Effects of Talker Variability on Vowel Recognition in Cochlear Implants

ERIC Educational Resources Information Center

Chang, Yi-ping; Fu, Qian-Jie

2006-01-01

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…

Simultaneous versus sequential bilateral cochlear implants in adults: Cost analysis in a US setting.

PubMed

Trinidade, Aaron; Page, Joshua C; Kennett, Sarah W; Cox, Matthew D; Dornhoffer, John L

2017-11-01

From a purely surgical efficiency point of view, simultaneous cochlear implantation (SimCI) is more cost-effective than sequential cochlear implantation (SeqCI) when total direct costs are considered (implant and hospital costs). However, in a setting where only SeqCI is practiced and a proportion of initially unilaterally implanted patients do not progress to a second implant, this may not be the case, especially when audiological costs are factored in. We present a cost analysis of such a scenario as would occur in our institution. Retrospective review and cost analysis. Between 2005 and 2015, 370 patients fulfilled the audiological criteria for bilateral implantation. Of those, 267 (72.1%) underwent unilateral cochlear implantation only, 101 (27.3%) progressed to SeqCI, and two underwent SimCI. The total hospital, surgical, and implant costs, and initial implant stimulation series audiological costs between August 2015 and August 2016 (29 adult patients) were used in this analysis. The total hospital, surgical, and implant costs for this period was $2,731,360.42. Based on previous local trends, if a projected eight (27.3%) of these patients decide to progress to SeqCI, this will cost an additional $750,811.04, resulting in an overall total of $3,482,171.46 for these 29 patients. Had all 29 undergone SimCI, the total projected cost would have been $3,332,991.75, representing a total potential saving of $149,179.67 (4.3%). In institutions where only SeqCI is allowed in adults, overall patient management may cost marginally more than if SimCI were practiced. This will be of interest to CI programs and health insurance companies. 4. Laryngoscope, 127:2615-2618, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Patients reported outcome post-cochlear implantation: how severe is their dizziness?

PubMed

Zawawi, Faisal; Alobaid, Faisal; Leroux, Tony; Zeitouni, Anthony G

2014-01-01

The reported prevalence of vestibular dysfunction after cochlear implantation (CI) is varies between different scientific papers. The aim of this study is to determine the reported post-implantation outcome in terms of dizziness, and to measure its impact on quality of life using the Dizziness handicap inventory (DHI). This was a prospective questionnaire based study of postoperative cochlear implant patients. The questionnaire assessed the type and onset of dizziness in addition to the DHI. 122 patients were recruited in this study, which is the largest sample size in the literature reported so far. Dizziness was evident in 45.9% of the population post-CI and in 27% pre-CI. The commonest subtype of the dizziness was unsteadiness followed by lightheadedness. The dizziness was mild in most of the patients. Although mild, dizziness is a common complaint post-cochlear implantation. An understanding of symptoms helps counsel patients preoperatively.

The effect of cochlear implantation in development of intelligence quotient of 6-9 deaf children in comparison with normal hearing children (Iran, 2009-2011).

PubMed

Hashemi, Seyed Basir; Monshizadeh, Leila

2012-06-01

Before the introduction of cochlear implant (CI) in 1980, hearing aids were the only means by which profoundly deaf children had access to auditory stimuli. Nowadays, CI is firmly established as effective option in speech and language rehabilitation of deaf children, but much of the literature regarding outcomes for children after CI are focused on development of speech and less is known about language acquisition. So, the main aim of this study is the evaluation of verbal intelligence quotient (IQ) of cochlear implanted children in comparison with normal children. 30 cochlear implanted and 30 normal hearing children with similar socio-economic level at the same age were compared by a revised version (in Persian) of WISC test (Wechsler, 1991). Then the data were analyzed through SPSS software 16. In spite of the fact that cochlear implanted children did well in different parameters of WISC test, the average scores of this group was less than normal hearing children. But in similarities (one of the parameters of WISC test) 2 group's performance was approximately the same. CI plays an important role in development of verbal IQ and language acquisition of deaf children. Different researches indicate that most of the cochlear implanted children show less language delay during the time. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Environmental Sound Training in Cochlear Implant Users

ERIC Educational Resources Information Center

Shafiro, Valeriy; Sheft, Stanley; Kuvadia, Sejal; Gygi, Brian

2015-01-01

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,…

Sequential bilateral cochlear implantation improves working performance, quality of life, and quality of hearing.

PubMed

Härkönen, Kati; Kivekäs, Ilkka; Rautiainen, Markus; Kotti, Voitto; Sivonen, Ville; Vasama, Juha-Pekka

2015-05-01

This prospective study shows that working performance, quality of life (QoL), and quality of hearing (QoH) are better with two compared with a single cochlear implant (CI). The impact of the second CI on the patient's QoL is as significant as the impact of the first CI. To evaluate the benefits of sequential bilateral cochlear implantation in working, QoL, and QoH. We studied working performance, work-related stress, QoL, and QoH with specific questionnaires in 15 patients with unilateral CI scheduled for sequential CI of another ear. Sound localization performance and speech perception in noise were measured with specific tests. All questionnaires and tests were performed before the second CI surgery and 6 and 12 months after its activation. Bilateral CIs increased patients' working performance and their work-related stress and fatigue decreased. Communication with co-workers was easier and patients were more active in their working environment. Sequential bilateral cochlear implantation improved QoL, QoH, sound localization, and speech perception in noise statistically significantly.

Cochlear implants and spoken language processing abilities: review and assessment of the literature.

PubMed

Peterson, Nathaniel R; Pisoni, David B; Miyamoto, Richard T

2010-01-01

Cochlear implants (CIs) process sounds electronically and then transmit electric stimulation to the cochlea of individuals with sensorineural deafness, restoring some sensation of auditory perception. Many congenitally deaf CI recipients achieve a high degree of accuracy in speech perception and develop near-normal language skills. Post-lingually deafened implant recipients often regain the ability to understand and use spoken language with or without the aid of visual input (i.e. lip reading). However, there is wide variation in individual outcomes following cochlear implantation, and some CI recipients never develop useable speech and oral language skills. The causes of this enormous variation in outcomes are only partly understood at the present time. The variables most strongly associated with language outcomes are age at implantation and mode of communication in rehabilitation. Thus, some of the more important factors determining success of cochlear implantation are broadly related to neural plasticity that appears to be transiently present in deaf individuals. In this article we review the expected outcomes of cochlear implantation, potential predictors of those outcomes, the basic science regarding critical and sensitive periods, and several new research directions in the field of cochlear implantation.

Speech Perception with Music Maskers by Cochlear Implant Users and Normal-Hearing Listeners

ERIC Educational Resources Information Center

Eskridge, Elizabeth N.; Galvin, John J., III; Aronoff, Justin M.; Li, Tianhao; Fu, Qian-Jie

2012-01-01

Purpose: The goal of this study was to investigate how the spectral and temporal properties in background music may interfere with cochlear implant (CI) and normal-hearing listeners' (NH) speech understanding. Method: Speech-recognition thresholds (SRTs) were adaptively measured in 11 CI and 9 NH subjects. CI subjects were tested while using their…

Nijmegen Cochlear Implant Questionnaire (NCIQ): translation, cultural adaptation, and application in adults with cochlear implants.

PubMed

Santos, Nathália Porfírio Dos; Couto, Maria Inês Vieira; Martinho-Carvalho, Ana Claudia

2017-12-11

Cross-cultural adaptation and translation of the Nijmegen Cochlear Implant Questionnaire (NCIQ) into Brazilian Portuguese and analysis of quality of life (QoL) results in adults with cochlear implant (CI). The NCIQ instrument was translated into Brazilian Portuguese and culturally adapted. After that, a cross-sectional and clinical QoL evaluation was conducted with a group of 24 adults with CI. The questionnaire title in Brazilian Portuguese is 'Questionário Nijmegen de Implantes Cocleares' (NCIQ-P). The version of the NCIQ questionnaire translated into Brazilian Portuguese presented good internal consistency (0.78). The social and physical domains presented the highest scores, with the basic and advanced sound perception subdomains achieving the highest scores. No correlation between gender and time of device use was found for the questionnaire domains and subdomains. The cross-cultural adaptation and translation of the NCIQ into Brazilian Portuguese suggests that this instrument is reliable and useful for clinical and research purposes in Brazilian adults with CI.

Hybrid cochlear implantation: quality of life, quality of hearing, and working performance compared to patients with conventional unilateral or bilateral cochlear implantation.

PubMed

Härkönen, Kati; Kivekäs, Ilkka; Kotti, Voitto; Sivonen, Ville; Vasama, Juha-Pekka

2017-10-01

The objective of the present study is to evaluate the effect of hybrid cochlear implantation (hCI) on quality of life (QoL), quality of hearing (QoH), and working performance in adult patients, and to compare the long-term results of patients with hCI to those of patients with conventional unilateral cochlear implantation (CI), bilateral CI, and single-sided deafness (SSD) with CI. Sound localization accuracy and speech-in-noise test were also compared between these groups. Eight patients with high-frequency sensorineural hearing loss of unknown etiology were selected in the study. Patients with hCI had better long-term speech perception in noise than uni- or bilateral CI patients, but the difference was not statistically significant. The sound localization accuracy was equal in the hCI, bilateral CI, and SSD patients. QoH was statistically significantly better in bilateral CI patients than in the others. In hCI patients, residual hearing was preserved in all patients after the surgery. During the 3.6-year follow-up, the mean hearing threshold at 125-500 Hz decreased on average by 15 dB HL in the implanted ear. QoL and working performance improved significantly in all CI patients. Hearing outcomes with hCI are comparable to the results of bilateral CI or CI with SSD, but hearing in noise and sound localization are statistically significantly better than with unilateral CI. Interestingly, the impact of CI on QoL, QoH, and working performance was similar in all groups.

Identification and Multiplicity of Double Vowels in Cochlear Implant Users

ERIC Educational Resources Information Center

Kwon, Bomjun J.; Perry, Trevor T.

2014-01-01

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…

Nonword Repetition with Spectrally Reduced Speech: Some Developmental and Clinical Findings from Pediatric Cochlear Implantation

ERIC Educational Resources Information Center

Burkholder-Juhasz, Rose A.; Levi, Susannah V.; Dillon, Caitlin M.; Pisoni, David B.

2007-01-01

Nonword repetition skills were examined in 24 pediatric cochlear implant (CI) users and 18 normal-hearing (NH) adult listeners listening through a CI simulator. Two separate groups of NH adult listeners assigned accuracy ratings to the nonword responses of the pediatric CI users and the NH adult speakers. Overall, the nonword repetitions of…

Song Recognition by Young Children with Cochlear Implants: Comparison between Unilateral, Bilateral, and Bimodal Users

ERIC Educational Resources Information Center

Bartov, Tamar; Most, Tova

2014-01-01

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…

Linguistic and Pragmatic Skills in Toddlers with Cochlear Implant

ERIC Educational Resources Information Center

Rinaldi, Pasquale; Baruffaldi, Francesca; Burdo, Sandro; Caselli, Maria Cristina

2013-01-01

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…

A comparative historical and demographic study of the neuromodulation management techniques of deep brain stimulation for dystonia and cochlear implantation for sensorineural deafness in children.

PubMed

Hudson, V E; Elniel, A; Ughratdar, I; Zebian, B; Selway, R; Lin, J P

2017-01-01

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. To compare cochlear implant (CI) neuromodulation with deep brain stimulation (DBS) for dystonia in childhood and explore relations between age and duration of symptoms at implantation and outcome. Comparison of published annual UK CI figures for 1985-2009 with a retrospective cohort of the first 9 years of DBS for dystonia in children at a single-site Functional Neurosurgery unit from 2006 to 14. From 2006 to 14, DBS neuromodulation of childhood dystonia increased by a factor of 3.8 to a total of 126 cases over the first 9 years, similar to the growth in cochlear implants which increased by a factor of 4.1 over a similar period in the 1980s rising to 527 children in 2009. The CI saw a dramatic shift in practice from implantation at >5 years of age at the start of the programme towards earlier implantation by the mid-1990s. Best language results were seen for implantation <5 years of age and duration of cochlear neuromodulation >4 years, hence implantation <1 year of age, indicating that severely deaf, pre-lingual children could benefit from cochlear neuromodulation if implanted early. Similar to initial CI use, the majority of children receiving DBS for dystonia in the first 9 years were 5-15 years of age, when the proportion of life lived with dystonia exceeds 90% thus limiting benefits. Early DBS neuromodulation for acquired motor disorders should be explored to maximise the benefits of dystonia reduction in a period of maximal developmental plasticity before the onset of disability. Learning from cochlear implantation, DBS can become an accepted management option in children under the age of 5 years who have a reduced proportion of life lived with dystonia, and not viewed as a last resort reserved for only the most severe cases where benefits may be at their most limited. Copyright © 2016 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

A software tool for analyzing multichannel cochlear implant signals.

PubMed

Lai, Wai Kong; Bögli, Hans; Dillier, Norbert

2003-10-01

A useful and convenient means to analyze the radio frequency (RF) signals being sent by a speech processor to a cochlear implant would be to actually capture and display them with appropriate software. This is particularly useful for development or diagnostic purposes. sCILab (Swiss Cochlear Implant Laboratory) is such a PC-based software tool intended for the Nucleus family of Multichannel Cochlear Implants. Its graphical user interface provides a convenient and intuitive means for visualizing and analyzing the signals encoding speech information. Both numerical and graphic displays are available for detailed examination of the captured CI signals, as well as an acoustic simulation of these CI signals. sCILab has been used in the design and verification of new speech coding strategies, and has also been applied as an analytical tool in studies of how different parameter settings of existing speech coding strategies affect speech perception. As a diagnostic tool, it is also useful for troubleshooting problems with the external equipment of the cochlear implant systems.

Deaf Teenagers with Cochlear Implants in Conversation with Hearing Peers

ERIC Educational Resources Information Center

Ibertsson, Tina; Hansson, Kristina; Maki-Torkko, Elina; Willstedt-Svensson, Ursula; Sahlen, Birgitta

2009-01-01

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…

Processing of Acoustic Cues in Lexical-Tone Identification by Pediatric Cochlear-Implant Recipients

ERIC Educational Resources Information Center

Peng, Shu-Chen; Lu, Hui-Ping; Lu, Nelson; Lin, Yung-Song; Deroche, Mickael L. D.; Chatterjee, Monita

2017-01-01

Purpose: The objective was to investigate acoustic cue processing in lexical-tone recognition by pediatric cochlear-implant (CI) recipients who are native Mandarin speakers. Method: Lexical-tone recognition was assessed in pediatric CI recipients and listeners with normal hearing (NH) in 2 tasks. In Task 1, participants identified naturally…

Cochlear Implant in the Second Year of Life: Lexical and Grammatical Outcomes

ERIC Educational Resources Information Center

Caselli, Maria Cristina; Rinaldi, Pasquale; Varuzza, Cristiana; Giuliani, Anna; Burdo, Sandro

2012-01-01

Purpose: The authors studied the effect of the cochlear implant (CI) on language comprehension and production in deaf children who had received a CI in the 2nd year of life. Method: The authors evaluated lexical and morphosyntactic skills in comprehension and production in 17 Italian children who are deaf (M = 54 months of age) with a CI and in 2…

Large vestibular aqueduct syndrome: Impedance changes over time with different cochlear implant electrode arrays.

PubMed

Powell, Harry R F; Birman, Catherine S

2015-01-01

The aim of this study was to assess if large vestibular aqueduct syndrome (LVAS), with the increase in perilymphatic pressure, affects impedance changes over time with different types of Cochlear(®) implant electrode arrays Contour, Straight, and CI 422. To report speech perception outcomes for these cochlear implant recipients. Retrospective case review of impedance levels and categories of auditory performance. Impedance data were collected at switch on, 1 month, 3, 6, 12, and 24 months after cochlear implantation and compared with control (non-LVAS cochlear implant recipient) data for each array type. Forty-seven patients with exclusive LVAS and no other vestibulocochlear abnormalities or other identifiable cause of deafness were eligible for inclusion in the study. In LVAS patients, there was a significant difference in impedance between the three types of device (P < 0.0001). Time since switch on was associated with a decrease in impedance for all three devices (P < 0.0001). The mean impedance reduced between switch on and 1 month and remained relatively constant thereafter. Sound variation with softening of sounds was seen in four CI 422 (Straight Research Array) recipients due to ongoing fluctuations in electrode compliance. For all three array types, there was no significant difference in the mean impedance between the LVAS patients and controls over the first 12 months. In keeping with previous studies cochlear implant recipients with LVAS hear very well through the cochlear implant.

Speech Recognition of Bimodal Cochlear Implant Recipients Using a Wireless Audio Streaming Accessory for the Telephone.

PubMed

Wolfe, Jace; Morais, Mila; Schafer, Erin

2016-02-01

The goals of the present investigation were (1) to evaluate recognition of recorded speech presented over a mobile telephone for a group of adult bimodal cochlear implant users, and (2) to measure the potential benefits of wireless hearing assistance technology (HAT) for mobile telephone speech recognition using bimodal stimulation (i.e., a cochlear implant in one ear and a hearing aid on the other ear). A three-by-two-way repeated measures design was used to evaluate mobile telephone sentence-recognition performance differences obtained in quiet and in noise with and without the wireless HAT accessory coupled to the hearing aid alone, CI sound processor alone, and in the bimodal condition. Outpatient cochlear implant clinic. Sixteen bimodal users with Nucleus 24, Freedom, CI512, or CI422 cochlear implants participated in this study. Performance was measured with and without the use of a wireless HAT for the telephone used with the hearing aid alone, CI alone, and bimodal condition. CNC word recognition in quiet and in noise with and without the use of a wireless HAT telephone accessory in the hearing aid alone, CI alone, and bimodal conditions. Results suggested that the bimodal condition gave significantly better speech recognition on the mobile telephone with the wireless HAT. A wireless HAT for the mobile telephone provides bimodal users with significant improvement in word recognition in quiet and in noise over the mobile telephone.

Implications of Minimizing Trauma During Conventional Cochlear Implantation

PubMed Central

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.

2014-01-01

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 recipients, even those destined for electric-only stimulation. PMID:21659922

Cochlear implant users' spectral ripple resolution.

PubMed

Jeon, Eun Kyung; Turner, Christopher W; Karsten, Sue A; Henry, Belinda A; Gantz, Bruce J

2015-10-01

This study revisits the issue of the spectral ripple resolution abilities of cochlear implant (CI) users. The spectral ripple resolution of recently implanted CI recipients (implanted during the last 10 years) were compared to those of CI recipients implanted 15 to 20 years ago, as well as those of normal-hearing and hearing-impaired listeners from previously published data from Henry, Turner, and Behrens [J. Acoust. Soc. Am. 118, 1111-1121 (2005)]. More recently, implanted CI recipients showed significantly better spectral ripple resolution. There is no significant difference in spectral ripple resolution for these recently implanted subjects compared to hearing-impaired (acoustic) listeners. The more recently implanted CI users had significantly better pre-operative speech perception than previously reported CI users. These better pre-operative speech perception scores in CI users from the current study may be related to better performance on the spectral ripple discrimination task; however, other possible factors such as improvements in internal and external devices cannot be excluded.

Cochlear implant users' spectral ripple resolution

PubMed Central

Jeon, Eun Kyung; Turner, Christopher W.; Karsten, Sue A.; Henry, Belinda A.; Gantz, Bruce J.

2015-01-01

This study revisits the issue of the spectral ripple resolution abilities of cochlear implant (CI) users. The spectral ripple resolution of recently implanted CI recipients (implanted during the last 10 years) were compared to those of CI recipients implanted 15 to 20 years ago, as well as those of normal-hearing and hearing-impaired listeners from previously published data from Henry, Turner, and Behrens [J. Acoust. Soc. Am. 118, 1111–1121 (2005)]. More recently, implanted CI recipients showed significantly better spectral ripple resolution. There is no significant difference in spectral ripple resolution for these recently implanted subjects compared to hearing-impaired (acoustic) listeners. The more recently implanted CI users had significantly better pre-operative speech perception than previously reported CI users. These better pre-operative speech perception scores in CI users from the current study may be related to better performance on the spectral ripple discrimination task; however, other possible factors such as improvements in internal and external devices cannot be excluded. PMID:26520316

Music Engineering as a Novel Strategy for Enhancing Music Enjoyment in the Cochlear Implant Recipient.

PubMed

Kohlberg, Gavriel D; Mancuso, Dean M; Chari, Divya A; Lalwani, Anil K

2015-01-01

Enjoyment of music remains an elusive goal following cochlear implantation. We test the hypothesis that reengineering music to reduce its complexity can enhance the listening experience for the cochlear implant (CI) listener. Normal hearing (NH) adults (N = 16) and CI listeners (N = 9) evaluated a piece of country music on three enjoyment modalities: pleasantness, musicality, and naturalness. Participants listened to the original version along with 20 modified, less complex, versions created by including subsets of the musical instruments from the original song. NH participants listened to the segments both with and without CI simulation processing. Compared to the original song, modified versions containing only 1-3 instruments were less enjoyable to the NH listeners but more enjoyable to the CI listeners and the NH listeners with CI simulation. Excluding vocals and including rhythmic instruments improved enjoyment for NH listeners with CI simulation but made no difference for CI listeners. Reengineering a piece of music to reduce its complexity has the potential to enhance music enjoyment for the cochlear implantee. Thus, in addition to improvements in software and hardware, engineering music specifically for the CI listener may be an alternative means to enhance their listening experience.

Timing and Impact of Hearing Healthcare in Adult Cochlear Implant Recipients: A Rural-Urban Comparison

PubMed Central

Hixon, Brian; Chan, Stephen; Adkins, Margaret; Shinn, Jennifer B.; Bush, Matthew L.

2016-01-01

Objective The purpose of this study is to compare the timing and impact of hearing healthcare of rural and urban adults with severe hearing loss who use cochlear implants (CI). Study Design Cross-sectional questionnaire study Setting Tertiary referral center Patients Adult cochlear implant recipients. Main Outcome Measures Data collected included county of residence, socioeconomic information, impact of hearing loss on education/employment, and timing of hearing loss treatment. The benefits obtained from cochlear implantation were also evaluated. Results There were 91 participants (32 from urban counties, 26 from moderately rural counties, and 33 for extremely rural counties). Rural participants have a longer commute time to the CI center (p<0.001), lower income (p<0.001) and higher percentage of Medicaid coverage (p=0.004). Compared with urban-metro participants, rural participants with gradually progressive hearing loss had a greater time interval from the onset of hearing loss to obtaining hearing aid amplification (10 years versus 5 years, p=0.04). There was also a greater time interval from onset of hearing loss to the time of cochlear implantation in rural participants (p=0.04). Reported job loss was higher in rural participants than in urban participants (p=0.05). Both groups reported comparable benefit from cochlear implantation. Conclusions Rural CI recipients differ from urban residents in socioeconomic characteristics and may be delayed in timely treatment of hearing loss. Further efforts to expand access to hearing healthcare services may benefit rural adult patients. PMID:27636389

Timing and Impact of Hearing Healthcare in Adult Cochlear Implant Recipients: A Rural-Urban Comparison.

PubMed

Hixon, Brian; Chan, Stephen; Adkins, Margaret; Shinn, Jennifer B; Bush, Matthew L

2016-10-01

The purpose of this study is to compare the timing and impact of hearing healthcare of rural and urban adults with severe hearing loss who use cochlear implants (CI). Cross-sectional questionnaire study. Tertiary referral center. Adult cochlear implant recipients. Data collected included county of residence, socioeconomic information, impact of hearing loss on education/employment, and timing of hearing loss treatment. The benefits obtained from cochlear implantation were also evaluated. There were 91 participants (32 from urban counties, 26 from moderately rural counties, and 33 for extremely rural counties). Rural participants have a longer commute time to the CI center (p < 0.001), lower income (p < 0.001), and higher percentage of Medicaid coverage (p = 0.004). Compared with urban-metro participants, rural participants with gradually progressive hearing loss had a greater time interval from the onset of hearing loss to obtaining hearing aid amplification (10 yr versus 5 yr, p = 0.04). There was also a greater time interval from onset of hearing loss to the time of cochlear implantation in rural participants (p = 0.04). Reported job loss was higher in rural participants than in urban participants (p = 0.05). Both groups reported comparable benefit from cochlear implantation. Rural CI recipients differ from urban residents in socioeconomic characteristics and may be delayed in timely treatment of hearing loss. Further efforts to expand access to hearing healthcare services may benefit rural adult patients.

[Cochlear implant in children: rational, indications and cost/efficacy].

PubMed

Martini, A; Bovo, R; Trevisi, P; Forli, F; Berrettini, S

2013-06-01

A cochlear implant (CI) is a partially implanted electronic device that can help to provide a sense of sound and support speech to severely to profoundly hearing impaired patients. It is constituted by an external portion, that usually sits behind the ear and an internal portion surgically placed under the skin. The external components include a microphone connected to a speech processor that selects and arranges sounds pucked up by the microphone. This is connected to a transmitter coil, worn on the side of the head, which transmits data to an internal receiver coil placed under the skin. The received data are delivered to an array of electrodes that are surgically implanted within the cochlea. The primary neural targets of the electrodes are the spiral ganglion cells which innervate fibers of the auditory nerve. When the electrodes are activated by the signal, they send a current along the auditory nerve and auditory pathways to the auditory cortex. Children and adults who are profoundly or severely hearing impaired can be fitted with cochlear implants. According to the Food and Drug Administration, approximately 188,000 people worldwide have received implants. In Italy it is extimated that there are about 6-7000 implanted patients, with an average of 700 CI surgeries per year. Cochlear implantation, followed by intensive postimplantation speech therapy, can help young children to acquire speech, language, and social skills. Early implantation provides exposure to sounds that can be helpful during the critical period when children learn speech and language skills. In 2000, the Food and Drug Administration lowered the age of eligibility to 12 months for one type of CI. With regard to the results after cochlear implantation in relation to early implantation, better linguistic results are reported in children implanted before 12 months of life, even if no sufficient data exist regarding the relation between this advantage and the duration of implant use and how long this advantage persists in the subsequent years. With regard to cochlear implantation in children older than 12 months the studies show better hearing and linguistic results in children implanted at earlier ages. A sensitive period under 24-36 months has been identified over which cochlear implantation is reported to be less effective in terms of improvement in speech and hearing results. With regard to clinical effectiveness of bilateral cochlear implantation, greater benefits from bilateral implants compared to monolateral ones when assessing hearing in quiet and in noise and in sound localization abilities are reported to be present in both case of simultaneous or sequential bilateral implantation. However, with regard to the delay between the surgeries in sequential bilateral implantation, although benefit is reported to be present even after very long delays, on average long delays between surgeries seems to negatively affect the outcome with the second implant. With regard to benefits after cochlear implantation in children with multiple disabilities, benefits in terms of speech perception and communication as well as in quality of the daily life are reported even if benefits are slower and lower in comparison to those generally attained by implanted children without additional disabilities. Regarding the costs/efficacy ratio, the CI is expensive, in particular because of the cost of the high technological device, long life support, but even if healthcare costs are high, the savings in terms of indirect costs and quality of life are important. The CI, in fact, has a positive impact in terms of quality of life.

Sound Source Localization and Speech Understanding in Complex Listening Environments by Single-sided Deaf Listeners After Cochlear Implantation.

PubMed

Zeitler, Daniel M; Dorman, Michael F; Natale, Sarah J; Loiselle, Louise; Yost, William A; Gifford, Rene H

2015-09-01

To assess improvements in sound source localization and speech understanding in complex listening environments after unilateral cochlear implantation for single-sided deafness (SSD). Nonrandomized, open, prospective case series. Tertiary referral center. Nine subjects with a unilateral cochlear implant (CI) for SSD (SSD-CI) were tested. Reference groups for the task of sound source localization included young (n = 45) and older (n = 12) normal-hearing (NH) subjects and 27 bilateral CI (BCI) subjects. Unilateral cochlear implantation. Sound source localization was tested with 13 loudspeakers in a 180 arc in front of the subject. Speech understanding was tested with the subject seated in an 8-loudspeaker sound system arrayed in a 360-degree pattern. Directionally appropriate noise, originally recorded in a restaurant, was played from each loudspeaker. Speech understanding in noise was tested using the Azbio sentence test and sound source localization quantified using root mean square error. All CI subjects showed poorer-than-normal sound source localization. SSD-CI subjects showed a bimodal distribution of scores: six subjects had scores near the mean of those obtained by BCI subjects, whereas three had scores just outside the 95th percentile of NH listeners. Speech understanding improved significantly in the restaurant environment when the signal was presented to the side of the CI. Cochlear implantation for SSD can offer improved speech understanding in complex listening environments and improved sound source localization in both children and adults. On tasks of sound source localization, SSD-CI patients typically perform as well as BCI patients and, in some cases, achieve scores at the upper boundary of normal performance.

Speech Recognition and Cognitive Skills in Bimodal Cochlear Implant Users

ERIC Educational Resources Information Center

Hua, Håkan; Johansson, Björn; Magnusson, Lennart; Lyxell, Björn; Ellis, Rachel J.

2017-01-01

Purpose: To examine the relation between speech recognition and cognitive skills in bimodal cochlear implant (CI) and hearing aid users. Method: Seventeen bimodal CI users (28-74 years) were recruited to the study. Speech recognition tests were carried out in quiet and in noise. The cognitive tests employed included the Reading Span Test and the…

Phonological Awareness in Deaf Children Who Use Cochlear Implants

ERIC Educational Resources Information Center

James, Deborah; Rajput, Kaukab; Brown, Tracey; Sirimanna, Tony; Brinton, Julie; Goswami, Usha

2005-01-01

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…

Perception of Cantonese Lexical Tones by Pediatric Cochlear Implant Users

ERIC Educational Resources Information Center

Holt, Colleen M.; Lee, Kathy Y. S.; Dowell, Richard C.; Vogel, Adam P.

2018-01-01

Purpose: The purpose of this study is to assess Cantonese word recognition and the discrimination of Cantonese tones with manipulated contours by child and adolescent cochlear implant (CI) users and a group of peers with normal hearing (NH). It was hypothesized that the CI users would perform more poorly than their counterparts with NH in both…

Cost-Utility Analysis of Cochlear Implantation in Australian Adults.

PubMed

Foteff, Chris; Kennedy, Steven; Milton, Abul Hasnat; Deger, Melike; Payk, Florian; Sanderson, Georgina

2016-06-01

Sequential and simultaneous bilateral cochlear implants are emerging as appropriate treatment options for Australian adults with sensory deficits in both cochleae. Current funding of Australian public hospitals does not provide for simultaneous bilateral cochlear implantation (CI) as a separate surgical procedure. Previous cost-effectiveness studies of sequential and simultaneous bilateral CI assumed 100% of unilaterally treated patients' transition to a sequential bilateral CI. This assumption does not place cochlear implantation in the context of the generally treated population. When mutually exclusive treatment options exist, such as unilateral CI, sequential bilateral CI, and simultaneous bilateral CI, the mean costs of the treated populations are weighted in the calculation of incremental cost-utility ratios. The objective was to evaluate the cost-utility of bilateral hearing aids (HAs) compared with unilateral, sequential, and simultaneous bilateral CI in Australian adults with bilateral severe to profound sensorineural hearing loss. Cost-utility analysis of secondary sources input to a Markov model. Australian health care perspective, lifetime horizon with costs and outcomes discounted 5% annually. Bilateral HAs as treatment for bilateral severe to profound sensorineural hearing loss compared with unilateral, sequential, and simultaneous bilateral CI. Incremental costs per quality adjusted life year (AUD/QALY). When compared with bilateral hearing aids the incremental cost-utility ratio for the CI treatment population was AUD11,160/QALY. The incremental cost-utility ratio was weighted according to the number of patients treated unilaterally, sequentially, and simultaneously, as these were mutually exclusive treatment options. No peer-reviewed articles have reported the incremental analysis of cochlear implantation in a continuum of care for surgically treated populations with bilateral severe to profound sensorineural hearing loss. Unilateral, sequential, and simultaneous bilateral CI were cost-effective when compared with bilateral hearing aids. Technologies that reduce the total number of visits for a patient could introduce additional cost efficiencies into clinical practice.

Judgment of musical emotions after cochlear implantation in adults with progressive deafness

PubMed Central

Ambert-Dahan, Emmanuèle; Giraud, Anne-Lise; Sterkers, Olivier; Samson, Séverine

2015-01-01

While cochlear implantation is rather successful in restoring speech comprehension in quiet environments (Nimmons et al., 2008), other auditory tasks, such as music perception, can remain challenging for implant users. Here, we tested how patients who had received a cochlear implant (CI) after post-lingual progressive deafness perceive emotions in music. Thirteen adult CI recipients with good verbal comprehension (dissyllabic words ≥70%) and 13 normal hearing participants matched for age, gender, and education listened to 40 short musical excerpts that selectively expressed fear, happiness, sadness, and peacefulness ( Vieillard et al., 2008). The participants were asked to rate (on a 0–100 scale) how much the musical stimuli expressed these four cardinal emotions, and to judge their emotional valence (unpleasant–pleasant) and arousal (relaxing–stimulating). Although CI users performed above chance level, their emotional judgments (mean correctness scores) were generally impaired for happy, scary, and sad, but not for peaceful excerpts. CI users also demonstrated deficits in perceiving arousal of musical excerpts, whereas rating of valence remained unaffected. The current findings indicate that judgments of emotional categories and dimensions of musical excerpts are not uniformly impaired after cochlear implantation. These results are discussed in relation to the relatively spared abilities of CI users in perceiving temporal (rhythm and metric) as compared to spectral (pitch and timbre) musical dimensions, which might benefit the processing of musical emotions (Cooper et al., 2008). PMID:25814961

Contribution of a Contralateral Hearing Aid to Perception of Consonant Voicing, Intonation, and Emotional State in Adult Cochlear Implantees

ERIC Educational Resources Information Center

Most, Tova; Gaon-Sivan, Gal; Shpak, Talma; Luntz, Michal

2012-01-01

Binaural hearing in cochlear implant (CI) users can be achieved either by bilateral implantation or bimodally with a contralateral hearing aid (HA). Binaural-bimodal hearing has the advantage of complementing the high-frequency electric information from the CI by low-frequency acoustic information from the HA. We examined the contribution of a…

Theory of Mind and Language in Children with Cochlear Implants

ERIC Educational Resources Information Center

Remmel, Ethan; Peters, Kimberly

2009-01-01

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…

Music Engineering as a Novel Strategy for Enhancing Music Enjoyment in the Cochlear Implant Recipient

PubMed Central

Kohlberg, Gavriel D.; Mancuso, Dean M.; Chari, Divya A.; Lalwani, Anil K.

2015-01-01

Objective. Enjoyment of music remains an elusive goal following cochlear implantation. We test the hypothesis that reengineering music to reduce its complexity can enhance the listening experience for the cochlear implant (CI) listener. Methods. Normal hearing (NH) adults (N = 16) and CI listeners (N = 9) evaluated a piece of country music on three enjoyment modalities: pleasantness, musicality, and naturalness. Participants listened to the original version along with 20 modified, less complex, versions created by including subsets of the musical instruments from the original song. NH participants listened to the segments both with and without CI simulation processing. Results. Compared to the original song, modified versions containing only 1–3 instruments were less enjoyable to the NH listeners but more enjoyable to the CI listeners and the NH listeners with CI simulation. Excluding vocals and including rhythmic instruments improved enjoyment for NH listeners with CI simulation but made no difference for CI listeners. Conclusions. Reengineering a piece of music to reduce its complexity has the potential to enhance music enjoyment for the cochlear implantee. Thus, in addition to improvements in software and hardware, engineering music specifically for the CI listener may be an alternative means to enhance their listening experience. PMID:26543322

Simultaneous cochlear implantation as a therapeutic option in vestibular schwannoma surgery: case report.

PubMed

Dos Santos Neto, Pedro Helo; Zamponi, Johnni Oswaldo; Hamerschmidt, Rogério; Wiemes, Gislaine Richter Minhoto; Rassi, Marcio S; Borba, Luis A B

2018-03-01

Hearing loss is the most common symptom of vestibular schwannomas (VSs). The management of these lesions includes observation, radiosurgery, and microsurgical resection. Hearing preservation and rehabilitation are the major challenges after the tumor treatment. A 43-year-old man with previous left-sided profound hearing loss and tinnitus presented with a 2-mm left-sided intracanalicular VS. The decision was made to perform a simultaneous cochlear implantation (CI) and microsurgical resection of the tumor. The patient did well postoperatively, with significant improvement of tinnitus, sound localization, and speech recognition in noise. Previous reports of simultaneous CI and VS resection in patients with neurofibromatosis type 2 and sporadic VS in the only hearing ear have been described. The role of CI in patients with VS and normal contralateral hearing has been recently described, showing positive outcomes due to the binaural benefits. Tinnitus also can be treated by the implantation of the cochlear device. The simultaneous microsurgical removal of VS and implantation of a cochlear device is a feasible approach in patients with unilateral hearing loss and severe tinnitus.

Factors Affecting Open-Set Word Recognition in Adults with Cochlear Implants

PubMed Central

Holden, Laura K.; Finley, Charles C.; Firszt, Jill B.; Holden, Timothy A.; Brenner, Christine; Potts, Lisa G.; Gotter, Brenda D.; Vanderhoof, Sallie S.; Mispagel, Karen; Heydebrand, Gitry; Skinner, Margaret W.

2012-01-01

A monosyllabic word test was administered to 114 postlingually-deaf adult cochlear implant (CI) recipients at numerous intervals from two weeks to two years post-initial CI activation. Biographic/audiologic information, electrode position, and cognitive ability were examined to determine factors affecting CI outcomes. Results revealed that Duration of Severe-to-Profound Hearing Loss, Age at Implantation, CI Sound-field Threshold Levels, Percentage of Electrodes in Scala Vestibuli, Medio-lateral Electrode Position, Insertion Depth, and Cognition were among the factors that affected performance. Knowledge of how factors affect performance can influence counseling, device fitting, and rehabilitation for patients and may contribute to improved device design. PMID:23348845

Enduring Advantages of Early Cochlear Implantation for Spoken Language Development

PubMed Central

Geers, Ann E.; Nicholas, Johanna G.

2013-01-01

Purpose 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 12–38 months of age. Relative advantages of receiving a bilateral CI after age 4.5, better pre-CI aided hearing, and longer CI experience were also examined. Method Sixty children participated in a prospective longitudinal study of outcomes at 4.5 and 10.5 years of age. Twenty-nine children received a sequential second CI. Test scores were compared to normative samples of hearing age-mates and predictors of outcomes identified. Results Standard scores on language tests at 10.5 years of age remained significantly correlated with age of first cochlear implantation. Scores were not associated with receipt of a second, sequentially-acquired CI. Significantly higher scores were achieved for vocabulary as compared with overall language, a finding not evident when the children were tested at younger ages. Conclusion Age-appropriate spoken language skills continued to be more likely with younger AOI, even after an average of 8.6 years of additional CI use. Receipt of a second implant between ages 4–10 years and longer duration of device use did not provide significant added benefit. PMID:23275406

Safety of Monopolar Electrocautery in Patients With Cochlear Implants.

PubMed

Tien, Duc A; Woodson, Erika A; Anne, Samantha

2016-09-01

The outcomes of 2 patients with cochlear implants (CIs) who underwent adenotonsillectomy (AT) with inadvertent use of monopolar cautery are presented. The safety data regarding monopolar cautery use in CI recipients is also reviewed. This is a retrospective case series of 2 CI recipients that underwent AT with monopolar cautery and literature review of electrocautery safety in the setting of CI. Two patients with CIs underwent AT with use of monopolar cautery inadvertently by surgeons that do not routinely perform cochlear implants as part of his or her clinical practice. Patient 1 was a 9-year-old female who had AT for obstructive sleep apnea (OSA) after undergoing unilateral CI for profound congenital sensorineural hearing loss (SNHL) 8 years ago. Patient 2 was a 7-year-old female who underwent AT for OSA 4 months after undergoing unilateral CI for congenital SNHL. Both patients had no immediate signs of complications with their CI use postoperatively. Both patients demonstrated unchanged postoperative neural response telemetry and behavioral audiometric testing. Patient 1 continues to have no CI-related complications 3.5 years after the procedure. Patient 2 has been followed for at least 3 months by audiometric testing and 10 months by otolaryngologist with no CI-related complications. Although animal and cadaveric studies suggest that monopolar cautery may be safely used in patients with cochlear implants, there have been no in vivo human studies that have evaluated the risk to the patient or implant. This is a report of a small, unintended experience with 2 patients, both of whom exhibit no complications or changes to CI function thus far. © The Author(s) 2016.

Phonological Awareness, Vocabulary, and Reading in Deaf Children with Cochlear Implants

ERIC Educational Resources Information Center

Johnson, Carol; Goswami, Usha

2010-01-01

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…

Cochlear blood flow and speech perception ability in cochlear implant users.

PubMed

Nakashima, Tsutomu; Hattori, Taku; Sone, Michihiko; Asahi, Kiyomitsu; Matsuda, Naoko; Teranishi, Masaaki; Yoshida, Tadao; Kato, Ken; Sato, Eisuke

2012-02-01

The effect of cochlear blood flow (CBF) on speech perception ability in cochlear implant (CI) users has not been reported. We investigated various factors influencing speech perception including CBF in CI users. Eighty-two patients who received CI surgery at an academic hospital. CBF was measured during CI surgery using laser Doppler flowmetry. The speech perception level was measured after a sufficient interval after CI surgery. Multivariate analysis was used to evaluate the influences of age, duration of deafness, sex, cause of deafness, and CBF on the speech perception level. CBF decreased significantly with age but was not related to the speech perception level. In patients with congenital hearing loss, the speech perception level was significantly worse in children who received a CI at 3 years of age than in those who received a CI at 2 years of age or younger. Duration of deafness before CI surgery had deteriorative effects on the speech perception level. CBF may be associated with progression of hearing loss. However, measuring CBF during CI surgery is not useful for predicting postoperative speech perception.

Technical devices for hearing-impaired individuals: cochlear implants and brain stem implants - developments of the last decade

PubMed Central

Müller, Joachim

2005-01-01

Over the past two decades, the fascinating possibilities of cochlear implants for congenitally deaf or deafened children and adults developed tremendously and created a rapidly developing interdisciplinary research field. The main advancements of cochlear implantation in the past decade are marked by significant improvement of hearing and speech understanding in CI users. These improvements are attributed to the enhancement of speech coding strategies. The Implantation of more (and increasingly younger) children as well as the possibilities of the restoration of binaural hearing abilities with cochlear implants reflect the high standards reached by this development. Despite this progress, modern cochlear implants do not yet enable normal speech understanding, not even for the best patients. In particular speech understanding in noise remains problematic [1]. Until the mid 1990ies research concentrated on unilateral implantation. Remarkable and effective improvements have been made with bilateral implantation since 1996. Nowadays an increasing numbers of patients enjoy these benefits. PMID:22073052

Technical devices for hearing-impaired individuals: cochlear implants and brain stem implants - developments of the last decade.

PubMed

Müller, Joachim

2005-01-01

Over the past two decades, the fascinating possibilities of cochlear implants for congenitally deaf or deafened children and adults developed tremendously and created a rapidly developing interdisciplinary research field.The main advancements of cochlear implantation in the past decade are marked by significant improvement of hearing and speech understanding in CI users. These improvements are attributed to the enhancement of speech coding strategies.The Implantation of more (and increasingly younger) children as well as the possibilities of the restoration of binaural hearing abilities with cochlear implants reflect the high standards reached by this development. Despite this progress, modern cochlear implants do not yet enable normal speech understanding, not even for the best patients. In particular speech understanding in noise remains problematic [1]. Until the mid 1990ies research concentrated on unilateral implantation. Remarkable and effective improvements have been made with bilateral implantation since 1996. Nowadays an increasing numbers of patients enjoy these benefits.

Experiments on Auditory-Visual Perception of Sentences by Users of Unilateral, Bimodal, and Bilateral Cochlear Implants

ERIC Educational Resources Information Center

Dorman, Michael F.; Liss, Julie; Wang, Shuai; Berisha, Visar; Ludwig, Cimarron; Natale, Sarah Cook

2016-01-01

Purpose: Five experiments probed auditory-visual (AV) understanding of sentences by users of cochlear implants (CIs). Method: Sentence material was presented in auditory (A), visual (V), and AV test conditions to listeners with normal hearing and CI users. Results: (a) Most CI users report that most of the time, they have access to both A and V…

Binaural Processing of Multiple Sound Sources

DTIC Science & Technology

2016-08-18

Sound Source Localization Identification, and Sound Source Localization When Listeners Move. The CI research was also supported by an NIH grant...8217Cochlear Implant Performance in Realistic Listening Environments,’ Dr. Michael Dorman, Principal Investigator, Dr. William Yost unpaid advisor. The other... Listeners Move. The CI research was also supported by an NIH grant (“Cochlear Implant Performance in Realistic Listening Environments,” Dr. Michael Dorman

Correlation between subjective and objective hearing tests after unilateral and bilateral cochlear implantation.

PubMed

Ramakers, Geerte G J; Smulders, Yvette E; van Zon, Alice; Van Zanten, Gijsbert A; Grolman, Wilko; Stegeman, Inge

2017-01-01

There are many methods for assessing hearing performance after cochlear implantation. Standard evaluations often encompass objective hearing tests only, while patients' subjective experiences gain importance in today's healthcare. The aim of the current study was to analyze the correlation between subjective (self-reported questionnaires) and objective (speech perception and localization) hearing test results in adult cochlear implant (CI) users. Secondary, the correlation between subjective and objective hearing tests was compared between bilateral and unilateral CI patients. Data for this study were prospectively collected as part of a multicentre randomized controlled trial. Thirty-eight postlingually deafened adult patients were randomly allocated to receive either unilateral ( n  = 19) or bilateral ( n  = 19) cochlear implantation. We used data gathered after one year of follow-up. We studied the correlation between objectively measured speech perception and localization skills on the one hand and related domains of the Speech, Spatial and Qualities of Hearing Scale (SSQ) and Nijmegen Cochlear Implant Questionnaire (NCIQ) on the other hand. We also compared these correlations between unilateral and bilateral CI users. We found significant weak to moderate negative correlations between the subjective test results (speech domain of the SSQ and the advanced speech perception domain of the NCIQ) and the related objective speech perception in noise test results ( r  = -0.33 to -0.48). A significant moderate correlation was found between the subjective test results (spatial domain of the SSQ) and the related objective localization test results ( r  = 0.59). The correlations in the group of bilateral CI patients ( r  = -0.28 to -0.54) did not differ significantly from the correlations in the group of unilateral CI patients ( r  = 0.15 to -0.40). Current objective tests do not fully reflect subjective everyday listening situations. This study elucidates the importance and necessity of questionnaires in the evaluation of cochlear implantation. Therefore, it is advised to evaluate both objective and subjective tests in CI patients on a regular basis. This trial was registered on March 11, 2009 in the Dutch Trial Register. Trial registration number: NTR1722.

Auditory Environment across the Life Span of Cochlear Implant Users: Insights from Data Logging

ERIC Educational Resources Information Center

Busch, Tobias; Vanpoucke, Filiep; van Wieringen, Astrid

2017-01-01

Purpose: We describe the natural auditory environment of people with cochlear implants (CIs), how it changes across the life span, and how it varies between individuals. Method: We performed a retrospective cross-sectional analysis of Cochlear Nucleus 6 CI sound-processor data logs. The logs were obtained from 1,501 people with CIs (ages 0-96…

The development of falling intonation in young children with cochlear implants: a 2-year longitudinal study.

PubMed

Snow, David P; Ertmer, David J

2013-07-01

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. However, children who were implanted early (before 25 months) did not have an advantage over the still younger control group of infants with normal hearing (NH), suggesting that the advantage requires a critical age of about 30 months. The younger CI-users reached this age in the second year of CI use. The results confirmed our expectation that even the younger CI recipients would acquire intonation more rapidly than infants with NH who had the same amount of robust hearing experience. Clinical implications are discussed in relation to the question of early versus late implantation.

Evidence-based guidelines for recommending cochlear implantation for young children: Audiological criteria and optimizing age at implantation.

PubMed

Leigh, Jaime R; Dettman, Shani J; Dowell, Richard C

2016-01-01

Establish up-to-date evidence-based guidelines for recommending cochlear implantation for young children. Speech perception results for early-implanted children were compared to children using traditional amplification. Equivalent pure-tone average (PTA) hearing loss for cochlear implant (CI) users was established. Language of early-implanted children was assessed over six years and compared to hearing peers. Seventy-eight children using CIs and 62 children using traditional amplification with hearing losses ranging 25-120 dB HL PTA (speech perception study). Thirty-two children who received a CI before 2.5 years of age (language study). Speech perception outcomes suggested that children with a PTA greater than 60 dB HL have a 75% chance of benefit over traditional amplification. More conservative criteria applied to the data suggested that children with PTA greater than 82 dB HL have a 95% chance of benefit. Children implanted under 2.5 years with no significant cognitive deficits made normal language progress but retained a delay approximately equal to their age at implantation. Hearing-impaired children under three years of age may benefit from cochlear implantation if their PTA exceeds 60 dB HL bilaterally. Implantation as young as possible should minimize any language delay resulting from an initial period of auditory deprivation.

The development of the Nucleus Freedom Cochlear implant system.

PubMed

Patrick, James F; Busby, Peter A; Gibson, Peter J

2006-12-01

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 Smart Sound 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.

Systematic review: Radiological and histological evidence of cochlear implant insertion trauma in adult patients.

PubMed

Hoskison, Emma; Mitchell, Scott; Coulson, Chris

2017-07-01

Cochlear implantation (CI) has developed from its origins in the 1980s. Initially, CI was for profound bilateral hearing impairment. However, candidacy for CI have become more widespread in recent years with unilateral implantation and an emphasis on hearing preservation. Evidence supports full electrode insertion in an atraumatic fashion into the scala tympani (ST) provides optimal hearing outcomes. The main aim of this systematic review was to elucidate the degree of trauma associated with CI insertion. A systematic literature search was undertaken using PubMed Medline. A grading system described by Eshraghi was used to classify cochlear trauma. Both radiological and histological studies were included. Twenty one papers were identified which were relevant to our search. In total, 653 implants were inserted and 115 (17.6%) showed evidence of trauma. The cochleas with trauma had basilar membrane elevation in 5.2%, ruptured in 5.2%, the electrode passed from the ST to the SV in 84.4% and there was grade 4 trauma in 5.2%. The studies used a variety of histological and radiological methods to assess for evidence of trauma in both cadaveric temporal bones and live recipients. Minimizing cochlear trauma during implant insertion is important to preserve residual hearing and optimize audiological performance. An overall 17.6% trauma rate suggests that CI insertion could be improved with more accurate and consistent electrode insertion such as in the form of robotic guidance. The correlation of cochlea trauma with post-operative hearing has yet to be determined.

Revision surgery due to magnet dislocation in cochlear implant patients: an emerging complication.

PubMed

Hassepass, Frederike; Stabenau, Vanessa; Maier, Wolfgang; Arndt, Susan; Laszig, Roland; Beck, Rainer; Aschendorff, Antje

2014-01-01

To analyze the cause and effect of magnet dislocation in cochlear implant (CI) recipients requiring magnet revision surgery for treatment. Retrospective study. Tertiary referral center. Case reports from 1,706 CI recipients consecutively implanted from January 2000 to December 2011 were reviewed. The number of cases requiring magnet revision surgery was assessed. Revision surgery involving magnet removal or replacement was indicated in 1.23% (21/1,706), of all CI recipients. Magnet dislocation occurring during magnetic resonance tomography (MRI), at 1.5 Tesla (T), with the magnet in place and with the application of compression bandaging around the head, was the main cause for revision surgery in 47.62% (10/21) of the affected cases. All 10 cases were implanted with Cochlear Nucleus cochlear implants. These events occurred, despite adherence to current recommendations of the manufacturer. The present study underlines that MRI examination is the main cause of magnet dislocation. The use of compressive bandaging when using 1.5-T MRI does not eliminate the risk of magnet dislocation. Additional cautionary measures are for required for conditional MRI. We recommend X-ray examination after MRI to determine magnet dislocation and avoid major complications in all cases reporting pain during or after MRI. Additional research regarding silicon magnet pocket design for added retention is needed. Effective communication of guidelines for precautionary measures during MRI examination in CI patients is mandatory for all clinicians involved. MRI in CI recipients should be indicated with caution.

Predicting social functioning in children with a cochlear implant and in normal-hearing children: the role of emotion regulation.

PubMed

Wiefferink, Carin H; Rieffe, Carolien; Ketelaar, Lizet; Frijns, Johan H M

2012-06-01

The purpose of the present study was to compare children with a cochlear implant and normal hearing children on aspects of emotion regulation (emotion expression and coping strategies) and social functioning (social competence and externalizing behaviors) and the relation between emotion regulation and social functioning. Participants were 69 children with cochlear implants (CI children) and 67 normal hearing children (NH children) aged 1.5-5 years. Parents answered questionnaires about their children's language skills, social functioning, and emotion regulation. Children also completed simple tasks to measure their emotion regulation abilities. Cochlear implant children had fewer adequate emotion regulation strategies and were less socially competent than normal hearing children. The parents of cochlear implant children did not report fewer externalizing behaviors than those of normal hearing children. While social competence in normal hearing children was strongly related to emotion regulation, cochlear implant children regulated their emotions in ways that were unrelated with social competence. On the other hand, emotion regulation explained externalizing behaviors better in cochlear implant children than in normal hearing children. While better language skills were related to higher social competence in both groups, they were related to fewer externalizing behaviors only in cochlear implant children. Our results indicate that cochlear implant children have less adequate emotion-regulation strategies and less social competence than normal hearing children. Since they received their implants relatively recently, they might eventually catch up with their hearing peers. Longitudinal studies should further explore the development of emotion regulation and social functioning in cochlear implant children. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Motor Development of Deaf Children with and without Cochlear Implants

ERIC Educational Resources Information Center

Gheysen, Freja; Loots, Gerrit; Van Waelvelde, Hilde

2008-01-01

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…

Music Therapy for Preschool Cochlear Implant Recipients

PubMed Central

Gfeller, Kate; Driscoll, Virginia; Kenworthy, Maura; Van Voorst, Tanya

2010-01-01

This paper provides research and clinical information relevant to music therapy for preschool children who use cochlear implants (CI). It consolidates information from various disciplinary sources regarding (a) cochlear implantation of young prelingually-deaf children (~age 2-5), (b) patterns of auditory and speech-language development, and (c) research regarding music perception of children with CIs. This information serves as a foundation for the final portion of the article, which describes typical music therapy goals and examples of interventions suitable for preschool children. PMID:23904691

Phonological Awareness, Vocabulary, and Word Reading in Children Who Use Cochlear Implants: Does Age of Implantation Explain Individual Variability in Performance Outcomes and Growth?

ERIC Educational Resources Information Center

James, Deborah; Rajput, Kaukab; Brinton, Julie; Goswami, Usha

2008-01-01

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…

Cochlear implantation in patients with autoimmune inner ear disease including cogan syndrome: a comparison with age- and sex-matched controls.

