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)
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.
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…
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,…
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.
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…
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…
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…
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…
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.
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…
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…
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…
... 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 ...
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…
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.
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…
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…
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
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.…
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…
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
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…
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…
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…
... 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 ...
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…
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…
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…
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.
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…
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.…
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…
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)
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…
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…
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.
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…
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.
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.
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.
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
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.
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.
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,…
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.
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…
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.
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…
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…
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…
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…
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…
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.
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)
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
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…
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.
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
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
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…
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.
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.
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…
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
... 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
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.
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…
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.
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…
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.…
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…
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.
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'…
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
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…
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…
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…
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
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.
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.
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…
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…
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…
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…
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…
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…
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.
... 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 ...
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.
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.
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.
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
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.
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…
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…
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…
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…
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…
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…
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…
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…
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…
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,…
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.…
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.
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
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.
Guillot, Kathryn M.; Ohde, Ralph N.; Hedrick, Mark
Purpose: This study was conducted to determine whether the perceptions of nasal consonants in children with normal hearing and children with cochlear implants were predicted by the discontinuity hypothesis. Methods: Four groups participated: 8 adults, 8 children with normal hearing (ages 5-7 years), 8 children with normal hearing (ages 3.5-4…
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.…
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…
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…
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…
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…
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…
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…
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…
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…
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,…
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…
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.
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.
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
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.
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
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
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…
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 extent of the children's word learning was assessed using three assessment tasks: receptive pointing, expressively labeling, and word defining. Children demonstrated greater immediate expressive labeling gains and definition generation gains for words taught in the treatment condition compared to those in the comparison condition. In addition, the children's performance on delayed posttest vocabulary assessments indicated better retention across the expressive vocabulary task for words taught within the treatment condition as compared to the comparison condition. Findings suggest that children with cochlear implants with functional speech perception can benefit from an oral-only multimedia-enhanced intensive vocabulary instruction.
Szagun, Gisela; Schramm, Satyam A.
The aim of the present study was to analyze the relative influence of age at implantation, parental expansions, and child language internal factors on grammatical progress in children with cochlear implants (CI). Data analyses used two longitudinal corpora of spontaneous speech samples, one with twenty-two and one with twenty-six children,…
Shmatko, N D
The objective of the present study was to characterize the peculiarities oforganization of pedagogical rehabilitation for the children with a cochlear implant and to demonstrate the most effective forms of their upbringing and education. Special attention is given to the organization ofsuch work during the preschool period with reference to potential difficulties encountered in the education of the children suffering a delay in the speech development.
Lantos, John D
The story of the ethical controversy over cochlear implants is unique in some ways and paradigmatic in others. It is unique in the ways that it was shaped by the history of deafness, and of cultural responses to deafness, in the United States. The story is paradigmatic in two ways. First, cochlear implantation was an innovative therapy that was introduced into practice without adequate study. Promising early trials led to FDA approval, although long-term outcome data from rigorous studies were lacking. In this respect, the story of cochlear implants is similar to the history of other innovations that were introduced without rigorous evaluation, innovations such as supplemental oxygen, extracorporeal membrane oxygenation, or corticosteroids for bronchopulmonary dysplasia. Cochlear implants also are paradigmatic of a particular type of ethical dilemma in which advocacy groups claim to know better what is best for children than do the children's parents or doctors. This controversy happened during the Baby Doe debate in the 1980s, when advocacy groups claimed that doctors and parents were conspiring to discriminate against children with disabilities. Ultimately, the US Supreme Court invalidated that interpretation of disability rights. Instead, parents and doctors working together are given discretion to make decisions about what is best for children. With regard to cochlear implants for children, the NAD realizes that they are walking a fine line. As one NAD spokesperson said, "We don't say that hearing parents aren't qualified to make decisions about their deaf children. We say that they need to have contact with deaf people if they're going to make educated decisions". The same could be said for pediatricians. There are 4,000 to 8,000 infants born each year in the United States with severe hearing impairment. Their parents will have to make decisions about what is best. Pediatricians need to understand the options and be prepared to help parents sort through the
Kelly, Patrick Michael
Parents of children diagnosed with severe-profound sensorineural hearing loss are selecting cochlear implants at an increasing rate and when their children are very young. Audiologists and speech-language pathologists are typically involved in habilitation activities following implantation in an effort to increase children's access to listening…
Schorr, Efrat A.; Roth, Froma P.; Fox, Nathan A.
This study explored the language skills of children with cochlear implants (CIs) compared to normal hearing (NH) peers. Standardized speech and language measures, including speech articulation, receptive and expressive vocabulary, syntax and morphology, and metalinguistics, were administered to 39 congenitally deaf children, ages 5 to 14, and a…
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.
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.
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
Sataeva, A I
This publication was designed to summarize the results of the long-term study with the purpose of developing a scientific and methodological approach to rehabilitation of the children having cochlear implants. The main emphasis is laid on the initial (launching) stage of rehabilitative measures aimed at the reconstruction of the sensory basis of communication and interaction with the surrounding hearing subjects taking into consideration peculiarities of the children who experienced the loss of hearing late in their life and deaf children with different levels of speech development. The main corrective measures are described to be taken at the initial stage of rehabilitation of the young and pre-school children unable to speak by the time of prescribed cochlear implantation. The markers of completion of the initial phase of the rehabilitative period are identified indicating transition of a child toward the normal development as a result of cochlear implantation. The author discusses the results of corrective pedagogical measures that can be achieved by their adequate organization and consistent implementation.
Ji, Fei; Li, Jianan; Hong, Mengdi; Chen, Aiting; Jiao, Qingshan; Sun, Li; Liang, Sichao; Yang, Shiming
Background Auditory neuropathy (AN) is a recently recognized hearing disorder characterized by intact outer hair cell function, disrupted auditory nerve synchronization and poor speech perception and recognition. Cochlear implants (CIs) are currently the most promising intervention for improving hearing and speech in individuals with AN. Although previous studies have shown optimistic results, there was large variability concerning benefits of CIs among individuals with AN. The data indicate that different criteria are needed to evaluate the benefit of CIs in these children compared to those with sensorineural hearing loss. We hypothesized that a hierarchic assessment would be more appropriate to evaluate the benefits of cochlear implantation in AN individuals. Methods Eight prelingual children with AN who received unilateral CIs were included in this study. Hearing sensitivity and speech recognition were evaluated pre- and postoperatively within each subject. The efficacy of cochlear implantation was assessed using a stepwise hierarchic evaluation for achieving: (1) effective audibility, (2) improved speech recognition, (3) effective speech, and (4) effective communication. Results The postoperative hearing and speech performance varied among the subjects. According to the hierarchic assessment, all eight subjects approached the primary level of effective audibility, with an average implanted hearing threshold of 43.8 ± 10.2 dB HL. Five subjects (62.5%) attained the level of improved speech recognition, one (12.5%) reached the level of effective speech, and none of the subjects (0.0%) achieved effective communication. Conclusion CIs benefit prelingual children with AN to varying extents. A hierarchic evaluation provides a more suitable method to determine the benefits that AN individuals will likely receive from cochlear implantation. PMID:26010832
Gallego, Carlos; Martín-Aragoneses, M Teresa; López-Higes, Ramón; Pisón, Guzmán
Deaf students have traditionally exhibited reading comprehension difficulties. In recent years, these comprehension problems have been partially offset through cochlear implantation (CI), and the subsequent improvement in spoken language skills. However, the use of cochlear implants has not managed to fully bridge the gap in language and reading between normally hearing (NH) and deaf children, as its efficacy depends on variables such as the age at implant. This study compared the reading comprehension of sentences in 19 children who received a cochlear implant before 24 months of age (early-CI) and 19 who received it after 24 months (late-CI) with a control group of 19 NH children. The task involved completing sentences in which the last word had been omitted. To complete each sentence children had to choose a word from among several alternatives that included one syntactic and two semantic foils in addition to the target word. The results showed that deaf children with late-CI performed this task significantly worse than NH children, while those with early-CI exhibited no significant differences with NH children, except under more demanding processing conditions (long sentences with infrequent target words). Further, the error analysis revealed a preference of deaf students with early-CI for selecting the syntactic foil over a semantic one, which suggests that they draw upon syntactic cues during sentence processing in the same way as NH children do. In contrast, deaf children with late-CI do not appear to use a syntactic strategy, but neither a semantic strategy based on the use of key words, as the literature suggests. Rather, the numerous errors of both kinds that the late-CI group made seem to indicate an inconsistent and erratic response when faced with a lack of comprehension. These findings are discussed in relation to differences in receptive vocabulary and short-term memory and their implications for sentence reading comprehension.
James, Deborah; Rajput, Kaukab; Brinton, Julie; Goswami, Usha
The phonological awareness (PA), vocabulary, and word reading abilities of 19 children with cochlear implants (CI) were assessed. Nine children had an implant early (between 2 and 3.6 years) and 10 had an implant later (between 5 and 7 years). Participants were tested twice over a 12-month period on syllable, rhyme, and phoneme awareness (see…
Bilingualism is common throughout the world, and bilingual children regularly develop into fluently bilingual adults. In contrast, children with cochlear implants (CIs) are frequently encouraged to focus on a spoken language to the exclusion of sign language. Here, we investigate the spoken English language skills of 5 children with CIs who also have deaf signing parents, and so receive exposure to a full natural sign language (American Sign Language, ASL) from birth, in addition to spoken English after implantation. We compare their language skills with hearing ASL/English bilingual children of deaf parents. Our results show comparable English scores for the CI and hearing groups on a variety of standardized language measures, exceeding previously reported scores for children with CIs with the same age of implantation and years of CI use. We conclude that natural sign language input does no harm and may mitigate negative effects of early auditory deprivation for spoken language development. PMID:24150489
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
Pixner, Silvia; Leyrer, Martin; Moeller, Korbinian
Though previous findings report that hearing impaired children exhibit impaired language and arithmetic skills, our current understanding of how hearing and the associated language impairments may influence the development of arithmetic skills is still limited. In the current study numerical/arithmetic performance of 45 children with a cochlea implant were compared to that of controls matched for hearing age, intelligence and sex. Our main results were twofold disclosing that children with CI show general as well as specific numerical/arithmetic impairments. On the one hand, we found an increased percentage of children with CI with an indication of dyscalculia symptoms, a general slowing in multiplication and subtraction as well as less accurate number line estimations. On the other hand, however, children with CI exhibited very circumscribed difficulties associated with place-value processing. Performance declined specifically when subtraction required a borrow procedure and number line estimation required the integration of units, tens, and hundreds instead of only units and tens. Thus, it seems that despite initially atypical language development, children with CI are able to acquire arithmetic skills in a qualitatively similar fashion as their normal hearing peers. Nonetheless, when demands on place-value understanding, which has only recently been proposed to be language mediated, hearing impaired children experience specific difficulties.
Pixner, Silvia; Leyrer, Martin; Moeller, Korbinian
Though previous findings report that hearing impaired children exhibit impaired language and arithmetic skills, our current understanding of how hearing and the associated language impairments may influence the development of arithmetic skills is still limited. In the current study numerical/arithmetic performance of 45 children with a cochlea implant were compared to that of controls matched for hearing age, intelligence and sex. Our main results were twofold disclosing that children with CI show general as well as specific numerical/arithmetic impairments. On the one hand, we found an increased percentage of children with CI with an indication of dyscalculia symptoms, a general slowing in multiplication and subtraction as well as less accurate number line estimations. On the other hand, however, children with CI exhibited very circumscribed difficulties associated with place-value processing. Performance declined specifically when subtraction required a borrow procedure and number line estimation required the integration of units, tens, and hundreds instead of only units and tens. Thus, it seems that despite initially atypical language development, children with CI are able to acquire arithmetic skills in a qualitatively similar fashion as their normal hearing peers. Nonetheless, when demands on place-value understanding, which has only recently been proposed to be language mediated, hearing impaired children experience specific difficulties. PMID:25566152
Pau, Henry; Gibson, William P R; Gardner-Berry, Kirsty; Sanli, Halit
Waardenburg syndrome presents with dystopia canthorum, pigmentary abnormalities of hair, iris and skin (often a white forelock and heterochromia iridis) and sensorineural deafness. The authors review the electrophysiological and psychophysical findings of implanted children with Waardenburg syndrome at the Sydney Cochlear Implant Centre. Twenty children with Waardenburg syndrome received cochlear implants between 1985 and 2001. Electrical auditory brainstem response (EABR) was performed in all of these patients intra-operatively as part of the routine investigations. Only 13 of these patients were assessed one year or more post-operatively by means of the Melbourne Categories (0-7). Four patients (20%) were found to have abnormal EABR recordings. The mode of Melbourne Categories in this group (n = 3) was 1 at one year post-operation. The other 16 patients were found to have normal EABR and the mode of Melbourne Categories in this group (n = 10) was 7. A poor outcome after cochlear implantation was associated with abnormal EABR recordings (a 'true' auditory neuropathy) and was found in a significant proportion of patients with Waardenburg syndrome.
Moura, Amanda Christina Gomes de; Goffi-Gomez, Maria Valéria Schmidt; Couto, Maria Ines Vieira; Brito, Rubens; Tsuji, Robinson Koji; Befi-Lopes, Debora Maria; Matas, Carla Gentile; Bento, Ricardo Ferreira
Introduction Currently the cochlear implant allows access to sounds in individuals with profound hearing loss. The objective methods used to verify the integrity of the cochlear device and the electrophysiologic response of users have noted these improvements. Objective To establish whether the evoked compound action potential of the auditory nerve can appear after electrical stimulation when it is absent intraoperatively. Methods The clinical records of children implanted with the Nucleus Freedom (Cochlear Ltd., Australia) (CI24RE) cochlear implant between January 2009 and January 2010 with at least 6 months of use were evaluated. The neural response telemetry (NRT) thresholds of electrodes 1, 6, 11, 16, and 22 during surgery and after at least 3 months of implant use were analyzed and correlated with etiology, length of auditory deprivation, and chronological age. These data were compared between a group of children exhibiting responses in all of the tested electrodes and a group of children who had at least one absent response. Results The sample was composed of clinical records of 51 children. From these, 21% (11) showed no NRT in at least one of the tested electrodes. After an average of 4.9 months of stimulation, the number of individuals exhibiting absent responses decreased from 21 to 11% (n = 6). Conclusion It is feasible that absent responses present after a period of electrical stimulation. In our sample, 45% (n = 5) of the patients with intraoperative absence exhibited a positive response after an average of 4.9 months of continued electrical stimulation.
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
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
DesJardin, Jean L.; Ambrose, Sophie E.; Eisenberg, Laurie S.
The goal of this study was to longitudinally examine relationships between early factors (child and mother) that may influence children's phonological awareness and reading skills 3 years later in a group of young children with cochlear implants (N = 16). Mothers and children were videotaped during two storybook interactions, and children's oral…
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…
Vavatzanidis, Niki K; Mürbe, Dirk; Friederici, Angela D; Hahne, Anja
Children with sensorineural hearing loss may (re)gain hearing with a cochlear implant-a device that transforms sounds into electric pulses and bypasses the dysfunctioning inner ear by stimulating the auditory nerve directly with an electrode array. Many implanted children master the acquisition of spoken language successfully, yet we still have little knowledge of the actual input they receive with the implant and specifically which language sensitive cues they hear. This would be important however, both for understanding the flexibility of the auditory system when presented with stimuli after a (life-) long phase of deprivation and for planning therapeutic intervention. In rhythmic languages the general stress pattern conveys important information about word boundaries. Infant language acquisition relies on such cues and can be severely hampered when this information is missing, as seen for dyslexic children and children with specific language impairment. Here we ask whether children with a cochlear implant perceive differences in stress patterns during their language acquisition phase and if they do, whether it is present directly following implant stimulation or if and how much time is needed for the auditory system to adapt to the new sensory modality. We performed a longitudinal ERP study, testing in bimonthly intervals the stress pattern perception of 17 young hearing impaired children (age range: 9-50 months; mean: 22 months) during their first 6 months of implant use. An additional session before the implantation served as control baseline. During a session they passively listened to an oddball paradigm featuring the disyllable "baba," which was stressed either on the first or second syllable (trochaic vs. iambic stress pattern). A group of age-matched normal hearing children participated as controls. Our results show, that within the first 6 months of implant use the implanted children develop a negative mismatch response for iambic but not for trochaic
Silva, Mariane Perin da; Comerlatto Junior, Ademir Antonio; Bevilacqua, Maria Cecília; Lopes-Herrera, Simone Aparecida
The oral language development depends on the effective development of the hearing system. In cases of children presenting with hearing loss, a cochlear implant is an electronic device indicated to (re)habilitate the hearing function. Thus, it is of paramount importance to assess and follow the oral language development of children fitted with a cochlear implant (CI) to measure the effectiveness of the electronic device and support the therapeutic planning of these children. Questions are currently being raised about the instruments to assess the oral language of children using a CI, and, seeking the answers, this systematic review aimed at surveying these instruments. Searches were performed in three different databases utilizing six different descriptors to select articles published from 2004 to 2009 that performed an oral language assessment of children with a CI. Initially, 373 articles were found, and, after the application of inclusion criteria, 47 articles were analyzed, resulting in a survey of 74 instruments for oral language assessment, including tests, questionnaires and inventories. In analyzing the articles, it was realized that the studies included in this systematic review presented varied methodologies and low levels of evidence, with a greater concentration of instruments assessing receptive and expressive language, emphasizing the survey of the child's vocabulary and questionnaires. Thus, it can be verified that other linguistic skills, such as morphosyntactic, semantic, and narrative-pragmatic ones that are important in structuring speech and language for the effectiveness of the child's speech, are not being focused on. Just one of the instruments cited, a questionnaire, was specific for the oral language assessment of children with cochlear implants.
