensitivity with 6000 pps stimuli, amplitude-modulated at 100 Hz, was similar to that with unmodulated pulse trains at 100 pps, but at 200 and 300 Hz performance was poorer than with unmodulated signals. Measures of sensitivity to binaural beats with unmodulated pulse-trains showed that all three subjects could use time-varying ITD cues at 100 pps, but not 300 pps, even though static ITD sensitivity was relatively unaffected over that range. The difference between static and dynamic ITD thresholds is discussed in terms of relative contributions from initial and later arriving cues, which was further examined in an experiment using two-pulse stimuli as a function of interpulse separation. In agreement with the binaural-beat data, findings from that experiment showed poor discrimination of ITDs on the second pulse when the interval between pulses was reduced to a few milliseconds.
Lutman, Mark E.; Ewert, Stephan D.; Li, Guoping; Bleeck, Stefan
Current cochlear implant (CI) strategies carry speech information via the waveform envelope in frequency subbands. CIs require efficient speech processing to maximize information transfer to the brain, especially in background noise, where the speech envelope is not robust to noise interference. In such conditions, the envelope, after decomposition into frequency bands, may be enhanced by sparse transformations, such as nonnegative matrix factorization (NMF). Here, a novel CI processing algorithm is described, which works by applying NMF to the envelope matrix (envelopogram) of 22 frequency channels in order to improve performance in noisy environments. It is evaluated for speech in eight-talker babble noise. The critical sparsity constraint parameter was first tuned using objective measures and then evaluated with subjective speech perception experiments for both normal hearing and CI subjects. Results from vocoder simulations with 10 normal hearing subjects showed that the algorithm significantly enhances speech intelligibility with the selected sparsity constraints. Results from eight CI subjects showed no significant overall improvement compared with the standard advanced combination encoder algorithm, but a trend toward improvement of word identification of about 10 percentage points at +15 dB signal-to-noise ratio (SNR) was observed in the eight CI subjects. Additionally, a considerable reduction of the spread of speech perception performance from 40% to 93% for advanced combination encoder to 80% to 100% for the suggested NMF coding strategy was observed. PMID:26721919
In patients with bilateral cochlear implants (CIs), pairing matched interaural electrodes and stimulating them with the same frequency band is expected to facilitate binaural functions such as binaural fusion, localization, and spatial release from masking. Because clinical procedures typically do not include patient-specific interaural electrode pairing, it remains the case that each electrode is allocated to a generic frequency range, based simply on the electrode number. Two psychoacoustic techniques for determining interaurally paired electrodes have been demonstrated in several studies: interaural pitch comparison and interaural time difference (ITD) sensitivity. However, these two methods are rarely, if ever, compared directly. A third, more objective method is to assess the amplitude of the binaural interaction component (BIC) derived from electrically evoked auditory brainstem responses for different electrode pairings; a method has been demonstrated to be a potential candidate for bilateral CI users. Here, we tested all three measures in the same eight CI users. We found good correspondence between the electrode pair producing the largest BIC and the electrode pair producing the maximum ITD sensitivity. The correspondence between the pairs producing the largest BIC and the pitch-matched electrode pairs was considerably weaker, supporting the previously proposed hypothesis that whilst place pitch might adapt over time to accommodate mismatched inputs, sensitivity to ITDs does not adapt to the same degree. PMID:26631108
Goldsworthy, Raymond L; Shannon, Robert V
The purpose of this study was to determine the extent to which cochlear implant (CI) rate discrimination can be improved through training. Six adult CI users took part in a study that included 32 h of training and assessment on rate discrimination measures. Rate difference limens (DLs) were measured from 110 to 3520 Hz in octave steps using 500 ms biphasic pulse trains; the target and standard stimuli were loudness-balanced with the target always at an adaptively lower rate. DLs were measured at four electrode positions corresponding to basal, mid-basal, mid-apical, and apical locations. Procedural variations were implemented to determine if rate discrimination was impacted by random variations in stimulus amplitude or by amplitude modulation. DLs improved by more than a factor of 2 across subjects, electrodes, and standard rates. Factor analysis indicated that the effect of training was comparable for all electrodes and standard rates tested. Neither level roving nor amplitude modulation had a significant effect on rate DLs. In conclusion, the results demonstrate that training can significantly improve CI rate discrimination on a psychophysical task.
Kong, Ying-Yee; Carlyon, Robert P
A recent study reported that a group of Med-El COMBI 40+CI (cochlear implant) users could, in a forced-choice task, detect changes in the rate of a pulse train for rates higher than the 300 pps "upper limit" commonly reported in the literature [Kong, Y.-Y., et al. (2009). J. Acoust. Soc. Am. 125, 1649-1657]. The present study further investigated the upper limit of temporal pitch in the same group of CI users on three tasks [pitch ranking, rate discrimination, and multidimensional scaling (MDS)]. The patterns of results were consistent across the three tasks and all subjects could follow rate changes above 300 pps. Two subjects showed exceptional ability to follow temporal pitch change up to about 900 pps. Results from the MDS study indicated that, for the two listeners tested, changes in pulse rate over the range of 500-840 pps were perceived along a perceptual dimension that was orthogonal to the place of excitation. Some subjects showed a temporal pitch reversal at rates beyond their upper limit of pitch and some showed a reversal within a small range of rates below the upper limit. These results are discussed in relation to the possible neural bases for temporal pitch processing at high rates.
Koester, AnjaLi Carrasco; Mailloux, Zoe; Coleman, Gina Geppert; Mori, Annie Baltazar; Paul, Steven M; Blanche, Erna; Muhs, Jill A; Lim, Deborah; Cermak, Sharon A
OBJECTIVE. We investigated sensory integration (SI) function in children with cochlear implants (CIs). METHOD. We analyzed deidentified records from 49 children ages 7 mo to 83 mo with CIs. Records included Sensory Integration and Praxis Tests (SIPT), Sensory Processing Measure (SPM), Sensory Profile (SP), Developmental Profile 3 (DP-3), and Peabody Developmental Motor Scales (PDMS), with scores depending on participants' ages. We compared scores with normative population mean scores and with previously identified patterns of SI dysfunction. RESULTS. One-sample t tests revealed significant differences between children with CIs and the normative population on the majority of the SIPT items associated with the vestibular and proprioceptive bilateral integration and sequencing (VPBIS) pattern. Available scores for children with CIs on the SPM, SP, DP-3, and PDMS indicated generally typical ratings. CONCLUSION. SIPT scores in a sample of children with CIs reflected the VPBIS pattern of SI dysfunction, demonstrating the need for further examination of SI functions in children with CIs during occupational therapy assessment and intervention planning.
Music represents a considerable challenge for many adult users of cochlear implants (CIs). Around half of adult CI users report that they do not find music enjoyable, and, in some cases, despite enhanced speech perception skills, this leads to considerable frustration and disappointment for the CI user. This paper presents suggestions to improve the musical experiences of deafened adults with CIs. Interviews with a number of adult CI users revealed that there were a number of factors which could lead to enhanced music experiences. The acronym FAVORS (familiar music, auditory-visual access, open-mindedness, and simple arrangements) summarizes the factors that have been identified, which can help CI users in their early music listening experiences. Each of these factors is discussed in detail, along with suggestions for how they can be used in therapy sessions. The use of a group approach (music focus groups) is also discussed and an overview of the approach and exercises used is presented. The importance of live music experiences is also discussed.
Walker, Elizabeth A.; McGregor, Karla K.
Purpose To determine whether three aspects of the word learning process—fast mapping, retention, and extension—are problematic for children with cochlear implants (CIs). Method We compared responses of 24 children with CIs, 24 age-matched hearing children and 23 vocabulary-matched hearing children to a novel object noun training episode. Comprehension and production were measured immediately following training (fast mapping) as well as one day later (retention). Extension was measured in terms of the ability of the participants to identify new (untrained) exemplars. Results Compared to their hearing age-mates, children with CIs performed marginally more poorly on fast mapping as measured by the comprehension probe and more poorly on retention as measured by comprehension and production probes. The age-mates improved over the retention interval but the children with CIs did not. Most of the children with CIs performed similarly to their age-mates on extension but two children underextended and five failed to understand the task. Compared to younger vocabulary-matched peers, children with CIs did not differ at fast mapping, retention, or extension. Conclusions Children with CIs demonstrated deficits in word learning, with retention being especially problematic. Their learning did not differ from that of younger children with similarly sized vocabularies. PMID:22896047
Shah, Udayan K.; Pawel, Bruce R.; Potsic, William P.
Cochlear implantation is a treatment for deafness that requires the surgical placement of electrodes within the cochlea, using a high-speed drill. While the drill is effective, the tip of the drill or the drill shaft may damage critical adjacent structures, such as the facial nerve. In addition, the narrow working spaces involved in this surgery make the drill a relatively cumbersome tool for such delicate work. The use of a flexible fiber to deliver the laser energy may make the surgery easier by allowing a more maneuverable instrument to access the region, while reducing the risk of injuring adjacent structures. We report our preliminary investigation of fiber delivery of CTH:YAG energy ((lambda) equals 2091 nm) for the purpose of bony ablation. A 550 micron diameter low-OH silica fiber was used to drill through up to 2.5 mm thick human temporal bone specimens. An average of 14 pulses was required for 1 mm thick bones, and an average of 33 pulses required to ablate 2 mm of bone. The holes drilled were precise, and showed limited adjacent tissue effect by gross and histopathologic evaluation. This work demonstrates the effective fiberoptic delivery of CTH:YAG energy for bone ablation. Further work is warranted to explore the clinical possibilities offered by this technique for precise bony ablation with limited adjacent tissue effect.
Shirvani, Sareh; Jafari, Zahra; Sheibanizadeh, Abdolreza; Motasaddi Zarandy, Masoud; Jalaie, Shohre
Introduction: Cochlear implantation (CI) improves language skills among children with hearing loss. However, children with CIs still fall short of fulfilling some other needs, including musical perception. This is often attributed to the biological, technological, and acoustic limitations of CIs. Emotions play a key role in the understanding and enjoyment of music. The present study aimed to investigate the emotional perception of music in children with bilaterally severe-to-profound hearing loss and unilateral CIs. Materials and Methods: Twenty-five children with congenital severe-to-profound hearing loss and unilateral CIs and 30 children with normal hearing participated in the study. The children’s emotional perceptions of music, as defined by Peretz (1998), were measured. Children were instructed to indicate happy or sad feelings fostered in them by the music by pointing to pictures of faces showing these emotions. Results: Children with CI obtained significantly lower scores than children with normal hearing, for both happy and sad items of music as well as in overall test scores (P<0.001). Furthermore, both in CI group (P=0.49) and the control one (P<0.001), the happy items were more often recognized correctly than the sad items. Conclusion: Hearing-impaired children with CIs had poorer emotional perception of music than their normal peers. Due to the importance of music in the development of language, cognitive and social interaction skills, aural rehabilitation programs for children with CIs should focus particularly on music. Furthermore, it is essential to enhance the quality of musical perception by improving the quality of implant prostheses. PMID:25320700
Rask-Andersen, Helge; Erixon, Elsa; Kinnefors, Anders; Löwenheim, Hubert; Schrott-Fischer, Anneliese; Liu, Wei
Since the classical description by Retzius in 1884, many extensive studies of the micro-anatomy of the human cochlea have been presented. The human cochlea is one of the most difficult tissues to study due to the bony capsule and its delicate contents. Most preparations suffer from post-mortem changes caused by the delay between demise and fixation. For over a decade, we have analyzed human inner-ear tissue obtained at surgery using transmission electron microscopy, scanning electron microscopy, in vitro culture, and immunohistochemistry. These studies show the value of these techniques for fine structural and molecular analyses. Modern cochlear implant surgery requires that ear surgeons are familiar with the intricate anatomy of the human cochlea and its variations. The classical technique to insert electrode arrays through a drilled cochleostomy has been abandoned by some surgeons today. Instead a round-window approach can be used as originally implemented by William House for short electrodes. This so-called 'hook' region of the cochlea presents extensive anatomical variations that can be difficult to foresee on pre-operative computed tomography. CI depends on the functional status of remaining spiral ganglion neurons. These cells are more or less preserved in CI patients but how the conservation influences the outcome of CI is debatable. Notwithstanding their preservation is crucial and more information should be attained about their deterioration and how it can be prevented. Better understanding of structure, function, and regenerative capability is needed to comprehend the nature of electrical stimulation of the peripheral and central nervous system to improve the design of future implant systems.
Friesen, Lendra M; Shannon, Robert V; Cruz, Rachel J
Phoneme and speech recognition were measured as a function of stimulation pulse rate in 12 listeners with three types of cochlear implants. Identification of consonants and vowels and recognition of words and sentences were measured in 5 Clarion C1 subjects fit with continuous interleaved sampling (CIS) processors having 4 or 8 electrodes, 4 Nucleus 24 subjects fit with CIS processors having 4, 8, 12 or 16 electrodes and 3 Clarion C2 subjects fit with CIS processors with 4, 8, 12 and 16 electrodes. Stimulation rates ranged from 200 to more than 5000 Hz per electrode, depending on the device, number of electrodes used and stimulation strategy. Listeners were also tested on the same materials with their original processor prior to receiving the experimental processors. All testing was done in quiet listening conditions with essentially no practice with the experimental processor prior to data collection. Listeners scored the highest with their original processor. Little difference in speech understanding was observed for listener scores with processors using different stimulation rates. Speech recognition was significantly poorer only at the lowest stimulation rate and at high rates that used noninterleaved pulses. Speech recognition was similar for processors using 8, 12 or 16 electrodes. Only 4-electrode processors produced a significantly poorer performance. These results suggest that patients with present commercial implants are not able to make full use of the number of channels of spectral information delivered by the present speech processors. In addition, the results show no significant change in performance as a function of stimulation rate, suggesting that high stimulation rates do not result in improved access to temporal cues in speech, at least under quiet listening conditions.
Yi, Haijin; Guo, Weiwei; Chen, Wei; Chen, Lei; Ye, Jingying; Yang, Shiming
The objective of this paper was to investigate the suitability of the miniature pig as a large animal model of cochlear implantation (CI). Micro-CT scanning and three-dimensional reconstructions of the inner ear were completed in six animals. Photographs of the procedures and measurements of the inner ear were made. The CI procedure was simulated in 10 animals. Electrically evoked auditory brain stem responses (EABRs) and radiographic images were evaluated during or after the CI procedure. Morphological examination and measurements of inner ears of the miniature pigs were completed by micro-CT scanning. The height of the scala tympani was 873.12 µm in the 1st turn, 641.46 µm in the 2nd turn, 445.13 µm in the third turn and 339.19 µm in the fourth turn. The length of the cochlea was 38.6 mm, larger than other animal models (7.2 mm in rats and 22 mm in macaque, for example) and similar to that in the human (36 mm). Commercial electrodes used in humans (870 µm at the end and 630 µm at the tip in diameter) were implanted in the pig’s cochlea, through which normal eABRs were obtained. Radiographic images after the CI procedure revealed electrodes located in the scala tympani of the first and second turns. Compared with traditional animal models, greater similarities of the inner ear between miniature pigs and humans make this animal a potentially useful model for CI studies. PMID:28078020
Fu, Qian-Jie; Chinchilla, Sherol; Nogaki, Geraldine; Galvin, John J.
The present study explored the relative contributions of spectral and temporal information to voice gender identification by cochlear implant users and normal-hearing subjects. Cochlear implant listeners were tested using their everyday speech processors, while normal-hearing subjects were tested under speech processing conditions that simulated various degrees of spectral resolution, temporal resolution, and spectral mismatch. Voice gender identification was tested for two talker sets. In Talker Set 1, the mean fundamental frequency values of the male and female talkers differed by 100 Hz while in Talker Set 2, the mean values differed by 10 Hz. Cochlear implant listeners achieved higher levels of performance with Talker Set 1, while performance was significantly reduced for Talker Set 2. For normal-hearing listeners, performance was significantly affected by the spectral resolution, for both Talker Sets. With matched speech, temporal cues contributed to voice gender identification only for Talker Set 1 while spectral mismatch significantly reduced performance for both Talker Sets. The performance of cochlear implant listeners was similar to that of normal-hearing subjects listening to 4-8 spectral channels. The results suggest that, because of the reduced spectral resolution, cochlear implant patients may attend strongly to periodicity cues to distinguish voice gender.