PubMed

Wang, Jenny R; Yuen, Heng W; Shipp, David B; Stewart, Suzanne; Lin, Vincent Y W; Chen, Joseph M; Nedzelski, Julian M

2010-12-01

Evaluate the characteristics and outcomes of patients with autoimmune inner ear disease (AIED) who have undergone cochlear implantation (CI) and compare post-CI performance in AIED to matched controls. Retrospective case control study. Study cohort was comprised of 25 adult implantees (AIED [n = 18], Cogan syndrome [n = 7]). The AIED group was defined by rapidly progressive bilateral sensorineural hearing loss leading to unusable hearing within weeks to months. Patients with Cogan syndrome, the archetypal inner ear autoimmune disease, were also examined and used for within-cohort comparison. Clinical and operative records were reviewed. Post-CI performance was assessed using open-set sentence tests. Age- and sex-matched individuals deafened by other postlingual causes were used as controls. Of 25 patients, 24 had uneventful, full electrode insertions. One AIED patient had partial insertion due to cochlear ossification and did not achieve open-set speech perception post-CI. Mean open-set sentence scores for study patients with uneventful insertions were 92.8%, 97.3%, and 96.4% at 6 months, 1 year, and ≥ 2 years, respectively. Compared to matched controls, patients deafened by autoimmune causes had significantly higher post-CI performance at all postoperative test intervals (P < .05). There was no significant difference in postimplantation performance between Cogan syndrome and AIED patients. To our knowledge this was the largest study of cochlear implantation in AIED and Cogan syndrome patients. In our experience, both groups generally attained high levels of post-CI speech perception and performed above average. Cochlear ossification affecting implantation in Cogan syndrome patients was not observed in our series, contrary to some reports.

[Quality of life and vertigo after bilateral cochlear implantation : Questionnaires as tools for quality assurance].

PubMed

Rader, T; Haerterich, M; Ernst, B P; Stöver, T; Strieth, S

2018-03-01

Persistent dizziness symptoms after cochlear implantation have an impact on quality of life. In this study, the effects of bilateral cochlear implants (CI) on quality of life as well as on subjective dizziness complaints are analyzed using questionnaires, some of which have never been applied before in these patient collectives. In this article, questionnaires for the assessment of dizziness symptoms and quality of life are introduced in order to realize quality assurance. A total of 32 patients with bilateral CI were questioned regarding dizziness symptoms and quality of life. The Nijmegen Cochlear Implant Questionnaire (NCIQ) was used. In the case of reported regular dizziness, the Vertigo Handicap Questionnaire (VHQ) and the Vertigo Symptom Scale (VSS) were also assessed. Persistent dizziness symptoms were shown in 8 of 32 patients. Quality of life was measured with the NCIQ and was improved significantly (p < 0.001) by 23.7% after the second CI. The dizziness symptoms changed slightly (VHQ -11.2%; VSS +16.4%) after the second implantation. The results show that the questionnaires are valid instruments for documenting quality of life and dizziness symptoms for quality assurance. These questionnaires may be applied as a complement or an alternative to device-based measurements of peripheral vestibular dysfunction.

Cochlear implantation for single-sided deafness and tinnitus suppression.

PubMed

Holder, Jourdan T; O'Connell, Brendan; Hedley-Williams, Andrea; Wanna, George

To quantify the potential effectiveness of cochlear implantation for tinnitus suppression in patients with single-sided deafness using the Tinnitus Handicap Inventory. The study included 12 patients with unilateral tinnitus who were undergoing cochlear implantation for single-sided deafness. The Tinnitus Handicap Inventory was administered at the patient's cochlear implant candidacy evaluation appointment prior to implantation and every cochlear implant follow-up appointment, except activation, following implantation. Patient demographics and speech recognition scores were also retrospectively recorded using the electronic medical record. A significant reduction was found when comparing Tinnitus Handicap Inventory score preoperatively (61.2±27.5) to the Tinnitus Handicap Inventory score after three months of cochlear implant use (24.6±28.2, p=0.004) and the Tinnitus Handicap Inventory score beyond 6months of CI use (13.3±18.9, p=0.008). Further, 45% of patients reported total tinnitus suppression. Mean CNC word recognition score improved from 2.9% (SD 9.4) pre-operatively to 40.8% (SD 31.7) by 6months post-activation, which was significantly improved from pre-operative scores (p=0.008). The present data is in agreement with previously published studies that have shown an improvement in tinnitus following cochlear implantation for the large majority of patients with single-sided deafness. Copyright © 2017 Elsevier Inc. All rights reserved.

Syntagmatic and paradigmatic development of cochlear implanted children in comparison with normally hearing peers up to age 7.

PubMed

Faes, Jolien; Gillis, Joris; Gillis, Steven

2015-09-01

Grammatical development is shown to be delayed in CI children. However, the literature has focussed mainly on one aspect of grammatical development, either morphology or syntax, and on standard tests instead of spontaneous speech. The aim of the present study was to compare grammatical development in the spontaneous speech of Dutch-speaking children with cochlear implants and normally hearing peers. Both syntagmatic and paradigmatic development will be assessed and compared with each other. Nine children with cochlear implants were followed yearly between ages 2 and 7. There was a cross-sectional control group of 10 normally hearing peers at each age. Syntactic development is measured by means of Mean Length of Utterance (MLU), morphological development by means of Mean Size of Paradigm (MSP). This last measure is relatively new in child language research. MLU and MSP of children with cochlear implants lag behind that of their normally hearing peers up to age 4 and up to age 6 respectively. By age 5, CI children catch up on MSP and by age 7 they caught up on MLU. Children with cochlear implants catch up with their normally hearing peers for both measures of syntax and morphology. However, it is shown that inflection is earlier age-appropriate than sentence length in CI children. Possible explanations for this difference in developmental pace are discussed. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Automatic localization of cochlear implant electrodes in CTs with a limited intensity range

NASA Astrophysics Data System (ADS)

Zhao, Yiyuan; Dawant, Benoit M.; Noble, Jack H.

2017-02-01

Cochlear implants (CIs) are neural prosthetics for treating severe-to-profound hearing loss. Our group has developed an image-guided cochlear implant programming (IGCIP) system that uses image analysis techniques to recommend patientspecific CI processor settings to improve hearing outcomes. One crucial step in IGCIP is the localization of CI electrodes in post-implantation CTs. Manual localization of electrodes requires time and expertise. To automate this process, our group has proposed automatic techniques that have been validated on CTs acquired with scanners that produce images with an extended range of intensity values. However, there are many clinical CTs acquired with a limited intensity range. This limitation complicates the electrode localization process. In this work, we present a pre-processing step for CTs with a limited intensity range and extend the methods we proposed for full intensity range CTs to localize CI electrodes in CTs with limited intensity range. We evaluate our method on CTs of 20 subjects implanted with CI arrays produced by different manufacturers. Our method achieves a mean localization error of 0.21mm. This indicates our method is robust for automatic localization of CI electrodes in different types of CTs, which represents a crucial step for translating IGCIP from research laboratory to clinical use.

Sources of Variability in Language Development of Children with Cochlear Implants: Age at Implantation, Parental Language, and Early Features of Children's Language Construction

ERIC Educational Resources Information Center

Szagun, Gisela; Schramm, Satyam A.

2016-01-01

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,…

Cochlear implant: the family's perspective.

PubMed

Vieira, Sheila de Souza; Dupas, Giselle; Chiari, Brasilia Maria

2018-07-01

To understand the family's experience of a child who uses a cochlear implant (CI). Specifically, to identify the difficulties, changes, and feelings entailed by deafness and the use of the CI; the coping strategies; and to understand the role of the family for the child with a CI. Qualitative research, using Symbolic Interactionism and Straussian Grounded Theory as the theoretical and methodological frameworks, respectively. Data collection instrument: semi-structured interview. A total of 9 families (32 individuals) participated in the study. The children's ages ranged from 6 to 11 years old (mean = 8.9 years old). Their experience is described in the following categories: Having to fight for results, Coping with difficult situations, Recognizing that you are not alone, Learning to overcome, and Having one's life restored by the implant. Cochlear implantation changes the direction of the child and the family's life by restoring the child's opportunity to hear and to obtain good results in her personal, social, and academic development. Even after implantation, the child continues to experience difficulties and requires the family's mobilization in order to be successful. The family is the principal actor in the process of the child's rehabilitation.

From isolation and dependence to autonomy - expectations before and experiences after cochlear implantation in adult cochlear implant users and their significant others.

PubMed

Mäki-Torkko, Elina Margareetta; Vestergren, Sara; Harder, Henrik; Lyxell, Björn

2015-01-01

The aim of the study was to examine pre-operative expectations and the post-operative experiences related to cochlear implants (CI) in CI-users and their significant others. A questionnaire was used and the responses were analysed by means of The Qualitative Content Analysis. All adults implanted between 1992 and 2010, who had had their implants for a minimum of 12 months (n = 120) were contacted. Response rate was high (90.8%), and all-inclusive answers were received from 101 CI-users (84.2%). The overall sense of increased well-being and life satisfaction was described as having lived in two different worlds, one with the auditory stimulation and one without. In the overall sense of increased well-being and satisfaction three interwoven subcategories, alienation - normality, fear - autonomy, and living a social life emerged. When CI-users and their significant others recalled the time prior to receiving the CI, a sense of fear was present with origins in the concern for the respondents' (CI-users) ability to cope and care independently in society. Conversely, after the implantation both parties emphasized the notion of a distinct transformation within the CI-user towards autonomy. Communication was highlighted as a large part of living social life. The CI increases well-being and satisfaction for both CI-users and their significant others, which is especially evident regarding enhanced autonomy, normality and living social life. Before implantation it is important to discuss the fact that phone calls and listening to music are improvement expectations that might not be met by the CI. The perceived life changes affect the lives of both the CI-users and the significant others, a finding important to take into consideration before implantation and during rehabilitation after the implantation. Before implantation it is important to inform both CI-recipients and significant others about the length of time required to be able to hear selectively after the implantation and about past experiences of CI-users.

Neural preservation underlies speech improvement from auditory deprivation in young cochlear implant recipients.

PubMed

Feng, Gangyi; Ingvalson, Erin M; Grieco-Calub, Tina M; Roberts, Megan Y; Ryan, Maura E; Birmingham, Patrick; Burrowes, Delilah; Young, Nancy M; Wong, Patrick C M

2018-01-30

Although cochlear implantation enables some children to attain age-appropriate speech and language development, communicative delays persist in others, and outcomes are quite variable and difficult to predict, even for children implanted early in life. To understand the neurobiological basis of this variability, we used presurgical neural morphological data obtained from MRI of individual pediatric cochlear implant (CI) candidates implanted younger than 3.5 years to predict variability of their speech-perception improvement after surgery. We first compared neuroanatomical density and spatial pattern similarity of CI candidates to that of age-matched children with normal hearing, which allowed us to detail neuroanatomical networks that were either affected or unaffected by auditory deprivation. This information enables us to build machine-learning models to predict the individual children's speech development following CI. We found that regions of the brain that were unaffected by auditory deprivation, in particular the auditory association and cognitive brain regions, produced the highest accuracy, specificity, and sensitivity in patient classification and the most precise prediction results. These findings suggest that brain areas unaffected by auditory deprivation are critical to developing closer to typical speech outcomes. Moreover, the findings suggest that determination of the type of neural reorganization caused by auditory deprivation before implantation is valuable for predicting post-CI language outcomes for young children.

A novel perfusion-based method for cochlear implant electrode insertion.

PubMed

Kale, Sushrut; Cervantes, Vanessa M; Wu, Mailing R; Pisano, Dominic V; Sheth, Nakul; Olson, Elizabeth S

2014-08-01

A cochlear implant (CI) restores partial hearing to profoundly deaf individuals. CI electrodes are inserted manually in the cochlea and surgeons rely on tactile feedback from the implant to determine when to stop the insertion. This manual insertion method results in a large degree of variability in surgical outcomes and intra-cochlear trauma. Additionally, implants often span only the basal turn. In the present study we report on the development of a new method to assist CI electrode insertion. The design objectives are (1) an automated and standardized insertion technique across patients with (2) more apical insertion than is possible by the contemporary methods, while (3) minimizing insertion trauma. The method relies on a viscous fluid flow through the cochlea to carry the electrode array with it. A small cochleostomy (∼100-150 um in diameter) is made in scala vestibuli (SV) and the round window (RW) membrane is opened. A flow of diluted Sodium Hyaluronate (also known as Hyaluronic Acid, (HA)) is set up from the RW to the SV opening using a perfusion pump that sets up a unidirectional flow. Once the flow is established an implant is dropped into the ongoing flow. Here we present a proof-of-concept study where we used this technique to insert silicone implants all the way to the cochlear apex in rats and gerbils. In light-microscopic histology, the implantation occurred without cochlear trauma. To further assess the ototoxicity of the HA perfusion, we measured compound action potential (CAP) thresholds following the perfusion of HA, and found that the CAP thresholds were substantially elevated. Thus, at this point the method is promising, and requires further development to become clinically viable. Copyright © 2014 Elsevier B.V. All rights reserved.

Current Research with Cochlear Implants at Arizona State University

PubMed Central

Dorman, Michael F.; Spahr, Anthony; Gifford, Rene H.; Cook, Sarah; Zhang, Ting; Loiselle, Louise; Yost, William; Cardy, Lara; Whittingham, JoAnne; Schramm, David

2013-01-01

In this article we review, and discuss the clinical implications of, five projects currently underway in the Cochlear Implant Laboratory at Arizona State University. The projects are (1) norming the AzBio sentence test, (2) comparing the performance of bilateral and bimodal cochlear implant (CI) patients in realistic listening environments, (3) accounting for the benefit provided to bimodal patients by low-frequency acoustic stimulation, (4) assessing localization by bilateral hearing aid patients and the implications of that work for hearing preservation patients, and (5) studying heart rate variability as a possible measure for quantifying the stress of listening via an implant. The long-term goals of the laboratory are to improve the performance of patients fit with cochlear implants and to understand the mechanisms, physiological or electronic, that underlie changes in performance. We began our work with cochlear implant patients in the mid-1980s and received our first grant from the National Institutes of Health (NIH) for work with implanted patients in 1989. Since that date our work with cochlear implant patients has been funded continuously by the NIH. In this report we describe some of the research currently being conducted in our laboratory. PMID:22668760

Imitative Production of Rising Speech Intonation in Pediatric Cochlear Implant Recipients

ERIC Educational Resources Information Center

Peng, Shu-Chen; Tomblin, J. Bruce; Spencer, Linda J.; Hurtig, Richard R.

2007-01-01

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…

Speech Intelligibility and Psychosocial Functioning in Deaf Children and Teens with Cochlear Implants

ERIC Educational Resources Information Center

Freeman, Valerie; Pisoni, David B.; Kronenberger, William G.; Castellanos, Irina

2017-01-01

Deaf children with cochlear implants (CIs) are at risk for psychosocial adjustment problems, possibly due to delayed speech-language skills. This study investigated associations between a core component of spoken-language ability--speech intelligibility--and the psychosocial development of prelingually deaf CI users. Audio-transcription measures…

[Bilateral cochlear implants].

PubMed

Müller, J

2017-07-01

Cochlear implants (CI) are standard for the hearing rehabilitation of severe to profound deafness. Nowadays, if bilaterally indicated, bilateral implantation is usually recommended (in accordance with German guidelines). Bilateral implantation enables better speech discrimination in quiet and in noise, and restores directional and spatial hearing. Children with bilateral CI are able to undergo hearing-based hearing and speech development. Within the scope of their individual possibilities, bilaterally implanted children develop faster than children with unilateral CI and attain, e.g., a larger vocabulary within a certain time interval. Only bilateral implantation allows "binaural hearing," with all the benefits that people with normal hearing profit from, namely: better speech discrimination in quiet and in noise, as well as directional and spatial hearing. Naturally, the developments take time. Binaural CI users benefit from the same effects as normal hearing persons: head shadow effect, squelch effect, and summation and redundancy effects. Sequential CI fitting is not necessarily disadvantageous-both simultaneously and sequentially fitted patients benefit in a similar way. For children, earliest possible fitting and shortest possible interval between the two surgeries seems to positively influence the outcome if bilateral CI are indicated.

Demographic factors influencing educational placement of the hearing-impaired child with a cochlear implant.

PubMed

Yehudai, Noam; Tzach, Naama; Shpak, Talma; Most, Tova; Luntz, Michal

2011-08-01

To analyze educational placement settings of Israeli children with cochlear implants (CIs) and evaluate the prognostic influence of the following demographic variables on mainstreaming: age at implantation, experience with CI, socioeconomic status, ethnicity, and parents' educational level. Retrospective review. Tertiary referral center. The study population comprised 245 children with severe-to-profound hearing impairment and at least 1 year of experience with a unilateral CI. Mean age at implantation was 4.5 ± 3.9 years, and mean duration of CI use was 5.4 ± 2.8 years. Follow-up review and statistical analysis of available data on educational placement after cochlear implantation. Placement in mainstream education. Regular schools were attended by 89 children (36.3%) and special education schools by 156 (63.7%). Variables found to be significantly associated with mainstream educational placement were younger age at implantation, higher level of parental education, higher socioeconomic status, and ethnicity. Multivariate analysis using a logistic regression model revealed that the factor with the highest positive correlation with mainstreaming was parental education level. Our results show that parental education, a variable that the health system cannot control, significantly influences postimplantation results in term of educational placement and can thus limit the chances of implanted children to achieve mainstream placement even when identified and implanted at an early age.

Evolution of crossmodal reorganization of the voice area in cochlear-implanted deaf patients.

PubMed

Rouger, Julien; Lagleyre, Sébastien; Démonet, Jean-François; Fraysse, Bernard; Deguine, Olivier; Barone, Pascal

2012-08-01

Psychophysical and neuroimaging studies in both animal and human subjects have clearly demonstrated that cortical plasticity following sensory deprivation leads to a brain functional reorganization that favors the spared modalities. In postlingually deaf patients, the use of a cochlear implant (CI) allows a recovery of the auditory function, which will probably counteract the cortical crossmodal reorganization induced by hearing loss. To study the dynamics of such reversed crossmodal plasticity, we designed a longitudinal neuroimaging study involving the follow-up of 10 postlingually deaf adult CI users engaged in a visual speechreading task. While speechreading activates Broca's area in normally hearing subjects (NHS), the activity level elicited in this region in CI patients is abnormally low and increases progressively with post-implantation time. Furthermore, speechreading in CI patients induces abnormal crossmodal activations in right anterior regions of the superior temporal cortex normally devoted to processing human voice stimuli (temporal voice-sensitive areas-TVA). These abnormal activity levels diminish with post-implantation time and tend towards the levels observed in NHS. First, our study revealed that the neuroplasticity after cochlear implantation involves not only auditory but also visual and audiovisual speech processing networks. Second, our results suggest that during deafness, the functional links between cortical regions specialized in face and voice processing are reallocated to support speech-related visual processing through cross-modal reorganization. Such reorganization allows a more efficient audiovisual integration of speech after cochlear implantation. These compensatory sensory strategies are later completed by the progressive restoration of the visuo-audio-motor speech processing loop, including Broca's area. Copyright © 2011 Wiley Periodicals, Inc.

Image-guidance enables new methods for customizing cochlear implant stimulation strategies

PubMed Central

Noble, Jack H.; Labadie, Robert F.; Gifford, René H.; Dawant, Benoit M.

2013-01-01

Over the last 20 years, cochlear implants (CIs) have become what is arguably the most successful neural prosthesis to date. Despite this success, a significant number of CI recipients experience marginal hearing restoration, and, even among the best performers, restoration to normal fidelity is rare. In this article, we present image processing techniques that can be used to detect, for the first time, the positions of implanted CI electrodes and the nerves they stimulate for individual CI users. These techniques permit development of new, customized CI stimulation strategies. We present one such strategy and show that it leads to significant hearing improvement in an experiment conducted with 11 CI recipients. These results indicate that image-guidance can be used to improve hearing outcomes for many existing CI recipients without requiring additional surgical procedures. PMID:23529109

Neural Processing of Musical and Vocal Emotions Through Cochlear Implants Simulation.

PubMed

Ahmed, Duha G; Paquette, Sebastian; Zeitouni, Anthony; Lehmann, Alexandre

2018-05-01

Cochlear implants (CIs) partially restore the sense of hearing in the deaf. However, the ability to recognize emotions in speech and music is reduced due to the implant's electrical signal limitations and the patient's altered neural pathways. Electrophysiological correlations of these limitations are not yet well established. Here we aimed to characterize the effect of CIs on auditory emotion processing and, for the first time, directly compare vocal and musical emotion processing through a CI-simulator. We recorded 16 normal hearing participants' electroencephalographic activity while listening to vocal and musical emotional bursts in their original form and in a degraded (CI-simulated) condition. We found prolonged P50 latency and reduced N100-P200 complex amplitude in the CI-simulated condition. This points to a limitation in encoding sound signals processed through CI simulation. When comparing the processing of vocal and musical bursts, we found a delay in latency with the musical bursts compared to the vocal bursts in both conditions (original and CI-simulated). This suggests that despite the cochlear implants' limitations, the auditory cortex can distinguish between vocal and musical stimuli. In addition, it adds to the literature supporting the complexity of musical emotion. Replicating this study with actual CI users might lead to characterizing emotional processing in CI users and could ultimately help develop optimal rehabilitation programs or device processing strategies to improve CI users' quality of life.

How does visual language affect crossmodal plasticity and cochlear implant success?

PubMed Central

Lyness, C.R.; Woll, B.; Campbell, R.; Cardin, V.

2013-01-01

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

Cultural Identity of Young Deaf Adults with Cochlear Implants in Comparison to Deaf without Cochlear Implants and Hard-of-Hearing Young Adults.

PubMed

Goldblat, Ester; Most, Tova

2018-07-01

This study examined the relationships between cultural identity, severity of hearing loss (HL), and the use of a cochlear implant (CI). One hundred and forty-one adolescents and young adults divided into three groups (deaf with CI, deaf without CI, and hard-of-hearing (HH)) and 134 parents participated. Adolescents and young adults completed questionnaires on cultural identity (hearing, Deaf, marginal, bicultural-hearing, and bicultural-deaf) and communication proficiencies (hearing, spoken language, and sign language). Parents completed a speech quality questionnaire. Deaf participants without CI and those with CI differed in all identities except marginal identity. CI users and HH participants had similar identities except for a stronger bicultural-deaf identity among CI users. Three clusters of participants evolved: participants with a dominant bicultural-deaf identity, participants with a dominant bicultural-hearing identity and participants without a formed cultural identity. Adolescents and young adults who were proficient in one of the modes of communication developed well-established bicultural identities. Adolescents and young adults who were not proficient in one of the modes of communication did not develop a distinguished cultural identity. These results suggest that communication proficiencies are crucial for developing defined identities.

Cochlear implantation in late-implanted adults with prelingual deafness.

PubMed

Most, Tova; Shrem, Hadas; Duvdevani, Ilana

2010-01-01

The purpose of this study was to examine the effect of cochlear implantation (CI) on prelingually deafened participants who were implanted as adults. The effect of the CI was examined with regard to the following variables: communication, family, social skills, education, and work satisfaction with one's life, loneliness, and self-esteem. Thirty-eight adults participated. Four self-report questionnaires were used at 2 points in time: before and after CI. The research findings show significant differences in the reports of most variables before and after implantation. The participants felt better with regard to communication, social skills, education, and work and satisfaction with one's life after implantation in comparison to their feelings before implantation. Furthermore, they felt less lonely after implantation. However, there were no significant differences before and after implantation regarding their feelings within the family and regarding their self-esteem. The results demonstrated the need to evaluate the benefits resulting from the CI not only with traditional clinical measures but with additional measures as well. Furthermore, they demonstrated the benefit of the CI on the positive psychosociological implications of prelingually deafened adults. Copyright © 2010 Elsevier Inc. All rights reserved.

Genetic Predisposition and Sensory Experience in Language Development: Evidence from Cochlear-Implanted Children

ERIC Educational Resources Information Center

Coene, Martine; Schauwers, Karen; Gillis, Steven; Rooryck, Johan; Govaerts, Paul J.

2011-01-01

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…

Gender Categorization in Cochlear Implant Users

ERIC Educational Resources Information Center

Massida, Zoe; Marx, Mathieu; Belin, Pascal; James, Christopher; Fraysse, Bernard; Barone, Pascal; Deguine, Olivier

2013-01-01

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…

Language and Psychosocial Functioning among Deaf Learners with and without Cochlear Implants

ERIC Educational Resources Information Center

Marschark, Marc; Machmer, Elizabeth; Spencer, Linda J.; Borgna, Georgianna; Durkin, Andreana; Convertino, Carol

2018-01-01

Various studies have examined psychosocial functioning and language abilities among deaf children with and without cochlear implants (CIs). Few, however, have explored how relations among those abilities might change with age and setting. Most relevant studies also have failed to consider that psychosocial functioning among both CI users and…

Sensitive Periods and Language in Cochlear Implant Users

ERIC Educational Resources Information Center

Moreno-Torres, Ignacio; Madrid-Canovas, Sonia; Blanco-Montanez, Gema

2016-01-01

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…

Speech Rate Normalization and Phonemic Boundary Perception in Cochlear-Implant Users

ERIC Educational Resources Information Center

Jaekel, Brittany N.; Newman, Rochelle S.; Goupell, Matthew J.

2017-01-01

Purpose: Normal-hearing (NH) listeners rate normalize, temporarily remapping phonemic category boundaries to account for a talker's speech rate. It is unknown if adults who use auditory prostheses called cochlear implants (CI) can rate normalize, as CIs transmit degraded speech signals to the auditory nerve. Ineffective adjustment to rate…

Concept Formation Skills in Long-Term Cochlear Implant Users

ERIC Educational Resources Information Center

Castellanos, Irina; Kronenberger, William G.; Beer, Jessica; Colson, Bethany G.; Henning, Shirley C.; Ditmars, Allison; Pisoni, David B.

2015-01-01

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.,…

Speech Intelligibility and Personality Peer-Ratings of Young Adults with Cochlear Implants

ERIC Educational Resources Information Center

Freeman, Valerie

2018-01-01

Speech intelligibility, or how well a speaker's words are understood by others, affects listeners' judgments of the speaker's competence and personality. Deaf cochlear implant (CI) users vary widely in speech intelligibility, and their speech may have a noticeable "deaf" quality, both of which could evoke negative stereotypes or…

A Comprehensive Study on the Etiology of Patients Receiving Cochlear Implantation With Special Emphasis on Genetic Epidemiology

PubMed Central

Miyagawa, Maiko; Nishio, Shin-Ya; Usami, Shin-Ichi

2016-01-01

Objective: Cochlear implantation is the most important treatment currently available for profound sensorineural hearing loss. The aim of this study was to investigate the etiology of hearing loss in patients with cochlear implantation, and to compare outcomes. Methods: Japanese hearing loss patients who received cochlear implants (CIs) or electric acoustic stimulation (EAS) in Shinshu University hospital (n = 173, prelingual onset: 92, postlingual onset: 81) participated in this study. Invader assay followed by the targeted exon-sequencing of 63 deafness genes using Massively parallel DNA sequencing (MPS) was applied. For prelingual patients, additional imaging examination, cCMV screening, and pediatric examination were performed for precise diagnosis. Results: Genetic screening successfully identified the causative mutation in 60% of patients with prelingual onset hearing loss and in 36% of those with postlingual hearing loss. Differences in the kinds of genes identified were observed between the two groups. Although there were marked variations in the outcome of cochlear implantation, patients with specific deafness gene mutations showed relatively good results. Conclusion: The present study showed genetic etiology is a major cause of hearing loss in CI/EAS patients. Patients possessing mutations in a number of deafness genes known to be expressed within inner ear have achieved satisfactory auditory performance, suggesting that the identification of the genetic background facilitates the prediction of post-CI performance. MPS is a powerful tool for the identification of causative deafness genes in patients receiving cochlear implantation. Therefore, determination of the involved region inside/outside of the cochlea by identification of the responsible gene is essential. PMID:26756145

Recognition of Speech from the Television with Use of a Wireless Technology Designed for Cochlear Implants.

PubMed

Duke, Mila Morais; Wolfe, Jace; Schafer, Erin

2016-05-01

Cochlear implant (CI) recipients often experience difficulty understanding speech in noise and speech that originates from a distance. Many CI recipients also experience difficulty understanding speech originating from a television. Use of hearing assistance technology (HAT) may improve speech recognition in noise and for signals that originate from more than a few feet from the listener; however, there are no published studies evaluating the potential benefits of a wireless HAT designed to deliver audio signals from a television directly to a CI sound processor. The objective of this study was to compare speech recognition in quiet and in noise of CI recipients with the use of their CI alone and with the use of their CI and a wireless HAT (Cochlear Wireless TV Streamer). A two-way repeated measures design was used to evaluate performance differences obtained in quiet and in competing noise (65 dBA) with the CI sound processor alone and with the sound processor coupled to the Cochlear Wireless TV Streamer. Sixteen users of Cochlear Nucleus 24 Freedom, CI512, and CI422 implants were included in the study. Participants were evaluated in four conditions including use of the sound processor alone and use of the sound processor with the wireless streamer in quiet and in the presence of competing noise at 65 dBA. Speech recognition was evaluated in each condition with two full lists of Computer-Assisted Speech Perception Testing and Training Sentence-Level Test sentences presented from a light-emitting diode television. Speech recognition in noise was significantly better with use of the wireless streamer compared to participants' performance with their CI sound processor alone. There was also a nonsignificant trend toward better performance in quiet with use of the TV Streamer. Performance was significantly poorer when evaluated in noise compared to performance in quiet when the TV Streamer was not used. Use of the Cochlear Wireless TV Streamer designed to stream audio from a television directly to a CI sound processor provides better speech recognition in quiet and in noise when compared to performance obtained with use of the CI sound processor alone. American Academy of Audiology.

Semantic and syntactic reading comprehension strategies used by deaf children with early and late cochlear implantation.

PubMed

Gallego, Carlos; Martín-Aragoneses, M Teresa; López-Higes, Ramón; Pisón, Guzmán

2016-01-01

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. Copyright © 2015 Elsevier Ltd. All rights reserved.

Music appreciation and music listening in prelingual and postlingually deaf adult cochlear implant recipients.

PubMed

Moran, Michelle; Rousset, Alexandra; Looi, Valerie

2016-01-01

To explore the music appreciation of prelingually deaf adults using cochlear implants (CIs). Cohort study. Adult CI recipients were recruited based on hearing history and asked to complete the University of Canterbury Music Listening Questionnaire (UCMLQ) to assess each individual's music listening and appreciation. Results were compared to previous responses to the UCMLQ from a large cohort of postlingually deaf CI recipients. Fifteen prelingually deaf and 15 postlingually deaf adult cochlear implant recipients. No significant differences were found between the prelingual and postlingual participants for amount of music listening or music listening enjoyment with their CI. Sound quality of common instruments was favourable for both groups, with no significant difference in the pleasantness/naturalness of instrument sounds between the groups. Prelingually deaf CI recipients rated themselves as significantly less able to follow a melody line and identify instrument styles compared to their postlingual peers. The results suggest that the pre- and postlingually deaf CI recipients demonstrate equivalent levels of music appreciation. This finding is of clinical importance, as CI clinicians should be actively encouraging all of their recipients to explore music listening as a part of their rehabilitation.

Auditory performance and subjective benefits in adults with congenital or prelinguistic deafness who receive cochlear implants during adulthood.

PubMed

Duchesne, Louise; Millette, Isabelle; Bhérer, Maurice; Gobeil, Suzie

2017-05-01

(1) To describe auditory performance and subjective benefits in adults with congenital or prelingual deafness who received a cochlear implant (CI) during adolescence or adulthood, and (2) to examine the benefits as experienced by these CI users. Twenty-one adults aged 23-65 years participated in the study. All had a congenital or prelingual deafness (onset before age 3). They received a CI between the age of 16 and 61 years (mean age: 31). Speech recognition scores before and after implantation were computed and a questionnaire on subjective benefits (French adaptation of the Adult Cochlear Implant Questionnaire, designed by Zwolan and collaborators (1996, Self-report of CI use and satisfaction by prelingually deafened adults. Ear and Hearing, 17(3): 198-210) was administered. Semi-structured interviews were subsequently conducted with a subsample of seven participants. Speech recognition scores after implantation ranged from 0 to 95%. Despite large inter-individual variability, most participants expressed high levels satisfaction and overall usefulness. Correlational analyses showed that speech recognition performance was moderately associated with subjective benefits. Data from the interviews revealed that the underlying sources of satisfaction with the implant are related to the discovery and enjoyment of environmental sounds, easier lip-reading, and improvement of self-confidence during communicative interactions. CI benefits are mostly subjective in this particular population: descriptive and qualitative approaches allow us to obtain a nuanced portrait of their experience and provide us with important elements that are not easily measurable with tests and scores.

Long-Term Speech and Language Outcomes in Prelingually Deaf Children, Adolescents and Young Adults Who Received Cochlear Implants in Childhood

PubMed Central

Ruffin, Chad V.; Kronenberger, William G.; Colson, Bethany G.; Henning, Shirley C.; Pisoni, David B.

2013-01-01

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 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 one standard deviation of the normative mean or higher on the Peabody Picture Vocabulary Test, Fourth Edition (63%) and 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 pre-implant unaided pure tone average thresholds, lower family income, and the use of Total Communication. Users of 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 users of 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. PMID:23988907

Cranial MRI in a young child with cochlear implants after bilateral magnet removal.

PubMed

Helbig, Silke; Stöver, Timo; Burck, Iris; Kramer, Sabine

2017-12-01

A young bilateral cochlear implant (CI) user required magnetic resonance imaging (MRI) to determine the cause of hydrocephalus. The images obtained with the CIs in place were not diagnostically useful due to large artefacts generated by the CI magnets. We obtained useful images by bilaterally explanting the CI-magnets and replacing them with non-magnetic placeholder dummies then conducted the imaging. The artefact in the new images was greatly reduced and the images were diagnostically useful. Lastly, we explanted the dummies and reimplanted the CI-magnets. This procedure should be useful to obtain useful images in CI users. Copyright © 2017 Elsevier B.V. All rights reserved.

Cortical Plasticity after Cochlear Implantation

PubMed Central

Petersen, B.; Gjedde, A.; Wallentin, M.; Vuust, P.

2013-01-01

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

Children Using Cochlear Implants Capitalize on Acoustical Hearing for Music Perception

PubMed Central

Hopyan, Talar; Peretz, Isabelle; Chan, Lisa P.; Papsin, Blake C.; Gordon, Karen A.

2012-01-01

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

Tinnitus after Simultaneous and Sequential Bilateral Cochlear Implantation.

PubMed

Ramakers, Geerte G J; Kraaijenga, Véronique J C; Smulders, Yvette E; van Zon, Alice; Stegeman, Inge; Stokroos, Robert J; Free, Rolien H; Frijns, Johan H M; Huinck, Wendy J; Van Zanten, Gijsbert A; Grolman, Wilko

2017-01-01

There is an ongoing global discussion on whether or not bilateral cochlear implantation should be standard care for bilateral deafness. Contrary to unilateral cochlear implantation, however, little is known about the effect of bilateral cochlear implantation on tinnitus. To investigate tinnitus outcomes 1 year after bilateral cochlear implantation. Secondarily, to compare tinnitus outcomes between simultaneous and sequential bilateral cochlear implantation and to investigate long-term follow-up (3 years). This study is a secondary analysis as part of a multicenter randomized controlled trial. Thirty-eight postlingually deafened adults were included in the original trial, in which the presence of tinnitus was not an inclusion criterion. All participants received cochlear implants (CIs) because of profound hearing loss. Nineteen participants received bilateral CIs simultaneously and 19 participants received bilateral CIs sequentially with an inter-implant interval of 2 years. The prevalence and severity of tinnitus before and after simultaneous and sequential bilateral cochlear implantation were measured preoperatively and each year after implantation with the Tinnitus Handicap Inventory (THI) and Tinnitus Questionnaire (TQ). The prevalence of preoperative tinnitus was 42% (16/38). One year after bilateral implantation, there was a median difference of -8 (inter-quartile range (IQR): -28 to 4) in THI score and -9 (IQR: -17 to -9) in TQ score in the participants with preoperative tinnitus. Induction of tinnitus occurred in five participants, all in the simultaneous group, in the year after bilateral implantation. Although the preoperative and also the postoperative median THI and TQ scores were higher in the simultaneous group, the median difference scores were equal in both groups. In the simultaneous group, tinnitus scores fluctuated in the 3 years after implantation. In the sequential group, four patients had an additional benefit of the second CI: a total suppression of tinnitus compared with their unilateral situation. While bilateral cochlear implantation can have a positive effect on preoperative tinnitus complaints, the induction of (temporary or permanent) tinnitus was also reported. Dutch Trial Register NTR1722.

Cost-Effectiveness of Pediatric Cochlear Implantation in Rural China.

PubMed

Qiu, Jianxin; Yu, Chongxian; Ariyaratne, Thathya V; Foteff, Chris; Ke, Zhangmin; Sun, Yi; Zhang, Li; Qin, Feifei; Sanderson, Georgina

2017-07-01

To evaluate the cost utility of cochlear implantation (CI) for severe to profound sensorineural hearing loss (SNHL) among children from rural settings in P.R. China (China). A cost-utility analysis (CUA) was undertaken using data generated from a single-center substudy of the Cochlear Pediatric Implanted Recipient Observational Study (Cochlear P-IROS). The data were projected over a 20-year time horizon using a decision tree model. The Chinese healthcare payer and patient perspectives were adopted. Unilateral CI of children with a severe-to-profound SNHL compared with their preimplantation state of no treatment or amplification with hearing aids ("no CI" status). Incremental costs per quality adjusted life year (QALY) gained. The mean total discounted cost of unilateral CI was CNY 252,506 (37,876 USD), compared with CNY 29,005 (4,351 USD) for the no CI status from the healthcare payer plus patient perspective. A total discounted benefit of 8.9 QALYs was estimated for CI recipients compared with 6.7 QALYs for the no CI status. From the healthcare payer plus patient perspective, incremental cost-effectiveness ratio (ICER) for unilateral CI compared with no CI was CNY 100,561 (15,084 USD) per QALY. The healthcare payer perspective yielded an ICER of CNY 40,929 (6,139 USD) per QALY. Both ICERs fell within one to three times China's gross domestic product per capita (GDP, 2011-2015), considered "cost-effective" by World Health Organization (WHO) standards. Treatment with unilateral CI is a cost-effective hearing solution for children with severe to profound SNHL in rural China. Increased access to mainstream education and greater opportunities for employment, are potential downstream benefits of CI that may yield further societal and economic benefits. CI may be considered favorably for broader inclusion in medical insurance schemes across China.

NANOCI-Nanotechnology Based Cochlear Implant With Gapless Interface to Auditory Neurons.

PubMed

Senn, Pascal; Roccio, Marta; Hahnewald, Stefan; Frick, Claudia; Kwiatkowska, Monika; Ishikawa, Masaaki; Bako, Peter; Li, Hao; Edin, Fredrik; Liu, Wei; Rask-Andersen, Helge; Pyykkö, Ilmari; Zou, Jing; Mannerström, Marika; Keppner, Herbert; Homsy, Alexandra; Laux, Edith; Llera, Miguel; Lellouche, Jean-Paul; Ostrovsky, Stella; Banin, Ehud; Gedanken, Aharon; Perkas, Nina; Wank, Ute; Wiesmüller, Karl-Heinz; Mistrík, Pavel; Benav, Heval; Garnham, Carolyn; Jolly, Claude; Gander, Filippo; Ulrich, Peter; Müller, Marcus; Löwenheim, Hubert

2017-09-01

: Cochlear implants (CI) restore functional hearing in the majority of deaf patients. Despite the tremendous success of these devices, some limitations remain. The bottleneck for optimal electrical stimulation with CI is caused by the anatomical gap between the electrode array and the auditory neurons in the inner ear. As a consequence, current devices are limited through 1) low frequency resolution, hence sub-optimal sound quality and 2), large stimulation currents, hence high energy consumption (responsible for significant battery costs and for impeding the development of fully implantable systems). A recently completed, multinational and interdisciplinary project called NANOCI aimed at overcoming current limitations by creating a gapless interface between auditory nerve fibers and the cochlear implant electrode array. This ambitious goal was achieved in vivo by neurotrophin-induced attraction of neurites through an intracochlear gel-nanomatrix onto a modified nanoCI electrode array located in the scala tympani of deafened guinea pigs. Functionally, the gapless interface led to lower stimulation thresholds and a larger dynamic range in vivo, and to reduced stimulation energy requirement (up to fivefold) in an in vitro model using auditory neurons cultured on multi-electrode arrays. In conclusion, the NANOCI project yielded proof of concept that a gapless interface between auditory neurons and cochlear implant electrode arrays is feasible. These findings may be of relevance for the development of future CI systems with better sound quality and performance and lower energy consumption. The present overview/review paper summarizes the NANOCI project history and highlights achievements of the individual work packages.

The cochlear implant as a tinnitus treatment.

PubMed

Vallés-Varela, Héctor; Royo-López, Juan; Carmen-Sampériz, Luis; Sebastián-Cortés, José M; Alfonso-Collado, Ignacio

2013-01-01

Tinnitus is a symptom of high prevalence in patients with cochlear pathology. We studied the evolution of tinnitus in patients undergoing unilateral cochlear implantation for treatment of profound hearing loss. This was a longitudinal, retrospective study of patients that underwent unilateral cochlear implantation and who had bilateral tinnitus. Tinnitus was assessed quantitatively and qualitatively before surgery and at 6 and 12 months after surgery. We evaluated 20 patients that underwent unilateral cochlear implantation with a Nucleus(®) CI24RE Contour Advance™ electrode device. During the periods in which the device was in operation, improvement or disappearance of tinnitus was evidenced in the ipsilateral ear in 65% of patients, and in the contralateral ear, in 50%. In periods in which the device was disconnected, improvement or disappearance of tinnitus was found in the ipsilateral ear in 50% of patients, and in the ear contralateral to the implant in 45% of the patients. In 10% of the patients, a new tinnitus appeared in the ipsilateral ear. The patients with profound hearing loss and bilateral tinnitus treated with unilateral cochlear implantation improved in a high percentage of cases, in the ipsilateral ear and in the contralateral ear. Copyright © 2012 Elsevier España, S.L. All rights reserved.

Auditory cortical activity during cochlear implant-mediated perception of spoken language, melody, and rhythm.

PubMed

Limb, Charles J; Molloy, Anne T; Jiradejvong, Patpong; Braun, Allen R

2010-03-01

Despite the significant advances in language perception for cochlear implant (CI) recipients, music perception continues to be a major challenge for implant-mediated listening. Our understanding of the neural mechanisms that underlie successful implant listening remains limited. To our knowledge, this study represents the first neuroimaging investigation of music perception in CI users, with the hypothesis that CI subjects would demonstrate greater auditory cortical activation than normal hearing controls. H(2) (15)O positron emission tomography (PET) was used here to assess auditory cortical activation patterns in ten postlingually deafened CI patients and ten normal hearing control subjects. Subjects were presented with language, melody, and rhythm tasks during scanning. Our results show significant auditory cortical activation in implant subjects in comparison to control subjects for language, melody, and rhythm. The greatest activity in CI users compared to controls was seen for language tasks, which is thought to reflect both implant and neural specializations for language processing. For musical stimuli, PET scanning revealed significantly greater activation during rhythm perception in CI subjects (compared to control subjects), and the least activation during melody perception, which was the most difficult task for CI users. These results may suggest a possible relationship between auditory performance and degree of auditory cortical activation in implant recipients that deserves further study.

Neuroelectrical imaging study of music perception by children with unilateral and bilateral cochlear implants.

PubMed

Marsella, Pasquale; Scorpecci, Alessandro; Vecchiato, Giovanni; Colosimo, Alfredo; Maglione, Anton Giulio; Babiloni, Fabio

2014-05-01

To investigate by means of non-invasive neuroelectrical imaging the differences in the perceived pleasantness of music between children with cochlear implants (CI) and normal-hearing (NH) children. 5 NH children and 5 children who received a sequential bilateral CI were assessed by means of High-Resolution EEG with Source Reconstruction as they watched a musical cartoon. Implanted children were tested before and after the second implant. For each subject the scalp Power Spectral Density was calculated in order to investigate the EEG alpha asymmetry. The scalp topographic distribution of the EEG power spectrum in the alpha band was different in children using one CI as compared to NH children (see figure). With two CIs the cortical activation pattern changed significantly, becoming more similar to the one observed in NH children. The findings support the hypothesis that bilateral CI users have a closer-to-normal perception of the pleasantness of music than unilaterally implanted children.

Cochlear implantation using a custom guide catheter in fourteen patients with incomplete partition type III.

PubMed

Tian, Hao; Wang, Line; Gao, Fenqi; Liang, Wenqi; Peng, Kevin A

2018-05-22

Incomplete partition type III (IP-III), also termed X-linked deafness with stapes gusher, is a heterogeneous condition that predominantly affects males; however, females demonstrating the phenotype also exist. The absence of a bony partition between the fundus of the internal auditory canal (IAC) and cochlea predisposes these patients to cerebrospinal fluid leak or electrode passage into the IAC when performing cochlear implantation. We describe a surgeon-fabricated guide catheter, made intraoperatively from a 16-gauge intravenous catheter, that helps avoid electrode passage into the IAC during CI for patients with IP-III. Acceptable cochlear implant outcomes were attainable in IP-III patients, but these patients scored worse than matched CI patients with normal inner ear structures. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Evidence-based guidelines for recommending cochlear implantation for postlingually deafened adults.

PubMed

Leigh, Jaime R; Moran, Michelle; Hollow, Rodney; Dowell, Richard C

2016-01-01

Adult selection criteria for cochlear implantation have been developed based on analysis of the post-operative performance of a large group of postlingually deafened adults. Original criteria published in 2004 were reviewed and amended to reflect outcomes currently being achieved by implant recipients. Retrospective review of 12-month post-operative speech perception performance of adults implanted at the Eye and Ear Hospital, Melbourne, Australia. A total of 382 postlingually deafened adults, using a Freedom, Nucleus 5, or CI422 Slim Straight cochlear implant were used to create a comparative set of data. Revised guidelines suggest that adults with postlingual hearing loss can now be considered cochlear implant candidates if they obtain scores of up to 55% for open-set phonemes in quiet in the ear to be implanted. Functional benefit may vary depending on the recipients' contralateral hearing. This study supports the provision of cochlear implants to candidates with significant residual hearing when at least one ear meets the criterion outlined above. Patient-specific counseling is required to ensure the potential to benefit predicted by the current model is acceptable to the individual patient and their family. Counseling regarding functional benefit must take into consideration hearing in the contralateral ear.

Computational Evaluation of Cochlear Implant Surgery Outcomes Accounting for Uncertainty and Parameter Variability.

PubMed

Mangado, Nerea; Pons-Prats, Jordi; Coma, Martí; Mistrík, Pavel; Piella, Gemma; Ceresa, Mario; González Ballester, Miguel Á

2018-01-01

Cochlear implantation (CI) is a complex surgical procedure that restores hearing in patients with severe deafness. The successful outcome of the implanted device relies on a group of factors, some of them unpredictable or difficult to control. Uncertainties on the electrode array position and the electrical properties of the bone make it difficult to accurately compute the current propagation delivered by the implant and the resulting neural activation. In this context, we use uncertainty quantification methods to explore how these uncertainties propagate through all the stages of CI computational simulations. To this end, we employ an automatic framework, encompassing from the finite element generation of CI models to the assessment of the neural response induced by the implant stimulation. To estimate the confidence intervals of the simulated neural response, we propose two approaches. First, we encode the variability of the cochlear morphology among the population through a statistical shape model. This allows us to generate a population of virtual patients using Monte Carlo sampling and to assign to each of them a set of parameter values according to a statistical distribution. The framework is implemented and parallelized in a High Throughput Computing environment that enables to maximize the available computing resources. Secondly, we perform a patient-specific study to evaluate the computed neural response to seek the optimal post-implantation stimulus levels. Considering a single cochlear morphology, the uncertainty in tissue electrical resistivity and surgical insertion parameters is propagated using the Probabilistic Collocation method, which reduces the number of samples to evaluate. Results show that bone resistivity has the highest influence on CI outcomes. In conjunction with the variability of the cochlear length, worst outcomes are obtained for small cochleae with high resistivity values. However, the effect of the surgical insertion length on the CI outcomes could not be clearly observed, since its impact may be concealed by the other considered parameters. Whereas the Monte Carlo approach implies a high computational cost, Probabilistic Collocation presents a suitable trade-off between precision and computational time. Results suggest that the proposed framework has a great potential to help in both surgical planning decisions and in the audiological setting process.

Pediatric Auditory Brainstem Implant Surgery: A New Option for Auditory Habilitation in Congenital Deafness?

PubMed

Shah, Parth V; Kozin, Elliott D; Kaplan, Alyson B; Lee, Daniel J

2016-01-01

The auditory brainstem implant (ABI) is a neuroprosthetic device that provides sound sensations to individuals with profound hearing loss who are not candidates for a cochlear implant (CI) because of anatomic constraints. Herein we describe the ABI for family physicians. PubMed was searched to identify articles relevant to the ABI, as well as articles that contain outcomes data for pediatric patients (age <18 years) who have undergone ABI surgery. The ABI was originally developed for patients with neurofibromatosis type 2 (NF2) who become deaf from bilateral vestibular schwannomas. Over the past decade, indications for an ABI have expanded to adult patients without tumors (without NF2) who cannot receive a CI and children with no cochlea or cochlear nerve. Outcomes among NF2 ABI users are modest compared to cochlear implant patients, but recent studies from Europe suggest that some non-tumor adult and pediatric ABI users achieve speech perception. The ABI is a reasonable surgical option for children with profound hearing loss due to severe cochlear or cochlear nerve deformities. Continued prospective data collection from several clinical trials in the U.S. will provide greater understanding on long term outcomes that focus on speech intelligibility. © Copyright 2016 by the American Board of Family Medicine.

Preparation and Perceptions of Speech-Language Pathologists Working with Children with Cochlear Implants

ERIC Educational Resources Information Center

Compton, Mary V.; Tucker, Denise A.; Flynn, Perry F.

2009-01-01

This study examined the level of preparedness of North Carolina speech-language pathologists (SLPs) who serve school-aged children with cochlear implants (CIs). A survey distributed to 190 school-based SLPs in North Carolina revealed that 79% of the participants felt they had little to no confidence in managing CI technology or in providing…

The Effect of Temporal Gap Identification on Speech Perception by Users of Cochlear Implants

ERIC Educational Resources Information Center

Sagi, Elad; Kaiser, Adam R.; Meyer, Ted A.; Svirsky, Mario A.

2009-01-01

Purpose: This study examined the ability of listeners using cochlear implants (CIs) and listeners with normal hearing (NH) to identify silent gaps of different duration and the relation of this ability to speech understanding in CI users. Method: Sixteen NH adults and 11 postlingually deafened adults with CIs identified synthetic vowel-like…

Speech Understanding in Complex Listening Environments by Listeners Fit with Cochlear Implants

ERIC Educational Resources Information Center

Dorman, Michael F.; Gifford, Rene H.

2017-01-01

Purpose: The aim of this article is to summarize recent published and unpublished research from our 2 laboratories on improving speech understanding in complex listening environments by listeners fit with cochlear implants (CIs). Method: CI listeners were tested in 2 listening environments. One was a simulation of a restaurant with multiple,…

Alveolar and Postalveolar Voiceless Fricative and Affricate Productions of Spanish-English Bilingual Children with Cochlear Implants

ERIC Educational Resources Information Center

Li, Fangfang; Bunta, Ferenc; Tomblin, J. Bruce

2017-01-01

Purpose: This study investigates the production of voiceless alveolar and postalveolar fricatives and affricates by bilingual and monolingual children with hearing loss who use cochlear implants (CIs) and their peers with normal hearing (NH). Method: Fifty-four children participated in our study, including 12 Spanish-English bilingual CI users (M…

Benefits of Music Training in Mandarin-Speaking Pediatric Cochlear Implant Users

ERIC Educational Resources Information Center

Fu, Qian-Jie; Galvin, John J., III; Wang, Xiaosong; Wu, Jiunn-Liang

2015-01-01

Purpose: The aims of this study were to assess young (5- to 10-year-old) Mandarin-speaking cochlear implant (CI) users' musical pitch perception and to assess the benefits of computer-based home training on performance. Method: Melodic contour identification (MCI) was used to assess musical pitch perception in 14 Mandarin-speaking pediatric CI…

Measuring Sound-Processor Threshold Levels for Pediatric Cochlear Implant Recipients Using Conditioned Play Audiometry via Telepractice

ERIC Educational Resources Information Center

Goehring, Jenny L.; Hughes, Michelle L.

2017-01-01

Purpose: This study evaluated the use of telepractice for measuring cochlear implant (CI) behavioral threshold (T) levels in children using conditioned play audiometry (CPA). The goals were to determine whether (a) T levels measured via telepractice were not significantly different from those obtained in person, (b) response probability differed…

Validation of the Common Objects Token (COT) Test for Children with Cochlear Implants

ERIC Educational Resources Information Center

Anderson, Ilona; Martin, Jane; Costa, Anne; Jamieson, Lyn; Bailey, Elspeth; Plant, Geoff; Pitterl, Markus

2005-01-01

Changes in selection criteria have meant that children are being provided with cochlear implants (CI) at increasingly younger ages. However, there is a paucity of measures that are appropriate for testing complex listening skills--most tests are too cognitively complex for such young children. The Common Objects Token (COT) Test was developed as a…

Music Perception of Cochlear Implant Recipients with Implications for Music Instruction: A Review of the Literature

ERIC Educational Resources Information Center

Hsiao, Feilin; Gfeller, Kate

2012-01-01

This review of the literature presents a systematic analysis of the capabilities and limitations of cochlear implant (CI) recipients with regard to music perception. Specifically, it (a) analyzes individual components of music (e.g., rhythm, timbre, and pitch) as they interface with the technical characteristics of CIs and the perceptual abilities…

Verbal Processing Speed and Executive Functioning in Long-Term Cochlear Implant Users

ERIC Educational Resources Information Center

AuBuchon, Angela M.; Pisoni, David B.; Kronenberger, William G.

2015-01-01

Purpose: The purpose of this study was to report how "verbal rehearsal speed" (VRS), a form of covert speech used to maintain verbal information in working memory, and another verbal processing speed measure, perceptual encoding speed, are related to 3 domains of executive function (EF) at risk in cochlear implant (CI) users: verbal…

Do Adults with Cochlear Implants Rely on Different Acoustic Cues for Phoneme Perception than Adults with Normal Hearing?

ERIC Educational Resources Information Center

Moberly, Aaron C.; Lowenstein, Joanna H.; Tarr, Eric; Caldwell-Tarr, Amanda; Welling, D. Bradley; Shahin, Antoine J.; Nittrouer, Susan

2014-01-01

Purpose: Several acoustic cues specify any single phonemic contrast. Nonetheless, adult, native speakers of a language share weighting strategies, showing preferential attention to some properties over others. Cochlear implant (CI) signal processing disrupts the salience of some cues: In general, amplitude structure remains readily available, but…

Evaluation on health-related quality of life in deaf children with cochlear implant in China.