da SILVA, Mariane Perin; COMERLATTO, Ademir Antonio; BEVILACQUA, Maria Cecília; LOPES-HERRERA, Simone Aparecida
The oral language development depends on the effective development of the hearing system. In cases of children presenting with hearing loss, a cochlear implant is an electronic device indicated to (re)habilitate the hearing function. Thus, it is of paramount importance to assess and follow the oral language development of children fitted with a cochlear implant (CI) to measure the effectiveness of the electronic device and support the therapeutic planning of these children. Questions are currently being raised about the instruments to assess the oral language of children using a CI, and, seeking the answers, this systematic review aimed at surveying these instruments. Searches were performed in three different databases utilizing six different descriptors to select articles published from 2004 to 2009 that performed an oral language assessment of children with a CI. Initially, 373 articles were found, and, after the application of inclusion criteria, 47 articles were analyzed, resulting in a survey of 74 instruments for oral language assessment, including tests, questionnaires and inventories. In analyzing the articles, it was realized that the studies included in this systematic review presented varied methodologies and low levels of evidence, with a greater concentration of instruments assessing receptive and expressive language, emphasizing the survey of the child's vocabulary and questionnaires. Thus, it can be verified that other linguistic skills, such as morphosyntactic, semantic, and narrative-pragmatic ones that are important in structuring speech and language for the effectiveness of the child's speech, are not being focused on. Just one of the instruments cited, a questionnaire, was specific for the oral language assessment of children with cochlear implants. PMID:22230986
Yang, Jing; Brown, Emily; Fox, Robert A.; Xu, Li
The present study examined the acoustic features of vowel production in Mandarin-speaking children with cochlear implants (CIs). The subjects included 14 native Mandarin-speaking, prelingually deafened children with CIs (2.9–8.3 yr old) and 60 age-matched, normal-hearing (NH) children (3.1–9.0 years old). Each subject produced a list of monosyllables containing seven Mandarin vowels: [i, a, u, y, ɤ, ʅ, ɿ]. Midpoint F1 and F2 of each vowel token were extracted and normalized to eliminate the effects of different vocal tract sizes. Results showed that the CI children produced significantly longer vowels and less compact vowel categories than the NH children did. The CI children's acoustic vowel space was reduced due to a retracted production of the vowel [i]. The vowel space area showed a strong negative correlation with age at implantation (r = −0.80). The analysis of acoustic distance showed that the CI children produced corner vowels [a, u] similarly to the NH children, but other vowels (e.g., [ʅ, ɿ]) differently from the NH children, which suggests that CI children generally follow a similar developmental path of vowel acquisition as NH children. These findings highlight the importance of early implantation and have implications in clinical aural habilitation in young children with CIs. PMID:26627755
Hyde, Merv; Punch, Renee
In a mixed-methods study, which included surveys of 247 parents and 151 teachers, the researchers investigated the modes of communication used by children with cochlear implants and the role of signed communication in the children's lives. Findings indicated that 15%-20% of the children in the parent surveys and approximately 30% of the children…
Guo, Ling-Yu; McGregor, Karla K.; Spencer, Linda J.
Purpose: The purpose of this study was to determine whether children with cochlear implants (CIs) are sensitive to statistical characteristics of words in the ambient spoken language, whether that sensitivity changes in expected ways as their spoken lexicon grows, and whether that sensitivity varies with unilateral or bilateral implantation.…
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
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
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…
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 the advantage of using the perspectives provided by manifest behavior, internal processes, and social meaning in the analysis of action. Two cases are used to describe the individual and joint actions and projects, as related to parents' involvement in the habilitation process of children's postcochlear implantation. These joint projects are described at the levels of meanings/goals, functional processes, behaviors, structural support, and resources. From the rich descriptions and analysis of the cases, we draw potentially illuminative implications for the "current thinking" in relation to parenting children with CIs.
Sarant, Julia; Garrard, Philippa
Little attention has been focused on stress levels of parents of children with cochlear implants (CIs). This study examined the stress experience of 70 parents of children with CIs by comparing stress levels in this group of parents to those in parents of children without disabilities, identifying primary stressors, examining the relationship between parent stress and child language, and comparing stress in parents of children with bilateral and unilateral CIs. Parents completed a parent stress questionnaire, and the receptive vocabulary and language abilities of the children were evaluated. Results indicated that these parents had a higher incidence of stress than the normative population. Parent stress levels and child language outcomes were negatively correlated. Child behavior and lack of spousal and social support were the prime causes of parent stress. Parents of children with bilateral CIs were significantly less stressed than were parents of children with unilateral CIs.
Chatterjee, Monita; Zion, Danielle; Deroche, Mickael L.; Burianek, Brooke; Limb, Charles; Goren, Alison; Kulkarni, Aditya M.; Christensen, Julie A.
Despite their remarkable success in bringing spoken language to hearing impaired listeners, the signal transmitted through cochlear implants (CIs) remains impoverished in spectro-temporal fine structure. As a consequence, pitch-dominant information such as voice emotion, is diminished. For young children, the ability to correctly identify the mood/intent of the speaker (which may not always be visible in their facial expression) is an important aspect of social and linguistic development. Previous work in the field has shown that children with cochlear implants (cCI) have significant deficits in voice emotion recognition relative to their normally hearing peers (cNH). Here, we report on voice emotion recognition by a cohort of 36 school-aged cCI. Additionally, we provide for the first time, a comparison of their performance to that of cNH and NH adults (aNH) listening to CI simulations of the same stimuli. We also provide comparisons to the performance of adult listeners with CIs (aCI), most of whom learned language primarily through normal acoustic hearing. Results indicate that, despite strong variability, on average, cCI perform similarly to their adult counterparts; that both groups’ mean performance is similar to aNHs’ performance with 8-channel noise-vocoded speech; that cNH achieve excellent scores in voice emotion recognition with full-spectrum speech, but on average, show significantly poorer scores than aNH with 8-channel noise-vocoded speech. A strong developmental effect was observed in the cNH with noise-vocoded speech in this task. These results point to the considerable benefit obtained by cochlear-implanted children from their devices, but also underscore the need for further research and development in this important and neglected area. PMID:25448167
Stieler, Olgierd; Sekula, Alicja
Early diagnosis of congenital defect of hearing poses new challenges for a multidisciplinary team of pedoaudiologists, ENT (ear-nose-throat) specialists and speech therapists. This study assessed the perception of phonemes in children with a cochlear implant and the possibilities of applying acoustical solutions in the audiologic evaluation. The participants were 17 implanted children, aged 5-9 years, who received a cochlear implant when they were from 18 months to 3 years old. Detection thresholds and discrimination score were assessed. This study also aimed at verifying the possibilities of applying the digital audioprocessing algorithm in clinical practice. The test based on the phonemes aa, uu, ii, ss, sh (Ling 5 sound test) was used. The test was modified in the frequency domain - the main aim of this modification was to improve the precision of the reconstruction of the audible threshold. The results indicated significant correlations between pure tone audiometry results and thresholds of phoneme detection [dB SPL]. The identification score in this group was 95-100% for sound pressure level 65 dB SPL.
Duchesne, Louise; Sutton, Ann; Bergeron, Francois
This study examined receptive and expressive vocabulary and grammar achievement of French-speaking children (n = 27) who received a cochlear implant (CI) between the age of 1 and 2. Standardized measures of language achievement were administered and the language levels attained by children with CIs were compared with that of the normative sample…
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…
Bunta, Ferenc; Goodin-Mayeda, C. Elizabeth; Procter, Amanda; Hernandez, Arturo
Purpose: This study focuses on stop voicing differentiation in bilingual children with normal hearing (NH) and their bilingual peers with hearing loss who use cochlear implants (CIs). Method: Twenty-two bilingual children participated in our study (11 with NH, "M" age = 5;1 [years;months], and 11 with CIs, "M" hearing age =…
Kumar, Prawin; Sanju, Himanshu Kumar; Mishra, Rajkishor; Singh, Varun; Mohan, Priyanka
Introduction Parental support is important in the habilitation/rehabilitation of children using cochlear implant devices. Hence, it is important for families to know the realistic expectations regarding outcomes from CIs. Objective The objective of the present study is to know the parents' expectation from children using CIs. Methods For this study, we recruited 23 parents of children using CIs. We administered 15 questions translated in to Hindi related to communication abilities, social skills, academic achievement, change in future life, rehabilitation demand, and stress due to hearing impairment. Results The response of the questions (5-point rating scale) related to communication abilities showed that parents were expecting children using CIs to use the telephone (95%), to be able to detect soft sounds (99%), to listen in crowds (86%), to be able to easily understand others (76%), and to show improvement in communication skills (78%). Similarly, for questions related to social skills showed 90% of the parents expecting that their children with CIs should be able to easily make friends with normal hearing peers, and 80% of the parents were expecting the children to achieve high standards in their reading and writing skills. Questions related to change in future life showed 86% of the parents expecting their children with CIs to act like normal hearing children. Further, 78% parents showed positive response regarding importance of intensive training. However, 70% of the parents reported stress in the family due to the existence of the hearing impaired child. Conclusion Overall, the existing questionnaire-based study showed that parents have high expectations from their children with cochlear implant.
Chuang, Hsiu-Feng; Yang, Cheng-Chieh; Chi, Lin-Yang; Weismer, Gary; Wang, Yu-Tsai
The effects of the use of cochlear implant (CI) on speech intelligibility, speaking rate, and vowel formant characteristics and the relationships between speech intelligibility, speaking rate, and vowel formant characteristics for children are clinically important. The purposes of this study were to report on the comparisons for speaking rate and vowel space area, and their relationship with speech intelligibility, between 24 Mandarin-speaking children with CI and 24 age-sex-education level matched normal hearing (NH) controls. Participants were audio recorded as they read a designed Mandarin intelligibility test, repeated prolongation of each of the three point vowels /i/, /a/, and /u/ five times, and repeated each of three sentences carrying one point vowel five times. Compared to the NH group, the CI group exhibited: (1) mild-to-moderate speech intelligibility impairment; (2) significantly reduced speaking rate mainly due to significantly longer inter-word pauses and larger pause proportion; and (3) significantly less vowel reduction in the horizontal dimension in sustained vowel phonation. The limitations of speech intelligibility development in children after cochlear implantation were related to atypical patterns and to a smaller degree in vowel reduction and slower speaking rate resulting from less efficient articulatory movement transition.
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 their hearing peers on the phonological awareness and reading tasks. Reading scores were found to be strongly correlated with measures of phonological awareness. These correlations remained the same when we statistically controlled for potentially confounding demographic variables such as age at testing and speech perception skills. However, these correlations decreased even after we statistically controlled for vocabulary size. This finding suggests that lexicon size is a mediating factor in the relationship between the children’s phonological awareness and reading skills, a finding that has also been reported for typically developing hearing children. PMID:22057983
Horn, David L.; Davisa, Rebecca A.O.; Pisoni, David B.; Miyamoto, Richard T.
We investigated relations between sustained visual attention, behavioral inhibition skills, and speech–language outcomes in prelingually deaf children who use cochlear implants (CIs) using two computerized continuous performance tasks (CPTs). One test measured their ability to sustain visual attention to a string of numbers and another test measured their ability to delay a behavioral response. Performance on latter task was related to postimplant scores on tests of vocabulary knowledge, language skills, and speech intelligibility. We conclude that behavioral inhibition skills of prelingually deaf children are related to several audiological outcome measures in deaf children with CIs. Our findings suggest that further investigation is warranted into executive functions and subvocal rehearsal skills of deaf children with CIs. PMID:23100855
Lyxell, Björn; Sahlén, Birgitta; Wass, Malin; Ibertsson, Tina; Larsby, Birgitta; Hällgren, Mathias; Mäki-Torkko, Elina
The purpose of the present article is to present an overview of a set of studies conducted in our own laboratory on cognitive and communicative development in children with cochlear implants (CI). The results demonstrate that children with CIs perform at significantly lower levels on the majority of the cognitive tasks. The exceptions to this trend are tasks with relatively lower demands on phonological processing. A fairly high proportion of the children can reach a level of reading comprehension that matches hearing children, despite the fact that they have relatively poor phonological skills. General working memory capacity is further correlated with the type of questions asked in a referential communication task. The results are discussed with respect to issues related to education and rehabilitation.
Graham, J M; Phelps, P D; Michaels, L
The objective of this review is to analyze aspects of congenital malformation of the ear in relation to cochlear implantation in children. Having briefly described the in utero development of the ear and the classification of types of external, middle and inner ear malformation, five practical aspects of these malformations are discussed. It seems likely that the combination of bilateral profound sensorineural deafness with bilateral microtia severe enough to make a surgical approach to the cochlea difficult will be extremely uncommon. No such cases have been reported, although Klippel-Feil deformity seems the syndrome most likely to produce this set of circumstances. Abnormalities in the intratympanic course of the facial nerve have been associated with cochlear malformation, emphasizing the benefit of intra-operative facial nerve monitoring, and a technique suggested for safely avoiding an abnormally placed nerve. Fistulae of cerebrospinal fluid (CSF) and perilymph can complicate surgery and are relatively common in common cavity and Mondini malformations. Strategies for facilitating surgery in the presence of 'gushers', for measuring the pressure of a gusher and for placement of the cochlear implant electrode array are reviewed, with reports of fluctuating levels of electric current when implants lie in dysplastic cochleas. The relationship of implant performance to VIIIth nerve tissue in malformed cochleas is discussed, with a description of the histological findings in a common cavity cochlea. Techniques for identifying the absence of the cochlear nerve are reviewed. Stimulation of the facial nerve by cochlear implants has been described in cases of congenital malformation of the labyrinth but is relatively uncommon. Case reports of the benefit received by implanted children with congenital cochlear malformation have appeared since 1988. Most cases reported have not yet been followed for long enough to establish a clear picture of the outcome following
Corina, David P; Blau, Shane; LaMarr, Todd; Lawyer, Laurel A; Coffey-Corina, Sharon
Deaf children who receive a cochlear implant early in life and engage in intensive oral/aural therapy often make great strides in spoken language acquisition. However, despite clinicians' best efforts, there is a great deal of variability in language outcomes. One concern is that cortical regions which normally support auditory processing may become reorganized for visual function, leaving fewer available resources for auditory language acquisition. The conditions under which these changes occur are not well understood, but we may begin investigating this phenomenon by looking for interactions between auditory and visual evoked cortical potentials in deaf children. If children with abnormal auditory responses show increased sensitivity to visual stimuli, this may indicate the presence of maladaptive cortical plasticity. We recorded evoked potentials, using both auditory and visual paradigms, from 25 typical hearing children and 26 deaf children (ages 2-8 years) with cochlear implants. An auditory oddball paradigm was used (85% /ba/ syllables vs. 15% frequency modulated tone sweeps) to elicit an auditory P1 component. Visual evoked potentials (VEPs) were recorded during presentation of an intermittent peripheral radial checkerboard while children watched a silent cartoon, eliciting a P1-N1 response. We observed reduced auditory P1 amplitudes and a lack of latency shift associated with normative aging in our deaf sample. We also observed shorter latencies in N1 VEPs to visual stimulus offset in deaf participants. While these data demonstrate cortical changes associated with auditory deprivation, we did not find evidence for a relationship between cortical auditory evoked potentials and the VEPs. This is consistent with descriptions of intra-modal plasticity within visual systems of deaf children, but do not provide evidence for cross-modal plasticity. In addition, we note that sign language experience had no effect on deaf children's early auditory and visual ERP
Ortmann, Magdalene; Knief, Arne; Deuster, Dirk; Brinkheetker, Stephanie; Zwitserlood, Pienie; Zehnhoff-Dinnesen, Antoinette am; Dobel, Christian
Prelingually deafened children with cochlear implants stand a good chance of developing satisfactory speech performance. Nevertheless, their eventual language performance is highly variable and not fully explainable by the duration of deafness and hearing experience. In this study, two groups of cochlear implant users (CI groups) with very good basic hearing abilities but non-overlapping speech performance (very good or very bad speech performance) were matched according to hearing age and age at implantation. We assessed whether these CI groups differed with regard to their phoneme discrimination ability and auditory sensory memory capacity, as suggested by earlier studies. These functions were measured behaviorally and with the Mismatch Negativity (MMN). Phoneme discrimination ability was comparable in the CI group of good performers and matched healthy controls, which were both better than the bad performers. Source analyses revealed larger MMN activity (155–225 ms) in good than in bad performers, which was generated in the frontal cortex and positively correlated with measures of working memory. For the bad performers, this was followed by an increased activation of left temporal regions from 225 to 250 ms with a focus on the auditory cortex. These results indicate that the two CI groups developed different auditory speech processing strategies and stress the role of phonological functions of auditory sensory memory and the prefrontal cortex in positively developing speech perception and production. PMID:23861784
Lee, Hyo Jeong; Kang, Eunjoo; Oh, Seung-Ha; Kang, Hyejin; Lee, Dong Soo; Lee, Myung Chul; Kim, Chong-Sun
In congenitally deaf children, chronological age is generally accepted as a critical factor that affects successful rehabilitation following cochlear implantation (CI). However, a wide variance among patients is known to exist regardless of the age at CI [Sarant, J.Z., Blamey, P.J., Dowell, R.C., Clark, G.M., Gibson, W.P., 2001. Variation in speech perception scores among children with cochlear implants. Ear Hear. 22, 18-28]. In a previous study, we reported that prelingually deaf children in the age range 5-7 years at implantation showed greatest outcome variability [Oh S.H., Kim C.S., Kang E.J., Lee D.S., Lee H.J., Chang S.O., Ahn S.H., Hwang C.H., Park H.J., Koo J.W., 2003. Speech perception after cochlear implantation over a 4-year time period. Acta Otolaryngol. 123, 148-153]. Eleven children who underwent CI between the age of 5 and 7 1/2 years were subdivided into a good (above 65%: GOOD) and a poor (below 45%: POOR) group based on the performance in a speech perception test given 2 years after CI. The preoperative (18)F-FDG-PET (F-18 fluorodeoxyglucose positron emission tomography) images were compared between the two groups in order to examine if regional glucose metabolic difference preexisted before the CI surgery. In the GOOD group, metabolic activity was greater in diverse fronto-parietal regions compared to the POOR group. In the POOR group, the regions related to the ventral visual pathway showed greater metabolic activity relative to the GOOD group. These findings suggest that the deaf children who had developed greater executive and visuospatial functions subserved by the prefrontal and parietal cortices might be successful in auditory language learning after CI. On the contrary, greater dependency on the visual function subserved by the occipito-temporal region due to auditory deprivation may interfere with acquisition of auditory language after CI.