Bazon, Aline Cristine; Mantello, Erika Barioni; Gonçales, Alina Sanches; Isaac, Myriam de Lima; Hyppolito, Miguel Angelo; Reis, Ana Cláudia Mirândola Barbosa
Introduction The objective of the evaluation of auditory perception of cochlear implant users is to determine how the acoustic signal is processed, leading to the recognition and understanding of sound. Objective To investigate the differences in the process of auditory speech perception in individuals with postlingual hearing loss wearing a cochlear implant, using two different speech coding strategies, and to analyze speech perception and handicap perception in relation to the strategy used. Methods This study is prospective cross-sectional cohort study of a descriptive character. We selected ten cochlear implant users that were characterized by hearing threshold by the application of speech perception tests and of the Hearing Handicap Inventory for Adults. Results There was no significant difference when comparing the variables subject age, age at acquisition of hearing loss, etiology, time of hearing deprivation, time of cochlear implant use and mean hearing threshold with the cochlear implant with the shift in speech coding strategy. There was no relationship between lack of handicap perception and improvement in speech perception in both speech coding strategies used. Conclusion There was no significant difference between the strategies evaluated and no relation was observed between them and the variables studied. PMID:27413409
Jepsen, Kim Sune; Bertilsson, T Margareta
Cochlear Implantation is now regarded as the most successful medical technology. It carries promises to provide deaf/hearing impaired individuals with a technological sense of hearing and an access to participate on a more equal level in social life. In this article, we explore the adoption of cochlear implantations among Danish users in order to shed more light on their social and political implications. We situate cochlear implantation in a framework of new life science advances, politics, and user experiences. Analytically, we draw upon the notion of social imaginary and explore the social dimension of life science through a notion of public politics adopted from the political theory of John Dewey. We show how cochlear implantation engages different social imaginaries on the collective and individual levels and we suggest that users share an imaginary of being "wired to freedom" that involves new access to social life, continuous communicative challenges, common practices, and experiences. In looking at their lives as "wired to freedom," we hope to promote a wider spectrum of civic participation in the benefit of future life science developments within and beyond the field of Cochlear Implantation. As our empirical observations are largely based in the Scandinavian countries (notably Denmark), we also provide some reflections on the character of the technology-friendly Scandinavian welfare states and the unintended consequences that may follow in the wake of rapid technology implementation of life science in society.
Limb, Charles J; Roy, Alexis T
Despite advances in technology, the ability to perceive music remains limited for many cochlear implant users. This paper reviews the technological, biological, and acoustical constraints that make music an especially challenging stimulus for cochlear implant users, while highlighting recent research efforts to overcome these shortcomings. The limitations of cochlear implant devices, which have been optimized for speech comprehension, become evident when applied to music, particularly with regards to inadequate spectral, fine-temporal, and dynamic range representation. Beyond the impoverished information transmitted by the device itself, both peripheral and central auditory nervous system deficits are seen in the presence of sensorineural hearing loss, such as auditory nerve degeneration and abnormal auditory cortex activation. These technological and biological constraints to effective music perception are further compounded by the complexity of the acoustical features of music itself that require the perceptual integration of varying rhythmic, melodic, harmonic, and timbral elements of sound. Cochlear implant users not only have difficulty perceiving spectral components individually (leading to fundamental disruptions in perception of pitch, melody, and harmony) but also display deficits with higher perceptual integration tasks required for music perception, such as auditory stream segregation. Despite these current limitations, focused musical training programs, new assessment methods, and improvements in the representation and transmission of the complex acoustical features of music through technological innovation offer the potential for significant advancements in cochlear implant-mediated music perception.
Won, Jong Ho; Jones, Gary L; Drennan, Ward R; Jameyson, Elyse M; Rubinstein, Jay T
Spectral-ripple discrimination has been used widely for psychoacoustical studies in normal-hearing, hearing-impaired, and cochlear implant listeners. The present study investigated the perceptual mechanism for spectral-ripple discrimination in cochlear implant listeners. The main goal of this study was to determine whether cochlear implant listeners use a local intensity cue or global spectral shape for spectral-ripple discrimination. The effect of electrode separation on spectral-ripple discrimination was also evaluated. Results showed that it is highly unlikely that cochlear implant listeners depend on a local intensity cue for spectral-ripple discrimination. A phenomenological model of spectral-ripple discrimination, as an "ideal observer," showed that a perceptual mechanism based on discrimination of a single intensity difference cannot account for performance of cochlear implant listeners. Spectral modulation depth and electrode separation were found to significantly affect spectral-ripple discrimination. The evidence supports the hypothesis that spectral-ripple discrimination involves integrating information from multiple channels.
Chouard, C H
On September 10th 2013, the clinical medical research Lasker award winners were rewarded for their work on multichannel cochlear implant. It has been my pleasure to see that such a major topic had caught the attention of the Members of the Jury for this prestigious award. That is why I accepted an invitation to participate in a special issue of Hearing Research devoted to the three winners. Here I highlight four scientific contributions made by the French team in late 1970s and early 1980s to modern multichannel cochlear implant development. 1) Chouard and MacLeod plotted an approximate frequency map of the whole length of the human cochlea, including its "hidden face" corresponding to speech frequencies. Moreover MacLeod suggested a sequential display of electrical stimulation as a function of each electrode, a precursor to today's electrodogram and interleaved stimulation. 2) Chouard performed total cochlear implantation in a deaf adult male with 8 electrically independent electrodes that were evenly distributed along the cochlea. 3) Chouard and MacLeod described in a patent detailed sound signal processing for a functional multichannel cochlear implant and reported speech discrimination without help of lip reading in some totally deafened patients. 4) Chouard experimentally demonstrated in the guinea pig the advantage of early cochlear implantation in treating profound neonatal deafness. This article is part of a Special Issue entitled
Amraei, K; Amirsalari, S; Ajalloueyan, M
Hearing impairment is a common type of sensory loss in children. Studies indicate that children with hearing impairment are deficient in social, cognitive and communication skills. This study compared the intelligence quotients of first- and second-generation deaf children with cochlear implants. This research is causal-comparative. All 15 deaf children investigated had deaf parents and were selected from Baqiyatallah Cochlear Implant Center. The 15 children with cochlear implants were paired with similar children with hearing parents using purposive sampling. The findings show that the Hotelling trace of multivariate analysis of variance (F = 6.78, p < 0.01, ηP(2) = 0.73) was significant. The tests of between-subjects effects for second-generation children was significantly higher than for first-generation children for all intelligence scales except knowledge. It can be assumed that second-generation children joined their family in the use of sign language as the primary experience before a cochlear implant. The use of sign language before cochlear implants is recommended.
Nguyen, Yann; Miroir, Mathieu; Kazmitcheff, Guillaume; Sutter, Jasmine; Bensidhoum, Morad; Ferrary, Evelyne; Sterkers, Olivier; Bozorg Grayeli, Alexis
Cochlear implant array insertion forces are potentially related to cochlear trauma. We compared these forces between a standard (Digisonic SP; Neurelec, Vallauris, France) and an array prototype (Neurelec) with a smaller diameter. The arrays were inserted by a mechatronic tool in 23 dissected human cochlea specimens exposing the basilar membrane. The array progression under the basilar membrane was filmed together with dynamic force measurements. Insertion force profiles and depth of insertion were compared. The recordings showed lower insertion forces beyond 270° of insertion and deeper insertions with the thin prototype array. This will potentially allow larger cochlear coverage with less trauma.
Papsin, Blake C.; Paludetti, Gaetano; Gordon, Karen A.
Children using unilateral cochlear implants abnormally rely on tempo rather than mode cues to distinguish whether a musical piece is happy or sad. This led us to question how this judgment is affected by the type of experience in early auditory development. We hypothesized that judgments of the emotional content of music would vary by the type and duration of access to sound in early life due to deafness, altered perception of musical cues through new ways of using auditory prostheses bilaterally, and formal music training during childhood. Seventy-five participants completed the Montreal Emotion Identification Test. Thirty-three had normal hearing (aged 6.6 to 40.0 years) and 42 children had hearing loss and used bilateral auditory prostheses (31 bilaterally implanted and 11 unilaterally implanted with contralateral hearing aid use). Reaction time and accuracy were measured. Accurate judgment of emotion in music was achieved across ages and musical experience. Musical training accentuated the reliance on mode cues which developed with age in the normal hearing group. Degrading pitch cues through cochlear implant-mediated hearing induced greater reliance on tempo cues, but mode cues grew in salience when at least partial acoustic information was available through some residual hearing in the contralateral ear. Finally, when pitch cues were experimentally distorted to represent cochlear implant hearing, individuals with normal hearing (including those with musical training) switched to an abnormal dependence on tempo cues. The data indicate that, in a western culture, access to acoustic hearing in early life promotes a preference for mode rather than tempo cues which is enhanced by musical training. The challenge to these preferred strategies during cochlear implant hearing (simulated and real), regardless of musical training, suggests that access to pitch cues for children with hearing loss must be improved by preservation of residual hearing and improvements in
Giannantonio, Sara; Polonenko, Melissa J; Papsin, Blake C; Paludetti, Gaetano; Gordon, Karen A
Children using unilateral cochlear implants abnormally rely on tempo rather than mode cues to distinguish whether a musical piece is happy or sad. This led us to question how this judgment is affected by the type of experience in early auditory development. We hypothesized that judgments of the emotional content of music would vary by the type and duration of access to sound in early life due to deafness, altered perception of musical cues through new ways of using auditory prostheses bilaterally, and formal music training during childhood. Seventy-five participants completed the Montreal Emotion Identification Test. Thirty-three had normal hearing (aged 6.6 to 40.0 years) and 42 children had hearing loss and used bilateral auditory prostheses (31 bilaterally implanted and 11 unilaterally implanted with contralateral hearing aid use). Reaction time and accuracy were measured. Accurate judgment of emotion in music was achieved across ages and musical experience. Musical training accentuated the reliance on mode cues which developed with age in the normal hearing group. Degrading pitch cues through cochlear implant-mediated hearing induced greater reliance on tempo cues, but mode cues grew in salience when at least partial acoustic information was available through some residual hearing in the contralateral ear. Finally, when pitch cues were experimentally distorted to represent cochlear implant hearing, individuals with normal hearing (including those with musical training) switched to an abnormal dependence on tempo cues. The data indicate that, in a western culture, access to acoustic hearing in early life promotes a preference for mode rather than tempo cues which is enhanced by musical training. The challenge to these preferred strategies during cochlear implant hearing (simulated and real), regardless of musical training, suggests that access to pitch cues for children with hearing loss must be improved by preservation of residual hearing and improvements in
Le Normand, M-T; Ouellet, C; Cohen, H
The productivity of lexical categories was studied longitudinally in a sample of 17 young hearing-impaired French-speaking children with cochlear implants. Age of implantation ranged from 22 months to 76 months. Spontaneous speech samples were collected at six-month intervals over a period of 36 months, starting at the one-word stage. Four general measures of their linguistic production (number of utterances, verbal fluency, vocabulary, and grammatical production) as well as 36 specific lexical categories, according to the CHILDES codes, were computed in terms of tokens, i.e., total number of words. Cochlear-implanted children (CI) were compared to a French database of normally hearing children aged 2-4 compiled by the first author. Follow-up results indicate that, at the two-year post-implantation follow-up, noun, and verb morphology was significantly impaired. At the three-year follow-up, the cochlear-implanted group had recovered on adjectives, determiners and nouns, main verbs, and auxiliaries. The two groups differed significantly in processing locative adverbs, prepositions, pronouns, and verbs (infinitive verb, modal, and modal lexical), but individual variability within the cochlear-implanted group was substantial. Results are discussed in terms of recovery and developmental trends and variability in the acquisition of lexical categories by French children two years and three years post-implantation.
Ceresa, Mario; Mangado, Nerea; Andrews, Russell J; Gonzalez Ballester, Miguel A
Electrical stimulation of the brain has resulted in the most successful neuroprosthetic techniques to date: deep brain stimulation (DBS) and cochlear implants (CI). In both cases, there is a lack of pre-operative measures to predict the outcomes after implantation. We argue that highly detailed computational models that are specifically tailored for a patient can provide useful information to improve the precision of the nervous system electrode interface. We apply our framework to the case of CI, showing how we can predict nerve response for patients with both intact and degenerated nerve fibers. Then, using the predicted response, we calculate a metric for the usefulness of the stimulation protocol and use this information to rerun the simulations with better parameters.
National Institutes of Health (DHHS), Bethesda, MD.
This paper reports the results of a Consensus Development Conference on Cochlear Implants sponsored by the National Institutes of Health to improve the hearing of children and adults with hearing impairments. The following questions are addressed: (1) Who is a suitable candidate for a cochlear implant? (2) What are the advantages and disadvantages…
Bruin, Marieke; Nevøy, Anne
After pediatric cochlear implantation, parents have to make decisions concerning which communication modality the child and the child's family will use. The choice has to be made against a background of opposing views on communication modality in follow-up after pediatric cochlear implantation. The opposing views form a discourse that has…
Chen, Yuan; Wong, Lena L. N.; Zhu, Shufeng; Xi, Xin
Objective To examine the direct and indirect effects of demographical factors on speech perception and vocabulary outcomes of Mandarin-speaking children with cochlear implants (CIs). Methods 115 participants implanted before the age of 5 and who had used CI before 1 to 3 years were evaluated using a battery of speech perception and vocabulary tests. Structural equation modeling was used to test the hypotheses proposed. Results Early implantation significantly contributed to speech perception outcomes while having undergone a hearing aid trial (HAT) before implantation, maternal educational level (MEL), and having undergone universal newborn hearing screening (UNHS) before implantation had indirect effects on speech perception outcomes via their effects on age at implantation. In addition, both age at implantation and MEL had direct and indirect effects on vocabulary skills, while UNHS and HAT had indirect effects on vocabulary outcomes via their effects on age at implantation. Conclusion A number of factors had indirect and direct effects on speech perception and vocabulary outcomes in Mandarin-speaking children with CIs and these factors were not necessarily identical to those reported among their English-speaking counterparts. PMID:26348360
Ali, Hussnain; Lobo, Arthur P.; Loizou, Philipos C.
This paper discusses the design, development, features, and clinical evaluation of a personal digital assistant (PDA)-based platform for cochlear implant research. This highly versatile and portable research platform allows researchers to design and perform complex experiments with cochlear implants manufactured by Cochlear Corporation with great ease and flexibility. The research platform includes a portable processor for implementing and evaluating novel speech processing algorithms, a stimulator unit which can be used for electrical stimulation and neurophysio-logic studies with animals, and a recording unit for collecting electroencephalogram/evoked potentials from human subjects. The design of the platform for real time and offline stimulation modes is discussed for electric-only and electric plus acoustic stimulation followed by results from an acute study with implant users for speech intelligibility in quiet and noisy conditions. The results are comparable with users’ clinical processor and very promising for undertaking chronic studies. PMID:23674422
Allingham, David; Stocks, Nigel G.; Morse, Robert P.; Meyer, Georg F.
Cochlear implants are used to restore functional hearing to people with profound deafness. Success, as measured by speech intelligibility scores, varies greatly amongst patients; a few receive almost no benefit while some are able to use a telephone under favourable listening conditions. Using a novel nerve model and the principles of suprathreshold stochastic resonance, we demonstrate that the rate of information transfer through a cochlear implant system can be globally maximized by the addition of noise. If this additional information could be used by the brain then it would lead to greater speech intelligibility, which is important given that the intelligibility of all cochlear implant recipients is poorer than that of people with normal hearing, particularly in adverse listening conditions.
Leybaert, Jacqueline; LaSasso, Carol J.
Nearly 300 million people worldwide have moderate to profound hearing loss. Hearing impairment, if not adequately managed, has strong socioeconomic and affective impact on individuals. Cochlear implants have become the most effective vehicle for helping profoundly deaf children and adults to understand spoken language, to be sensitive to environmental sounds, and, to some extent, to listen to music. The auditory information delivered by the cochlear implant remains non-optimal for speech perception because it delivers a spectrally degraded signal and lacks some of the fine temporal acoustic structure. In this article, we discuss research revealing the multimodal nature of speech perception in normally-hearing individuals, with important inter-subject variability in the weighting of auditory or visual information. We also discuss how audio-visual training, via Cued Speech, can improve speech perception in cochlear implantees, particularly in noisy contexts. Cued Speech is a system that makes use of visual information from speechreading combined with hand shapes positioned in different places around the face in order to deliver completely unambiguous information about the syllables and the phonemes of spoken language. We support our view that exposure to Cued Speech before or after the implantation could be important in the aural rehabilitation process of cochlear implantees. We describe five lines of research that are converging to support the view that Cued Speech can enhance speech perception in individuals with cochlear implants. PMID:20724357
Palomeque Vera, Juan Miguel; Platero Sánchez-Escribano, María; Gómez Hervás, Javier; Fernández Prada, María; González Ramírez, Amanda Rocío; Sainz Quevedo, Manuel
Inner ear bone malformations are one cause of profound sensorineural hearing loss. This investigation focused on those affecting the posterior labyrinth, especially enlarged vestibular aqueduct syndrome, which is associated with fluctuating and progressive hearing loss. The objectives of this study were to analyze the behavior of the electrical stimulation, auditory functionality and linguistic development in patients with inner ear malformations involving the posterior labyrinth. The study included ten patients undergoing cochlear implantation (cases: five with enlarged vestibular aqueduct, two with vestibular aqueduct stenosis/aplasia, and three with semicircular canal disorders). Post-implantation, data were gathered on the electrical stimulation threshold and maximum comfort levels and on the number of functioning electrodes. Evaluation of Auditory Responses to Speech (EARS) subtests were used to assess auditory functionality and language acquisition at 6, 12, and 24 months post-implantation. Results were compared with findings in a control group of 28 cochlear implantation patients without these malformations. No significant differences were found between case and control groups in electrical stimulation parameters; auditory functionality subtest scores were lower in cases than controls, although the difference was only statistically significant for some subtests. In conclusion, cochlear implantation patients with posterior labyrinth bone malformations and profound hearing loss, including those with enlarged vestibular aqueduct syndrome, showed no significant difference in electrical stimulation threshold with controls. Although some auditory functionality test results were lower in cases than in controls, cochlear implantation appears to be beneficial for all patients with these malformations.