PubMed

Liu, Hong; Liu, Hong-Xiang; Kang, Hou-Yong; Gu, Zheng; Hong, Su-Ling

2016-09-01

Previous studies have shown that deaf children benefit considerably from cochlear implants. These improvements are found in areas such as speech perception, speech production, and audiology-verbal performance. Despite the increasing prevalence of cochlear implants in China, few studies have reported on health-related quality of life in children with cochlear implants. The main objective of this study was to explore health-related quality of life on children with cochlear implants in South-west China. A retrospective observational study of 213 CI users in Southwest China between 2010 and 2013. Participants were 213 individuals with bilateral severe-to-profound hearing loss who wore unilateral cochlear implants. The Nijmegen Cochlear Implant Questionnaire and Health Utility Index Mark III were used pre-implantation and 1 year post-implantation. Additionally, 1-year postoperative scores for Mandarin speech perception were compared with preoperative scores. Health-related quality of life improved post-operation with scores on the Nijmegen Cochlear Implant Questionnaire improving significantly in all subdomains, and the Health Utility Index 3 showing a significant improvement in the utility score and the subdomains of ''hearing," ''speech," and "emotion". Additionally, a significant improvement in speech recognition scores was found. No significant correlation was found between increased in quality of life and speech perception scores. Health-related quality of life and speech recognition in prelingual deaf children significantly improved post-operation. The lack of correlation between quality of life and speech perception suggests that when evaluating performance post-implantation in prelingual deaf children and adolescents, measures of both speech perception and quality of life should be used. Copyright © 2016. Published by Elsevier Ireland Ltd.

PubMed Central

BERRETTINI, S.; ARSLAN, E.; BAGGIANI, A.; BURDO, S.; CASSANDRO, E.; CUDA, D.; FILIPO, R.; GIORGI ROSSI, P.; MANCINI, P.; MARTINI, A.; QUARANTA, A.; QUARANTA, N.; TURCHETTI, G.; FORLI, F.

2011-01-01

SUMMARY The aim of Health Technology Assessment (HTA) is to provide decision-makers, distributors and recipients with information on the effectiveness, cost and impact of health technologies. The present study constitutes a subproject within the wider project “Analysis of the impact of professional involvement in evidence generation for the HTA process”, which is part of the strategic programme “Transfer of the results of the research in clinical practice and organisation of healthcare services”, coordinated by Laziosanità – Agency of Public Healthcare of the Lazio Region and AgeNaS (National Agency for Regional Healthcare Services). The objectives of the present subproject (cochlear implants) are as follows: a) to produce a report regarding the health impact of cochlear implants (CI) on their recipients, through a systematic review of literature and extensive selection of relative studies, combining the outcomes with metanalytical techniques. Output: report on the indications of usage in the groups of population for which benefits are controversial; b) to create a registry of patients using cochlear implants. The registry should contain a selection of anagraphic and clinical information relative to patient follow-up in order to assess factors associated with safety and impact on cochlear implant users. This source of information is essential for future observational studies. This was divided into 4 phases: 1st phase: definition of key participants in the assessment process; 2nd phase: definition of methods and timing of “Aims” (definition of the objective); 3rd phase: definition of the methods and times of the “assessment process”, 4th phase: production of the final report. From the analysis of systematic reviews and italian and international guidelines, the Working Group members approved recommendations on the following topics: results after CI in children in relation to age at implantation, bilateral CI in children, CI in deaf children with associated disabilities, CI in adults with advanced age, bilateral CI in adults and CI in adults with pre-lingual deafness. These recommendations have also been evaluated by the Consulting Committee members and approved with minimal suggestions. PMID:22287819

Perceptual Learning and Auditory Training in Cochlear Implant Recipients

PubMed Central

Fu, Qian-Jie; Galvin, John J.

2007-01-01

Learning electrically stimulated speech patterns can be a new and difficult experience for cochlear implant (CI) recipients. Recent studies have shown that most implant recipients at least partially adapt to these new patterns via passive, daily-listening experiences. Gradually introducing a speech processor parameter (eg, the degree of spectral mismatch) may provide for more complete and less stressful adaptation. Although the implant device restores hearing sensation and the continued use of the implant provides some degree of adaptation, active auditory rehabilitation may be necessary to maximize the benefit of implantation for CI recipients. Currently, there are scant resources for auditory rehabilitation for adult, postlingually deafened CI recipients. We recently developed a computer-assisted speech-training program to provide the means to conduct auditory rehabilitation at home. The training software targets important acoustic contrasts among speech stimuli, provides auditory and visual feedback, and incorporates progressive training techniques, thereby maintaining recipients’ interest during the auditory training exercises. Our recent studies demonstrate the effectiveness of targeted auditory training in improving CI recipients’ speech and music perception. Provided with an inexpensive and effective auditory training program, CI recipients may find the motivation and momentum to get the most from the implant device. PMID:17709574

Survey on the knowledge of cochlear implant indication in the treatment of hearing loss in Spain.

PubMed

Manrique, Manuel; Ramos, Ángel; Pradel, Beatriz; Cenjor, Carlos; Calavia, Diego; Morera, Constantino

2017-08-28

This study aims to analyse the knowledge of cochlear implant (CI) candidacy criteria of otorhinolaryngology specialists in Spain, and from the results, consider whether it is necessary to implement training measures aimed at improving knowledge in this area. A questionnaire was designed for measuring the level of knowledge of cochlear implant candidacy criteria (CI) in people with hearing loss. The questionnaire collected the demographic data of the respondents and their knowledge on the conventional and emergency indications for CI, technical characteristics of CI and results in the implanted population. A total of 222 Spanish specialists in otorhinolaryngology answered the questionnaire (10.29% of the sample surveyed). The 50% of all respondents showed a medium-high knowledge about CI. Epidemiological data suggest that a high percentage of adults with postlocutive deafness and candidates for a CI are not referred for treatment. The lack of knowledge about the criteria for the indication of CI by otorhinolaryngology specialists may contribute to inadequate guidance of patients who are potential candidates for CI. The greatest shortcomings are found in the most emergency indications for a CI. Among otorhinolaryngology professionals, the greatest knowledge about CI is found in those who work in tertiary hospitals in the areas of otology and otoneurology, either in the public or private sector. This study suggests that training on CI should be increased for otorhinolaryngology professionals, especially for general otorhinolaryngologists. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

Selective Neuronal Activation by Cochlear Implant Stimulation in Auditory Cortex of Awake Primate

PubMed Central

Johnson, Luke A.; Della Santina, Charles C.

2016-01-01

Despite the success of cochlear implants (CIs) in human populations, most users perform poorly in noisy environments and music and tonal language perception. How CI devices engage the brain at the single neuron level has remained largely unknown, in particular in the primate brain. By comparing neuronal responses with acoustic and CI stimulation in marmoset monkeys unilaterally implanted with a CI electrode array, we discovered that CI stimulation was surprisingly ineffective at activating many neurons in auditory cortex, particularly in the hemisphere ipsilateral to the CI. Further analyses revealed that the CI-nonresponsive neurons were narrowly tuned to frequency and sound level when probed with acoustic stimuli; such neurons likely play a role in perceptual behaviors requiring fine frequency and level discrimination, tasks that CI users find especially challenging. These findings suggest potential deficits in central auditory processing of CI stimulation and provide important insights into factors responsible for poor CI user performance in a wide range of perceptual tasks. SIGNIFICANCE STATEMENT The cochlear implant (CI) is the most successful neural prosthetic device to date and has restored hearing in hundreds of thousands of deaf individuals worldwide. However, despite its huge successes, CI users still face many perceptual limitations, and the brain mechanisms involved in hearing through CI devices remain poorly understood. By directly comparing single-neuron responses to acoustic and CI stimulation in auditory cortex of awake marmoset monkeys, we discovered that neurons unresponsive to CI stimulation were sharply tuned to frequency and sound level. Our results point out a major deficit in central auditory processing of CI stimulation and provide important insights into mechanisms underlying the poor CI user performance in a wide range of perceptual tasks. PMID:27927962

Short-Term and Working Memory Impairments in Early-Implanted, Long-Term Cochlear Implant Users Are Independent of Audibility and Speech Production

PubMed Central

AuBuchon, Angela M.; Pisoni, David B.; Kronenberger, William G.

2015-01-01

OBJECTIVES Determine if early-implanted, long-term cochlear implant (CI) users display delays in verbal short-term and working memory capacity when processes related to audibility and speech production are eliminated. DESIGN Twenty-three long-term CI users and 23 normal-hearing controls each completed forward and backward digit span tasks under testing conditions which differed in presentation modality (auditory or visual) and response output (spoken recall or manual pointing). RESULTS Normal-hearing controls reproduced more lists of digits than the CI users, even when the test items were presented visually and the responses were made manually via touchscreen response. CONCLUSIONS Short-term and working memory delays observed in CI users are not due to greater demands from peripheral sensory processes such as audibility or from overt speech-motor planning and response output organization. Instead, CI users are less efficient at encoding and maintaining phonological representations in verbal short-term memory utilizing phonological and linguistic strategies during memory tasks. PMID:26496666

Short-Term and Working Memory Impairments in Early-Implanted, Long-Term Cochlear Implant Users Are Independent of Audibility and Speech Production.

PubMed

AuBuchon, Angela M; Pisoni, David B; Kronenberger, William G

2015-01-01

To determine whether early-implanted, long-term cochlear implant (CI) users display delays in verbal short-term and working memory capacity when processes related to audibility and speech production are eliminated. Twenty-three long-term CI users and 23 normal-hearing controls each completed forward and backward digit span tasks under testing conditions that differed in presentation modality (auditory or visual) and response output (spoken recall or manual pointing). Normal-hearing controls reproduced more lists of digits than the CI users, even when the test items were presented visually and the responses were made manually via touchscreen response. Short-term and working memory delays observed in CI users are not due to greater demands from peripheral sensory processes such as audibility or from overt speech-motor planning and response output organization. Instead, CI users are less efficient at encoding and maintaining phonological representations in verbal short-term memory using phonological and linguistic strategies during memory tasks.

Contribution of hearing aids to music perception by cochlear implant users.

PubMed

Peterson, Nathaniel; Bergeson, Tonya R

2015-09-01

Modern cochlear implant (CI) encoding strategies represent the temporal envelope of sounds well but provide limited spectral information. This deficit in spectral information has been implicated as a contributing factor to difficulty with speech perception in noisy conditions, discriminating between talkers and melody recognition. One way to supplement spectral information for CI users is by fitting a hearing aid (HA) to the non-implanted ear. In this study 14 postlingually deaf adults (half with a unilateral CI and the other half with a CI and an HA (CI + HA)) were tested on measures of music perception and familiar melody recognition. CI + HA listeners performed significantly better than CI-only listeners on all pitch-based music perception tasks. The CI + HA group did not perform significantly better than the CI-only group in the two tasks that relied on duration cues. Recognition of familiar melodies was significantly enhanced for the group wearing an HA in addition to their CI. This advantage in melody recognition was increased when melodic sequences were presented with the addition of harmony. These results show that, for CI recipients with aidable hearing in the non-implanted ear, using a HA in addition to their implant improves perception of musical pitch and recognition of real-world melodies.

Factors contributing to communication skills development in cochlear implanted children.

PubMed

Ostojić, Sanja; Djoković, Sanja; Radić-šestić, Marina; Nikolić, Mina; Mikić, Branka; Mirić, Danica

2015-08-01

Over the last 10 years more than 300 persons received cochlear implant in Serbia and more than 90% of the recipients were children under 10 years of age. The program of cochlear implantation includes postoperative rehabilitation in which cognitive, integrative and developmental methods are used. The study was conducted to reveal factors affecting communication performance (CP) of cochlear implanted (Cl) children. Special attention was focused on the influence of the duration and intensity of rehabilitation and hearing age on further development of communication skills. A group of 30 CI children (13 boys and 17 girls) aged 2 to 5 years was enrolled in the study. All of the children had average intelligence and no other developmental disorder. They lived in families and attended rehabilitative seances 3 to 5 times a week. Their parents/caregivers answered structured questionnaire about functioning after pediatric cochlear implantation (FAPCI) and the results were the subject of detailed statistical analysis. Analysis of variance did not show any difference between the boys and the girls regarding FAPCI achievements (F(1, 28) = 2.909; p = 0.099) and age aberration in CP score (F(1,28) = 0.114, p = 0.738). Correlation analysis showed a statistically significant difference in FAPCI scores related to hearing age and duration of rehabilitation. Regression analysis (enter method) showed that model consisting of indipendent variables significantly contributed to prediction of overall FAPCI scores and Adjusted R2 value could explain 32% difference in communication skills of participants in this study. Communication skills of CI children evaluated by FAPCI are falling behind normatives for normal hearing children 18.6 months on the average. Hearing age, duration and intensity of rehabilitation have positive predictive value for communication skills development. Later identification of hearing loss and later cochlear implantation lead to delayed development of communication skills.

Does quality of life depend on speech recognition performance for adult cochlear implant users?

PubMed

Capretta, Natalie R; Moberly, Aaron C

2016-03-01

Current postoperative clinical outcome measures for adults receiving cochlear implants (CIs) consist of testing speech recognition, primarily under quiet conditions. However, it is strongly suspected that results on these measures may not adequately reflect patients' quality of life (QOL) using their implants. This study aimed to evaluate whether QOL for CI users depends on speech recognition performance. Twenty-three postlingually deafened adults with CIs were assessed. Participants were tested for speech recognition (Central Institute for the Deaf word and AzBio sentence recognition in quiet) and completed three QOL measures-the Nijmegen Cochlear Implant Questionnaire; either the Hearing Handicap Inventory for Adults or the Hearing Handicap Inventory for the Elderly; and the Speech, Spatial and Qualities of Hearing Scale questionnaires-to assess a variety of QOL factors. Correlations were sought between speech recognition and QOL scores. Demographics, audiologic history, language, and cognitive skills were also examined as potential predictors of QOL. Only a few QOL scores significantly correlated with postoperative sentence or word recognition in quiet, and correlations were primarily isolated to speech-related subscales on QOL measures. Poorer pre- and postoperative unaided hearing predicted better QOL. Socioeconomic status, duration of deafness, age at implantation, duration of CI use, reading ability, vocabulary size, and cognitive status did not consistently predict QOL scores. For adult, postlingually deafened CI users, clinical speech recognition measures in quiet do not correlate broadly with QOL. Results suggest the need for additional outcome measures of the benefits and limitations of cochlear implantation. 4. Laryngoscope, 126:699-706, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

A Manually Operated, Advance Off-Stylet Insertion Tool for Minimally Invasive Cochlear Implantation Surgery

PubMed Central

Kratchman, Louis B.; Schurzig, Daniel; McRackan, Theodore R.; Balachandran, Ramya; Noble, Jack H.; Webster, Robert J.; Labadie, Robert F.

2014-01-01

The current technique for cochlear implantation (CI) surgery requires a mastoidectomy to gain access to the cochlea for electrode array insertion. It has been shown that microstereotactic frames can enable an image-guided, minimally invasive approach to CI surgery called percutaneous cochlear implantation (PCI) that uses a single drill hole for electrode array insertion, avoiding a more invasive mastoidectomy. Current clinical methods for electrode array insertion are not compatible with PCI surgery because they require a mastoidectomy to access the cochlea; thus, we have developed a manually operated electrode array insertion tool that can be deployed through a PCI drill hole. The tool can be adjusted using a preoperative CT scan for accurate execution of the advance off-stylet (AOS) insertion technique and requires less skill to operate than is currently required to implant electrode arrays. We performed three cadaver insertion experiments using the AOS technique and determined that all insertions were successful using CT and microdissection. PMID:22851233

Cochlear implantation and clinical features in patients with Noonan syndrome and Noonan syndrome with multiple lentigines caused by a mutation in PTPN11.

PubMed

van Nierop, Josephine W I; van Trier, Dorothée C; van der Burgt, Ineke; Draaisma, Jos M T; Mylanus, Emmanuel A M; Snik, Ad F; Admiraal, Ronald J C; Kunst, Henricus P M

2017-06-01

Existing literature only reports a few patients with Noonan syndrome (NS) and Noonan syndrome with multiple lentigines (NSML) who underwent cochlear implantation (CI). The present study describes four NS patients and one NSML patient with a PTPN11 mutation. They all had severe to profound hearing loss, and they received a CI. The age at which the CI surgery occurred ranged from 1 to 13 years old, and the audiological results in all five patients improved after the CI. Otological and audiological examinations in NS and NSML are important, and for those with severe hearing loss, the CI surgery improved the audiological outcome regardless of age. Published by Elsevier B.V.

Perceptual “vowel spaces” of cochlear implant users: Implications for the study of auditory adaptation to spectral shift

PubMed Central

Harnsberger, James D.; Svirsky, Mario A.; Kaiser, Adam R.; Pisoni, David B.; Wright, Richard; Meyer, Ted A.

2012-01-01

Cochlear implant (CI) users differ in their ability to perceive and recognize speech sounds. Two possible reasons for such individual differences may lie in their ability to discriminate formant frequencies or to adapt to the spectrally shifted information presented by cochlear implants, a basalward shift related to the implant’s depth of insertion in the cochlea. In the present study, we examined these two alternatives using a method-of-adjustment (MOA) procedure with 330 synthetic vowel stimuli varying in F1 and F2 that were arranged in a two-dimensional grid. Subjects were asked to label the synthetic stimuli that matched ten monophthongal vowels in visually presented words. Subjects then provided goodness ratings for the stimuli they had chosen. The subjects’ responses to all ten vowels were used to construct individual perceptual “vowel spaces.” If CI users fail to adapt completely to the basalward spectral shift, then the formant frequencies of their vowel categories should be shifted lower in both F1 and F2. However, with one exception, no systematic shifts were observed in the vowel spaces of CI users. Instead, the vowel spaces differed from one another in the relative size of their vowel categories. The results suggest that differences in formant frequency discrimination may account for the individual differences in vowel perception observed in cochlear implant users. PMID:11386565

The Use of Voice Cues for Speaker Gender Recognition in Cochlear Implant Recipients

ERIC Educational Resources Information Center

Meister, Hartmut; Fürsen, Katrin; Streicher, Barbara; Lang-Roth, Ruth; Walger, Martin

2016-01-01

Purpose: The focus of this study was to examine the influence of fundamental frequency (F0) and vocal tract length (VTL) modifications on speaker gender recognition in cochlear implant (CI) recipients for different stimulus types. Method: Single words and sentences were manipulated using isolated or combined F0 and VTL cues. Using an 11-point…

Lexical and Grammatical Development in a Child with Cochlear Implant and Attention Deficit: A Case Study

ERIC Educational Resources Information Center

Moreno-Torres, Ignacio; Torres, Santiago; Santana, Rafael

2010-01-01

This is the first study to explore lexical and grammatical development in a deaf child diagnosed with Attention Deficit Hyperactivity Disorder, Inattentive sub-type (ADHDI). The child, whose family language was Spanish, was fitted with a cochlear implant (CI) when she was 18 months old. ADHDI, for which she was prescribed medication, was diagnosed…

Perception and Confusion of Speech Sounds by Adults with a Cochlear Implant

ERIC Educational Resources Information Center

Rodvik, Arne K.

2008-01-01

The aim of this pilot study was to identify the most common speech sound confusions of 5 Norwegian cochlear implanted post-lingually deafened adults. We played recorded nonwords, aCa, iCi and bVb, to our informants, asked them to repeat what they heard, recorded their repetitions and transcribed these phonetically. We arranged the collected data…

Consonant Cluster Production in Children with Cochlear Implants: A Comparison with Normally Hearing Peers

ERIC Educational Resources Information Center

Faes, Jolien; Gillis, Steven

2017-01-01

In early word productions, the same types of errors are manifest in children with cochlear implants (CI) as in their normally hearing (NH) peers with respect to consonant clusters. However, the incidence of those types and their longitudinal development have not been examined or quantified in the literature thus far. Furthermore, studies on the…

Perception of Suprasegmental Speech Features via Bimodal Stimulation: Cochlear Implant on One Ear and Hearing Aid on the Other

ERIC Educational Resources Information Center

Most, Tova; Harel, Tamar; Shpak, Talma; Luntz, Michal

2011-01-01

Purpose: The purpose of the study was to evaluate the contribution of acoustic hearing to the perception of suprasegmental features by adults who use a cochlear implant (CI) and a hearing aid (HA) in opposite ears. Method: 23 adults participated in this study. Perception of suprasegmental features--intonation, syllable stress, and word…

Picture-Elicited Written Narratives, Process and Product, in 18 Children with Cochlear Implants

ERIC Educational Resources Information Center

Asker-Arnason, Lena; Ibertsson, Tina; Wass, Malin; Wengelin, Asa; Sahlen, Birgitta

2010-01-01

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…

Use of Telehealth for Research and Clinical Measures in Cochlear Implant Recipients: A Validation Study

ERIC Educational Resources Information Center

Hughes, Michelle L.; Goehring, Jenny L.; Baudhuin, Jacquelyn L.; Diaz, Gina R.; Sanford, Todd; Harpster, Roger; Valente, Daniel L.

2012-01-01

Purpose: The goal of this study was to compare clinical and research-based cochlear implant (CI) measures using telehealth versus traditional methods. Method: This prospective study used an ABA design (A = laboratory, B = remote site). All measures were made twice per visit for the purpose of assessing within-session variability. Twenty-nine adult…

Academic Outcomes for School-Aged Children with Severe-Profound Hearing Loss and Early Unilateral and Bilateral Cochlear Implants

ERIC Educational Resources Information Center

Sarant, Julia Z.; Harris, David C.; Bennet, Lisa A.

2015-01-01

Purpose: This study sought to (a) determine whether academic outcomes for children who received early cochlear implants (CIs) are age appropriate, (b) determine whether bilateral CI use significantly improves academic outcomes, and (c) identify other factors that are predictive of these outcomes. Method: Forty-four 8-year-old children with…

Spatial Release from Masking in Adults with Bilateral Cochlear Implants: Effects of Distracter Azimuth and Microphone Location

ERIC Educational Resources Information Center

Davis, Timothy J.; Gifford, René H.

2018-01-01

Purpose: The primary purpose of this study was to derive spatial release from masking (SRM) performance-azimuth functions for bilateral cochlear implant (CI) users to provide a thorough description of SRM as a function of target/distracter spatial configuration. The secondary purpose of this study was to investigate the effect of the microphone…

Early speech perception in Mandarin-speaking children at one-year post cochlear implantation.

PubMed

Chen, Yuan; Wong, Lena L N; Zhu, Shufeng; Xi, Xin

2016-01-01

The aim in this study was to examine early speech perception outcomes in Mandarin-speaking children during the first year of cochlear implant (CI) use. A hierarchical early speech perception battery was administered to 80 children before and 3, 6, and 12 months after implantation. Demographic information was obtained to evaluate its relationship with these outcomes. Regardless of dialect exposure and whether a hearing aid was trialed before implantation, implant recipients were able to attain similar pre-lingual auditory skills after 12 months of CI use. Children speaking Mandarin developed early Mandarin speech perception faster than those with greater exposure to other Chinese dialects. In addition, children with better pre-implant hearing levels and younger age at implantation attained significantly better speech perception scores after 12 months of CI use. Better pre-implant hearing levels and higher maternal education level were also associated with a significantly steeper growth in early speech perception ability. Mandarin-speaking children with CIs are able to attain early speech perception results comparable to those of their English-speaking counterparts. In addition, consistent single language input via CI probably enhances early speech perception development at least during the first-year of CI use. Copyright © 2015 Elsevier Ltd. All rights reserved.

The intensity-pitch relation revisited: monopolar versus bipolar cochlear stimulation.

PubMed

Arnoldner, Christoph; Riss, Dominik; Kaider, Alexandra; Mair, Alois; Wagenblast, Jens; Baumgartner, Wolf-Dieter; Gstöttner, Wolfgang; Hamzavi, Jafar-Sasan

2008-09-01

The very high speech perception scores now being achieved with cochlear implants have led to demands for similar levels of achievement in music perception and perception in noisy environments. One of the crucial factors in these fields is pitch perception. The aim of the present study was to investigate the extent to which pitch perception is influenced by the intensity of the stimulus, through the use of different stimulation modes (monopolar, bipolar) and different electrodes (lateral and perimodiolar). Sixteen postlingually deafened patients with an average implant use of 3.1 years were included in this study. All patients were using a Cochlear (CI24M, CI24R, CI24RE) cochlear implant. Subjects were asked to compare the pitch of an intensity-constant reference tone with the pitch of a test tone of varying intensity. The test was repeated for apical, mediocochlear, and basal channel locations, and also for monopolar and bipolar stimulation. It was found that in monopolar stimulation 87.5% and in bipolar stimulation 85.7% of the patients perceived a clear pitch change with changing intensity of the stimulus (Spearman correlation coefficients r < -0.3 or r > 0.3, respectively). A total of 73.1% of these patients perceived lower pitches with increasing intensity, 26.9% reported the opposite effect. No statistically significant difference in the intensity-pitch correlation could be found between mono- and bipolar stimulation. Neither the mean dynamic range nor the type of electrode used was found to be related to the correlation coefficient. Although the majority of today's cochlear implant recipients perform well and the intensity-pitch relation in cochlear implant recipients is still poorly understood, rising demands on speech-coding strategies may soon make a compensation of the pitch shifts desirable. Although the results of our study tend to argue against a peripheral mechanism, the exact origin of this phenomenon remains unclear.

Effect of age at cochlear implantation on auditory and speech development of children with auditory neuropathy spectrum disorder.

PubMed

Liu, Yuying; Dong, Ruijuan; Li, Yuling; Xu, Tianqiu; Li, Yongxin; Chen, Xueqing; Gong, Shusheng

2014-12-01

To evaluate the auditory and speech abilities in children with auditory neuropathy spectrum disorder (ANSD) after cochlear implantation (CI) and determine the role of age at implantation. Ten children participated in this retrospective case series study. All children had evidence of ANSD. All subjects had no cochlear nerve deficiency on magnetic resonance imaging and had used the cochlear implants for a period of 12-84 months. We divided our children into two groups: children who underwent implantation before 24 months of age and children who underwent implantation after 24 months of age. Their auditory and speech abilities were evaluated using the following: behavioral audiometry, the Categories of Auditory Performance (CAP), the Meaningful Auditory Integration Scale (MAIS), the Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS), the Standard-Chinese version of the Monosyllabic Lexical Neighborhood Test (LNT), the Multisyllabic Lexical Neighborhood Test (MLNT), the Speech Intelligibility Rating (SIR) and the Meaningful Use of Speech Scale (MUSS). All children showed progress in their auditory and language abilities. The 4-frequency average hearing level (HL) (500Hz, 1000Hz, 2000Hz and 4000Hz) of aided hearing thresholds ranged from 17.5 to 57.5dB HL. All children developed time-related auditory perception and speech skills. Scores of children with ANSD who received cochlear implants before 24 months tended to be better than those of children who received cochlear implants after 24 months. Seven children completed the Mandarin Lexical Neighborhood Test. Approximately half of the children showed improved open-set speech recognition. Cochlear implantation is helpful for children with ANSD and may be a good optional treatment for many ANSD children. In addition, children with ANSD fitted with cochlear implants before 24 months tended to acquire auditory and speech skills better than children fitted with cochlear implants after 24 months. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Cochlear's unique electrode portfolio now and in the future.

PubMed

von Wallenberg, E; Briggs, R

2014-05-01

To review Cochlear's electrode portfolio and discuss the merits of current and future straight and perimodiolar electrode arrays. To present an update on implant reliability. Performance and hearing preservation data from studies involving the Slim Straight (CI422), Hybrid L24 and Contour Advance electrode array were reviewed. While several studies in past found little difference in performance outcomes between subjects implanted with perimodiolar and straight arrays, recent studies demonstrated that proximity to the modiolus is correlated with better performance. Hearing threshold increase was lowest with the Hybrid L24, closely followed by the slim straight array and was largest with the Contour Advance array. The CI24RE receiver-stimulator used for the three arrays had a cumulative survival of 99% at eight years post implantation. Combining the hearing preservation benefits of slim straight arrays with perimodiolar proximity is the design objective of Cochlear's next generation electrodes.

The use of fundamental frequency for lexical segmentation in listeners with cochlear implants.

PubMed

Spitzer, Stephanie; Liss, Julie; Spahr, Tony; Dorman, Michael; Lansford, Kaitlin

2009-06-01

Fundamental frequency (F0) variation is one of a number of acoustic cues normal hearing listeners use for guiding lexical segmentation of degraded speech. This study examined whether F0 contour facilitates lexical segmentation by listeners fitted with cochlear implants (CIs). Lexical boundary error patterns elicited under unaltered and flattened F0 conditions were compared across three groups: listeners with conventional CI, listeners with CI and preserved low-frequency acoustic hearing, and normal hearing listeners subjected to CI simulations. Results indicate that all groups attended to syllabic stress cues to guide lexical segmentation, and that F0 contours facilitated performance for listeners with low-frequency hearing.

Auditory Speech Perception Development in Relation to Patient's Age with Cochlear Implant

PubMed Central

Ciscare, Grace Kelly Seixas; Mantello, Erika Barioni; Fortunato-Queiroz, Carla Aparecida Urzedo; Hyppolito, Miguel Angelo; Reis, Ana Cláudia Mirândola Barbosa dos

2017-01-01

Introduction  A cochlear implant in adolescent patients with pre-lingual deafness is still a debatable issue. Objective  The objective of this study is to analyze and compare the development of auditory speech perception in children with pre-lingual auditory impairment submitted to cochlear implant, in different age groups in the first year after implantation. Method  This is a retrospective study, documentary research, in which we analyzed 78 reports of children with severe bilateral sensorineural hearing loss, unilateral cochlear implant users of both sexes. They were divided into three groups: G1, 22 infants aged less than 42 months; G2, 28 infants aged between 43 to 83 months; and G3, 28 older than 84 months. We collected medical record data to characterize the patients, auditory thresholds with cochlear implants, assessment of speech perception, and auditory skills. Results  There was no statistical difference in the association of the results among groups G1, G2, and G3 with sex, caregiver education level, city of residence, and speech perception level. There was a moderate correlation between age and hearing aid use time, age and cochlear implants use time. There was a strong correlation between age and the age cochlear implants was performed, hearing aid use time and age CI was performed. Conclusion  There was no statistical difference in the speech perception in relation to the patient's age when cochlear implant was performed. There were statistically significant differences for the variables of auditory deprivation time between G3 - G1 and G2 - G1 and hearing aid use time between G3 - G2 and G3 - G1. PMID:28680487

Discrimination of intonation contours by adolescents with cochlear implants.

PubMed

Holt, Colleen M; McDermott, Hugh J

2013-12-01

Differences in fundamental frequency (F0) contour peak alignment contribute to the perception of pitch accents in speech intonation. The present study assessed the discrimination of differences in F0 contour peak alignment by adolescent users of cochlear implants (CIs). In Experiment 1, subjects discriminated between rise-fall F0 contours located early in the syllable and those aligned late. Recorded utterances with manipulated F0 were used as stimuli and all subjects wore a unilateral CI. In Experiment 2, bilaterally-implanted subjects repeated Experiment 1 in the bilateral condition. Twenty-one CI users aged 12-21 years participated. A normally-hearing control group (n = 20) also completed Experiment 1. Listeners with normal hearing (NH) could discriminate between F0 peaks differing by 80 ms or more. Results varied among the CI users, with only four users displaying a pattern of results similar to that of the NH listeners. Sixteen CI users responded inconsistently or at chance levels (p > 0.05; binomial test). Ten CI users who were bilaterally implanted completed the tests in unilateral and bilateral listening conditions. Results suggest that CI users may have difficulty discriminating between F0 alignment and that use of bilateral implants did not provide an advantage to discrimination.

Consonant Acquisition in Young Cochlear Implant Recipients and Their Typically Developing Peers

PubMed Central

Jung, Jongmin; Ertmer, David J.

2017-01-01

Purpose Consonant acquisition was examined in 13 young cochlear implant (CI) recipients and 11 typically developing (TD) children. Method A longitudinal research design was implemented to determine the rate and nature of consonant acquisition during the first 2 years of robust hearing experience. Twenty-minute adult–child (typically a parent) interactions were video and audio recorded at 3-month intervals following implantation until 24 months of robust hearing experience was achieved. TD children were similarly recorded between 6 and 24 months of age. Consonants that were produced twice within a 50-utterance sample were considered “established” within a child's consonant inventory. Results Although the groups showed similar trajectories, the CI group produced larger consonant inventories than the TD group at each interval except for 21 and 24 months. A majority of children with CIs also showed more rapid acquisition of consonants and more diverse consonant inventories than TD children. Conclusions These results suggest that early auditory deprivation does not significantly affect consonant acquisition for most CI recipients. Tracking early consonant development appears to be a useful way to assess the effectiveness of cochlear implantation in young recipients. PMID:28474085

Bilingualism: A Pearl to Overcome Certain Perils of Cochlear Implants

PubMed Central

Humphries, Tom; Kushalnagar, Poorna; Mathur, Gaurav; Napoli, Donna Jo; Padden, Carol; Rathmann, Christian; Smith, Scott

2014-01-01

Cochlear implants (CI) have demonstrated success in improving young deaf children’s speech and low-level speech awareness across a range of auditory functions, but this success is highly variable, and how this success correlates to high-level language development is even more variable. Prevalence on the success rate of CI as an outcome for language development is difficult to obtain because studies vary widely in methodology and variables of interest, and because not all cochlear implant technology (which continues to evolve) is the same. Still, even if the notion of treatment failure is limited narrowly to those who gain no auditory benefit from CI in that they cannot discriminate among ambient noises, the reported treatment failure rate is high enough to call into question the current lack of consideration of alternative approaches to ensure young deaf children’s language development. Recent research has highlighted the risks of delaying language input during critical periods of brain development with concomitant consequences for cognitive and social skills. As a result, we propose that before, during, and after implantation deaf children learn a sign language along with a spoken language to ensure their maximal language development and optimal long-term developmental outcomes. PMID:25419095

A semi-supervised Support Vector Machine model for predicting the language outcomes following cochlear implantation based on pre-implant brain fMRI imaging.

PubMed

Tan, Lirong; Holland, Scott K; Deshpande, Aniruddha K; Chen, Ye; Choo, Daniel I; Lu, Long J

2015-12-01

We developed a machine learning model to predict whether or not a cochlear implant (CI) candidate will develop effective language skills within 2 years after the CI surgery by using the pre-implant brain fMRI data from the candidate. The language performance was measured 2 years after the CI surgery by the Clinical Evaluation of Language Fundamentals-Preschool, Second Edition (CELF-P2). Based on the CELF-P2 scores, the CI recipients were designated as either effective or ineffective CI users. For feature extraction from the fMRI data, we constructed contrast maps using the general linear model, and then utilized the Bag-of-Words (BoW) approach that we previously published to convert the contrast maps into feature vectors. We trained both supervised models and semi-supervised models to classify CI users as effective or ineffective. Compared with the conventional feature extraction approach, which used each single voxel as a feature, our BoW approach gave rise to much better performance for the classification of effective versus ineffective CI users. The semi-supervised model with the feature set extracted by the BoW approach from the contrast of speech versus silence achieved a leave-one-out cross-validation AUC as high as 0.97. Recursive feature elimination unexpectedly revealed that two features were sufficient to provide highly accurate classification of effective versus ineffective CI users based on our current dataset. We have validated the hypothesis that pre-implant cortical activation patterns revealed by fMRI during infancy correlate with language performance 2 years after cochlear implantation. The two brain regions highlighted by our classifier are potential biomarkers for the prediction of CI outcomes. Our study also demonstrated the superiority of the semi-supervised model over the supervised model. It is always worthwhile to try a semi-supervised model when unlabeled data are available.

Deeper Cochlear Implant Electrode Insertion Angle Improves Detection of Musical Sound Quality Deterioration Related to Bass Frequency Removal.

PubMed

Roy, Alexis T; Penninger, Richard T; Pearl, Monica S; Wuerfel, Waldemar; Jiradejvong, Patpong; Carver, Courtney; Buechner, Andreas; Limb, Charles J

2016-02-01

Cochlear implant (CI) electrode arrays typically do not reach the most apical regions of the cochlea that intrinsically encode low frequencies. This may contribute to diminished implant-mediated musical sound quality perception. The objective of this study was to assess the effect of varying degrees of apical cochlear stimulation (measured by angular insertion depth) on musical sound quality discrimination. Increased apical cochlear stimulation will improve low-frequency perception and musical sound quality discrimination. Standard (31.5 mm, n = 17) and medium (24 mm, n = 8) array Med-EL CI users, and normal hearing (NH) listeners (n = 16) participated. Imaging confirmed angular insertion depth. Participants completed a musical discrimination task in which they listened to a real-world musical stimulus (labeled reference) and provided sound quality ratings to versions of the reference, which included a hidden reference and test stimuli with increasing amounts of low-frequency removal. Scores for each CI users were calculated on the basis of how much their ratings differed from NH listeners for each stimulus version. Medium array and standard users had significantly different insertion depths (389.4 ± 64.5 and 583.9 ± 78.5 degrees, respectively; p <  .001). A significant Pearson's correlation was observed between angular insertion depth and the hidden reference scores (p < 0.05). CI users with greater apical stimulation made sound quality discriminations that more closely resembled those of NH controls for stimuli that contained low frequencies (< 200 Hz of information). These findings suggest that increased apical cochlear stimulation improves musical low-frequency perception, which may provide a more satisfactory music listening experience for CI users.

Productivity of lexical categories in French-speaking children with cochlear implants.

PubMed

Le Normand, M-T; Ouellet, C; Cohen, H

2003-11-01

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.

[Technical advancements in cochlear implants : State of the art].

PubMed

Büchner, A; Gärtner, L

2017-04-01

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.

Identifying Children With Poor Cochlear Implantation Outcomes Using Massively Parallel Sequencing

PubMed Central

Wu, Chen-Chi; Lin, Yin-Hung; Liu, Tien-Chen; Lin, Kai-Nan; Yang, Wei-Shiung; Hsu, Chuan-Jen; Chen, Pei-Lung; Wu, Che-Ming

2015-01-01

Abstract Cochlear implantation is currently the treatment of choice for children with severe to profound hearing impairment. However, the outcomes with cochlear implants (CIs) vary significantly among recipients. The purpose of the present study is to identify the genetic determinants of poor CI outcomes. Twelve children with poor CI outcomes (the “cases”) and 30 “matched controls” with good CI outcomes were subjected to comprehensive genetic analyses using massively parallel sequencing, which targeted 129 known deafness genes. Audiological features, imaging findings, and auditory/speech performance with CIs were then correlated to the genetic diagnoses. We identified genetic variants which are associated with poor CI outcomes in 7 (58%) of the 12 cases; 4 cases had bi-allelic PCDH15 pathogenic mutations and 3 cases were homozygous for the DFNB59 p.G292R variant. Mutations in the WFS1, GJB3, ESRRB, LRTOMT, MYO3A, and POU3F4 genes were detected in 7 (23%) of the 30 matched controls. The allele frequencies of PCDH15 and DFNB59 variants were significantly higher in the cases than in the matched controls (both P < 0.001). In the 7 CI recipients with PCDH15 or DFNB59 variants, otoacoustic emissions were absent in both ears, and imaging findings were normal in all 7 implanted ears. PCDH15 or DFNB59 variants are associated with poor CI performance, yet children with PCDH15 or DFNB59 variants might show clinical features indistinguishable from those of other typical pediatric CI recipients. Accordingly, genetic examination is indicated in all CI candidates before operation. PMID:26166082

Voice emotion recognition by cochlear-implanted children and their normally-hearing peers

PubMed Central

Chatterjee, Monita; Zion, Danielle; Deroche, Mickael L.; Burianek, Brooke; Limb, Charles; Goren, Alison; Kulkarni, Aditya M.; Christensen, Julie A.

2014-01-01

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

[The Heidelberg CI database module : Quality control in hearing restoration with cochlear implants].

PubMed

Herisanu, I T; Hoth, S; Praetorius, M

2016-12-01

Cochlear implants (CI) have been established as the therapy of choice for functional deafness. The number of CI-rehabilitated patients is continuously growing. The resulting data can provide important information for physicians, health insurance companies, and scientists. Assessment and structuring of data becomes more feasible with the application of modern database systems. In collaboration with Innoforce Est., Liechtenstein, the authors developed a database module for the specific needs of CI patients. Data of 100 patients were included and evaluated. The main features of the module and an example data analysis are presented. Analysis of data from these 100 patients reveals 50 men and 50 women aged between 1 and 87 years, with a maximum value in the 51-60-years age group. More than 50% of the patients were also severely hearing impaired in the contralateral ear and fitted the CI indication criteria. Functional deafness in the ear subsequently fitted with CI in most of the patients had arisen more than 20 years previously. Preoperative diagnostic electrical stimulation of the cochlear nerve was positive in 67 patients. All 100 patients perceived auditory sensations with the CI. The presented patient cohort is representative of patients at the Department of Otorhinolaryngology, University of Heidelberg Medical Center, Germany, and the demographic distribution is in accordance with the literature. The state of the contralateral ear, often also fitting the CI indication, is not surprising, as cochlear implantation is a comparatively new procedure. Preoperative electrical stimulation turned out not to be significant by itself. The hearing results and overview of complications were easy to calculate in comparison to a pure data storage system such as i.s.h.med.

The development of intonation in young children with cochlear implants: A preliminary study of the influence of age at implantation and length of implant experience

PubMed Central

Snow, David; Ertmer, David

2010-01-01

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

Case report: traumatic displacement of a cochlear implant magnet.

PubMed

Keereweer, Stijn; Van der Schroeff, Marc P; Pullens, Bas

2014-04-01

To date, over 200 000 cochlear implants (CIs) have been implanted worldwide and the incidence is still increasing. We present a case of traumatic displacement of CI magnet to raise awareness about this complication and to highlight the need for vigilance during surgery as well as for proper counseling. The clinical presentation of a 1.5-year-old boy with a traumatic displacement of a CI magnet was presented and the literature was reviewed for this rare complication. After minor head injury, the sound processor could no longer connect to the CI. X-ray imaging demonstrated displacement of the CI magnet. During revision surgery, the magnet was replaced by a new magnet in the silicon holding cap. Intraoperative impedance measurements were normal and the CI was successfully activated 4 weeks postoperatively. Clinicians and patients should be aware of the risk of displacement of the CI magnet after (minor) head injury. Young boys tend to have a higher risk for this complication.

Trimodal speech perception: how residual acoustic hearing supplements cochlear-implant consonant recognition in the presence of visual cues.

PubMed

Sheffield, Benjamin M; Schuchman, Gerald; Bernstein, Joshua G W

2015-01-01

As cochlear implant (CI) acceptance increases and candidacy criteria are expanded, these devices are increasingly recommended for individuals with less than profound hearing loss. As a result, many individuals who receive a CI also retain acoustic hearing, often in the low frequencies, in the nonimplanted ear (i.e., bimodal hearing) and in some cases in the implanted ear (i.e., hybrid hearing) which can enhance the performance achieved by the CI alone. However, guidelines for clinical decisions pertaining to cochlear implantation are largely based on expectations for postsurgical speech-reception performance with the CI alone in auditory-only conditions. A more comprehensive prediction of postimplant performance would include the expected effects of residual acoustic hearing and visual cues on speech understanding. An evaluation of auditory-visual performance might be particularly important because of the complementary interaction between the speech information relayed by visual cues and that contained in the low-frequency auditory signal. The goal of this study was to characterize the benefit provided by residual acoustic hearing to consonant identification under auditory-alone and auditory-visual conditions for CI users. Additional information regarding the expected role of residual hearing in overall communication performance by a CI listener could potentially lead to more informed decisions regarding cochlear implantation, particularly with respect to recommendations for or against bilateral implantation for an individual who is functioning bimodally. Eleven adults 23 to 75 years old with a unilateral CI and air-conduction thresholds in the nonimplanted ear equal to or better than 80 dB HL for at least one octave frequency between 250 and 1000 Hz participated in this study. Consonant identification was measured for conditions involving combinations of electric hearing (via the CI), acoustic hearing (via the nonimplanted ear), and speechreading (visual cues). The results suggest that the benefit to CI consonant-identification performance provided by the residual acoustic hearing is even greater when visual cues are also present. An analysis of consonant confusions suggests that this is because the voicing cues provided by the residual acoustic hearing are highly complementary with the mainly place-of-articulation cues provided by the visual stimulus. These findings highlight the need for a comprehensive prediction of trimodal (acoustic, electric, and visual) postimplant speech-reception performance to inform implantation decisions. The increased influence of residual acoustic hearing under auditory-visual conditions should be taken into account when considering surgical procedures or devices that are intended to preserve acoustic hearing in the implanted ear. This is particularly relevant when evaluating the candidacy of a current bimodal CI user for a second CI (i.e., bilateral implantation). Although recent developments in CI technology and surgical techniques have increased the likelihood of preserving residual acoustic hearing, preservation cannot be guaranteed in each individual case. Therefore, the potential gain to be derived from bilateral implantation needs to be weighed against the possible loss of the benefit provided by residual acoustic hearing.

Reading and Reading-Related Skills in Children Using Cochlear Implants: Prospects for the Influence of Cued Speech

ERIC Educational Resources Information Center

Bouton, Sophie; Bertoncini, Josiane; Serniclaes, Willy; Cole, Pascale

2011-01-01

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…

Functional Near-Infrared Spectroscopy Brain Imaging Investigation of Phonological Awareness and Passage Comprehension Abilities in Adult Recipients of Cochlear Implants

ERIC Educational Resources Information Center

Bisconti, Silvia; Shulkin, Masha; Hu, Xiaosu; Basura, Gregory J.; Kileny, Paul R.; Kovelman, Ioulia

2016-01-01

Purpose: The aim of this study was to examine how the brains of individuals with cochlear implants (CIs) respond to spoken language tasks that underlie successful language acquisition and processing. Method: During functional near-infrared spectroscopy imaging, CI recipients with hearing impairment (n = 10, mean age: 52.7 ± 17.3 years) and…

Objective and Subjective Measures of Simultaneous vs Sequential Bilateral Cochlear Implants in Adults: A Randomized Clinical Trial.

PubMed

Kraaijenga, Véronique J C; Ramakers, Geerte G J; Smulders, Yvette E; van Zon, Alice; Stegeman, Inge; Smit, Adriana L; Stokroos, Robert J; Hendrice, Nadia; Free, Rolien H; Maat, Bert; Frijns, Johan H M; Briaire, Jeroen J; Mylanus, E A M; Huinck, Wendy J; Van Zanten, Gijsbert A; Grolman, Wilko

2017-09-01

To date, no randomized clinical trial on the comparison between simultaneous and sequential bilateral cochlear implants (BiCIs) has been performed. To investigate the hearing capabilities and the self-reported benefits of simultaneous BiCIs compared with those of sequential BiCIs. A multicenter randomized clinical trial was conducted between January 12, 2010, and September 2, 2012, at 5 tertiary referral centers among 40 participants eligible for BiCIs. Main inclusion criteria were postlingual severe to profound hearing loss, age 18 to 70 years, and a maximum duration of 10 years without hearing aid use in both ears. Data analysis was conducted from May 24 to June 12, 2016. The simultaneous BiCI group received 2 cochlear implants during 1 surgical procedure. The sequential BiCI group received 2 cochlear implants with an interval of 2 years between implants. First, the results 1 year after receiving simultaneous BiCIs were compared with the results 1 year after receiving sequential BiCIs. Second, the results of 3 years of follow-up for both groups were compared separately. The primary outcome measure was speech intelligibility in noise from straight ahead. Secondary outcome measures were speech intelligibility in noise from spatially separated sources, speech intelligibility in silence, localization capabilities, and self-reported benefits assessed with various hearing and quality of life questionnaires. Nineteen participants were randomized to receive simultaneous BiCIs (11 women and 8 men; median age, 52 years [interquartile range, 36-63 years]), and another 19 participants were randomized to undergo sequential BiCIs (8 women and 11 men; median age, 54 years [interquartile range, 43-64 years]). Three patients did not receive a second cochlear implant and were unavailable for follow-up. Comparable results were found 1 year after simultaneous or sequential BiCIs for speech intelligibility in noise from straight ahead (difference, 0.9 dB [95% CI, -3.1 to 4.4 dB]) and all secondary outcome measures except for localization with a 30° angle between loudspeakers (difference, -10% [95% CI, -20.1% to 0.0%]). In the sequential BiCI group, all participants performed significantly better after the BiCIs on speech intelligibility in noise from spatially separated sources and on all localization tests, which was consistent with most of the participants' self-reported hearing capabilities. Speech intelligibility-in-noise results improved in the simultaneous BiCI group up to 3 years following the BiCIs. This study shows comparable objective and subjective hearing results 1 year after receiving simultaneous BiCIs and sequential BiCIs with an interval of 2 years between implants. It also shows a significant benefit of sequential BiCIs over a unilateral cochlear implant. Until 3 years after receiving simultaneous BiCIs, speech intelligibility in noise significantly improved compared with previous years. trialregister.nl Identifier: NTR1722.

[Audiophonological evaluation of 16 children fitted with cochlear implants for sensorineural hearing loss induced by bacterial meningitis].

PubMed

Teissier, N; Doehring, I; Noel-Petroff, N; Elmaleh-Bergès, M; Viala, P; François, M; Faye, A; Van Den Abbeele, T; Lorrot, M

2013-06-01

Bacterial meningitis (BM) is the primary etiology of acquired sensorineural hearing loss (SNHL) in children and may compromise language development. Since the 1990 s, cochlear implants (CIs) have become part of the management of children with profound SNHL with encouraging results. The aim of this study was to analyze the audiophonological performance of children before and after cochlear implantation for SNHL following bacterial meningitis. Retrospective study of all children fitted with CIs for bilateral severe to profound SNHL after bacterial meningitis in the Robert-Debré pediatric ENT department between August 1990 and March 2009. Audiophonological performance was assessed using the APCEI profile. Of the 283 children receiving implants during that period, 16 children (6%; 6 boys, 10 girls) underwent CI implantation after bacterial meningitis (Streptococcus pneumoniae in 8 cases, Neisseria meningitidis in 2 cases, and Haemophilus influenzae in 4 cases). The mean time from meningitis to SNHL was 8.3 months (median, 1.5 months; range, 1 day to 13 years). The mean time from meningitis to cochlear implantation was 2 years and 3 months (median, 7 months; range, 1 month to 13 years 3 months). Twelve children (75%) presented partial cochlear and/or vestibular ossification on presurgical CT scan. Three children received bilateral implants. Thirteen children (81%) developed early SNHL in the first 3 months, whereas 3 children developed SNHL more than 10 months after meningitis. As for the benefits of cochlear implantation, 11 children presented near to normal intelligibility and optimal use of their cochlear implant; 5 children presented partial benefits due to neurological sequelae (1), a long delay before implantation (1), technical problems (2), or a social problem in relation to low socioeconomic status (1). After bacterial meningitis, audiological evaluation must be made carefully during the first 3 months to detect early SNHL, but SNHL may also develop several years later. In case of profound SNHL and a modified signal of the labyrinth on the MRI, cochlear implantation must be performed without delay before cochlear and/or vestibular ossification. Cochlear implantation is an effective technique with good long-term audiologic results. The coexistence of neurological lesions may compromise the results, but it should not contraindicate a cochlear implantation. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Assessment of the Speech Intelligibility Performance of Post Lingual Cochlear Implant Users at Different Signal-to-Noise Ratios Using the Turkish Matrix Test.

PubMed

Polat, Zahra; Bulut, Erdoğan; Ataş, Ahmet

2016-09-01

Spoken word recognition and speech perception tests in quiet are being used as a routine in assessment of the benefit which children and adult cochlear implant users receive from their devices. Cochlear implant users generally demonstrate high level performances in these test materials as they are able to achieve high level speech perception ability in quiet situations. Although these test materials provide valuable information regarding Cochlear Implant (CI) users' performances in optimal listening conditions, they do not give realistic information regarding performances in adverse listening conditions, which is the case in the everyday environment. The aim of this study was to assess the speech intelligibility performance of post lingual CI users in the presence of noise at different signal-to-noise ratio with the Matrix Test developed for Turkish language. Cross-sectional study. The thirty post lingual implant user adult subjects, who had been using implants for a minimum of one year, were evaluated with Turkish Matrix test. Subjects' speech intelligibility was measured using the adaptive and non-adaptive Matrix Test in quiet and noisy environments. The results of the study show a correlation between Pure Tone Average (PTA) values of the subjects and Matrix test Speech Reception Threshold (SRT) values in the quiet. Hence, it is possible to asses PTA values of CI users using the Matrix Test also. However, no correlations were found between Matrix SRT values in the quiet and Matrix SRT values in noise. Similarly, the correlation between PTA values and intelligibility scores in noise was also not significant. Therefore, it may not be possible to assess the intelligibility performance of CI users using test batteries performed in quiet conditions. The Matrix Test can be used to assess the benefit of CI users from their systems in everyday life, since it is possible to perform intelligibility test with the Matrix test using a material that CI users experience in their everyday life and it is possible to assess their difficulty in speech discrimination in noisy conditions they have to cope with.

Reverberation negatively impacts musical sound quality for cochlear implant users.

PubMed

Roy, Alexis T; Vigeant, Michelle; Munjal, Tina; Carver, Courtney; Jiradejvong, Patpong; Limb, Charles J

2015-09-01

Satisfactory musical sound quality remains a challenge for many cochlear implant (CI) users. In particular, questionnaires completed by CI users suggest that reverberation due to room acoustics can negatively impact their music listening experience. The objective of this study was to more specifically characterize of the effect of reverberation on musical sound quality in CI users, normal hearing (NH) non-musicians, and NH musicians using a previously designed assessment method, called Cochlear Implant-MUltiple Stimulus with Hidden Reference and Anchor (CI-MUSHRA). In this method, listeners were randomly presented with an anechoic musical segment and five-versions of this segment in which increasing amounts of reverberation were artificially added. Participants listened to the six reverberation versions and provided sound quality ratings between 0 (very poor) and 100 (excellent). Results demonstrated that on average CI users and NH non-musicians preferred the sound quality of anechoic versions to more reverberant versions. In comparison, NH musicians could be delineated into those who preferred the sound quality of anechoic pieces and those who preferred pieces with some reverberation. This is the first study, to our knowledge, to objectively compare the effects of reverberation on musical sound quality ratings in CI users. These results suggest that musical sound quality for CI users can be improved by non-reverberant listening conditions and musical stimuli in which reverberation is removed.

Vocabulary development in Mandarin-speaking children with cochlear implants and its relationship with speech perception abilities.

PubMed

Chen, Yuan; Wong, Lena L N; Zhu, Shufeng; Xi, Xin

2017-01-01

China has the largest population of children with hearing impairments and cochlear implantation is gaining popularity there. However, the vocabulary development in this population is largely unexplored. This study examined early vocabulary outcomes, factors influencing early vocabulary development and the relationship between speech perception and vocabulary development in Mandarin-speaking children during the first year of cochlear implant use. A battery of vocabulary tests was administered to 80 children before implantation and 3, 6, and 12 months after implantation. Demographic information was obtained to evaluate their relationships with vocabulary outcomes. The Mandarin-speaking children, who received their cochlear implants before 3 years of age, developed vocabulary at a rate faster than that of their same-aged peers with normal hearing. Better pre-implant hearing levels, younger age at implantation, and higher maternal education level contributed to the early vocabulary development. The trajectories of speech perception development highly correlated with those of vocabulary development during 3 to 12 months of CI use. and Implications: These findings imply that the vocabulary development of children implanted before 3 years of age may catch up with that of their hearing peers. Copyright © 2016 Elsevier Ltd. All rights reserved.

Focused tight dressing does not prevent cochlear implant magnet migration under 1.5 Tesla MRI.