Soleimanifar, Simin; Jafari, Zahra; Motasaddi Zarandy, Masoud; Asadi, Houman; Haghani, Hamid
Introduction: Children with cochlear implants (CIs) may experience few opportunities for positive musical experiences, and musical perception is therefore often not sufficiently developed. This paper investigates and discusses the relationship between intelligence quotient (IQ) and musical ability in children with CIs compared with children with normal hearing. Materials and Methods: This was a comparative analytical study conducted in 48 children with unilateral CI and 48 normal-hearing children, 6–8 years of age, with ‘normal’ IQ and no formal music training. The average IQ score in the experimental and control groups were 105.41 and 106.31, respectively. No statistically significant differences were detected between Raven’s IQ scores in both groups. Data were collected by administering Raven's Colored Progressive Matrices IQ Tests and the Montreal Battery of Evaluation of Musical Abilities (MBEMA) Test, consisting of scale, contour, interval, rhythm, and memory sections. Results: Mean total MBEMA score in the experimental and control groups was 58.93 and 72.16 (out of 100), respectively. Significant differences were evident between scores of children with CIs in comparison with their normal-hearing peers (P≤0.001). A remarkable direct correlation between IQ and musical scores in both the control (r≥0.38) and experimental (r≥0.37) groups was observed. Conclusion: IQ has a noticeable effect on music processing and facilitates the perception of various musical elements. With regard to the mutual relationship between IQ and musical skills, this study illustrates the advantage of determining music perception scores and highlights the importance of appropriate musical intervention in order to enhance auditory neural plasticity, especially in children with cochlear implantation. PMID:27738611
Corina, David P.; Blau, Shane; LaMarr, Todd; Lawyer, Laurel A.; Coffey-Corina, Sharon
Deaf children who receive a cochlear implant early in life and engage in intensive oral/aural therapy often make great strides in spoken language acquisition. However, despite clinicians’ best efforts, there is a great deal of variability in language outcomes. One concern is that cortical regions which normally support auditory processing may become reorganized for visual function, leaving fewer available resources for auditory language acquisition. The conditions under which these changes occur are not well understood, but we may begin investigating this phenomenon by looking for interactions between auditory and visual evoked cortical potentials in deaf children. If children with abnormal auditory responses show increased sensitivity to visual stimuli, this may indicate the presence of maladaptive cortical plasticity. We recorded evoked potentials, using both auditory and visual paradigms, from 25 typical hearing children and 26 deaf children (ages 2–8 years) with cochlear implants. An auditory oddball paradigm was used (85% /ba/ syllables vs. 15% frequency modulated tone sweeps) to elicit an auditory P1 component. Visual evoked potentials (VEPs) were recorded during presentation of an intermittent peripheral radial checkerboard while children watched a silent cartoon, eliciting a P1–N1 response. We observed reduced auditory P1 amplitudes and a lack of latency shift associated with normative aging in our deaf sample. We also observed shorter latencies in N1 VEPs to visual stimulus offset in deaf participants. While these data demonstrate cortical changes associated with auditory deprivation, we did not find evidence for a relationship between cortical auditory evoked potentials and the VEPs. This is consistent with descriptions of intra-modal plasticity within visual systems of deaf children, but do not provide evidence for cross-modal plasticity. In addition, we note that sign language experience had no effect on deaf children’s early auditory and visual
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…
Mitchiner, Julie Cantrell
This study investigated 17 Deaf (1) 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. The majority of the Deaf families exhibited positive beliefs toward bimodal bilingualism, where they set high expectations for their children to become equally fluent in both languages. However, their perspectives about the purpose for each language differed; they viewed English as a "survival language" and ASL as a "cultural language" but supported the use of both languages at home as part of their children's lives.
Ricci, Giampietro; Trabalzini, Franco; Faralli, Mario; D'Ascanio, Luca; Cristi, Cristina; Molini, Egisto
CHARGE syndrome is a rare, polymalformative disease, representing one of the major causes of associated blindness and deafness. Bilateral, severe-profound, sensorineural hearing loss is common in CHARGE children. Aim of this study is to present our results in children with "CHARGE syndrome" submitted to cochlear implantation (CI). The frequency of anatomic anomalies, possible variations in the surgical technique of CI, and the audiological/rehabilitative benefits attained in our patients are reported. we submitted 5 children affected by CHARGE syndrome with profound, bilateral, sensorineural hearing loss to CI. Otoacoustic emissions, auditory brainstem response, acoustic impedance testing, cranial computed tomography and magnetic resonance were carried out preoperatively in all children. CI was performed using the mastoidotomy-posterior tympanotomy approach in two cases, and the suprameatal approach in three children. Infant toddler-meaningful auditory integration scale was used to evaluate kid's audiological performance before and after CI. Intra-operatory findings and postsurgical complications were evaluated. Among our patients, intraoperative anatomical malformations were cochlear hypoplasia (100 %), ossicles malformations (100 %), semicircular canals aplasia (100 %), oval window atresia (60 %), round window atresia (40 %), widening of the aqueduct of the vestibule (20 %), and aberrant course of the facial nerve (20 %). No intra- or postoperative complication was recorded in relation to implant positioning. After a follow-up ranging from 1 to 4.5 years, only 2/5 patients used oral language as the sole mean of communication, 1 started utilizing oral language as the main mean of communication, while 2 patients did not develop any linguistic ability. In conclusion, CI in patients with CHARGE association is feasible and, despite results variability, it should be carried out in CHARGE children with severe hearing loss as soon as possible. Although the selection of a
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…
Schwartz, Richard G.; Steinman, Susan; Ying, Elizabeth; Mystal, Elana Ying; Houston, Derek M.
In this plenary paper, we present a review of language research in children with cochlear implants along with an outline of a 5-year project designed to examine the lexical access for production and recognition. The project will use auditory priming, picture naming with auditory or visual interfering stimuli (Picture-Word Interference and…
Mitchiner, Julie Cantrell
This study examines Deaf parents with children who have cochlear implants on their beliefs and perspectives of bilingualism in American Sign Language and English using complementary mixed methods through surveys and follow-up interviews. Seventeen families participated in the survey and eight families continued their participation in semi-formal…
Punch, Renee; Hyde, Merv
Psychosocial factors, including socioemotional well-being, peer relationships, and social inclusion with hearing and deaf peers, are increasingly becoming a focus of research investigating children with cochlear implants. The study reported here extends the largely quantitative findings of previous research through a qualitative analysis of…
Domínguez, Ana-Belén; Carrillo, María-Soledad; González, Virginia; Alegria, Jesús
The aim of this study is to examine the mechanisms used by deaf children with and without cochlear implants (CIs) to read sentences and the linguistic bases (vocabulary and syntax) underlying those reading mechanisms. Previous studies have shown that deaf persons read sentences using the key word strategy (KWS), which consists of identifying some…
Bouton, Sophie; Bertoncini, Josiane; Serniclaes, Willy; Cole, Pascale
We assessed the reading and reading-related skills (phonemic awareness and phonological short-term memory) of deaf children fitted with cochlear implants (CI), either exposed to cued speech early (before 2 years old) (CS+) or never (CS-). Their performance was compared to that of 2 hearing control groups, 1 matched for reading level (RL), and 1…
Bharadwaj, Sneha V.; Graves, Amanda G.
Purpose: This investigation explored the utility of an acoustic measure, called the discreteness of voicing category (DOVC), in identifying voicing errors in stop consonants produced by children with cochlear implants. Another objective was to examine the perceptual relevance of the DOVC measure and 2 commonly used voice onset time (VOT)-based…
Swanwick, Ruth; Tsverik, Isabel
A central feature of a sign bilingual approach is the use of sign language, and the associated role of deaf adults in deaf children's education. This project explores whether this approach is compatible with the goals of cochlear implantation, which are to maximise a deaf child's potential to hear and improve speech perception. There is no…
Steel, Morrison M.; Papsin, Blake C.; Gordon, Karen A.
Bilateral cochlear implants aim to provide hearing to both ears for children who are deaf and promote binaural/spatial hearing. Benefits are limited by mismatched devices and unilaterally-driven development which could compromise the normal integration of left and right ear input. We thus asked whether children hear a fused image (ie. 1 vs 2 sounds) from their bilateral implants and if this “binaural fusion” reduces listening effort. Binaural fusion was assessed by asking 25 deaf children with cochlear implants and 24 peers with normal hearing whether they heard one or two sounds when listening to bilaterally presented acoustic click-trains/electric pulses (250 Hz trains of 36 ms presented at 1 Hz). Reaction times and pupillary changes were recorded simultaneously to measure listening effort. Bilaterally implanted children heard one image of bilateral input less frequently than normal hearing peers, particularly when intensity levels on each side were balanced. Binaural fusion declined as brainstem asymmetries increased and age at implantation decreased. Children implanted later had access to acoustic input prior to implantation due to progressive deterioration of hearing. Increases in both pupil diameter and reaction time occurred as perception of binaural fusion decreased. Results indicate that, without binaural level cues, children have difficulty fusing input from their bilateral implants to perceive one sound which costs them increased listening effort. Brainstem asymmetries exacerbate this issue. By contrast, later implantation, reflecting longer access to bilateral acoustic hearing, may have supported development of auditory pathways underlying binaural fusion. Improved integration of bilateral cochlear implant signals for children is required to improve their binaural hearing. PMID:25668423
Burkholder, Rose A; Pisoni, David B
Thirty-seven profoundly deaf children between 8- and 9-years-old with cochlear implants and a comparison group of normal-hearing children were studied to measure speaking rates, digit spans, and speech timing during digit span recall. The deaf children displayed longer sentence durations and pauses during recall and shorter digit spans compared to the normal-hearing children. Articulation rates, measured from sentence durations, were strongly correlated with immediate memory span in both normal-hearing and deaf children, indicating that both slower subvocal rehearsal and scanning processes may be factors that contribute to the deaf children's shorter digit spans. These findings demonstrate that subvocal verbal rehearsal speed and memory scanning processes are not only dependent on chronological age as suggested in earlier research by. Instead, in this clinical population the absence of early auditory experience and phonological processing activities before implantation appears to produce measurable effects on the working memory processes that rely on verbal rehearsal and serial scanning of phonological information in short-term memory.
Horn, David L; Davis, Rebecca A O; Pisoni, David B; Miyamoto, Richard T
We investigated the predictive relations between pre-implant visuomotor integration ability and subsequent oral speech/language outcomes in prelingually deaf children who use cochlear implants (CIs). Prior to implantation, children were given a task that tested their accuracy in copying geometric forms. Performance on this task predicted speech perception, sentence comprehension, and speech intelligibility outcomes over 3 years of CI use. We conclude that individual differences in visuomotor integration ability are predictive of some audiological outcome measures in deaf children with CIs.
Horn, David L.; Davis, Rebecca A.O.; Pisoni, David B.; Miyamoto, Richard T.
We investigated the predictive relations between pre-implant visuomotor integration ability and subsequent oral speech/language outcomes in prelingually deaf children who use cochlear implants (CIs). Prior to implantation, children were given a task that tested their accuracy in copying geometric forms. Performance on this task predicted speech perception, sentence comprehension, and speech intelligibility outcomes over 3 years of CI use. We conclude that individual differences in visuomotor integration ability are predictive of some audiological outcome measures in deaf children with CIs. PMID:23060686
Huttunen, Kerttu; Ryder, Nuala
This study explored the use of mental state and emotion terms and other evaluative expressions in the story generation of 65 children (aged 2-8 years) with normal hearing (NH) and 11 children (aged 3-7 years) using a cochlear implant (CI). Children generated stories on the basis of sets of sequential pictures. The stories of the children with CI…
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
Wu, Che-Ming; Ko, Hui-Chen; Chen, Yen-An; Tsou, Yung-Ting; Chao, Wei-Chieh
Objectives. To examine narrative writing in cochlear implant (CI) children and understand the factors associated with unfavorable outcomes. Materials and Methods. Forty-five CI children in grades 2–6 participated in this study. They received CIs at 4.1 ± 2.1 years of age and had used them for 6.5 ± 2.7 years. A story-writing test was conducted and scored on 4 subscales: Total Number of Words, Words per Sentence, Morphosyntax, and Semantics. Scores more than 1.5 SD lower than the mean of the normal-hearing normative sample were considered problematic. Language and speech skills were examined. Results. Significantly more implanted students were problematic on “Total Number of Words” (p < 0.001), “Words per Sentence” (p = 0.049), and “Semantics” (p < 0.001). Poorer receptive language and auditory performance were independently associated with problematic “Total Number of Words” (R2 = 0.489) and “Semantics” (R2 = 0.213), respectively. “Semantics” problem was more common in lower graders (grades 2–4) than in higher graders (grades 5-6; p = 0.016). Conclusion. Implanted children tend to write stories that are shorter, worse-organized, and without a plot, while formulating morphosyntactically correct sentences. Special attention is required on their auditory and language performances, which could lead to written language problems. PMID:26236722
Torppa, Ritva; Huotilainen, Minna; Leminen, Miika; Lipsanen, Jari; Tervaniemi, Mari
Informal music activities such as singing may lead to augmented auditory perception and attention. In order to study the accuracy and development of music-related sound change detection in children with cochlear implants (CIs) and normal hearing (NH) aged 4-13 years, we recorded their auditory event-related potentials twice (at T1 and T2, 14-17 months apart). We compared their MMN (preattentive discrimination) and P3a (attention toward salient sounds) to changes in piano tone pitch, timbre, duration, and gaps. Of particular interest was to determine whether singing can facilitate auditory perception and attention of CI children. It was found that, compared to the NH group, the CI group had smaller and later timbre P3a and later pitch P3a, implying degraded discrimination and attention shift. Duration MMN became larger from T1 to T2 only in the NH group. The development of response patterns for duration and gap changes were not similar in the CI and NH groups. Importantly, CI singers had enhanced or rapidly developing P3a or P3a-like responses over all change types. In contrast, CI non-singers had rapidly enlarging pitch MMN without enlargement of P3a, and their timbre P3a became smaller and later over time. These novel results show interplay between MMN, P3a, brain development, cochlear implantation, and singing. They imply an augmented development of neural networks for attention and more accurate neural discrimination associated with singing. In future studies, differential development of P3a between CI and NH children should be taken into account in comparisons of these groups. Moreover, further studies are needed to assess whether singing enhances auditory perception and attention of children with CIs.
Torppa, Ritva; Huotilainen, Minna; Leminen, Miika; Lipsanen, Jari; Tervaniemi, Mari
Informal music activities such as singing may lead to augmented auditory perception and attention. In order to study the accuracy and development of music-related sound change detection in children with cochlear implants (CIs) and normal hearing (NH) aged 4–13 years, we recorded their auditory event-related potentials twice (at T1 and T2, 14–17 months apart). We compared their MMN (preattentive discrimination) and P3a (attention toward salient sounds) to changes in piano tone pitch, timbre, duration, and gaps. Of particular interest was to determine whether singing can facilitate auditory perception and attention of CI children. It was found that, compared to the NH group, the CI group had smaller and later timbre P3a and later pitch P3a, implying degraded discrimination and attention shift. Duration MMN became larger from T1 to T2 only in the NH group. The development of response patterns for duration and gap changes were not similar in the CI and NH groups. Importantly, CI singers had enhanced or rapidly developing P3a or P3a-like responses over all change types. In contrast, CI non-singers had rapidly enlarging pitch MMN without enlargement of P3a, and their timbre P3a became smaller and later over time. These novel results show interplay between MMN, P3a, brain development, cochlear implantation, and singing. They imply an augmented development of neural networks for attention and more accurate neural discrimination associated with singing. In future studies, differential development of P3a between CI and NH children should be taken into account in comparisons of these groups. Moreover, further studies are needed to assess whether singing enhances auditory perception and attention of children with CIs. PMID:25540628
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.
Hoffman, Michael F.; Cejas, Ivette; Quittner, Alexandra L.
Objective To evaluate the longitudinal effects of cochlear implantation (CIs) on young, deaf children’s social competence over 5 years of implant use and compare their social skills to those of same-aged, hearing peers. Study Design Prospective, longitudinal between- and within-subjects design, with assessments completed 3 times over 5 years. Setting This study was conducted at 6 cochlear implant centers and 2 preschools that enrolled both CI and hearing children. Patients Parents of 132 children with CIs and 67 age-matched hearing controls completed the study measures. Children were between 5 and 9 years of age at the first time point. Interventions Cochlear implantation and speech-language therapy. Main Outcome Measures 3 subscales were drawn from 2 standardized measures of behavioral and social functioning, the Behavioral Assessment Scale for Children (Adaptability, Social Skills) and the Social Skills Rating System (Social Skills). A latent social competence variable was created using multiple subscales, which was modeled over time. Results Parent data indicated that children with CIs were delayed in comparison to their hearing peers on the social competence latent variable across all time points. Further, there was minimal evidence of “catch-up” growth over this 5-year period. Conclusion Children with CIs continued to experience delays in social competence after several years of implant use. Despite documented gains in oral language, deficits in social competence remained. To date, no interventions for children with CIs have targeted these social and behavioral skills. Thus, interventions that address the functioning of the “whole child” following cochlear implantation are needed. PMID:26719958
Nittrouer, Susan; Kuess, Jamie; Lowenstein, Joanna H.