Jiang, Yi; Gu, Ping; Li, Beicheng; Gao, Xue; Sun, Baochun; Song, Yueshuai; Wang, Guojian; Yuan, Yongyi; Wang, Cuicui; Liu, Miao; Han, Dongyi; Dai, Pu
Objectives: To analyze complications associated with minimally invasive cochlear implantation by comparing data from different centers, to discuss major reasons for complications, and to refine implantation techniques to decrease them. Patients: Patients who underwent cochlear implantation at our center by the same surgeon (the corresponding author of this article) from March 2006 to March 2015 were enrolled. Intervention: First, a retrospective analysis of the complications associated with minimally invasive cochlear implantation at our center was performed. Second, published reports from other centers that describe complications were reviewed. Differences between complications in our cohort and other studies were evaluated. Main Outcome Measure: Strategies for reducing complications were assessed and modifications in surgical protocol proposed accordingly. Results: In total, 1,014 patients underwent 1,065 cochlear implantations. There were 28 complications (7 major, 21 minor) and only 2 reimplantations for the entire cohort, with no case of severe infection, flap necrosis, or device extrusion. The major complications were electrode misplacement, magnet displacement, implant failure secondary to trauma, and temporary cerebrospinal fluid leakage. The rates of major complications in our cohort were very low (0.6%) compared with those in the literature. Conclusion: Preoperative surgical planning based on individual patient anatomy and employment of soft surgical techniques can minimize surgical complications. PMID:28192378
Luo, Xin; Chang, Yi-Ping; Lin, Chun-Yi; Chang, Ronald Y
Native Mandarin normal-hearing (NH) listeners can easily perceive lexical tones even under conditions of great voice pitch variations across speakers by using the pitch contrast between context and target stimuli. It is however unclear whether cochlear implant (CI) users with limited access to pitch cues can make similar use of context pitch cues for tone normalization. In this study, native Mandarin NH listeners and pre-lingually deafened unilaterally implanted CI users were asked to recognize a series of Mandarin tones varying from Tone 1 (high-flat) to Tone 2 (mid-rising) with or without a preceding sentence context. Most of the CI subjects used a hearing aid (HA) in the non-implanted ear (i.e., bimodal users) and were tested both with CI alone and CI + HA. In the test without context, typical S-shaped tone recognition functions were observed for most CI subjects and the function slopes and perceptual boundaries were similar with either CI alone or CI + HA. Compared to NH subjects, CI subjects were less sensitive to the pitch changes in target tones. In the test with context, NH subjects had more (resp. fewer) Tone-2 responses in a context with high (resp. low) fundamental frequencies, known as the contrastive context effect. For CI subjects, a similar contrastive context effect was found statistically significant for tone recognition with CI + HA but not with CI alone. The results suggest that the pitch cues from CIs may not be sufficient to consistently support the pitch contrast processing for tone normalization. The additional pitch cues from aided residual acoustic hearing can however provide CI users with a similar tone normalization capability as NH listeners.
Luo, Xin; Chang, Yi-ping; Lin, Chun-yi; Chang, Ronald Y.
Native Mandarin normal-hearing (NH) listeners can easily perceive lexical tones even under conditions of great voice pitch variations across speakers by using the pitch contrast between context and target stimuli. It is however unclear whether cochlear implant (CI) users with limited access to pitch cues can make similar use of context pitch cues for tone normalization. In this study, native Mandarin NH listeners and pre-lingually deafened unilaterally implanted CI users were asked to recognize a series of Mandarin tones varying from Tone 1 (high-flat) to Tone 2 (mid-rising) with or without a preceding sentence context. Most of the CI subjects used a hearing aid (HA) in the non-implanted ear (i.e., bimodal users) and were tested both with CI alone and CI+HA. In the test without context, typical S-shaped tone recognition functions were observed for most CI subjects and the function slopes and perceptual boundaries were similar with either CI alone or CI+HA. Compared to NH subjects, CI subjects were less sensitive to the pitch changes in target tones. In the test with context, NH subjects had more (resp. fewer) Tone-2 responses in a context with high (resp. low) fundamental frequencies, known as the contrastive context effect. For CI subjects, a similar contrastive context effect was found statistically significant for tone recognition with CI+HA but not with CI alone. The results suggest that the pitch cues from CIs may not be sufficient to consistently support the pitch contrast processing for tone normalization. The additional pitch cues from aided residual acoustic hearing can however provide CI users with a similar tone normalization capability as NH listeners. PMID:24576834
Silva, Liliane Aparecida Fagundes; Couto, Maria Inês Vieira; Magliaro, Fernanda C. L.; Tsuji, Robinson Koji; Bento, Ricardo Ferreira; de Carvalho, Ana Claudia Martinho; Matas, Carla Gentile
Central auditory pathway maturation in children depends on auditory sensory stimulation. The objective of the present study was to monitor the cortical maturation of children with cochlear implants using electrophysiological and auditory skills measurements. The study was longitudinal and consisted of 30 subjects, 15 (8 girls and 7 boys) of whom had a cochlear implant, with a mean age at activation time of 36.4 months (minimum, 17 months; maximum, 66 months), and 15 of whom were normal-hearing children who were matched based on gender and chronological age. The auditory and speech skills of the children with cochlear implants were evaluated using GASP, IT-MAIS and MUSS measures. Both groups underwent electrophysiological evaluation using long-latency auditory evoked potentials. Each child was evaluated at three and nine months after cochlear implant activation, with the same time interval adopted for the hearing children. The results showed improvements in auditory and speech skills as measured by IT-MAIS and MUSS. Similarly, the long-latency auditory evoked potential evaluation revealed a decrease in P1 component latency; however, the latency remained significantly longer than that of the hearing children, even after nine months of cochlear implant use. It was observed that a shorter P1 latency corresponded to more evident development of auditory skills. Regarding auditory behavior, it was observed that children who could master the auditory skill of discrimination showed better results in other evaluations, both behavioral and electrophysiological, than those who had mastered only the speech-detection skill. Therefore, cochlear implant auditory stimulation facilitated auditory pathway maturation, which decreased the latency of the P1 component and advanced the development of auditory and speech skills. The analysis of the long-latency auditory evoked potentials revealed that the P1 component was an important biomarker of auditory development during the
Rossi, Roberta; Scimemi, Pietro; Cama, Elona; Valentino, Maria Lucia; La Morgia, Chiara; Caporali, Leonardo; Liguori, Rocco; Magnavita, Vincenzo; Monteleone, Anna; Biscaro, Ariella; Arslan, Edoardo; Carelli, Valerio
Hearing impairment is the second most prevalent clinical feature after optic atrophy in dominant optic atrophy associated with mutations in the OPA1 gene. In this study we characterized the hearing dysfunction in OPA1-linked disorders and provided effective rehabilitative options to improve speech perception. We studied two groups of OPA1 subjects, one comprising 11 patients (seven males; age range 13–79 years) carrying OPA1 mutations inducing haploinsufficiency, the other, 10 subjects (three males; age range 5–58 years) carrying OPA1 missense mutations. Both groups underwent audiometric assessment with pure tone and speech perception evaluation, and otoacoustic emissions and auditory brainstem response recording. Cochlear potentials were recorded through transtympanic electrocochleography from the group of patients harbouring OPA1 missense mutations and were compared to recordings obtained from 20 control subjects with normal hearing and from 19 subjects with cochlear hearing loss. Eight patients carrying OPA1 missense mutations underwent cochlear implantation. Speech perception measures and electrically-evoked auditory nerve and brainstem responses were obtained after 1 year of cochlear implant use. Nine of 11 patients carrying OPA1 mutations inducing haploinsufficiency had normal hearing function. In contrast, all but one subject harbouring OPA1 missense mutations displayed impaired speech perception, abnormal brainstem responses and presence of otoacoustic emissions consistent with auditory neuropathy. In electrocochleography recordings, cochlear microphonic had enhanced amplitudes while summating potential showed normal latency and peak amplitude consistent with preservation of both outer and inner hair cell activities. After cancelling the cochlear microphonic, the synchronized neural response seen in both normally-hearing controls and subjects with cochlear hearing loss was replaced by a prolonged, low-amplitude negative potential that decreased in both
Won, Jong Ho; Moon, Il Joon; Jin, Sunhwa; Park, Heesung; Woo, Jihwan; Cho, Yang-Sun; Chung, Won-Ho; Hong, Sung Hwa
Spectrotemporal modulation (STM) detection performance was examined for cochlear implant (CI) users. The test involved discriminating between an unmodulated steady noise and a modulated stimulus. The modulated stimulus presents frequency modulation patterns that change in frequency over time. In order to examine STM detection performance for different modulation conditions, two different temporal modulation rates (5 and 10 Hz) and three different spectral modulation densities (0.5, 1.0, and 2.0 cycles/octave) were employed, producing a total 6 different STM stimulus conditions. In order to explore how electric hearing constrains STM sensitivity for CI users differently from acoustic hearing, normal-hearing (NH) and hearing-impaired (HI) listeners were also tested on the same tasks. STM detection performance was best in NH subjects, followed by HI subjects. On average, CI subjects showed poorest performance, but some CI subjects showed high levels of STM detection performance that was comparable to acoustic hearing. Significant correlations were found between STM detection performance and speech identification performance in quiet and in noise. In order to understand the relative contribution of spectral and temporal modulation cues to speech perception abilities for CI users, spectral and temporal modulation detection was performed separately and related to STM detection and speech perception performance. The results suggest that that slow spectral modulation rather than slow temporal modulation may be important for determining speech perception capabilities for CI users. Lastly, test-retest reliability for STM detection was good with no learning. The present study demonstrates that STM detection may be a useful tool to evaluate the ability of CI sound processing strategies to deliver clinically pertinent acoustic modulation information.
Di Nardo, W; Schinaia, L; Anzivino, R; De Corso, E; Ciacciarelli, A; Paludetti, G
Although the voice in a free field has an excellent recruitment by a cochlear implant (CI), the situation is different for music because it is a much more complex process, where perceiving the pitch discrimination becomes important to appreciate it. The aim of this study is to determine the music perception abilities among children with Cis and to verify the benefit of a training period for specific musical frequency discrimination. Our main goals were to prepare a computer tool for pitch discrimination training and to assess musical improvements. Ten children, aged between 5 and 12 years, with optimal phoneme recognition in quiet and with no disabilities associated with deafness, were selected to join the training. Each patient received, before training period, two types of exams: a pitch discrimination test, consisting of discovering if two notes were different or not; and a music test consisting of two identification tasks (melodic and full version) of one music-item among 5 popular childhood songs. After assessment, a music training software was designed and utilised individually at home for a period of six months. The results following complete training showed significantly higher performance in the task of frequency discrimination. After a proper musical training identification, frequency discrimination performance was significantly higher (p < 0.001). The same considerations can be made in the identification of the songs presented in their melodic (p = 0.0151) and full songs version (p = 0.0071). Cases where children did not reach the most difficult level may be due to insufficient time devoted to training (ideal time estimated at 2-3 hours per week). In conclusion, this study shows that is possible to assess musical enhancement and to achieve improvements in frequency discrimination, following pitch discrimination training.
Won, Jong Ho; Moon, Il Joon; Jin, Sunhwa; Park, Heesung; Woo, Jihwan; Cho, Yang-Sun; Chung, Won-Ho; Hong, Sung Hwa
Spectrotemporal modulation (STM) detection performance was examined for cochlear implant (CI) users. The test involved discriminating between an unmodulated steady noise and a modulated stimulus. The modulated stimulus presents frequency modulation patterns that change in frequency over time. In order to examine STM detection performance for different modulation conditions, two different temporal modulation rates (5 and 10 Hz) and three different spectral modulation densities (0.5, 1.0, and 2.0 cycles/octave) were employed, producing a total 6 different STM stimulus conditions. In order to explore how electric hearing constrains STM sensitivity for CI users differently from acoustic hearing, normal-hearing (NH) and hearing-impaired (HI) listeners were also tested on the same tasks. STM detection performance was best in NH subjects, followed by HI subjects. On average, CI subjects showed poorest performance, but some CI subjects showed high levels of STM detection performance that was comparable to acoustic hearing. Significant correlations were found between STM detection performance and speech identification performance in quiet and in noise. In order to understand the relative contribution of spectral and temporal modulation cues to speech perception abilities for CI users, spectral and temporal modulation detection was performed separately and related to STM detection and speech perception performance. The results suggest that that slow spectral modulation rather than slow temporal modulation may be important for determining speech perception capabilities for CI users. Lastly, test–retest reliability for STM detection was good with no learning. The present study demonstrates that STM detection may be a useful tool to evaluate the ability of CI sound processing strategies to deliver clinically pertinent acoustic modulation information. PMID:26485715
Fuller, Christina D; Gaudrain, Etienne; Clarke, Jeanne N; Galvin, John J; Fu, Qian-Jie; Free, Rolien H; Başkent, Deniz
In normal hearing (NH), the perception of the gender of a speaker is strongly affected by two anatomically related vocal characteristics: the fundamental frequency (F0), related to vocal pitch, and the vocal tract length (VTL), related to the height of the speaker. Previous studies on gender categorization in cochlear implant (CI) users found that performance was variable, with few CI users performing at the level of NH listeners. Data collected with recorded speech produced by multiple talkers suggests that CI users might rely more on F0 and less on VTL than NH listeners. However, because VTL cannot be accurately estimated from recordings, it is difficult to know how VTL contributes to gender categorization. In the present study, speech was synthesized to systematically vary F0, VTL, or both. Gender categorization was measured in CI users, as well as in NH participants listening to unprocessed (only synthesized) and vocoded (and synthesized) speech. Perceptual weights for F0 and VTL were derived from the performance data. With unprocessed speech, NH listeners used both cues (normalized perceptual weight: F0 = 3.76, VTL = 5.56). With vocoded speech, NH listeners still made use of both cues but less efficiently (normalized perceptual weight: F0 = 1.68, VTL = 0.63). CI users relied almost exclusively on F0 while VTL perception was profoundly impaired (normalized perceptual weight: F0 = 6.88, VTL = 0.59). As a result, CI users' gender categorization was abnormal compared to NH listeners. Future CI signal processing should aim to improve the transmission of both F0 cues and VTL cues, as a normal gender categorization may benefit speech understanding in competing talker situations.
Bender, Denise G
Currently, the decision concerning pediatric cochlear implantation for children remains a personal choice for parents to make. Economic factors, educational outcomes, and societal attitudes concerning deafness could result in an increased governmental interest in this choice. This article examines case law related to the issue of parental autonomy to determine whether the state, acting in the role of parens patriae, could use economic and social reasons to mandate the provision of cochlear implants for all eligible children. The author uses previous cases as a framework to develop an opinion on whether a constitutional protection for parents may exist.
Kong, Soo-Keun; Oh, Se-Joon; Lee, Il-Woo; Goh, Eui-Kyung
Cochlear implants (CI) have now become a standard method of treating severe to profound hearing loss. Recently, the number of patients with CI has been rapidly increasing as the big benefits of CI become more widely known. Magnetic resonance imaging (MRI) has also become a routine diagnostic imaging modality, used in the diagnosis of common conditions, including stroke, back pain, and headache. We report our recent experience with a case in which internal magnet of the cochlear implant was reversed after 1.5-T lumbar spine MRI. This complication is managed successfully by reversing the orientation of the external magnet in the head coil.
Conway, Christopher M; Karpicke, Jennifer; Anaya, Esperanza M; Henning, Shirley C; Kronenberger, William G; Pisoni, David B
We assessed profoundly deaf children with cochlear implants (CIs) (N = 24) and age-matched normal-hearing children (N = 31) on several nonverbal cognition measures: motor sequencing, tactile discrimination, response inhibition, visual-motor integration, and visual-spatial processing. The results revealed that the children with CIs showed disturbances solely on motor sequencing and that performance on this task was significantly correlated with scores on the Clinical Evaluation of Language Fundamentals, 4th Edition (CELF-4). These findings suggest that a period of auditory deprivation before cochlear implantation affects motor sequencing skills, which in turn may mediate the language delays displayed by some deaf children with CIs.
Vannson, Nicolas; Innes-Brown, Hamish
Musical enjoyment for cochlear implant (CI) recipients is often reported to be unsatisfactory. Our goal was to determine whether the musical experience of postlingually deafened adult CI recipients could be enriched by presenting the bass and treble clef parts of short polyphonic piano pieces separately to each ear (dichotic). Dichotic presentation should artificially enhance the lateralization cues of each part and help the listeners to better segregate them and thus provide greater clarity. We also hypothesized that perception of the intended emotion of the pieces and their overall enjoyment would be enhanced in the dichotic mode compared with the monophonic (both parts in the same ear) and the diotic mode (both parts in both ears). Twenty-eight piano pieces specifically composed to induce sad or happy emotions were selected. The tempo of the pieces, which ranged from lento to presto covaried with the intended emotion (from sad to happy). Thirty participants (11 normal-hearing listeners, 11 bimodal CI and hearing-aid users, and 8 bilaterally implanted CI users) participated in this study. Participants were asked to rate the perceived clarity, the intended emotion, and their preference of each piece in different listening modes. Results indicated that dichotic presentation produced small significant improvements in subjective ratings based on perceived clarity. We also found that preference and clarity ratings were significantly higher for pieces with fast tempi compared with slow tempi. However, no significant differences between diotic and dichotic presentation were found for the participants’ preference ratings, or their judgments of intended emotion. PMID:26316123
Huang, Christie Qi; Tykocinski, Michael; Stathopoulos, Dimitra; Cowan, Robert
The present study examined the effects of steroids and lubricants on electrical impedance and tissue response following cochlear implantation in animal models. Guinea pigs were implanted following either no treatment, or intrascalar injection with dexamethasone, triamcinolone, sodium hyaluronate or saline. Cats were implanted following either no treatment, or intrascalar injection with dexamethasone, triamcinolone or a mixture of triamcinolone with sodium hyaluronate. In guinea pigs, impedance changes and intracochlear tissue response were less for the hyaluronate and saline groups. In cats, impedance in the dexamethasone group increased similar to non-treated cats. Impedance of triamcinolone treated cats remained low for about two months after implantation, before increasing to levels similar to the other groups. Significant fibrous tissue growth was observed histologically. The results of the present study indicate that a single intracochlear application of hyaluronate or triamcinolone may postpone, but will ultimately not prevent the rise in impedance following cochlear implantation.