PubMed

Cuda, D; Murri, A; Succo, G

2013-04-01

We report a retrospective case of inner magnet migration, which occurred after 1.5 Tesla MRI scanning in an adult recipient of a bilateral cochlear implant (CI) despite a focused head dressing. The patient, bilaterally implanted with Nucleus 5 CIs (Cochlear LTD, Sydney, Australia), underwent a 1.5 Tesla cholangio-MRI scan for biliary duct pathology. In subsequent days, a focal skin alteration appeared over the left inner coil. Plain skull radiographs showed partial magnet migration on the left side. Surgical exploration confirmed magnet twisting; the magnet was effectively repositioned. Left CI performance was restored to pre-migration level. The wound healed without complications. Thus, focused dressing does not prevent magnet migration in CI recipients undergoing 1.5 Tesla MRI. All patients should be counselled on this potential complication. A minor surgical procedure is required to reposition the magnet. Nevertheless, timely diagnosis is necessary to prevent skin breakdown and subsequent device contamination. Plain skull radiograph is very effective in identifying magnet twisting; it should be performed systematically after MRI or minimally on all suspected cases.

Monaural or binaural sound deprivation in postlingual hearing loss: Cochlear implant in the worse ear.

PubMed

Canale, Andrea; Dalmasso, Giulia; Dagna, Federico; Lacilla, Michelangelo; Montuschi, Carla; Rosa, Rosalba Di; Albera, Roberto

2016-08-01

To determine whether speech recognition scores (SRS) differ between adults with long-term auditory deprivation in the implanted ear and adults who received cochlear implant (CI) in the nonsound-deprived ear, either for hearing aid-assisted or due to rapidly deteriorating hearing loss. Retrospective study. Speech recognition scores at evaluations (3 and 14 months postimplantation) conducted with CI alone at 60-dB sound pressure level intensity were compared in 15 patients (4 with bilateral severe hearing loss; 11 with asymmetric hearing loss, 7 of which had contralateral hearing aid), all with long-term auditory deprivation (mean duration 16.9 years) (group A), and in 15 other patients with postlingual hearing loss (10 symmetric, 5 asymmetric with bimodal stimulation) (controls, group B). Comparison of mean percentage of correctly recognized words on speech audiometry at 3 and 14 months showed improvement within each group (P < 0.05). Between-group comparison showed no significant difference at 3 (P = 0.17) or 14 months (P = 0.46). Comparison of SRSs in group A (bimodal stimulation [n = 7] and binaural sound deprivation [n = 4]) versus group B showed no significant differences at 3 (bimodal stimulation P = 0.16; binaural sound deprivation P = 0.19) or 14 months (bimodal stimulation P = 0.14; binaural sound deprivation P = 0.82). Speech recognition scores in monaural and binaural sound-deprived ears did not significantly differ from ears with unilateral cochlear implantation in nonsound-deprived ears when tested with CI alone. Improvement in the implanted worse ear indicates that it could be a potential candidate ear for cochlear implantation even when sound deprived. 4. Laryngoscope, 126:1905-1910, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

Pilot study on the use of data mining to identify cochlear implant candidates.

PubMed

Grisel, Jedidiah J; Schafer, Erin; Lam, Anne; Griffin, Terry

2018-05-01

The goal of this pilot study was to determine the clinical utility of data-mining software that screens for cochlear implant (CI) candidacy. The Auditory Implant Initiative developed a software module that screens for CI candidates via integration with a software system (Noah 4) that serves as a depository for hearing test data. To identify candidates, patient audiograms from one practice were exported into the screening module. Candidates were tracked to determine if any eventually underwent implantation. After loading 4836 audiograms from the Noah 4 system, the screening module identified 558 potential CI candidates. After reviewing the data for the potential candidates, 117 were targeted and invited to an educational event. Following the event, a total of six candidates were evaluated, and two were implanted. This objective approach to identifying candidates has the potential to address the gross underutilization of CIs by removing any bias or lack of knowledge regarding the management of severe to profound sensorineural hearing loss with CIs. The screening module was an effective tool for identifying potential CI candidates at one ENT practice. On a larger scale, the screening module has the potential to impact thousands of CI candidates worldwide.

Speech perception scores in cochlear implant recipients: An analysis of ceiling effects in the CUNY sentence test (Quiet) in post-lingually deafened cochlear implant recipients.

PubMed

Ebrahimi-Madiseh, Azadeh; Eikelboom, Robert H; Jayakody, Dona Mp; Atlas, Marcus D

2016-01-01

To evaluate the clinical utility of the City University of New York sentence test in a cohort of post-lingually deafened cochlear implants recipients over time. 117 post-lingually deafened, Australian English-speaking CI recipients aged between 23 and 98 years (M = 66 years; SD = 15.09) were recruited. CUNY sentence test scores in quiet were collated and analysed at two cut-offs, 95% and 100%, as ceiling scores. CUNY sentence scores ranged from 4% to 100% (M = 86.75; SD = 20.65), with 38.8% of participants scoring 95% and 16.5% of participants reaching the 100% scores. The percentage of participants reaching the 95% and 100% ceiling scores increased over time (6 and 12 months post-implantation). The distribution of all post-operative CUNY test scores skewed to the right with 82% of test scores reaching above 90%. This study demonstrates that the CUNY test cannot be used as a valid tool to measure the speech perception skills of post-lingually deafened CI recipients over time. This may be overcome by using adaptive test protocols or linguistically, cognitively or contextually demanding test materials. The high percentage of CI recipients achieving ceiling scores for the CUNY sentence test in quiet at 3 months post-implantation, questions the validity of using CUNY in CI assessment test battery and limits its application for use in longitudinal studies evaluating CI outcomes. Further studies are required to examine different methods to overcome this problem.

Understanding minds: early cochlear implantation and the development of theory of mind in children with profound hearing impairment.

PubMed

Sundqvist, Annette; Lyxell, Björn; Jönsson, Radoslava; Heimann, Mikael

2014-03-01

The present study investigates how auditory stimulation from cochlear implants (CI) is associated with the development of Theory of Mind (ToM) in severely and profoundly hearing impaired children with hearing parents. Previous research has shown that deaf children of hearing parents have a delayed ToM development. This is, however, not always the case with deaf children of deaf parents, who presumably are immersed in a more vivid signing environment. Sixteen children with CI (4.25 to 9.5 years of age) were tested on measures of cognitive and emotional ToM, language and cognition. Eight of the children received their first implant relatively early (before 27 months) and half of them late (after 27 months). The two groups did not differ in age, gender, language or cognition at entry of the study. ToM tests included the unexpected location task and a newly developed Swedish social-emotional ToM test. The tests aimed to test both cognitive and emotional ToM. A comparison group of typically developing hearing age matched children was also added (n=18). Compared to the comparison group, the early CI-group did not differ in emotional ToM. The late CI-group differed significantly from the comparison group on both the cognitive and emotional ToM tests. The results revealed that children with early cochlear implants solved ToM problems to a significantly higher degree than children with late implants, although the groups did not differ on language or cognitive measures at baseline. The outcome suggests that early cochlear implantation for deaf children in hearing families, in conjunction with early social and communicative stimulation in a language that is native to the parents, can provide a foundation for a more normalized ToM development. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Morpho-syntactic reading comprehension in children with early and late cochlear implants.

PubMed

López-Higes, Ramón; Gallego, Carlos; Martín-Aragoneses, María Teresa; Melle, Natalia

2015-04-01

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. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Barriers to early cochlear implantation.

PubMed

Dettman, Shani; Choo, Dawn; Dowell, Richard

2016-01-01

Identify variables associated with paediatric access to cochlear implants (CIs). Part 1. Trends over time for age at CI surgery (N = 802) and age at hearing aid (HA) fitting (n = 487) were examined with regard to periods before, during, and after newborn hearing screening (NHS). Part 2. Demographic factors were explored for 417 children implanted under 3 years of age. Part 3. Pre-implant steps for the first 20 children to receive CIs under 12 months were examined. Part 1. Age at HA fitting and CI surgery reduced over time, and were associated with NHS implementation. Part 2. For children implanted under 3 years, earlier age at HA fitting and higher family socio-economic status were associated with earlier CI. Progressive hearing loss was associated with later CIs. Children with a Connexin 26 diagnosis received CIs earlier than children with a premature / low birth weight history. Part 3. The longest pre-CI steps were Step 1: Birth to diagnosis/identification of hearing loss (mean 16.43 weeks), and Step 11: MRI scans to implant surgery (mean 15.05 weeks) for the first 20 infants with CIs under 12 months. NHS implementation was associated with reductions in age at device intervention in this cohort.

Reading skills in Persian deaf children with cochlear implants and hearing aids.

PubMed

Rezaei, Mohammad; Rashedi, Vahid; Morasae, Esmaeil Khedmati

2016-10-01

Reading skills are necessary for educational development in children. Many studies have shown that children with hearing loss often experience delays in reading. This study aimed to examine reading skills of Persian deaf children with cochlear implant and hearing aid and compare them with normal hearing counterparts. The sample consisted of 72 s and third grade Persian-speaking children aged 8-12 years. They were divided into three equal groups including 24 children with cochlear implant (CI), 24 children with hearing aid (HA), and 24 children with normal hearing (NH). Reading performance of participants was evaluated by the "Nama" reading test. "Nama" provides normative data for hearing and deaf children and consists of 10 subtests and the sum of the scores is regarded as reading performance score. Results of ANOVA on reading test showed that NH children had significantly better reading performance than deaf children with CI and HA in both grades (P < 0.001). Post-hoc analysis, using Tukey test, indicated that there was no significant difference between HA and CI groups in terms of non-word reading, word reading, and word comprehension skills (respectively, P = 0.976, P = 0.988, P = 0.998). Considering the findings, cochlear implantation is not significantly more effective than hearing aid for improvement of reading abilities. It is clear that even with considerable advances in hearing aid technology, many deaf children continue to find literacy a challenging struggle. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Auditory Cortical Maturation in a Child with Cochlear Implant: Analysis of Electrophysiological and Behavioral Measures

PubMed Central

Silva, Liliane Aparecida Fagundes; Couto, Maria Inês Vieira; Tsuji, Robinson Koji; Bento, Ricardo Ferreira; de Carvalho, Ana Claudia Martinho; Matas, Carla Gentile

2015-01-01

The purpose of this study was to longitudinally assess the behavioral and electrophysiological hearing changes of a girl inserted in a CI program, who had bilateral profound sensorineural hearing loss and underwent surgery of cochlear implantation with electrode activation at 21 months of age. She was evaluated using the P1 component of Long Latency Auditory Evoked Potential (LLAEP); speech perception tests of the Glendonald Auditory Screening Procedure (GASP); Infant Toddler Meaningful Auditory Integration Scale (IT-MAIS); and Meaningful Use of Speech Scales (MUSS). The study was conducted prior to activation and after three, nine, and 18 months of cochlear implant activation. The results of the LLAEP were compared with data from a hearing child matched by gender and chronological age. The results of the LLAEP of the child with cochlear implant showed gradual decrease in latency of the P1 component after auditory stimulation (172 ms–134 ms). In the GASP, IT-MAIS, and MUSS, gradual development of listening skills and oral language was observed. The values of the LLAEP of the hearing child were expected for chronological age (132 ms–128 ms). The use of different clinical instruments allow a better understanding of the auditory habilitation and rehabilitation process via CI. PMID:26881163

Noise reduction technologies implemented in head-worn preprocessors for improving cochlear implant performance in reverberant noise fields.

PubMed

Chung, King; Nelson, Lance; Teske, Melissa

2012-09-01

The purpose of this study was to investigate whether a multichannel adaptive directional microphone and a modulation-based noise reduction algorithm could enhance cochlear implant performance in reverberant noise fields. A hearing aid was modified to output electrical signals (ePreprocessor) and a cochlear implant speech processor was modified to receive electrical signals (eProcessor). The ePreprocessor was programmed to flat frequency response and linear amplification. Cochlear implant listeners wore the ePreprocessor-eProcessor system in three reverberant noise fields: 1) one noise source with variable locations; 2) three noise sources with variable locations; and 3) eight evenly spaced noise sources from 0° to 360°. Listeners' speech recognition scores were tested when the ePreprocessor was programmed to omnidirectional microphone (OMNI), omnidirectional microphone plus noise reduction algorithm (OMNI + NR), and adaptive directional microphone plus noise reduction algorithm (ADM + NR). They were also tested with their own cochlear implant speech processor (CI_OMNI) in the three noise fields. Additionally, listeners rated overall sound quality preferences on recordings made in the noise fields. Results indicated that ADM+NR produced the highest speech recognition scores and the most preferable rating in all noise fields. Factors requiring attention in the hearing aid-cochlear implant integration process are discussed. Copyright © 2012 Elsevier B.V. All rights reserved.

Cochlear Implantation After Partial or Subtotal Cochleoectomy for Intracochlear Schwannoma Removal-A Technical Report.

PubMed

Plontke, Stefan K; Kösling, Sabrina; Rahne, Torsten

2018-03-01

To describe the technique for surgical tumor removal, cochlear implant (CI) electrode placement and reconstruction of the surgical defect in patients with intracochlear schwannomas. Retrospective case review. Tertiary referral center. Ten patients (five men, five women, mean age 48 ± 12 yr) with profound or severe to profound hearing loss due to intralabyrinthine schwannomas with intracochlear location. Surgical tumor removal through extended round window approach, partial or subtotal cochleoectomy with or without labyrinthectomy and reconstruction of the surgical defect with cartilage, perichondrium or temporal muscle fascia, and bone pâté. Eight patients received a cochlear implant in the same procedure. Retrospective evaluation of clinical outcome including safety aspects (adverse events) and audiological performance at early follow up in cases of cochlear implantation. The tumor was successfully removed in all cases without macroscopic (operation microscope and endoscope) tumor remnants in the bony labyrinth apart from one case with initial transmodiolar growth. One patient needed revision surgery for labyrinthine fistula. At short-term follow up (3-month post-surgery), good hearing results with the cochlear implant were obtained in all but one patient with a word recognition score of 100% for numbers, and 64 ± 14% for monosyllables (at 65 dB SPL in quiet). Surgical tumor removal and cochlear implantation is a promising treatment strategy in the management of intralabyrinthine schwannoma with intracochlear location, further extending the indication range for cochlear implantation. It is, however, of importance to observe the long-term outcome in these patients and to address challenges like follow up with magnetic resonance imaging.

[Music therapy in adults with cochlear implants : Effects on music perception and subjective sound quality].

PubMed

Hutter, E; Grapp, M; Argstatter, H

2016-12-01

People with severe hearing impairments and deafness can achieve good speech comprehension using a cochlear implant (CI), although music perception often remains impaired. A novel concept of music therapy for adults with CI was developed and evaluated in this study. This study included 30 adults with a unilateral CI following postlingual deafness. The subjective sound quality of the CI was rated using the hearing implant sound quality index (HISQUI) and musical tests for pitch discrimination, melody recognition and timbre identification were applied. As a control 55 normally hearing persons also completed the musical tests. In comparison to normally hearing subjects CI users showed deficits in the perception of pitch, melody and timbre. Specific effects of therapy were observed in the subjective sound quality of the CI, in pitch discrimination into a high and low pitch range and in timbre identification, while general learning effects were found in melody recognition. Music perception shows deficits in CI users compared to normally hearing persons. After individual music therapy in the rehabilitation process, improvements in this delicate area could be achieved.

Cochlear implantation in the world's largest medical device market: utilization and awareness of cochlear implants in the United States.

PubMed

Sorkin, Donna L

2013-03-01

Provision of cochlear implants (CIs) for those within the criteria for implantation remains lower in the United States than in some other developed nations. When adults and children are grouped together, the rate of utilization/provision remains low at around 6%. For children, the provision rate is about 50% of those who could benefit from an implant, compared with figures of about 90% for the Flanders part of Belgium, the United Kingdom and other European countries. The probable reasons for this underprovision include: low awareness of the benefits of CIs among the population; low awareness among health-care professionals; the lack of specific referral pathways; some political issues relating to the Deaf Community; and financial issues related to health provision. Such financial issues result in situations which either fail to provide for access to implants or provide too low a level of the necessary funding, especially for low-income individuals covered by public health-care programs such as Medicaid. These issues might be mitigated by adoption and publication of standards for best clinical practices for CI provision, availability of current cost-effectiveness data, and the existence of an organization dedicated to cochlear implantation. Such an organization, the American Cochlear Implant Alliance (ACI Alliance), was recently organized and is described in the paper by Niparko et al. in this Supplement.

An Acoustic Analysis of the Vowel Space in Young and Old Cochlear-Implant Speakers

ERIC Educational Resources Information Center

Neumeyer, Veronika; Harrington, Jonathan; Draxler, Christoph

2010-01-01

The main purpose of this study was to compare acoustically the vowel spaces of two groups of cochlear implantees (CI) with two age-matched normal hearing groups. Five young test persons (15-25 years) and five older test persons (55-70 years) with CI and two control groups of the same age with normal hearing were recorded. The speech material…

Hearing history influences voice gender perceptual performance in cochlear implant users.

PubMed

Kovačić, Damir; Balaban, Evan

2010-12-01

The study was carried out to assess the role that five hearing history variables (chronological age, age at onset of deafness, age of first cochlear implant [CI] activation, duration of CI use, and duration of known deafness) play in the ability of CI users to identify speaker gender. Forty-one juvenile CI users participated in two voice gender identification tasks. In a fixed, single-interval task, subjects listened to a single speech item from one of 20 adult male or 20 adult female speakers and had to identify speaker gender. In an adaptive speech-based voice gender discrimination task with the fundamental frequency difference between the voices as the adaptive parameter, subjects listened to a pair of speech items presented in sequential order, one of which was always spoken by an adult female and the other by an adult male. Subjects had to identify the speech item spoken by the female voice. Correlation and regression analyses between perceptual scores in the two tasks and the hearing history variables were performed. Subjects fell into three performance groups: (1) those who could distinguish voice gender in both tasks, (2) those who could distinguish voice gender in the adaptive but not the fixed task, and (3) those who could not distinguish voice gender in either task. Gender identification performance for single voices in the fixed task was significantly and negatively related to the duration of deafness before cochlear implantation (shorter deafness yielded better performance), whereas performance in the adaptive task was weakly but significantly related to age at first activation of the CI device, with earlier activations yielding better scores. The existence of a group of subjects able to perform adaptive discrimination but unable to identify the gender of singly presented voices demonstrates the potential dissociability of the skills required for these two tasks, suggesting that duration of deafness and age of cochlear implantation could have dissociable effects on the development of different skills required by CI users to identify speaker gender.

Music enjoyment with cochlear implantation.

PubMed

Prevoteau, Charlotte; Chen, Stephanie Y; Lalwani, Anil K

2018-10-01

Since the advent of cochlear implant (CI) surgery in the 1960s, there have been remarkable technological and surgical advances enabling excellent speech perception in quiet with many CI users able to use the telephone. However, many CI users struggle with music perception, particularly with the pitch-based and melodic elements of music. Yet remarkably, despite poor music perception, many CI users enjoy listening to music based on self-report questionnaires, and prospective studies have suggested a disassociation between music perception and enjoyment. Music enjoyment is arguably a more functional measure of one's listening experience, and thus enhancing one's listening experience is a worthy goal. Recent studies have shown that re-engineering music to reduce its complexity may enhance enjoyment in CI users and also delineate differences in musical preferences from normal hearing listeners. Copyright © 2017 Elsevier B.V. All rights reserved.

Speech understanding in noise with the Roger Pen, Naida CI Q70 processor, and integrated Roger 17 receiver in a multi-talker network.

PubMed

De Ceulaer, Geert; Bestel, Julie; Mülder, Hans E; Goldbeck, Felix; de Varebeke, Sebastien Pierre Janssens; Govaerts, Paul J

2016-05-01

Roger is a digital adaptive multi-channel remote microphone technology that wirelessly transmits a speaker's voice directly to a hearing instrument or cochlear implant sound processor. Frequency hopping between channels, in combination with repeated broadcast, avoids interference issues that have limited earlier generation FM systems. This study evaluated the benefit of the Roger Pen transmitter microphone in a multiple talker network (MTN) for cochlear implant users in a simulated noisy conversation setting. Twelve post-lingually deafened adult Advanced Bionics CII/HiRes 90K recipients were recruited. Subjects used a Naida CI Q70 processor with integrated Roger 17 receiver. The test environment simulated four people having a meal in a noisy restaurant, one the CI user (listener), and three companions (talkers) talking non-simultaneously in a diffuse field of multi-talker babble. Speech reception thresholds (SRTs) were determined without the Roger Pen, with one Roger Pen, and with three Roger Pens in an MTN. Using three Roger Pens in an MTN improved the SRT by 14.8 dB over using no Roger Pen, and by 13.1 dB over using a single Roger Pen (p < 0.0001). The Roger Pen in an MTN provided statistically and clinically significant improvement in speech perception in noise for Advanced Bionics cochlear implant recipients. The integrated Roger 17 receiver made it easy for users of the Naida CI Q70 processor to take advantage of the Roger system. The listening advantage and ease of use should encourage more clinicians to recommend and fit Roger in adult cochlear implant patients.

The role of eABR with intracochlear test electrode in decision making between cochlear and brainstem implants: preliminary results.

PubMed

Cinar, Betul Cicek; Yarali, Mehmet; Atay, Gamze; Bajin, Munir Demir; Sennaroglu, Gonca; Sennaroglu, Levent

2017-09-01

The objective of the study was to discuss the findings of intraoperative electrically evoked auditory brainstem response (eABR) test results with a recently designed intracochlear test electrode (ITE) in terms of their relation to decisions of cochlear or auditory brainstem implantation. This clinical study was conducted in Hacettepe University, Department of Otolaryngology, Head and Neck Surgery and Department of Audiology. Subjects were selected from inner ear malformation (IEM) database. Eleven subjects with profound sensorineural hearing loss were included in the current study with age range from 1 year 3 months to 4 years 3 months for children with prelingual hearing loss. There was only one 42-year-old post-lingual subject. eABR was recorded with an ITE and intraoperatively with an original cochlear implant (CI) electrode in 11 cases with different IEMs. Findings of eABR with ITE and their relation to the decision for CI or auditory brainstem implant (ABI) are discussed. Positive eABR test results were found to be dependent on close to normal cochlear structures and auditory nerve. The probability of positive result decreases with increasing degree of malformation severity. The prediction value of eABR via ITE on decision for hearing restoration was found to be questionable in this study. The results of eABR with ITE have predictive value on what we will get with the actual CI electrode. ITE appears to stimulate the cochlea like an actual CI. If the eABR is positive, the results are reliable. However, if eABR is negative, the results should be evaluated with preoperative audiological testing and MRI findings.

[The contribution of different cochlear insertion region to Mandarin speech perception in users of cochlear implant].

PubMed

Qi, Beier; Liu, Bo; Liu, Sha; Liu, Haihong; Dong, Ruijuan; Zhang, Ning; Gong, Shusheng

2011-05-01

To study the effect of cochlear electrode coverage and different insertion region on speech recognition, especially tone perception of cochlear implant users whose native language is Mandarin Chinese. Setting seven test conditions by fitting software. All conditions were created by switching on/off respective channels in order to simulate different insertion position. Then Mandarin CI users received 4 Speech tests, including Vowel Identification test, Consonant Identification test, Tone Identification test-male speaker, Mandarin HINT test (SRS) in quiet and noise. To all test conditions: the average score of vowel identification was significantly different, from 56% to 91% (Rank sum test, P < 0.05). The average score of consonant identification was significantly different, from 72% to 85% (ANOVNA, P < 0.05). The average score of Tone identification was not significantly different (ANOVNA, P > 0.05). However the more channels activated, the higher scores obtained, from 68% to 81%. This study shows that there is a correlation between insertion depth and speech recognition. Because all parts of the basement membrane can help CI users to improve their speech recognition ability, it is very important to enhance verbal communication ability and social interaction ability of CI users by increasing insertion depth and actively stimulating the top region of cochlear.

An Objective Estimation of Air-Bone-Gap in Cochlear Implant Recipients with Residual Hearing Using Electrocochleography.

PubMed

Koka, Kanthaiah; Saoji, Aniket A; Attias, Joseph; Litvak, Leonid M

2017-01-01

Although, cochlear implants (CI) traditionally have been used to treat individuals with bilateral profound sensorineural hearing loss, a recent trend is to implant individuals with residual low-frequency hearing. Notably, many of these individuals demonstrate an air-bone gap (ABG) in low-frequency, pure-tone thresholds following implantation. An ABG is the difference between audiometric thresholds measured using air conduction (AC) and bone conduction (BC) stimulation. Although, behavioral AC thresholds are straightforward to assess, BC thresholds can be difficult to measure in individuals with severe-to-profound hearing loss because of vibrotactile responses to high-level, low-frequency stimulation and the potential contribution of hearing in the contralateral ear. Because of these technical barriers to measuring behavioral BC thresholds in implanted patients with residual hearing, it would be helpful to have an objective method for determining ABG. This study evaluated an innovative technique for measuring electrocochleographic (ECochG) responses using the cochlear microphonic (CM) response to assess AC and BC thresholds in implanted patients with residual hearing. Results showed high correlations between CM thresholds and behavioral audiograms for AC and BC conditions, thereby demonstrating the feasibility of using ECochG as an objective tool for quantifying ABG in CI recipients.

[Correlation between the thresholds acquired with ASSR and sbjective thresholds in cochlear implants in prelingually deaf children].

PubMed

Wang, Z; Gu, J; Jiang, X J

2017-04-20

Objective: To learn the relationship between the auditory steady state responses(ASSR)threshold and C-level and behavior T-level in cochlear implants in prelingually deaf children. Method: One hundred and twelve children with Nucleus CI24R(CA) cochlear implants were divided into residual hearing group and no residual hearing group on the basis of the results of ASSR before operation in this study.Compare the difference between the two groups in C-level and behavior T-level one year after operation. Result: There was difference in C-level and behavior T-level between residual hearing group and no residual hearing group( P <0.05 or P <0.01). Conclusion: According to the results of ASSR before operation,we can estimate the effect of cochlear implants,providing reference for the selection of choosing operating ears,and providing a reasonable expectation for physicians and parents of the patients. Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.

Adequate formal language performance in unilateral cochlear implanted children: is it indicative of complete recovery in all linguistic domains? Insights from referential communication.

PubMed

Mancini, Patrizia; Dincer D'Alessandro, Hilal; Guerzoni, Letizia; Cuda, Domenico; Ruoppolo, Giovanni; Musacchio, Angela; Di Mario, Alessia; De Seta, Elio; Bosco, Ersilia; Nicastri, Maria

2015-04-01

Referential communication (RC) is a key element in achieving a successful communication. This case series aimed to evaluate RC in children with unilateral cochlear implants (CIs) with formal language skills within the normal range. A total of 31 children with CIs, with language development within the normal range, were assessed using the Pragmatic Language Skills test (MEDEA). Of the children with CIs, 83.9% reached performance levels appropriate for their chronological ages. The results confirmed a positive effect of cochlear implantation on RC development, although difficulties remained in some CI users. The outcomes emphasize the need to pay greater attention to the pragmatic aspects of language, assessing them with adequate testing in the early phase after cochlear implantation. Clear knowledge of children's communicative competence is the key in optimizing their communicative environments in order to create the basis for future successful interpersonal exchanges and social integration. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

How Children with Normal Hearing and Children with a Cochlear Implant Use Mentalizing Vocabulary and Other Evaluative Expressions in Their Narratives

ERIC Educational Resources Information Center

Huttunen, Kerttu; Ryder, Nuala

2012-01-01

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…

Social skills and developmental delay: importance in predicting the auditory and speech outcomes after cochlear implantation in children.

PubMed

Chang, Young-Soo; Moon, Il Joon; Kim, Eun Yeon; Ahn, Jungmin; Chung, Won-Ho; Cho, Yang-Sun; Hong, Sung Hwa

2015-02-01

Preoperative evaluation of social interaction and global development levels using the Vineland Social Maturity Scale (VSMS) and Bayley Scales of Infant Development-2nd edition (BSID-II) may be beneficial in predicting the postoperative outcome in pediatric cochlear implant recipients. In particular, cautious preoperative counseling regarding the poor postoperative prognosis may be necessary in children with low social skills and developmental status. To determine the clinical benefit of preoperative evaluation of social interaction and global development levels using VSMS and BSID-II in predicting the postoperative outcome in pediatric cochlear implant recipients. A total of 65 deaf children who underwent cochlear implantation (CI) were included in this study. Age at the time of implantation ranged from 12 to 76 months. All of the children underwent a comprehensive preimplant psychological assessment by a clinical psychologist. The VSMS and BSID-II were used for evaluating social skills and a child's development preoperatively. A social quotient (SQ) was calculated by using the VSMS for each subject using the following formula: (social age/chronological age) × 100. The auditory perception and speech production abilities were evaluated using the Categories of Auditory Performance (CAP) scale and the Korean version of the Ling's stage (K-Ling), respectively, at 1 year after CI. The associations between the preoperative SQ/developmental levels and the postoperative auditory/speech outcomes were evaluated. The mean SQ was significantly decreased in the enrolled children (90.6 ± 26.1). The improvement in CAP score at 1 year after CI was correlated with preoperative SQ. The improvements in phonemic and phonologic levels of K-Ling were correlated with preoperative VSMS and BSID-II scores.

Audio-visual speech perception in prelingually deafened Japanese children following sequential bilateral cochlear implantation.

PubMed

Yamamoto, Ryosuke; Naito, Yasushi; Tona, Risa; Moroto, Saburo; Tamaya, Rinko; Fujiwara, Keizo; Shinohara, Shogo; Takebayashi, Shinji; Kikuchi, Masahiro; Michida, Tetsuhiko

2017-11-01

An effect of audio-visual (AV) integration is observed when the auditory and visual stimuli are incongruent (the McGurk effect). In general, AV integration is helpful especially in subjects wearing hearing aids or cochlear implants (CIs). However, the influence of AV integration on spoken word recognition in individuals with bilateral CIs (Bi-CIs) has not been fully investigated so far. In this study, we investigated AV integration in children with Bi-CIs. The study sample included thirty one prelingually deafened children who underwent sequential bilateral cochlear implantation. We assessed their responses to congruent and incongruent AV stimuli with three CI-listening modes: only the 1st CI, only the 2nd CI, and Bi-CIs. The responses were assessed in the whole group as well as in two sub-groups: a proficient group (syllable intelligibility ≥80% with the 1st CI) and a non-proficient group (syllable intelligibility < 80% with the 1st CI). We found evidence of the McGurk effect in each of the three CI-listening modes. AV integration responses were observed in a subset of incongruent AV stimuli, and the patterns observed with the 1st CI and with Bi-CIs were similar. In the proficient group, the responses with the 2nd CI were not significantly different from those with the 1st CI whereas in the non-proficient group the responses with the 2nd CI were driven by visual stimuli more than those with the 1st CI. Our results suggested that prelingually deafened Japanese children who underwent sequential bilateral cochlear implantation exhibit AV integration abilities, both in monaural listening as well as in binaural listening. We also observed a higher influence of visual stimuli on speech perception with the 2nd CI in the non-proficient group, suggesting that Bi-CIs listeners with poorer speech recognition rely on visual information more compared to the proficient subjects to compensate for poorer auditory input. Nevertheless, poorer quality auditory input with the 2nd CI did not interfere with AV integration with binaural listening (with Bi-CIs). Overall, the findings of this study might be used to inform future research to identify the best strategies for speech training using AV integration effectively in prelingually deafened children. Copyright © 2017 Elsevier B.V. All rights reserved.

Speech Intelligibility in Persian Hearing Impaired Children with Cochlear Implants and Hearing Aids.

PubMed

Rezaei, Mohammad; Emadi, Maryam; Zamani, Peyman; Farahani, Farhad; Lotfi, Gohar

2017-04-01

The aim of present study is to evaluate and compare speech intelligibility in hearing impaired children with cochlear implants (CI) and hearing aid (HA) users and children with normal hearing (NH). The sample consisted of 45 Persian-speaking children aged 3 to 5-years-old. They were divided into three groups, and each group had 15, children, children with CI and children using hearing aids in Hamadan. Participants was evaluated by the test of speech intelligibility level. Results of ANOVA on speech intelligibility test showed that NH children had significantly better reading performance than hearing impaired children with CI and HA. Post-hoc analysis, using Scheffe test, indicated that the mean score of speech intelligibility of normal children was higher than the HA and CI groups; but the difference was not significant between mean of speech intelligibility in children with hearing loss that use cochlear implant and those using HA. It is clear that even with remarkabkle advances in HA technology, many hearing impaired children continue to find speech production a challenging problem. Given that speech intelligibility is a key element in proper communication and social interaction, consequently, educational and rehabilitation programs are essential to improve speech intelligibility of children with hearing loss.

Phonological Awareness and Print Knowledge of Preschool Children with Cochlear Implants

PubMed Central

Ambrose, Sophie E.; Fey, Marc E.; Eisenberg, Laurie S.

2012-01-01

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 24 children with cochlear implants (CIs) and 23 peers with normal hearing (NH), ages 36 to 60 months, participated. Children’s print knowledge, phonological awareness, language, speech production, and speech perception abilities were assessed. Results For phonological awareness, the CI group’s mean score fell within 1 standard deviation of the TOPEL’s normative sample mean but was more than 1 standard deviation below our NH group mean. The CI group’s performance did not differ significantly from that of the NH group for print knowledge. For the CI group, phonological awareness and print knowledge were significantly correlated with language, speech production, and speech perception. Together, these predictor variables accounted for 34% of variance in the CI group’s phonological awareness but no significant variance in their print knowledge. Conclusions Children with CIs have the potential to develop age-appropriate early literacy skills by preschool-age but are likely to lag behind their NH peers in phonological awareness. Intervention programs serving these children should target these skills with instruction and by facilitating speech and language development. PMID:22223887

Understanding music with cochlear implants

PubMed Central

Bruns, Lisa; Mürbe, Dirk; Hahne, Anja

2016-01-01

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

The effects of reverberant self- and overlap-masking on speech recognition in cochlear implant listeners.

PubMed

Desmond, Jill M; Collins, Leslie M; Throckmorton, Chandra S

2014-06-01

Many cochlear implant (CI) listeners experience decreased speech recognition in reverberant environments [Kokkinakis et al., J. Acoust. Soc. Am. 129(5), 3221-3232 (2011)], which may be caused by a combination of self- and overlap-masking [Bolt and MacDonald, J. Acoust. Soc. Am. 21(6), 577-580 (1949)]. Determining the extent to which these effects decrease speech recognition for CI listeners may influence reverberation mitigation algorithms. This study compared speech recognition with ideal self-masking mitigation, with ideal overlap-masking mitigation, and with no mitigation. Under these conditions, mitigating either self- or overlap-masking resulted in significant improvements in speech recognition for both normal hearing subjects utilizing an acoustic model and for CI listeners using their own devices.

Sources of variability in language development of children with cochlear implants: age at implantation, parental language, and early features of children's language construction.

PubMed

Szagun, Gisela; Schramm, Satyam A

2016-05-01

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, implanted between 0;6 and 3;10. Analyses were performed on the combined and separate samples. Regression analyses indicate that early child MLU is the strongest predictor of child MLU two and two-and-a-half years later, followed by parental expansions and age at implantation. Associations between earliest MLU gains and MLU two years later point to stability of individual differences. Early type and token frequencies of determiners predict MLU two years later more strongly than early frequency of lexical words. We conclude that features of CI children's very early language have considerable predictive value for later language outcomes.

Psychosocial Outcomes in Long-Term Cochlear Implant Users.

PubMed

Castellanos, Irina; Kronenberger, William G; Pisoni, David B

The objectives of this study were to investigate psychosocial outcomes in a sample of prelingually deaf, early-implanted children, adolescents, and young adults who are long-term cochlear implant (CI) users and to examine the extent to which language and executive functioning predict psychosocial outcomes. Psychosocial outcomes were measured using two well-validated, parent-completed checklists: the Behavior Assessment System for Children and the Conduct Hyperactive Attention Problem Oppositional Symptom. Neurocognitive skills were measured using gold standard, performance-based assessments of language and executive functioning. CI users were at greater risk for clinically significant deficits in areas related to attention, oppositional behavior, hyperactivity-impulsivity, and social-adaptive skills compared with their normal-hearing peers, although the majority of CI users scored within average ranges relative to Behavior Assessment System for Children norms. Regression analyses revealed that language, visual-spatial working memory, and inhibition-concentration skills predicted psychosocial outcomes. Findings suggest that underlying delays and deficits in language and executive functioning may place some CI users at a risk for difficulties in psychosocial adjustment.

[(Re)habilitation after cochlear implantation].

PubMed

Diller, G

2009-07-01

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.

Auditory Environment Across the Life Span of Cochlear Implant Users: Insights From Data Logging.

PubMed

Busch, Tobias; Vanpoucke, Filiep; van Wieringen, Astrid

2017-05-24

We describe the natural auditory environment of people with cochlear implants (CIs), how it changes across the life span, and how it varies between individuals. We performed a retrospective cross-sectional analysis of Cochlear Nucleus 6 CI sound-processor data logs. The logs were obtained from 1,501 people with CIs (ages 0-96 years). They covered over 2.4 million hr of implant use and indicated how much time the CI users had spent in various acoustical environments. We investigated exposure to spoken language, noise, music, and quiet, and analyzed variation between age groups, users, and countries. CI users spent a substantial part of their daily life in noisy environments. As a consequence, most speech was presented in background noise. We found significant differences between age groups for all auditory scenes. Yet even within the same age group and country, variability between individuals was substantial. Regardless of their age, people with CIs face challenging acoustical environments in their daily life. Our results underline the importance of supporting them with assistive listening technology. Moreover, we found large differences between individuals' auditory diets that might contribute to differences in rehabilitation outcomes. Their causes and effects should be investigated further.

Effects of Electrical Stimulation Rate on Speech Recognition in Cochlear Implant Users

PubMed Central

Park, Sung Hye; Kim, Eunoak; Lee, Hyo-Jeong

2012-01-01

Background and Objectives The stimulus signals delivered in cochlear implant (CI) systems are generally derived by sampling the temporal envelope of each channel at some constant rate and using its intensity to control the stimulation current level delivered to the corresponding electrode site. The objective of the study was to investigate speech recognition performance of cochlear implant users in quiet and noisy environments using either moderate or high rates of electrical stimulations. Materials and Methods Six post-lingually deafened adult users of the Nucleus CI24 cochlear implant (Contour® electrode array, Cochlear™, Macquarie Park, Australia) with the Freedom® speech processor participated in the study. Stimulation rates of 900 and 2400 pulses-per-second/channel (pps/ch) were used after both stimulation programs were balanced for loudness. Monosyllabic word and sentence recognition scores in quiet and noisy environments were evaluated for each stimulation program after two months of practice. Subjects were also asked to respond to a questionnaire to examine their preference to any stimulation rate in different hearing conditions. Results Word recognition scores for monosyllabic words in quiet conditions with the 900 stimulation rate was better than that of the 2400 stimulation rate, although no significant differences between them were found for sentence test in noise. A survey questionnaire indicated that most subjects preferred the 900 stimulation rate to the 2400 stimulation rate, especially in quiet conditions. Conclusions Most subjects indicated a preference for 900 pps/ch rate in quiet conditions. It is recommended to remap at 900 pps/ch for those CI users whose performance in quiet conditions is less than ideal. PMID:24653862

The contribution of visual areas to speech comprehension: a PET study in cochlear implants patients and normal-hearing subjects.

PubMed

Giraud, Anne Lise; Truy, Eric

2002-01-01

Early visual cortex can be recruited by meaningful sounds in the absence of visual information. This occurs in particular in cochlear implant (CI) patients whose dependency on visual cues in speech comprehension is increased. Such cross-modal interaction mirrors the response of early auditory cortex to mouth movements (speech reading) and may reflect the natural expectancy of the visual counterpart of sounds, lip movements. Here we pursue the hypothesis that visual activations occur specifically in response to meaningful sounds. We performed PET in both CI patients and controls, while subjects listened either to their native language or to a completely unknown language. A recruitment of early visual cortex, the left posterior inferior temporal gyrus (ITG) and the left superior parietal cortex was observed in both groups. While no further activation occurred in the group of normal-hearing subjects, CI patients additionally recruited the right perirhinal/fusiform and mid-fusiform, the right temporo-occipito-parietal (TOP) junction and the left inferior prefrontal cortex (LIPF, Broca's area). This study confirms a participation of visual cortical areas in semantic processing of speech sounds. Observation of early visual activation in normal-hearing subjects shows that auditory-to-visual cross-modal effects can also be recruited under natural hearing conditions. In cochlear implant patients, speech activates the mid-fusiform gyrus in the vicinity of the so-called face area. This suggests that specific cross-modal interaction involving advanced stages in the visual processing hierarchy develops after cochlear implantation and may be the correlate of increased usage of lip-reading.

Effects of electrical stimulation rate on speech recognition in cochlear implant users.

PubMed

Park, Sung Hye; Kim, Eunoak; Lee, Hyo-Jeong; Kim, Hyung-Jong

2012-04-01

The stimulus signals delivered in cochlear implant (CI) systems are generally derived by sampling the temporal envelope of each channel at some constant rate and using its intensity to control the stimulation current level delivered to the corresponding electrode site. The objective of the study was to investigate speech recognition performance of cochlear implant users in quiet and noisy environments using either moderate or high rates of electrical stimulations. Six post-lingually deafened adult users of the Nucleus CI24 cochlear implant (Contour® electrode array, Cochlear™, Macquarie Park, Australia) with the Freedom® speech processor participated in the study. Stimulation rates of 900 and 2400 pulses-per-second/channel (pps/ch) were used after both stimulation programs were balanced for loudness. Monosyllabic word and sentence recognition scores in quiet and noisy environments were evaluated for each stimulation program after two months of practice. Subjects were also asked to respond to a questionnaire to examine their preference to any stimulation rate in different hearing conditions. Word recognition scores for monosyllabic words in quiet conditions with the 900 stimulation rate was better than that of the 2400 stimulation rate, although no significant differences between them were found for sentence test in noise. A survey questionnaire indicated that most subjects preferred the 900 stimulation rate to the 2400 stimulation rate, especially in quiet conditions. Most subjects indicated a preference for 900 pps/ch rate in quiet conditions. It is recommended to remap at 900 pps/ch for those CI users whose performance in quiet conditions is less than ideal.

Children’s development of intonation during the first year of cochlear implant experience

PubMed Central

Snow, David P.; Ertmer, David J.

2012-01-01

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

Voice emotion recognition by cochlear-implanted children and their normally-hearing peers.

PubMed

Chatterjee, Monita; Zion, Danielle J; Deroche, Mickael L; Burianek, Brooke A; Limb, Charles J; Goren, Alison P; Kulkarni, Aditya M; Christensen, Julie A

2015-04-01

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. This article is part of a Special Issue entitled . Copyright © 2014 Elsevier B.V. All rights reserved.

Speech intelligibility and subjective benefit in single-sided deaf adults after cochlear implantation.

PubMed

Finke, Mareike; Strauß-Schier, Angelika; Kludt, Eugen; Büchner, Andreas; Illg, Angelika

2017-05-01

Treatment with cochlear implants (CIs) in single-sided deaf individuals started less than a decade ago. CIs can successfully reduce incapacitating tinnitus on the deaf ear and allow, so some extent, the restoration of binaural hearing. Until now, systematic evaluations of subjective CI benefit in post-lingually single-sided deaf individuals and analyses of speech intelligibility outcome for the CI in isolation have been lacking. For the prospective part of this study, the Bern Benefit in Single-Sided Deafness Questionnaire (BBSS) was administered to 48 single-sided deaf CI users to evaluate the subjectively perceived CI benefit across different listening situations. In the retrospective part, speech intelligibility outcome with the CI up to 12 month post-activation was compared between 100 single-sided deaf CI users and 125 bilaterally implanted CI users (2nd implant). The positive median ratings in the BBSS differed significantly from zero for all items suggesting that most individuals with single-sided deafness rate their CI as beneficial across listening situations. The speech perception scores in quiet and noise improved significantly over time in both groups of CI users. Speech intelligibility with the CI in isolation was significantly better in bilaterally implanted CI users (2nd implant) compared to the scores obtained from single-sided deaf CI users. Our results indicate that CI users with single-sided deafness can reach open set speech understanding with their CI in isolation, encouraging the extension of the CI indication to individuals with normal hearing on the contralateral ear. Compared to the performance reached with bilateral CI users' second implant, speech reception threshold are lower, indicating an aural preference and dominance of the normal hearing ear. The results from the BBSS propose good satisfaction with the CI across several listening situations. Copyright © 2017 Elsevier B.V. All rights reserved.

Speech intonation and melodic contour recognition in children with cochlear implants and with normal hearing.

PubMed

See, Rachel L; Driscoll, Virginia D; Gfeller, Kate; Kliethermes, Stephanie; Oleson, Jacob

2013-04-01

Cochlear implant (CI) users have difficulty perceiving some intonation cues in speech and melodic contours because of poor frequency selectivity in the cochlear implant signal. To assess perceptual accuracy of normal hearing (NH) children and pediatric CI users on speech intonation (prosody), melodic contour, and pitch ranking, and to determine potential predictors of outcomes. Does perceptual accuracy for speech intonation or melodic contour differ as a function of auditory status (NH, CI), perceptual category (falling versus rising intonation/contour), pitch perception, or individual differences (e.g., age, hearing history)? NH and CI groups were tested on recognition of falling intonation/contour versus rising intonation/contour presented in both spoken and melodic (sung) conditions. Pitch ranking was also tested. Outcomes were correlated with variables of age, hearing history, HINT, and CNC scores. The CI group was significantly less accurate than the NH group in spoken (CI, M = 63.1%; NH, M = 82.1%) and melodic (CI, M = 61.6%; NH, M = 84.2%) conditions. The CI group was more accurate in recognizing rising contour in the melodic condition compared with rising intonation in the spoken condition. Pitch ranking was a significant predictor of outcome for both groups in falling intonation and rising melodic contour; age at testing and hearing history variables were not predictive of outcomes. Children with CIs were less accurate than NH children in perception of speech intonation, melodic contour, and pitch ranking. However, the larger pitch excursions of the melodic condition may assist in recognition of the rising inflection associated with the interrogative form.

Speech Intonation and Melodic Contour Recognition in Children with Cochlear Implants and with Normal Hearing

PubMed Central

See, Rachel L.; Driscoll, Virginia D.; Gfeller, Kate; Kliethermes, Stephanie; Oleson, Jacob

2013-01-01

Background Cochlear implant (CI) users have difficulty perceiving some intonation cues in speech and melodic contours because of poor frequency selectivity in the cochlear implant signal. Objectives To assess perceptual accuracy of normal hearing (NH) children and pediatric CI users on speech intonation (prosody), melodic contour, and pitch ranking, and to determine potential predictors of outcomes. Hypothesis Does perceptual accuracy for speech intonation or melodic contour differ as a function of auditory status (NH, CI), perceptual category (falling vs. rising intonation/contour), pitch perception, or individual differences (e.g., age, hearing history)? Method NH and CI groups were tested on recognition of falling intonation/contour vs. rising intonation/contour presented in both spoken and melodic (sung) conditions. Pitch ranking was also tested. Outcomes were correlated with variables of age, hearing history, HINT, and CNC scores. Results The CI group was significantly less accurate than the NH group in spoken (CI, M=63.1 %; NH, M=82.1%) and melodic (CI, M=61.6%; NH, M=84.2%) conditions. The CI group was more accurate in recognizing rising contour in the melodic condition compared with rising intonation in the spoken condition. Pitch ranking was a significant predictor of outcome for both groups in falling intonation and rising melodic contour; age at testing and hearing history variables were not predictive of outcomes. Conclusions Children with CIs were less accurate than NH children in perception of speech intonation, melodic contour, and pitch ranking. However, the larger pitch excursions of the melodic condition may assist in recognition of the rising inflection associated with the interrogative form. PMID:23442568

Perception of suprasegmental features of speech by children with cochlear implants and children with hearing AIDS.

PubMed

Most, Tova; Peled, Miriam

2007-01-01

This study assessed perception of suprasegmental features of speech by 30 prelingual children with sensorineural hearing loss. Ten children had cochlear implants (CIs), and 20 children wore hearing aids (HA): 10 with severe hearing loss and 10 with profound hearing loss. Perception of intonation, syllable stress, word emphasis, and word pattern was assessed. Results revealed that the two HA groups significantly outperformed the CI group in perceiving both intonation and stress. Within each group, word pattern was perceived best, and then intonation and emphasis, with syllable stress perceived poorest. No significant correlation emerged between age at implantation and perception of the various suprasegmental features, possibly due to participants' relatively late age at implantation. Results indicated that CI use did not show an advantage over HA use in the perception of suprasegmental features of speech. Future research should continue to explore variables that might improve this perception.

Assessment of auditory skills in 140 cochlear implant children using the EARS protocol.

PubMed

Sainz, Manuel; Skarzynski, Henryk; Allum, John H J; Helms, Jan; Rivas, Adriana; Martin, Jane; Zorowka, Patrick Georg; Phillips, Lucy; Delauney, Joseph; Brockmeyer, Steffi Johanna; Kompis, Martin; Korolewa, Inna; Albegger, Klaus; Zwirner, Petra; Van De Heyning, Paul; D'Haese, Patrick

2003-01-01

Auditory performance of cochlear implant (CI) children was assessed with the Listening Progress Profile (LiP) and the Monosyllabic-Trochee-Polysyllabic-Word Test (MTP) following the EARS protocol. Additionally, the 'initial drop' phenomenon, a recently reported decrease of auditory performance occurring immediately after first fitting, was investigated. Patients were 140 prelingually deafened children from various clinics and centers worldwide implanted with a MEDEL COMBI 40/40+. Analysis of LiP data showed a significant increase after 1 month of CI use compared to preoperative scores (p < 0.01). No initial decrease was observed with this test. Analysis of MTP data revealed a significant improvement of word recognition after 6 months (p < 0.01), with a significant temporary decrease after initial fitting (p < 0.01). With both tests, children's auditory skills improved up to 2 years. Amount of improvement was negatively correlated with age at implantation. Copyright 2003 S. Karger AG, Basel

Using Electrically-evoked Compound Action Potentials to Estimate Perceptive Levels in Experienced Adult Cochlear Implant Users.

PubMed

Joly, Charles-Alexandre; Péan, Vincent; Hermann, Ruben; Seldran, Fabien; Thai-Van, Hung; Truy, Eric

2017-10-01

The cochlear implant (CI) fitting level prediction accuracy of electrically-evoked compound action potential (ECAP) should be enhanced by the addition of demographic data in models. No accurate automated fitting of CI based on ECAP has yet been proposed. We recorded ECAP in 45 adults who had been using MED-EL CIs for more than 11 months and collected the most comfortable loudness level (MCL) used for CI fitting (prog-MCL), perception thresholds (meas-THR), and MCL (meas-MCL) measured with the stimulation used for ECAP recording. Linear mixed models taking into account cochlear site factors were computed to explain prog-MCL, meas-MCL, and meas-THR. Cochlear region and ECAP threshold were predictors of the three levels. In addition, significant predictors were the ECAP amplitude for the prog-MCL and the duration of deafness for the prog-MCL and the meas-THR. Estimations were more accurate for the meas-THR, then the meas-MCL, and finally the prog-MCL. These results show that 1) ECAP thresholds are more closely related to perception threshold than to comfort level, 2) predictions are more accurate when the inter-subject and cochlear regions variations are considered, and 3) differences between the stimulations used for ECAP recording and for CI fitting make it difficult to accurately predict the prog-MCL from the ECAP recording. Predicted prog-MCL could be used as bases for fitting but should be used with care to avoid any uncomfortable or painful stimulation.

Social media utilization in the cochlear implant community.

PubMed

Saxena, Rajeev C; Lehmann, Ashton E; Hight, A Ed; Darrow, Keith; Remenschneider, Aaron; Kozin, Elliott D; Lee, Daniel J

2015-02-01

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. The purpose of this study was to investigate participation of the CI community in social media Websites. 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. Social media sources included Facebook, Twitter, YouTube, blogs, and online forums. Each source was assigned one of six functional categories based on its description. No intervention was performed. We conducted all online searches in February 2014. Total counts of each CI-related social media source were summed, and descriptive statistics were calculated. 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%). 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 endeavors, and sharing of personal experiences. Future studies are needed to investigate how social media Websites may be harnessed to improve patient-provider relationships and potentially used to augment patient education. American Academy of Audiology.

Social Media Utilization in the Cochlear Implant Community

PubMed Central

Saxena, Rajeev C.; Lehmann, Ashton E.; Hight, A. Ed; Darrow, Keith; Remenschneider, Aaron; Kozin, Elliott D.; Lee, Daniel J.

2015-01-01

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 endeavors, and sharing of personal experiences. Future studies are needed to investigate how social media Websites may be harnessed to improve patient-provider relationships and potentially used to augment patient education. PMID:25690778

Prelinguistic Vocal Development in Young Cochlear Implant Recipients and Typically Developing Infants: Year 1 of Robust Hearing Experience

PubMed Central

Ertmer, David J.; Jung, Jongmin

2012-01-01

This investigation examined the time course and sequence of prelinguistic vocal development during the first year of cochlear implant (CI) experience. Thirteen children who were implanted between 8 and 35 months and 11 typically developing (TD) infants participated in this longitudinal study. Adult–child play interactions were video- and audio-recorded at trimonthly intervals for each group, and child utterances were classified into categories representing progressively more mature productions: Precanonical Vocalizations, Basic Canonical Syllables, and Advanced Form vocalizations. Young CI recipients met the 20% criterion for establishment of the Basic Canonical Syllables and Advanced Forms levels with fewer months of robust hearing experience than the TD infants. Most CI recipients followed the sequence of development predicted by the Stark Assessment of Early Vocal Development—Revised. The relatively rapid progress of the CI children suggests that an earlier period of auditory deprivation did not have negative consequences for prelinguistic vocal development. It also supports the notion that young CI recipients comparatively advanced maturity facilitated expeditious auditory-guided speech development. PMID:21586617

Perception of suprasegmental speech features via bimodal stimulation: cochlear implant on one ear and hearing aid on the other.

PubMed

Most, Tova; Harel, Tamar; Shpak, Talma; Luntz, Michal

2011-04-01

The purpose of the study was to evaluate the contribution of acoustic hearing to the perception of suprasegmental features by adults who use a cochlear implant (CI) and a hearing aid (HA) in opposite ears. 23 adults participated in this study. Perception of suprasegmental features-intonation, syllable stress, and word emphasis-was assessed. All tests were administered in 2 conditions: CI alone and CI + HA (bimodal). Scores were significantly higher in the bimodal condition in comparison to scores in CI alone for all 3 tests. In both conditions, there was great variability among the individual participants. Significant negative correlations emerged between perception of suprasegmental features and the unaided pure-tone average of the contralateral ear to the CI. This study found a significant bimodal advantage for perception of all suprasegmental features, most probably due to the better low-frequency acoustic hearing that is provided by the HA. Outcomes suggest that in cases of residual hearing in the contralateral ear to the implanted ear, HA use should be encouraged.