Children need to discover linguistically meaningful structures in the acoustic speech signal. Being attentive to recurring, time-varying formant patterns helps in that process. However, that kind of acoustic structure may not be available to children with cochlear implants (CIs), thus hindering development. The major goal of this study was to examine whether children with CIs are as sensitive to time-varying formant structure as children with normal hearing (NH) by asking them to recognize sine-wave speech. The same materials were presented as speech in noise, as well, to evaluate whether any group differences might simply reflect general perceptual deficits on the part of children with CIs. Vocabulary knowledge, phonemic awareness, and “top-down” language effects were all also assessed. Finally, treatment factors were examined as possible predictors of outcomes. Results showed that children with CIs were as accurate as children with NH at recognizing sine-wave speech, but poorer at recognizing speech in noise. Phonemic awareness was related to that recognition. Top-down effects were similar across groups. Having had a period of bimodal stimulation near the time of receiving a first CI facilitated these effects. Results suggest that children with CIs have access to the important time-varying structure of vocal-tract formants. PMID:25994709
Hopyan, Talar; Manno, Francis A M; Papsin, Blake C; Gordon, Karen A
Children using cochlear implants (CIs) develop speech perception but have difficulty perceiving complex acoustic signals. Mode and tempo are the two components used to recognize emotion in music. Based on CI limitations, we hypothesized children using CIs would have impaired perception of mode cues relative to their normal hearing peers and would rely more heavily on tempo cues to distinguish happy from sad music. Study participants were children with 13 right CIs and 3 left CIs (M = 12.7, SD = 2.6 years) and 16 normal hearing peers. Participants judged 96 brief piano excerpts from the classical genre as happy or sad in a forced-choice task. Music was randomly presented with alterations of transposed mode, tempo, or both. When music was presented in original form, children using CIs discriminated between happy and sad music with accuracy well above chance levels (87.5%) but significantly below those with normal hearing (98%). The CI group primarily used tempo cues, whereas normal hearing children relied more on mode cues. Transposing both mode and tempo cues in the same musical excerpt obliterated cues to emotion for both groups. Children using CIs showed significantly slower response times across all conditions. Children using CIs use tempo cues to discriminate happy versus sad music reflecting a very different hearing strategy than their normal hearing peers. Slower reaction times by children using CIs indicate that they found the task more difficult and support the possibility that they require different strategies to process emotion in music than normal.
Litovsky, Ruth Y; Gordon, Karen
Spatial hearing skills are essential for children as they grow, learn and play. These skills provide critical cues for determining the locations of sources in the environment, and enable segregation of important sounds, such as speech, from background maskers or interferers. Spatial hearing depends on availability of monaural cues and binaural cues. The latter result from integration of inputs arriving at the two ears from sounds that vary in location. The binaural system has exquisite mechanisms for capturing differences between the ears in both time of arrival and intensity. The major cues that are thus referred to as being vital for binaural hearing are: interaural differences in time (ITDs) and interaural differences in levels (ILDs). In children with normal hearing (NH), spatial hearing abilities are fairly well developed by age 4-5 years. In contrast, most children who are deaf and hear through cochlear implants (CIs) do not have an opportunity to experience normal, binaural acoustic hearing early in life. These children may function by having to utilize auditory cues that are degraded with regard to numerous stimulus features. In recent years there has been a notable increase in the number of children receiving bilateral CIs, and evidence suggests that while having two CIs helps them function better than when listening through a single CI, these children generally perform worse than their NH peers. This paper reviews some of the recent work on bilaterally implanted children. The focus is on measures of spatial hearing, including sound localization, release from masking for speech understanding in noise and binaural sensitivity using research processors. Data from behavioral and electrophysiological studies are included, with a focus on the recent work of the authors and their collaborators. The effects of auditory plasticity and deprivation on the emergence of binaural and spatial hearing are discussed along with evidence for reorganized processing from both
Arndt, Susan; Prosse, Susanne; Laszig, Roland; Wesarg, Thomas; Aschendorff, Antje; Hassepass, Frederike
For adult patients with single-sided deafness (SSD), treatment with a cochlear implant (CI) is well established as an acceptable and beneficial hearing rehabilitation method administered routinely in clinical practice. In contrast, for children with SSD, CI has been applied less often to date, with the rationale to decide either on a case-by-case basis or under the realm of clinical research. The aim of our clinical study was to evaluate the longitudinal benefits of CI for a group of children diagnosed with SSD and to compare their outcomes with respect to patient characteristics. Evaluating a pool of paediatric SSD patients presenting for possible CI surgery revealed that the primary aetiology of deafness was congenital cochlear nerve deficiency. A subgroup of children meeting the CI candidacy criteria for the affected ear (the majority with acquired hearing loss) were enrolled in the study. Preliminary group results suggest substantial improvements in speech comprehension in noise and in the ability to localise sound, which was demonstrated through objective and subjective assessments after CI treatment for the group, with results varying from patient to patient. Our study shows a trend towards superior outcomes for children with acquired hearing loss and a shorter duration of hearing loss compared to congenitally deafened children who had a longer duration of SSD. This indicates an interactive influence of the age at onset, aetiology and duration of deafness upon the restoration of binaural integration and the overall benefits of sound stimulation to two ears after CI treatment. Continued longitudinal investigation of these children and further studies in larger groups may provide more guidance on the optimal timing of treatment for paediatric patients with acquired and congenital SSD.
Monshizadeh, Leila; Vameghi, Roshanak; Yadegari, Fariba; Sajedi, Firoozeh; Hashemi, Seyed Basir
AIM To study how language acquisition can be facilitated for cochlear implanted children based on cognitive and behavioral psychology viewpoints? METHODS To accomplish this objective, literature related to behaviorist and cognitive psychology prospects about language acquisition were studied and some relevant books as well as Medline, Cochrane Library, Google scholar, ISI web of knowledge and Scopus databases were searched. Among 25 articles that were selected, only 11 met the inclusion criteria and were included in the study. Based on the inclusion criteria, review articles, expert opinion studies, non-experimental and experimental studies that clearly focused on behavioral and cognitive factors affecting language acquisition in children were selected. Finally, the selected articles were appraised according to guidelines of appraisal of medical studies. RESULTS Due to the importance of the cochlear implanted child’s language performance, the comparison of behaviorist and cognitive psychology points of view in child language acquisition was done. Since each theoretical basis, has its own positive effects on language, and since the two are not in opposition to one another, it can be said that a set of behavioral and cognitive factors might facilitate the process of language acquisition in children. Behavioral psychologists believe that repetition, as well as immediate reinforcement of child’s language behavior help him easily acquire the language during a language intervention program, while cognitive psychologists emphasize on the relationship between information processing, memory improvement through repetitively using words along with “associated” pictures and objects, motor development and language acquisition. CONCLUSION It is recommended to use a combined approach based on both theoretical frameworks while planning a language intervention program. PMID:27872829
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 perceptual reasoning, working memory, receptive vocabulary, and morpho-syntactic comprehension were used in the assessment. It was observed that while children with l-CI showed a delay, those with e-CI reached a level close to that which was obtained by their control peers in morpho-syntactic comprehension. Thus, results confirm a positive effect of early implantation on morpho-syntactic reading comprehension. Inflectional morphology and simple sentence comprehension were noted to be better in the e-CI group than in the l-CI group. The most important factor in distinguishing between the HC and l-CI groups or the e-CI and l-CI groups was verbal inflectional morphology.
Hart, Catherine K; Wiley, Susan; Choo, Daniel I; Eby, Christine; Tucker, Laura; Schapiro, Mark; Meinzen-Derr, Jareen
Objective. To examine the association of intracranial radiographic abnormalities and developmental measures with outcomes in children with congenital symptomatic cytomegalovirus (CMV) and cochlear implants (CI). Design/Methods. It was a retrospective review of 15 children implanted from 2004 to 2010. Preimplant nonverbal intelligence quotient/developmental quotient (IQ/DQ) and head circumference (HC) were obtained. Computed tomography and magnetic resonance imaging of the brain and post-CI audiometry and language assessments were reviewed. Results. Eleven children (73%) had cognitive delay. Most had >1 developmental disability. Median IQ/DQ was 65 (23-90). All had imaging abnormalities. Most imaging abnormalities were in parietal (60%) and temporal (60%) lobes. Children with HC < 5th percentile had poorer median post-CI PTA (38 dB versus 27 dB, P = 0.02). Periventricular calcifications were associated with lower receptive (r b = -0.75, P = 0.03) and expressive (r b = -0.84, P = 0.008) language. Because IQ/DQ was associated with periventricular calcifications (r b = -0.53, P = 0.04) and small HC (r b = -0.73, P = 0.002), their relationships with language appear partially driven by IQ/DQ. Conclusions. The location of brain abnormalities appears to correlate with worse outcomes after CI. These findings may allow for more accurate counseling of parents regarding anticipated postimplantation performance.
Lu, Xiaopan; Wong, Lena L-N; Wong, Anita M-Y; Xi, Xin
Cochlear implants (CIs) provide children with profound hearing loss access to sounds and speech. Research on the effects of CI on speech and language development in mainland China is scarce due to the lack of standardized tests. This study aims at developing a vocabulary measure, the Mandarin Expressive and Receptive Vocabulary Test (MERVT), for pre-school children with CIs. Using responses from 102 normal-hearing preschool children, the initial vocabulary set was subjected to analyses to identify items with appropriate levels of difficulty and discrimination. Norms on 245 normal-hearing children aged 1;6 to 3;11 were later collected based on the final set of the items. Evaluation of the test's psychometric properties revealed good internal consistency. Significant correlations between the total MERVT scores and the Gesell Developmental Scale scores, between the MERVT expressive and receptive subtest scores and the total scores, and the gradual increase in MERVT scores with age, provided evidence of construct validity. Results from 29 children with CIs were also examined for evidence of the MERVT's construct validity. There was a significant correlation between these children's MERVT scores and their scores from an intelligence test. The MERVT scores increased with an increase in the duration of CI use and in chronological age. With good reliability and strong validity, the test is recommended for use in the monitoring of language development in children with CI.
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.
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.
Ronkainen, Riitta; Laakso, Minna; Lonka, Eila; Tykkyläinen, Tuula
This study examines lexical intervention sessions in speech and language therapy for children with cochlear implants (CIs). Particular focus is on the therapist's professional practices in doing the therapy. The participants in this study are three congenitally deaf children with CIs together with their speech and language therapist. The video recorded therapy sessions of these children are studied using conversation analysis. The analysis reveals the ways in which the speech and language therapist formulates her speaking turns to support the children's lexical learning in task interaction. The therapist's multimodal practices, for example linguistic and acoustic highlighting, focus both on the lexical meaning and the phonological form of the words. Using these means, the therapist expands the child's lexical networks, specifies and corrects the meaning of the target words, and models the correct phonological form of the words. The findings of this study are useful in providing information for clinicians and speech and language therapy students working with children who have CIs as well as for the children's parents.
Svirsky, Mario A; Teoh, Su-Wooi; Neuburger, Heidi
Like any other surgery requiring anesthesia, cochlear implantation in the first few years of life carries potential risks, which makes it important to assess the potential benefits. This study introduces a new method to assess the effect of age at implantation on cochlear implant outcomes: developmental trajectory analysis (DTA). DTA compares curves representing change in an outcome measure over time (i.e. developmental trajectories) for two groups of children that differ along a potentially important independent variable (e.g. age at intervention). This method was used to compare language development and speech perception outcomes in children who received cochlear implants in the second, third or fourth year of life. Within this range of age at implantation, it was found that implantation before the age of 2 resulted in speech perception and language advantages that were significant both from a statistical and a practical point of view. Additionally, the present results are consistent with the existence of a 'sensitive period' for language development, a gradual decline in language acquisition skills as a function of age.
The cochlear implant (CI) is increasingly used to treat deafness, despite arguments from the deaf community. Deaf children born to hearing parents are the fastest growing group of CI recipients, making parents the primary consumers. Instead of focusing on the controversy over implants, this article examines the clinical structures shaping parental decision-making and how parents integrate clinical practices into family and community. Observations and in-depth interviews were conducted in a CI clinic and at various community sites. The data reveal strong inter-institutional co-operations between the clinic, the state and local school districts. Working together, these institutions anticipate parental needs, foster a CI community and thus increase compliance. I conclude that implantation is an ongoing practice enculturating parents into a new community characterised by the adoption of long-term rehabilitative duties. However, the long-term nature of rehabilitation creates disparities in outcomes, which would be better understood through further research on the social relations in families and across parent networks in the CI community.
Bharadwaj, Sneha V.; Tobey, Emily A.; Assmann, Peter F.; Katz, William F.
A prominent theory of speech production proposes that speech segments are largely controlled by reference to an internal model, with minimal reliance on auditory feedback. This theory also maintains that suprasegmental aspects of speech are directly regulated by auditory feedback. Accordingly, if a talker is briefly deprived of auditory feedback speech segments should not be affected, but suprasegmental properties should show significant change. To test this prediction, comparisons were made between speech samples obtained from cochlear implant users who repeated words under two conditions (1) implant device turned ON, and (2) implant switched OFF immediately before the repetition of each word. To determine whether producing unfamiliar speech requires greater reliance on auditory feedback than producing familiar speech, English and French words were elicited from English-speaking subjects. Subjects were congenitally deaf children (n=4) and adventitiously deafened adults (n=4). Vowel fundamental frequency and formant frequencies, vowel and syllable durations, and fricative spectral moments were analyzed. Preliminary data only partially confirm the predictions, in that both segmental and suprasegmental aspects of speech were significantly modified in the absence of auditory feedback. Modifications were greater for French compared to English words, suggesting greater reliance on auditory feedback for unfamiliar words. [Work supported by NIDCD.
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
Deroche, Mickael L. D.; Kulkarni, Aditya M.; Christensen, Julie A.; Limb, Charles J.; Chatterjee, Monita
Sensitivity to static changes in pitch has been shown to be poorer in school-aged children wearing cochlear implants (CIs) than children with normal hearing (NH), but it is unclear whether this is also the case for dynamic changes in pitch. Yet, dynamically changing pitch has considerable ecological relevance in terms of natural speech, particularly aspects such as intonation, emotion, or lexical tone information. Twenty one children with NH and 23 children wearing a CI participated in this study, along with 18 NH adults and 6 CI adults for comparison. Listeners with CIs used their clinically assigned settings with envelope-based coding strategies. Percent correct was measured in one- or three-interval two-alternative forced choice tasks, for the direction or discrimination of harmonic complexes based on a linearly rising or falling fundamental frequency. Sweep rates were adjusted per subject, in a logarithmic scale, so as to cover the full extent of the psychometric function. Data for up- and down-sweeps were fitted separately, using a maximum-likelihood technique. Fits were similar for up- and down-sweeps in the discrimination task, but diverged in the direction task because psychometric functions for down-sweeps were very shallow. Hits and false alarms were then converted into d′ and beta values, from which a threshold was extracted at a d′ of 0.77. Thresholds were very consistent between the two tasks and considerably higher (worse) for CI listeners than for their NH peers. Thresholds were also higher for children than adults. Factors such as age at implantation, age at profound hearing loss, and duration of CI experience did not play any major role in this sensitivity. Thresholds of dynamic pitch sensitivity (in either task) also correlated with thresholds for static pitch sensitivity and with performance in tasks related to speech prosody. PMID:26973451
Kuzovkov, Vladislav; Sugarova, Serafima; Yanov, Yuri
Conclusion The study demonstrates the medium-term stability and safety of the CONCERTO PIN cochlear implant. The use of the CONCERTO PIN proved to be suitable for the use of a surgical technique without the need for suture fixation and resulted in short surgery duration and a low medium-term complication rate. Objective The primary aim was to provide data on medium-term safety and stability of the CONCERTO PIN cochlear implant in adults and children, and to collect feedback on the surgical technique used, which involved no drilling and no suture fixation. The secondary aim was to analyze surgery duration. Methods Implantation was performed using minimally invasive surgery. During surgery, data on the surgical procedure was collected by the attending surgeons or a designee. Safety and stability of the CONCERTO PIN were assessed at first fitting (1 month after implantation) and 6 months after first fitting. Results Ninety-nine patients were implanted with a CONCERTO PIN implant and one patient with a CONCERTO implant. The CONCERTO PIN implants implanted during this study were immobilized by pins and a tight periosteal pocket. The mean (± SD) surgery duration was 27:52 (± 9:19) min.
McGregor, Karla K.; Spencer, Linda J.
Purpose The purpose of this study was to determine whether children with cochlear implants (CIs) are sensitive to statistical characteristics of words in the ambient spoken language, whether that sensitivity changes in expected ways as their spoken lexicon grows, and whether that sensitivity varies with unilateral or bilateral implantation. Method We analyzed archival data collected from the parents of 36 children who received cochlear implantation (20 unilateral, 16 bilateral) before 24 months of age. The parents reported their children's word productions 12 months after implantation using the MacArthur Communicative Development Inventories: Words and Sentences (Fenson et al., 1993). We computed the number of words, out of 292 possible monosyllabic nouns, verbs, and adjectives, that each child was reported to say and calculated the average phonotactic probability, neighborhood density, and word frequency of the reported words. Results Spoken vocabulary size positively correlated with average phonotactic probability and negatively correlated with average neighborhood density, but only in children with bilateral CIs. Conclusion At 12 months postimplantation, children with bilateral CIs demonstrate sensitivity to statistical characteristics of words in the ambient spoken language akin to that reported for children with normal hearing during the early stages of lexical development. Children with unilateral CIs do not. PMID:25677929
DesJardin, Jean L; Ambrose, Sophie E; Eisenberg, Laurie S
The goal of this study was to longitudinally examine relationships between early factors (child and mother) that may influence children's phonological awareness and reading skills 3 years later in a group of young children with cochlear implants (N = 16). Mothers and children were videotaped during two storybook interactions, and children's oral language skills were assessed using the "Reynell Developmental Language Scales, third edition." Three years later, phonological awareness, reading skills, and language skills were assessed using the "Phonological Awareness Test," the "Woodcock-Johnson-III Diagnostic Reading Battery," and the "Oral Written Language Scales." Variables included in the data analyses were child (age, age at implant, and language skills) and mother factors (facilitative language techniques) and children's phonological awareness and reading standard scores. Results indicate that children's early expressive oral language skills and mothers' use of a higher level facilitative language technique (open-ended question) during storybook reading, although related, each contributed uniquely to children's literacy skills. Individual analyses revealed that the children with expressive standard scores below 70 at Time 1 also performed below average (<85) on phonological awareness and total reading tasks 3 years later. Guidelines for professionals are provided to support literacy skills in young children with cochlear implants.