Shanbhag, Jyoti; Vaid, Neelam
Outcomes of cochlear implantation in individuals with known central nervous system conditions are varied. Long-standing deafness is also thought to correlate negatively with auditory performance in post-linguistically deaf adult implant users. We present a case study of cochlear implantation in a post-lingual adult having bilateral profound hearing loss for over 30 years in addition to multiple sclerosis unrelated to his deafness. Assessment of benefit in terms of speech-perception ability and quality of life reveal that long-term auditory deprivation and co-incidental multiple sclerosis are not a contraindication for cochlear implantation.
Janssen, A. Miranda L.; Chalupper, Josef; Stokroos, Robert J.; George, Erwin L. J.
Objective To evaluate monaural beamforming in bimodally aided cochlear implant (CI) users. Design The study enrolled twelve adult bimodal listeners with at least six months of CI-experience and using a contralateral hearing aid (HA) most of the daytime. Participants were uniformly fitted with the same CI speech processor and HA, giving access to an identical monaural beamformer in both ears. A within-subject repeated measures design evaluated three directional configurations [omnidirectional, asymmetric directivity (in CI alone) and symmetric directivity (in both CI and HA)] in two noise types [stationary and fluctuating]. Bimodal speech reception thresholds (SRT) as well as listening effort ratings were assessed in a diffuse noise field. Results Symmetric monaural beamforming provided a significant SRT improvement of 2.6 dB SNR, compared to 1.6 dB SNR for asymmetric monaural beamforming. Directional benefits were similarly observed in stationary and fluctuating noise. Directivity did not contribute to less listening effort in addition to improvement in speech intelligibility. Bimodal performance was about 7 dB SNR worse in fluctuating than in stationary noise. Conclusions Monaural beamforming provided substantial benefit for speech intelligibility in noise for bimodal listeners. The greatest benefit occurred when monaural beamforming was activated symmetrically in both CI and HA. Monaural beamforming does not bridge the gap between bimodal and normal hearing performance, especially in fluctuating noise. Results advocate further bimodal co-operation. Trial Registration This trial was registered in www.trialregister.nl under number NTR4901. PMID:27537075
Eppsteiner, Robert W.; Shearer, A. Eliot; Hildebrand, Michael S.; DeLuca, Adam P.; Ji, Haihong; Dunn, Camille C.; Black-Ziegelbein, Elizabeth A.; Casavant, Thomas L.; Braun, Terry A.; Scheetz, Todd E.; Scherer, Steven E.; Hansen, Marlan R.; Gantz, Bruce J.; Smith, Richard J.H.
Background Up to 7% of patients with severe-to-profound deafness do not benefit from cochlear implantation. Given the high surgical implantation and clinical management cost of cochlear implantation (> $1 million lifetime cost), prospective identification of the worst performers would reduce unnecessary procedures and healthcare costs. Because cochlear implants bypass the membranous labyrinth but rely on the spiral ganglion for functionality, we hypothesize that cochlear implant (CI) performance is dictated in part by the anatomic location of the cochlear pathology that underlies the hearing loss. As a corollary, we hypothesize that because genetic testing can identify sites of cochlear pathology, it may be useful in predicting CI performance. Methods 29 adult CI recipients with idiopathic adult-onset severe-to-profound hearing loss were studied. DNA samples were subjected to solution-based sequence capture and massively parallel sequencing using the OtoSCOPE® platform. The cohort was divided into three CI performance groups (good, intermediate, poor) and genetic causes of deafness were correlated with audiometric data to determine whether there was a gene-specific impact on CI performance. Results The genetic cause of deafness was determined in 3/29 (10%) individuals. The two poor performers segregated mutations in TMPRSS3, a gene expressed in the spiral ganglion, while the good performer segregated mutations in LOXHD1, a gene expressed in the membranous labyrinth. Comprehensive literature review identified other good performers with mutations in membranous labyrinth-expressed genes; poor performance was associated with spiral ganglion-expressed genes. Conclusions Our data support the underlying hypothesis that mutations in genes preferentially expressed in the spiral ganglion portend poor CI performance while mutations in genes expressed in the membranous labyrinth portend good CI performance. Although the low mutation rate in known deafness genes in this cohort
Sudano, A; Accoto, D; Francomano, M T; Salvinelli, F; Guglielmelli, E
Fully implantable Cochlear Implants (CIs) would represent a tremendous advancement in terms of quality of life, comfort and cosmetics, for patients with profound sensorineural deafness. One of the main challenges involved in the development of such implants consists of finding a power supply means which does not require recharging. To this aim an inertial Energy Harvester (EH), exploiting the kinetic energy produced by vertical movements of the head during walking, has been investigated. Compared to existing devices, the EH needs to exploit very low frequency vibrations (<2.5 Hz) with small amplitude (<9 m/s(2)). In order to maximize the power transduced, an optimization method has been developed, which is the objective of this paper. The method consists in calculating the dynamical behavior of the EH using discrete transforms of experimentally measured acceleration profiles. It is shown that the quick integration of the second order dynamical equation allows the use of computationally intensive optimization techniques, such as Genetic Algorithms (GAs). The robustness of the solution is also evaluated.
Venail, Frederic; Mathiolon, Caroline; Menjot de Champfleur, Sophie; Piron, Jean Pierre; Sicard, Marielle; Villemus, Françoise; Vessigaud, Marie Aude; Sterkers-Artieres, Françoise; Mondain, Michel; Uziel, Alain
Frequency-place mismatch often occurs after cochlear implantation, yet its effect on speech perception outcome remains unclear. In this article, we propose a method, based on cochlea imaging, to determine the cochlear place-frequency map. We evaluated the effect of frequency-place mismatch on speech perception outcome in subjects implanted with 3 different lengths of electrode arrays. A deeper insertion was responsible for a larger frequency-place mismatch and a decreased and delayed speech perception improvement by comparison with a shallower insertion, for which a similar but slighter effect was noticed. Our results support the notion that selecting an electrode array length adapted to each individual's cochlear anatomy may reduce frequency-place mismatch and thus improve speech perception outcome.
Black, F. O.; Lilly, D. J.; Peterka, R. J.; Fowler, L. P.; Simmons, F. B.
Vestibular function in cochlear implant candidates varies from normal to total absence of function. In patients with intact vestibular function preoperatively, invasion of the otic capsule places residual vestibular function at risk. Speech-processing strategies that result in large amplitude electrical transients or strategies that employ high amplitude broad frequency carrier signals have the potential for disrupting vestibular function. Five patients were tested with and without electrical stimulation via cochlear electrodes. Two patients experienced subjective vestibular effects that were quickly resolved. No long-term vestibular effects were noted for the two types of second generation cochlear implants evaluated. Histopathological findings from another patient, who had electrically generated vestibular reflex responses to intramodiolar electrodes, indicated that responses elicited were a function of several variables including electrode location, stimulus intensity, stimulus amplitude, and stimulus frequency. Differential auditory, vestibulocolic, and vestibulospinal reflexes were demonstrated from the same electrode as a function of stimulus amplitude, frequency, and duration.
Sibella, F.; Parazzini, M.; Paglialonga, A.; Ravazzani, P.
Cochlear implants (CI) are electronic devices used to restore partial hearing to people with severe hearing impairment. This paper aims to investigate if the introduction of a CI has an effect on SAR distribution in a head model exposed to radiofrequency electromagnetic fields (RF EMF) at mobile communication frequencies. The head model was obtained by image segmentation, the implant was modelled as a geometric structure and the exposure source was modelled as a uniform plane wave at 900 MHz, 1750 MHz and 1950 MHz, incident on the side of the head with the CI. Vertical and horizontal polarizations were simulated. Results show that the presence of a CI inside the cochlea produces negligible variations in the averaged SAR values, both in the head and in the cochlear tissues, although very localized differences in point SAR were found in the cochlea. Globally, these results suggest that finding harmful effects in the cochlear tissues will be unlikely.
Busi, Micol; Rosignoli, Monica; Castiglione, Alessandro; Minazzi, Federica; Trevisi, Patrizia; Aimoni, Claudia; Calzolari, Ferdinando; Granieri, Enrico; Martini, Alessandro
Background. Specific clinical conditions could compromise cochlear implantation outcomes and drastically reduce the chance of an acceptable development of perceptual and linguistic capabilities. These conditions should certainly include the presence of inner ear malformations or brain abnormalities. The aims of this work were to study the diagnostic value of high resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) in children with sensorineural hearing loss who were candidates for cochlear implants and to analyse the anatomic abnormalities of the ear and brain in patients who underwent cochlear implantation. We also analysed the effects of ear malformations and brain anomalies on the CI outcomes, speculating on their potential role in the management of language developmental disorders. Methods. The present study is a retrospective observational review of cochlear implant outcomes among hearing-impaired children who presented ear and/or brain anomalies at neuroimaging investigations with MRI and HRCT. Furthermore, genetic results from molecular genetic investigations (GJB2/GJB6 and, additionally, in selected cases, SLC26A4 or mitochondrial-DNA mutations) on this study group were herein described. Longitudinal and cross-sectional analysis was conducted using statistical tests. Results. Between January 1, 1996 and April 1, 2012, at the ENT-Audiology Department of the University Hospital of Ferrara, 620 cochlear implantations were performed. There were 426 implanted children at the time of the present study (who were <18 years). Among these, 143 patients (64 females and 79 males) presented ear and/or brain anomalies/lesions/malformations at neuroimaging investigations with MRI and HRCT. The age of the main study group (143 implanted children) ranged from 9 months and 16 years (average = 4.4; median = 3.0). Conclusions. Good outcomes with cochlear implants are possible in patients who present with inner ear or brain abnormalities, even if central
Smith, Zachary M; Delgutte, Bertrand
Bilateral cochlear implantation seeks to restore the advantages of binaural hearing to the profoundly deaf by providing binaural cues normally important for accurate sound localization and speech reception in noise. Psychophysical observations suggest that a key issue for the implementation of a successful binaural prosthesis is the ability to match the cochlear positions of stimulation channels in each ear. We used a cat model of bilateral cochlear implants with eight-electrode arrays implanted in each cochlea to develop and test a noninvasive method based on evoked potentials for matching interaural electrodes. The arrays allowed the cochlear location of stimulation to be independently varied in each ear. The binaural interaction component (BIC) of the electrically evoked auditory brainstem response (EABR) was used as an assay of binaural processing. BIC amplitude peaked for interaural electrode pairs at the same relative cochlear position and dropped with increasing cochlear separation in either direction. To test the hypothesis that BIC amplitude peaks when electrodes from the two sides activate maximally overlapping neural populations, we measured multiunit neural activity along the tonotopic gradient of the inferior colliculus (IC) with 16-channel recording probes and determined the spatial pattern of IC activation for each stimulating electrode. We found that the interaural electrode pairings that produced the best aligned IC activation patterns were also those that yielded maximum BIC amplitude. These results suggest that EABR measurements may provide a method for assigning frequency-channel mappings in bilateral implant recipients, such as pediatric patients, for which psychophysical measures of pitch ranking or binaural fusion are unavailable.
Martin, Daniela; Bat-Chava, Yael; Lalwani, Anil; Waltzman, Susan B
This study investigated factors that affect the development of positive peer relationships among deaf children with cochlear implants. Ten 5- to 6-year-old deaf children with implants were observed under conditions varying peer context difficulty in a Peer Entry task. Results revealed better outcomes for deaf children interacting in one-on-one situations compared to interactions including two other hearing children and better performance among girls than boys. In addition, longer duration of implant use and higher self-esteem were associated with better performance on the Peer Task, which was in turn related to parental reports of children's social functioning outside the experimental situation. These findings contribute to the growing literature describing the benefits of cochlear implantation in the areas of communication and socialization, while pointing to interventions that may enhance deaf children's social competence.
Sarant, J Z; Cowan, R S; Blamey, P J; Galvin, K L; Clark, G M
The prognosis for benefit from use of cochlear implants in congenitally deaf adolescents, who have a long duration of profound deafness prior to implantation, has typically been low. Speech perception results for two congenitally deaf patients implanted as adolescents at the University of Melbourne/Royal Victorian Eye and Ear Hospital Clinic show that, after 12 months of experience, both patients had significant open-set speech discrimination scores without lipreading. These results suggest that although benefits may in general be low for congenitally deaf adolescents, individuals may attain significant benefits to speech perception after a short period of experience. Prospective patients from this group should therefore be considered on an individual basis with regard to prognosis for benefit from cochlear implantation.
Suaning, G J; Lovell, N H
The principles of Monte Carlo simulation are applied to critical manufacturing process in the construction of cochlear implants. In this application, the tuning of the implant's radio frequency (RF) communication system is dependent upon a "select on test" tuning capacitance. The aim is to accurately predict the usage of capacitors of a given size in future production of cochlear implants using Monte-Carlo simulation. The predicted quantities may then be purchased from a supplier to satisfy the requirements of high volume manufacturing without maintaining unnecessary and expensive stock levels of infrequently or never used capacitors. Simulations indicate that for large production runs, prediction of the necessary quantities of particular tuning capacitor sizes may enable the implant manufacturer to reduce their capacitor stock levels by as much as 82 percent. This significant reduction is in comparison to maintaining a uniform stock level of all sizes of capacitors, assuming random probability of requiring each size of tuning capacitor.
Ricketts, Todd; Grantham, D Wesley; D'Haese, Patrick; Edwards, Jason; Barco, Amy
The purpose of this investigation was to determine the impact of commonly recommended cochlear implant (CI) speech processor placements on microphone output both with and without single channel front-end compression. The impact of this compression use on interaural level difference (ILD) magnitude was also evaluated for the ear-level position. Finally, pilot localization data collected with and without single channel front-end compression was collected on seven bilateral cochlear implant recipients. The results revealed that differences in signal audibility due to clinical placement of CI speech processors in ear, shoulder, and collar positions can at least partially be offset through the use of front-end compression. These data also revealed that compression impacted ILD cues. Preliminary data indicated that some bilaterally implanted subjects were able to take advantage of the enhanced ILD cues when compression was turned off, while other bilaterally implanted subjects did not localize better in the compression-off condition.
Strelnikov, K; Rouger, J; Demonet, J-F; Lagleyre, S; Fraysse, B; Deguine, O; Barone, P
In functional neuroimaging studies, task-related activity refers to the signal difference between the stimulation and rest conditions. We asked whether long-term changes in the sensory environment may affect brain activity at rest. To answer this question, we compared regional cerebral blood flow between a group of normally hearing controls and a group of cochlear-implanted (CI) deaf patients. Here we present evidence that long-term alteration of auditory experience, such as profound deafness followed by partial auditory recuperation through cochlear implantation, leads to functional cortical reorganizations at rest. Without any visual or auditory stimulation, CI subjects showed changes of cerebral blood flow in the visual, auditory cortex, Broca area, and in the posterior temporal cortex with an increment of activity in these areas from the time of activation of the implant to less than a year after the implantation.
Alfelasi, Mohammad; Piron, Jean Pierre; Mathiolon, Caroline; Lenel, Nadjmah; Mondain, Michel; Uziel, Alain; Venail, Frederic
Transtympanic promontory stimulation test (TPST) has been suggested to be a useful tool in predicting postoperative outcomes in patients at risk of poor auditory neuron functioning, especially after a long auditory deprivation. However, only sparse data are available on this topic. This study aimed at showing correlations between the auditory nerve dynamic range, evaluated by TPST, the electrical dynamic range of the cochlear implant and speech perception outcome. We evaluated 65 patients with postlingual hearing loss and no residual hearing, implanted with a Nucleus CI24 cochlear implant device for at least 2 years and with a minimum of 17 active electrodes. Using the TPST, we measured the threshold for auditory perception (T-level) and the maximum acceptable level of stimulation (M-level) at stimulation frequencies of 50, 100 and 200 Hz. General linear regression was performed to correlate 1/speech perception, evaluated using the PBK test 1 year after surgery, and 2/cochlear implant electrical dynamic range, with the age at time of implantation, the duration of auditory deprivation, the etiology of the deafness, the duration of cochlear implant use and auditory nerve dynamic range. Postoperative speech perception outcome correlated with etiology, duration of auditory deprivation and implant use, and TPST at 100 and 200 Hz. The dynamic range of the cochlear implant map correlated with duration of auditory deprivation, speech perception outcome at 6 months and TPST at 100 and 200 Hz. TPST test can be used to predict functional outcome after cochlear implant surgery in difficult cases.