Factors associated with Hearing Loss in a Normal-Hearing Guinea Pig Model of Hybrid Cochlear Implants

PubMed Central

Tanaka, Chiemi; Nguyen-Huynh, Anh; Loera, Katherine; Stark, Gemaine; Reiss, Lina

2014-01-01

The Hybrid cochlear implant (CI), also known as Electro- Acoustic Stimulation (EAS), is a new type of CI that preserves residual acoustic hearing and enables combined cochlear implant and hearing aid use in the same ear. However, 30-55% of patients experience acoustic hearing loss within days to months after activation, suggesting that both surgical trauma and electrical stimulation may cause hearing loss. The goals of this study were to: 1) determine the contributions of both implantation surgery and EAS to hearing loss in a normal-hearing guinea pig model; 2) determine which cochlear structural changes are associated with hearing loss after surgery and EAS. Two groups of animals were implanted (n=6 per group), with one group receiving chronic acoustic and electric stimulation for 10 weeks, and the other group receiving no direct acoustic or electric stimulation during this time frame. A third group (n=6) was not implanted, but received chronic acoustic stimulation. Auditory brainstem response thresholds were followed over time at 1, 2, 6, and 16 kHz. At the end of the study, the following cochlear measures were quantified: hair cells, spiral ganglion neuron density, fibrous tissue density, and stria vascularis blood vessel density; the presence or absence of ossification around the electrode entry was also noted. After surgery, implanted animals experienced a range of 0-55 dB of threshold shifts in the vicinity of the electrode at 6 and 16 kHz. The degree of hearing loss was significantly correlated with reduced stria vascularis vessel density and with the presence of ossification, but not with hair cell counts, spiral ganglion neuron density, or fibrosis area. After 10 weeks of stimulation, 67% of implanted, stimulated animals had more than 10 dB of additional threshold shift at 1 kHz, compared to 17% of implanted, non-stimulated animals and 0% of non-implanted animals. This 1-kHz hearing loss was not associated with changes in any of the cochlear measures quantified in this study. The variation in hearing loss after surgery and electrical stimulation in this animal model is consistent with the variation in human patients. Further, these findings illustrate an advantage of a normal-hearing animal model for quantification of hearing loss and damage to cochlear structures without the confounding effects of chemical- or noise-induced hearing loss. Finally, this study is the first to suggest a role of the stria vascularis and damage to the lateral wall in implantation-induced hearing loss. Further work is needed to determine the mechanisms of implantation- and electrical-stimulation-induced hearing loss. PMID:25128626

Identification of musical instruments by normal-hearing subjects listening through a cochlear-implant simulation

NASA Astrophysics Data System (ADS)

Reich, Rebecca D.; Eddington, Donald

2002-05-01

Signal processing in a cochlear implant (CI) is primarily designed to convey speech and environmental sounds, and can cause distortion of musical timbre. Systematic investigation of musical instrument identification through a CI has not yet revealed how timbre is affected by the implant's processing. In this experiment, the bandpass filtering, rectification, and low-pass filtering of an implant are simulated in MATLAB. Synthesized signals representing 12 common instruments, each performing a major scale, are processed by simulations using up to 8 analysis channels. The unprocessed recordings, together with the 8 simulation conditions for 12 instruments, are presented in random order to each of the subjects. The subject's task is to identify the instrument represented by each item. The subjects also subjectively score each item based on similarity and pleasantness. We anticipate performance using the simulation will be worse than the unprocessed condition because of the limited information delivered by the envelopes of the analysis channels. These results will be analyzed as a confusion matrix and provide a basis for contrasting the information used by subjects listening to the unprocessed and processed materials. Understanding these differences should aid in the development of new processing strategies to better represent music for cochlear implant users.

Single-Center Study Investigating Foreign Language Acquisition at School in Children, Adolescents, and Young Adults With Uni- or Bilateral Cochlear Implants in the Swiss German Population.

PubMed

Beeres-Scheenstra, Renske; Ohnsorg, Claudia; Candreia, Claudia; Heinzmann, Sybille; Castellanos, Susana; De Min, Nicola; Linder, Thomas E

2017-07-01

To evaluate foreign language acquisition at school in cochlear implant patients. Cohort study. CI center. Forty three cochlear implants (CI) patients (10-18 yr) were evaluated. CI nonusers and patients with CI-explantation, incomplete datasets, mental retardation, or concomitant medical disorders were excluded. Additional data (type of schooling, foreign language learning, and bilingualism) were obtained with questionnaires. German-speaking children with foreign tuition language (English and/or French) at school were enrolled for further testing. General patient data, auditory data, and foreign language data from both questionnaires and tests were collected and analyzed. Thirty seven out of 43 questionnaires (86%) were completed. Sixteen (43%) were in mainstream education. Twenty-seven CI users (73%) have foreign language learning at school. Fifteen of these were in mainstream education (55%), others in special schooling. From 10 CI users without foreign language learning, one CI user was in mainstream education (10%) and nine patients (90%) were in special schooling. Eleven German-speaking CI users were further tested in English and six additionally in French. For reading skills, the school objectives for English were reached in 7 of 11 pupils (64%) and for French in 3 of 6 pupils (50%). For listening skills, 3 of 11 pupils (27%) reached the school norm in English and none in French. Almost 75% of our CI users learn foreign language(s) at school. A small majority of the tested CI users reached the current school norm for in English and French in reading skills, whereas for hearing skills most of them were not able to reach the norm.

[The Russian-language version of the matrix test (RUMatrix) in free field in patients after cochlear implantation in the long term].

PubMed

Goykhburg, M V; Bakhshinyan, V V; Petrova, I P; Wazybok, A; Kollmeier, B; Tavartkiladze, G A

The deterioration of speech intelligibility in the patients using cochlear implantation (CI) systems is especially well apparent in the noisy environment. It explains why phrasal speech tests, such as a Matrix sentence test, have become increasingly more popular in the speech audiometry during rehabilitation after CI. The Matrix test allows to estimate speech perception by the patients in a real life situation. The objective of this study was to assess the effectiveness of audiological rehabilitation of CI patients using the Russian-language version of the matrix test (RUMatrix) in free field in the noisy environment. 33 patients aged from 5 to 40 years with a more than 3 year experience of using cochlear implants inserted at the National Research Center for Audiology and Hearing Rehabilitation were included in our study. Five of these patients were implanted bilaterally. The results of our study showed a statistically significant improvement of speech intelligibility in the noisy environment after the speech processor adjustment; dynamics of the signal-to-noise ratio changes was -1.7 dB (p<0.001). The RUMatrix test is a highly efficient method for the estimation of speech intelligibility in the patients undergoing clinical investigations in the noisy environment. The high degree of comparability of the RUMatrix test with the Matrix tests in other languages makes possible its application in international multicenter studies.

Cochlear implantation in children with congenital cytomegalovirus infection accompanied by psycho-neurological disorders.

PubMed

Yamazaki, Hiroshi; Yamamoto, Rinko; Moroto, Saburo; Yamazaki, Tomoko; Fujiwara, Keizo; Nakai, Masako; Ito, Juichi; Naito, Yasushi

2012-04-01

Cochlear implantation was effective for deaf children with congenital cytomegalovirus (CMV) infection, but their cochlear implant (CI) outcomes were often impaired, depending on the types of CMV-associated psycho-neurological disorders. Evaluation of cognitive development and autistic tendency of implantees might be useful to predict their CI outcomes. To reveal the influence of CMV-associated psycho-neurological disorders on CI outcomes. This was a retrospective evaluation of 11 implantees with congenital CMV infection (CMV-CIs) and 14 implantees with autosomal recessive hearing loss (genetic-CIs). Nine of 11 CMV-CIs suffered from psycho-neurological disorders; one from attention deficit hyperactivity disorder, two from pervasive developmental disorder, and six from mental retardation. Aided hearing thresholds with CIs in the two groups did not differ, but two autistic and two mentally retarded CMV-CIs showed significantly low scores in speech discrimination tests. Language-Social (L-S) developmental quotients (DQs) evaluated by the Kyoto Scale of Psychological development were improved after the implantation in both groups, but the postoperative increase of L-S DQs was significantly smaller in the CMV-CIs than that of genetic-CIs. Interestingly, the postoperative L-S and Cognitive-Adaptive (C-A) DQs showed statistically significant correlation in all cases except for two autistic CMV-CIs whose L-S DQs were much lower than those expected from their C-A DQs.

Music therapy as specific and complementary training for adults after cochlear implantation: A pilot study.

PubMed

Hutter, E; Argstatter, H; Grapp, M; Plinkert, P K

2015-09-01

Although cochlear implant (CI) users achieve good speech comprehension, they experience difficulty perceiving music and prosody in speech. As the provision of music training in rehabilitation is limited, a novel concept of music therapy for rehabilitation of adult CI users was developed and evaluated in this pilot study. Twelve unilaterally implanted, postlingually deafened CI users attended ten sessions of individualized and standardized training. The training started about 6 weeks after the initial activation of the speech processor. Before and after therapy, psychological and musical tests were applied in order to evaluate the effects of music therapy. CI users completed the musical tests in two conditions: bilateral (CI + contralateral, unimplanted ear) and unilateral (CI only). After therapy, improvements were observed in the subjective sound quality (Hearing Implant Sound Quality Index) and the global score on the self-concept questionnaire (Multidimensional Self-Concept Scales) as well as in the musical subtests for melody recognition and for timbre identification in the unilateral condition. Discussion Preliminary results suggest improvements in subjective hearing and music perception, with an additional increase in global self-concept and enhanced daily listening capacities. The novel concept of individualized music therapy seems to provide an effective treatment option in the rehabilitation of adult CI users. Further investigations are necessary to evaluate effects in the area of prosody perception and to separate therapy effects from general learning effects in CI rehabilitation.

Complications of cochlear implant surgery: A ten-year experience in a referral hospital in Peru, 2006-2015.

PubMed

Alcas, Olenka; Salazar, Miguel A

2016-09-01

To describe the frequency and characteristics of complications of cochlear implant (CI) surgery at Edgardo Rebagliati Martins Hospital of social security in Lima-Peru between 2006 and 2015. A retrospective descriptive study of patients that underwent CI surgery between August 2006 and December 2015. Among the 107 patients with CIs, the overall proportion of complications was 18.7% (20/107): 14.9% (16/107) of minor complications, and 3.7% (4/107) of major complications. Regarding the time of onset of complications, 2.8% (3/107) were intraoperative and 14% (15/107) postoperative. CI surgery in Peru is a safe procedure with a low frequency of major complications, representing an effective therapy for patients with sensorineural hearing loss who do not respond to hearing aids.

A clinical assessment of cochlear implant recipient performance: implications for individualized map settings in specific environments.

PubMed

Hey, Matthias; Hocke, Thomas; Mauger, Stefan; Müller-Deile, Joachim

2016-11-01

Individual speech intelligibility was measured in quiet and noise for cochlear Implant recipients upgrading from the Freedom to the CP900 series sound processor. The postlingually deafened participants (n = 23) used either Nucleus CI24RE or CI512 cochlear implant, and currently wore a Freedom sound processor. A significant group mean improvement in speech intelligibility was found in quiet (Freiburg monosyllabic words at 50 dB SPL ) and in noise (adaptive Oldenburger sentences in noise) for the two CP900 series SmartSound programs compared to the Freedom program. Further analysis was carried out on individual's speech intelligibility outcomes in quiet and in noise. Results showed a significant improvement or decrement for some recipients when upgrading to the new programs. To further increase speech intelligibility outcomes when upgrading, an enhanced upgrade procedure is proposed that includes additional testing with different signal-processing schemes. Implications of this research are that future automated scene analysis and switching technologies could provide additional performance improvements by introducing individualized scene-dependent settings.

CT findings of the temporal bone in CHARGE syndrome: aspects of importance in cochlear implant surgery.

PubMed

Vesseur, A C; Verbist, B M; Westerlaan, H E; Kloostra, F J J; Admiraal, R J C; van Ravenswaaij-Arts, C M A; Free, R H; Mylanus, E A M

2016-12-01

To provide an overview of anomalies of the temporal bone in CHARGE syndrome relevant to cochlear implantation (CI), anatomical structures of the temporal bone and the respective genotypes were analysed. In this retrospective study, 42 CTs of the temporal bone of 42 patients with CHARGE syndrome were reviewed in consensus by two head-and-neck radiologists and two otological surgeons. Anatomical structures of the temporal bone were evaluated and correlated with genetic data. Abnormalities that might affect CI surgery were seen, such as a vascular structure, a petrosquamosal sinus (13 %), an underdeveloped mastoid (8 %) and an aberrant course of the facial nerve crossing the round window (9 %) and/or the promontory (18 %). The appearance of the inner ear varied widely: in 77 % of patients all semicircular canals were absent and the cochlea varied from normal to hypoplastic. A stenotic cochlear aperture was observed in 37 %. The middle ear was often affected with a stenotic round (14 %) or oval window (71 %). More anomalies were observed in patients with truncating mutations than with non-truncating mutations. Temporal bone findings in CHARGE syndrome vary widely. Vascular variants, aberrant route of the facial nerve, an underdeveloped mastoid, aplasia of the semicircular canals, and stenotic round window may complicate cochlear implantation.

Use of intonation contours for speech recognition in noise by cochlear implant recipients.

PubMed

Meister, Hartmut; Landwehr, Markus; Pyschny, Verena; Grugel, Linda; Walger, Martin

2011-05-01

The corruption of intonation contours has detrimental effects on sentence-based speech recognition in normal-hearing listeners Binns and Culling [(2007). J. Acoust. Soc. Am. 122, 1765-1776]. This paper examines whether this finding also applies to cochlear implant (CI) recipients. The subjects' F0-discrimination and speech perception in the presence of noise were measured, using sentences with regular and inverted F0-contours. The results revealed that speech recognition for regular contours was significantly better than for inverted contours. This difference was related to the subjects' F0-discrimination providing further evidence that the perception of intonation patterns is important for the CI-mediated speech recognition in noise.

Pulse-spreading harmonic complex as an alternative carrier for vocoder simulations of cochlear implants.

PubMed

Mesnildrey, Quentin; Hilkhuysen, Gaston; Macherey, Olivier

2016-02-01

Noise- and sine-carrier vocoders are often used to acoustically simulate the information transmitted by a cochlear implant (CI). However, sine-waves fail to mimic the broad spread of excitation produced by a CI and noise-bands contain intrinsic modulations that are absent in CIs. The present study proposes pulse-spreading harmonic complexes (PSHCs) as an alternative acoustic carrier in vocoders. Sentence-in-noise recognition was measured in 12 normal-hearing subjects for noise-, sine-, and PSHC-vocoders. Consistent with the amount of intrinsic modulations present in each vocoder condition, the average speech reception threshold obtained with the PSHC-vocoder was higher than with sine-vocoding but lower than with noise-vocoding.

One-Year Results for Patients with Unilateral Hearing Loss and Accompanying Severe Tinnitus and Hyperacusis Treated with a Cochlear Implant.

PubMed

Ramos Macías, Angel; Falcón-González, Juan Carlos; Manrique Rodríguez, Manuel; Morera Pérez, Constantino; García-Ibáñez, Luis; Cenjor Español, Carlos; Coudert-Koall, Chrystelle; Killian, Matthijs

2018-06-21

To show that patients with unilateral hearing loss (UHL), with one ear fulfilling cochlear implant (CI) indication criteria, and an additional severe tinnitus handicap can be treated effectively with a CI. A prospective multi-centre study was conducted in five Spanish centres. Sixteen adult patients with UHL and a mean Tinnitus Handicap Inventory (THI) score of at least 58 were implanted. The study design included repeated within-subject measures of quality of life (Health Utility Index Mark 3 [HUI3]), tinnitus (THI, Visual Analogue Scale [VAS] on tinnitus loudness), hearing (Speech, Spatial, and Qualities of Hearing Scale- [SSQ]), and hyperacusis (Test de Hipersensibilidad al Sonido [THS]) up to 12 months after the initial CI fitting. Group data showed significant subjective benefit from CI treatment: the preoperative HUI3 total utility score of 0.45 went up to 0.57 at 6 months and 0.63 at 12 months; the preoperative THI total score of 75 decreased to 40 at 6 months and 35 at 12 months. The preoperative tinnitus loudness VAS score of 8.2 decreased to 2.4 at 6 months and 2.2 at 12 months with the implant "On" and to 6.7 at 6 months and 6.5 at 12 months with the implant "Off." The preoperative THS total score of 26 decreased to 17 at 12 months. The preoperative SSQ total score of 4.2 increased to 5.1 at 6 months and 6.3 at 12 months. No unanticipated adverse events were reported during the study period. At 12 months after CI activation all subjects (except 1 subject who used the device 6 days a week) wore their devices all day and every day. The primary reason for CI use was split evenly between tinnitus suppression (n = 6) and both hearing and tinnitus (n = 6). A CI should be considered as a treatment option in patients with UHL and a concomitant severe tinnitus handicap. However, appropriate counselling of candidates on the anticipated risks, benefits, and limitations that are inherent to cochlear implantation is imperative. © 2018 The Author(s) Published by S. Karger AG, Basel.

Cochlear Implant Outcomes and Genetic Mutations in Children with Ear and Brain Anomalies

PubMed Central

Busi, Micol; Rosignoli, Monica; Minazzi, Federica; Trevisi, Patrizia; Aimoni, Claudia; Calzolari, Ferdinando; Martini, Alessandro

2015-01-01

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 nervous system anomalies represent a negative prognostic factor that is made worse by the concomitant presence of cochlear malformations. Common cavity and stenosis of the internal auditory canal (less than 2 mm) are negative prognostic factors even if brain lesions are absent. PMID:26236732

Cochlear Implant Outcomes and Genetic Mutations in Children with Ear and Brain Anomalies.

PubMed

Busi, Micol; Rosignoli, Monica; Castiglione, Alessandro; Minazzi, Federica; Trevisi, Patrizia; Aimoni, Claudia; Calzolari, Ferdinando; Granieri, Enrico; Martini, Alessandro

2015-01-01

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. 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. 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). Good outcomes with cochlear implants are possible in patients who present with inner ear or brain abnormalities, even if central nervous system anomalies represent a negative prognostic factor that is made worse by the concomitant presence of cochlear malformations. Common cavity and stenosis of the internal auditory canal (less than 2 mm) are negative prognostic factors even if brain lesions are absent.

A preliminary report of music-based training for adult cochlear implant users: rationales and development

PubMed Central

Gfeller, Kate; Guthe, Emily; Driscoll, Virginia; Brown, Carolyn J.

2015-01-01

Objective This paper provides a preliminary report of a music-based training program for adult cochlear implant (CI) recipients. Included in this report are descriptions of the rationale for music-based training, factors influencing program development, and the resulting program components. Methods Prior studies describing experience-based plasticity in response to music training, auditory training for persons with hearing impairment, and music training for cochlear implant recipients were reviewed. These sources revealed rationales for using music to enhance speech, factors associated with successful auditory training, relevant aspects of electric hearing and music perception, and extant evidence regarding limitations and advantages associated with parameters for music training with CI users. This information formed the development of a computer-based music training program designed specifically for adult CI users. Results Principles and parameters for perceptual training of music, such as stimulus choice, rehabilitation approach, and motivational concerns were developed in relation to the unique auditory characteristics of adults with electric hearing. An outline of the resulting program components and the outcome measures for evaluating program effectiveness are presented. Conclusions Music training can enhance the perceptual accuracy of music, but is also hypothesized to enhance several features of speech with similar processing requirements as music (e.g., pitch and timbre). However, additional evaluation of specific training parameters and the impact of music-based training on speech perception of CI users are required. PMID:26561884

Clinical evaluation of music perception, appraisal and experience in cochlear implant users.

PubMed

Drennan, Ward R; Oleson, Jacob J; Gfeller, Kate; Crosson, Jillian; Driscoll, Virginia D; Won, Jong Ho; Anderson, Elizabeth S; Rubinstein, Jay T

2015-02-01

The objectives were to evaluate the relationships among music perception, appraisal, and experience in cochlear implant users in multiple clinical settings and to examine the viability of two assessments designed for clinical use. Background questionnaires (IMBQ) were administered by audiologists in 14 clinics in the United States and Canada. The CAMP included tests of pitch-direction discrimination, and melody and timbre recognition. The IMBQ queried users on prior musical involvement, music listening habits pre and post implant, and music appraisals. One-hundred forty-five users of Advanced Bionics and Cochlear Ltd cochlear implants. Performance on pitch direction discrimination, melody recognition, and timbre recognition tests were consistent with previous studies with smaller cohorts, as well as with more extensive protocols conducted in other centers. Relationships between perceptual accuracy and music enjoyment were weak, suggesting that perception and appraisal are relatively independent for CI users. Perceptual abilities as measured by the CAMP had little to no relationship with music appraisals and little relationship with musical experience. The CAMP and IMBQ are feasible for routine clinical use, providing results consistent with previous thorough laboratory-based investigations.

Moving Beyond GDP: Cost Effectiveness of Cochlear Implantation and Deaf Education in Latin America.

PubMed

Emmett, Susan D; Tucci, Debara L; Bento, Ricardo F; Garcia, Juan M; Juman, Solaiman; Chiossone-Kerdel, Juan A; Liu, Ta J; de Muñoz, Patricia Castellanos; Ullauri, Alejandra; Letort, Jose J; Mansilla, Teresita; Urquijo, Diana P; Aparicio, Maria L; Gong, Wenfeng; Francis, Howard W; Saunders, James E

2016-09-01

Cochlear implantation (CI) and deaf education are cost effective management strategies of childhood profound sensorineural hearing loss in Latin America. CI has been widely established as cost effective in North America and Europe and is considered standard of care in those regions, yet cost effectiveness in other economic environments has not been explored. With 80% of the global hearing loss burden existing in low- and middle-income countries, developing cost effective management strategies in these settings is essential. This analysis represents the continuation of a global assessment of CI and deaf education cost effectiveness. Brazil, Colombia, Ecuador, Guatemala, Paraguay, Trinidad and Tobago, and Venezuela participated in the study. A Disability Adjusted Life Years model was applied with 3% discounting and 10-year length of analysis. Experts from each country supplied cost estimates from known costs and published data. Sensitivity analysis was performed to evaluate the effect of device cost, professional salaries, annual number of implants, and probability of device failure. Cost effectiveness was determined using the World Health Organization standard of cost effectiveness ratio/gross domestic product per capita (CER/GDP)<3. Deaf education was very cost effective in all countries (CER/GDP 0.07-0.93). CI was cost effective in all countries (CER/GDP 0.69-2.96), with borderline cost effectiveness in the Guatemalan sensitivity analysis (Max CER/GDP 3.21). Both cochlear implantation and deaf education are widely cost effective in Latin America. In the lower-middle income economy of Guatemala, implant cost may have a larger impact. GDP is less influential in the middle- and high-income economies included in this study.

Prevalence of Extracochlear Electrodes: Computerized Tomography Scans, Cochlear Implant Maps, and Operative Reports.

PubMed

Holder, Jourdan T; Kessler, David M; Noble, Jack H; Gifford, René H; Labadie, Robert F

2018-06-01

To quantify and compare the number of cochlear implant (CI) electrodes found to be extracochlear on postoperative computerized tomography (CT) scans, the number of basal electrodes deactivated during standard CI mapping (without knowledge of the postoperative CT scan), and the extent of electrode insertion noted by the surgeon. Retrospective. Academic Medical Center. Two hundred sixty-two patients underwent standard cochlear implantation and postoperative temporal bone CT scanning. Scans were analyzed to determine the number of extracochlear electrodes. Standard CI programming had been completed without knowledge of the extracochlear electrodes identified on the CT. These standard CI maps were reviewed to record the number of deactivated basal electrodes. Lastly, each operative report was reviewed to record the extent of reported electrode insertion. 13.4% (n = 35) of CIs were found to have at least one electrode outside of the cochlea on the CT scan. Review of CI mapping indicated that audiologists had deactivated extracochlear electrodes in 60% (21) of these cases. Review of operative reports revealed that surgeons correctly indicated the number of extracochlear electrodes in 6% (2) of these cases. Extracochlear electrodes were correctly identified audiologically in 60% of cases and in surgical reports in 6% of cases; however, it is possible that at least a portion of these cases involved postoperative electrode migration. Given these findings, postoperative CT scans can provide information regarding basal electrode location, which could help improve programming accuracy, associated frequency allocation, and audibility with appropriate deactivation of extracochlear electrodes.

Cochlear implantation with hearing preservation yields significant benefit for speech recognition in complex listening environments

PubMed Central

Gifford, René H.; Dorman, Michael F.; Skarzynski, Henryk; Lorens, Artur; Polak, Marek; Driscoll, Colin L. W.; Roland, Peter; Buchman, Craig A.

2012-01-01

Objective The aim of this study was to assess the benefit of having preserved acoustic hearing in the implanted ear for speech recognition in complex listening environments. Design The current study included a within subjects, repeated-measures design including 21 English speaking and 17 Polish speaking cochlear implant recipients with preserved acoustic hearing in the implanted ear. The patients were implanted with electrodes that varied in insertion depth from 10 to 31 mm. Mean preoperative low-frequency thresholds (average of 125, 250 and 500 Hz) in the implanted ear were 39.3 and 23.4 dB HL for the English- and Polish-speaking participants, respectively. In one condition, speech perception was assessed in an 8-loudspeaker environment in which the speech signals were presented from one loudspeaker and restaurant noise was presented from all loudspeakers. In another condition, the signals were presented in a simulation of a reverberant environment with a reverberation time of 0.6 sec. The response measures included speech reception thresholds (SRTs) and percent correct sentence understanding for two test conditions: cochlear implant (CI) plus low-frequency hearing in the contralateral ear (bimodal condition) and CI plus low-frequency hearing in both ears (best aided condition). A subset of 6 English-speaking listeners were also assessed on measures of interaural time difference (ITD) thresholds for a 250-Hz signal. Results Small, but significant, improvements in performance (1.7 – 2.1 dB and 6 – 10 percentage points) were found for the best-aided condition vs. the bimodal condition. Postoperative thresholds in the implanted ear were correlated with the degree of EAS benefit for speech recognition in diffuse noise. There was no reliable relationship among measures of audiometric threshold in the implanted ear nor elevation in threshold following surgery and improvement in speech understanding in reverberation. There was a significant correlation between ITD threshold at 250 Hz and EAS-related benefit for the adaptive SRT. Conclusions Our results suggest that (i) preserved low-frequency hearing improves speech understanding for CI recipients (ii) testing in complex listening environments, in which binaural timing cues differ for signal and noise, may best demonstrate the value of having two ears with low-frequency acoustic hearing and (iii) preservation of binaural timing cues, albeit poorer than observed for individuals with normal hearing, is possible following unilateral cochlear implantation with hearing preservation and is associated with EAS benefit. Our results demonstrate significant communicative benefit for hearing preservation in the implanted ear and provide support for the expansion of cochlear implant criteria to include individuals with low-frequency thresholds in even the normal to near-normal range. PMID:23446225

Cochlear implant performance in children deafened by congenital cytomegalovirus-A systematic review.

PubMed

Kraaijenga, V J C; Van Houwelingen, F; Van der Horst, S F; Visscher, J; Huisman, J M L; Hollman, E J; Stegeman, I; Smit, A L

2018-05-16

Congenital cytomegalovirus (cCMV) infection is a major cause of sensorineural hearing loss in children. The objective of this systematic review was to compare performance in paediatric cochlear implant users with SNHL caused by cCMV compared to non-cCMV implantees. Systematic review SEARCH STRATEGY: PubMed, EMBASE and the Cochrane databases were searched from inception up to 15 May 2017 for children, cochlear implant, performance and their synonyms. Titles, abstracts and full texts were screened for eligibility. Directness of evidence and risk of bias were assessed. From the included studies, study characteristics and outcome data (speech perception, speech production, receptive language and auditory performance of cCMV groups and non-cCMV groups) were extracted. A total of 5280 unique articles were screened of which 28 were eligible for critical appraisal. After critical appraisal, 12 studies remained for data extraction. Seven of 12 studies showed worse performance after cochlear implantation in cCMV children compared to non-cCMV children. Worse performance in cCMV children was attributed to cCMV-related comorbidities in six of these studies. Available data on asymptomatic cCMV children compared to non-cCMV children did not reveal an unfavourable effect on cochlear implant performance. The available evidence reveals that cCMV children often have worse cochlear implant performance compared to non-cCMV children, which can be attributed to cCMV related comorbidities. We urge physicians to take into account the cCMV related comorbidities in the counselling of paediatric CI users deafened by cCMV. © 2018 The Authors. Clinical Otolaryngology Published by John Wiley & Sons Ltd.

Factors limiting vocal-tract length discrimination in cochlear implant simulations.

PubMed

Gaudrain, Etienne; Başkent, Deniz

2015-03-01

Perception of voice characteristics allows normal hearing listeners to identify the gender of a speaker, and to better segregate speakers from each other in cocktail party situations. This benefit is largely driven by the perception of two vocal characteristics of the speaker: The fundamental frequency (F0) and the vocal-tract length (VTL). Previous studies have suggested that cochlear implant (CI) users have difficulties in perceiving these cues. The aim of the present study was to investigate possible causes for limited sensitivity to VTL differences in CI users. Different acoustic simulations of CI stimulation were implemented to characterize the role of spectral resolution on VTL, both in terms of number of channels and amount of channel interaction. The results indicate that with 12 channels, channel interaction caused by current spread is likely to prevent CI users from perceiving VTL differences typically found between male and female speakers.

Prior exposure to a reverberant listening environment improves speech intelligibility in adult cochlear implant listeners.

PubMed

Srinivasan, Nirmal Kumar; Tobey, Emily A; Loizou, Philipos C

2016-01-01

The goal of this study is to investigate whether prior exposure to reverberant listening environment improves speech intelligibility of adult cochlear implant (CI) users. Six adult CI users participated in this study. Speech intelligibility was measured in five different simulated reverberant listening environments with two different speech corpuses. Within each listening environment, prior exposure was varied by either having the same environment across all trials (blocked presentation) or having different environment from trial to trial (unblocked). Speech intelligibility decreased as reverberation time increased. Although substantial individual variability was observed, all CI listeners showed an increase in the blocked presentation condition as compared to the unblocked presentation condition for both speech corpuses. Prior listening exposure to a reverberant listening environment improves speech intelligibility in adult CI listeners. Further research is required to understand the underlying mechanism of adaptation to listening environment.

Verification of a Proposed Clinical Electroacoustic Test Protocol for Personal Digital Modulation Receivers Coupled to Cochlear Implant Sound Processors.

PubMed

Nair, Erika L; Sousa, Rhonda; Wannagot, Shannon

Guidelines established by the AAA currently recommend behavioral testing when fitting frequency modulated (FM) systems to individuals with cochlear implants (CIs). A protocol for completing electroacoustic measures has not yet been validated for personal FM systems or digital modulation (DM) systems coupled to CI sound processors. In response, some professionals have used or altered the AAA electroacoustic verification steps for fitting FM systems to hearing aids when fitting FM systems to CI sound processors. More recently steps were outlined in a proposed protocol. The purpose of this research is to review and compare the electroacoustic test measures outlined in a 2013 article by Schafer and colleagues in the Journal of the American Academy of Audiology titled "A Proposed Electroacoustic Test Protocol for Personal FM Receivers Coupled to Cochlear Implant Sound Processors" to the AAA electroacoustic verification steps for fitting FM systems to hearing aids when fitting DM systems to CI users. Electroacoustic measures were conducted on 71 CI sound processors and Phonak Roger DM systems using a proposed protocol and an adapted AAA protocol. Phonak's recommended default receiver gain setting was used for each CI sound processor manufacturer and adjusted if necessary to achieve transparency. Electroacoustic measures were conducted on Cochlear and Advanced Bionics (AB) sound processors. In this study, 28 Cochlear Nucleus 5/CP810 sound processors, 26 Cochlear Nucleus 6/CP910 sound processors, and 17 AB Naida CI Q70 sound processors were coupled in various combinations to Phonak Roger DM dedicated receivers (25 Phonak Roger 14 receivers-Cochlear dedicated receiver-and 9 Phonak Roger 17 receivers-AB dedicated receiver) and 20 Phonak Roger Inspiro transmitters. Employing both the AAA and the Schafer et al protocols, electroacoustic measurements were conducted with the Audioscan Verifit in a clinical setting on 71 CI sound processors and Phonak Roger DM systems to determine transparency and verify FM advantage, comparing speech inputs (65 dB SPL) in an effort to achieve equal outputs. If transparency was not achieved at Phonak's recommended default receiver gain, adjustments were made to the receiver gain. The integrity of the signal was monitored with the appropriate manufacturer's monitor earphones. Using the AAA hearing aid protocol, 50 of the 71 CI sound processors achieved transparency, and 59 of the 71 CI sound processors achieved transparency when using the proposed protocol at Phonak's recommended default receiver gain. After the receiver gain was adjusted, 3 of 21 CI sound processors still did not meet transparency using the AAA protocol, and 2 of 12 CI sound processors still did not meet transparency using the Schafer et al proposed protocol. Both protocols were shown to be effective in taking reliable electroacoustic measurements and demonstrate transparency. Both protocols are felt to be clinically feasible and to address the needs of populations that are unable to reliably report regarding the integrity of their personal DM systems. American Academy of Audiology

Temporal Sensitivity Measured Shortly After Cochlear Implantation Predicts 6-Month Speech Recognition Outcome.

PubMed

Erb, Julia; Ludwig, Alexandra Annemarie; Kunke, Dunja; Fuchs, Michael; Obleser, Jonas

2018-04-24

Psychoacoustic tests assessed shortly after cochlear implantation are useful predictors of the rehabilitative speech outcome. While largely independent, both spectral and temporal resolution tests are important to provide an accurate prediction of speech recognition. However, rapid tests of temporal sensitivity are currently lacking. Here, we propose a simple amplitude modulation rate discrimination (AMRD) paradigm that is validated by predicting future speech recognition in adult cochlear implant (CI) patients. In 34 newly implanted patients, we used an adaptive AMRD paradigm, where broadband noise was modulated at the speech-relevant rate of ~4 Hz. In a longitudinal study, speech recognition in quiet was assessed using the closed-set Freiburger number test shortly after cochlear implantation (t0) as well as the open-set Freiburger monosyllabic word test 6 months later (t6). Both AMRD thresholds at t0 (r = -0.51) and speech recognition scores at t0 (r = 0.56) predicted speech recognition scores at t6. However, AMRD and speech recognition at t0 were uncorrelated, suggesting that those measures capture partially distinct perceptual abilities. A multiple regression model predicting 6-month speech recognition outcome with deafness duration and speech recognition at t0 improved from adjusted R = 0.30 to adjusted R = 0.44 when AMRD threshold was added as a predictor. These findings identify AMRD thresholds as a reliable, nonredundant predictor above and beyond established speech tests for CI outcome. This AMRD test could potentially be developed into a rapid clinical temporal-resolution test to be integrated into the postoperative test battery to improve the reliability of speech outcome prognosis.

PubMed Central

MUZZI, E.; MARCHI, R.; FALZONE, C.; BATTELINO, S.; CICIRIELLO, E.

2016-01-01

SUMMARY 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. PMID:27054390

A Case Study Assessing the Auditory and Speech Development of Four Children Implanted with Cochlear Implants by the Chronological Age of 12 Months

PubMed Central

2013-01-01

Children with severe hearing loss most likely receive the greatest benefit from a cochlear implant (CI) when implanted at less than 2 years of age. Children with a hearing loss may also benefit greater from binaural sensory stimulation. Four children who received their first CI under 12 months of age were included in this study. Effects on auditory development were determined using the German LittlEARS Auditory Questionnaire, closed- and open-set monosyllabic word tests, aided free-field, the Mainzer and Göttinger speech discrimination tests, Monosyllabic-Trochee-Polysyllabic (MTP), and Listening Progress Profile (LiP). Speech production and grammar development were evaluated using a German language speech development test (SETK), reception of grammar test (TROG-D) and active vocabulary test (AWST-R). The data showed that children implanted under 12 months of age reached open-set monosyllabic word discrimination at an age of 24 months. LiP results improved over time, and children recognized 100% of words in the MTP test after 12 months. All children performed as well as or better than their hearing peers in speech production and grammar development. SETK showed that the speech development of these children was in general age appropriate. The data suggests that early hearing loss intervention benefits speech and language development and supports the trend towards early cochlear implantation. Furthermore, the data emphasizes the potential benefits associated with bilateral implantation. PMID:23509653

A case study assessing the auditory and speech development of four children implanted with cochlear implants by the chronological age of 12 months.

PubMed

May-Mederake, Birgit; Shehata-Dieler, Wafaa

2013-01-01

Children with severe hearing loss most likely receive the greatest benefit from a cochlear implant (CI) when implanted at less than 2 years of age. Children with a hearing loss may also benefit greater from binaural sensory stimulation. Four children who received their first CI under 12 months of age were included in this study. Effects on auditory development were determined using the German LittlEARS Auditory Questionnaire, closed- and open-set monosyllabic word tests, aided free-field, the Mainzer and Göttinger speech discrimination tests, Monosyllabic-Trochee-Polysyllabic (MTP), and Listening Progress Profile (LiP). Speech production and grammar development were evaluated using a German language speech development test (SETK), reception of grammar test (TROG-D) and active vocabulary test (AWST-R). The data showed that children implanted under 12 months of age reached open-set monosyllabic word discrimination at an age of 24 months. LiP results improved over time, and children recognized 100% of words in the MTP test after 12 months. All children performed as well as or better than their hearing peers in speech production and grammar development. SETK showed that the speech development of these children was in general age appropriate. The data suggests that early hearing loss intervention benefits speech and language development and supports the trend towards early cochlear implantation. Furthermore, the data emphasizes the potential benefits associated with bilateral implantation.

The Development of Auditory Perception in Children Following Auditory Brainstem Implantation

PubMed Central

Colletti, Liliana; Shannon, Robert V.; Colletti, Vittorio

2014-01-01

Auditory brainstem implants (ABI) can provide useful auditory perception and language development in deaf children who are not able to use a cochlear implant (CI). We prospectively followed-up a consecutive group of 64 deaf children up to 12 years following ABI implantation. The etiology of deafness in these children was: cochlear nerve aplasia in 49, auditory neuropathy in 1, cochlear malformations in 8, bilateral cochlear post-meningitic ossification in 3, NF2 in 2, and bilateral cochlear fractures due to a head injury in 1. Thirty five children had other congenital non-auditory disabilities. Twenty two children had previous CIs with no benefit. Fifty eight children were fitted with the Cochlear 24 ABI device and six with the MedEl ABI device and all children followed the same rehabilitation program. Auditory perceptual abilities were evaluated on the Categories of Auditory Performance (CAP) scale. No child was lost to follow-up and there were no exclusions from the study. All children showed significant improvement in auditory perception with implant experience. Seven children (11%) were able to achieve the highest score on the CAP test; they were able to converse on the telephone within 3 years of implantation. Twenty children (31.3%) achieved open set speech recognition (CAP score of 5 or greater) and 30 (46.9%) achieved a CAP level of 4 or greater. Of the 29 children without non-auditory disabilities, 18 (62%) achieved a CAP score of 5 or greater with the ABI. All children showed continued improvements in auditory skills over time. The long-term results of ABI implantation reveal significant auditory benefit in most children, and open set auditory recognition in many. PMID:25377987

Computer-based auditory phoneme discrimination training improves speech recognition in noise in experienced adult cochlear implant listeners.

PubMed

Schumann, Annette; Serman, Maja; Gefeller, Olaf; Hoppe, Ulrich

2015-03-01

Specific computer-based auditory training may be a useful completion in the rehabilitation process for cochlear implant (CI) listeners to achieve sufficient speech intelligibility. This study evaluated the effectiveness of a computerized, phoneme-discrimination training programme. The study employed a pretest-post-test design; participants were randomly assigned to the training or control group. Over a period of three weeks, the training group was instructed to train in phoneme discrimination via computer, twice a week. Sentence recognition in different noise conditions (moderate to difficult) was tested pre- and post-training, and six months after the training was completed. The control group was tested and retested within one month. Twenty-seven adult CI listeners who had been using cochlear implants for more than two years participated in the programme; 15 adults in the training group, 12 adults in the control group. Besides significant improvements for the trained phoneme-identification task, a generalized training effect was noted via significantly improved sentence recognition in moderate noise. No significant changes were noted in the difficult noise conditions. Improved performance was maintained over an extended period. Phoneme-discrimination training improves experienced CI listeners' speech perception in noise. Additional research is needed to optimize auditory training for individual benefit.

Cross-modal perception of rhythm in music and dance by cochlear implant users.

PubMed

Vongpaisal, Tara; Monaghan, Melanie

2014-05-01

Two studies examined adult cochlear implant (CI) users' ability to match auditory rhythms occurring in music to visual rhythms occurring in dance (Cha Cha, Slow Swing, Tango and Jive). In Experiment 1, adults CI users (n = 10) and hearing controls matched a music excerpt to choreographed dance sequences presented as silent videos. In Experiment 2, participants matched a silent video of a dance sequence to music excerpts. CI users were successful in detecting timing congruencies across music and dance at well above-chance levels suggesting that they were able to process distinctive auditory and visual rhythm patterns that characterized each style. However, they were better able to detect cross-modal timing congruencies when the reference was an auditory rhythm than when the reference was a visual rhythm. Learning strategies that encourage cross-modal learning of musical rhythms may have applications in developing novel rehabilitative strategies to enhance music perception and appreciation outcomes of child implant users.

Reading instead of reasoning? Predictors of arithmetic skills in children with cochlear implants.

PubMed

Huber, Maria; Kipman, Ulrike; Pletzer, Belinda

2014-07-01

The aim of the present study was to evaluate whether the arithmetic achievement of children with cochlear implants (CI) was lower or comparable to that of their normal hearing peers and to identify predictors of arithmetic achievement in children with CI. In particular we related the arithmetic achievement of children with CI to nonverbal IQ, reading skills and hearing variables. 23 children with CI (onset of hearing loss in the first 24 months, cochlear implantation in the first 60 months of life, atleast 3 years of hearing experience with the first CI) and 23 normal hearing peers matched by age, gender, and social background participated in this case control study. All attended grades two to four in primary schools. To assess their arithmetic achievement, all children completed the "Arithmetic Operations" part of the "Heidelberger Rechentest" (HRT), a German arithmetic test. To assess reading skills and nonverbal intelligence as potential predictors of arithmetic achievement, all children completed the "Salzburger Lesetest" (SLS), a German reading screening, and the Culture Fair Intelligence Test (CFIT), a nonverbal intelligence test. Children with CI did not differ significantly from hearing children in their arithmetic achievement. Correlation and regression analyses revealed that in children with CI, arithmetic achievement was significantly (positively) related to reading skills, but not to nonverbal IQ. Reading skills and nonverbal IQ were not related to each other. In normal hearing children, arithmetic achievement was significantly (positively) related to nonverbal IQ, but not to reading skills. Reading skills and nonverbal IQ were positively correlated. Hearing variables were not related to arithmetic achievement. Children with CI do not show lower performance in non-verbal arithmetic tasks, compared to normal hearing peers. Copyright © 2014. Published by Elsevier Ireland Ltd.

[Speech perception with electric-acoustic stimulation : Comparison with bilateral cochlear implant users in different noise conditions].

PubMed

Rader, T

2015-02-01

Cochlear implantation with the aim of hearing preservation for combined electric-acoustic stimulation (EAS) is the therapy of choice for patients with residual low-frequency hearing. Preserved residual acoustic hearing has a positive effect on speech intelligibility in difficult noise conditions. The goal of this study was to assess speech reception thresholds in various complex noise conditions for patients with EAS in comparison with patients using bilateral cochlear implants (CI). Speech perception in noise was measured for bilateral CI and EAS patient groups. A total of 22 listeners with normal hearing served as a control group. Speech reception thresholds (SRT) were measured using a closed-set sentence matrix test. Speech was presented with a single source in frontal position; noise was presented in frontal position or in a multisource noise field (MSNF) consisting of a four-loudspeaker array with independent noise sources. Modulated speech-simulating noise and pseudocontinuous noise served respectively as interference signal with different temporal characteristics. The average SRTs in the EAS group were significantly better in all test conditions than those of the group with bilateral CI. Both user groups showed significant improvement in the MSNF condition compared with the frontal noise condition as a result of bilateral interaction. The normal-hearing control group was able to use short temporal gaps in modulated noise to improve speech perception in noise (gap listening). This effect was absent in both implanted user groups. Patients with combined EAS in one ear and a hearing aid in the contralateral ear show significantly improved speech perception in complex noise conditions compared with bilateral CI recipients.

Comparisons of Auditory Performance and Speech Intelligibility after Cochlear Implant Reimplantation in Mandarin-Speaking Users

PubMed Central

Hwang, Chung-Feng; Ko, Hui-Chen; Tsou, Yung-Ting; Chan, Kai-Chieh; Fang, Hsuan-Yeh; Wu, Che-Ming

2016-01-01

Objectives. We evaluated the causes, hearing, and speech performance before and after cochlear implant reimplantation in Mandarin-speaking users. Methods. In total, 589 patients who underwent cochlear implantation in our medical center between 1999 and 2014 were reviewed retrospectively. Data related to demographics, etiologies, implant-related information, complications, and hearing and speech performance were collected. Results. In total, 22 (3.74%) cases were found to have major complications. Infection (n = 12) and hard failure of the device (n = 8) were the most common major complications. Among them, 13 were reimplanted in our hospital. The mean scores of the Categorical Auditory Performance (CAP) and the Speech Intelligibility Rating (SIR) obtained before and after reimplantation were 5.5 versus 5.8 and 3.7 versus 4.3, respectively. The SIR score after reimplantation was significantly better than preoperation. Conclusions. Cochlear implantation is a safe procedure with low rates of postsurgical revisions and device failures. The Mandarin-speaking patients in this study who received reimplantation had restored auditory performance and speech intelligibility after surgery. Device soft failure was rare in our series, calling attention to Mandarin-speaking CI users requiring revision of their implants due to undesirable symptoms or decreasing performance of uncertain cause. PMID:27413753

Auditory Implant Research at the House Ear Institute 1989–2013

PubMed Central

Shannon, Robert V.

2014-01-01

The House Ear Institute (HEI) had a long and distinguished history of auditory implant innovation and development. Early clinical innovations include being one of the first cochlear implant (CI) centers, being the first center to implant a child with a cochlear implant in the US, developing the auditory brainstem implant, and developing multiple surgical approaches and tools for Otology. This paper reviews the second stage of auditory implant research at House – in-depth basic research on perceptual capabilities and signal processing for both cochlear implants and auditory brainstem implants. Psychophysical studies characterized the loudness and temporal perceptual properties of electrical stimulation as a function of electrical parameters. Speech studies with the noise-band vocoder showed that only four bands of tonotopically arrayed information were sufficient for speech recognition, and that most implant users were receiving the equivalent of 8–10 bands of information. The noise-band vocoder allowed us to evaluate the effects of the manipulation of the number of bands, the alignment of the bands with the original tonotopic map, and distortions in the tonotopic mapping, including holes in the neural representation. Stimulation pulse rate was shown to have only a small effect on speech recognition. Electric fields were manipulated in position and sharpness, showing the potential benefit of improved tonotopic selectivity. Auditory training shows great promise for improving speech recognition for all patients. And the Auditory Brainstem Implant was developed and improved and its application expanded to new populations. Overall, the last 25 years of research at HEI helped increase the basic scientific understanding of electrical stimulation of hearing and contributed to the improved outcomes for patients with the CI and ABI devices. PMID:25449009

In Patients Undergoing Cochlear Implantation, Psychological Burden Affects Tinnitus and the Overall Outcome of Auditory Rehabilitation

PubMed Central

Brüggemann, Petra; Szczepek, Agnieszka J.; Klee, Katharina; Gräbel, Stefan; Mazurek, Birgit; Olze, Heidi

2017-01-01

Cochlear implantation (CI) is increasingly being used in the auditory rehabilitation of deaf patients. Here, we investigated whether the auditory rehabilitation can be influenced by the psychological burden caused by mental conditions. Our sample included 47 patients who underwent implantation. All patients were monitored before and 6 months after CI. Auditory performance was assessed using the Oldenburg Inventory (OI) and Freiburg monosyllable (FB MS) speech discrimination test. The health-related quality of life was measured with Nijmegen Cochlear implantation Questionnaire (NCIQ) whereas tinnitus-related distress was measured with the German version of Tinnitus Questionnaire (TQ). We additionally assessed the general perceived quality of life, the perceived stress, coping abilities, anxiety levels and the depressive symptoms. Finally, a structured interview to detect mental conditions (CIDI) was performed before and after surgery. We found that CI led to an overall improvement in auditory performance as well as the anxiety and depression, quality of life, tinnitus distress and coping strategies. CIDI revealed that 81% of patients in our sample had affective, anxiety, and/or somatoform disorders before or after CI. The affective disorders included dysthymia and depression, while anxiety disorders included agoraphobias and unspecified phobias. We also diagnosed cases of somatoform pain disorders and unrecognizable figure somatoform disorders. We found a positive correlation between the auditory performance and the decrease of anxiety and depression, tinnitus-related distress and perceived stress. There was no association between the presence of a mental condition itself and the outcome of auditory rehabilitation. We conclude that the CI candidates exhibit high rates of psychological disorders, and there is a particularly strong association between somatoform disorders and tinnitus. The presence of mental disorders remained unaffected by CI but the degree of psychological burden decreased significantly post-CI. The implants benefitted patients in a number of psychosocial areas, improving the symptoms of depression and anxiety, tinnitus, and their quality of life and coping strategies. The prevalence of mental disorders in patients who are candidates for CI suggests the need for a comprehensive psychological and psychosomatic management of their treatment. PMID:28529479

The Relationship Between Spectral Modulation Detection and Speech Recognition: Adult Versus Pediatric Cochlear Implant Recipients

PubMed Central

Noble, Jack H.; Camarata, Stephen M.; Sunderhaus, Linsey W.; Dwyer, Robert T.; Dawant, Benoit M.; Dietrich, Mary S.; Labadie, Robert F.

2018-01-01

Adult cochlear implant (CI) recipients demonstrate a reliable relationship between spectral modulation detection and speech understanding. Prior studies documenting this relationship have focused on postlingually deafened adult CI recipients—leaving an open question regarding the relationship between spectral resolution and speech understanding for adults and children with prelingual onset of deafness. Here, we report CI performance on the measures of speech recognition and spectral modulation detection for 578 CI recipients including 477 postlingual adults, 65 prelingual adults, and 36 prelingual pediatric CI users. The results demonstrated a significant correlation between spectral modulation detection and various measures of speech understanding for 542 adult CI recipients. For 36 pediatric CI recipients, however, there was no significant correlation between spectral modulation detection and speech understanding in quiet or in noise nor was spectral modulation detection significantly correlated with listener age or age at implantation. These findings suggest that pediatric CI recipients might not depend upon spectral resolution for speech understanding in the same manner as adult CI recipients. It is possible that pediatric CI users are making use of different cues, such as those contained within the temporal envelope, to achieve high levels of speech understanding. Further investigation is warranted to investigate the relationship between spectral and temporal resolution and speech recognition to describe the underlying mechanisms driving peripheral auditory processing in pediatric CI users. PMID:29716437

Residual neural processing of musical sound features in adult cochlear implant users.

PubMed

Timm, Lydia; Vuust, Peter; Brattico, Elvira; Agrawal, Deepashri; Debener, Stefan; Büchner, Andreas; Dengler, Reinhard; Wittfoth, Matthias

2014-01-01

Auditory processing in general and music perception in particular are hampered in adult cochlear implant (CI) users. To examine the residual music perception skills and their underlying neural correlates in CI users implanted in adolescence or adulthood, we conducted an electrophysiological and behavioral study comparing adult CI users with normal-hearing age-matched controls (NH controls). We used a newly developed musical multi-feature paradigm, which makes it possible to test automatic auditory discrimination of six different types of sound feature changes inserted within a musical enriched setting lasting only 20 min. The presentation of stimuli did not require the participants' attention, allowing the study of the early automatic stage of feature processing in the auditory cortex. For the CI users, we obtained mismatch negativity (MMN) brain responses to five feature changes but not to changes of rhythm, whereas we obtained MMNs for all the feature changes in the NH controls. Furthermore, the MMNs to deviants of pitch of CI users were reduced in amplitude and later than those of NH controls for changes of pitch and guitar timber. No other group differences in MMN parameters were found to changes in intensity and saxophone timber. Furthermore, the MMNs in CI users reflected the behavioral scores from a respective discrimination task and were correlated with patients' age and speech intelligibility. Our results suggest that even though CI users are not performing at the same level as NH controls in neural discrimination of pitch-based features, they do possess potential neural abilities for music processing. However, CI users showed a disrupted ability to automatically discriminate rhythmic changes compared with controls. The current behavioral and MMN findings highlight the residual neural skills for music processing even in CI users who have been implanted in adolescence or adulthood. -Automatic brain responses to musical feature changes reflect the limitations of central auditory processing in adult Cochlear Implant users.-The brains of adult CI users automatically process sound features changes even when inserted in a musical context.-CI users show disrupted automatic discriminatory abilities for rhythm in the brain.-Our fast paradigm demonstrate residual musical abilities in the brains of adult CI users giving hope for their future rehabilitation.

Residual Neural Processing of Musical Sound Features in Adult Cochlear Implant Users

PubMed Central

Timm, Lydia; Vuust, Peter; Brattico, Elvira; Agrawal, Deepashri; Debener, Stefan; Büchner, Andreas; Dengler, Reinhard; Wittfoth, Matthias

2014-01-01

Auditory processing in general and music perception in particular are hampered in adult cochlear implant (CI) users. To examine the residual music perception skills and their underlying neural correlates in CI users implanted in adolescence or adulthood, we conducted an electrophysiological and behavioral study comparing adult CI users with normal-hearing age-matched controls (NH controls). We used a newly developed musical multi-feature paradigm, which makes it possible to test automatic auditory discrimination of six different types of sound feature changes inserted within a musical enriched setting lasting only 20 min. The presentation of stimuli did not require the participants’ attention, allowing the study of the early automatic stage of feature processing in the auditory cortex. For the CI users, we obtained mismatch negativity (MMN) brain responses to five feature changes but not to changes of rhythm, whereas we obtained MMNs for all the feature changes in the NH controls. Furthermore, the MMNs to deviants of pitch of CI users were reduced in amplitude and later than those of NH controls for changes of pitch and guitar timber. No other group differences in MMN parameters were found to changes in intensity and saxophone timber. Furthermore, the MMNs in CI users reflected the behavioral scores from a respective discrimination task and were correlated with patients’ age and speech intelligibility. Our results suggest that even though CI users are not performing at the same level as NH controls in neural discrimination of pitch-based features, they do possess potential neural abilities for music processing. However, CI users showed a disrupted ability to automatically discriminate rhythmic changes compared with controls. The current behavioral and MMN findings highlight the residual neural skills for music processing even in CI users who have been implanted in adolescence or adulthood. Highlights: -Automatic brain responses to musical feature changes reflect the limitations of central auditory processing in adult Cochlear Implant users.-The brains of adult CI users automatically process sound features changes even when inserted in a musical context.-CI users show disrupted automatic discriminatory abilities for rhythm in the brain.-Our fast paradigm demonstrate residual musical abilities in the brains of adult CI users giving hope for their future rehabilitation. PMID:24772074

Preservation of vestibular function after scala vestibuli cochlear implantation.

PubMed

Suzuki, Mitsuya; Goto, Takio; Kashio, Akinori; Yasui, Takuya; Sakamoto, Takashi; Ito, Ken; Yamasoba, Tatsuya

2011-10-01

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. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Persistent Language Delay Versus Late Language Emergence in Children With Early Cochlear Implantation

PubMed Central

Nicholas, Johanna; Tobey, Emily; Davidson, Lisa

2016-01-01

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

Concept Formation Skills in Long-Term Cochlear Implant Users

PubMed Central

Castellanos, Irina; Kronenberger, William G.; Beer, Jessica; Colson, Bethany G.; Henning, Shirley C.; Ditmars, Allison; Pisoni, David B.