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.
Schlumberger, Emilie; Narbona, Juan; Manrique, Manuel
Deprivation of sensory input affects neurological development. Our objective was to explore clinically the role of hearing in development of sensorimotor integration and non-verbal cognition. The study involved 54 children (15 males, 839 females; 5 to 9 years old) with severe or profound bilateral prelocutive deafness but without neurological or cognitive impairment. Of these, 25 had received an early cochlear implant (CIm). Patients were compared with 40 children with normal hearing. All were given a battery of non-verbal neuropsychological tests and a balance test, and were timed for simple and complex movement of limbs. Deafness, whether treated by CIm or not, resulted in a delay in development of complex motor sequences and balance. Lack of auditory input was also associated with lower, but non-pathological, scores in visual gnoso-praxic tasks and sustained attention. Such differences were not observed in children with CIm. Hearing contributes to clinical development of spatial integration, motor control, and attention. An early CIm enables good verbal development and might also improve non-verbal capacities.
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…
Snow, David; Ertmer, David
This study describes the development of emerging intonation in six children who had received a cochlear implant (CI) before the age of three years. At the time their implant was activated, the children ranged in age from 11 to 37 months. Spontaneous longitudinal speech samples were recorded from 30-minute sessions in which the child interacted with his or her mother. Data were collected 2 months before activation of each child's CI and at monthly intervals after activation for 6 months. The findings were compared to the typical pattern of early intonation development in children with normal hearing (NH). The results suggested that young CI recipients progress through stages similar to those observed in children with NH. However, the intonation development of children with a CI reflects a marked interaction between chronological age at implantation and amount of CI experience. That is, after 2 months of CI-assisted hearing experience, the older children demonstrated a later stage of intonation development than younger children. These preliminary results support the idea that children acquire some foundations or prerequisites of intonation production through maturation, as measured by chronological age, even without robust auditory experience. PMID:20882119
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.
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
Zheng, Yi; Godar, Shelly P; Litovsky, Ruth Y
Localizing sounds in our environment is one of the fundamental perceptual abilities that enable humans to communicate, and to remain safe. Because the acoustic cues necessary for computing source locations consist of differences between the two ears in signal intensity and arrival time, sound localization is fairly poor when a single ear is available. In adults who become deaf and are fitted with cochlear implants (CIs) sound localization is known to improve when bilateral CIs (BiCIs) are used compared to when a single CI is used. The aim of the present study was to investigate the emergence of spatial hearing sensitivity in children who use BiCIs, with a particular focus on the development of behavioral localization patterns when stimuli are presented in free-field horizontal acoustic space. A new analysis was implemented to quantify patterns observed in children for mapping acoustic space to a spatially relevant perceptual representation. Children with normal hearing were found to distribute their responses in a manner that demonstrated high spatial sensitivity. In contrast, children with BiCIs tended to classify sound source locations to the left and right; with increased bilateral hearing experience, they developed a perceptual map of space that was better aligned with the acoustic space. The results indicate experience-dependent refinement of spatial hearing skills in children with CIs. Localization strategies appear to undergo transitions from sound source categorization strategies to more fine-grained location identification strategies. This may provide evidence for neural plasticity, with implications for training of spatial hearing ability in CI users.
Jung, Kyu Hwan; Won, Jong Ho; Drennan, Ward R; Jameyson, Elyse; Miyasaki, Gary; Norton, Susan J; Rubinstein, Jay T
The number of pediatric cochlear implant (CI) recipients has increased substantially over the past 10 years, and it has become more important to understand the underlying mechanisms of the variable outcomes in this population. In this study, psychoacoustic measures of spectral-ripple and Schroeder-phase discrimination, the Clinical Assessment of Music Perception, and consonant-nucleus-consonant (CNC) word recognition in quiet and spondee reception threshold (SRT) in noise tests have been presented to 11 prelingually deafened CI users, aged 8-16 years with at least 5 years of CI experience. The children's performance was compared to the previously reported results of postlingually deafened adult CI users. The average spectral-ripple threshold (n = 10) was 2.08 ripples/octave. The average Schroeder-phase discrimination was 67.3% for 50 Hz and 56.5% for 200 Hz (n = 9). The Clinical Assessment of Music Perception test showed that the average complex pitch direction discrimination was 2.98 semitones. The mean melody score was at a chance level, and the mean timbre score was 34.1% correct. The mean CNC word recognition score was 68.6%, and the mean SRT in steady noise was -8.5 dB SNR. The children's spectral-ripple resolution, CNC word recognition, and SRT in noise performances were, within statistical bounds, the same as in a population of postlingually deafened adult CI users. However, Schroeder-phase discrimination and music perception were generally poorer than in the adults. It is possible then that this poorer performance seen in the children might be partly accounted for by the delayed maturation in their temporal processing ability, and because of this, the children's performance may have been driven more by their spectral sensitivity.
Janky, Kristen; Givens, Diane
There is a high incidence of vestibular loss in children with cochlear implants (CCI). However, the relationship between vestibular loss and various outcomes is unknown in children. Objectives 1) determine if age-related changes in peripheral vestibular tests occur; 2) quantify peripheral vestibular function in children with normal hearing (CNH) and CCI; 3) determine if amount of vestibular loss predicts visual acuity and balance performance. Design Eleven CCI and 12 CNH completed the following tests of vestibular function: ocular and cervical vestibular evoked myogenic potential (VEMP) to assess utricle and saccule function, and the video head impulse test (vHIT) to assess semicircular canal function. The relationship between amount of vestibular loss and the following balance and visual acuity outcomes was assessed: dynamic gait index, single leg stance, the sensory organization test, and tests of visual acuity, including dynamic visual acuity and the gaze stabilization test. Results 1) There were no significant age-related changes in peripheral vestibular testing with the exception of the n23 cervical VEMP latency, which was moderately correlated with age; 2) CCI had significantly higher rates of vestibular loss for each test of canal and otolith function; 3) Amount of vestibular loss predicted performance on single leg stance, the dynamic gait index, some conditions of the sensory organization test, and the dynamic visual acuity test. Age was also a contributing factor for predicting the performance of almost all outcomes. Conclusions Preliminarily, children with vestibular loss do not recover naturally to levels of their healthy peers, particularly with activities that utilize vestibular input; they have poorer visual acuity and balance function. PMID:26182202
Barton, Christine; Robbins, Amy McConkey
Musical experiences are a valuable part of the lives of children with cochlear implants (CIs). In addition to the pleasure, relationships and emotional outlet provided by music, it serves to enhance or 'jumpstart' other auditory and cognitive skills that are critical for development and learning throughout the lifespan. Musicians have been shown to be 'better listeners' than non-musicians with regard to how they perceive and process sound. A heuristic model of music therapy is reviewed, including six modulating factors that may account for the auditory advantages demonstrated by those who participate in music therapy. The integral approach to music therapy is described along with the hybrid approach to pediatric language intervention. These approaches share the characteristics of placing high value on ecologically valid therapy experiences, i.e., engaging in 'real' music and 'real' communication. Music and language intervention techniques used by the authors are presented. It has been documented that children with CIs consistently have lower music perception scores than do their peers with normal hearing (NH). On the one hand, this finding matters a great deal because it provides parameters for setting reasonable expectations and highlights the work still required to improve signal processing with the devices so that they more accurately transmit music to CI listeners. On the other hand, the finding might not matter much if we assume that music, even in its less-than-optimal state, functions for CI children, as for NH children, as a developmental jumpstarter, a language-learning tool, a cognitive enricher, a motivator, and an attention enhancer.
Schnabl, Johannes; Wolf-Magele, Astrid; Pok, Stefan Marcel; Url, Christoph; Zorowka, Patrick; Sprinzl, Georg
In 2011, Med-El (Innsbruck, Austria) introduced a new cochlear implant system, designed to require a minimally invasive surgical technique and allow greater positional flexibility for its fixation on the skull. The Concerto Pin implant system is a good option for patients with thinner bone, such as children and elderly. The aim of this study was to investigate the implant’s stability in children using our minimally invasive surgical technique. This was a prospective, longitudinal study with a single-subject, repeated-examination design. Six children, implanted with a Concerto Pin using our minimally invasive surgical technique between October 2011 and September 2012, were assessed 1, 3 and 6 months after surgery. In each case, the implant remained in a stable position and no adverse events or problems with healing were observed at any time during the investigation. The minimally invasive technique and the method of implant fixation that bypass drilling a deep implant bed constitute a good option for patients with thinner bone, such as children. This clinical study shows the safety and stability of the Concerto Pin implant system using a minimally invasive surgical technique.
Noble, Jack H.; Hedley-Williams, Andrea J.; Sunderhaus, Linsey; Dawant, Benoit M.; Labadie, Robert F.; Camarata, Stephen M.; Gifford, René H.
Hypothesis Image-guided cochlear implant (CI) programming can improve hearing outcomes for pediatric CI recipients. Background CIs have been highly successful for children with severe-to-profound hearing loss, offering potential for mainstreamed education and auditory-oral communication. Despite this, a significant number of recipients still experience poor speech understanding, language delay, and, even among the best performers, restoration to normal auditory fidelity is rare. While significant research efforts have been devoted to improving stimulation strategies, few developments have led to significant hearing improvement over the past two decades. Recently introduced techniques for image-guided CI programming (IGCIP) permit creating patient-customized CI programs by making it possible, for the first time, to estimate the position of implanted CI electrodes relative to the nerves they stimulate using CT images. This approach permits identification of electrodes with high levels of stimulation overlap and to deactivate them from a patient’s map. Prior studies have shown that IGCIP can significantly improve hearing outcomes for adults with CIs. Methods The IGCIP technique was tested for 21 ears of 18 pediatric CI recipients. Participants had long-term experience with their CI (5 months-13 years) and ranged in age from 5-17 years old. Speech understanding was assessed after approximately 4 weeks of experience with the IGCIP map. Results Using a two-tailed Wilcoxon signed-rank test, statistically significant improvement (p<0.05) was observed for word and sentence recognition in quiet and noise as well as pediatric self-reported quality of life (QOL) measures. Conclusion Our results indicate that image-guidance significantly improves hearing and QOL outcomes for pediatric CI recipients. PMID:26756157
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.
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
Vongpaisal, Tara; Caruso, Daniela; Yuan, Zhicheng
Music perception of cochlear implants (CI) users is constrained by the absence of salient musical pitch cues crucial for melody identification, but is made possible by timing cues that are largely preserved by current devices. While musical timing cues, including beats and rhythms, are a potential route to music learning, it is not known what extent they are perceptible to CI users in complex sound scenes, especially when pitch and timbral features can co-occur and obscure these musical features. The task at hand, then, becomes one of optimizing the available timing cues for young CI users by exploring ways that they might be perceived and encoded simultaneously across multiple modalities. Accordingly, we examined whether training tasks that engage active music listening through dance might enhance the song identification skills of deaf children with CIs. Nine CI children learned new songs in two training conditions: (a) listening only (auditory learning), and (2) listening and dancing (auditory-motor learning). We examined children's ability to identify original song excerpts, as well as mistuned, and piano versions from a closed-set task. While CI children were less accurate than their normal hearing peers, they showed greater song identification accuracies in versions that preserved the original instrumental beats following learning that engaged active listening with dance. The observed performance advantage is further qualified by a medium effect size, indicating that the gains afforded by auditory-motor learning are practically meaningful. Furthermore, kinematic analyses of body movements showed that CI children synchronized to temporal structures in music in a manner that was comparable to normal hearing age-matched peers. Our findings are the first to indicate that input from CI devices enables good auditory-motor integration of timing cues in child CI users for the purposes of listening and dancing to music. Beyond the heightened arousal from active
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…
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
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
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.
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.
Ryu, Nam-Gyu; Chang, Young Soo; Kim, Byoung Kil; Chung, Won-Ho; Cho, Yang-Sun; Hong, Sung Hwa
Objectives Neuroblastoma (NBL) predominantly affects children under 5 years of age. Through multimodal therapy, including chemotherapy, radiotherapy, surgery, and peripheral blood stem cell transplantation, the survival rate in patients with NBL have improved while treatment-related complications have also increased. Treatment-related ototoxicity, mainly from cisplatin, can result in profound hearing loss requiring cochlear implantation (CI). We analyzed the effectiveness and hearing preservation of CI recipients who had treated with multimodal therapy due to NBL. Methods Patients who received multimodal therapy for NBL and subsequent CIs were enrolled. A detailed review of the perioperative hearing test, speech evaluation, and posttreatment complications was conducted. Speech performance was analyzed using the category of auditory performance (CAP) score and the postoperative hearing preservation of low frequencies was also compared. Patients who were candidates for electro-acoustic stimulation (EAS) used an EAS electrode for low frequency hearing preservation. Results Three patients were identified and all patients showed improvement of speech performance after CI. The average of CAP score improved from 4.3 preoperatively to 5.8 at 1 year postoperatively. Two patients who were fitted with the Flex electrode showed complete hearing preservation and the preserved hearing was maintained over 1 year. The one remaining patient was given the standard CI-512 electrode and showed partial hearing preservation. Conclusion Patients with profound hearing loss resulting from NBL multimodal therapy can be good candidates for CI, especially for EAS. A soft surgical technique as well as a specifically designed electrode should be applied to this specific population during the CI operation in order to preserve residual hearing and achieve better outcomes. PMID:26622949
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.
Havy, Melanie; Nazzi, Thierry; Bertoncini, Josiane
The present study explores phonetic processing in deaf children with cochlear implants (CIs) when they have to learn phonetically similar words. Forty-six 34-to-78-month-old French-speaking deaf children with CIs were tested on 16 different trials. In each trial, they were first trained with two word-object pairings, and then a third object was…
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…
This paper focuses on the singing activity of prelingually deaf children under four years of age who are using cochlear implants (CIs) and presents a strand of a larger study that aimed to observe, record and analyse the musical activity of seven profoundly deaf children using CIs in the UK, for a period of one calendar year. The singing activity…
Willstedt-Svensson, Ursula; Löfqvist, Anders; Almqvist, Bengt; Sahlén, Birgitta
In this study, we explored the influence of time factors (age at implant, time with cochlear implant and age), complex working memory and phonological short-term memory on lexical and grammatical development in congenitally deaf children with cochlear implants. Fifteen children (aged 5 years 4 months to 11 years 5 months) were examined with the use of several linguistic and cognitive measures after a minimum of 18 months of implant use. Phonological short-term memory was assessed with non-word repetition, where the percentage of correctly repeated consonants and vowels was counted. For the assessment of lexical acquisition. a novel word learning task was administered. Receptive and expressive grammar was tested. Our results corroborate earlier findings on the influence of phonological short-term memory on novel word learning. The percentage of vowels correctly produced in non-word repetition was more important in this group than age at implant, not only for novel word learning. but also for receptive and expressive grammar.
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).…
Sharma, Anu; Campbell, Julia; Cardon, Garrett
Cortical development is dependent on extrinsic stimulation. As such, sensory deprivation, as in congenital deafness, can dramatically alter functional connectivity and growth in the auditory system. Cochlear implants ameliorate deprivation-induced delays in maturation by directly stimulating the central nervous system, and thereby restoring auditory input. The scenario in which hearing is lost due to deafness and then reestablished via a cochlear implant provides a window into the development of the central auditory system. Converging evidence from electrophysiologic and brain imaging studies of deaf animals and children fitted with cochlear implants has allowed us to elucidate the details of the time course for auditory cortical maturation under conditions of deprivation. Here, we review how the P1 cortical auditory evoked potential (CAEP) provides useful insight into sensitive period cut-offs for development of the primary auditory cortex in deaf children fitted with cochlear implants. Additionally, we present new data on similar sensitive period dynamics in higher-order auditory cortices, as measured by the N1 CAEP in cochlear implant recipients. Furthermore, cortical re-organization, secondary to sensory deprivation, may take the form of compensatory cross-modal plasticity. We provide new case-study evidence that cross-modal re-organization, in which intact sensory modalities (i.e., vision and somatosensation) recruit cortical regions associated with deficient sensory modalities (i.e., auditory) in cochlear implanted children may influence their behavioral outcomes with the implant. Improvements in our understanding of developmental neuroplasticity in the auditory system should lead to harnessing central auditory plasticity for superior clinical technique. PMID:24780192
Sharma, Anu; Campbell, Julia; Cardon, Garrett
Cortical development is dependent on extrinsic stimulation. As such, sensory deprivation, as in congenital deafness, can dramatically alter functional connectivity and growth in the auditory system. Cochlear implants ameliorate deprivation-induced delays in maturation by directly stimulating the central nervous system, and thereby restoring auditory input. The scenario in which hearing is lost due to deafness and then reestablished via a cochlear implant provides a window into the development of the central auditory system. Converging evidence from electrophysiologic and brain imaging studies of deaf animals and children fitted with cochlear implants has allowed us to elucidate the details of the time course for auditory cortical maturation under conditions of deprivation. Here, we review how the P1 cortical auditory evoked potential (CAEP) provides useful insight into sensitive period cut-offs for development of the primary auditory cortex in deaf children fitted with cochlear implants. Additionally, we present new data on similar sensitive period dynamics in higher-order auditory cortices, as measured by the N1 CAEP in cochlear implant recipients. Furthermore, cortical re-organization, secondary to sensory deprivation, may take the form of compensatory cross-modal plasticity. We provide new case-study evidence that cross-modal re-organization, in which intact sensory modalities (i.e., vision and somatosensation) recruit cortical regions associated with deficient sensory modalities (i.e., auditory) in cochlear implanted children may influence their behavioral outcomes with the implant. Improvements in our understanding of developmental neuroplasticity in the auditory system should lead to harnessing central auditory plasticity for superior clinical technique.