Moreno-Torres, Ignacio; Torres, Santiago; Santana, Rafael
This is the first study to explore lexical and grammatical development in a deaf child diagnosed with Attention Deficit Hyperactivity Disorder, Inattentive sub-type (ADHDI). The child, whose family language was Spanish, was fitted with a cochlear implant (CI) when she was 18 months old. ADHDI, for which she was prescribed medication, was diagnosed…
Maglione, Anton Giulio; Vecchiato, Giovanni; Leone, Carlo Antonio; Grassia, Rosa; Mosca, Franco; Colosimo, Alfredo; Malerba, Paolo; Babiloni, Fabio
The aim of the present study is to measure the perceived pleasantness during the observation of a musical video clip in a group of cochlear implanted adult patients when compared to a group of normal hearing subjects. This comparison was performed by using the imbalance of the EEG power spectra in alpha band over frontal areas as a metric for the perceived pleasantness. Subjects were asked to watch a musical video clip in three different experimental conditions: with the original audio included (Norm), with a distorted version of the audio (Dist), and without the audio (Mute). The frontal EEG imbalance between the estimated power spectra for the left and right prefrontal areas has been calculated to investigate the differences among the two populations. Results suggested that the perceived pleasantness of the musical video clip in the normal hearing population and in the bilateral cochlear implanted populations has similar range of variation across the different stimulations (Norm, Dist, and Mute), when compared to the range of variation of video clip's pleasantness for the monolateral cochlear implanted population. A similarity exists in the trends of the perceived pleasantness across the different experimental conditions in the mono- and bilaterally cochlear implanted patients.
Boons, Tinne; De Raeve, Leo; Langereis, Margreet; Peeraer, Louis; Wouters, Jan; van Wieringen, Astrid
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…
Mitchiner, Julie Cantrell
This study investigated 17 Deaf families in North America with cochlear-implanted children about their attitudes, beliefs, and practices on bimodal bilingualism (defined as using both a visual/manual language and an aural/oral language) in American Sign Language (ASL) and English. A survey and follow-up interviews with 8 families were conducted.…
Kondaurova, Maria V.; Bergeson, Tonya R.; Xu, Huiping; Kitamura, Christine
Purpose: The affective properties of infant-directed speech influence the attention of infants with normal hearing to speech sounds. This study explored the affective quality of maternal speech to infants with hearing impairment (HI) during the 1st year after cochlear implantation as compared to speech to infants with normal hearing. Method:…
Fu, Qian-Jie; Galvin, John J., III; Wang, Xiaosong; Wu, Jiunn-Liang
Purpose: The aims of this study were to assess young (5- to 10-year-old) Mandarin-speaking cochlear implant (CI) users' musical pitch perception and to assess the benefits of computer-based home training on performance. Method: Melodic contour identification (MCI) was used to assess musical pitch perception in 14 Mandarin-speaking pediatric CI…
Dorman, Michael F.; Sharma, Anu; Gilley, Phillip; Martin, Kathryn; Roland, Peter
In normal-hearing children the latency of the P1 component of the cortical evoked response to sound varies as a function of age and, thus, can be used as a biomarker for maturation of central auditory pathways. We assessed P1 latency in 245 congenitally deaf children fit with cochlear implants following various periods of auditory deprivation. If…
Clarós, P; Sanz, J J; Clavería, M A; Costa, C; Clarós, A
We present an 8 years patient old with a giant dilatation of the vestibular aqueduct associated with profound and progressive bilateral sensorineural hearing loss. The patient received a cochlear implant and during the surgery a pulsatile clear fluid via the cochleostomy was observed, without gusher. We present all the problems, and offer some advices for this kind of surgery.
Watson, Linda M.; Gregory, Susan
Five cases of non-use of cochlear implants by children were investigated through semi-structured interviews with the children and their carers. The children were interviewed at school by a researcher who is deaf, and the carers, all of whom were hearing, were interviewed at home by a hearing researcher when the children were not present. The…
Goehring, Jenny L.; Hughes, Michelle L.; Baudhuin, Jacquelyn L.; Valente, Daniel L.; McCreery, Ryan W.; Diaz, Gina R.; Sanford, Todd; Harpster, Roger
Purpose: In this study, the authors evaluated the effect of remote system and acoustic environment on speech perception via telehealth with cochlear implant recipients. Method: Speech perception was measured in quiet and in noise. Systems evaluated were Polycom visual concert (PVC) and a hybrid presentation system (HPS). Each system was evaluated…
Hughes, Michelle L.; Goehring, Jenny L.; Baudhuin, Jacquelyn L.; Diaz, Gina R.; Sanford, Todd; Harpster, Roger; Valente, Daniel L.
Purpose: The goal of this study was to compare clinical and research-based cochlear implant (CI) measures using telehealth versus traditional methods. Method: This prospective study used an ABA design (A = laboratory, B = remote site). All measures were made twice per visit for the purpose of assessing within-session variability. Twenty-nine adult…
Burkholder-Juhasz, Rose A.; Levi, Susannah V.; Dillon, Caitlin M.; Pisoni, David B.
Nonword repetition skills were examined in 24 pediatric cochlear implant (CI) users and 18 normal-hearing (NH) adult listeners listening through a CI simulator. Two separate groups of NH adult listeners assigned accuracy ratings to the nonword responses of the pediatric CI users and the NH adult speakers. Overall, the nonword repetitions of…
It has been proposed that cochlear implant users may develop robust categorical perception skills, but that they show limited precision in perception. This article explores if a parallel contrast is observable in production, and if, despite acquiring typical linguistic representations, their early words are inconsistent. The participants were…
Maglione, Anton Giulio; Leone, Carlo Antonio; Grassia, Rosa; Mosca, Franco; Colosimo, Alfredo; Malerba, Paolo
The aim of the present study is to measure the perceived pleasantness during the observation of a musical video clip in a group of cochlear implanted adult patients when compared to a group of normal hearing subjects. This comparison was performed by using the imbalance of the EEG power spectra in alpha band over frontal areas as a metric for the perceived pleasantness. Subjects were asked to watch a musical video clip in three different experimental conditions: with the original audio included (Norm), with a distorted version of the audio (Dist), and without the audio (Mute). The frontal EEG imbalance between the estimated power spectra for the left and right prefrontal areas has been calculated to investigate the differences among the two populations. Results suggested that the perceived pleasantness of the musical video clip in the normal hearing population and in the bilateral cochlear implanted populations has similar range of variation across the different stimulations (Norm, Dist, and Mute), when compared to the range of variation of video clip's pleasantness for the monolateral cochlear implanted population. A similarity exists in the trends of the perceived pleasantness across the different experimental conditions in the mono- and bilaterally cochlear implanted patients. PMID:25180046
Houston, Derek M.; Stewart, Jessica; Moberly, Aaron; Hollich, George; Miyamoto, Richard T.
Word-learning skills were tested in normal-hearing 12- to 40-month-olds and in deaf 22- to 40-month-olds 12 to 18 months after cochlear implantation. Using the Intermodal Preferential Looking Paradigm (IPLP), children were tested for their ability to learn two novel-word/novel-object pairings. Normal-hearing children demonstrated learning on this…
Titterington, Jill; Henry, Alison; Kramer, Martin; Toner, Joe G.; Stevenson, Mike
In this study the influence of prosodic foot structure on the processing of weak syllables in children with cochlear implants (CI) was investigated. A battery of tests investigating processing of weak syllables in single and multiword utterances was carried out on four groups of children: 15 children with CI developing spoken language as expected…
Hyde, Merv; Punch, Renee; Komesaroff, Linda
This study combined quantitative and qualitative methods in a sequential approach to investigate the experiences of parents making decisions about cochlear implants for their deaf children. Quantitative findings from a survey instrument completed by 247 parents were extended and elaborated by qualitative findings from in-depth interviews with 27…
Teoh, Amy P.; Chin, Steven B.
Purpose: The phonological systems of children with cochlear implants may include segment inventories that contain both target and nontarget speech sounds. These children may not consistently follow phonological rules of the target language. These issues present a challenge for the clinical speech-language pathologist who uses phonetic…
DesJardin, Jean L.; Ambrose, Sophie E.; Eisenberg, Laurie S.
This study examines the home literacy environment in a group of mothers and their early-school-age children with cochlear implants (N = 16). The goals of this investigation are to (a) describe the characteristics of the home literacy environment and (b) study the relationships between home literacy factors and children's reading skills. Mothers…
Messier, Jane; Wood, Carla
The present intervention study explored the word learning of 18 children with cochlear implants in response to E-book instruction. Capitalizing on the multimedia options available in electronic storybooks, the intervention incorporated videos and definitions to provide a vocabulary intervention that includes evidence-based teaching strategies. The…
This article employs meta-analysis procedures to evaluate whether children with cochlear implants demonstrate lower spoken-language vocabulary knowledge than peers with normal hearing. Of the 754 articles screened and 52 articles coded, 12 articles met predetermined inclusion criteria (with an additional 5 included for one analysis). Effect sizes…
Belzner, Kate A.; Seal, Brenda C.
Children with severe to profound hearing loss in the United States are diverse in their racial-ethnic backgrounds, comorbid disabilities, socioeconomic levels, and communication modalities. The present article addresses demographic variables and communication outcomes of children with cochlear implants by means of a review of longitudinal studies…
Beer, Jessica; Kronenberger, William G.; Castellanos, Irina; Colson, Bethany G.; Henning, Shirley C.; Pisoni, David B.
Purpose: The purpose of this study was to determine whether deficits in executive functioning (EF) in children with cochlear implants (CIs) emerge as early as the preschool years. Method: Two groups of children ages 3 to 6 years participated in this cross-sectional study: 24 preschoolers who had CIs prior to 36 months of age and 21 preschoolers…
Bartov, Tamar; Most, Tova
Purpose: To examine song identification by preschoolers with normal hearing (NH) versus preschoolers with cochlear implants (CIs). Method: Participants included 45 children ages 3;8-7;3 (years;months): 12 with NH and 33 with CIs, including 10 with unilateral CI, 14 with bilateral CIs, and 9 bimodal users (CI-HA) with unilateral CI and…
Lane, Harlan; Denny, Margaret; Guenther, Frank H.; Hanson, Helen M.; Marrone, Nicole; Matthies, Melanie L.; Perkell, Joseph S.; Stockmann, Ellen; Tiede, Mark; Vick, Jennell; Zandipour, Majid
Purpose: To describe cochlear implant users' phoneme labeling, discrimination, and prototypes for a vowel and a sibilant contrast, and to assess the effects of 1 year's experience with prosthetic hearing. Method: Based on naturally produced clear examples of "boot," "beet," "said," and "shed" by 1 male and 1 female speaker, continua with 13…
Dillon, Caitlin M.; de Jong, Kenneth; Pisoni, David B.
In hearing children, reading skills have been found to be closely related to phonological awareness. We used several standardized tests to investigate the reading and phonological awareness skills of 27 deaf school-age children who were experienced cochlear implant users. Approximately two-thirds of the children performed at or above the level of…
This study aimed to describe and categorize the attributes that parents of young children with cochlear implants (CIs) consider as facilitating their parental coping experience. I interviewed 15 hearing mothers and 13 hearing fathers (including 12 married couples) whose children had CIs, using the critical incident technique that asked parents to…
Kronenberger, William G.; Pisoni, David B.; Harris, Michael S.; Hoen, Helena M.; Xu, Huiping; Miyamoto, Richard T.
Purpose: Verbal short-term memory (STM) and working memory (WM) skills predict speech and language outcomes in children with cochlear implants (CIs) even after conventional demographic, device, and medical factors are taken into account. However, prior research has focused on single end point outcomes as opposed to the longitudinal process of…
Archbold, Sue; Sach, Tracey; O/Neill, Ciaran; Lutman, Mark; Gregory, Susan
Cochlear implantation provides a means of hearing to profoundly deaf children. As it is an elective procedure, parents must make the decision to proceed with this option if their child is suitable. The processes involved are complex and stressful, involving hope and expectation on the one hand, and doubts and caution on the other. This study…
Staller, Steven J.; And Others
This paper describes components of the Nucleus 22 Channel Cochlear Implant System used with deaf children and adults. It discusses speech coding strategies, programming concepts, programming the device for children, trouble-shooting, and fitting an FM system to a speech processor. It reports data showing improved ability to use auditory…
Bergeson, Tonya R.; Miller, Rachel J.; McCune, Kasi
This study investigated the effects of age, hearing loss, and cochlear implantation on mothers' speech to infants and children. We recorded normal-hearing (NH) mothers speaking to their children as they typically would do at home and speaking to an adult experimenter. Nine infants (10-37 months) were hearing-impaired and had used a cochlear…
Flipsen, Peter, Jr.; Parker, Rhonda G.
In this descriptive, longitudinal study, phonological patterns (i.e., natural phonological processes) were examined in a set of conversational speech samples obtained from six young children fitted with cochlear implants. Both developmental and non-developmental patterns were observed. This is consistent with findings from previous studies of the…
Klein, Kelsey E.; Wie, Ona Bø
Narratives require the integration of many different linguistic skills and can be used as an ecologically valid measure of child language development. This study investigated the narrative skills of 18 six- to seven-year-old prelingually deaf children who received simultaneous bilateral cochlear implants (CI) between 5 and 18 months of age. No…
Hsiao, Feilin; Gfeller, Kate
This review of the literature presents a systematic analysis of the capabilities and limitations of cochlear implant (CI) recipients with regard to music perception. Specifically, it (a) analyzes individual components of music (e.g., rhythm, timbre, and pitch) as they interface with the technical characteristics of CIs and the perceptual abilities…
Collison, Elizabeth A.; Munson, Benjamin; Carney, Arlene Earley
This study examined spoken word recognition in adults with cochlear implants (CIs) to determine the extent to which linguistic and cognitive abilities predict variability in speech-perception performance. Both a traditional consonant-vowel-consonant (CVC)-repetition measure and a gated-word recognition measure (F. Grosjean, 1996) were used.…
Miller, Sharon E.; Zhang, Yang; Nelson, Peggy B.
Purpose: This study implemented a pretest-intervention-posttest design to examine whether multiple-talker identification training enhanced phonetic perception of the /ba/-/da/ and /wa/-/ja/ contrasts in adult listeners who were deafened postlingually and have cochlear implants (CIs). Method: Nine CI recipients completed 8 hours of identification…
Abdurehim, Yasin; Lehmann, Alexandre; Zeitouni, Anthony G
Objective To systematically review and quantify current evidence regarding the association of GJB2 mutation status with outcomes of pediatric cochlear implantation. Data Sources PubMed, Embase, and the Cochrane Library were searched for "GJB2,"pediatric hearing loss," and "cochlear implantation" and their synonyms, with no language restrictions, until December 2, 2015. Review Methods Studies were included that investigated the status of GJB2 mutation and its predictive value for outcomes of pediatric cochlear implantation. Speech recognition scores, Infant-Toddler Meaningful Auditory Integration Scale, Speech Intelligibility Rating, and Categorized Auditory Performance were pooled using weighted mean differences, and a 95% confidence interval. Results Eighteen studies met the inclusion criteria. The differences between GJB2-related deafness and non- GJB2-related deafness due to unidentified causes and other types of genetic deafness without additional disabilities were not statistically significant ( P = .15 and P = .30, respectively); however, the difference between GJB2-related deafness and acquired hearing loss due to environmental etiologies was statistically significant and favored GJB2-related deafness ( P = .03). Conclusion GJB2-related deafness leads to significantly better cochlear implantation outcomes when compared with acquired deafness caused by environmental etiologies. However, GJB2 mutation is not associated with a significantly better prognosis when compared with those whose deafness results from either nonsyndromic hearing loss of unknown origin or other types of genetic mutations in the absence of other neurologic deficits.
Bhatti, P. T.; McClellan, J. H.
This paper presents an introductory signal processing laboratory and examines this laboratory exercise in the context of problem-based learning (PBL). Centered in a real-world application, a cochlear implant, the exercise challenged students to demonstrate a working software-based signal processor. Partnering in groups of two or three, second-year…
Ruggirello, Caterina; Mayer, Connie
This case study is an examination of the language development of a single pair of fraternal twins--one with a profound, sensorineural hearing loss who received simultaneous bilateral cochlear implants at 1 year of age and the other with normal hearing. The purpose of the study was to compare the twins' language development over time from 6 months…
Plontke, S K; Götze, G; Rahne, T; Liebau, A
Local drug application to the inner ear offers a number of advantages over systemic delivery. Local drug therapy currently encompasses extracochlear administration (i. e., through intratympanic injection), intracochlear administration (particularly for gene and stem cell therapy), as well as various combinations with auditory neurosensory prostheses, either evaluated in preclinical or clinical studies, or off-label. To improve rehabilitation with cochlear implants (CI), one focus is the development of drug-releasing electrode carriers, e. g., for delivery of glucocorticosteroids, antiapoptotic substances, or neurotrophins to the inner ear. The performance of cochlear implants may thus be improved by protecting neuronal structures from insertion trauma, reducing fibrosis in the inner ear, and by stimulating growth of neuronal structures in the direction of the electrodes. Controlled drug release after extracochlear or intracochlear application in conjunction with a CI can also be achieved by use of a biocompatible, resorbable controlled-release drug-delivery system. Two case reports for intracochlear controlled release drug delivery in combination with cochlear implants are presented. In order to treat progressive reduction in speech discrimination and increased impedance, two cochlear implant patients successfully underwent intracochlear placement of a biocompatible, resorbable drug-delivery system for controlled release of dexamethasone. The drug levels reached in inner ear fluids after different types of local drug application strategies can be calculated using a computer model. The intracochlear drug concentrations calculated in this way were compared for different dexamethasone application strategies.