2015-01-01

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

Effects of cooperating and conflicting cues on speech intonation recognition by cochlear implant users and normal hearing listeners

PubMed Central

Peng, Shu-Chen; Lu, Nelson; Chatterjee, Monita

2009-01-01

Cochlear implant (CI) recipients have only limited access to fundamental frequency (F0) information, and thus exhibit deficits in speech intonation recognition. For speech intonation, F0 serves as the primary cue, and other potential acoustic cues (e.g., intensity properties) may also contribute. This study examined the effects of acoustic cues being cooperating or conflicting on speech intonation recognition by adult cochlear implant (CI), and normal-hearing (NH) listeners with full-spectrum and spectrally degraded speech stimuli. Identification of speech intonation that signifies question and statement contrasts was measured in 13 CI recipients and 4 NH listeners, using resynthesized bi-syllabic words, where F0 and intensity properties were systematically manipulated. The stimulus set was comprised of tokens whose acoustic cues, i.e., F0 contour and intensity patterns, were either cooperating or conflicting. Subjects identified if each stimulus is a “statement” or a “question” in a single-interval, two-alternative forced-choice (2AFC) paradigm. Logistic models were fitted to the data, and estimated coefficients were compared under cooperating and conflicting conditions, between the subject groups (CI vs. NH), and under full-spectrum and spectrally degraded conditions for NH listeners. The results indicated that CI listeners’ intonation recognition was enhanced by F0 contour and intensity cues being cooperating, but was adversely affected by these cues being conflicting. On the other hand, with full-spectrum stimuli, NH listeners’ intonation recognition was not affected by cues being cooperating or conflicting. The effects of cues being cooperating or conflicting were comparable between the CI group and NH listeners with spectrally-degraded stimuli. These findings suggest the importance of taking multiple acoustic sources for speech recognition into consideration in aural rehabilitation for CI recipients. PMID:19372651

Identifying emotions in music through electrical hearing in deaf children using cochlear implants.

PubMed

Hopyan, T; Gordon, K A; Papsin, B C

2011-02-01

Cochlear implant (CI) devices are the choice of treatment for individuals with severe to profound hearing loss. The CI devices provide the opportunity for children who are deaf to perceive sound by electrical stimulation of the auditory nerve, with the goal of optimizing oral communication. A natural benefit of acquiring hearing using CIs is the ability to hear, and perhaps enjoy, music. Music is a non-verbal auditory stimulus and a powerful tool for transmitting emotion. Identifying emotional cues is an important part of normal social development and communication and thus music may play an important role in establishing these skills during development. To date, it is not known whether children who use cochlear implants to hear can identify the emotional content carried in music. Our objective in the present study was to determine whether children who have been deaf from infancy and are experienced CI users have acquired the ability to identify emotion in musical phrases. Study participants were 18 CI users (ages 7-13 years) who received right unilateral CIs (mean age at CI activation of 2.9 years) and 18 age-and gender-matched controls. Participants were asked to judge 32 brief musical excerpts as happy or sad by pointing to simple graphics of a smiling or frowning face. Children using CIs were able to correctly distinguish happy versus sad music well above chance levels, but performed more poorly on this task than their peers with typical hearing. Age at CI activation and time since CI activation were both uncorrelated with outcome measures. Children with CIs show the ability to perceive emotion in music but do so less accurately than typically hearing peers.

Beneficial auditory and cognitive effects of auditory brainstem implantation in children.

PubMed

Colletti, Liliana

2007-09-01

This preliminary study demonstrates the development of hearing ability and shows that there is a significant improvement in some cognitive parameters related to selective visual/spatial attention and to fluid or multisensory reasoning, in children fitted with auditory brainstem implantation (ABI). The improvement in cognitive paramenters is due to several factors, among which there is certainly, as demonstrated in the literature on a cochlear implants (CIs), the activation of the auditory sensory canal, which was previously absent. The findings of the present study indicate that children with cochlear or cochlear nerve abnormalities with associated cognitive deficits should not be excluded from ABI implantation. The indications for ABI have been extended over the last 10 years to adults with non-tumoral (NT) cochlear or cochlear nerve abnormalities that cannot benefit from CI. We demonstrated that the ABI with surface electrodes may provide sufficient stimulation of the central auditory system in adults for open set speech recognition. These favourable results motivated us to extend ABI indications to children with profound hearing loss who were not candidates for a CI. This study investigated the performances of young deaf children undergoing ABI, in terms of their auditory perceptual development and their non-verbal cognitive abilities. In our department from 2000 to 2006, 24 children aged 14 months to 16 years received an ABI for different tumour and non-tumour diseases. Two children had NF2 tumours. Eighteen children had bilateral cochlear nerve aplasia. In this group, nine children had associated cochlear malformations, two had unilateral facial nerve agenesia and two had combined microtia, aural atresia and middle ear malformations. Four of these children had previously been fitted elsewhere with a CI with no auditory results. One child had bilateral incomplete cochlear partition (type II); one child, who had previously been fitted unsuccessfully elsewhere with a CI, had auditory neuropathy; one child showed total cochlear ossification bilaterally due to meningitis; and one child had profound hearing loss with cochlear fractures after a head injury. Twelve of these children had multiple associated psychomotor handicaps. The retrosigmoid approach was used in all children. Intraoperative electrical auditory brainstem responses (EABRs) and postoperative EABRs and electrical middle latency responses (EMLRs) were performed. Perceptual auditory abilities were evaluated with the Evaluation of Auditory Responses to Speech (EARS) battery - the Listening Progress Profile (LIP), the Meaningful Auditory Integration Scale (MAIS), the Meaningful Use of Speech Scale (MUSS) - and the Category of Auditory Performance (CAP). Cognitive evaluation was performed on seven children using the Leiter International Performance Scale - Revised (LIPS-R) test with the following subtests: Figure ground, Form completion, Sequential order and Repeated pattern. No postoperative complications were observed. All children consistently used their devices for >75% of waking hours and had environmental sound awareness and utterance of words and simple sentences. Their CAP scores ranged from 1 to 7 (average =4); with MAIS they scored 2-97.5% (average =38%); MUSS scores ranged from 5 to 100% (average =49%) and LIP scores from 5 to 100% (average =45%). Owing to associated disabilities, 12 children were given other therapies (e.g. physical therapy and counselling) in addition to speech and aural rehabilitation therapy. Scores for two of the four subtests of LIPS-R in this study increased significantly during the first year of auditory brainstem implant use in all seven children selected for cognitive evaluation.

Speech detection in noise and spatial unmasking in children with simultaneous versus sequential bilateral cochlear implants.

PubMed

Chadha, Neil K; Papsin, Blake C; Jiwani, Salima; Gordon, Karen A

2011-09-01

To measure speech detection in noise performance for children with bilateral cochlear implants (BiCI), to compare performance in children with simultaneous implant versus those with sequential implant, and to compare performance to normal-hearing children. Prospective cohort study. Tertiary academic pediatric center. Children with early-onset bilateral deafness and 2-year BiCI experience, comprising the "sequential" group (>2 yr interimplantation delay, n = 12) and "simultaneous group" (no interimplantation delay, n = 10) and normal-hearing controls (n = 8). Thresholds to speech detection (at 0-degree azimuth) were measured with noise at 0-degree azimuth or ± 90-degree azimuth. Spatial unmasking (SU) as the noise condition changed from 0-degree azimuth to ± 90-degree azimuth and binaural summation advantage (BSA) of 2 over 1 CI. Speech detection in noise was significantly poorer than controls for both BiCI groups (p < 0.0001). However, the SU in the simultaneous group approached levels found in normal controls (7.2 ± 0.6 versus 8.6 ± 0.6 dB, p > 0.05) and was significantly better than that in the sequential group (3.9 ± 0.4 dB, p < 0.05). Spatial unmasking was unaffected by the side of noise presentation in the simultaneous group but, in the sequential group, was significantly better when noise was moved to the second rather than the first implanted ear (4.8 ± 0.5 versus 3.0 ± 0.4 dB, p < 0.05). This was consistent with a larger BSA from the sequential group's second rather than first CI. Children with simultaneously implanted BiCI demonstrated an advantage over children with sequential implant by using spatial cues to improve speech detection in noise.

Perception of Consonants in Reverberation and Noise by Adults Fitted with Bimodal Devices

ERIC Educational Resources Information Center

Mason, Michelle; Kokkinakis, Kostas

2014-01-01

Purpose: The purpose of this study was to evaluate the contribution of a contralateral hearing aid to the perception of consonants, in terms of voicing, manner, and place-of-articulation cues in reverberation and noise by adult cochlear implantees aided by bimodal fittings. Method: Eight postlingually deafened adult cochlear implant (CI) listeners…

Social Maturity and Executive Function among Deaf Learners

ERIC Educational Resources Information Center

Marschark, Marc; Kronenberger, William G.; Rosica, Mark; Borgna, Georgianna; Convertino, Carol; Durkin, Andreana; Machmer, Elizabeth; Schmitz, Kathryn L.

2017-01-01

Two experiments examined relations among social maturity, executive function, language, and cochlear implant (CI) use among deaf high school and college students. Experiment 1 revealed no differences between deaf CI users, deaf nonusers, and hearing college students in measures of social maturity. However, deaf students (both CI users and…

Low-resolution electromagnetic tomography (LORETA) in children with cochlear implants: a preliminary report.

PubMed

Henkin, Yael; Kishon-Rabin, Liat; Tatin-Schneider, Simona; Urbach, Doron; Hildesheimer, Minka; Kileny, Paul R

2004-12-01

The current preliminary report describes the utilization of low-resolution electromagnetic tomography (LORETA) in a small group of highly performing children using the Nucleus 22 cochlear implant (CI) and in normal-hearing (NH) adults. LORETA current density estimations were performed on an averaged target P3 component that was elicited by non-speech and speech oddball discrimination tasks. The results indicated that, when stimulated with tones, patients with right implants and NH adults (regardless of stimulated ear) showed enhanced activation in the right temporal lobe, whereas patients with left implants showed enhanced activation in the left temporal lobe. When stimulated with speech, patients with right implants showed bilateral activation of the temporal and frontal lobes, whereas patients with left implants showed only left temporal lobe activation. NH adults (regardless of stimulated ear) showed enhanced bilateral activation of the temporal and parietal lobes. The differences in activation patterns between patients with CI and NH subjects may be attributed to the long-term exposure to degraded input conditions which may have resulted in reorganization in terms of functional specialization. The difference between patients with right versus left implants, however, is intriguing and requires further investigation.

Impact of early hearing screening and treatment on language development and education level: evaluation of 6 years of universal newborn hearing screening (ALGO) in Flanders, Belgium.

PubMed

Verhaert, N; Willems, M; Van Kerschaver, E; Desloovere, C

2008-05-01

Early intervention in hearing-impaired children may improve language outcomes and subsequent school and occupational performance. The objective of this study was to retrospectively analyze over 6 years the educational outcome and language development of a first cohort of children, detected by the Flemish universal newborn hearing screening (UNHS) program based on automated auditory brainstem response (AABR), with the oldest children being in primary school. We studied 229 hearing-impaired children from 1998 till 2003. The following variables were considered: the age during the school year 2005-2006, the degree of hearing loss, additional impairments including presence of intellectual disability, school placement and early intervention. Analysis showed that 85.4% of the children with moderate, severe or profound hearing loss and no additional disability, older than 5.5 years, reach mainstream education. Further detailed description was provided for the outcomes of children with uni- and bilateral cochlear implants. Overall results stress that 46% of all children with a cochlear implant obtain mainstream education. Of all cochlear implant (CI) children above 5.5 years, without additional handicaps, 78.9% of children attend primary mainstream school. Data on language development show that up to 45% of the children with unilateral cochlear implant and no additional disabilities had normal to slight delay on language development. These data are fulfilling the goals stated by the JCIH and the American Academy of Pediatrics (AAP) in 2000. The role and impact of additional handicaps is discussed. The importance of early hearing loss identification and hearing therapy for appropriate language development is highlighted. Finally our preliminary results on children with bilateral cochlear implants without additional handicaps present an improved language development in comparison to unilateral CI-children. A vast majority of the children detected by the UNHS program, with moderate, severe or profound hearing loss and no additional disability, older than 5.5 years, reach mainstream education. Additional disabilities have a major influence.

Voice gender discrimination provides a measure of more than pitch-related perception in cochlear implant users.

PubMed

Li, Tianhao; Fu, Qian-Jie

2011-08-01

(1) To investigate whether voice gender discrimination (VGD) could be a useful indicator of the spectral and temporal processing abilities of individual cochlear implant (CI) users; (2) To examine the relationship between VGD and speech recognition with CI when comparable acoustic cues are used for both perception processes. VGD was measured using two talker sets with different inter-gender fundamental frequencies (F(0)), as well as different acoustic CI simulations. Vowel and consonant recognition in quiet and noise were also measured and compared with VGD performance. Eleven postlingually deaf CI users. The results showed that (1) mean VGD performance differed for different stimulus sets, (2) VGD and speech recognition performance varied among individual CI users, and (3) individual VGD performance was significantly correlated with speech recognition performance under certain conditions. VGD measured with selected stimulus sets might be useful for assessing not only pitch-related perception, but also spectral and temporal processing by individual CI users. In addition to improvements in spectral resolution and modulation detection, the improvement in higher modulation frequency discrimination might be particularly important for CI users in noisy environments.

Facial nerve stimulation associated with cochlear implant use following temporal bone fractures.

PubMed

Espahbodi, Mana; Sweeney, Alex D; Lennon, Kristen J; Wanna, George B

2015-01-01

To describe the incidence and management of patients with facial nerve stimulation (FNS) associated with cochlear implant (CI) use in the setting of a prior temporal bone fracture. One adult CI recipient is reported who experienced implant associated FNS with a history of a temporal bone fracture. Additionally, a literature search was performed to identify similar patients from previous descriptions of CI related FNS. Presence of FNS after implantation and ability to modify implant programming to avoid FNS. The patient in the present report experienced FNS for middle and basal electrodes during intraoperative neural response telemetry (NRT) in the absence of any surgical exposure or manipulation of the facial nerve. FNS was absent during device activation, but it recurred during follow-up programming sessions. However, additional programming has prevented further FNS during regular implant use. Four other patients with FNS after temporal bone fracture were identified from the literature, and the present case represents the one of two cases in which reprogramming allowed for implant use without FNS. CI associated FNS is uncommon in patients with a history of a temporal bone fracture, but it is likely that fracture lines provide a lower impedance pathway to the adjacent facial nerve and thus reduce the threshold for FNS. The present report suggests that, in the setting of a prior temporal bone fracture, NRT is not always a reliable predictor of FNS during implant use, and programming changes can help to mitigate FNS when it occurs. Copyright © 2015 Elsevier Inc. All rights reserved.

Cochlear implant effectiveness in postlingual single-sided deaf individuals: what's the point?

PubMed

Finke, Mareike; Bönitz, Hanna; Lyxell, Björn; Illg, Angelika

2017-06-01

By extending the indication criteria for cochlear implants (CI), the population of CI candidates increased in age, as well as range and type of hearing loss. This qualitative study identified factors that contributed to seek CI treatment in single-sided deaf individuals and gained insights how single-sided deafness (SSD) and hearing with a CI affect their lives. An open-ended questionnaire and a standardised inventory (IOI-HA) were used. Qualitative data reflecting the reasons to seek CI treatment and the individual experiences after CI switch-on were collected. A total of 19 postlingually deafened single-sided deaf CI users. Participants use their CI daily and stated that their life satisfaction increased since CI activation. The analysis of the qualitative data revealed four core categories: sound localisation, tinnitus and noise sensitivity, fear to lose the second ear and quality of life. Our results show how strongly and diversely quality of hearing and quality of life is affected by acquired SSD and improved after CI activation. Our data suggest that the fear of hearing loss (HL) on the normal hearing (NH) ear is an important but so far neglected reason to seek treatment with a CI in individuals with postlingual SSD.

Spoken Language Development in Children Following Cochlear Implantation

PubMed Central

Niparko, John K.; Tobey, Emily A.; Thal, Donna J.; Eisenberg, Laurie S.; Wang, Nae-Yuh; Quittner, Alexandra L.; Fink, Nancy E.

2010-01-01

Context Cochlear implantation (CI) is a surgical alternative to traditional amplification (hearing aids) that can facilitate spoken language development in young children with severe-to-profound sensorineural hearing loss (SNHL). Objective To prospectively assess spoken language acquisition following CI in young children with adjustment of co-variates. Design, Setting, and Participants Prospective, longitudinal, and multidimensional assessment of spoken language growth over a 3-year period following CI. Prospective cohort study of children who underwent CI before 5 years of age (n=188) from 6 US centers and hearing children of similar ages (n=97) from 2 preschools recruited between November, 2002 and December, 2004. Follow-up completed between November, 2005 and May, 2008. Main Outcome Measures Performance on measures of spoken language comprehension and expression. Results Children undergoing CI showed greater growth in spoken language performance (10.4;[95% confidence interval: 9.6–11.2] points/year in comprehension; 8.4;[7.8–9.0] in expression) than would be predicted by their pre-CI baseline scores (5.4;[4.1–6.7] comprehension; 5.8;[4.6–7.0] expression). Although mean scores were not restored to age-appropriate levels after 3 years, significantly greater annual rates of language acquisition were observed in children who were younger at CI (1.1;[0.5–1.7] points in comprehension per year younger; 1.0;[0.6–1.5] in expression), and in children with shorter histories of hearing deficit (0.8;[0.2,1.2] points in comprehension per year shorter; 0.6;[0.2–1.0] for expression). In multivariable analyses, greater residual hearing prior to CI, higher ratings of parent-child interactions, and higher SES associated with greater rates of growth in comprehension and expression. Conclusions The use of cochlear implants in young children was associated with better spoken language learning than would be predicted from their pre-implantation scores. However, discrepancies between participants’ chronologic and language age persisted after CI, underscoring the importance of early CI in appropriately selected candidates. PMID:20407059

Social Connectedness and Perceived Listening Effort in Adult Cochlear Implant Users: A Grounded Theory to Establish Content Validity for a New Patient-Reported Outcome Measure.

PubMed

Hughes, Sarah E; Hutchings, Hayley A; Rapport, Frances L; McMahon, Catherine M; Boisvert, Isabelle

2018-02-08

Individuals with hearing loss often report a need for increased effort when listening, particularly in challenging acoustic environments. Despite audiologists' recognition of the impact of listening effort on individuals' quality of life, there are currently no standardized clinical measures of listening effort, including patient-reported outcome measures (PROMs). To generate items and content for a new PROM, this qualitative study explored the perceptions, understanding, and experiences of listening effort in adults with severe-profound sensorineural hearing loss before and after cochlear implantation. Three focus groups (1 to 3) were conducted. Purposive sampling was used to recruit 17 participants from a cochlear implant (CI) center in the United Kingdom. The participants included adults (n = 15, mean age = 64.1 years, range 42 to 84 years) with acquired severe-profound sensorineural hearing loss who satisfied the UK's national candidacy criteria for cochlear implantation and their normal-hearing significant others (n = 2). Participants were CI candidates who used hearing aids (HAs) and were awaiting CI surgery or CI recipients who used a unilateral CI or a CI and contralateral HA (CI + HA). Data from a pilot focus group conducted with 2 CI recipients were included in the analysis. The data, verbatim transcripts of the focus group proceedings, were analyzed qualitatively using constructivist grounded theory (GT) methodology. A GT of listening effort in cochlear implantation was developed from participants' accounts. The participants provided rich, nuanced descriptions of the complex and multidimensional nature of their listening effort. Interpreting and integrating these descriptions through GT methodology, listening effort was described as the mental energy required to attend to and process the auditory signal, as well as the effort required to adapt to, and compensate for, a hearing loss. Analyses also suggested that listening effort for most participants was motivated by a need to maintain a sense of social connectedness (i.e., the subjective awareness of being in touch with one's social world). Before implantation, low social connectedness in the presence of high listening effort encouraged self-alienating behaviors and resulted in social isolation with adverse effects for participant's well-being and quality of life. A CI moderated but did not remove the requirement for listening effort. Listening effort, in combination with the improved auditory signal supplied by the CI, enabled most participants to listen and communicate more effectively. These participants reported a restored sense of social connectedness and an acceptance of the continued need for listening effort. Social connectedness, effort-reward balance, and listening effort as a multidimensional phenomenon were the core constructs identified as important to participants' experiences and understanding of listening effort. The study's findings suggest: (1) perceived listening effort is related to social and psychological factors and (2) these factors may influence how individuals with hearing loss report on the actual cognitive processing demands of listening. These findings provide evidence in support of the Framework for Understanding Effortful Listening a heuristic that describes listening effort as a function of both motivation and demands on cognitive capacity. This GT will inform item development and establish the content validity for a new PROM for measuring listening effort.

Cochlear implantation in children and adults in Switzerland.

PubMed

Brand, Yves; Senn, Pascal; Kompis, Martin; Dillier, Norbert; Allum, John H J

2014-02-04

The cochlear implant (CI) is one of the most successful neural prostheses developed to date. It offers artificial hearing to individuals with profound sensorineural hearing loss and with insufficient benefit from conventional hearing aids. The first implants available some 30 years ago provided a limited sensation of sound. The benefit for users of these early systems was mostly a facilitation of lip-reading based communication rather than an understanding of speech. Considerable progress has been made since then. Modern, multichannel implant systems feature complex speech processing strategies, high stimulation rates and multiple sites of stimulation in the cochlea. Equipped with such a state-of-the-art system, the majority of recipients today can communicate orally without visual cues and can even use the telephone. The impact of CIs on deaf individuals and on the deaf community has thus been exceptional. To date, more than 300,000 patients worldwide have received CIs. In Switzerland, the first implantation was performed in 1977 and, as of 2012, over 2,000 systems have been implanted with a current rate of around 150 CIs per year. The primary purpose of this article is to provide a contemporary overview of cochlear implantation, emphasising the situation in Switzerland.

Future technology in cochlear implants: assessing the benefit.

PubMed

Briggs, Robert J S

2011-05-01

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); automated fitting; and reduction in outcome variability. This paper provides examples of relevant potential future technologies that can be applied to reach these goals. In the quest for better outcomes, future technology must deliver improved reliability and usability for both clinicians and recipients that does not compromise safety and is affordable. One of the challenges related to the introduction of new technologies is the 'classification' of CI systems and the framework under which sufficient change and increased benefit can be demonstrated to establish a claim of 'new generation CI' and hence increased reimbursement from third-party payers. Significant improvements in hearing outcomes and quality of life associated with CI design changes are difficult to measure, particularly when there is such dramatic benefit from the intervention of cochlear implantation from the individual's perspective. Manufacturers and clinicians need to be objective and undertake appropriate safety studies and long-term and multi-centre clinical trials to ensure that the introduction of new technology is both safe and effective and supported by health systems worldwide.

The effect of differential listening experience on the development of expressive and receptive language in children with bilateral cochlear implants.

PubMed

Hess, Christi; Zettler-Greeley, Cynthia; Godar, Shelly P; Ellis-Weismer, Susan; Litovsky, Ruth Y

2014-01-01

Growing evidence suggests that children who are deaf and use cochlear implants (CIs) can communicate effectively using spoken language. Research has reported that age of implantation and length of experience with the CI play an important role in a predicting a child's linguistic development. In recent years, the increase in the number of children receiving bilateral CIs (BiCIs) has led to interest in new variables that may also influence the development of hearing, speech, and language abilities, such as length of bilateral listening experience and the length of time between the implantation of the two CIs. One goal of the present study was to determine how a cohort of children with BiCIs performed on standardized measures of language and nonverbal cognition. This study examined the relationship between performance on language and nonverbal intelligence quotient (IQ) tests and the ages at implantation of the first CI and second CI. This study also examined whether early bilateral activation is related to better language scores. Children with BiCIs (n = 39; ages 4 to 9 years) were tested on two standardized measures, the Test of Language Development and the Leiter International Performance Scale-Revised, to evaluate their expressive/receptive language skills and nonverbal IQ/memory. Hierarchical regression analyses were used to evaluate whether BiCI hearing experience predicts language performance. While large intersubject variability existed, on average, almost all the children with BiCIs scored within or above normal limits on measures of nonverbal cognition. Expressive and receptive language scores were highly variable, less likely to be above the normative mean, and did not correlate with Length of first CI Use, defined as length of auditory experience with one cochlear implant, or Length of second CI Use, defined as length of auditory experience with two cochlear implants. All children in the present study had BiCIs. Most IQ scores were either at or above that found in the general population of typically hearing children. However, there was greater variability in their performance on a standardized test of expressive and receptive language. This cohort of children, who are mainstreamed in schools at age-appropriate grades, whose mothers' education is high, and whose families' socioecononomic status is high, had, as a group, on average, language scores within the same range as the normative sample of hearing children. Further research identifying the predictors that contribute to the high variability in both expressive and receptive language scores in children with BiCIs will provide useful information that can aid in clinical management and decision making.

Children with a cochlear implant: characteristics and determinants of speech recognition, speech-recognition growth rate, and speech production.

PubMed

Wie, Ona Bø; Falkenberg, Eva-Signe; Tvete, Ole; Tomblin, Bruce

2007-05-01

The objectives of the study were to describe the characteristics of the first 79 prelingually deaf cochlear implant users in Norway and to investigate to what degree the variation in speech recognition, speech- recognition growth rate, and speech production could be explained by the characteristics of the child, the cochlear implant, the family, and the educational setting. Data gathered longitudinally were analysed using descriptive statistics, multiple regression, and growth-curve analysis. The results show that more than 50% of the variation could be explained by these characteristics. Daily user-time, non-verbal intelligence, mode of communication, length of CI experience, and educational placement had the highest effect on the outcome. The results also indicate that children educated in a bilingual approach to education have better speech perception and faster speech perception growth rate with increased focus on spoken language.

Experiences of the use of FOX, an intelligent agent, for programming cochlear implant sound processors in new users.

PubMed

Vaerenberg, Bart; Govaerts, Paul J; de Ceulaer, Geert; Daemers, Kristin; Schauwers, Karen

2011-01-01

This report describes the application of the software tool "Fitting to Outcomes eXpert" (FOX) in programming the cochlear implant (CI) processor in new users. FOX is an intelligent agent to assist in the programming of CI processors. The concept of FOX is to modify maps on the basis of specific outcome measures, achieved using heuristic logic and based on a set of deterministic "rules". A prospective study was conducted on eight consecutive CI-users with a follow-up of three months. Eight adult subjects with postlingual deafness were implanted with the Advanced Bionics HiRes90k device. The implants were programmed using FOX, running a set of rules known as Eargroup's EG0910 advice, which features a set of "automaps". The protocol employed for the initial 3 months is presented, with description of the map modifications generated by FOX and the corresponding psychoacoustic test results. The 3 month median results show 25 dBHL as PTA, 77% (55 dBSPL) and 71% (70 dBSPL) phoneme score at speech audiometry and loudness scaling in or near to the normal zone at different frequencies. It is concluded that this approach is feasible to start up CI fitting and yields good outcome.

Lexical tone recognition in noise in normal-hearing children and prelingually deafened children with cochlear implants

PubMed Central

Mao, Yitao; Xu, Li

2016-01-01

Objective The purpose of the present study was to investigate Mandarin tone recognition in background noise in children with cochlear implants (CIs), and to examine the potential factors contributing to their performance. Design Tone recognition was tested using a two-alternative forced-choice paradigm in various signal-to-noise ratio (SNR) conditions (i.e., quiet, +12, +6, 0, and −6 dB). Linear correlation analysis was performed to examine possible relationships between the tone-recognition performance of the CI children and the demographic factors. Study sample Sixty-six prelingually deafened children with CIs and 52 normal-hearing (NH) children as controls participated in the study. Results Children with CIs showed overall poorer tone-recognition performance and were more susceptible to noise than their NH peers. Tone confusions between Mandarin tone 2 and tone 3 were most prominent in both CI and NH children except for in the poorest SNR conditions. Age at implantation was significantly correlated with tone-recognition performance of the CI children in noise. Conclusions There is a marked deficit in tone recognition in prelingually deafened children with CIs, particularly in noise listening conditions. While factors that contribute to the large individual differences are still elusive, early implantation could be beneficial to tone development in pediatric CI users. PMID:27564095

Lexical tone recognition in noise in normal-hearing children and prelingually deafened children with cochlear implants.

PubMed

Mao, Yitao; Xu, Li

2017-01-01

The purpose of the present study was to investigate Mandarin tone recognition in background noise in children with cochlear implants (CIs), and to examine the potential factors contributing to their performance. Tone recognition was tested using a two-alternative forced-choice paradigm in various signal-to-noise ratio (SNR) conditions (i.e. quiet, +12, +6, 0, and -6 dB). Linear correlation analysis was performed to examine possible relationships between the tone-recognition performance of the CI children and the demographic factors. Sixty-six prelingually deafened children with CIs and 52 normal-hearing (NH) children as controls participated in the study. Children with CIs showed an overall poorer tone-recognition performance and were more susceptible to noise than their NH peers. Tone confusions between Mandarin tone 2 and tone 3 were most prominent in both CI and NH children except for in the poorest SNR conditions. Age at implantation was significantly correlated with tone-recognition performance of the CI children in noise. There is a marked deficit in tone recognition in prelingually deafened children with CIs, particularly in noise listening conditions. While factors that contribute to the large individual differences are still elusive, early implantation could be beneficial to tone development in pediatric CI users.

Clinical evaluation of music perception, appraisal and experience in cochlear implant users

PubMed Central

Drennan, Ward. R.; Oleson, Jacob J.; Gfeller, Kate; Crosson, Jillian; Driscoll, Virginia D.; Won, Jong Ho; Anderson, Elizabeth S.; Rubinstein, Jay T.

2014-01-01

Objectives The objectives were to evaluate the relationships among music perception, appraisal, and experience in cochlear implant users in multiple clinical settings and to examine the viability of two assessments designed for clinical use. Design Background questionnaires (IMBQ) were administered by audiologists in 14 clinics in the United States and Canada. The CAMP included tests of pitch-direction discrimination, and melody and timbre recognition. The IMBQ queried users on prior musical involvement, music listening habits pre and post implant, and music appraisals. Study sample One-hundred forty-five users of Advanced Bionics and Cochlear Ltd cochlear implants. Results Performance on pitch direction discrimination, melody recognition, and timbre recognition tests were consistent with previous studies with smaller cohorts, as well as with more extensive protocols conducted in other centers. Relationships between perceptual accuracy and music enjoyment were weak, suggesting that perception and appraisal are relatively independent for CI users. Conclusions Perceptual abilities as measured by the CAMP had little to no relationship with music appraisals and little relationship with musical experience. The CAMP and IMBQ are feasible for routine clinical use, providing results consistent with previous thorough laboratory-based investigations. PMID:25177899

Music perception and appraisal: cochlear implant users and simulated cochlear implant listening.

PubMed

Wright, Rose; Uchanski, Rosalie M

2012-05-01

The inability to hear music well may contribute to decreased quality of life for cochlear implant (CI) users. Researchers have reported recently on the generally poor ability of CI users to perceive music, and a few researchers have reported on the enjoyment of music by CI users. However, the relation between music perception skills and music enjoyment is much less explored. Only one study has attempted to predict CI users' enjoyment and perception of music from the users' demographic variables and other perceptual skills (Gfeller et al, 2008). Gfeller's results yielded different predictive relationships for music perception and music enjoyment, and the relationships were weak, at best. The first goal of this study is to clarify the nature and relationship between music perception skills and musical enjoyment for CI users, by employing a battery of music tests. The second goal is to determine whether normal hearing (NH) subjects, listening with a CI simulation, can be used as a model to represent actual CI users for either music enjoyment ratings or music perception tasks. A prospective, cross-sectional observational study. Original music stimuli (unprocessed) were presented to CI users, and music stimuli processed with CI-simulation software were presented to 20 NH listeners (CIsim). As a control, original music stimuli were also presented to five other NH listeners. All listeners appraised 24 musical excerpts, performed music perception tests, and filled out a musical background questionnaire. Music perception tests were the Appreciation of Music in Cochlear Implantees (AMICI), Montreal Battery for Evaluation of Amusia (MBEA), Melodic Contour Identification (MCI), and University of Washington Clinical Assessment of Music Perception (UW-CAMP). Twenty-five NH adults (22-56 yr old), recruited from the local and research communities, participated in the study. Ten adult CI users (46-80 yr old), recruited from the patient population of the local adult cochlear implant program, also participated in this study. Musical excerpts were appraised using a seven-point rating scale, and music perception tests were scored as designed. Analysis of variance was performed on appraisal ratings, perception scores, and questionnaire data with listener group as a factor. Correlations were computed between musical appraisal ratings and perceptual scores on each music test. Music is rated as more enjoyable by CI users than by the NH listeners hearing music through a simulation (CIsim), and the difference is statistically significant. For roughly half of the music perception tests, there are no statistically significant differences between the performance of the CI users and of the CIsim listeners. Generally, correlations between appraisal ratings and music perception scores are weak or nonexistent. NH adults listening to music that has been processed through a CI-simulation program are a reasonable model for actual CI users for many music perception skills, but not for rating musical enjoyment. For CI users, the apparent independence of music perception skills and music enjoyment (as assessed by appraisals) indicates that music enjoyment should not be assumed and should be examined explicitly. American Academy of Audiology.

New Criteria of Indication and Selection of Patients to Cochlear Implant

PubMed Central

Sampaio, André L. L.; Araújo, Mercêdes F. S.; Oliveira, Carlos A. C. P.

2011-01-01

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

Central Auditory Maturation and Behavioral Outcome in Children with Auditory Neuropathy Spectrum Disorder who Use Cochlear Implants

PubMed Central

Cardon, Garrett; Sharma, Anu

2013-01-01

Objective We examined cortical auditory development and behavioral outcomes in children with ANSD fitted with cochlear implants (CI). Design Cortical maturation, measured by P1 cortical auditory evoked potential (CAEP) latency, was regressed against scores on the Infant Toddler Meaningful Auditory Integration Scale (IT-MAIS). Implantation age was also considered in relation to CAEP findings. Study Sample Cross-sectional and longitudinal samples of 24 and 11 children, respectively, with ANSD fitted with CIs. Result P1 CAEP responses were present in all children after implantation, though previous findings suggest that only 50-75% of ANSD children with hearing aids show CAEP responses. P1 CAEP latency was significantly correlated with participants' IT-MAIS scores. Furthermore, more children implanted before age two years showed normal P1 latencies, while those implanted later mainly showed delayed latencies. Longitudinal analysis revealed that most children showed normal or improved cortical maturation after implantation. Conclusion Cochlear implantation resulted in measureable cortical auditory development for all children with ANSD. Children fitted with CIs under age two years were more likely to show age-appropriate CAEP responses within 6 months after implantation, suggesting a possible sensitive period for cortical auditory development in ANSD. That CAEP responses were correlated with behavioral outcome highlights their clinical decision-making utility. PMID:23819618

Health-Related Quality of Life Among Young Children With Cochlear Implants and Developmental Disabilities.

PubMed

Zaidman-Zait, Anat; Curle, Deirdre; Jamieson, Janet R; Chia, Ruth; Kozak, Frederick K

The present study examined differences in health-related quality of life (HRQoL) between deaf children with cochlear implants (CI) with and without developmental disabilities (DD) and differences across HRQoL domains within both groups of children. Ninety-two parents of children with CI aged 3-7 years participated in this cross-sectional study. Of these children, 43 had DD (i.e., CI-DD group) and 49 had no DD or chronic illness, demonstrating overall typical development (i.e., CI-TD group). Parents of children in both groups completed the KINDL, a generic HRQoL questionnaire. Parents also provided anecdotal comments to open-ended questions, and parent comments were evaluated on a CI benefits scale to assess parent-perceived benefits of CI for the deaf children with and without disabilities. Children in the CI-DD group had significantly lower HRQoL compared to children in the CI-TD group, including lower scores on the self-esteem, friend, school, and family HRQoL subscales. No significant differences among groups were found on the physical well-being and emotional well-being subscales. For the CI-TD group, age at implantation correlated negatively with self-esteem and school HRQoL subscales. In the CI-DD group, children's current age correlated negatively with family and with the total HRQoL scores. Parent anecdotal comments and scores on the CI-benefits scale indicated strong parent perceptions of benefits of implantation for children in both groups. Based on parents' proxy report, findings suggest that having DD affects multiple domains of HRQoL among young children with CIs above and beyond that of the CI itself. Parents of deaf children with DD may need greater support through the CI process and follow-up than parents of deaf children without DD.

Ten-year follow-up of a consecutive series of children with multichannel cochlear implants.

PubMed

Uziel, Alain S; Sillon, Martine; Vieu, Adrienne; Artieres, Françoise; Piron, Jean-Pierre; Daures, Jean-Pierre; Mondain, Michel

2007-08-01

To assess a group of children who consecutively received implants more than 10 years after implantation with regard to speech perception, speech intelligibility, receptive language level, and academic/occupational status. A prospective longitudinal study. Pediatric referral center for cochlear implantation. Eighty-two prelingually deafened children received the Nucleus multichannel cochlear implant. Cochlear implantation with Cochlear Nucleus CI22 implant. The main outcome measures were open-set Phonetically Balanced Kindergarten word test, discrimination of sentences in noise, connective discourse tracking (CDT) using voice and telephone, speech intelligibility rating (SIR), vocabulary knowledge measured using the Peabody Picture Vocabulary Test (Revised), academic performance on French language, foreign language, and mathematics, and academic/occupational status. After 10 years of implant experience, 79 children (96%) reported that they always wear the device; 79% (65 of 82 children) could use the telephone. The mean scores were 72% for the Phonetically Balanced Kindergarten word test, 44% for word recognition in noise, 55.3 words per minute for the CDT, and 33 words per minute for the CDT via telephone. Thirty-three children (40%) developed speech intelligible to the average listener (SIR 5), and 22 (27%) developed speech intelligible to a listener with little experience of deaf person's speech (SIR 4). The measures of vocabulary showed that most (76%) of children who received implants scored below the median value of their normally hearing peers. The age at implantation was the most important factor that may influence the postimplant outcomes. Regarding educational/vocational status, 6 subjects attend universities, 3 already have a professional activity, 14 are currently at high school level, 32 are at junior high school level, 6 additional children are enrolled in a special unit for children with disability, and 3 children are still attending elementary schools. Seventeen are in further noncompulsory education studying a range of subjects at vocational level. This long-term report shows that many profoundly hearing-impaired children using cochlear implants can develop functional levels of speech perception and production, attain age-appropriate oral language, develop competency level in a language other than their primary language, and achieve satisfactory academic performance.

Selecting electrode configurations for image-guided cochlear implant programming using template matching.

PubMed

Zhang, Dongqing; Zhao, Yiyuan; Noble, Jack H; Dawant, Benoit M

2018-04-01

Cochlear implants (CIs) are neural prostheses that restore hearing using an electrode array implanted in the cochlea. After implantation, the CI processor is programmed by an audiologist. One factor that negatively impacts outcomes and can be addressed by programming is cross-electrode neural stimulation overlap (NSO). We have proposed a system to assist the audiologist in programming the CI that we call image-guided CI programming (IGCIP). IGCIP permits using CT images to detect NSO and recommend deactivation of a subset of electrodes to avoid NSO. We have shown that IGCIP significantly improves hearing outcomes. Most of the IGCIP steps are robustly automated but electrode configuration selection still sometimes requires manual intervention. With expertise, distance-versus-frequency curves, which are a way to visualize the spatial relationship learned from CT between the electrodes and the nerves they stimulate, can be used to select the electrode configuration. We propose an automated technique for electrode configuration selection. A comparison between this approach and one we have previously proposed shows that our method produces results that are as good as those obtained with our previous method while being generic and requiring fewer parameters.

Interplay between singing and cortical processing of music: a longitudinal study in children with cochlear implants.

PubMed

Torppa, Ritva; Huotilainen, Minna; Leminen, Miika; Lipsanen, Jari; Tervaniemi, Mari

2014-01-01

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.

Single-Sided Deafness: Impact of Cochlear Implantation on Speech Perception in Complex Noise and on Auditory Localization Accuracy.

PubMed

Döge, Julia; Baumann, Uwe; Weissgerber, Tobias; Rader, Tobias

2017-12-01

To assess auditory localization accuracy and speech reception threshold (SRT) in complex noise conditions in adult patients with acquired single-sided deafness, after intervention with a cochlear implant (CI) in the deaf ear. Nonrandomized, open, prospective patient series. Tertiary referral university hospital. Eleven patients with late-onset single-sided deafness (SSD) and normal hearing in the unaffected ear, who received a CI. All patients were experienced CI users. Unilateral cochlear implantation. Speech perception was tested in a complex multitalker equivalent noise field consisting of multiple sound sources. Speech reception thresholds in noise were determined in aided (with CI) and unaided conditions. Localization accuracy was assessed in complete darkness. Acoustic stimuli were radiated by multiple loudspeakers distributed in the frontal horizontal plane between -60 and +60 degrees. In the aided condition, results show slightly improved speech reception scores compared with the unaided condition in most of the patients. For 8 of the 11 subjects, SRT was improved between 0.37 and 1.70 dB. Three of the 11 subjects showed deteriorations between 1.22 and 3.24 dB SRT. Median localization error decreased significantly by 12.9 degrees compared with the unaided condition. CI in single-sided deafness is an effective treatment to improve the auditory localization accuracy. Speech reception in complex noise conditions is improved to a lesser extent in 73% of the participating CI SSD patients. However, the absence of true binaural interaction effects (summation, squelch) impedes further improvements. The development of speech processing strategies that respect binaural interaction seems to be mandatory to advance speech perception in demanding listening situations in SSD patients.

A Follow-Up Study on Music and Lexical Tone Perception in Adult Mandarin-Speaking Cochlear Implant Users.

PubMed

Gu, Xin; Liu, Bo; Liu, Ziye; Qi, Beier; Wang, Shuo; Dong, Ruijuan; Chen, Xueqing; Zhou, Qian

2017-12-01

The aim was to evaluate the development of music and lexical tone perception in Mandarin-speaking adult cochlear implant (CI) users over a period of 1 year. Prospective patient series. Tertiary hospital and research institute. Twenty five adult CI users, with ages ranging from 19 to 75 years old, participated in a year-long follow-up evaluation. There were also 40 normal hearing adult subjects who participated as a control group to provide the normal value range. Musical sounds in cochlear implants (Mu.S.I.C.) test battery was undertaken to evaluate music perception ability. Mandarin Tone Identification in Noise Test (M-TINT) was used to assess lexical tone recognition. The tests for CI users were completed at 1, 3, 6, and 12 months after the CI switch-on. Quantitative and statistical analysis of their results from music and tone perception tests. The performance of music perception and tone recognition both demonstrated an overall improvement in outcomes during the entire 1-year follow-up process. The increasing trends were obvious in the early period especially in the first 6 months after switch-on. There was a significant improvement in the melody discrimination (p < 0.01), timbre identification (p < 0.001), tone recognition in quiet (p < 0.0001), and in noise (p < 0.0001). Adult Mandarin-speaking CI users show an increasingly improved performance on music and tone perception during the 1-year follow-up. The improvement was the most prominent in the first 6 months of CI use. It is essential to strengthen the rehabilitation training within the first 6 months.

Deficits in the pitch sensitivity of cochlear-implanted children speaking English or Mandarin

PubMed Central

Deroche, Mickael L. D.; Lu, Hui-Ping; Limb, Charles J.; Lin, Yung-Song; Chatterjee, Monita

2014-01-01

Sensitivity to complex pitch is notoriously poor in adults with cochlear implants (CIs), but it is unclear whether this is true for children with CIs. Many are implanted today at a very young age, and factors related to brain plasticity (age at implantation, duration of CI experience, and speaking a tonal language) might have strong influences on pitch sensitivity. School-aged children participated, speaking English or Mandarin, having normal hearing (NH) or wearing a CI, using their clinically assigned settings with envelope-based coding strategies. Percent correct was measured in three-interval three-alternative forced choice tasks, for the discrimination of fundamental frequency (F0) of broadband harmonic complexes, and for the discrimination of sinusoidal amplitude modulation rate (AMR) of broadband noise, with reference frequencies at 100 and 200 Hz to focus on voice pitch processing. Data were fitted using a maximum-likelihood technique. CI children displayed higher thresholds and shallower slopes than NH children in F0 discrimination, regardless of linguistic background. Thresholds and slopes were more similar between NH and CI children in AMR discrimination. Once the effect of chronological age was extracted from the variance, the aforementioned factors related to brain plasticity did not contribute significantly to the CI children's sensitivity to pitch. Unless different strategies attempt to encode fine structure information, potential benefits of plasticity may be missed. PMID:25249932

Prelingual auditory-perceptual skills as indicators of initial oral language development in deaf children with cochlear implants.

PubMed

Pianesi, Federica; Scorpecci, Alessandro; Giannantonio, Sara; Micardi, Mariella; Resca, Alessandra; Marsella, Pasquale

2016-03-01

To assess when prelingually deaf children with a cochlear implant (CI) achieve the First Milestone of Oral Language, to study the progression of their prelingual auditory skills in the first year after CI and to investigate a possible correlation between such skills and the timing of initial oral language development. The sample included 44 prelingually deaf children (23 M and 21 F) from the same tertiary care institution, who received unilateral or bilateral cochlear implants. Achievement of the First Milestone of Oral Language (FMOL) was defined as speech comprehension of at least 50 words and speech production of a minimum of 10 words, as established by administration of a validated Italian test for the assessment of initial language competence in infants. Prelingual auditory-perceptual skills were assessed over time by means of a test battery consisting of: the Infant Toddler Meaningful Integration Scale (IT-MAIS); the Infant Listening Progress Profile (ILiP) and the Categories of Auditory Performance (CAP). On average, the 44 children received their CI at 24±9 months and experienced FMOL after 8±4 months of continuous CI use. The IT-MAIS, ILiP and CAP scores increased significantly over time, the greatest improvement occurring between baseline and six months of CI use. On multivariate regression analysis, age at diagnosis and age at CI did not appear to bear correlation with FMOL timing; instead, the only variables contributing to its variance were IT-MAIS and ILiP scores after six months of CI use, accounting for 43% and 55%, respectively. Prelingual auditory skills of implanted children assessed via a test battery six months after CI treatment, can act as indicators of the timing of initial oral language development. Accordingly, the period from CI switch-on to six months can be considered as a window of opportunity for appropriate intervention in children failing to show the expected progression of their auditory skills and who would have higher risk of delayed oral language development. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Interdependence of Linguistic and Indexical Speech Perception Skills in School-Aged Children with Early Cochlear Implantation

PubMed Central

Geers, Ann; Davidson, Lisa; Uchanski, Rosalie; Nicholas, Johanna

2013-01-01

Objectives This study documented the ability of experienced pediatric cochlear implant (CI) users to perceive linguistic properties (what is said) and indexical attributes (emotional intent and talker identity) of speech, and examined the extent to which linguistic (LSP) and indexical (ISP) perception skills are related. Pre-implant aided hearing, age at implantation, speech processor technology, CI-aided thresholds, sequential bilateral cochlear implantation, and academic integration with hearing age-mates were examined for their possible relationships to both LSP and ISP skills. Design Sixty 9–12 year olds, first implanted at an early age (12–38 months), participated in a comprehensive test battery that included the following LSP skills: 1) recognition of monosyllabic words at loud and soft levels, 2) repetition of phonemes and suprasegmental features from non-words, and 3) recognition of keywords from sentences presented within a noise background, and the following ISP skills: 1) discrimination of male from female and female from female talkers and 2) identification and discrimination of emotional content from spoken sentences. A group of 30 age-matched children without hearing loss completed the non-word repetition, and talker- and emotion-perception tasks for comparison. Results Word recognition scores decreased with signal level from a mean of 77% correct at 70 dB SPL to 52% at 50 dB SPL. On average, CI users recognized 50% of keywords presented in sentences that were 9.8 dB above background noise. Phonetic properties were repeated from non-word stimuli at about the same level of accuracy as suprasegmental attributes (70% and 75%, respectively). The majority of CI users identified emotional content and differentiated talkers significantly above chance levels. Scores on LSP and ISP measures were combined into separate principal component scores and these components were highly correlated (r = .76). Both LSP and ISP component scores were higher for children who received a CI at the youngest ages, upgraded to more recent CI technology and had lower CI-aided thresholds. Higher scores, for both LSP and ISP components, were also associated with higher language levels and mainstreaming at younger ages. Higher ISP scores were associated with better social skills. Conclusions Results strongly support a link between indexical and linguistic properties in perceptual analysis of speech. These two channels of information appear to be processed together in parallel by the auditory system and are inseparable in perception. Better speech performance, for both linguistic and indexical perception, is associated with younger age at implantation and use of more recent speech processor technology. Children with better speech perception demonstrated better spoken language, earlier academic mainstreaming, and placement in more typically-sized classrooms (i.e., >20 students). Well-developed social skills were more highly associated with the ability to discriminate the nuances of talker identity and emotion than with the ability to recognize words and sentences through listening. The extent to which early cochlear implantation enabled these early-implanted children to make use of both linguistic and indexical properties of speech influenced not only their development of spoken language, but also their ability to function successfully in a hearing world. PMID:23652814

Cochlear Implants.

ERIC Educational Resources Information Center

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…

Knowledge, experience and practice of SLTs regarding (re)habilitation in deaf children with cochlear implants.

PubMed

Okalidou, Areti; Kitsona, Mariana; Anagnostou, Flora; Tsoukala, Marinella; Santzakli, Stella; Gouda, Stamatia; Nikolopoulos, Thomas P

2014-07-01

To assess the knowledge, experience and practices of speech and language therapists (SLTs) in Greece regarding children with cochlear implants. A special designed questionnaire was originally completed electronically by 313 SLTs via surveymonkey platform. From the 313 respondents 35% had worked with implanted children, 37% received course training and 44% had participated in post-graduate seminars. Although 96% believe that there are differences in the management of these children, almost 47% of the participants did not have adequate knowledge on the candidacy criteria for implantation and 70% regarding the available technology for implanted children. Knowledge and skills on CI were better for those SLTs who worked with hearing-impairment. Diverse practice models were noted. Interestingly, more than 87% of the participants advocated toward further training and supervision in the field, even the ones who had less than extensive knowledge in working with CI. As for practice, a lack of organizational interdisciplinary structure became evident. There is a growing need for well organized professional training and team networks for SLTs in order for them to further improve their knowledge and service delivery to implanted children. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Effect of age at cochlear implantation and at exposure to Cued Speech on literacy skills in deaf children.

PubMed

Colin, S; Ecalle, J; Truy, E; Lina-Granade, G; Magnan, A

2017-12-01

The aim of this study was to investigate how age at cochlear implantation (CI) and age at exposure to Cued Speech (CS, Manual system that resolves the ambiguity inherent lipreading) could impact literacy skills in deaf children. Ninety deaf children fitted with CI (early vs late) and exposed to CS (early vs late) from primary schools (from Grade 2 to Grade 5) took part in this study. Five literacy skills were assessed: phonological skills through phoneme deletion, reading (decoding and sentence comprehension), word spelling and vocabulary. The results showed that both age at CI and age at first exposure to CS had some influence on literacy skills but there was no interaction between these factors. This implies that the positive effects of age at CI, especially on all literacy skills in the younger children, were not strengthened by age at exposure to CS. Copyright © 2017 Elsevier Ltd. All rights reserved.

Internalized elevation perception of simple stimuli in cochlear-implant and normal-hearing listeners

PubMed Central

Thakkar, Tanvi; Goupell, Matthew J.

2014-01-01

In normal-hearing (NH) listeners, elevation perception is produced by the spectral cues imposed by the pinna, head, and torso. Elevation perception in cochlear-implant (CI) listeners appears to be non-existent; this may be a result of poorly encoded spectral cues. In this study, an analog of elevation perception was investigated by having 15 CI and 8 NH listeners report the intracranial location of spectrally simple signals (single-electrode or bandlimited acoustic stimuli, respectively) in both horizontal and vertical dimensions. Thirteen CI listeners and all of the NH listeners showed an association between place of stimulation (i.e., stimulus frequency) and perceived elevation, generally responding with higher elevations for more basal stimulation. This association persisted in the presence of a randomized temporal pitch, suggesting that listeners were not associating pitch with elevation. These data provide evidence that CI listeners might perceive changes in elevation if they were presented stimuli with sufficiently salient elevation cues. PMID:25096117

Musical FAVORS: Reintroducing music to adult cochlear implant users.

PubMed

Plant, Geoff

2015-09-01

Music represents a considerable challenge for many adult users of cochlear implants (CIs). Around half of adult CI users report that they do not find music enjoyable, and, in some cases, despite enhanced speech perception skills, this leads to considerable frustration and disappointment for the CI user. This paper presents suggestions to improve the musical experiences of deafened adults with CIs. Interviews with a number of adult CI users revealed that there were a number of factors which could lead to enhanced music experiences. The acronym FAVORS (familiar music, auditory-visual access, open-mindedness, and simple arrangements) summarizes the factors that have been identified, which can help CI users in their early music listening experiences. Each of these factors is discussed in detail, along with suggestions for how they can be used in therapy sessions. The use of a group approach (music focus groups) is also discussed and an overview of the approach and exercises used is presented. The importance of live music experiences is also discussed.

Reversing the polarity of a cochlear implant magnet after magnetic resonance imaging.

PubMed

Jeon, Ju Hyun; Bae, Mi Ran; Chang, Jae Won; Choi, Jae Young

2012-08-01

The number of patients with cochlear implant (CI) has been rapidly increasing in recent years, and these patients show a growing need of examination by magnetic resonance imaging (MRI). However, the use of MRI on patients with CI is restricted by the internal magnet of the CI. Many studies have investigated the safety of performing 1.5T MRI on patients with CI, which is now being practiced in a clinical setting. We experienced a case in which the polarity of the cochlear implant magnet was reversed after the patient was examined using 1.5T MRI. The external device was attached to the internal device oppositely. We could not find displacement of the internal device, magnet, or electrode upon radiological evaluation. We came up with two possible mechanisms by which the polarity of the magnet reversed. The first possibility was that the magnetic field of MRI reversed the polarity of the magnet. The second was that the internal magnet was physically realigned while interacting with the MRI. We believe the second hypothesis to be more reliable. A removable magnet and a loose magnet boundary of a CI device may have allowed for physical reorientation of the internal magnet. Therefore, in order to avoid these complications, first, the internal magnet must not be aligned anti-parallel with the magnetic polarity of MRI. In the Siemens MRI, the vector of the magnetic field is downward, so implant site should be placed in facing upwards to minimize demagnetization. In the GE Medical Systems MRI, the vector of the magnetic field is upward, so the implant site should be placed facing downwards. Second, wearing of a commercial mold which is fixed to the internal device before performing MRI can be helpful. In addition, any removable internal magnets in a CI device should be removed before MRI, especially in the trunk. However, to ultimately solve this problem, the pocket of the internal magnet should be redesigned for safety. Copyright © 2011. Published by Elsevier Ireland Ltd.

Response Changes During Insertion of a Cochlear Implant Using Extracochlear Electrocochleography.