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.
Nasralla, Heloisa Romeiro; Goffi Gomez, Maria Valéria Schimidt; Magalhaes, Ana Tereza; Bento, Ricardo Ferreira
Introduction The factors that affect the development of children with and without hearing disabilities are similar, provided their innate communication abilities are taken into account. Parents need to mourn the loss of the expected normally hearing child, and it is important that parents create bonds of affection with their child. Objective To conduct a postevaluation of the development and cognition of 20 candidates for cochlear implants between 1 and 13 years of age and to observe important factors in their development. Methods The following instruments were used in accordance with their individual merits: interviews with parents; the Vineland Social Maturity Scale; the Columbia Maturity Scale; free drawings; Bender and Pre-Bender testing; and pedagogical tests. Results The results are described. Conclusion Parental acceptance of a child's deafness proved to be the starting point for the child's verbal or gestural communication development, as well as for cognitive, motor, and emotional development. If the association between deafness and fine motor skills (with or without multiple disabilities) undermines the development of a child's speech, it does not greatly affect communication when the child interacts with his or her peers and receives maternal stimulation. Overprotection and poor sociability make children less independent, impairs their development, and causes low self-esteem. Further observational studies are warranted to determine how cochlear implants contribute to patient recovery.
Nasralla, Heloisa Romeiro; Goffi Gomez, Maria Valéria Schimidt; Magalhaes, Ana Tereza; Bento, Ricardo Ferreira
Introduction The factors that affect the development of children with and without hearing disabilities are similar, provided their innate communication abilities are taken into account. Parents need to mourn the loss of the expected normally hearing child, and it is important that parents create bonds of affection with their child. Objective To conduct a postevaluation of the development and cognition of 20 candidates for cochlear implants between 1 and 13 years of age and to observe important factors in their development. Methods The following instruments were used in accordance with their individual merits: interviews with parents; the Vineland Social Maturity Scale; the Columbia Maturity Scale; free drawings; Bender and Pre-Bender testing; and pedagogical tests. Results The results are described. Conclusion Parental acceptance of a child's deafness proved to be the starting point for the child's verbal or gestural communication development, as well as for cognitive, motor, and emotional development. If the association between deafness and fine motor skills (with or without multiple disabilities) undermines the development of a child's speech, it does not greatly affect communication when the child interacts with his or her peers and receives maternal stimulation. Overprotection and poor sociability make children less independent, impairs their development, and causes low self-esteem. Further observational studies are warranted to determine how cochlear implants contribute to patient recovery. PMID:25992122
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
Misurelli, Sara M.
The ability to analyze an "auditory scene"---that is, to selectively attend to a target source while simultaneously segregating and ignoring distracting information---is one of the most important and complex skills utilized by normal hearing (NH) adults. The NH adult auditory system and brain work rather well to segregate auditory sources in adverse environments. However, for some children and individuals with hearing loss, selectively attending to one source in noisy environments can be extremely challenging. In a normal auditory system, information arriving at each ear is integrated, and thus these binaural cues aid in speech understanding in noise. A growing number of individuals who are deaf now receive cochlear implants (CIs), which supply hearing through electrical stimulation to the auditory nerve. In particular, bilateral cochlear implants (BICIs) are now becoming more prevalent, especially in children. However, because CI sound processing lacks both fine structure cues and coordination between stimulation at the two ears, binaural cues may either be absent or inconsistent. For children with NH and with BiCIs, this difficulty in segregating sources is of particular concern because their learning and development commonly occurs within the context of complex auditory environments. This dissertation intends to explore and understand the ability of children with NH and with BiCIs to function in everyday noisy environments. The goals of this work are to (1) Investigate source segregation abilities in children with NH and with BiCIs; (2) Examine the effect of target-interferer similarity and the benefits of source segregation for children with NH and with BiCIs; (3) Investigate measures of executive function that may predict performance in complex and realistic auditory tasks of source segregation for listeners with NH; and (4) Examine source segregation abilities in NH listeners, from school-age to adults.
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…
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
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
Driscoll, Virginia; Gfeller, Kate; Tan, Xueli; See, Rachel L; Cheng, Hsin-Yi; Kanemitsu, Mikiko
Objective Children with cochlear implants (CIs) participate in musical activities in school and daily lives. Considerable variability exists regarding the amount of music involvement and enjoyment. Using the Music Engagement Questionnaire-Preschool/Elementary (MEQ-P/E), we wanted to determine patterns of musical participation and the impact of familial factors on engagement. Methods Parents of 32 children with CIs (16 preschool and 16 elementary) completed a questionnaire regarding the musical involvement of their child with an implant and a normal-hearing (NH) sibling (if one existed). We compared CI children's involvement to that of their NH siblings as well as across groups of children with and without CIs. Correlations between parent ratings of music importance, demographic factors, and involvement of CI and NH children were conducted within and across groups. Results No significant differences were found between children with CIs and NH siblings, meaning children from the same family showed similar levels of musical involvement. When compared at the same developmental stage, no significant differences were found between preschool children with and without CIs. Parents who rated the importance of music as 'low' or 'middle' had children (NH and CI) who were less involved in music activities. Children whose parents rated music importance as 'high' were involved in monthly to weekly music activities with 81.25% reporting daily music listening. Conclusion Despite a less-than-ideal auditory signal for music, preschool and school-aged CI children enjoy and are involved in musical experiences. Families who enjoy and spend a greater amount of time involved in music tend to have children who also engage more actively in music.
Driscoll, Virginia; Gfeller, Kate; Tan, Xueli; See, Rachel L.; Cheng, Hsin-Yi; Kanemitsu, Mikiko
Objective Children with cochlear implants (CIs) participate in musical activities in school and daily lives. Considerable variability exists regarding the amount of music involvement and enjoyment. Using the Music Engagement Questionnaire-Preschool/Elementary (MEQ-P/E), we wanted to determine patterns of musical participation and the impact of familial factors on engagement. Methods Parents of 32 children with CIs (16 preschool, 16 elementary) completed a questionnaire regarding the musical involvement of their child with an implant and a normal-hearing (NH) sibling (if one existed). We compared CI children's involvement to that of their NH siblings as well as across groups of children with and without CIs. Correlations between parent ratings of music importance, demographic factors, and involvement of CI and NH children were conducted within and across groups. Results No significant differences were found between children with CIs and NH siblings, meaning children from the same family showed similar levels of musical involvement. When compared at the same developmental stage, no significant differences were found between preschool children with and without CIs. Parents who rated the importance of music as “low” or “middle” had children (NH and CI) who were less involved in music activities. Children whose parents rated music importance as “high” were involved in monthly to weekly music activities with 81.25% reporting daily music listening. Conclusion Despite a less-than-ideal auditory signal for music, preschool and school-aged CI children enjoy and are involved in musical experiences. Families who enjoy and spend a greater amount of time involved in music tend to have children who also engage more actively in music. PMID:25431978
Zhou, Ning; Xu, Li
The aim of the study was (1) to develop methods for evaluating tone production of children with cochlear implants (CIs) who speak Mandarin Chinese and (2) to evaluate the efficacy of using these methods to assess tone production. The subjects included two groups of native-Mandarin-Chinese-speaking children: 14 prelingually deafened children who had received CIs and 61 normal-hearing (NH) children as controls. The acoustic analysis focused on quantification of the degree of differentiation among lexical tones based on tonal ellipses and the overall similarity of tone contours produced by the children with CIs to normative contours derived from the 61 NH children. An artificial neural network was used to recognize tones produced by the children with CIs after trained with tone tokens produced by the NH children. Finally, perceptual judgments on the tone production of both groups were obtained from eight native-Mandarin-speaking NH adults to evaluate the efficacy of the methods. The results showed that all measures using the acoustic, neural-network, and perceptual analyses were highly correlated with each other and could be used to effectively evaluate tone production of children with CIs.
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
... 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 ...
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.
Ketelaar, Lizet; Wiefferink, Carin H; Frijns, Johan H M; Broekhof, Evelien; Rieffe, Carolien
Moral emotions such as shame, guilt and pride are the result of an evaluation of the own behavior as (morally) right or wrong. The capacity to experience moral emotions is thought to be an important driving force behind socially appropriate behavior. The relationship between moral emotions and social behavior in young children has not been studied extensively in normally hearing (NH) children, let alone in those with a hearing impairment. This study compared young children with hearing impairments who have a cochlear implant (CI) to NH peers regarding the extent to which they display moral emotions, and how this relates to their social functioning and language skills. Responses of 184 NH children and 60 children with CI (14-61 months old) to shame-/guilt- and pride-inducing events were observed. Parents reported on their children's social competence and externalizing behavior, and experimenters observed children's cooperative behavior. To examine the role of communication in the development of moral emotions and social behavior, children's language skills were assessed. Results show that children with CI displayed moral emotions to a lesser degree than NH children. An association between moral emotions and social functioning was found in the NH group, but not in the CI group. General language skills were unrelated to moral emotions in the CI group, yet emotion vocabulary was related to social functioning in both groups of children. We conclude that facilitating emotion language skills has the potential to promote children's social functioning, and could contribute to a decrease in behavioral problems in children with CI specifically. Future studies should examine in greater detail which factors are associated with the development of moral emotions, particularly in children with CI. Some possible directions for future research are discussed.
Conway, Christopher M.; Deocampo, Joanne A.; Walk, Anne M.; Anaya, Esperanza M.; Pisoni, David B.
Purpose The authors investigated the ability of deaf children with cochlear implants (CIs) to use sentence context to facilitate the perception of spoken words. Method Deaf children with CIs (n = 24) and an age-matched group of children with normal hearing (n = 31) were presented with lexically controlled sentences and were asked to repeat each sentence in its entirety. Performance was analyzed at each of 3 word positions of each sentence (first, second, and third key word). Results Whereas the children with normal hearing showed robust effects of contextual facilitation—improved speech perception for the final words in a sentence—the deaf children with CIs on average showed no such facilitation. Regression analyses indicated that for the deaf children with CIs, Forward Digit Span scores significantly predicted accuracy scores for all 3 positions, whereas performance on the Stroop Color and Word Test, Children’s Version (Golden, Freshwater, & Golden, 2003) predicted how much contextual facilitation was observed at the final word. Conclusions The pattern of results suggests that some deaf children with CIs do not use sentence context to improve spoken word recognition. The inability to use sentence context may be due to possible interactions between language experience and cognitive factors that affect the ability to successfully integrate temporal–sequential information in spoken language. PMID:25029170
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
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…
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.
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
Goodin-Mayeda, C. Elizabeth; Procter, Amanda; Hernandez, Arturo
Purpose This study focuses on stop voicing differentiation in bilingual children with normal hearing (NH) and their bilingual peers with hearing loss who use cochlear implants (CIs). Method Twenty-two bilingual children participated in our study (11 with NH, M age = 5;1 [years;months], and 11 with CIs, M hearing age = 5;1). The groups were matched on hearing age and a range of demographic variables. Single-word picture elicitation was used with word-initial singleton stop consonants. Repeated measures analyses of variance with three within-subject factors (language, stop voicing, and stop place of articulation) and one between-subjects factor (NH vs. CI user) were conducted with voice onset time and percentage of prevoiced stops as dependent variables. Results Main effects were statistically significant for language, stop voicing, and stop place of articulation on both voice onset time and prevoicing. There were no significant main effects for NH versus CI groups. Both children with NH and with CIs differentiated stop voicing in their languages and by stop place of articulation. Stop voicing differentiation was commensurate across the groups of children with NH versus CIs. Conclusions Stop voicing differentiation is accomplished in a similar fashion by bilingual children with NH and CIs, and both groups differentiate stop voicing in a language-specific fashion. PMID:27366990
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.
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.
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…
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…
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…
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…
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
Catli, Tolgahan; Uckan, Burcu; Olgun, Levent
The aim of this study was to investigate speech and language development after long-term cochlear implantation in children with bony labyrinth malformations (BLMs) and to present the surgical findings in this group of patients. The auditory and linguistic skills of 21 children who had BLM were assessed in this study. They were implanted between 1998 and 2009. Twenty-two sex-matched and age-matched implantees without BLM were evaluated as the control group. To compare speech perception and speech intelligibility between the groups, the categories of auditory performance (CAP) test and speech intelligibility rating (SIR) test, respectively, were administered. The Turkish version of the Test of Early Language Development (TELD-3-T) was administered to evaluate and compare the linguistic skills of the groups. Surgical findings and complications were also analyzed. Implanted anomalies were common cavity in five patients, incomplete partition type 1 in 5 patients, and incomplete partition type 2 in 11 patients. The CAP and SIR scores were significantly higher in the control group (p < 0.05), but the TELD-3-T test scores were comparable among the groups (p > 0.05). Based on the specific type of malformation, the CAP and SIR scores were comparable between the subgroups (p > 0.05). No perioperative complications occurred in the control group. However, various perioperative complications (gusher, etc.) and surgical difficulty occurred in the anomaly group. The malformation group had unsatisfactory results with regard to speech perception skills; however, this group and the non-anomalous group exhibited comparable long-term results on linguistic development.
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.
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
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
Vecchiato, G; Maglione, A G; Scorpecci, A; Malerba, P; Graziani, I; Cherubino, P; Astolfi, L; Marsella, P; Colosimo, A; Babiloni, Fabio
The perception of the music in cochlear implanted (CI) patients is an important aspect of their quality of life. In fact, the pleasantness of the music perception by such CI patients can be analyzed through a particular analysis of EEG rhythms. Studies on healthy subjects show that exists a particular frontal asymmetry of the EEG alpha rhythm which can be correlated with pleasantness of the perceived stimuli (approach-withdrawal theory). In particular, here we describe differences between EEG activities estimated in the alpha frequency band for a monolateral CI group of children and a normal hearing one during the fruition of a musical cartoon. The results of the present analysis showed that the alpha EEG asymmetry patterns related to the normal hearing group refers to a higher pleasantness perception when compared to the cerebral activity of the monolateral CI patients. In fact, the present results support the statement that a monolateral CI group could perceive the music in a less pleasant way when compared to normal hearing children.
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
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…
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…
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…
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…
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…
Wu, Che-Ming; Chen, Yen-An; Chan, Kai-Chieh; Lee, Li-Ang; Hsu, Kuang-Hung; Lin, Bao-Guey; Liu, Tien-Chen
The aim of this study was to document receptive and expressive language levels and reading skills achieved by Mandarin-speaking children who had received cochlear implants (CIs) and used them for 4.75-7.42 years. The effects of possible associated factors were also analyzed. Standardized Mandarin language and reading tests were administered to 39 prelingually deaf children with Nucleus 24 devices. The Mandarin Chinese version of the Peabody Picture Vocabulary Test was used to assess their receptive vocabulary knowledge and the Revised Primary School Language Assessment Test for their receptive and expressive language skills. The Graded Chinese Character Recognition Test was used to test their written word recognition ability and the Reading Comprehension Test for their reading comprehension ability. Raw scores from both language and reading measurements were compared to normative data of nor- mal-hearing children to obtain standard scores. The results showed that the mean standard score for receptive vocabulary measurement and the mean T scores for the receptive language, expressive language and total language measurement were all in the low-average range in comparison to the normative sample. In contrast, the mean T scores for word and text reading comprehension were almost the same as for their age-matched hearing counterparts. Among all children with CIs, 75.7% scored within or above the normal range of their age-matched hearing peers on receptive vocabulary measurement. For total language, Chinese word recognition and reading scores, 71.8, 77 and 82% of children with CIs were age appropriate, respectively. A strong correlation was found between language and reading skills. Age at implantation and sentence perception scores account for 37% of variance for total language outcome. Sentence perception scores and preimplantation residual hearing were revealed to be associated with the outcome of reading comprehension. We concluded that by using standard tests, the
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…
The acquisition of case and gender marking on the definite and indefinite article was studied in a sample of 6 normally-hearing children and 9 children xith cochlear implants. Longitudinal spontaneous speech data are used. Children were matched by MLU, with 4 MLU levels: 1.8, 2.8, 3.6, 4.8. Age ranges for normally-hearing children were 1-4 to 3-8 and for children with cochlear implants 1;8 to 7;0. Frequencies of correctly marked article forms increased over MLU but less so in the hearing-impaired group. In both groups error rates were high. However, error patterns were different. In normally-hearing children errors of case predominated, in hearing-impaired children errors of gender and omission. Error patterns suggest that in normally-hearing children syntactic categorization interacts with input frequency and low discriminability of article forms. In the hearing-impaired group the article system is less advanced, despite higher frequencies of definite articles in adult speech. The predominance of article omission is discussed in terms of persisting perceptual problems or a working memory deficit.
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.
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.
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
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.
Nonverbal cognitive development in children with cochlear implants: relationship between the Mullen Scales of Early Learning and later performance on the Leiter International Performance Scales-Revised.
Caudle, Susan E; Katzenstein, Jennifer M; Oghalai, John S; Lin, Jerry; Caudle, Donald D
Methodologically, longitudinal assessment of cognitive development in young children has proven difficult because few measures span infancy through school age. This matter is further complicated when the child presents with a sensory deficit such as hearing loss. Few measures are validated in this population, and children who are evaluated for cochlear implantation are often reevaluated annually. The authors sought to evaluate the predictive validity of subscales of the Mullen Scales of Early Learning (MSEL) on Leiter International Performance Scales-Revised (LIPS-R) Full-Scale IQ scores. To further elucidate the relationship of these two measures, comparisons were also made with the Vineland Adaptive Behavior Scale-Second Edition (VABS), which provides a measure of adaptive functioning across the life span. Participants included 35 children (14 female, 21 male) who were evaluated both as part of the precandidacy process for cochlear implantation using the MSEL and VABS and following implantation with the LIPS-R and VABS. Hierarchical linear regression revealed that the MSEL Visual Reception subdomain score significantly predicted 52% of the variance in LIPS-R Full-Scale IQ scores at follow-up, F(1, 34) = 35.80, p < .0001, R (2) = .52, β = .72. This result suggests that the Visual Reception subscale offers predictive validity of later LIPS-R Full-Scale IQ scores. The VABS was also significantly correlated with cognitive variables at each time point.