Tomblin, J. Bruce; Peng, Shu-Chen; Spencer, Linda J.; Lu, Nelson
Purpose: This study characterized the development of speech sound production in prelingually deaf children with a minimum of 8 years of cochlear implant (CI) experience. Method: Twenty-seven pediatric CI recipients' spontaneous speech samples from annual evaluation sessions were phonemically transcribed. Accuracy for these speech samples was…
Burkholder, Rose A.; Pisoni, David B.
Compared speaking rates, digit span, and speech timing in profoundly deaf 8- and 9-year-olds with cochlear implants and normal-hearing children. Found that deaf children displayed longer sentence durations and pauses during recall and shorter digit spans than normal-hearing children. Articulation rates strongly correlated with immediate memory…
Moreno-Torres, Ignacio; Torres, Santiago
This paper describes early language development in a deaf Spanish child fitted with a cochlear implant (CI) when she was 1 year 6 months old. The girl had been exposed to Cued Speech (CS) since that age. The main aim of the research was to identify potential areas of slow language development as well as the potential benefit of CI and CS. At the…
Dillon, Caitlin M.; Burkholder, Rose A.; Cleary, Miranda; Pisoni, David B.
Seventy-six children with cochlear implants completed a nonword repetition task. The children were presented with 20 nonword auditory patterns over a loudspeaker and were asked to repeat them aloud to the experimenter. The children's responses were recorded on digital audiotape and then played back to normal-hearing adult listeners to obtain…
AuBuchon, Angela M.; Pisoni, David B.; Kronenberger, William G.
Purpose: The purpose of this study was to report how "verbal rehearsal speed" (VRS), a form of covert speech used to maintain verbal information in working memory, and another verbal processing speed measure, perceptual encoding speed, are related to 3 domains of executive function (EF) at risk in cochlear implant (CI) users: verbal…
Coene, Martine; Schauwers, Karen; Gillis, Steven; Rooryck, Johan; Govaerts, Paul J.
Recent neurobiological studies have advanced the hypothesis that language development is not continuously plastic but is governed by biological constraints that may be modified by experience within a particular time window. This hypothesis is tested based on spontaneous speech data from deaf cochlear-implanted (CI) children with access to…
Connor, Carol McDonald; Hieber, Sara; Arts, H. Alexander; Zwolan, Teresa A.
This study examined the relationship between the teaching method, oral or total communication, used at children's schools and children's consonant-production accuracy and vocabulary development over time. The children (N=147) had used cochlear implants for between 6 months and 10 years. Results indicated a complex relationship among children's…
Peng, Shu-Chen; Tomblin, J. Bruce; Spencer, Linda J.; Hurtig, Richard R.
Purpose: This study investigated the acoustic characteristics of pediatric cochlear implant (CI) recipients' imitative production of rising speech intonation, in relation to the perceptual judgments by listeners with normal hearing (NH). Method: Recordings of a yes-no interrogative utterance imitated by 24 prelingually deafened children with a CI…
Vermeulen, Anneke; De Raeve, Leo; Langereis, Margreet; Snik, Ad
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…
Research has shown how cochlear implants (CIs), in children with hearing impairments, have improved speech perception and production, but very little is known about the children's pragmatic language development. During a 4-year longitudinal study of three children with CIs, certain aspects of pragmatic language development were observed in free…
Kronenberger, William G.; Colson, Bethany G.; Henning, Shirley C.; Pisoni, David B.
Neurocognitive processes such as executive functioning (EF) may influence the development of speech-language skills in deaf children after cochlear implantation in ways that differ from normal-hearing, typically developing children. Conversely, spoken language abilities and experiences may also exert reciprocal effects on the development of EF.…
McCracken, Wendy; Turner, Oliver
This paper discusses the experiences of parents of deaf children with additional complex needs (ACN) in accessing cochlear implant (CI) services and achieving ongoing support. Of a total study group of fifty-one children with ACN, twelve had been fitted with a CI. The parental accounts provide a rich and varied picture of service access. For some…
Encinas, Danielle; Plante, Elena
Purpose: There is little to guide clinicians in terms of evidence-based interventions for children with cochlear implants who demonstrate morpheme errors. This feasibility study tested the utility of a treatment targeting grammatical morpheme errors. Method: Three children (ages 4-5 years) received Enhanced Conversational Recast treatment, a…
Zaidman-Zait, Anat; Young, Richard A.
Action theory and the qualitative action-project method are used in this study to address and illustrate the complexity of parenting children who have received cochlear implants (CIs) as well as the intentionality of parents engaged in that process. "Action" refers to individual and joint goal-directed and intentional behaviors. Action theory has…
Holt, Colleen M.; Dowell, Richard C.
This study examined changes to speech production in adolescents with hearing impairment following a period of actor vocal training. In addition to vocal parameters, the study also investigated changes to psychosocial factors such as confidence, self-esteem, and anxiety. The group were adolescent users of cochlear implants (mean age at commencement…
Han, Min Kyung; Storkel, Holly L.; Lee, Jaehoon; Yoshinaga-Itano, Christine
The goal of this study was to explore the effects of phonotactic probability, word length, word frequency, and neighborhood density on the words known by children with cochlear implants (CIs) varying in vocabulary outcomes in a retrospective analysis of a subset of data from a longitudinal study of hearing loss. Generalized linear mixed modeling…
Most deaf children are born to hearing families. During the last twenty years deaf children, in increasing numbers and at an early age, receive a cochlear implant, a highly technological hearing device. The aim of this qualitative, longitudinal, single-case study was to explore and describe critical changes in naturalistic, video-observed…
Rodvik, Arne K.
The aim of this pilot study was to identify the most common speech sound confusions of 5 Norwegian cochlear implanted post-lingually deafened adults. We played recorded nonwords, aCa, iCi and bVb, to our informants, asked them to repeat what they heard, recorded their repetitions and transcribed these phonetically. We arranged the collected data…
Spencer, Linda J.; Tomblin, J. Bruce
This study investigated the phonological processing skills of 29 children with prelingual, profound hearing loss with 4 years of cochlear implant experience. Results were group matched with regard to word-reading ability and mother's educational level with the performance of 29 hearing children. Results revealed that it is possible to obtain a…
Eskridge, Elizabeth N.; Galvin, John J., III; Aronoff, Justin M.; Li, Tianhao; Fu, Qian-Jie
Purpose: The goal of this study was to investigate how the spectral and temporal properties in background music may interfere with cochlear implant (CI) and normal-hearing listeners' (NH) speech understanding. Method: Speech-recognition thresholds (SRTs) were adaptively measured in 11 CI and 9 NH subjects. CI subjects were tested while using their…
Bouton, Sophie; Serniclaes, Willy; Bertoncini, Josiane; Cole, Pascale
Purpose: The present study investigates the perception of phonological features in French-speaking children with cochlear implants (CIs) compared with normal-hearing (NH) children matched for listening age. Method: Scores for discrimination and identification of minimal pairs for all features defining consonants (e.g., place, voicing, manner,…
This Canadian study reports on the experiences of parents whose children use cochlear implants and on their perspectives prior to and following the transition to Auditory-Verbal therapy. A qualitative case study design, framed in social-ecological theory, guided this research. Data collection procedures included a family information questionnaire,…
Meister, Hartmut; Fürsen, Katrin; Streicher, Barbara; Lang-Roth, Ruth; Walger, Martin
Purpose: The focus of this study was to examine the influence of fundamental frequency (F0) and vocal tract length (VTL) modifications on speaker gender recognition in cochlear implant (CI) recipients for different stimulus types. Method: Single words and sentences were manipulated using isolated or combined F0 and VTL cues. Using an 11-point…
López-Higes, Ramón; Gallego, Carlos; Martín-Aragoneses, María Teresa; Melle, Natalia
This study explores morpho-syntactic reading comprehension in 19 Spanish children who received a cochlear implant (CI) before 24 months of age (early CI [e-CI]) and 19 Spanish children who received a CI after 24 months (late CI [l-CI]). They all were in primary school and were compared to a hearing control (HC) group of 19 children. Tests of…
Ertmer, David J.; Kloiber, Diana True; Jung, Jongmin; Kirleis, Katie Connell; Bradford, Denise
Purpose: To compare young cochlear implant (CI) recipients' consonant production accuracy with that of age- and gender-matched peers who were typically developing (TD). In addition to examining initial consonants, the authors compiled new data regarding the accuracy of final consonants and the order of consonant acquisition. Methods: Eleven young…
Asker-Arnason, Lena; Ibertsson, Tina; Wass, Malin; Wengelin, Asa; Sahlen, Birgitta
The purpose of the study was to explore the narrative writing of 18 children, ages 11 to 19, with severe and profound hearing impairment who had cochlear implants (CI), compared with the performance of hearing children. Nine of the 18 children had prelingual deafness and 9 children had postlingual deafness. The hearing impairment was progressive…
Golfeto, Raquel M.; de Souza, Deisy G.
Three children with neurosensory deafness who used cochlear implants were taught to match video clips to dictated sentences. We used matrix training with overlapping components and tested for recombinative generalization. Two 3?×?3 matrices generated 18 sentences. For each matrix, we taught 6 sentences and evaluated generalization with the…
Most, Tova; Wiesel, Amatzia; Blitzer, Tamar
This study examined the relationships between identity orientations and attitudes toward cochlear implant (CI). A total of 115 deaf and hard of hearing (D/HH) adolescents completed a demographic questionnaire, the Deaf Identity Developmental Scale (DIDS) and an attitudes toward CI questionnaire. The DIDS results showed that participants'…
Cherney, James L.
Examines the potential benefits and limitations of cyborg politics. Explores depictions of cyborgs in science fiction stories and examines the deaf culture's arguments in the cochlear-implant debate. Investigates the current viability of cyborg politics as a mode of advocacy for people with disabilities. (SC)
Kronenberger, William G.; Pisoni, David B.; Henning, Shirley C.; Colson, Bethany G.; Hazzard, Lindsey M.
Purpose: This study investigated the feasibility and efficacy of a working memory training program for improving memory and language skills in a sample of 9 children who are deaf (age 7-15 years) with cochlear implants (CIs). Method: All children completed the Cogmed Working Memory Training program on a home computer over a 5-week period.…
Magierska-Krzysztoń, Magdalena; Szyfter, Witold
This paper is a preliminary report concerning result of social integration of children after cochlear implantation in the mainstream education system. It has been proofed that the presence of hearing impaired child in the class has an influence on other children. These other became more sensitive, less selfish and able to see needs of other human being. The tests were conducted on the group of 34 children and adolescents implanted in Poznań, learning in schools in the mainstream education system.
Fiorino, Francesco; Amadori, Maurizio
The objective of the present paper was to acquire information about the mastoidectomy size necessary to obtain an optimal placement of the direct acoustic cochlear implant actuator and fixation system. Ten human cadaveric temporal bones were dissected and implanted with direct acoustic cochlear implant. Mastoidectomy size was determined after implantation in each temporal bone. A bone bed for the receiver/stimulator, mastoidectomy and a large posterior tympanotomy were drilled out. The mastoidectomy was progressively enlarged posteriorly in small steps until the actuator template was judged adequately oriented to enable passage of the rod through the posterior tympanotomy without any contact with the bony walls. The distance between different landmarks in the mastoidectomy was measured. All measured values showed a high degree of consistency, with limited median absolute deviation values. One of the most critical measure, i.e. the distance between the posterior margin of the mastoidectomy to the superior rim of the bony external ear canal wall, ranged from 13 to 16 mm with a median value of 15 mm. Prior knowledge of the ideal size of the mastoidectomy for direct acoustic cochlear implant facilitates the positioning of the fixation system and may save time during implant surgery.
Takahashi, Daisuke; Ogura, Akio; Hayashi, Norio; Seino, Shinya; Kawai, Ryosuke; Matsuda, Tsuyoshi; Doi, Tsukasa; Tsuchihashi, Toshio
In magnetic resonance imaging (MRI) examination of the patients with the cochlear implant, only limited data have a mention for safety information in the instruction manual supplied by the manufacturers. Therefore, imaging operators require more detailed safety information for implant device. We conducted detailed examination about displacement force, torque, and demagnetizing of the cochlear implant magnet based on American Society for Testing and Materials (ASTM) standard using the PULSAR and CONCERTO (MED-EL) with 1.5 tesla MRI system. As a result, the displacement force and the torque of the implant magnet were less than the numerical values descried in the manual. Therefore, these have almost no effect on the body under the condition described in a manual. In addition, the demagnetizing factor of the cochlear implant magnet occurred by a change magnetic field. The demagnetization depended on the direction of a line of magnetic force of the static magnetic field and the implant magnet. In conclusion, the operator must warn the position of the patients on inducing in the magnet room.
Cheon, Gyeong-Woo; Jeong, Hyun-Woo; Chalasani, Preetham; Chien, Wade W.; Iordachita, Iulian; Taylor, Russell; Niparko, John; Kang, Jin U.
In cochlear implant surgery, an electrode array is inserted into the cochlear canal to restore hearing to a person who is profoundly deaf or significantly hearing impaired. One critical part of the procedure is the insertion of the electrode array, which looks like a thin wire, into the cochlear canal. Although X-ray or computed tomography (CT) could be used as a reference to evaluate the pathway of the whole electrode array, there is no way to depict the intra-cochlear canal and basal turn intra-operatively to help guide insertion of the electrode array. Optical coherent tomography (OCT) is a highly effective way of visualizing internal structures of cochlea. Swept source OCT (SSOCT) having center wavelength of 1.3 micron and 2D Galvonometer mirrors was used to achieve 7-mm depth 3-D imaging. Graphics processing unit (GPU), OpenGL, C++ and C# were integrated for real-time volumetric rendering simultaneously. The 3D volume images taken by the OCT system were assembled and registered which could be used to guide a cochlear implant. We performed a feasibility study using both dry and wet temporal bones and the result is presented.
Goldwyn, Joshua H; Shea-Brown, Eric; Rubinstein, Jay T
Cochlear implant speech processors stimulate the auditory nerve by delivering amplitude-modulated electrical pulse trains to intracochlear electrodes. Studying how auditory nerve cells encode modulation information is of fundamental importance, therefore, to understanding cochlear implant function and improving speech perception in cochlear implant users. In this paper, we analyze simulated responses of the auditory nerve to amplitude-modulated cochlear implant stimuli using a point process model. First, we quantify the information encoded in the spike trains by testing an ideal observer's ability to detect amplitude modulation in a two-alternative forced-choice task. We vary the amount of information available to the observer to probe how spike timing and averaged firing rate encode modulation. Second, we construct a neural decoding method that predicts several qualitative trends observed in psychophysical tests of amplitude modulation detection in cochlear implant listeners. We find that modulation information is primarily available in the sequence of spike times. The performance of an ideal observer, however, is inconsistent with observed trends in psychophysical data. Using a neural decoding method that jitters spike times to degrade its temporal resolution and then computes a common measure of phase locking from spike trains of a heterogeneous population of model nerve cells, we predict the correct qualitative dependence of modulation detection thresholds on modulation frequency and stimulus level. The decoder does not predict the observed loss of modulation sensitivity at high carrier pulse rates, but this framework can be applied to future models that better represent auditory nerve responses to high carrier pulse rate stimuli. The supplemental material of this article contains the article's data in an active, re-usable format.
de Brito, Rubens; Bittencourt, Aline Gomes; Goffi-Gomez, Maria Valéria; Magalhães, Ana Tereza; Samuel, Paola; Tsuji, Robinson Koji; Bento, Ricardo Ferreira
Summary Introduction: Cochlear implants may guarantee sound perception and the ability to detect speech at a close-to-normal hearing intensity; however, differences have been observed among implantees in terms of performance on discrimination tests and speech recognition. Objective: To identify whether patients with post-meningitis deafness perform similarly to patients with hearing loss due to other causes. Method: A retrospective clinical study involving post-lingual patients who had been using Nucleus-22 or Nucleus-24 cochlear implants for at least 1 year. These patients were matched with respect to age (± 2 years), time since the onset of deafness (± 1 year), and the duration of implant use with implant users who had hearing loss due to other causes. Speech perception was assessed using the Portuguese version of the Latin-American Protocol for the Evaluation of Cochlear Implants. Results: The sample consisted of 52 individuals (26 in each of the 2 groups). The post-meningitic group had a median of 18.5 active electrodes. The group with hearing loss due to other causes had a median of 21, but no significant statistical difference was observed (p = 0.07). The results of closed- and open-set speech recognition tests showed great variability in speech recognition between the studied groups. These differences were more pronounced for the most difficult listening tasks, such as the medial consonant task (in the vowel-consonant-vowel format). Conclusion: Cochlear implant recipients with hearing loss due to bacterial meningitis, who had been using the device for 1 year performed more poorly on closed- and open-set speech recognition tests than did implant recipients with hearing loss due to other causes. PMID:25991995
Niedermeier, Katharina; Braun, Susanne; Fauser, Claudius; Straubinger, Reinhard K; Stark, Thomas
In 2002 an increased number of cochlear implant related meningitis cases was reported by the U. S. Food and Drug Administration (FDA). The most commonly identified causative agent was Streptococcus pneumoniae. Although most cases of meningitis were related to a special electrode design, the risk for post-operative pneumococcal meningitis might nonetheless be enhanced by opening of the cochlea during implantation. In the present study, a threshold model for middle ear inoculation of S. pneumoniae was established in the guinea pig after cochlear implantation to assess the post-operative risk of meningitis. Guinea pigs were implanted unilaterally with a silicone cochlear implant electrode dummy. Five weeks after implantation, animals were challenged via the middle ear with a clinically relevant strain of S. pneumoniae and monitored over a period of five days for signs of meningitis. Meningitis was confirmed by clinical outcome in the animals, histological investigation of brains, as well as by pleocytosis and presence of bacteria in cerebrospinal fluid (CSF). By inoculation of varying numbers of bacteria (between 1 × 10(4) and 1 × 10(9) CFU/ml in 10 μl), a threshold model was established. The attack rate, pattern and onset of meningitis depended on number of inoculated bacteria. An increased meningitis rate in different experimental groups shows that greater bacterial burden leads to an increased attack rate after intratympanal inoculation. The established animal model provides a potential tool to assess the meningitis risk after cochlear implantation. Its implementation in future studies will allow the investigation of existing and newly developed prostheses for postoperatively infection risk.