PubMed

Giardina, Christopher K; Khan, Tatyana E; Pulver, Stephen H; Adunka, Oliver F; Buchman, Craig A; Brown, Kevin D; Pillsbury, Harold C; Fitzpatrick, Douglas C

2018-03-16

Electrocochleography is increasingly being utilized as an intraoperative monitor of cochlear function during cochlear implantation (CI). Intracochlear recordings from the advancing electrode can be obtained through the device by on-board capabilities. However, such recordings may not be ideal as a monitor because the recording electrode moves in relation to the neural and hair cell generators producing the responses. The purposes of this study were to compare two extracochlear recording locations in terms of signal strength and feasibility as intraoperative monitoring sites and to characterize changes in cochlear physiology during CI insertion. In 83 human subjects, responses to 90 dB nHL tone bursts were recorded both at the round window (RW) and then at an extracochlear position-either adjacent to the stapes or on the promontory just superior to the RW. Recording from the fixed, extracochlear position continued during insertion of the CI in 63 cases. Before CI insertion, responses to low-frequency tones at the RW were roughly 6 dB larger than when recording at either extracochlear site, but the two extracochlear sites did not differ from one another. During CI insertion, response losses from the promontory or adjacent to the stapes stayed within 5 dB in ≈61% (38/63) of cases, presumably indicating atraumatic insertions. Among responses which dropped more than 5 dB at any time during CI insertion, 12 subjects showed no response recovery, while in 13, the drop was followed by partial or complete response recovery by the end of CI insertion. In cases with recovery, the drop in response occurred relatively early (<15 mm insertion) compared to those where there was no recovery. Changes in response phase during the insertion occurred in some cases; these may indicate a change in the distributions of generators contributing to the response. Monitoring the electrocochleography during CI insertion from an extracochlear site reveals insertions that are potentially atraumatic show interaction with cochlear structures followed by response recovery or show interactions such that response losses persist to the end of recording.

Auditory, speech and language development in young children with cochlear implants compared with children with normal hearing.

PubMed

Schramm, Bianka; Bohnert, Andrea; Keilmann, Annerose

2010-07-01

This study had two aims: (1) to document the auditory and lexical development of children who are deaf and received the first cochlear implant (CI) by the age of 16 months and the second CI by the age of 31 months and (2) to compare these children's results with those of children with normal hearing (NH). This longitudinal study included five children with NH and five with sensorineural deafness. All children of the second group were observed for 36 months after the first fitting of the device (cochlear implant). The auditory development of the CI group was documented every 3 months up to the age of two years in hearing age and chronological age and for the NH group in chronological age. The language development of each NH child was assessed at 12, 18, 24 and 36 months of chronological age. Children with CIs were examined at the same age intervals at chronological and hearing age. In both groups, children showed individual patterns of auditory and language development. The children with CIs developed differently in the amount of receptive and expressive vocabulary compared with the NH control group. Three children in the CI group needed almost 6 months to make gains in speech development that were consistent with what would be expected for their chronological age. Overall, the receptive and expressive development in all children of the implanted group increased with their hearing age. These results indicate that early identification and early implantation is advisable to give children with sensorineural hearing loss a realistic chance to develop satisfactory expressive and receptive vocabulary and also to develop stable phonological, morphological and syntactical skills for school life. On the basis of these longitudinal data, we will be able to develop new diagnostic tools that enable clinicians to assess child's progress in hearing and speech development. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

Cochlear Implantation in Patients With Usher Syndrome Type IIa Increases Performance and Quality of Life.

PubMed

Hartel, Bas P; van Nierop, Josephine W I; Huinck, Wendy J; Rotteveel, Liselotte J C; Mylanus, Emmanuel A M; Snik, Ad F; Kunst, Henricus P M; Pennings, Ronald J E

2017-07-01

Usher syndrome type IIa (USH2a) is characterized by congenital moderate to severe hearing impairment and retinitis pigmentosa. Hearing rehabilitation starts in early childhood with the application of hearing aids. In some patients with USH2a, severe progression of hearing impairment leads to insufficient speech intelligibility with hearing aids and issues with adequate communication and safety. Cochlear implantation (CI) is the next step in rehabilitation of such patients. This study evaluates the performance and benefit of CI in patients with USH2a. Retrospective case-control study to evaluate the performance and benefit of CI in 16 postlingually deaf adults (eight patients with USH2a and eight matched controls). Performance and benefit were evaluated by a speech intelligibility test and three quality-of-life questionnaires. Patients with USH2a with a mean age of 59 years at implantation exhibited good performance after CI. The phoneme scores improved significantly from 41 to 87% in patients with USH2a (p = 0.02) and from 30 to 86% in the control group (p = 0.001). The results of the questionnaire survey demonstrated a clear benefit from CI. There were no differences in performance or benefit between patients with USH2a and control patients before and after CI. CI increases speech intelligibility and improves quality of life in patients with USH2a.

Contralateral Bimodal Stimulation: A Way to Enhance Speech Performance in Arabic-Speaking Cochlear Implant Patients.

PubMed

Abdeltawwab, Mohamed M; Khater, Ahmed; El-Anwar, Mohammad W

2016-01-01

The combination of acoustic and electric stimulation as a way to enhance speech recognition performance in cochlear implant (CI) users has generated considerable interest in the recent years. The purpose of this study was to evaluate the bimodal advantage of the FS4 speech processing strategy in combination with hearing aids (HA) as a means to improve low-frequency resolution in CI patients. Nineteen postlingual CI adults were selected to participate in this study. All patients wore implants on one side and HA on the contralateral side with residual hearing. Monosyllabic word recognition, speech in noise, and emotion and talker identification were assessed using CI with fine structure processing/FS4 and high-definition continuous interleaved sampling strategies, HA alone, and a combination of CI and HA. The bimodal stimulation showed improvement in speech performance and emotion identification for the question/statement/order tasks, which was statistically significant compared to patients with CI alone, but there were no significant statistical differences in intragender talker discrimination and emotion identification for the happy/angry/neutral tasks. The poorest performance was obtained with HA only, and it was statistically significant compared to the other modalities. The bimodal stimulation showed enhanced speech performance in CI patients, and it improves the limitations provided by electric or acoustic stimulation alone. © 2016 S. Karger AG, Basel.

Cortical reorganization in postlingually deaf cochlear implant users: Intra-modal and cross-modal considerations.

PubMed

Stropahl, Maren; Chen, Ling-Chia; Debener, Stefan

2017-01-01

With the advances of cochlear implant (CI) technology, many deaf individuals can partially regain their hearing ability. However, there is a large variation in the level of recovery. Cortical changes induced by hearing deprivation and restoration with CIs have been thought to contribute to this variation. The current review aims to identify these cortical changes in postlingually deaf CI users and discusses their maladaptive or adaptive relationship to the CI outcome. Overall, intra-modal and cross-modal reorganization patterns have been identified in postlingually deaf CI users in visual and in auditory cortex. Even though cross-modal activation in auditory cortex is considered as maladaptive for speech recovery in CI users, a similar activation relates positively to lip reading skills. Furthermore, cross-modal activation of the visual cortex seems to be adaptive for speech recognition. Currently available evidence points to an involvement of further brain areas and suggests that a focus on the reversal of visual take-over of the auditory cortex may be too limited. Future investigations should consider expanded cortical as well as multi-sensory processing and capture different hierarchical processing steps. Furthermore, prospective longitudinal designs are needed to track the dynamics of cortical plasticity that takes place before and after implantation. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

Electric-acoustic stimulation suppresses tinnitus in a subject with high-frequency single-sided deafness.

PubMed

Mertens, Griet; Van Rompaey, Vincent; Van de Heyning, Paul

2018-05-17

A suggested solution to suppress tinnitus is to restore the normal sensory input. This is based on the auditory deprivation hypothesis. It is known that hearing aids can provide sufficient activation of the auditory nervous system and reduce tinnitus in subjects with mild to moderate hearing loss and that cochlear implantation can reduce tinnitus in subjects with severe to profound hearing loss. This applies to subjects with single-sided deafness (SSD) or bilateral hearing loss. To investigate if electric-acoustic stimulation (EAS) can reduce severe tinnitus in a subject with residual hearing in the ipsilateral ear and contralateral normal hearing (high-frequency SSD) by restoring the auditory input. Tinnitus reduction was investigated for 1 year after implantation in a subject with high-frequency SSD, who uses EAS, and was compared to 11 subjects with a cochlear implant (CI) with SSD. The Visual Analogue Scale (VAS) and the Tinnitus Questionnaire (TQ) were administered pre-operatively and at 1, 3, 6, and 12 months after implantation. Significant tinnitus reduction was observed 1 month after implantation on the VAS in the subjects with SSD using a CI. Tinnitus reduction was also observed in the subject with high-frequency SSD using EAS. A further decrease was observed 3 months after implantation. The TQ and VAS scores remained stable up to 1 year after implantation. A CI can significantly reduce ipsilateral severe tinnitus in a subject with SSD. Ipsilateral severe tinnitus can also be reduced using EAS in subjects with high-frequency SSD.

Comprehensive analysis of cochlear implant failure: usefulness of clinical symptom-based algorithm combined with in situ integrity testing.

PubMed

Yamazaki, Hiroshi; O'Leary, Stephen; Moran, Michelle; Briggs, Robert

2014-04-01

Accurate diagnosis of cochlear implant failures is important for management; however, appropriate strategies to assess possible device failures are not always clear. The purpose of this study is to understand correlation between causes of device failure and the presenting clinical symptoms as well as results of in situ integrity testing and to propose effective strategies for diagnosis of device failure. Retrospective case review. Cochlear implant center at a tertiary referral hospital. Twenty-seven cases with suspected device failure of Cochlear Nucleus systems (excluding CI512 failures) on the basis of deterioration in auditory perception from January 2000 to September 2012 in the Melbourne cochlear implant clinic. Clinical presentations and types of abnormalities on in situ integrity testing were compared with modes of device failure detected by returned device analysis. Sudden deterioration in auditory perception was always observed in cases with "critical damage": either fracture of the integrated circuit or most or all of the electrode wires. Subacute or gradually progressive deterioration in auditory perception was significantly associated with a more limited number of broken electrode wires. Cochlear implant mediated auditory and nonauditory symptoms were significantly associated with an insulation problem. An algorithm based on the time course of deterioration in auditory perception and cochlear implant-mediated auditory and nonauditory symptoms was developed on the basis of these retrospective analyses, to help predict the mode of device failure. In situ integrity testing, which included close monitoring of device function in routine programming sessions as well as repeating the manufacturer's integrity test battery, was sensitive enough to detect malfunction in all suspected device failures, and each mode of device failure showed a characteristic abnormality on in situ integrity testing. Our clinical manifestation-based algorithm combined with in situ integrity testing may be useful for accurate diagnosis and appropriate management of device failure. Close monitoring of device function in routine programming sessions as well as repeating the manufacturer's integrity test battery is important if the initial in situ integrity testing is inconclusive because objective evidence of failure in the implanted device is essential to recommend explantation/reimplantation.

Reduction of the Harmonic Series Influences Musical Enjoyment with Cochlear Implants

PubMed Central

Nemer, John S.; Kohlberg, Gavriel D.; Mancuso, Dean M.; Griffin, Brianna M.; Certo, Michael V.; Chen, Stephanie Y.; Chun, Michael B.; Spitzer, Jaclyn B.; Lalwani, Anil K.

2016-01-01

Objective Cochlear implantation is associated with poor music perception and enjoyment. Reducing music complexity has been shown to enhance music enjoyment in cochlear implant (CI) recipients. In this study, we assess the impact of harmonic series reduction on music enjoyment. Study Design Prospective analysis of music enjoyment in normal-hearing (NH) individuals and CI recipients. Setting Single tertiary academic medical center. Patients NH adults (N=20) and CI users (N=8) rated the Happy Birthday song on three validated enjoyment modalities–musicality, pleasantness, and naturalness. Intervention Subjective rating of music excerpts. Main outcome measures Participants listened to seven different instruments play the melody, each with five levels of harmonic reduction (Full|F3+F2+F1+F0|F2+F1+F0|F1+F0|F0). NH participants listened to the segments both with and without CI simulation. Linear mixed effect models (LME) and likelihood ratio tests were used to assess the impact of harmonic reduction on enjoyment. Results NH listeners without simulation rated segments with the first four harmonics (F3+F2+F1+F0) most pleasant and natural (p<0.001|p=0.004). NH listeners with simulation rated the first harmonic alone (F0) most pleasant and natural (p<0.001|p=0.003). Their ratings demonstrated a positive linear relationship between harmonic reduction and both pleasantness (slope estimate=0.030|SE=0.004|p<0.001|LME) and naturalness (slope estimate=0.012|SE=0.003|p=0.003|LME). CI recipients also found the first harmonic alone (F0) to be most pleasant (p=0.003), with a positive linear relationship between harmonic reduction and pleasantness (slope estimate=0.029|SE=0.008|p<0.001|LME). Conclusions Harmonic series reduction increases music enjoyment in CI and NH individuals with or without CI simulation. Therefore, minimization of the harmonics may be a useful strategy for enhancing musical enjoyment among both NH and CI listeners. PMID:27755358

Reduction of the Harmonic Series Influences Musical Enjoyment With Cochlear Implants.

PubMed

Nemer, John S; Kohlberg, Gavriel D; Mancuso, Dean M; Griffin, Brianna M; Certo, Michael V; Chen, Stephanie Y; Chun, Michael B; Spitzer, Jaclyn B; Lalwani, Anil K

2017-01-01

Cochlear implantation is associated with poor music perception and enjoyment. Reducing music complexity has been shown to enhance music enjoyment in cochlear implant (CI) recipients. In this study, we assess the impact of harmonic series reduction on music enjoyment. Prospective analysis of music enjoyment in normal-hearing (NH) individuals and CI recipients. Single tertiary academic medical center. NH adults (N = 20) and CI users (N = 8) rated the Happy Birthday song on three validated enjoyment modalities-musicality, pleasantness, and naturalness. Subjective rating of music excerpts. Participants listened to seven different instruments play the melody, each with five levels of harmonic reduction (Full, F3+F2+F1+F0, F2+F1+F0, F1+F0, F0). NH participants listened to the segments both with and without CI simulation. Linear mixed effect models (LME) and likelihood ratio tests were used to assess the impact of harmonic reduction on enjoyment. NH listeners without simulation rated segments with the first four harmonics (F3+F2+F1+F0) most pleasant and natural (p <0.001, p = 0.004). NH listeners with simulation rated the first harmonic alone (F0) most pleasant and natural (p <0.001, p = 0.003). Their ratings demonstrated a positive linear relationship between harmonic reduction and both pleasantness (slope estimate = 0.030, SE = 0.004, p <0.001, LME) and naturalness (slope estimate = 0.012, SE = 0.003, p = 0.003, LME). CI recipients also found the first harmonic alone (F0) to be most pleasant (p = 0.003), with a positive linear relationship between harmonic reduction and pleasantness (slope estimate = 0.029, SE = 0.008, p <0.001, LME). Harmonic series reduction increases music enjoyment in CI and NH individuals with or without CI simulation. Therefore, minimization of the harmonics may be a useful strategy for enhancing musical enjoyment among both NH and CI listeners.

Bilateral globus pallidus internus deep brain stimulation for dyskinetic cerebral palsy supports success of cochlear implantation in a 5-year old ex-24 week preterm twin with absent cerebellar hemispheres.

PubMed

Lin, Jean-Pierre; Kaminska, Margaret; Perides, Sarah; Gimeno, Hortensia; Baker, Lesley; Lumsden, Daniel E; Britz, Anzell; Driver, Sandra; Fitzgerald-O'Connor, Alec; Selway, Richard

2017-01-01

Early onset dystonia (dyskinesia) and deafness in childhood pose significant challenges for children and carers and are the cause of multiple disability. It is particularly tragic when the child cannot make use of early cochlear implantation (CI) technology to relieve deafness and improve language and communication, because severe cervical and truncal dystonia brushes off the magnetic amplifier behind the ears. Bilateral globus pallidus internus (GPi) deep brain stimulation (DBS) neuromodulation can reduce dyskinesia, thus supporting CI neuromodulation success. We describe the importance of the order of dual neuromodulation surgery for dystonia and deafness. First with bilateral GPi DBS using a rechargeable ACTIVA-RC neurostimulator followed 5 months later by unilateral CI with a Harmony (BTE) Advanced Bionics Hi Res 90 K cochlear device. This double neuromodulation was performed in series in a 12.5 kg 5 year-old ex-24 week gestation-born twin without a cerebellum. Relief of dyskinesia enabled continuous use of the CI amplifier. Language understanding and communication improved. Dystonic storms abated. Tolerance of sitting increased with emergence of manual function. Status dystonicus ensued 10 days after ACTIVA-RC removal for infection-erosion at 3 years and 10 months. He required intensive care and DBS re-implantation 3 weeks later together with 8 months of hospital care. Today he is virtually back to the level of functioning before the DBS removal in 2012 and background medication continues to be slowly weaned. This case illustrates that early neuromodulation with DBS for dystonic cerebral palsy followed by CI for deafness is beneficial. Both should be considered early i.e. under the age of five years. The DBS should precede the CI to maximise dystonia reduction and thus benefits from CI. This requires close working between the paediatric DBS and CI services. Copyright © 2016. Published by Elsevier Ltd.

Contribution of a contralateral hearing aid to perception of consonant voicing, intonation, and emotional state in adult cochlear implantees.

PubMed

Most, Tova; Gaon-Sivan, Gal; Shpak, Talma; Luntz, Michal

2012-01-01

Binaural hearing in cochlear implant (CI) users can be achieved either by bilateral implantation or bimodally with a contralateral hearing aid (HA). Binaural-bimodal hearing has the advantage of complementing the high-frequency electric information from the CI by low-frequency acoustic information from the HA. We examined the contribution of a contralateral HA in 25 adult implantees to their perception of fundamental frequency-cued speech characteristics (initial consonant voicing, intonation, and emotions). Testing with CI alone, HA alone, and bimodal hearing showed that all three characteristics were best perceived under the bimodal condition. Significant differences were recorded between bimodal and HA conditions in the initial voicing test, between bimodal and CI conditions in the intonation test, and between both bimodal and CI conditions and between bimodal and HA conditions in the emotion-in-speech test. These findings confirmed that such binaural-bimodal hearing enhances perception of these speech characteristics and suggest that implantees with residual hearing in the contralateral ear may benefit from a HA in that ear.

Prosody perception and musical pitch discrimination in adults using cochlear implants.

PubMed

Kalathottukaren, Rose Thomas; Purdy, Suzanne C; Ballard, Elaine

2015-07-01

This study investigated prosodic perception and musical pitch discrimination in adults using cochlear implants (CI), and examined the relationship between prosody perception scores and non-linguistic auditory measures, demographic variables, and speech recognition scores. Participants were given four subtests of the PEPS-C (profiling elements of prosody in speech-communication), the adult paralanguage subtest of the DANVA 2 (diagnostic analysis of non verbal accuracy 2), and the contour and interval subtests of the MBEA (Montreal battery of evaluation of amusia). Twelve CI users aged 25;5 to 78;0 years participated. CI participants performed significantly more poorly than normative values for New Zealand adults for PEPS-C turn-end, affect, and contrastive stress reception subtests, but were not different from the norm for the chunking reception subtest. Performance on the DANVA 2 adult paralanguage subtest was lower than the normative mean reported by Saindon (2010) . Most of the CI participants performed at chance level on both MBEA subtests. CI users have difficulty perceiving prosodic information accurately. Difficulty in understanding different aspects of prosody and music may be associated with reduced pitch perception ability.

Differences in the perceived music pleasantness between monolateral cochlear implanted and normal hearing children assessed by EEG.

PubMed

Vecchiato, G; Maglione, A G; Scorpecci, A; Malerba, P; Graziani, I; Cherubino, P; Astolfi, L; Marsella, P; Colosimo, A; Babiloni, Fabio

2013-01-01

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.

Age-Dependent Cost-Utility of Pediatric Cochlear Implantation

PubMed Central

Semenov, Yevgeniy R.; Yeh, Susan T.; Seshamani, Meena; Wang, Nae-Yuh; Tobey, Emily A.; Eisenberg, Laurie S.; Quittner, Alexandra L.; Frick, Kevin D.; Niparko, John K.

2013-01-01

Objective Cochlear implantation has become the mainstay of treatment for children with severe-to-profound sensorineural hearing loss (SNHL). Yet, despite mounting evidence on the clinical benefits of early implantation, little data are available on the long-term societal benefits and comparative effectiveness of this procedure across various ages of implantation--a choice parameter for parents and clinicians with high prognostic value for clinical outcome. As such, the aim of the current study is to evaluate a model of the consequences of the timing of this intervention from a societal economic perspective. Average cost-utility of pediatric cochlear implantation by age at intervention will be analyzed. Design Prospective, longitudinal assessment of health-utility and educational placement outcomes in 175 children recruited from 6 US centers between November 2002 and December 2004, who had severe-to-profound SNHL onset within 1 year of age, underwent cochlear implantation before 5 years of age, and had up to 6 years of post-implant follow-up that ended in November 2008 to December 2011. Costs of care were collected retrospectively and stratified by pre-operative, operative, and post-operative expenditures. Incremental costs and benefits of implantation were compared between the three age groups and relative to a non-implantation baseline. Results Children implanted at <18 months of age gained an average of 10.7 QALYs over their projected lifetime as compared to 9.0 and 8.4 QALYs for those implanted between 18 and 36 months and at >36 months of age, respectively. Medical and surgical complication rates were not significantly different between the 3 age groups. Additionally, mean lifetime costs of implantation were similar between the 3 groups, at approximately $2,000/child/year (77.5 year life expectancy), yielding costs of $14,996, $17,849, and $19,173 per QALY for the youngest, middle, and oldest implant age groups, respectively. Full mainstream classroom integration rate was significantly higher in the youngest group at 81% as compared to 57% and 63% for the middle and oldest groups, respectively (p<0.05) after six years of follow-up. After incorporating lifetime educational cost savings, cochlear implantation led to net societal savings of $31,252, $10,217, and $6,680 for the youngest, middle, and oldest groups at CI, respectively, over the child’s projected lifetime. Conclusions Even without considering improvements in lifetime earnings, the overall cost-utility results indicate highly favorable ratios. Early (<18 months) intervention with cochlear implantation was associated with greater and longer quality of life improvements, similar direct costs of implantation, and economically-valuable improved classroom placement, without a greater incidence of medical and surgical complications when compared to cochlear implantation at older ages. PMID:23558665

What Does Music Sound Like for a Cochlear Implant User?

PubMed

Jiam, Nicole T; Caldwell, Meredith T; Limb, Charles J

2017-09-01

Cochlear implant research and product development over the past 40 years have been heavily focused on speech comprehension with little emphasis on music listening and enjoyment. The relatively little understanding of how music sounds in a cochlear implant user stands in stark contrast to the overall degree of importance the public places on music and quality of life. The purpose of this article is to describe what music sounds like to cochlear implant users, using a combination of existing research studies and listener descriptions. We examined the published literature on music perception in cochlear implant users, particularly postlingual cochlear implant users, with an emphasis on the primary elements of music and recorded music. Additionally, we administered an informal survey to cochlear implant users to gather first-hand descriptions of music listening experience and satisfaction from the cochlear implant population. Limitations in cochlear implant technology lead to a music listening experience that is significantly distorted compared with that of normal hearing listeners. On the basis of many studies and sources, we describe how music is frequently perceived as out-of-tune, dissonant, indistinct, emotionless, and weak in bass frequencies, especially for postlingual cochlear implant users-which may in part explain why music enjoyment and participation levels are lower after implantation. Additionally, cochlear implant users report difficulty in specific musical contexts based on factors including but not limited to genre, presence of lyrics, timbres (woodwinds, brass, instrument families), and complexity of the perceived music. Future research and cochlear implant development should target these areas as parameters for improvement in cochlear implant-mediated music perception.

Interdependence of linguistic and indexical speech perception skills in school-age children with early cochlear implantation.

PubMed

Geers, Ann E; Davidson, Lisa S; Uchanski, Rosalie M; Nicholas, Johanna G

2013-09-01

This study documented the ability of experienced pediatric cochlear implant (CI) users to perceive linguistic properties (what is said) and indexical attributes (emotional intent and talker identity) of speech, and examined the extent to which linguistic (LSP) and indexical (ISP) perception skills are related. Preimplant-aided hearing, age at implantation, speech processor technology, CI-aided thresholds, sequential bilateral cochlear implantation, and academic integration with hearing age-mates were examined for their possible relationships to both LSP and ISP skills. Sixty 9- to 12-year olds, first implanted at an early age (12 to 38 months), participated in a comprehensive test battery that included the following LSP skills: (1) recognition of monosyllabic words at loud and soft levels, (2) repetition of phonemes and suprasegmental features from nonwords, and (3) recognition of key words from sentences presented within a noise background, and the following ISP skills: (1) discrimination of across-gender and within-gender (female) talkers and (2) identification and discrimination of emotional content from spoken sentences. A group of 30 age-matched children without hearing loss completed the nonword repetition, and talker- and emotion-perception tasks for comparison. Word-recognition scores decreased with signal level from a mean of 77% correct at 70 dB SPL to 52% at 50 dB SPL. On average, CI users recognized 50% of key words presented in sentences that were 9.8 dB above background noise. Phonetic properties were repeated from nonword stimuli at about the same level of accuracy as suprasegmental attributes (70 and 75%, respectively). The majority of CI users identified emotional content and differentiated talkers significantly above chance levels. Scores on LSP and ISP measures were combined into separate principal component scores and these components were highly correlated (r = 0.76). Both LSP and ISP component scores were higher for children who received a CI at the youngest ages, upgraded to more recent CI technology and had lower CI-aided thresholds. Higher scores, for both LSP and ISP components, were also associated with higher language levels and mainstreaming at younger ages. Higher ISP scores were associated with better social skills. Results strongly support a link between indexical and linguistic properties in perceptual analysis of speech. These two channels of information appear to be processed together in parallel by the auditory system and are inseparable in perception. Better speech performance, for both linguistic and indexical perception, is associated with younger age at implantation and use of more recent speech processor technology. Children with better speech perception demonstrated better spoken language, earlier academic mainstreaming, and placement in more typically sized classrooms (i.e., >20 students). Well-developed social skills were more highly associated with the ability to discriminate the nuances of talker identity and emotion than with the ability to recognize words and sentences through listening. The extent to which early cochlear implantation enabled these early-implanted children to make use of both linguistic and indexical properties of speech influenced not only their development of spoken language, but also their ability to function successfully in a hearing world.

Effects of Removing Low-Frequency Electric Information on Speech Perception with Bimodal Hearing

ERIC Educational Resources Information Center

Fowler, Jennifer R.; Eggleston, Jessica L.; Reavis, Kelly M.; McMillan, Garnett P.; Reiss, Lina A. J.

2016-01-01

Purpose: The objective was to determine whether speech perception could be improved for bimodal listeners (those using a cochlear implant [CI] in one ear and hearing aid in the contralateral ear) by removing low-frequency information provided by the CI, thereby reducing acoustic-electric overlap. Method: Subjects were adult CI subjects with at…

The impact of ethnicity on cochlear implantation in Norwegian children.

PubMed

Amundsen, Viktoria Vedeler; Wie, Ona Bø; Myhrum, Marte; Bunne, Marie

2017-02-01

To explore the impact of parental ethnicity on cochlear implantation in children in Norway with regard to incidence rates of cochlear implants (CIs), comorbidies, age at onset of profound deafness (AOD), age at first implantation, uni- or bilateral CI, and speech recognition. This retrospective cohort study included all children (N = 278) aged <18 years in Norway who received their first CI during the years 2004-2010. 86 children (30.9%) in our study sample had parents of non-Nordic ethnicity, of whom 46 were born in Nordic countries with two non-Nordic parents. Compared with the background population, children with non-Nordic parents were 1.9 times more likely to have received CI than Nordic children (i.e., born in Nordic countries with Nordic parents). When looking at AOD, uni-vs. bilateral CIs, and comorbidities, no significant differences were found between Nordic children and children with a non-Nordic ethnicity. Among children with AOD <1 year (n = 153), those born in non-Nordic countries with two non-Nordic parents (n = 6) and adopted non-Nordic children (n = 6) received their first CI on average 14.9 and 21.1 months later than Nordic children (n = 104), respectively (p = 0.006 and 0.005). Among children with AOD <1 year, those born in Nordic countries with two non-Nordic parents (n = 31) received their CI at an older age than Nordic children, but this difference was not significant after adjusting for calendar year of implantation and excluding comorbidity as a potential cause of delayed implantation. The mean age at implantation for children with AOD <1 year dropped 2.3 months/year over the study period. The mean monosyllable speech recognition score was 84.7% for Nordic children and 76.3% for children born in Norway with two non-Nordic parents (p = 0.002). The incidence of CI was significantly higher in children with a non-Nordic vs. a Nordic ethnicity, reflecting a higher incidence of profound deafness. Children born in Norway have equal access to CIs regardless of their ethnicity, but despite being born and receiving care in Norway, prelingually deaf children with non-Nordic parents are at risk of receiving CI later than Nordic children. Moreover, prelingually deaf children who arrive in Norway at an older age may be at risk for a worse prognosis after receiving a CI due to lack of auditory stimulation in early childhood, which is critical for language development and late implantation; this is a serious issue with regard to deafness among refugees. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Cochlear Implant Electrode Effect on Sound Energy Transfer within the Cochlea during Acoustic Stimulation

PubMed Central

Greene, Nathaniel T.; Mattingly, Jameson K.; Jenkins, Herman A.; Tollin, Daniel J.; Easter, James R.; Cass, Stephen P.

2015-01-01

Hypothesis Cochlear implants (CI) designed for hearing preservation will not alter mechanical properties of the middle and inner ear as measured by intracochlear pressure (PIC) and stapes velocity (Vstap). Background CIs designed to provide combined electrical and acoustic stimulation (EAS) are now available. To maintain functional acoustic hearing, it is important to know if a CI electrode can alter middle or inner ear mechanics, as any alteration could contribute to elevated low-frequency thresholds in EAS patients. Methods Seven human cadaveric temporal bones were prepared, and pure-tone stimuli from 120Hz–10kHz were presented at a range of intensities up to 110 dB SPL. PIC in the scala vestibuli (PSV) and tympani (PST) were measured with fiber-optic pressure sensors concurrently with VStap using laser Doppler vibrometry. Five CI electrodes from two different manufacturers, with varying dimensions were inserted via a round window approach at six different depths (16–25 mm). Results The responses of PIC and VStap to acoustic stimulation were assessed as a function of stimulus frequency, normalized to SPL in the external auditory canal (EAC), in baseline and electrode inserted conditions. Responses measured with electrodes inserted were generally within ~5 dB of baseline, indicating little effect of cochlear implant electrode insertion on PIC and VStap. Overall, mean differences across conditions were small for all responses, and no substantial differences were consistently visible across electrode types. Conclusions Results suggest that the influence of a CI electrode on middle and inner ear mechanics is minimal, despite variation in electrode lengths and configurations. PMID:26333018

Timing of cochlear implantation and parents' global ratings of children's health and development.

PubMed

Clark, James H; Wang, Nae-Yuh; Riley, Anne W; Carson, Christine M; Meserole, Rachel L; Lin, Frank R; Eisenberg, Laurie S; Tobey, Emily A; Quittner, Alexandra L; Francis, Howard W; Niparko, John K

2012-06-01

To assess children's health-related quality of life (HRQL) and development after cochlear implant (CI) surgery and compare improvements between different age of implantation categories. Prospective, longitudinal study comparing outcomes of deaf children post-CI with hearing controls. Six US CI centers. Deaf children who received CI (n = 188) and hearing children of comparable ages (n = 97). CI before 5 years of age. Parental ratings of global HRQL and development, as assessed over the first 4 years of follow-up using visual analog scales. Development scores assess parental views of children's growth and development, motor skills, ability to express themselves and communicate with others, and learning abilities. Associations of baseline child and family characteristics with post-CI HRQL and development were investigated using multivariable analysis, controlling for factors that influence post-CI language learning. Baseline deficits of CI candidates relative to hearing controls were larger in development than HRQL. Development scores improved significantly by 4 years after CI, particularly in the youngest CI recipients. Developmental deficits of older CI recipients with early, extended hearing aid use were only partially remediated by CI. Overall, no significant health deficits were observed in CI children after 4 years. Cognition and speech recognition were positively associated with both HRQL and development. Parental perspectives on quality of their child's life and development provide practical insight into the optimal timing of interventions for early-onset deafness. Validity of parental global assessments is supported by clinical measures of speech perception and language learning and comparison with a well-validated health status instrument.

Impedance testing on cochlear implants after electroconvulsive therapy.

PubMed

McRackan, Theodore R; Rivas, Alejandro; Hedley-Williams, Andrea; Raj, Vidya; Dietrich, Mary S; Clark, Nathaniel K; Labadie, Robert F

2014-12-01

Cochlear implants (CI) are neural prostheses that restore hearing to individuals with profound sensorineural hearing loss. The surgically implanted component consists of an electrode array, which is threaded into the cochlea, and an electronic processor, which is buried under the skin behind the ear. The Food and Drug Administration and CI manufacturers contend that electroconvulsive therapy (ECT) is contraindicated in CI recipients owing to risk of damage to the implant and/or the patient. We hypothesized that ECT does no electrical damage to CIs. Ten functional CIs were implanted in 5 fresh cadaveric human heads. Each head then received a consecutive series of 12 unilateral ECT sessions applying maximum full pulse-width energy settings. Electroconvulsive therapy was delivered contralaterally to 5 CIs and ipsilaterally to 5 CIs. Electrical integrity testing (impedance testing) of the electrode array was performed before and after CI insertion, and after the first, third, fifth, seventh, ninth, and 12th ECT sessions. Electroconvulsive therapy was performed by a staff psychiatrist experienced with the technique. Explanted CIs were sent back to the manufacturer for further integrity testing. No electrical damage was identified during impedance testing. Overall, there were statistically significant decreases in impedances (consistent with no electrical damage) when comparing pre-ECT impedance values to those after 12 sessions. There was no statistically significant difference (P > 0.05) in impedance values comparing ipsilateral to contralateral ECT. Manufacturer testing revealed no other electrical damage to the CIs. Electroconvulsive therapy does not seem to cause any detectable electrical injury to CIs.

Speech Rate Normalization and Phonemic Boundary Perception in Cochlear-Implant Users.

PubMed

Jaekel, Brittany N; Newman, Rochelle S; Goupell, Matthew J

2017-05-24

Normal-hearing (NH) listeners rate normalize, temporarily remapping phonemic category boundaries to account for a talker's speech rate. It is unknown if adults who use auditory prostheses called cochlear implants (CI) can rate normalize, as CIs transmit degraded speech signals to the auditory nerve. Ineffective adjustment to rate information could explain some of the variability in this population's speech perception outcomes. Phonemes with manipulated voice-onset-time (VOT) durations were embedded in sentences with different speech rates. Twenty-three CI and 29 NH participants performed a phoneme identification task. NH participants heard the same unprocessed stimuli as the CI participants or stimuli degraded by a sine vocoder, simulating aspects of CI processing. CI participants showed larger rate normalization effects (6.6 ms) than the NH participants (3.7 ms) and had shallower (less reliable) category boundary slopes. NH participants showed similarly shallow slopes when presented acoustically degraded vocoded signals, but an equal or smaller rate effect in response to reductions in available spectral and temporal information. CI participants can rate normalize, despite their degraded speech input, and show a larger rate effect compared to NH participants. CI participants may particularly rely on rate normalization to better maintain perceptual constancy of the speech signal.

Sequential stream segregation in normally-hearing and cochlear-implant listenersa)

PubMed Central

Tejani, Viral D.; Schvartz-Leyzac, Kara C.; Chatterjee, Monita

2017-01-01

Sequential stream segregation by normal hearing (NH) and cochlear implant (CI) listeners was investigated using an irregular rhythm detection (IRD) task. Pure tones and narrowband noises of different bandwidths were presented monaurally to older and younger NH listeners via headphones. For CI users, stimuli were delivered as pure tones via soundfield and via direct electrical stimulation. Results confirmed that tonal pitch is not essential for stream segregation by NH listeners and that aging does not reduce NH listeners' stream segregation. CI listeners' stream segregation was significantly poorer than NH listeners' with pure tone stimuli. With direct stimulation, however, CI listeners showed significantly stronger stream segregation, with a mean normalized pattern similar to NH listeners, implying that the CI speech processors possibly degraded acoustic cues. CI listeners' performance on an electrode discrimination task indicated that cues that are salient enough to make two electrodes highly discriminable may not be sufficiently salient for stream segregation, and that gap detection/discrimination, which must depend on perceptual electrode differences, did not play a role in the IRD task. Although the IRD task does not encompass all aspects of full stream segregation, these results suggest that some CI listeners may demonstrate aspects of stream segregation. PMID:28147600

Voice gender discrimination provides a measure of more than pitch-related perception in cochlear implant users

PubMed Central

Li, Tianhao; Fu, Qian-Jie

2013-01-01

Objectives (1) To investigate whether voice gender discrimination (VGD) could be a useful indicator of the spectral and temporal processing abilities of individual cochlear implant (CI) users; (2) To examine the relationship between VGD and speech recognition with CI when comparable acoustic cues are used for both perception processes. Design VGD was measured using two talker sets with different inter-gender fundamental frequencies (F0), as well as different acoustic CI simulations. Vowel and consonant recognition in quiet and noise were also measured and compared with VGD performance. Study sample Eleven postlingually deaf CI users. Results The results showed that (1) mean VGD performance differed for different stimulus sets, (2) VGD and speech recognition performance varied among individual CI users, and (3) individual VGD performance was significantly correlated with speech recognition performance under certain conditions. Conclusions VGD measured with selected stimulus sets might be useful for assessing not only pitch-related perception, but also spectral and temporal processing by individual CI users. In addition to improvements in spectral resolution and modulation detection, the improvement in higher modulation frequency discrimination might be particularly important for CI users in noisy environments. PMID:21696330

Enhanced audio-visual interactions in the auditory cortex of elderly cochlear-implant users.

PubMed

Schierholz, Irina; Finke, Mareike; Schulte, Svenja; Hauthal, Nadine; Kantzke, Christoph; Rach, Stefan; Büchner, Andreas; Dengler, Reinhard; Sandmann, Pascale

2015-10-01

Auditory deprivation and the restoration of hearing via a cochlear implant (CI) can induce functional plasticity in auditory cortical areas. How these plastic changes affect the ability to integrate combined auditory (A) and visual (V) information is not yet well understood. In the present study, we used electroencephalography (EEG) to examine whether age, temporary deafness and altered sensory experience with a CI can affect audio-visual (AV) interactions in post-lingually deafened CI users. Young and elderly CI users and age-matched NH listeners performed a speeded response task on basic auditory, visual and audio-visual stimuli. Regarding the behavioral results, a redundant signals effect, that is, faster response times to cross-modal (AV) than to both of the two modality-specific stimuli (A, V), was revealed for all groups of participants. Moreover, in all four groups, we found evidence for audio-visual integration. Regarding event-related responses (ERPs), we observed a more pronounced visual modulation of the cortical auditory response at N1 latency (approximately 100 ms after stimulus onset) in the elderly CI users when compared with young CI users and elderly NH listeners. Thus, elderly CI users showed enhanced audio-visual binding which may be a consequence of compensatory strategies developed due to temporary deafness and/or degraded sensory input after implantation. These results indicate that the combination of aging, sensory deprivation and CI facilitates the coupling between the auditory and the visual modality. We suggest that this enhancement in multisensory interactions could be used to optimize auditory rehabilitation, especially in elderly CI users, by the application of strong audio-visually based rehabilitation strategies after implant switch-on. Copyright © 2015 Elsevier B.V. All rights reserved.

Patient-Related Benefits for Adults with Cochlear Implantation: A Multicultural Longitudinal Observational Study

PubMed Central

Lenarz, Thomas; Muller, Lida; Czerniejewska-Wolska, Hanna; Vallés Varela, Hector; Orús Dotú, César; Durko, Marcin; Huarte Irujo, Alicia; Piszczatowski, Bartosz; Zadrożniak, Marek; Irwin, Colin; Graham, Petra L.; Wyss, Josie

2017-01-01

Objectives To assess subjectively perceived, real-world benefits longitudinally for unilateral cochlear implant (CI) recipients in a multinational population treated routinely. To identify possible predictors of self-reported benefits. Design This was a prospective, multicenter, repeated-measures study. Self-assessment of performance at preimplantation and postimplantation at 1, 2, and 3 years using standardized, validated, local language versions of the Speech, Spatial, and Qualities of Hearing Scale (SSQ), and the Health Utilities Index Mark 3 (HUI3) was performed. Outcomes were analyzed using a longitudinal mixed-effects model incorporating country effect. Patient demographics were explored for associations with change over time. Subjects Two hundred ninety-one routinely treated, unilateral CI recipients, aged 137–81 years, from 9 clinics across 4 countries. Results Highly significant improvements were observed for all outcome measures (p < 0.0001). Postimplantation, mean outcome scores remained stable beyond 1 year, with notable individual variability. A significant association for one or more outcomes with preimplantation contralateral hearing aid use, telephone use, age at implantation, implantation side, preimplantation comorbidities, dizziness, and tinnitus was observed (p < 0.004). Conclusions Longitudinal benefits of CI treatment can be measured using clinically standardized self-assessment tools to provide a holistic view of patient-related benefits in routine clinical practice for aggregated data from multinational populations. Self-reported outcomes can provide medical-based evidence regarding CI treatment to support decision-making by health service providers. PMID:28719901

Acoustic properties of vowel production in prelingually deafened Mandarin-speaking children with cochlear implants

PubMed Central

Yang, Jing; Brown, Emily; Fox, Robert A.; Xu, Li

2015-01-01

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

Temporal stability of music perception and appraisal scores of adult cochlear implant recipients.

PubMed

Gfeller, Kate; Jiang, Dingfeng; Oleson, Jacob J; Driscoll, Virginia; Knutson, John F

2010-01-01

An extensive body of literature indicates that cochlear implants (CIs) are effective in supporting speech perception of persons with severe to profound hearing losses who do not benefit to any great extent from conventional hearing aids. Adult CI recipients tend to show significant improvement in speech perception within 3 mo following implantation as a result of mere experience. Furthermore, CI recipients continue to show modest improvement as long as 5yr postimplantation. In contrast, data taken from single testing protocols of music perception and appraisal indicate that CIs are less than ideal in transmitting important structural features of music, such as pitch, melody, and timbre. However, there is presently little information documenting changes in music perception or appraisal over extended time as a result of mere experience. This study examined two basic questions: (1) Do adult CI recipients show significant improvement in perceptual acuity or appraisal of specific music listening tasks when tested in two consecutive years? (2) If there are tasks for which CI recipients show significant improvement with time, are there particular demographic variables that predict those CI recipients most likely to show improvement with extended CI use? A longitudinal cohort study. Implant recipients return annually for visits to the clinic. The study included 209 adult cochlear implant recipients with at least 9 mo implant experience before their first year measurement. Outcomes were measured on the patient's annual visit in two consecutive years. Paired t-tests were used to test for significant improvement from one year to the next. Those variables demonstrating significant improvement were subjected to regression analyses performed to detect the demographic variables useful in predicting said improvement. There were no significant differences in music perception outcomes as a function of type of device or processing strategy used. Only familiar melody recognition (FMR) and recognition of melody excerpts with lyrics (MERT-L) showed significant improvement from one year to the next. After controlling for the baseline value, hearing aid use, months of use, music listening habits after implantation, and formal musical training in elementary school were significant predictors of FMR improvement. Bilateral CI use, formal musical training in high school and beyond, and a measure of sequential cognitive processing were significant predictors of MERT-L improvement. These adult CI recipients as a result of mere experience demonstrated fairly consistent music perception and appraisal on measures gathered in two consecutive years. Gains made tend to be modest, and can be associated with characteristics such as use of hearing aids, listening experiences, or bilateral use (in the case of lyrics). These results have implications for counseling of CI recipients with regard to realistic expectations and strategies for enhancing music perception and enjoyment.

The perception of stress and intonation in children with a cochlear implant and a hearing aid.

PubMed

Hegarty, Lauren; Faulkner, Andrew

2013-11-01

This study investigated whether low frequency information from a hearing aid improved the perception of stress and intonation by English-speaking children with cochlear implants. As pitch information is limited for cochlear implant users, this study also investigated if users rely more on the cues of duration and amplitude to perceive stress and intonation. Nine children with bimodal stimulation (cochlear implant and hearing aid) participated in two experiments. The first measured the just audible change in F0 (pitch) and amplitude for a speech-like word 'baba'. The second experiment examined the children's ability to identify focus in natural and manipulated sentences. Overall, group results did not show a bimodal advantage in perceiving stress and intonation. However, the children were significantly better at perceiving focus in sentences with natural speech compared with manipulated speech in both the CI and bimodal conditions. The results suggest that in the absence of pitch cues, amplitude and duration cues are used to perceive stress and intonation. However, the majority of children only perceived amplitude changes greater than the changes typically found in speech, implying duration cues were the most valuable. Taken together the findings suggest that for children with cochlear implants, cues to F0 may not be essential for prosody perception and in the absence of cues to F0 and amplitude, duration may offer an alternative cue. Although a bimodal advantage was not demonstrated for all participants, it is recommended that if clinically appropriate, a contralateral hearing aid is fitted and trialled to exploit any residual hearing.

Results using the OPAL strategy in Mandarin speaking cochlear implant recipients.

PubMed

Vandali, Andrew E; Dawson, Pam W; Arora, Komal

2017-01-01

To evaluate the effectiveness of an experimental pitch-coding strategy for improving recognition of Mandarin lexical tone in cochlear implant (CI) recipients. Adult CI recipients were tested on recognition of Mandarin tones in quiet and speech-shaped noise at a signal-to-noise ratio of +10 dB; Mandarin sentence speech-reception threshold (SRT) in speech-shaped noise; and pitch discrimination of synthetic complex-harmonic tones in quiet. Two versions of the experimental strategy were examined: (OPAL) linear (1:1) mapping of fundamental frequency (F0) to the coded modulation rate; and (OPAL+) transposed mapping of high F0s to a lower coded rate. Outcomes were compared to results using the clinical ACE™ strategy. Five Mandarin speaking users of Nucleus® cochlear implants. A small but significant benefit in recognition of lexical tones was observed using OPAL compared to ACE in noise, but not in quiet, and not for OPAL+ compared to ACE or OPAL in quiet or noise. Sentence SRTs were significantly better using OPAL+ and comparable using OPAL to those using ACE. No differences in pitch discrimination thresholds were observed across strategies. OPAL can provide benefits to Mandarin lexical tone recognition in moderately noisy conditions and preserve perception of Mandarin sentences in challenging noise conditions.

Binaural release from masking with single- and multi-electrode stimulation in children with cochlear implants.

PubMed

Todd, Ann E; Goupell, Matthew J; Litovsky, Ruth Y

2016-07-01

Cochlear implants (CIs) provide children with access to speech information from a young age. Despite bilateral cochlear implantation becoming common, use of spatial cues in free field is smaller than in normal-hearing children. Clinically fit CIs are not synchronized across the ears; thus binaural experiments must utilize research processors that can control binaural cues with precision. Research to date has used single pairs of electrodes, which is insufficient for representing speech. Little is known about how children with bilateral CIs process binaural information with multi-electrode stimulation. Toward the goal of improving binaural unmasking of speech, this study evaluated binaural unmasking with multi- and single-electrode stimulation. Results showed that performance with multi-electrode stimulation was similar to the best performance with single-electrode stimulation. This was similar to the pattern of performance shown by normal-hearing adults when presented an acoustic CI simulation. Diotic and dichotic signal detection thresholds of the children with CIs were similar to those of normal-hearing children listening to a CI simulation. The magnitude of binaural unmasking was not related to whether the children with CIs had good interaural time difference sensitivity. Results support the potential for benefits from binaural hearing and speech unmasking in children with bilateral CIs.

Early Bimodal Stimulation Benefits Language Acquisition for Children With Cochlear Implants.

PubMed

Moberly, Aaron C; Lowenstein, Joanna H; Nittrouer, Susan

2016-01-01

Adding a low-frequency acoustic signal to the cochlear implant (CI) signal (i.e., bimodal stimulation) for a period of time early in life improves language acquisition. Children must acquire sensitivity to the phonemic units of language to develop most language-related skills, including expressive vocabulary, working memory, and reading. Acquiring sensitivity to phonemic structure depends largely on having refined spectral (frequency) representations available in the signal, which does not happen with CIs alone. Combining the low-frequency acoustic signal available through hearing aids with the CI signal can enhance signal quality. A period with this bimodal stimulation has been shown to improve language skills in very young children. This study examined whether these benefits persist into childhood. Data were examined for 48 children with CIs implanted under age 3 years, participating in a longitudinal study. All children wore hearing aids before receiving a CI, but upon receiving a first CI, 24 children had at least 1 year of bimodal stimulation (Bimodal group), and 24 children had only electric stimulation subsequent to implantation (CI-only group). Measures of phonemic awareness were obtained at second and fourth grades, along with measures of expressive vocabulary, working memory, and reading. Children in the Bimodal group generally performed better on measures of phonemic awareness, and that advantage was reflected in other language measures. Having even a brief period of time early in life with combined electric-acoustic input provides benefits to language learning into childhood, likely because of the enhancement in spectral representations provided.

Early Sign Language Experience Goes along with an Increased Cross-Modal Gain for Affective Prosodic Recognition in Congenitally Deaf CI Users

ERIC Educational Resources Information Center

Fengler, Ineke; Delfau, Pia-Céline; Röder, Brigitte

2018-01-01

It is yet unclear whether congenitally deaf cochlear implant (CD CI) users' visual and multisensory emotion perception is influenced by their history in sign language acquisition. We hypothesized that early-signing CD CI users, relative to late-signing CD CI users and hearing, non-signing controls, show better facial expression recognition and…

Cochlear implantation outcomes in children with common cavity deformity; a retrospective study.

PubMed

Zhang, Li; Qiu, Jianxin; Qin, Feifei; Zhong, Mei; Shah, Gyanendra

2017-09-01

A common cavity deformity (CCD) is a deformed inner ear in which the cochlea and vestibule are confluent forming a common rudimentary cystic cavity that results in profound hearing loss. There are few studies paying attention to common cavity. Our group is engrossed in observing the improvement of auditory and verbal abilities in children who have received cochlear implantation (CI), and comparing these targets between children with common cavity and normal inner ear structure. A retrospective study was conducted in 12 patients with profound hearing loss that were divided into a common cavity group and a control group, six in each group matched in sex, age and time of implantation, based on inner ear structure. Categories of Auditory Performance (CAP) and speech intelligibility rating (SIR) scores and aided hearing thresholds were collected and compared between the two groups. All patients wore CI for more than 1 year at the Cochlear Center of Anhui Medical University from 2011 to 2015. Postoperative CAP and SIR scores were higher than before operation in both groups (p < 0.05), although the scores were lower in the CCD group than in the control group (p < 0.05). The aided threshold was also lower in the control group than in the CCD group (p < 0.05). Even though audiological improvement in children with CCD was not as good as in those without CCD, CI provides benefits in auditory perception and communication skills in these children.

Sound-direction identification with bilateral cochlear implants.

PubMed

Neuman, Arlene C; Haravon, Anita; Sislian, Nicole; Waltzman, Susan B

2007-02-01

The purpose of this study was to compare the accuracy of sound-direction identification in the horizontal plane by bilateral cochlear implant users when localization was measured with pink noise and with speech stimuli. Eight adults who were bilateral users of Nucleus 24 Contour devices participated in the study. All had received implants in both ears in a single surgery. Sound-direction identification was measured in a large classroom by using a nine-loudspeaker array. Localization was tested in three listening conditions (bilateral cochlear implants, left cochlear implant, and right cochlear implant), using two different stimuli (a speech stimulus and pink noise bursts) in a repeated-measures design. Sound-direction identification accuracy was significantly better when using two implants than when using a single implant. The mean root-mean-square error was 29 degrees for the bilateral condition, 54 degrees for the left cochlear implant, and 46.5 degrees for the right cochlear implant condition. Unilateral accuracy was similar for right cochlear implant and left cochlear implant performance. Sound-direction identification performance was similar for speech and pink noise stimuli. The data obtained in this study add to the growing body of evidence that sound-direction identification with bilateral cochlear implants is better than with a single implant. The similarity in localization performance obtained with the speech and pink noise supports the use of either stimulus for measuring sound-direction identification.

[Model oriented assessment of literacy performance in children with cochlear implants].

PubMed

Fiori, A; Reichmuth, K; Matulat, P; Schmidt, C M; Dinnesen, A G

2006-07-01

Although most hearing-impaired children lag behind normally hearing children in literacy acquisition, this aspect has hardly been addressed in the evaluation of language acquisition after cochlear implantation. The present study investigated written language abilities in 8 school-age children with cochlear implants. Neurolinguistic dual-route-models of written language processing indicate that literacy acquisition leads to the establishment of two distinct reading and writing strategies: a lexical one for the quick processing of known words and a sublexical one for decoding unfamiliar words or nonwords letter by letter. 8 school-aged children were investigated, a very heterogeneous group concerning age of onset of hearing impairment, educational placement, and competences in sign language. However, this range is typical of the group of CI-children. The aim was to investigate if children with cochlear implants are able to establish both strategies or if they need to find a differential and individual access to written language. Performance within the Salzburger Lese-Rechtschreib-Test was evaluated. Individual performance of each subject was analysed. Performance varied substantially ranging from only rudimentary spoken and written language abilities in two children to age-equivalent performance in three of them. Severe qualitative differences in written language processing were shown in the remaining three subjects. Suggestions for remediation were made and a re-test was carried out after 12 months. Their individual profiles of performance are described in detail. The present study stresses the importance of a thorough investigation of written language performance in the evaluation of language acquisition after cochlear implantation. The results draw a very heterogeneous picture of performance. Model-oriented testing and analysis of performance prove to be sensible in at least a subpopulation of children with cochlear implants. Based on a better understanding of their acquired word-processing strategies, remediation programs meeting the needs of each individual child can be derived.

Effects of congruent and incongruent visual cues on speech perception and brain activity in cochlear implant users.

PubMed

Song, Jae-Jin; Lee, Hyo-Jeong; Kang, Hyejin; Lee, Dong Soo; Chang, Sun O; Oh, Seung Ha

2015-03-01

While deafness-induced plasticity has been investigated in the visual and auditory domains, not much is known about language processing in audiovisual multimodal environments for patients with restored hearing via cochlear implant (CI) devices. Here, we examined the effect of agreeing or conflicting visual inputs on auditory processing in deaf patients equipped with degraded artificial hearing. Ten post-lingually deafened CI users with good performance, along with matched control subjects, underwent H 2 (15) O-positron emission tomography scans while carrying out a behavioral task requiring the extraction of speech information from unimodal auditory stimuli, bimodal audiovisual congruent stimuli, and incongruent stimuli. Regardless of congruency, the control subjects demonstrated activation of the auditory and visual sensory cortices, as well as the superior temporal sulcus, the classical multisensory integration area, indicating a bottom-up multisensory processing strategy. Compared to CI users, the control subjects exhibited activation of the right ventral premotor-supramarginal pathway. In contrast, CI users activated primarily the visual cortices more in the congruent audiovisual condition than in the null condition. In addition, compared to controls, CI users displayed an activation focus in the right amygdala for congruent audiovisual stimuli. The most notable difference between the two groups was an activation focus in the left inferior frontal gyrus in CI users confronted with incongruent audiovisual stimuli, suggesting top-down cognitive modulation for audiovisual conflict. Correlation analysis revealed that good speech performance was positively correlated with right amygdala activity for the congruent condition, but negatively correlated with bilateral visual cortices regardless of congruency. Taken together these results suggest that for multimodal inputs, cochlear implant users are more vision-reliant when processing congruent stimuli and are disturbed more by visual distractors when confronted with incongruent audiovisual stimuli. To cope with this multimodal conflict, CI users activate the left inferior frontal gyrus to adopt a top-down cognitive modulation pathway, whereas normal hearing individuals primarily adopt a bottom-up strategy.