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
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.
Ruffin, Chad V; Kronenberger, William G; Colson, Bethany G; Henning, Shirley C; Pisoni, David B
This study investigated long-term speech and language outcomes in 51 prelingually deaf children, adolescents and young adults who received cochlear implants (CIs) prior to 7 years of age and had used their implants for at least 7 years. Average speech perception scores were similar to those found in prior research with other samples of experienced CI users. Mean language test scores were lower than norm-referenced scores from nationally representative normal-hearing, typically developing samples, although a majority of the CI users scored within 1 standard deviation of the normative mean or higher on the Peabody Picture Vocabulary Test, Fourth Edition (63%), and the Clinical Evaluation of Language Fundamentals, Fourth Edition (69%). Speech perception scores were negatively associated with a meningitic etiology of hearing loss, older age at implantation, poorer preimplant unaided pure-tone average thresholds, lower family income and the use of 'total communication'. Subjects who had used CIs for 15 years or more were more likely to have these characteristics and were more likely to score lower on measures of speech perception compared to those who had used CIs for 14 years or less. The aggregation of these risk factors in the >15 years of CI use subgroup accounts for their lower speech perception scores and may stem from more conservative CI candidacy criteria in use at the beginning of pediatric cochlear implantation.
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.
Changing Trends within the Population of Children Who Are Deaf or Hard of Hearing in Flanders (Belgium): Effects of 12 Years of Universal Newborn Hearing Screening, Early Intervention, and Early Cochlear Implantation
De Raeve, Leo; Lichtert, Guido
The purpose of this study is to show the changing trends within the population of children who are deaf and hard of hearing in Belgium over the last 12 years. The combination of Universal Newborn Hearing Screening programs, early intervention, and cochlear implants have tremendously influenced the education and support of children who are deaf or…
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)
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…
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.
Ramos, Daniela; Jorge, João Xavier; Teixeira, António; Ribeiro, Carlos; Paiva, António
Introdução: As crianças com surdez neurossensorial severa a profunda podem adquirir vocabulário e estruturas sintácticas para comunicarem pela linguagem oral, após implante coclear. Objectivo: Identificar as capacidades linguísticas em crianças, com implante coclear. Material e Métodos: Estudou-se a linguagem oral em 18 crianças, entre nove e 10 anos, com surdez neurossensorial profunda bilateral congénita, com implante coclear, avaliadas com a Grelha de Observação da Linguagem-Nível Escolar. As pontuações obtidas foram comparadas com as das crianças normo-ouvintes com igual idade auditiva. Resultados: As pontuações nas estruturas linguísticas estudadas, crianças implantadas vs. padrão das normo-ouvintes foram: fonologia 29,44 ± 8,4 vs. 29,68 ± 5,90, p = 0,91; semântica 18,55 ± 8,89 vs. 19,20 ± 4,85, p = 0,76; morfossintaxe 21,89 ± 12,85 vs. 26,35 ± 10,36, p = 0,159. Nas provas da estrutura semântica, não se registaram diferenças estatisticamente significativas. Na morfossintaxe, adiferença foi estatisticamente significativa na derivação das palavras, 2,83 ± 2,81 vs. 4,65 ± 1,64, p = 0,014. Na fonologia, verificou-se diferença significativa, na prova de discriminação de pseudopalavras, 6,6 ± 2,8 vs. 8,37 ± 2,32, p = 0,023. Na segmentação silábica, as crianças implantadas tiveram uma pontuação significativamente superior ao padrão 8,56 ± 1,6 vs. 5,9 ± 1,58, p < 0,001. Discussão: A semelhança das pontuações obtidas pelas crianças com implante coclear em relação ao padrão nas componentes linguísticas estudadas, confirma que o implante coclear promove o desenvolvimento da linguagem verbal oral nas crianças com surdez congénita. Conclusão: As crianças implantadas obtiveram ganhos de linguagem similares às normo-ouvintes com igual idade auditiva.
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
Kushalnagar, Poorna; Krull, Kevin; Hannay, Julia; Mehta, Paras; Caudle, Susan; Oghalai, John
Cognitive ability and behavioral adaptability are distinct, yet related, constructs that can impact childhood development. Both are often reduced in deaf children of hearing parents who do not provide sufficient language and communication access. Additionally, parental depression is commonly observed due to parent-child communication difficulties…
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
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.
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.
Houston, Derek M.; Beer, Jessica; Bergeson, Tonya R.; Chin, Steven B.; Pisoni, David B.; Miyamoto, Richard T.
Since the early 1980s, the DeVault Otologic Research Laboratory at the Indiana University School of Medicine has been on the forefront of research on speech and language outcomes in children with cochlear implants. This paper highlights work over the last decade that has moved beyond collecting speech and language outcome measures to focus more on investigating the underlying cognitive, social, and linguistic skills that predict speech and language outcomes. This recent work reflects our growing appreciation that early auditory deprivation can affect more than hearing and speech perception. The new directions include research on attention to speech, word learning, phonological development, social development, and neurocognitive processes. We have also expanded our subject populations to include infants and children with additional disabilities PMID:22668765
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.
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…
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
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
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…
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.
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.
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.
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.
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.
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.
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…
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…
Ortmann, Magdalene; Zwitserlood, Pienie; Knief, Arne; Baare, Johanna; Brinkheetker, Stephanie; am Zehnhoff-Dinnesen, Antoinette; Dobel, Christian
Cochlear implants provide individuals who are deaf with access to speech. Although substantial advancements have been made by novel technologies, there still is high variability in language development during childhood, depending on adaptation and neural plasticity. These factors have often been investigated in the auditory domain, with the mismatch negativity as an index for sensory and phonological processing. Several studies have demonstrated that the MMN is an electrophysiological correlate for hearing improvement with cochlear implants. In this study, two groups of cochlear implant users, both with very good basic hearing abilities but with non-overlapping speech performance (very good or very poor speech performance), were matched according to device experience and age at implantation. We tested the perception of phonemes in the context of specific other phonemes from which they were very hard to discriminate (e.g., the vowels in /bu/ vs. /bo/). The most difficult pair was individually determined for each participant. Using behavioral measures, both cochlear implants groups performed worse than matched controls, and the good performers performed better than the poor performers. Cochlear implant groups and controls did not differ during time intervals typically used for the mismatch negativity, but earlier: source analyses revealed increased activity in the region of the right supramarginal gyrus (220–260 ms) in good performers. Poor performers showed increased activity in the left occipital cortex (220–290 ms), which may be an index for cross-modal perception. The time course and the neural generators differ from data from our earlier studies, in which the same phonemes were assessed in an easy-to-discriminate context. The results demonstrate that the groups used different language processing strategies, depending on the success of language development and the particular language context. Overall, our data emphasize the role of neural plasticity and use
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.
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,…
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…
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
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…
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.
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.; 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.…
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…
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…
Research has shown a prevalence of psychosocial difficulties ranging from about 20% to 50% among children with hearing loss. This study evaluates the prevalence of psychosocial difficulties in a Danish population in relation to different explanatory variables. Five scales and questionnaires measuring sign language, spoken language, hearing…
Holt, Rachael Frush; Kirk, Karen Iler; Hay-McCutcheon, Marcia
Purpose: To examine multimodal spoken word-in-sentence recognition in children. Method: Two experiments were undertaken. In Experiment 1, the youngest age with which the multimodal sentence recognition materials could be used was evaluated. In Experiment 2, lexical difficulty and presentation modality effects were examined, along with test-retest…
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
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
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.
Sevy, Alexander B G; Bortfeld, Heather; Huppert, Theodore J; Beauchamp, Michael S; Tonini, Ross E; Oghalai, John S
Cochlear implants (CI) are commonly used to treat deafness in young children. While many factors influence the ability of a deaf child who is hearing through a CI to develop speech and language skills, an important factor is that the CI has to stimulate the auditory cortex. Obtaining behavioral measurements from young children with CIs can often be unreliable. While a variety of noninvasive techniques can be used for detecting cortical activity in response to auditory stimuli, many have critical limitations when applied to the pediatric CI population. We tested the ability of near-infrared spectroscopy (NIRS) to detect cortical responses to speech stimuli in pediatric CI users. Neuronal activity leads to changes in blood oxy- and deoxy-hemoglobin concentrations that can be detected by measuring the transmission of near-infrared light through the tissue. To verify the efficacy of NIRS, we first compared auditory cortex responses measured with NIRS and fMRI in normal-hearing adults. We then examined four different participant cohorts with NIRS alone. Speech-evoked cortical activity was observed in 100% of normal-hearing adults (11 of 11), 82% of normal-hearing children (9 of 11), 78% of deaf children who have used a CI > 4 months (28 of 36), and 78% of deaf children who completed NIRS testing on the day of CI initial activation (7 of 9). Therefore, NIRS can measure cortical responses in pediatric CI users, and has the potential to be a powerful adjunct to current CI assessment tools.
Sevy, Alexander B.G.; Bortfeld, Heather; Huppert, Theodore J.; Beauchamp, Michael S.; Tonini, Ross E.; Oghalai, John S.
Cochlear implants (CI) are commonly used to treat deafness in young children. While many factors influence the ability of a deaf child who is hearing through a CI to develop speech and language skills, an important factor is that the CI has to stimulate the auditory cortex. Obtaining behavioral measurements from young children with CIs can often be unreliable. While a variety of noninvasive techniques can be used for detecting cortical activity in response to auditory stimuli, many have critical limitations when applied to the pediatric CI population. We tested the ability of near-infrared spectroscopy (NIRS) to detect cortical responses to speech stimuli in pediatric CI users. Neuronal activity leads to changes in blood oxy- and de-oxyhemoglobin concentrations that can be detected by measuring the transmission of near-infrared light through the tissue. To verify the efficacy of NIRS, we first compared auditory cortex responses measured with NIRS and fMRI in normal-hearing adults. We then examined four different participant cohorts with NIRS alone. Speech-evoked cortical activity was observed in 100% of normal-hearing adults (11 of 11), 82% of normal-hearing children (9 of 11), 78% of deaf children who have used a CI >4 months (28 of 36), and 78% of deaf children who completed NIRS testing on the day of CI initial activation (7 of 9). Therefore, NIRS can measure cortical responses in pediatric CI users, and has the potential to be a powerful adjunct to current CI assessment tools. PMID:20888894
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.
... 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 ...
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…
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
He, Shuman; Grose, John H.; Teagle, Holly F.B.; Woodard, Jennifer; Park, Lisa R.; Hatch, Debora R.; Roush, Patricia; Buchman, Craig A.
Objective: The overall aim of the study was to evaluate the feasibility of using electrophysiological measures of the auditory change complex (ACC) to identify candidates for cochlear implantation in children with auditory neuropathy spectrum disorder (ANSD). In order to achieve this overall aim, this study 1) assessed the feasibility of measuring the ACC evoked by temporal gaps in a group of children with ANSD across a wide age range; and 2) investigated the association between gap detection thresholds (GDTs) measured by the ACC recordings and open-set speech-perception performance in these subjects. Design: Nineteen children with bilateral ANSD ranging in age between 1.9 to 14.9 yrs (mean: 7.8 yrs) participated in this study. Electrophysiological recordings of the auditory event-related potential (ERP), including the onset ERP response and the ACC, were completed in all subjects and open-set speech perception was evaluated for a subgroup of sixteen subjects. For the ERP recordings, the stimulus was a Gaussian noise presented through ER-3A insert earphones to the test ear. Two stimulation conditions were used. In the “control condition,” the stimulus was an 800-ms Gaussian noise. In the “gapped condition”, the stimuli were two noise segments, each being 400 ms in duration, separated by one of five gaps (i.e. 5, 10, 20, 50, or 100 ms). The inter-stimulation interval was 1200 ms. The aided open-set speech perception ability was assessed using the Phonetically Balanced Kindergarten (PBK) word lists presented at 60 dB SPL using recorded testing material in a sound booth. For speech perception tests, subjects wore their hearing aids at the settings recommended by their clinical audiologists. For a subgroup of five subjects, psychophysical gap detection thresholds for the Gaussian noise were also assessed using a three-interval, three-alternative forced-choice procedure. Results: Responses evoked by the onset of the Gaussian noise (i.e. onset responses) were
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
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…
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…
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…
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…
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.
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.
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.
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.
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…
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.…
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…
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 three 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 made when the children had equivalent amounts of robust hearing experience but different chronological ages. This paper reports the results for the 6-month period ending 9 months after activation of the child’s device for children with CIs, and the 6-month period ending at 12 months of age for TD infants. The findings were compared to a model of early intonation development in children with normal hearing. The results indicated that all groups progressed through 1 or more of the stages predicted by the normative model. At the end of the study period, however, children who had received a cochlear implant later than 24 months reached a more mature stage of intonation development than younger CI-recipients. Moreover, the older CI group reached the same stage of development as the TD infants who had 3 additional months of language listening experience. The findings suggest that the developmental advantage which older children had previously demonstrated shortly after activation of their CIs is maintained throughout most or all of the first year of cochlear implant use. PMID:21728834
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
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
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
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.
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.
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.
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
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
Warner-Czyz, Andrea D.; Davis, Barbara L.; MacNeilage, Peter F.
Purpose: Attaining speech accuracy requires that children perceive and attach meanings to vocal output on the basis of production system capacities. Because auditory perception underlies speech accuracy, profiles for children with hearing loss (HL) differ from those of children with normal hearing (NH). Method: To understand the impact of auditory…
Le Maner-Idrissi, Gaid; Dardier, Virginie; Pajon, Cecile; Tan-Bescond, Geraldine; David, Kristell; Deleau, Michel; Godey, Benoit
Previous studies of preverbal development have highlighted the recurrent difficulties experienced by deaf children in acquiring knowledge of the social rules and social skills pertaining to discourse. We expected cochlear implants in children with bilateral profound deafness to improve their use of verbal language, so that their communication…
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.
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.
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.
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.
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…
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…
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
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…
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…
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…
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.,…
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.
van der Kant, Anne; Vermeulen, Anneke; De Raeve, Leo; Schreuder, Robert
This paper reports the results of two studies of reading comprehension of Flemish children in Belgium. In the northern part of Belgium (Flanders), Dutch is the official language. The Dutch-speaking inhabitants of Flanders are called Flemish. Dutch is also the national language of the Netherlands. Despite both groups using Dutch, cultural…
Prakash, Santhi S; Prakash, S. G. R.; Ravichandran, Aparna; Susan, K. Y.; Alex, Winnie
Hearing impairment is an exceptional circumstance that restricts the child's ability to communicate verbally. Depression is a common stress-related response for hearing parents of children with hearing loss. Evidence suggests that mothers are more inclined than fathers to experience depression in response to their child's hearing loss (Mavrolas,…
Oktapoti, Maria; Okalidou, Areti; Kyriafinis, George; Petinou, Kakia; Vital, Victor; Herman, Rosalind
Objective: There are very few measures of language development in spoken Greek that can be used with young deaf children. This study investigated the use of Cyprus Lexical List (CYLEX), a receptive and expressive vocabulary assessment based on parent report that has recently been adapted to Standard Greek, to measure the vocabulary development of…
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
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
Kyriafinis, G; Vital, V; Psifidis, A; Constantinidis, J; Nikolaou, A; Hitoglou-Antoniadou, M; Kouloulas, A
Background: The cochlear implantation is among the most important achievements of medicine and biotechnology in the last 20 years, because it allows individuals who had never heard or had lost their hearing to perceive sound and improve their quality of life. Selection criteria for candidates are strict and are evaluated in each individual by a scientific committee specially trained for implantations which includes Ear Nose and Throat (ENT) surgeon, audiologist, psychiatrist and speech therapist. Patients and methods: In our department, the first cochlear implantation was performed in 1995. During the last ten years more than 250 individuals have been evaluated due to profound hearing loss and 170 of them were found to be suitable candidates for cochlear implantation. One hundred and fifty (150) have already been operated and most of them are children with congenital hearing loss. No major or permanent complications were recorded in any of our 150 patients. Activation and fitting/mapping of the cochlear implant is initiated three weeks post-operatively. Regular follow- up and mapping of the implant are held, more frequently in children, along with specialized speech therapy. Each new mapping is evaluated according to the record of the patient with regard to the acoustic perception of sounds and speech and the discrimination of individual elements of phonation based on a protocol that we have created for the needs of Greek language. Results: Speech discrimination (AHEPA Hospital protocol), before the Implantation, at the activation of the cochlear implant and till 4 years of the follow-up showed that in our patients, we obtained better and faster results in post-speech acquisition adults with recent or chronic deafness and in children with congenital deafness operated before the 5th year of age, who underwent special preoperative speech therapy programme, fact which is in agreement with current literature. Patient satisfaction evaluated by "Sanders" psychometrics
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.
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.
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 version of conversational recast treatment that focuses on a single morpheme error at a time, emphasizes attention to clinician input, and uses high linguistic variability with clinician input. A period of recasting was followed by 24 auditory presentations of the target morpheme in short sentences. After an initial baseline period, children were treated in individual sessions over 21–26 days. Results All children showed improved use of targeted grammatical morpheme use, both in elicited contexts and in terms of spontaneous use. Spontaneous use was best for the 2 children who were implanted earliest and whose audiograms showed the best hearing postimplant. Performance by a 3rd child diagnosed with auditory neuropathy spectrum disorder was more variable but still showed positive change. Conclusions The results indicate that the treatment can be effective for children with cochlear implants. The pattern of results across children also suggests potential variables that may moderate treatment effects. PMID:27097229
Convertino, Carol; Borgna, Georgianna; Marschark, Marc; Durkin, Andreana
Deaf learners frequently demonstrate significantly less vocabulary knowledge than hearing age-mates. Studies involving other domains of knowledge, and perhaps deaf learners' academic performance, indicate similar lags with regard to world knowledge. Such gaps often are attributed to limitations on deaf children's incidental learning by virtue of not having access to the conversations of others. Cochlear implants (CIs) have been described as providing such access, and rapid growth in vocabularies following pediatric cochlear implantation has suggested that, over time, children with implants might close the gap relative to hearing peers. Two experiments evaluated this possibility through the assessment of word and world knowledge among deaf college students with and without CIs and a hearing comparison group. Results across essentially all tasks indicated hearing students to outperform deaf students both with and without CIs with no significant differences between the latter two groups. Separate analyses of a subset of implant users who received their implants at a young age did not reveal any long-term advantages, nor was age of implantation related to enhanced performance on any of the tasks. Results are discussed in terms of incidental learning and the accessibility of word and world knowledge to deaf learners with and without CIs.