Lopez-Poveda, Enrique A; Eustaquio-Martín, Almudena; Stohl, Joshua S; Wolford, Robert D; Schatzer, Reinhold; Wilson, Blake S
Our two ears do not function as fixed and independent sound receptors; their functioning is coupled and dynamically adjusted via the contralateral medial olivocochlear efferent reflex (MOCR). The MOCR possibly facilitates speech recognition in noisy environments. Such a role, however, is yet to be demonstrated because selective deactivation of the reflex during natural acoustic listening has not been possible for human subjects up until now. Here, we propose that this and other roles of the MOCR may be elucidated using the unique stimulus controls provided by cochlear implants (CIs). Pairs of sound processors were constructed to mimic or not mimic the effects of the contralateral MOCR with CIs. For the non-mimicking condition (STD strategy), the two processors in a pair functioned independently of each other. When configured to mimic the effects of the MOCR (MOC strategy), however, the two processors communicated with each other and the amount of compression in a given frequency channel of each processor in the pair decreased with increases in the output energy from the contralateral processor. The analysis of output signals from the STD and MOC strategies suggests that in natural binaural listening, the MOCR possibly causes a small reduction of audibility but enhances frequency-specific inter-aural level differences and the segregation of spatially non-overlapping sound sources. The proposed MOC strategy could improve the performance of CI and hearing-aid users.
Chung, King; Zeng, Fan-Gang; Acker, Kyle N
Although cochlear implant (CI) users have enjoyed good speech recognition in quiet, they still have difficulties understanding speech in noise. We conducted three experiments to determine whether a directional microphone and an adaptive multichannel noise reduction algorithm could enhance CI performance in noise and whether Speech Transmission Index (STI) can be used to predict CI performance in various acoustic and signal processing conditions. In Experiment I, CI users listened to speech in noise processed by 4 hearing aid settings: omni-directional microphone, omni-directional microphone plus noise reduction, directional microphone, and directional microphone plus noise reduction. The directional microphone significantly improved speech recognition in noise. Both directional microphone and noise reduction algorithm improved overall preference. In Experiment II, normal hearing individuals listened to the recorded speech produced by 4- or 8-channel CI simulations. The 8-channel simulation yielded similar speech recognition results as in Experiment I, whereas the 4-channel simulation produced no significant difference among the 4 settings. In Experiment III, we examined the relationship between STIs and speech recognition. The results suggested that STI could predict actual and simulated CI speech intelligibility with acoustic degradation and the directional microphone, but not the noise reduction algorithm. Implications for intelligibility enhancement are discussed.
Sadadcharam, M; Warner, L; Henderson, L; Brown, N; Bruce, I A
Increasingly, children are considered for a unilateral CI, even if the contralateral ear falls outside current audiological guidelines, especially if they are not considered to be reaching their educational potential. The primary aim was to investigate the benefit of unilateral CI in children currently outside UK [National Institute for Health and Care Excellence Technology Appraisal Guidance. 2009. Cochlear implants for children and adults with severe to profound deafness. NICE technology appraisal guidance [TAG166]. Available January 29, 2016 from http://www.nice.org.uk/ta166 ] audiological guidelines in the contralateral ear. The secondary aim was to measure compliance. A retrospective case review with standard demographic data was performed. Forty-seven children were identified as having received a unilateral CI with the contralateral ear falling outside of current UK audiological criteria. These children were allocated to two groups; with hearing between 50 and 70 dB, and 70 and 90 dB at 2 and 4 kHz in the contralateral ear, respectively. Categories of auditory performance (CAP) were assessed. Pre- and post-operative CAP scores demonstrated a statistically significant improvement in auditory perception. We would suggest that assessing candidacy in individual ears and subsequent unilateral CI, has given these children a benefit they may not otherwise have acquired if they only had bilateral hearing aid.
Schurzig, Daniel; Labadie, Robert F; Hussong, Andreas; Rau, Thomas S; Webster, Robert J
The quality of hearing restored to a deaf patient by a cochlear implant in hearing preservation cochlear implant surgery (and possibly also in routine cochlear implant surgery) is believed to depend on preserving delicate cochlear membranes while accurately inserting an electrode array deep into the spiral cochlea. Membrane rupture forces, and possibly, other indicators of suboptimal placement, are below the threshold detectable by human hands, motivating a force sensing insertion tool. Furthermore, recent studies have shown significant variability in manual insertion forces and velocities that may explain some instances of imperfect placement. Toward addressing this, an automated insertion tool was recently developed by Hussong et al. By following the same insertion tool concept, in this paper, we present mechanical enhancements that improve the surgeon's interface with the device and make it smaller and lighter. We also present electomechanical design of new components enabling integrated force sensing. The tool is designed to be sufficiently compact and light that it can be mounted to a microstereotactic frame for accurate image-guided preinsertion positioning. The new integrated force sensing system is capable of resolving forces as small as 0.005 N, and we provide experimental illustration of using forces to detect errors in electrode insertion.
Wu, Xihong; Qu, Hongwei; Chen, Jing; Qu, Tianshu; Li, Liang
Electrical stimulation of the auditory pathway produces different patterns of neural activity than those acoustically elicited. Traditional signal-processing strategies for cochlear implant usually do not utilize phase information contained in sound waves. Here, to evaluate potential advantages of introducing phase information to cochlear implant devices, a new signal processing method, so called simulated phase-locking stimulation (SPLS), was developed. To convey phase information of sound signals to the auditory nerve, electrical stimulation pulses were delivered at the zero-crossing time of sine waves of frequency bands after band-pass filtering and envelope extraction. The advantages of the SPLS method over the method of Continuous Interleaved Sampling (CIS+) were demonstrated by both objective evaluations, such as the spectro-temporal modulation index (STMI), and subjective evaluations, such as recognition of processed Chinese speech by normal hearing listeners under either noise (energetic) masking or speech (informational) masking conditions. The results suggest that the SPLS method is able to improve the function of cochlear devices by extracting and transferring fine-structure signals, which are important for cochlear-implant listeners to perceive tonal speech and music.
Morton, Kenneth D; Torrione, Peter A; Throckmorton, Chandra S; Collins, Leslie M
It has been established that current cochlear implants do not supply adequate spectral information for perception of tonal languages. Comprehension of a tonal language, such as Mandarin Chinese, requires recognition of lexical tones. New strategies of cochlear stimulation such as variable stimulation rate and current steering may provide the means of delivering more spectral information and thus may provide the auditory fine-structure required for tone recognition. Several cochlear implant signal processing strategies are examined in this study, the continuous interleaved sampling (CIS) algorithm, the frequency amplitude modulation encoding (FAME) algorithm, and the multiple carrier frequency algorithm (MCFA). These strategies provide different types and amounts of spectral information. Pattern recognition techniques can be applied to data from Mandarin Chinese tone recognition tasks using acoustic models as a means of testing the abilities of these algorithms to transmit the changes in fundamental frequency indicative of the four lexical tones. The ability of processed Mandarin Chinese tones to be correctly classified may predict trends in the effectiveness of different signal processing algorithms in cochlear implants. The proposed techniques can predict trends in performance of the signal processing techniques in quiet conditions but fail to do so in noise.
Wenzel, Gentiana I; Sarnes, Petra; Warnecke, Athanasia; Stöver, Timo; Jäger, Burkard; Lesinski-Schiedat, Anke; Lenarz, Thomas
One main theory behind the origin of tinnitus is based on the idea that alterations of the spontaneous electrical activity within the auditory system lead to abnormal firing patterns in the affected nervous structures . A possible therapeutic option is the use of electrical stimulation of the auditory nerve for the recovery or at least limitation of the abnormal firing pattern to a level that can be easily tolerated by the patient. The Tinnelec Implant consists of a single non-penetrating stimulation electrode connected to a Neurelec cochlear implant system. As a first feasibility study, before starting implantations in hearing patients, we thought to assess the potential of the Tinnelec stimulation to treat tinnitus in unilateral deaf patients, analysing hereby its effectivity and risks. Three patients suffering from unilateral tinnitus resistant to pharmacological treatment and ipsilateral severe to profound sensorineural hearing loss/deafness were implanted with a Tinnelec system between September 2007 and July 2008, at the ENT Department of Hannover Medical School. The stimulation strategy was chosen to induce alleviation of the tinnitus through suppression, masking and/or habituation and the response of each patient on the treatment was monitored using a visual analogue scale (VAS) on loudness and annoyance of tinnitus, mood of the patient, as well as the tinnitus handicap inventory (THI). All patients had a benefit from the electrical stimulation for their tinnitus (THI-score improvement of 20-70), however, not all participants profited from the Tinnelec system in same way and degree. In one patient, despite good results, the device had to be replaced with a conventional cochlear implant because of Tinnelec-independent increase in hearing loss on the contralateral ear. Additionally, due to the extension of cochlear implant indications, the devices of the other two patients have been meanwhile replaced with a conventional cochlear implant to benefit
Cosetti, Maura K; Pinkston, James B; Flores, Jose M; Friedmann, David R; Jones, Callie B; Roland, J Thomas; Waltzman, Susan B
Objective The aim of this case series was to assess the impact of auditory rehabilitation with cochlear implantation on the cognitive function of elderly patients over time. Design This is a longitudinal case series of prospective data assessing neurocognitive function and speech perception in an elderly cohort pre- and post-implantation. Setting University cochlear implant center. Participants The patients were post-lingually deafened elderly female (mean, 73.6 years; SD, 5.82; range, 67–81 years) cochlear implant recipients (n=7). Measurements A neurocognitive battery of 20 tests assessing intellectual function, learning, short- and long-term memory, verbal fluency, attention, mental flexibility, and processing speed was performed prior to and 2–4.1 years (mean, 3.7) after cochlear implant (CI). Speech perception testing using Consonant–Nucleus–Consonant words was performed prior to implantation and at regular intervals postoperatively. Individual and aggregate differences in cognitive function pre- and post-CI were estimated. Logistic regression with cluster adjustment was used to estimate the association (%improvement or %decline) between speech understanding and years from implantation at 1 year, 2 years, and 3 years post-CI. Results Improvements after CI were observed in 14 (70%) of all subtests administered. Declines occurred in five (25%) subtests. In 55 individual tests (43%), post-CI performance improved compared to a patient’s own performance before implantation. Of these, nine (45%) showed moderate or pronounced improvement. Overall, improvements were largest in the verbal and memory domains. Logistic regression demonstrated a significant relationship between speech perception and cognitive function over time. Five neurocognitive tests were predictive of improved speech perception following implantation. Conclusion Comprehensive neurocognitive testing of elderly women demonstrated areas of improvement in cognitive function and auditory
Nittrouer, Susan; Caldwell, Amanda; Holloman, Christopher
Objective To evaluate how well various language measures typically used with very young children after they receive cochlear implants predict language and literacy skills as they enter school. Methods Subjects were 50 children who had just completed kindergarten and were 6 or 7 years of age. All had previously participated in a longitudinal study from 12 to 48 months of age. 27 children had severe-to-profound hearing loss and wore cochlear implants, 8 had moderate hearing loss and wore hearing aids, and 15 had normal hearing. A latent variable of language/literacy skill was constructed from scores on six kinds of measures: (1) language comprehension; (2) expressive vocabulary; (3) phonological awareness; (4) literacy; (5) narrative skill; and (6) processing speed. Five kinds of language measures obtained at six-month intervals from 12 to 48 months of age were used as predictor variables in correlational analyses: (1) language comprehension; (2) expressive vocabulary; (3) syntactic structure of productive speech; (4) form and (5) function of language used in language samples. Results Outcomes quantified how much variance in kindergarten language/literacy performance was explained by each predictor variable, at each earlier age of testing. Comprehension measures consistently predicted roughly 25 to 50 percent of the variance in kindergarten language/literacy performance, and were the only effective predictors before 24 months of age. Vocabulary and syntactic complexity were strong predictors after roughly 36 months of age. Amount of speech produced in language samples and number of answers to parental queries explained moderate amounts of variance in performance after 24 months of age. Number of manual gestures and nonspeech vocalizations produced in language samples explained little to no variance before 24 months of age, and after that were negatively correlated with kindergarten performance. The number of imitations produced in language samples at 24 months of age
Phillips-Silver, Jessica; Toiviainen, Petri; Gosselin, Nathalie; Turgeon, Christine; Lepore, Franco; Peretz, Isabelle
Cochlear implant users show a profile of residual, yet poorly understood, musical abilities. An ability that has received little to no attention in this population is entrainment to a musical beat. We show for the first time that a heterogeneous group of cochlear implant users is able to find the beat and move their bodies in time to Latin Merengue music, especially when the music is presented in unpitched drum tones. These findings not only reveal a hidden capacity for feeling musical rhythm through the body in the deaf and hearing impaired population, but illuminate promising avenues for designing early childhood musical training that can engage implanted children in social musical activities with benefits potentially extending to non-musical domains.
Yang, Li-Ping; Fu, Qian-Jie
A single-channel speech enhancement algorithm utilizing speech pause detection and nonlinear spectral subtraction is proposed for cochlear implant patients in the present study. The spectral subtraction algorithm estimates the short-time spectral magnitude of speech by subtracting the estimated noise spectral magnitude from the noisy speech spectral magnitude. The artifacts produced by spectral subtraction (such as ``musical noise'') were significantly reduced by combining variance-reduced gain function and spectral flooring. Sentence recognition by seven cochlear implant subjects was tested under different noisy listening conditions (speech-shaped noise and 6-talker speech babble at +9, +6, +3, and 0 dB SNR) with and without the speech enhancement algorithm. For speech-shaped noise, performance for all subjects at all SNRs was significantly improved by the speech enhancement algorithm; for speech babble, performance was only modestly improved. The results suggest that the proposed speech enhancement algorithm may be beneficial for implant users in noisy listening. .
Belzner, Kate A; Seal, Brenda C
Children with severe to profound hearing loss in the United States are diverse in their racial-ethnic backgrounds, comorbid disabilities, socioeconomic levels, and communication modalities. The present article addresses demographic variables and communication outcomes of children with cochlear implants by means of a review of longitudinal studies published from 2000 through 2007. Information gathered from these reports reflects several trends over the years. Chi-square testing, however, revealed that two large samples chosen from the review failed to conform to an expected population profile for demographic diversity. This literature review and synthesis provides a body of evidence that should be useful for cochlear implant educators, clinicians, and researchers in determining the relevance of previous outcomes to individuals and groups who differ from those reported, and in devising suggestions for increased efforts to represent children of diverse backgrounds in investigations of implant outcomes.
Hwang, Chung-Feng; Ko, Hui-Chen; Tsou, Yung-Ting; Chan, Kai-Chieh; Fang, Hsuan-Yeh; Wu, Che-Ming
Objectives. We evaluated the causes, hearing, and speech performance before and after cochlear implant reimplantation in Mandarin-speaking users. Methods. In total, 589 patients who underwent cochlear implantation in our medical center between 1999 and 2014 were reviewed retrospectively. Data related to demographics, etiologies, implant-related information, complications, and hearing and speech performance were collected. Results. In total, 22 (3.74%) cases were found to have major complications. Infection (n = 12) and hard failure of the device (n = 8) were the most common major complications. Among them, 13 were reimplanted in our hospital. The mean scores of the Categorical Auditory Performance (CAP) and the Speech Intelligibility Rating (SIR) obtained before and after reimplantation were 5.5 versus 5.8 and 3.7 versus 4.3, respectively. The SIR score after reimplantation was significantly better than preoperation. Conclusions. Cochlear implantation is a safe procedure with low rates of postsurgical revisions and device failures. The Mandarin-speaking patients in this study who received reimplantation had restored auditory performance and speech intelligibility after surgery. Device soft failure was rare in our series, calling attention to Mandarin-speaking CI users requiring revision of their implants due to undesirable symptoms or decreasing performance of uncertain cause. PMID:27413753
This article employs meta-analysis procedures to evaluate whether children with cochlear implants demonstrate lower spoken-language vocabulary knowledge than peers with normal hearing. Of the 754 articles screened and 52 articles coded, 12 articles met predetermined inclusion criteria (with an additional 5 included for one analysis). Effect sizes were calculated for relevant studies and forest plots were used to compare differences between groups of children with normal hearing and children with cochlear implants. Weighted effect size averages for expressive vocabulary measures (g = -11.99; p < .001) and for receptive vocabulary measures (g = -20.33; p < .001) indicated that children with cochlear implants demonstrate lower vocabulary knowledge than children with normal hearing. Additional analyses confirmed the value of comparing vocabulary knowledge of children with hearing loss to a tightly matched (e.g., socioeconomic status-matched) sample. Age of implantation, duration of implantation, and chronological age at testing were not significantly related to magnitude of weighted effect size. Findings from this analysis represent a first step toward resolving discrepancies in the vocabulary knowledge literature.
Staecker, Hinrich; Garnham, Carolyn
Cochlear implantation is a highly successful intervention for the treatment of deafness that depends on electrical stimulation of the inner ear's surviving spiral ganglion neurons. It is thought that some of the variability in hearing outcomes that is seen in patients receiving implants may be a reflection of the number or health of surviving neurons. A variety of studies have demonstrated a relationship between hair cell loss and degeneration of the spiral ganglion. This has been attributed to the loss of neurotrophin production with destruction of the spiral ganglion's target, the hair cell. Delivery of neurotrophins either through a device or through gene therapy has been shown to improve spiral ganglion survival after hair cell loss and additionally improves the function of cochlear implants in animal models. Translation of these observations to human therapy will require a clear understanding of the relationship between human spiral ganglion health and cochlear implant outcomes as well as the development of novel pre- and post-implantation outcomes measures.
Vidas, S; Hassan, R; Parnes, L S
Most pediatric cochlear implant programs support a team approach for post-implant services. However, individuals directly involved in the care of these children often have differing opinions on the child's performance. We describe our experience with four children, aged 3 to 10 at the time of implantation, who have used the Nucleus 22-channel cochlear implant device for at least nine months. A questionnaire, focusing on the individual's observations of the child's speech and hearing performance in their particular setting (i.e., clinic, home, school), was completed by the child's parent(s), therapist and classroom teacher. Overall, performance in structured settings (i.e., testing and therapy sessions) was not in agreement with performance in unstructured settings (i.e., classroom and home environments). The results suggest that different individuals interacting with the same child in different environments often have differing perceptions of the child's performance. Based on the information obtained on the four cases, we discuss factors to consider in assessing the real-life performance of pediatric cochlear implant recipients.
Servais, Jérôme J.; Hörmann, Karl; Wallhäusser-Franke, Elisabeth
Perceptive and receptive aspects of subjective tinnitus like loudness and tinnitus-related distress are partly independent. The high percentage of hearing loss in individuals with tinnitus suggests causality of hearing impairment particularly for the tinnitus percept, leading to the hypothesis that restoration of auditory input has a larger effect on tinnitus loudness than on tinnitus-related distress. Furthermore, it is assumed that high levels of depression or anxiety prevent reductions of tinnitus loudness and distress following restoration of activity in the cochlea. This prospective study investigated the influence of unilateral cochlear implant (CI) on tinnitus in 19 postlingually deafened adults during 6 months following implantation. All had bimodal provision with the other ear being continuously supported by a hearing aid. On the day before CI implantation (T1, T2), and at about 3 and 6 months postsurgery (T3, T4), participants were questioned about their current tinnitus. Loudness was rated on a Numeric Rating Scale, distress was assessed by the TQ12 Tinnitus Questionnaire, and depression and anxiety were recorded with the Hospital Anxiety and Depression Scale. At T2, 79% experienced tinnitus, one participant developed tinnitus after implantation. Following implantation, tinnitus loudness was reduced significantly by 42%, while reductions in tinnitus-related distress (−24%), depression (−20%), and anxiety (−20%) did not attain statistical significance. Significant correlations existed between tinnitus measures, and between postimplantation tinnitus-related distress and anxiety and depression scores. Moreover, improvement of hearing in the CI ear was significantly correlated with reduction in tinnitus loudness. A new aspect of this study is the particular influence of CI provision on perceptive aspects of preexisting tinnitus (hypothesis 1), with the effect size regarding postimplant reduction of perceived tinnitus loudness (1.40) being much
Morse, Robert P.; Roper, Peter
Analog electrical stimulation of the cochlear nerve (the nerve of hearing) by a cochlear implant is an effective method of providing functional hearing to profoundly deaf people. Recent physiological and computational experiments have shown that analog cochlear implants are unlikely to convey certain speech cues by the temporal pattern of evoked nerve discharges. However, these experiments have also shown that the optimal addition of noise to cochlear implant signals can enhance the temporal representation of speech cues [R. P. Morse and E. F. Evans, Nature Medicine 2, 928 (1996)]. We present a simple model to explain this enhancement of temporal representation. Our model derives from a rate equation for the mean threshold-crossing rate of an infinite set of parallel discriminators (level-crossing detectors); a system that well describes the time coding of information by a set of nerve fibers. Our results show that the optimal transfer of information occurs when the threshold level of each discriminator is equal to the root-mean-square noise level. The optimal transfer of information by a cochlear implant is therefore expected to occur when the internal root-mean-square noise level of each stimulated fiber is approximately equal to the nerve threshold. When interpreted within the framework of aperiodic stochastic resonance, our results indicate therefore that for an infinite array of discriminators, a tuning of the noise is still necessary for optimal performance. This is in contrast to previous results [Collins, Chow, and Imhoff, Nature 376, 236 (1995); Chialvo, Longtin, and Müller-Gerking, Phys. Rev. E 55, 1798 (1997)] on arrays of FitzHugh-Nagumo neurons.
cochlear implants , in hybrid cochlear implants and hearing aids, in intelligent personal protective equipment, and in noise dosimeters. Summary of...medical devices including cochlear implants for the deaf, hybrid hearing implants , brain-machine interfaces, and other neural stimulation devices. In...Technical 05/11/2009-09/30/2011 4. TITLE AND SUBTITLE Sa. CONTRACT NUMBER An Electronic System for Ultra-low Power Hearing Implants Sb. GRANT NUMBER
Bell, Tracy Elizabeth
This dissertation presents the design and fabrication of two generations of a silicon microelectrode array for use in a cochlear implant. A cochlear implant is a device that is inserted into the inner ear and uses electrical stimulation to provide sound sensations to the profoundly deaf. The first-generation silicon cochlear implant is a passive device fabricated using silicon microprobe technology developed at the University of Michigan. It contains twenty-two iridium oxide (IrO) stimulating sites that are 250 mum in diameter and spaced at 750 mum intervals. In-vivo recordings were made in guinea pig auditory cortex in response to electrical stimulation with this device, verifying its ability to electrically evoke an auditory response. Auditory thresholds as low as 78 muA were recorded. The second-generation implant is a thirty-two site, four-channel device with on-chip CMOS site-selection circuitry and integrated position sensing. It was fabricated using a novel bulk silicon surface micromachining process which was developed as a part of this dissertation work. While the use of semiconductor technology offers many advantages in fabricating cochlear implants over the methods currently used, it was felt that even further advantages could be gained by developing a new micromachining process which would allow circuitry to be distributed along the full length of the cochlear implant substrate. The new process uses electropolishing of an n+ bulk silicon sacrificial layer to undercut and release n- epitaxial silicon structures from the wafer. An extremely abrupt etch-stop between the n+ and n- silicon is obtained, with no electropolishing taking place in the n-type silicon that is doped lower than 1 x 1017 cm-3 in concentration. Lateral electropolishing rates of up to 50 mum/min were measured using this technique, allowing one millimeter-wide structures to be fully undercut in as little as 10 minutes. The new micromachining process was integrated with a standard p
Kludt, Eugen; Büchner, Andreas; Schwab, Burkard; Lenarz, Thomas; Maier, Hannes
The new implantable hearing system Codacs™ was designed to close the treatment gap between active middle ear implants and cochlear implants in cases of severe-to-profound mixed hearing loss. The Codacs™ actuator is attached to conventional stapes prosthesis during the implantation and thereby provides acoustical stimulation through a stapedotomy to the cochlea. Cochlear implants (CIs) on the other hand are an established treatment option for profoundly deaf patients including mixed hearing losses that are possible candidates for the Codacs™. In this retrospective study, we compared the clinical outcome of 25 patients with the Codacs™ (≥3 month post-activation) to 54 CI patients (two years post-activation) with comparable pre-operative bone conduction (BC) thresholds that were potential candidates for both categories of devices. The word recognition score (Freiburg monosyllables test) in quiet was significantly (p < 0.05) better in the Codacs™ than in the corresponding CI patients for average pre-operative bone conduction below 60 dB HL and equal in patients with a pre-operative BC PTA between 60 and 70 dB HL. Speech in noise intelligibility (HSM sentences test at +10 dB SNR) was significantly (p < 0.001) better in Codacs™ (80% median) than in CI patients (25% median) in all tested groups. Our results indicate for patients with sufficient cochlear reserve that speech intelligibility in noise with the Codacs™ hearing implant is significantly better than with a CI. Further, results in Codacs™ were better predictable, encouraging the extension of the indication to patients with less cochlear reserve than reported here.
Liu, Ya; Jolly, Claude; Braun, Susanne; Stark, Thomas; Scherer, Elias; Plontke, Stefan K; Kiefer, Jan
Cochlear implants have been widely used for patients with profound hearing loss and partial deafness. Residual low-frequency hearing, however, may deteriorate due to insertion trauma and tissue response around the electrode array. The present study investigated in vitro and in vivo release of dexamethasone from silicone used for cochlear implant electrode carriers. The in vitro experiment involved an apparatus simulating the inner ear fluid environment in humans. Release from two sizes of silicone films (200 µm × 1 mm × 10 mm and 500 µm × 1 mm × 10 mm), each loaded with 2 % dexamethasone, and was measured for 24 weeks. In the in vivo experiment, silicone rods loaded with 2 or 10 % dexamethasone, respectively, were implanted into the scala tympani of guinea pigs. Perilymph concentrations were measured during the first week after implantation. The results showed that dexamethasone was released from the silicone in a sustained manner. After a burst release, perilymph concentration was similar for silicone incorporated with 2 and 10 % dexamethasone, respectively. The similar pharmacokinetic profile was found in the in vitro experiment. The period of sustained drug delivery was maintained for 20 weeks in vitro and for 1 week in vivo. The results of the present study suggest that drugs like dexamethasone are released in a controlled manner from silicon electrode carriers of cochlear implants. Further studies will identify optimal release profiles for the use with cochlear implants to improve their safety and long-term performance.
Kale, Sushrut; Cervantes, Vanessa M.; Wu, Mailing R.; Pisano, Dominic V.; Sheth, Nakul; Olson, Elizabeth S.
A cochlear implant (CI) restores partial hearing to profoundly deaf individuals. CI electrodes are inserted manually in the cochlea and surgeons rely on tactile feedback from the implant to determine when to stop the insertion. This manual insertion method results in a large degree of variability in surgical outcomes and intra-cochlear trauma. Additionally, implants often span only the basal turn. In the present study we report on the development of a new method to assist CI electrode insertion. The design objectives are (1) an automated and standardized insertion technique across patients with (2) more apical insertion than is possible by the contemporary methods, while (3) minimizing insertion trauma. The method relies on a viscous fluid flow through the cochlea to carry the electrode array with it. A small cochleostomy (∼ 100-150 um in diameter) is made in scala vestibuli (SV) and the round window (RW) membrane is opened. A flow of diluted Sodium Hyaluronate (also known as Hyaluronic Acid, (HA)) is set up from the RW to the SV opening using a perfusion pump that sets up a unidirectional flow. Once the flow is established an implant is dropped into the ongoing flow. Here we present a proof-of-concept study where we used this technique to insert silicone implants all the way to the cochlear apex in rats and gerbils. In light-microscopic histology, the implantation occurred without cochlear trauma. To further assess the ototoxicity of the HA perfusion, we measured compound action potential (CAP) thresholds following the perfusion of HA, and found that the CAP thresholds were substantially elevated. Thus, at this point the method is promising, and requires further development to become clinically viable. PMID:24882641
Lee, Joonhan; Nadol, Joseph B; Eddington, Donald K
The depth of electrode insertion of a multichannel cochlear implant has been suggested as a clinical variable that may correlate with word recognition using the implant. The current study evaluates this relationship using the human temporal bone collection at the Massachusetts Eye and Ear Infirmary. Twenty-seven temporal bones of subjects with cochlear implants were studied. Temporal bones were removed at autopsy, fixed and prepared for histological study by standard techniques. Specimens were then serially sectioned, and reconstructed by two-dimensional methods. Three measures of length were made from each subject's reconstruction: (1) depth of insertion (DI) of the cochlear implant electrode array, from the round window to the array's apical tip; (2) inserted length (IL) from the cochleostomy to the apical tip of the array, and (3) cochlear duct length (CDL) from the round window to the helicotrema. The active electrode length (AEL) was defined as the distance between the most apical and most basal electrodes of the array. Stepwise regression was used to identify whether subsets of six metrics associated with insertion depth (DI, DI/AEL, DI/CDL, IL, IL/AEL and IL/CDL), duration of deafness, sound-processing strategy, potential for central impairment and age at implantation accounted for significant across-subject variance in the last recorded NU-6 word score measured during each subject's life. Age at implantation and potential for central impairment account for significant percentages of the across-subject variance in NU-6 word scores for the 27 subjects studied. None of the insertion metrics accounted for significant performance variance, even when the variance associated with the other variables was controlled. These results, together with those of previous studies, are consistent with a relatively weak association between electrode insertion depth and speech reception.
Varga, L; Mašindová, I; Hučková, M; Kabátová, Z; Gašperíková, D; Klimeš, I; Profant, M
Hereditary etiology plays an important role in bilateral profound deafness as a main indication for cochlear implantation. Mutations in DFNB1 locus account for most of the inherited deafness cases in Caucasians. To provide actual data on mutation prevalence among implanted deaf subpopulation, we performed DNA analysis of GJB2 and GJB6 genes in 131 unrelated Slovak cochlear implant users. Eight previously described causal mutations and one probably pathogenic missense variant (c.127G>A) were detected in the GJB2 gene in 58 (44.28%) subjects. The most common mutation found was c.35delG with frequency 83.02% of all disease alleles, followed by c.71G>A, c.1-3201G>A, c.313_326del14, c.109G>A, 167delT, c.269T>C, and c.333_334delAA. GJB6 deletion delD13S1830 was identified in only one subject, in double heterozygosity with a GJB6 mutation. Thus, the deafness cause could be clearly attributable to DFNB1 mutations in 36.64% of the patients examined. In summary, the mutation profile found in our cohort was similar to the mutation spectrum reported for Central European deaf populations. The mutation prevalence in cochlear implant users was, however, almost by 25% higher than previously established for non-implanted hearing-impaired population in Slovakia. Finally, we also demonstrate a certain variability in deafness onset in patients with causal genotype and coincidence with other risk factors for deafness. Our results underline the importance of genetic tests in all cochlear implant candidates.
The Repeatable Battery for the Assessment of Neuropsychological Status for Hearing Impaired Individuals (RBANS-H) before and after Cochlear Implantation: A Protocol for a Prospective, Longitudinal Cohort Study
Claes, Annes J.; Mertens, Griet; Gilles, Annick; Hofkens-Van den Brandt, Anouk; Fransen, Erik; Van Rompaey, Vincent; Van de Heyning, Paul
Background: Currently, an independent relationship between hearing loss and cognitive decline in older adults is suggested by large prospective studies. In general, cochlear implants improve hearing and the quality of life in severely to profoundly hearing impaired older persons. However, little is known about the effects of cochlear implantation on the cognitive evolution in this population. Aim of the study: The primary goal of this prospective, longitudinal cohort study is to explore the cognitive profile of severely to profoundly postlingually hearing impaired subjects before and after cochlear implantation. In addition, the current study aims to investigate the relationship between the cognitive function, audiometric performances, quality of life, and self-reliance in these patients. Methods: Twenty-five patients aged 55 or older, scheduled for cochlear implantation, will be enrolled in the study. They will be examined prior to implantation, at 6 and 12 months after implantation and annually thereafter. The test battery consists of (1) a cognitive examination, using the Repeatable Battery for the Assessment of Neuropsychological Status adapted for Hearing impaired persons (RBANS-H), (2) an audiological examination, including unaided and aided pure tone audiometry, speech audiometry in quiet and speech audiometry in noise, (3) the administration of four questionnaires evaluating quality of life and subjective hearing benefit and (4) a semi-structured interview about the self-reliance of the participant. Discussion: Up until now only one study has been conducted on this topic, focusing on the short-term effects of cochlear implantation on cognition in older adults. The present study is the first study to apply a comprehensive neuropsychological assessment adapted for severely to profoundly hearing impaired subjects in order to investigate the cognitive capabilities before and after cochlear implantation. Trial registration: The present protocol is
Reeder, Ruth M.; Firszt, Jill B.; Holden, Laura K.; Strube, Michael J.
Purpose: The purpose of this study was to examine the rate of progress in the 2nd implanted ear as it relates to the 1st implanted ear and to bilateral performance in adult sequential cochlear implant recipients. In addition, this study aimed to identify factors that contribute to patient outcomes. Method: The authors performed a prospective…