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
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.
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
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
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.
Jones, David L.; Gao, Sujuan; Svirsky, Mario A.
A study investigated whether two speech measures (peak intraoral air pressure (IOP) and IOP duration) obtained during production of intervocalic stops would be altered by the presence or absence of a cochlear implant in five children (ages 7-10). The auditory condition affected peak IOP more than IOP duration. (Contains references.) (Author/CR)
Clark, Graeme M
The multichannel cochlear implant is the first neural prosthesis to effectively and safely bring electronic technology into a direct physiological relation with the central nervous system and human consciousness. It is also the first cochlear implant to give speech understanding to tens of thousands of persons with profound deafness and spoken language to children born deaf in more than 80 countries. In so doing, it is the first major advance in research and technology to help deaf children communicate since Sign Language of the Deaf was developed at the Paris deaf school (L'Institut National de Jeunes Sourds de Paris) >200 years ago. Furthermore, biomedical research has been fundamental for ensuring that the multielectrode implant is safe as well as effective. More recent research has also shown that bilateral implants confer the benefits of binaural hearing. Future research using nanotechnology should see high-fidelity sound received, which would help deaf persons communicate in noise and enjoy music. Research should also lead to implants in ears with useful hearing.
Convertino, Carol; Borgna, Georgianna; Marschark, Marc; Durkin, Andreana
Deaf learners frequently demonstrate significantly less vocabulary knowledge than hearing age-mates. Studies involving other domains of knowledge, and perhaps deaf learners’ academic performance, indicate similar lags with regard to world knowledge. Such gaps often are attributed to limitations on deaf children’s incidental learning by virtue of not having access to the conversations of others. Cochlear implants (CIs) have been described as providing such access, and rapid growth in vocabularies following pediatric cochlear implantation has suggested that, over time, children with implants might close the gap relative to hearing peers. Two experiments evaluated this possibility through the assessment of word and world knowledge among deaf college students with and without CIs and a hearing comparison group. Results across essentially all tasks indicated hearing students to outperform deaf students both with and without CIs with no significant differences between the latter two groups. Separate analyses of a subset of implant users who received their implants at a young age did not reveal any long-term advantages, nor was age of implantation related to enhanced performance on any of the tasks. Results are discussed in terms of incidental learning and the accessibility of word and world knowledge to deaf learners with and without CIs. PMID:25145461
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 Guidance Services). The study used CI age as a referent for 32 children who received their CI before 30 months of age. Consonants produced by 70% of the children were listed, as were the most common error types, which were consonant omissions and substitutions. Using consonant repertoire lists and standard scores, the study revealed that children with CIs had acquisition patterns that were similar to their peers when the duration of CI experience was similar to the chronological age norms of typically developing children. The results revealed that CI users need time to coordinate their articulatory organizing principles with the input they receive from their CI. It is appropriate to use length of CI use as a proxy for chronological age during the first 4 years when comparing articulation development with hearing peers.
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.
Frisch, Stefan A.; Pisoni, David B.
Objective Computational simulations were carried out to evaluate the appropriateness of several psycholinguistic theories of spoken word recognition for children who use cochlear implants. These models also investigate the interrelations of commonly used measures of closed-set and open-set tests of speech perception. Design A software simulation of phoneme recognition performance was developed that uses feature identification scores as input. Two simulations of lexical access were developed. In one, early phoneme decisions are used in a lexical search to find the best matching candidate. In the second, phoneme decisions are made only when lexical access occurs. Simulated phoneme and word identification performance was then applied to behavioral data from the Phonetically Balanced Kindergarten test and Lexical Neighborhood Test of open-set word recognition. Simulations of performance were evaluated for children with prelingual sensorineural hearing loss who use cochlear implants with the MPEAK or SPEAK coding strategies. Results Open-set word recognition performance can be successfully predicted using feature identification scores. In addition, we observed no qualitative differences in performance between children using MPEAK and SPEAK, suggesting that both groups of children process spoken words similarly despite differences in input. Word recognition ability was best predicted in the model in which phoneme decisions were delayed until lexical access. Conclusions Closed-set feature identification and open-set word recognition focus on different, but related, levels of language processing. Additional insight for clinical intervention may be achieved by collecting both types of data. The most successful model of performance is consistent with current psycholinguistic theories of spoken word recognition. Thus it appears that the cognitive process of spoken word recognition is fundamentally the same for pediatric cochlear implant users and children and adults with
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…
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…
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.
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…
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.
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
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.
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
Lake, Samantha; Kollia, Betty
Four hearing-impaired children with prelingual, bilateral, severe-to-profound hearing loss were grouped by age, gender, and age at implantation; the younger group consisted of females approximately 6 years old and implanted between 1-2 years of age and the older group consisted of males approximately 14 years old and implanted at 9 years of age. Each child was diagnosed with prelingual hearing loss, was implanted with the Nucleus 24® cochlear implant in 1998, and has approximately 4 years of experience using the implant consistently. All subjects receive 8 h of direct instruction with the implant per week, in a school for the deaf that utilizes total communication. Each subject also receives speech therapy in 30-min sessions four times per week and exhibits intelligible speech. Coarticulation in the children's speech was studied using five consonant-diphthong-consonant pseudowords, in the carrier sentence ``it's a -- again.'' The recordings were digitized and analyzed acoustically. The results are discussed with reference to the age of cochlear implantation of the children and its role in the quality of their speech.
Park, Mina; Song, Jae-Jin; Oh, Seo Jin; Shin, Min-Sup; Lee, Jun Ho; Oh, Seung Ha
Objectives. This study assessed the correlation between performance intelligence and the postoperative cochlear implant (CI) outcome in Korean-speaking children. In addition, the relationship between the performance intelligence subscales and the post-CI speech outcome was evaluated. Materials and Methods. Thirteen pediatric CI users (five males, eight females; median age at implantation 6.2 (range 1.3–14.2) years; median age at intelligence test 9.3 (range 5–16) years) who were tested using the Korean Educational Development Institute-Wechsler Intelligence Scale for children were studied. The correlations between the intelligence scores and 1-2 years postoperative Categories of Auditory Performance (CAP) scores and between subscales of performance and 1-2 years postoperative CAP scores were analyzed. Results. There was no correlation between the categories of verbal intelligence quotient (IQ) and performance IQ for “mentally retarded” and “average,” respectively (Spearman's rho = 0.42, P = 0.15). There was a strong correlation between performance IQ and the postoperative CAP scale (Spearman's rho = 0.8977, P = 0.0008). “Picture arrangement” and “picture completion,” reflecting social cognition, were strongly correlated with the postoperative CAP scales. Conclusion. Performance intelligence, especially social cognition, was strongly related to the postoperative CI outcome of cochlear implant users. Therefore, auditory rehabilitation, including social rehabilitation, should maximize the postoperative CI outcomes. PMID:26236723
Park, Mina; Song, Jae-Jin; Oh, Seo Jin; Shin, Min-Sup; Lee, Jun Ho; Oh, Seung Ha
Objectives. This study assessed the correlation between performance intelligence and the postoperative cochlear implant (CI) outcome in Korean-speaking children. In addition, the relationship between the performance intelligence subscales and the post-CI speech outcome was evaluated. Materials and Methods. Thirteen pediatric CI users (five males, eight females; median age at implantation 6.2 (range 1.3-14.2) years; median age at intelligence test 9.3 (range 5-16) years) who were tested using the Korean Educational Development Institute-Wechsler Intelligence Scale for children were studied. The correlations between the intelligence scores and 1-2 years postoperative Categories of Auditory Performance (CAP) scores and between subscales of performance and 1-2 years postoperative CAP scores were analyzed. Results. There was no correlation between the categories of verbal intelligence quotient (IQ) and performance IQ for "mentally retarded" and "average," respectively (Spearman's rho = 0.42, P = 0.15). There was a strong correlation between performance IQ and the postoperative CAP scale (Spearman's rho = 0.8977, P = 0.0008). "Picture arrangement" and "picture completion," reflecting social cognition, were strongly correlated with the postoperative CAP scales. Conclusion. Performance intelligence, especially social cognition, was strongly related to the postoperative CI outcome of cochlear implant users. Therefore, auditory rehabilitation, including social rehabilitation, should maximize the postoperative CI outcomes.
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. The purpose of this study was to identify EF domains that are related to speech-language skills in cochlear implant (CI) users, compared to normal-hearing peers. Sixty-four prelingually deaf, early-implanted, long-term users of CIs and 74 normal-hearing peers equivalent in age and nonverbal intelligence completed measures of speech-language skills and three domains of EF: working memory, fluency-speed, and inhibition-concentration. Verbal working memory and fluency-speed were more strongly associated with speech-language outcomes in the CI users than in the normal-hearing peers. Spatial working memory and inhibition-concentration correlated positively with language skills in normal-hearing peers but not in CI users. The core domains of EF that are associated with spoken language development are different in long-term CI users compared to normal-hearing peers, suggesting important dissociations in neurocognitive development.
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
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.
Ingvalson, Erin M.; Young, Nancy M.; Wong, Patrick C. M.
Objectives Phonological and working memory skills have been shown to be important for the development of spoken language. Children who use a cochlear implant (CI) show performance deficits relative to normal hearing (NH) children on all constructs: phonological skills, working memory, and spoken language. Given that phonological skills and working memory have been shown to be important for spoken language development in NH children, we hypothesized that training these foundational skills would result in improved spoken language performance in CI-using children. Design Nineteen prelingually deafened CI-using children aged 4- to 7-years-old participated. All children had been using their implants for at least one year and were matched on pre-implant hearing thresholds, hearing thresholds at study enrollment, and non-verbal IQ. Children were assessed on expressive vocabulary, listening language, spoken language, and composite language. Ten children received four weeks of training on phonological skills including rhyme, sound blending, and sound discrimination and auditory working memory. The remaining nine children continued with their normal classroom activities for four weeks. Language assessments were repeated following the training/control period. Results Children who received combined phonological-working memory training showed significant gains on expressive and composite language scores. Children who did not receive training showed no significant improvements at post-test. On average, trained children had gain scores of 6.35 points on expressive language and gain scores of 6.15 points whereas the untrained children had test-retest gain scores of 2.89 points for expressive language and 2.56 for composite language. Conclusion Our results suggest that training to improve the phonological and working memory skills in CI-using children may lead to improved language performance. PMID:25109453
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.
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.
Yan, Yu-jun; Li, Yun; Yang, Tao; Huang, Qi; Wu, Hao
To analyze the treatment outcomes in pediatric cochlear implant patients with mutations in GJB2 or SLC26A4 and to determine these mutations' impact on rehabilitative outcomes. The study included 41 children who received unilateral cochlear implantations. Fifteen of these children had GJB2-related deafness, 10 had SLC26A4-related deafness, and 16 had deafness of unknown etiology. Speech perception and language development evaluations, including the Meaningful Auditory Integration Scale (MAIS), categories of auditory performance (CAP), speech intelligibility rating (SIR) and babbling spurt, were conducted before and after the implantation. Better results for the GJB2 group (vs. the control group) were observed regarding MAIS, CAP and SIR at 24 months after implantation (P < 0.05). The performance of GJB2 group was better than SLC26A4 group, expressed by a significant difference in the variance of CAP and SIR at 24 months postoperatively (P < 0.05). A trend towards earlier babbling spurt onset could be observed for the GJB2 group, intergroup comparison did not reveal any significant difference among the three groups (P > 0.05). The SLC26A4 group performed better than the control group at 12 and 24 months postoperatively, although without a statistically significant difference (P > 0.05). The GJB2 gene mutations had a significantly positive impact on the outcome of cochlear implantation. Patients with SLC26A4-related deafness were shown to benefit from cochlear implantation.
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.
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
Lyness, C.R.; Woll, B.; Campbell, R.; Cardin, V.
Cochlear implants (CI) are the most successful intervention for ameliorating hearing loss in severely or profoundly deaf children. Despite this, educational performance in children with CI continues to lag behind their hearing peers. From animal models and human neuroimaging studies it has been proposed the integrative functions of auditory cortex are compromised by crossmodal plasticity. This has been argued to result partly from the use of a visual language. Here we argue that ‘cochlear implant sensitive periods’ comprise both auditory and language sensitive periods, and thus cannot be fully described with animal models. Despite prevailing assumptions, there is no evidence to link the use of a visual language to poorer CI outcome. Crossmodal reorganisation of auditory cortex occurs regardless of compensatory strategies, such as sign language, used by the deaf person. In contrast, language deprivation during early sensitive periods has been repeatedly linked to poor language outcomes. Language sensitive periods have largely been ignored when considering variation in CI outcome, leading to ill-founded recommendations concerning visual language in CI habilitation. PMID:23999083
Pisoni, David B.; Kronenberger, William G.; Chandramouli, Suyog H.; Conway, Christopher M.
At the present time, there is no question that cochlear implants (CIs) work and often work very well in quiet listening conditions for many profoundly deaf children and adults. The speech and language outcomes data published over the last two decades document quite extensively the clinically significant benefits of CIs. Although there now is a large body of evidence supporting the “efficacy” of CIs as a medical intervention for profound hearing loss in both children and adults, there still remain a number of challenging unresolved clinical and theoretical issues that deal with the “effectiveness” of CIs in individual patients that have not yet been successfully resolved. In this paper, we review recent findings on learning and memory, two central topics in the field of cognition that have been seriously neglected in research on CIs. Our research findings on sequence learning, memory and organization processes, and retrieval strategies used in verbal learning and memory of categorized word lists suggests that basic domain-general learning abilities may be the missing piece of the puzzle in terms of understanding the cognitive factors that underlie the enormous individual differences and variability routinely observed in speech and language outcomes following cochlear implantation. PMID:27092098
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.
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.
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.
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.
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.
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.
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
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.
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…
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
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.
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.
Houston, Derek M.; Bergeson, Tonya R.
The advent of cochlear implantation has provided thousands of deaf infants and children access to speech and the opportunity to learn spoken language. Whether or not deaf infants successfully learn spoken language after implantation may depend in part on the extent to which they listen to speech rather than just hear it. We explore this question by examining the role that attention to speech plays in early language development according to a prominent model of infant speech perception – Jusczyk’s WRAPSA model – and by reviewing the kinds of speech input that maintains normal-hearing infants’ attention. We then review recent findings suggesting that cochlear-implanted infants’ attention to speech is reduced compared to normal-hearing infants and that speech input to these infants differs from input to infants with normal hearing. Finally, we discuss possible roles attention to speech may play on deaf children’s language acquisition after cochlear implantation in light of these findings and predictions from Jusczyk’s WRAPSA model. PMID:24729634
Yuba, T; Itoh, T; Kaga, K
It is known that children with cochlear implants tend to sing off-key, monotonously, and flat. There are a few reports that it is possible to improve off-key singing mainly through instruction using the falsetto voice for people with normal hearing. We examined whether their singing skills could be improved through instruction. Eight subjects (five boys and three girls aged 10.4+/-2.4 years) with cochlear implants were selected. Speech perception scores of short sentences were on average 66.5%+/-26.5%. We diagnosed their singing acuity by letting them sing a nursery song, well known to all of them, before and after the instruction. The mean fundamental frequencies of their singing approached the mean Musical Instrument Digital Interface (MIDI)-specified frequencies as references and the deviation between fundamental frequencies of their singing and reference MIDI sounds became smaller. This study shows a clear improvement in the singing ability of children with cochlear implants through a unique technological voice method, mainly focused on the falsetto voice in this experiment.
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
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…
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
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
Moon, Il Joon; Kim, Eun Yeon; Park, Ga-Young; Jang, Min Seok; Kim, Ji Hye; Lee, Jeehun; Chung, Won-Ho; Cho, Yang-Sun; Hong, Sung Hwa
Although central nervous system abnormalities are incidentally detected in preoperative brain magnetic resonance imaging (MRI) studies in pediatric cochlear implant (CI) candidates, the clinical significance of the abnormalities remains unclear. We aimed to assess post-implantation auditory and speech performance in patients with brain lesions seen on MRI. Pediatric CI recipients (n = 177) who underwent preoperative MRI scans of the brain between January 2002 and June 2009 were included in this study. Patients with brain lesions on MRI were reviewed and categorized into the following groups: brain parenchymal lesions (focal vs. diffuse), ventriculomegaly, and extra-axial lesion. The main communication mode as well as progress in auditory perception and speech production were evaluated preoperatively and at 3, 6, 12, and 24 months postoperatively. Performance in patients with brain lesions was compared with the age- and sex-matched control group. Various brain lesions were found in 27 out of 177 patients. Children with brain lesions who received CIs showed gradual progress in auditory and speech outcomes for 2 years, though performance was reduced compared with the control group. In addition, there was a significant difference in the main communication mode between the two groups at 2 years following cochlear implantation. This difference was especially significant in patients with diffuse brain parenchymal lesions after further stratification of the brain lesion group. Preoperative brain MRI may have a role in improving the prediction of adverse outcomes in pediatric CI recipients. In particular, children with diffuse brain parenchymal lesions should be counseled regarding the poor prognosis preoperatively, and followed up with special attention.
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.