Music Perception of Cochlear Implant Recipients with Implications for Music Instruction: A Review of Literature

PubMed Central

Hsiao, Feilin; Gfeller, Kate

2013-01-01

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. PMID:23469365

Provincial Variation of Cochlear Implantation Surgical Volumes and Cost in Canada.

PubMed

Crowson, Matthew G; Chen, Joseph M; Tucci, Debara

2017-01-01

Objectives To investigate provincial cochlear implantation (CI) annual volume and cost trends. Study Design Database analysis. Setting National surgical volume and cost database. Subjects and Methods Aggregate-level provincial CI volumes and cost data for adult and pediatric CI surgery from 2005 to 2014 were obtained from the Canadian Institute for Health Information. Population-level aging forecast estimates were obtained from the Ontario Ministry of Finance and Statistics Canada. Linear fit, analysis of variance, and Tukey's analyses were utilized to compare variances and means. Results The national volume of annual CI procedures is forecasted to increase by <30 per year ( R 2 = 0.88). Ontario has the highest mean annual CI volume (282; 95% confidence interval, 258-308), followed by Alberta (92.0; 95% confidence interval, 66.3-118), which are significantly higher than all other provinces ( P < .05 for each). Ontario's annual CI procedure volume is forecasted to increase by <11 per year ( R 2 = 0.62). Newfoundland and Nova Scotia have the highest CI procedures per 100,000 residents as compared with all other provinces ( P < .05). Alberta, Newfoundland, and Manitoba have the highest estimated implantation cost of all provinces ( P < .05). Conclusions Historical trends of CI forecast modest national volume growth. Potential bottlenecks include provincial funding and access to surgical expertise. The proportion of older adult patients who may benefit from a CI will rise, and there may be insufficient capacity to meet this need. Delayed access to CI for pediatric patients is also a concern, given recent reports of long wait times for CI surgery.

Outcomes of cochlear implantation in deaf children of deaf parents: comparative study.

PubMed

Hassanzadeh, S

2012-10-01

This retrospective study compared the cochlear implantation outcomes of first- and second-generation deaf children. The study group consisted of seven deaf, cochlear-implanted children with deaf parents. An equal number of deaf children with normal-hearing parents were selected by matched sampling as a reference group. Participants were matched based on onset and severity of deafness, duration of deafness, age at cochlear implantation, duration of cochlear implantation, gender, and cochlear implant model. We used the Persian Auditory Perception Test for the Hearing Impaired, the Speech Intelligibility Rating scale, and the Sentence Imitation Test, in order to measure participants' speech perception, speech production and language development, respectively. Both groups of children showed auditory and speech development. However, the second-generation deaf children (i.e. deaf children of deaf parents) exceeded the cochlear implantation performance of the deaf children with hearing parents. This study confirms that second-generation deaf children exceed deaf children of hearing parents in terms of cochlear implantation performance. Encouraging deaf children to communicate in sign language from a very early age, before cochlear implantation, appears to improve their ability to learn spoken language after cochlear implantation.

Cochlear implant revision surgeries in children.

PubMed

Amaral, Maria Stella Arantes do; Reis, Ana Cláudia Mirândola B; Massuda, Eduardo T; Hyppolito, Miguel Angelo

2018-02-16

The surgery during which the cochlear implant internal device is implanted is not entirely free of risks and may produce problems that will require revision surgeries. To verify the indications for cochlear implantation revision surgery for the cochlear implant internal device, its effectiveness and its correlation with certain variables related to language and hearing. A retrospective study of patients under 18 years submitted to cochlear implant Surgery from 2004 to 2015 in a public hospital in Brazil. Data collected were: age at the time of implantation, gender, etiology of the hearing loss, audiological and oral language characteristics of each patient before and after Cochlear Implant surgery and any need for surgical revision and the reason for it. Two hundred and sixty-five surgeries were performed in 236 patients. Eight patients received a bilateral cochlear implant and 10 patients required revision surgery. Thirty-two surgeries were necessary for these 10 children (1 bilateral cochlear implant), of which 21 were revision surgeries. In 2 children, cochlear implant removal was necessary, without reimplantation, one with cochlear malformation due to incomplete partition type I and another due to trauma. With respect to the cause for revision surgery, of the 8 children who were successfully reimplanted, four had cochlear calcification following meningitis, one followed trauma, one exhibited a facial nerve malformation, one experienced a failure of the cochlear implant internal device and one revision surgery was necessary because the electrode was twisted. The incidence of the cochlear implant revision surgery was 4.23%. The period following the revision surgeries revealed an improvement in the subject's hearing and language performance, indicating that these surgeries are valid in most cases. Copyright © 2018 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

Parental expectations and outcomes of pediatric cochlear implantation.

PubMed

Piazza, Elizabeth; Kandathil, Cherian; Carron, Jeffrey D

2009-10-01

Cochlear implants have been used with increasing frequency over the past twenty years, including very young patients. To determine if parents are satisfied with their children's performance after cochlear implantation. Survey mailed to parents of children receiving cochlear implants. 31 questionnaires were returned out of 69 mailed (45 %). The vast majority of responding parents felt that their children benefited substantially from cochlear implant surgery. Cochlear implantation is effective in helping children develop auditory-oral communication skills. Access to auditory/oral communication programs in this state remains an obstacle in postoperative habilitation.

Development of a speaker discrimination test for cochlear implant users based on the Oldenburg Logatome corpus.

PubMed

Mühler, Roland; Ziese, Michael; Rostalski, Dorothea

2009-01-01

The purpose of the study was to develop a speaker discrimination test for cochlear implant (CI) users. The speech material was drawn from the Oldenburg Logatome (OLLO) corpus, which contains 150 different logatomes read by 40 German and 10 French native speakers. The prototype test battery included 120 logatome pairs spoken by 5 male and 5 female speakers with balanced representations of the conditions 'same speaker' and 'different speaker'. Ten adult normal-hearing listeners and 12 adult postlingually deafened CI users were included in a study to evaluate the suitability of the test. The mean speaker discrimination score for the CI users was 67.3% correct and for the normal-hearing listeners 92.2% correct. A significant influence of voice gender and fundamental frequency difference on the speaker discrimination score was found in CI users as well as in normal-hearing listeners. Since the test results of the CI users were significantly above chance level and no ceiling effect was observed, we conclude that subsets of the OLLO corpus are very well suited to speaker discrimination experiments in CI users. Copyright 2008 S. Karger AG, Basel.

Crossmodal interactions during non-linguistic auditory processing in cochlear-implanted deaf patients.

PubMed

Barone, Pascal; Chambaudie, Laure; Strelnikov, Kuzma; Fraysse, Bernard; Marx, Mathieu; Belin, Pascal; Deguine, Olivier

2016-10-01

Due to signal distortion, speech comprehension in cochlear-implanted (CI) patients relies strongly on visual information, a compensatory strategy supported by important cortical crossmodal reorganisations. Though crossmodal interactions are evident for speech processing, it is unclear whether a visual influence is observed in CI patients during non-linguistic visual-auditory processing, such as face-voice interactions, which are important in social communication. We analyse and compare visual-auditory interactions in CI patients and normal-hearing subjects (NHS) at equivalent auditory performance levels. Proficient CI patients and NHS performed a voice-gender categorisation in the visual-auditory modality from a morphing-generated voice continuum between male and female speakers, while ignoring the presentation of a male or female visual face. Our data show that during the face-voice interaction, CI deaf patients are strongly influenced by visual information when performing an auditory gender categorisation task, in spite of maximum recovery of auditory speech. No such effect is observed in NHS, even in situations of CI simulation. Our hypothesis is that the functional crossmodal reorganisation that occurs in deafness could influence nonverbal processing, such as face-voice interaction; this is important for patient internal supramodal representation. Copyright © 2016 Elsevier Ltd. All rights reserved.

Comparison of memory and meta-memory abilities of children with cochlear implant and normal hearing peers.

PubMed

Engel-Yeger, Batya; Durr, Doris H; Josman, Naomi

2011-01-01

This study aimed (1) to compare visual memory and meta-memory abilities, including the use of strategies as context, of children with cochlear implant (CI) and children with normal hearing; (2) to examine the concurrent and construct validity of 'The Contextual Memory Test for Children' (CMT-CH). Twenty children with CI and 20 children with normal hearing, aged 8-10 years, participated in this study. Memory abilities were measured by two subtests of the Children's Memory Scale (CMS) and by CMT-CH, which also measures meta-memory abilities. Children with CI scored significantly lower in both tests of memory and meta-memory and showed less efficient use of context to memorise. Significant positive correlations were found between CMS and CMT-CH memory tests in both groups. Visual memory and meta-memory abilities may be impaired in children with CI. Evaluation and intervention for children with CI should refer to their memory and meta-memory abilities in order to measure the outcomes of CIs, and enhance language development academic achievements. Although more studies on CMT-CH should be performed, the CMT-CH may be used for the evaluation of visual memory of children with CI.

A Deep Denoising Autoencoder Approach to Improving the Intelligibility of Vocoded Speech in Cochlear Implant Simulation.

PubMed

Lai, Ying-Hui; Chen, Fei; Wang, Syu-Siang; Lu, Xugang; Tsao, Yu; Lee, Chin-Hui

2017-07-01

In a cochlear implant (CI) speech processor, noise reduction (NR) is a critical component for enabling CI users to attain improved speech perception under noisy conditions. Identifying an effective NR approach has long been a key topic in CI research. Recently, a deep denoising autoencoder (DDAE) based NR approach was proposed and shown to be effective in restoring clean speech from noisy observations. It was also shown that DDAE could provide better performance than several existing NR methods in standardized objective evaluations. Following this success with normal speech, this paper further investigated the performance of DDAE-based NR to improve the intelligibility of envelope-based vocoded speech, which simulates speech signal processing in existing CI devices. We compared the performance of speech intelligibility between DDAE-based NR and conventional single-microphone NR approaches using the noise vocoder simulation. The results of both objective evaluations and listening test showed that, under the conditions of nonstationary noise distortion, DDAE-based NR yielded higher intelligibility scores than conventional NR approaches. This study confirmed that DDAE-based NR could potentially be integrated into a CI processor to provide more benefits to CI users under noisy conditions.

Practices in habilitation of pediatric recipients of cochlear implants in India: A survey.

PubMed

Jeyaraman, Janani

2013-01-01

Cochlear implant (CI) (re)habilitation programs are long-term processes, with many factors contributing to the overall success. The clinics in India that are working toward pediatric CI habilitation vary in their team philosophy, clinical practices, and service delivery. It is important to explore their clinical perspectives and practices to appreciate their current state and suggest directions for improvement in the future. The objective of the study was to characterize the current status and clinical practices of the pediatric CI programs in India. Twenty-two clinics involved in the pediatric CI habilitation program across India participated in the survey. The heads of the CI teams of the participant clinics completed a validated survey questionnaire containing multiple-choice and open-ended questions on the details of the CI habilitation team, assessment and therapy protocols used, and other related clinical services. The categorical data obtained were analyzed using descriptive statistical measures. The interpretation of results indicated a need to focus future discussions on early identification and management of hearing impairment, funding for CIs, continuing education programs for professionals, decision processes for providing CIs for children with multiple concerns, choice of language(s) of instruction, assessment protocols used, and outreach/consultation services.

Auditory and language development in Mandarin-speaking children after cochlear implantation.

PubMed

Lu, Xing; Qin, Zhaobing

2018-04-01

To evaluate early auditory performance, speech perception and language skills in Mandarin-speaking prelingual deaf children in the first two years after they received a cochlear implant (CI) and analyse the effects of possible associated factors. The Infant-Toddler Meaningful Auditory Integration Scale (ITMAIS)/Meaningful Auditory Integration Scale (MAIS), Mandarin Early Speech Perception (MESP) test and Putonghua Communicative Development Inventory (PCDI) were used to assess auditory and language outcomes in 132 Mandarin-speaking children pre- and post-implantation. Children with CIs exhibited an ITMAIS/MAIS and PCDI developmental trajectory similar to that of children with normal hearing. The increased number of participants who achieved MESP categories 1-6 at each test interval showed a significant improvement in speech perception by paediatric CI recipients. Age at implantation and socioeconomic status were consistently associated with both auditory and language outcomes in the first two years post-implantation. Mandarin-speaking children with CIs exhibit significant improvements in early auditory and language development. Though these improvements followed the normative developmental trajectories, they still exhibited a gap compared with normative values. Earlier implantation and higher socioeconomic status are consistent predictors of greater auditory and language skills in the early stage. Copyright © 2018 Elsevier B.V. All rights reserved.

Channel interaction limits melodic pitch perception in simulated cochlear implants

PubMed Central

Crew, Joseph D.; Galvin, John J.; Fu, Qian-Jie

2012-01-01

In cochlear implants (CIs), melodic pitch perception is limited by the spectral resolution, which in turn is limited by the number of spectral channels as well as interactions between adjacent channels. This study investigated the effect of channel interaction on melodic contour identification (MCI) in normal-hearing subjects listening to novel 16-channel sinewave vocoders that simulated channel interaction in CI signal processing. MCI performance worsened as the degree of channel interaction increased. Although greater numbers of spectral channels may be beneficial to melodic pitch perception, the present data suggest that it is also important to improve independence among spectral channels. PMID:23145706

Temporal Stability of Music Perception and Appraisal Scores of Adult Cochlear Implant Recipients

PubMed Central

Gfeller, Kate; Jiang, Dingfeng; Oleson, Jacob; Driscoll, Virginia; Knutson, John F.

2010-01-01

Background An extensive body of literature indicates that cochlear implants are effective in supporting speech perception of persons with severe to profound hearing losses who do not benefit to any great extent from conventional hearing aids. Adult CI recipients tend to show significant improvement in speech perception within 3 months following implantation as a result of mere experience. Furthermore, CI recipients continue to show modest improvement as long as 5 years post implantation. In contrast, data taken from single testing protocols of music perception and appraisal indicate that CIs are less than ideal in transmitting important structural features of music, such as pitch, melody and timbre. However, there is presently little information documenting changes in music perception or appraisal over extended time as a result of mere experience. Purpose This study examined two basic questions: 1) Do adult CI recipients show significant improvement in perceptual acuity or appraisal of specific music listening tasks when tested in two consecutive years? 2) If there are tasks for which CI recipients show significant improvement with time, are there particular demographic variables that predict those CI recipients most likely to show improvement with extended CI use? Research Design A longitudinal cohort study. Implant recipients return annually for visits to the clinic. Study Sample The study included 209 adult cochlear implant recipients with at least 9 months implant experience before their first year measurement. Data collection and analysis Outcomes were measured on the patient’s annual visit in two consecutive years. Paired t-tests were used to test for significant improvement from one year to the next. Those variables demonstrating significant improvement were subjected to regression analyses performed to detect the demographic variables useful in predicting said improvement. Results There were no significant differences in music perception outcomes as a function of type of device or processing strategy used. Only familiar melody recognition (FMR) and recognition of melody excerpts with lyrics (MERT-L) showed significant improvement from one year to the next. After controlling for the baseline value, hearing aid use, months of use, music listening habits after implantation and formal musical training in elementary school were significant predictors of FMR improvement. Bilateral CI use, formal musical training in high school and beyond, and a measure of sequential cognitive processing were significant predictors of MERT-L improvement. Conclusions These adult CI recipients as a result of mere experience demonstrated fairly consistent music perception and appraisal on measures gathered in two consecutive years. Gains made tend to be modest, and can be associated with characteristics such as use of hearing aids, listening experiences, or bilateral use (in the case of lyrics). These results have implications for counseling of CI recipients with regard to realistic expectations and strategies for enhancing music perception and enjoyment. PMID:20085197

Long-Term Trajectories of the Development of Speech Sound Production in Pediatric Cochlear Implant Recipients

PubMed Central

Tomblin, J. Bruce; Peng, Shu-Chen; Spencer, Linda J.; Lu, Nelson

2011-01-01

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 evaluated in piecewise regression models. Results As a group, pediatric CI recipients showed steady improvement in speech sound production following implantation, but the improvement rate declined after 6 years of device experience. Piecewise regression models indicated that the slope estimating the participants' improvement rate was statistically greater than 0 during the first 6 years postimplantation, but not after 6 years. The group of pediatric CI recipients' accuracy of speech sound production after 4 years of device experience reasonably predicts their speech sound production after 5–10 years of device experience. Conclusions The development of speech sound production in prelingually deaf children stabilizes after 6 years of device experience, and typically approaches a plateau by 8 years of device use. Early growth in speech before 4 years of device experience did not predict later rates of growth or levels of achievement. However, good predictions could be made after 4 years of device use. PMID:18695018

A Systematic Review of Perioperative Versus Prophylactic Antibiotics for Cochlear Implantation.

PubMed

Anne, Samantha; Ishman, Stacey L; Schwartz, Seth

2016-11-01

Previous Cochrane review of prophylactic antibiotic use in clean and clean-contaminated ear surgery showed no benefit; however, these studies did not address cochlear implant (CI) surgery specifically. Systematically review effects of perioperative antibiotics on risk of infections and related complications in CI surgery SEARCH METHODS: PubMed, EMBASE, Medline, CINAHL, and Cochrane library were searched from inception to March 2015. Manual searches of bibliographies were also completed. We included all studies that describe perioperative antibiotic use in CI surgery. Outcome measures included infection, meningitis, implant extrusion, and adverse antibiotics effects. Two independent evaluators reviewed each abstract and article. One hundred and seventy-three studies were identified in search. Three met inclusion criteria and were reviewed. Articles were low quality; no randomized trials were identified. For included studies, numerous antibiotic types and dosing regimens were used. Recorded outcome measures were heterogeneous, and detailed information was frequently unavailable. Overall infection rate was low (3%-4.5%); single dose antibiotic prophylaxis showed low rate of complications (1%) in 2 studies. There is insufficient evidence to make definitive conclusions about the role of perioperative antibiotics in CI surgery. Reported infection rates are low; however, decision to use antibiotics should be based on assessment of risks and benefits to each patient. © The Author(s) 2016.

Rate discrimination at low pulse rates in normal-hearing and cochlear implant listeners: Influence of intracochlear stimulation site.

PubMed

Stahl, Pierre; Macherey, Olivier; Meunier, Sabine; Roman, Stéphane

2016-04-01

Temporal pitch perception in cochlear implantees remains weaker than in normal hearing listeners and is usually limited to rates below about 300 pulses per second (pps). Recent studies have suggested that stimulating the apical part of the cochlea may improve the temporal coding of pitch by cochlear implants (CIs), compared to stimulating other sites. The present study focuses on rate discrimination at low pulse rates (ranging from 20 to 104 pps). Two experiments measured and compared pulse rate difference limens (DLs) at four fundamental frequencies (ranging from 20 to 104 Hz) in both CI and normal-hearing (NH) listeners. Experiment 1 measured DLs in users of the (Med-El CI, Innsbruck, Austria) device for two electrodes (one apical and one basal). In experiment 2, DLs for NH listeners were compared for unresolved harmonic complex tones filtered in two frequency regions (lower cut-off frequencies of 1200 and 3600 Hz, respectively) and for different bandwidths. Pulse rate discrimination performance was significantly better when stimulation was provided by the apical electrode in CI users and by the lower-frequency tone complexes in NH listeners. This set of data appears consistent with better temporal coding when stimulation originates from apical regions of the cochlea.

Efficacy of Multiple-Talker Phonetic Identification Training in Postlingually Deafened Cochlear Implant Listeners.

PubMed

Miller, Sharon E; Zhang, Yang; Nelson, Peggy B

2016-02-01

This study implemented a pretest-intervention-posttest design to examine whether multiple-talker identification training enhanced phonetic perception of the /ba/-/da/ and /wa/-/ja/ contrasts in adult listeners who were deafened postlingually and have cochlear implants (CIs). Nine CI recipients completed 8 hours of identification training using a custom-designed training package. Perception of speech produced by familiar talkers (talkers used during training) and unfamiliar talkers (talkers not used during training) was measured before and after training. Five additional untrained CI recipients completed identical pre- and posttests over the same time course as the trainees to control for procedural learning effects. Perception of the speech contrasts produced by the familiar talkers significantly improved for the trained CI listeners, and effects of perceptual learning transferred to unfamiliar talkers. Such training-induced significant changes were not observed in the control group. The data provide initial evidence of the efficacy of the multiple-talker identification training paradigm for CI users who were deafened postlingually. This pattern of results is consistent with enhanced phonemic categorization of the trained speech sounds.

Cochlear implants in children implanted in Jordan: A parental overview.

PubMed

Alkhamra, Rana A

2015-07-01

Exploring the perspective of parents on the cochlear implant process in Jordan. Sixty parents of deaf children were surveyed on the information gathering process prior to cochlear implant surgery, and their implant outcome expectations post-surgery. Whether child or parent characteristics may impact parents' post-surgical expectations was explored. Although parents used a variety of information sources when considering a cochlear implant, the ear, nose and throat doctor comprised their major source of information (60%). Parents received a range of information prior to cochlear implant but agreed (93.3%) on the need for a multidisciplinary team approach. Post-surgically, parents' expected major developments in the areas of spoken language (97%), and auditory skills (100%). Receiving education in mainstream schools (92%) was expected too. Parents perceived the cochlear implant decision as the best decision they can make for their child (98.3%). A significant correlation was found between parents contentment with the cochlear implant decision and expecting developments in the area of reading and writing (r=0.7). Child's age at implantation and age at hearing loss diagnosis significantly affected parents' post-implant outcome expectations (p<0.05). Despite the general satisfaction from the information quantity and quality prior to cochlear implant, parents agree on the need for a comprehensive multidisciplinary team approach during the different stages of the cochlear implant process. Parents' education about cochlear implants prior to the surgery can affect their post-surgical outcome expectations. The parental perspective presented in this study can help professionals develop better understanding of parents' needs and expectations and henceforth improve their services and support during the different stages of the cochlear implant process. Copyright © 2015. Published by Elsevier Ireland Ltd.

Developing a music programme for preschool children with cochlear implants.

PubMed

Koşaner, Julie; Kilinc, Aynur; Deniz, Murat

2012-11-01

Although music perception is especially challenging for cochlear implant (CI) users, young CI users' musical perception abilities are improved by participation in structured musical activities. To design, implement, evaluate, and publish a music training programme with a monitoring tool for preschool CI users, for use in family-centred habilitation programmes. We devised a programme of musical activities, Musical EARS®, and a curriculum-related hierarchical Evaluation Form to represent performance. The programme included sections on singing; recognizing songs, tunes, and timbre; and responding appropriately to music and rhythm. It was implemented over 18 months at Ilkses Rehabilitation Centre, with 25 paediatric MED-EL CI users split into three groups of varying age, duration of CI use, and ability. Mean total scores increased significantly for all groups. Scores increased unevenly across subscales. Participation in and enjoyment of musical activities increased for both children and parents. Significant correlations were found between scores and length of CI use. The training programme effectively enriches child CI users' musical experience. To varying degrees, children learned to perform the Musical EARS® activities. The study allowed us to validate the lesson content and the hierarchical nature of the Evaluation Form. We conclude that prelingually deafened CI users should be systematically involved in musical activities to help them acquire skills acquired more easily by hearing peers.

Visualization of spiral ganglion neurites within the scala tympani with a cochlear implant in situ

PubMed Central

Chikar, Jennifer A.; Batts, Shelley A.; Pfingst, Bryan E.; Raphael, Yehoash

2009-01-01

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

Visualization of spiral ganglion neurites within the scala tympani with a cochlear implant in situ.

PubMed

Chikar, Jennifer A; Batts, Shelley A; Pfingst, Bryan E; Raphael, Yehoash

2009-05-15

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.

Value of pre-operative caloric test in predicting speech perception after cochlear implantation in adults with post-lingual hearing loss.

PubMed

Yang, Chan Joo; Lee, Jee Yeon; Ahn, Joong Ho; Lee, Kwang-Sun

2016-09-01

This study shows that, in cochlear implantation (CI) surgery, pre-operative caloric test results are not correlated with post-operative outcomes of dizziness or speech perception. To determine the role of pre-operative caloric tests in CI. The records of 95 patients who underwent unilateral CI were reviewed retrospectively. Patients were divided into four groups according to caloric response. Forty-six patients with normal caloric responses were classified as Group A, 19 patients who underwent CI in the ear with worse caloric responses as Group B, 18 patients with bilateral loss of caloric responses as Group C, and 12 patients who underwent CI in the ear with better caloric responses as Group D. Speech performance and post-operative dizziness were compared between the four groups. Speech perception was determined by evaluating consonant-vowel phoneme detection, closed-set word and open-set mono-syllabic and bi-syllabic word identification, and sentence comprehension test scores. The speech perception and aided pure-tone average (PTA) test results at 3 and 6 months and at 1, 2, and 3 years after implantation were not significantly different between Groups A, B, C, and D (p > 0.05). Eight patients (8.4%) reported post-operative dizziness, but there was no significant difference between the four groups (p = 0.627).

The Electrically Evoked Auditory Change Complex Evoked by Temporal Gaps Using Cochlear Implants or Auditory Brainstem Implants in Children With Cochlear Nerve Deficiency.

PubMed

He, Shuman; McFayden, Tyler C; Shahsavarani, Bahar S; Teagle, Holly F B; Ewend, Matthew; Henderson, Lillian; Buchman, Craig A

This study aimed to (1) establish the feasibility of measuring the electrically evoked auditory change complex (eACC) in response to temporal gaps in children with cochlear nerve deficiency (CND) who are using cochlear implants (CIs) and/or auditory brainstem implants (ABIs); and (2) explore the association between neural encoding of, and perceptual sensitivity to, temporal gaps in these patients. Study participants included 5 children (S1 to S5) ranging in age from 3.8 to 8.2 years (mean: 6.3 years) at the time of testing. All subjects were unilaterally implanted with a Nucleus 24M ABI due to CND. For each subject, two or more stimulating electrodes of the ABI were tested. S2, S3, and S5 previously received a CI in the contralateral ear. For these 3 subjects, at least two stimulating electrodes of their CIs were also tested. For electrophysiological measures, the stimulus was an 800-msec biphasic pulse train delivered to individual electrodes at the maximum comfortable level (C level). The electrically evoked responses, including the onset response and the eACC, were measured for two stimulation conditions. In the standard condition, the 800-msec pulse train was delivered uninterrupted to individual stimulating electrodes. In the gapped condition, a temporal gap was inserted into the pulse train after 400 msec of stimulation. Gap durations tested in this study ranged from 2 up to 128 msec. The shortest gap that could reliably evoke the eACC was defined as the objective gap detection threshold (GDT). For behavioral GDT measures, the stimulus was a 500-msec biphasic pulse train presented at the C level. The behavioral GDT was measured for individual stimulating electrodes using a one-interval, two-alternative forced-choice procedure. The eACCs to temporal gaps were recorded successfully in all subjects for at least one stimulating electrode using either the ABI or the CI. Objective GDTs showed intersubject variations, as well as variations across stimulating electrodes of the ABI or the CI within each subject. Behavioral GDTs were measured for one ABI electrode in S2 and for multiple ABI and CI electrodes in S5. All other subjects could not complete the task. S5 showed smaller behavioral GDTs for CI electrodes than those measured for ABI electrodes. One CI and two ABI electrodes in S5 showed comparable objective and behavioral GDTs. In contrast, one CI and two ABI electrodes in S5 and one ABI electrode in S2 showed measurable behavioral GDTs but no identifiable eACCs. The eACCs to temporal gaps were recorded in children with CND using either ABIs or CIs. Both objective and behavioral GDTs showed inter- and intrasubject variations. Consistency between results of eACC recordings and psychophysical measures of GDT was observed for some but not all ABI or CI electrodes in these subjects.

Auditory steady state responses and cochlear implants: Modeling the artifact-response mixture in the perspective of denoising

PubMed Central

Mina, Faten; Attina, Virginie; Duroc, Yvan; Veuillet, Evelyne; Truy, Eric; Thai-Van, Hung

2017-01-01

Auditory steady state responses (ASSRs) in cochlear implant (CI) patients are contaminated by the spread of a continuous CI electrical stimulation artifact. The aim of this work was to model the electrophysiological mixture of the CI artifact and the corresponding evoked potentials on scalp electrodes in order to evaluate the performance of denoising algorithms in eliminating the CI artifact in a controlled environment. The basis of the proposed computational framework is a neural mass model representing the nodes of the auditory pathways. Six main contributors to auditory evoked potentials from the cochlear level and up to the auditory cortex were taken into consideration. The simulated dynamics were then projected into a 3-layer realistic head model. 32-channel scalp recordings of the CI artifact-response were then generated by solving the electromagnetic forward problem. As an application, the framework’s simulated 32-channel datasets were used to compare the performance of 4 commonly used Independent Component Analysis (ICA) algorithms: infomax, extended infomax, jade and fastICA in eliminating the CI artifact. As expected, two major components were detectable in the simulated datasets, a low frequency component at the modulation frequency and a pulsatile high frequency component related to the stimulation frequency. The first can be attributed to the phase-locked ASSR and the second to the stimulation artifact. Among the ICA algorithms tested, simulations showed that infomax was the most efficient and reliable in denoising the CI artifact-response mixture. Denoising algorithms can induce undesirable deformation of the signal of interest in real CI patient recordings. The proposed framework is a valuable tool for evaluating these algorithms in a controllable environment ahead of experimental or clinical applications. PMID:28350887

Auditory steady state responses and cochlear implants: Modeling the artifact-response mixture in the perspective of denoising.

PubMed

Mina, Faten; Attina, Virginie; Duroc, Yvan; Veuillet, Evelyne; Truy, Eric; Thai-Van, Hung

2017-01-01

Auditory steady state responses (ASSRs) in cochlear implant (CI) patients are contaminated by the spread of a continuous CI electrical stimulation artifact. The aim of this work was to model the electrophysiological mixture of the CI artifact and the corresponding evoked potentials on scalp electrodes in order to evaluate the performance of denoising algorithms in eliminating the CI artifact in a controlled environment. The basis of the proposed computational framework is a neural mass model representing the nodes of the auditory pathways. Six main contributors to auditory evoked potentials from the cochlear level and up to the auditory cortex were taken into consideration. The simulated dynamics were then projected into a 3-layer realistic head model. 32-channel scalp recordings of the CI artifact-response were then generated by solving the electromagnetic forward problem. As an application, the framework's simulated 32-channel datasets were used to compare the performance of 4 commonly used Independent Component Analysis (ICA) algorithms: infomax, extended infomax, jade and fastICA in eliminating the CI artifact. As expected, two major components were detectable in the simulated datasets, a low frequency component at the modulation frequency and a pulsatile high frequency component related to the stimulation frequency. The first can be attributed to the phase-locked ASSR and the second to the stimulation artifact. Among the ICA algorithms tested, simulations showed that infomax was the most efficient and reliable in denoising the CI artifact-response mixture. Denoising algorithms can induce undesirable deformation of the signal of interest in real CI patient recordings. The proposed framework is a valuable tool for evaluating these algorithms in a controllable environment ahead of experimental or clinical applications.

Electrophysiological channel interactions using focused multipolar stimulation for cochlear implants

NASA Astrophysics Data System (ADS)

George, Shefin S.; Shivdasani, Mohit N.; Wise, Andrew K.; Shepherd, Robert K.; Fallon, James B.

2015-12-01

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 acoustic environments.

Assessment and improvement of sound quality in cochlear implant users

PubMed Central

Caldwell, Meredith T.; Jiam, Nicole T.

2017-01-01

Objectives Cochlear implants (CIs) have successfully provided speech perception to individuals with sensorineural hearing loss. Recent research has focused on more challenging acoustic stimuli such as music and voice emotion. The purpose of this review is to evaluate and describe sound quality in CI users with the purposes of summarizing novel findings and crucial information about how CI users experience complex sounds. Data Sources Here we review the existing literature on PubMed and Scopus to present what is known about perceptual sound quality in CI users, discuss existing measures of sound quality, explore how sound quality may be effectively studied, and examine potential strategies of improving sound quality in the CI population. Results Sound quality, defined here as the perceived richness of an auditory stimulus, is an attribute of implant‐mediated listening that remains poorly studied. Sound quality is distinct from appraisal, which is generally defined as the subjective likability or pleasantness of a sound. Existing studies suggest that sound quality perception in the CI population is limited by a range of factors, most notably pitch distortion and dynamic range compression. Although there are currently very few objective measures of sound quality, the CI‐MUSHRA has been used as a means of evaluating sound quality. There exist a number of promising strategies to improve sound quality perception in the CI population including apical cochlear stimulation, pitch tuning, and noise reduction processing strategies. Conclusions In the published literature, sound quality perception is severely limited among CI users. Future research should focus on developing systematic, objective, and quantitative sound quality metrics and designing therapies to mitigate poor sound quality perception in CI users. Level of Evidence NA PMID:28894831

Cost Effectiveness of Childhood Cochlear Implantation and Deaf Education in Nicaragua: A Disability Adjusted Life Year Model.

PubMed

Saunders, James E; Barrs, David M; Gong, Wenfeng; Wilson, Blake S; Mojica, Karen; Tucci, Debara L

2015-09-01

Cochlear implantation (CI) is a common intervention for severe-to-profound hearing loss in high-income countries, but is not commonly available to children in low resource environments. Owing in part to the device costs, CI has been assumed to be less economical than deaf education for low resource countries. The purpose of this study is to compare the cost effectiveness of the two interventions for children with severe-to-profound sensorineural hearing loss (SNHL) in a model using disability adjusted life years (DALYs). Cost estimates were derived from published data, expert opinion, and known costs of services in Nicaragua. Individual costs and lifetime DALY estimates with a 3% discounting rate were applied to both two interventions. Sensitivity analysis was implemented to evaluate the effect on the discounted cost of five key components: implant cost, audiology salary, speech therapy salary, number of children implanted per year, and device failure probability. The costs per DALY averted are $5,898 and $5,529 for CI and deaf education, respectively. Using standards set by the WHO, both interventions are cost effective. Sensitivity analysis shows that when all costs set to maximum estimates, CI is still cost effective. Using a conservative DALY analysis, both CI and deaf education are cost-effective treatment alternatives for severe-to-profound SNHL. CI intervention costs are not only influenced by the initial surgery and device costs but also by rehabilitation costs and the lifetime maintenance, device replacement, and battery costs. The major CI cost differences in this low resource setting were increased initial training and infrastructure costs, but lower medical personnel and surgery costs.

Cochlear implants: system design, integration, and evaluation.

PubMed

Zeng, Fan-Gang; Rebscher, Stephen; Harrison, William; Sun, Xiaoan; Feng, Haihong

2008-01-01

As the most successful neural prosthesis, cochlear implants have provided partial hearing to more than 120000 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 in cochlear implant research and development. 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.

Interplay between singing and cortical processing of music: a longitudinal study in children with cochlear implants

PubMed Central

Torppa, Ritva; Huotilainen, Minna; Leminen, Miika; Lipsanen, Jari; Tervaniemi, Mari

2014-01-01

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

Cochlear implantation with hearing preservation yields significant benefit for speech recognition in complex listening environments.

PubMed

Gifford, René H; Dorman, Michael F; Skarzynski, Henryk; Lorens, Artur; Polak, Marek; Driscoll, Colin L W; Roland, Peter; Buchman, Craig A

2013-01-01

The aim of this study was to assess the benefit of having preserved acoustic hearing in the implanted ear for speech recognition in complex listening environments. The present study included a within-subjects, repeated-measures design including 21 English-speaking and 17 Polish-speaking cochlear implant (CI) recipients with preserved acoustic hearing in the implanted ear. The patients were implanted with electrodes that varied in insertion depth from 10 to 31 mm. Mean preoperative low-frequency thresholds (average of 125, 250, and 500 Hz) in the implanted ear were 39.3 and 23.4 dB HL for the English- and Polish-speaking participants, respectively. In one condition, speech perception was assessed in an eight-loudspeaker environment in which the speech signals were presented from one loudspeaker and restaurant noise was presented from all loudspeakers. In another condition, the signals were presented in a simulation of a reverberant environment with a reverberation time of 0.6 sec. The response measures included speech reception thresholds (SRTs) and percent correct sentence understanding for two test conditions: CI plus low-frequency hearing in the contralateral ear (bimodal condition) and CI plus low-frequency hearing in both ears (best-aided condition). A subset of six English-speaking listeners were also assessed on measures of interaural time difference thresholds for a 250-Hz signal. Small, but significant, improvements in performance (1.7-2.1 dB and 6-10 percentage points) were found for the best-aided condition versus the bimodal condition. Postoperative thresholds in the implanted ear were correlated with the degree of electric and acoustic stimulation (EAS) benefit for speech recognition in diffuse noise. There was no reliable relationship among measures of audiometric threshold in the implanted ear nor elevation in threshold after surgery and improvement in speech understanding in reverberation. There was a significant correlation between interaural time difference threshold at 250 Hz and EAS-related benefit for the adaptive speech reception threshold. The findings of this study suggest that (1) preserved low-frequency hearing improves speech understanding for CI recipients, (2) testing in complex listening environments, in which binaural timing cues differ for signal and noise, may best demonstrate the value of having two ears with low-frequency acoustic hearing, and (3) preservation of binaural timing cues, although poorer than observed for individuals with normal hearing, is possible after unilateral cochlear implantation with hearing preservation and is associated with EAS benefit. The results of this study demonstrate significant communicative benefit for hearing preservation in the implanted ear and provide support for the expansion of CI criteria to include individuals with low-frequency thresholds in even the normal to near-normal range.

Biomaterials in cochlear implants

PubMed Central

Stöver, Timo; Lenarz, Thomas

2011-01-01

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

United Kingdom national paediatric bilateral cochlear implant audit: preliminary results.

PubMed

Cullington, Helen; Bele, Devyanee; Brinton, Julie; Lutman, Mark

2013-11-01

Prior to 2009, United Kingdom (UK) public funding was mainly only available for children to receive unilateral cochlear implants. In 2009, the National Institute for Health and Care Excellence published guidance for cochlear implantation following their review. According to these guidelines, all suitable children are eligible to have simultaneous bilateral cochlear implants or a sequential bilateral cochlear implant if they had received the first before the guidelines were published. Fifteen UK cochlear implant centres formed a consortium to carry out a multi-centre audit. The audit involves collecting data from simultaneously and sequentially implanted children at four intervals: before bilateral cochlear implants or before the sequential implant, 1, 2, and 3 years after bilateral implants. The measures include localization, speech recognition in quiet and background noise, speech production, listening, vocabulary, parental perception, quality of life, and surgical data including complications. The audit has now passed the 2-year point, and data have been received on 850 children. This article provides a first view of some data received up until March 2012.

Cochlear implantation in patients with bilateral cochlear trauma.

PubMed

Serin, Gediz Murat; Derinsu, Ufuk; Sari, Murat; Gergin, Ozgül; Ciprut, Ayça; Akdaş, Ferda; Batman, Cağlar

2010-01-01

Temporal bone fracture, which involves the otic capsule, can lead to complete loss of auditory and vestibular functions, whereas the patients without fractures may experience profound sensorineural hearing loss due to cochlear concussion. Cochlear implant is indicated in profound sensorineural hearing loss due to cochlear trauma but who still have an intact auditory nerve. This is a retrospective review study. We report 5 cases of postlingually deafened patients caused by cochlear trauma, who underwent cochlear implantation. Preoperative and postoperative hearing performance will be presented. These patients are cochlear implanted after the cochlear trauma in our department between 2001 and 2006. All patients performed very well with their implants, obtained open-set speech understanding. They all became good telephone users after implantation. Their performance in speech understanding was comparable to standard postlingual adult patients implanted. Cochlear implantation is an effective aural rehabilitation in profound sensorineural hearing loss caused by temporal bone trauma. Preoperative temporal bone computed tomography, magnetic resonance imaging, and promontorium stimulation testing are necessary to make decision for the surgery and to determine the side to be implanted. Surgery could be challenging and complicated because of anatomical irregularity. Moreover, fibrosis and partial or total ossification within the cochlea must be expected. Copyright 2010. Published by Elsevier Inc.

A partial hearing animal model for chronic electro-acoustic stimulation

NASA Astrophysics Data System (ADS)

Irving, S.; Wise, A. K.; Millard, R. E.; Shepherd, R. K.; Fallon, J. B.

2014-08-01

Objective. Cochlear implants (CIs) have provided some auditory function to hundreds of thousands of people around the world. Although traditionally carried out only in profoundly deaf patients, the eligibility criteria for implantation have recently been relaxed to include many partially-deaf patients with useful levels of hearing. These patients receive both electrical stimulation from their implant and acoustic stimulation via their residual hearing (electro-acoustic stimulation; EAS) and perform very well. It is unclear how EAS improves speech perception over electrical stimulation alone, and little evidence exists about the nature of the interactions between electric and acoustic stimuli. Furthermore, clinical results suggest that some patients that undergo cochlear implantation lose some, if not all, of their residual hearing, reducing the advantages of EAS over electrical stimulation alone. A reliable animal model with clinically-relevant partial deafness combined with clinical CIs is important to enable these issues to be studied. This paper outlines such a model that has been successfully used in our laboratory. Approach. This paper outlines a battery of techniques used in our laboratory to generate, validate and examine an animal model of partial deafness and chronic CI use. Main results. Ototoxic deafening produced bilaterally symmetrical hearing thresholds in neonatal and adult animals. Electrical activation of the auditory system was confirmed, and all animals were chronically stimulated via adapted clinical CIs. Acoustic compound action potentials (CAPs) were obtained from partially-hearing cochleae, using the CI amplifier. Immunohistochemical analysis allows the effects of deafness and electrical stimulation on cell survival to be studied. Significance. This animal model has applications in EAS research, including investigating the functional interactions between electric and acoustic stimulation, and the development of techniques to maintain residual hearing following cochlear implantation. The ability to record CAPs via the CI has clinical direct relevance for obtaining objective measures of residual hearing.

Processing F0 with cochlear implants: Modulation frequency discrimination and speech intonation recognition.

PubMed

Chatterjee, Monita; Peng, Shu-Chen

2008-01-01

Fundamental frequency (F0) processing by cochlear implant (CI) listeners was measured using a psychophysical task and a speech intonation recognition task. Listeners' Weber fractions for modulation frequency discrimination were measured using an adaptive, 3-interval, forced-choice paradigm: stimuli were presented through a custom research interface. In the speech intonation recognition task, listeners were asked to indicate whether resynthesized bisyllabic words, when presented in the free field through the listeners' everyday speech processor, were question-like or statement-like. The resynthesized tokens were systematically manipulated to have different initial-F0s to represent male vs. female voices, and different F0 contours (i.e. falling, flat, and rising) Although the CI listeners showed considerable variation in performance on both tasks, significant correlations were observed between the CI listeners' sensitivity to modulation frequency in the psychophysical task and their performance in intonation recognition. Consistent with their greater reliance on temporal cues, the CI listeners' performance in the intonation recognition task was significantly poorer with the higher initial-F0 stimuli than with the lower initial-F0 stimuli. Similar results were obtained with normal hearing listeners attending to noiseband-vocoded CI simulations with reduced spectral resolution.

Processing F0 with Cochlear Implants: Modulation Frequency Discrimination and Speech Intonation Recognition

PubMed Central

Chatterjee, Monita; Peng, Shu-Chen

2008-01-01

Fundamental frequency (F0) processing by cochlear implant (CI) listeners was measured using a psychophysical task and a speech intonation recognition task. Listeners’ Weber fractions for modulation frequency discrimination were measured using an adaptive, 3-interval, forced-choice paradigm: stimuli were presented through a custom research interface. In the speech intonation recognition task, listeners were asked to indicate whether resynthesized bisyllabic words, when presented in the free field through the listeners’ everyday speech processor, were question-like or statement-like. The resynthesized tokens were systematically manipulated to have different initial F0s to represent male vs. female voices, and different F0 contours (i.e., falling, flat, and rising) Although the CI listeners showed considerable variation in performance on both tasks, significant correlations were observed between the CI listeners’ sensitivity to modulation frequency in the psychophysical task and their performance in intonation recognition. Consistent with their greater reliance on temporal cues, the CI listeners’ performance in the intonation recognition task was significantly poorer with the higher initial-F0 stimuli than with the lower initial-F0 stimuli. Similar results were obtained with normal hearing listeners attending to noiseband-vocoded CI simulations with reduced spectral resolution. PMID:18093766

The effect of short-term auditory deprivation on the control of intraoral pressure in pediatric cochlear implant users.

PubMed

Jones, David L; Gao, Sujuan; Svirsky, Mario A

2003-06-01

The purpose of this study was to determine whether 2 speech measures (peak intraoral air pressure [IOP] and IOP duration) obtained during the production of intervocalic stops would be altered as a function of the presence or absence of auditory stimulation provided by a cochlear implant (CI). Five pediatric CI users were required to produce repetitions of the words puppy and baby with their CIs turned on. The CIs were then turned off for 1 hr, at which time the speech sample was repeated with the CI still turned off. Seven children with normal hearing formed a comparison group. They were also tested twice, with a 1-hr intermediate interval. IOP and IOP duration were measured for the medial consonant in both auditory conditions. The results show that auditory condition affected peak IOP more so than IOP duration. Peak IOP was greater for /p/ than /b/ with the CI off, but some participants reduced or reversed this contrast when the CI was on. The findings suggest that different speakers with CIs may use different speech production strategies as they learn to use the auditory signal for speech.

Spatial hearing benefits demonstrated with presentation of acoustic temporal fine structure cues in bilateral cochlear implant listeners.

PubMed

Churchill, Tyler H; Kan, Alan; Goupell, Matthew J; Litovsky, Ruth Y

2014-09-01

Most contemporary cochlear implant (CI) processing strategies discard acoustic temporal fine structure (TFS) information, and this may contribute to the observed deficits in bilateral CI listeners' ability to localize sounds when compared to normal hearing listeners. Additionally, for best speech envelope representation, most contemporary speech processing strategies use high-rate carriers (≥900 Hz) that exceed the limit for interaural pulse timing to provide useful binaural information. Many bilateral CI listeners are sensitive to interaural time differences (ITDs) in low-rate (<300 Hz) constant-amplitude pulse trains. This study explored the trade-off between superior speech temporal envelope representation with high-rate carriers and binaural pulse timing sensitivity with low-rate carriers. The effects of carrier pulse rate and pulse timing on ITD discrimination, ITD lateralization, and speech recognition in quiet were examined in eight bilateral CI listeners. Stimuli consisted of speech tokens processed at different electrical stimulation rates, and pulse timings that either preserved or did not preserve acoustic TFS cues. Results showed that CI listeners were able to use low-rate pulse timing cues derived from acoustic TFS when presented redundantly on multiple electrodes for ITD discrimination and lateralization of speech stimuli.

The ability of cochlear implant users to use temporal envelope cues recovered from speech frequency modulation.

PubMed

Won, Jong Ho; Lorenzi, Christian; Nie, Kaibao; Li, Xing; Jameyson, Elyse M; Drennan, Ward R; Rubinstein, Jay T

2012-08-01

Previous studies have demonstrated that normal-hearing listeners can understand speech using the recovered "temporal envelopes," i.e., amplitude modulation (AM) cues from frequency modulation (FM). This study evaluated this mechanism in cochlear implant (CI) users for consonant identification. Stimuli containing only FM cues were created using 1, 2, 4, and 8-band FM-vocoders to determine if consonant identification performance would improve as the recovered AM cues become more available. A consistent improvement was observed as the band number decreased from 8 to 1, supporting the hypothesis that (1) the CI sound processor generates recovered AM cues from broadband FM, and (2) CI users can use the recovered AM cues to recognize speech. The correlation between the intact and the recovered AM components at the output of the sound processor was also generally higher when the band number was low, supporting the consonant identification results. Moreover, CI subjects who were better at using recovered AM cues from broadband FM cues showed better identification performance with intact (unprocessed) speech stimuli. This suggests that speech perception performance variability in CI users may be partly caused by differences in their ability to use AM cues recovered from FM speech cues.

Early Sign Language Exposure and Cochlear Implantation Benefits.

PubMed

Geers, Ann E; Mitchell, Christine M; Warner-Czyz, Andrea; Wang, Nae-Yuh; Eisenberg, Laurie S

2017-07-01

Most children with hearing loss who receive cochlear implants (CI) learn spoken language, and parents must choose early on whether to use sign language to accompany speech at home. We address whether parents' use of sign language before and after CI positively influences auditory-only speech recognition, speech intelligibility, spoken language, and reading outcomes. Three groups of children with CIs from a nationwide database who differed in the duration of early sign language exposure provided in their homes were compared in their progress through elementary grades. The groups did not differ in demographic, auditory, or linguistic characteristics before implantation. Children without early sign language exposure achieved better speech recognition skills over the first 3 years postimplant and exhibited a statistically significant advantage in spoken language and reading near the end of elementary grades over children exposed to sign language. Over 70% of children without sign language exposure achieved age-appropriate spoken language compared with only 39% of those exposed for 3 or more years. Early speech perception predicted speech intelligibility in middle elementary grades. Children without sign language exposure produced speech that was more intelligible (mean = 70%) than those exposed to sign language (mean = 51%). This study provides the most compelling support yet available in CI literature for the benefits of spoken language input for promoting verbal development in children implanted by 3 years of age. Contrary to earlier published assertions, there was no advantage to parents' use of sign language either before or after CI. Copyright © 2017 by the American Academy of Pediatrics.

Patient-Related Benefits for Adults with Cochlear Implantation: A Multicultural Longitudinal Observational Study.

PubMed

Lenarz, Thomas; Muller, Lida; Czerniejewska-Wolska, Hanna; Vallés Varela, Hector; Orús Dotú, César; Durko, Marcin; Huarte Irujo, Alicia; Piszczatowski, Bartosz; Zadrożniak, Marek; Irwin, Colin; Graham, Petra L; Wyss, Josie

2017-01-01

To assess subjectively perceived, real-world benefits longitudinally for unilateral cochlear implant (CI) recipients in a multinational population treated routinely. To identify possible predictors of self-reported benefits. This was a prospective, multicenter, repeated-measures study. Self-assessment of performance at preimplantation and postimplantation at 1, 2, and 3 years using standardized, validated, local language versions of the Speech, Spatial, and Qualities of Hearing Scale (SSQ), and the Health Utilities Index Mark 3 (HUI3) was performed. Outcomes were analyzed using a longitudinal mixed-effects model incorporating country effect. Patient demographics were explored for associations with change over time. Two hundred ninety-one routinely treated, unilateral CI recipients, aged 13-81 years, from 9 clinics across 4 countries. Highly significant improvements were observed for all outcome measures (p < 0.0001). Postimplantation, mean outcome scores remained stable beyond 1 year, with notable individual variability. A significant association for one or more outcomes with preimplantation contralateral hearing aid use, telephone use, age at implantation, implantation side, preimplantation comorbidities, dizziness, and tinnitus was observed (p < 0.004). Longitudinal benefits of CI treatment can be measured using clinically standardized self-assessment tools to provide a holistic view of patient-related benefits in routine clinical practice for aggregated data from multinational populations. Self-reported outcomes can provide medical-based evidence regarding CI treatment to support decision-making by health service providers. © 2017 The Author(s) Published by S. Karger AG, Basel.

Speech Rate Normalization and Phonemic Boundary Perception in Cochlear-Implant Users

PubMed Central

Newman, Rochelle S.; Goupell, Matthew J.

2017-01-01

Purpose Normal-hearing (NH) listeners rate normalize, temporarily remapping phonemic category boundaries to account for a talker's speech rate. It is unknown if adults who use auditory prostheses called cochlear implants (CI) can rate normalize, as CIs transmit degraded speech signals to the auditory nerve. Ineffective adjustment to rate information could explain some of the variability in this population's speech perception outcomes. Method Phonemes with manipulated voice-onset-time (VOT) durations were embedded in sentences with different speech rates. Twenty-three CI and 29 NH participants performed a phoneme identification task. NH participants heard the same unprocessed stimuli as the CI participants or stimuli degraded by a sine vocoder, simulating aspects of CI processing. Results CI participants showed larger rate normalization effects (6.6 ms) than the NH participants (3.7 ms) and had shallower (less reliable) category boundary slopes. NH participants showed similarly shallow slopes when presented acoustically degraded vocoded signals, but an equal or smaller rate effect in response to reductions in available spectral and temporal information. Conclusion CI participants can rate normalize, despite their degraded speech input, and show a larger rate effect compared to NH participants. CI participants may particularly rely on rate normalization to better maintain perceptual constancy of the speech signal. PMID:28395319

The effect of temporal gap identification on speech perception by users of cochlear implants

PubMed Central

Sagi, Elad; Kaiser, Adam R.; Meyer, Ted A.; Svirsky, Mario A.

2008-01-01

Purpose This study examined the ability of listeners using cochlear implants (CIs) and listeners with normal-hearing (NH) to identify silent gaps of different duration, and the relation of this ability to speech understanding in CI users. Method Sixteen NH adults and eleven postlingually deafened adults with CIs identified synthetic vowel-like stimuli that were either continuous or contained an intervening silent gap ranging from 15 to 90 ms. Cumulative d’, an index of discriminability, was calculated for each participant. Consonant and CNC word identification tasks were administered to the CI group. Results Overall, the ability to identify stimuli with gaps of different duration was better for the NH group than for the CI group. Seven CI users had cumulative d' scores that were no higher than those of any NH listener, and their CNC word scores ranged from 0 to 30%. The other four CI users had cumulative d’ scores within the range of the NH group, and their CNC word scores ranged from 46% to 68%. For the CI group, cumulative d’ scores were significantly correlated with their speech testing scores. Conclusions The ability to identify silent gap duration may help explain individual differences in speech perception by CI users. PMID:18806216

Word segmentation in phonemically identical and prosodically different sequences using cochlear implants: A case study.

PubMed

Basirat, Anahita

2017-01-01

Cochlear implant (CI) users frequently achieve good speech understanding based on phoneme and word recognition. However, there is a significant variability between CI users in processing prosody. The aim of this study was to examine the abilities of an excellent CI user to segment continuous speech using intonational cues. A post-lingually deafened adult CI user and 22 normal hearing (NH) subjects segmented phonemically identical and prosodically different sequences in French such as 'l'affiche' (the poster) versus 'la fiche' (the sheet), both [lafiʃ]. All participants also completed a minimal pair discrimination task. Stimuli were presented in auditory-only and audiovisual presentation modalities. The performance of the CI user in the minimal pair discrimination task was 97% in the auditory-only and 100% in the audiovisual condition. In the segmentation task, contrary to the NH participants, the performance of the CI user did not differ from the chance level. Visual speech did not improve word segmentation. This result suggests that word segmentation based on intonational cues is challenging when using CIs even when phoneme/word recognition is very well rehabilitated. This finding points to the importance of the assessment of CI users' skills in prosody processing and the need for specific interventions focusing on this aspect of speech communication.

Remote programming of MED-EL cochlear implants: users' and professionals' evaluation of the remote programming experience.

PubMed

Kuzovkov, Vladislav; Yanov, Yuri; Levin, Sergey; Bovo, Roberto; Rosignoli, Monica; Eskilsson, Gunnar; Willbas, Staffan

2014-07-01

Remote programming is safe and is well received by health-care professionals and cochlear implant (CI) users. It can be adopted into clinic routine as an alternative to face-to-face programming. Telemedicine allows a patient to be treated anywhere in the world. Although it is a growing field, little research has been published on its application to CI programming. We examined hearing professionals' and CI users' subjective reactions to the remote programming experience, including the quality of the programming and the use of the relevant technology. Remote CI programming was performed in Italy, Sweden, and Russia. Programming sessions had three participants: a CI user, a local host, and a remote expert. After the session, each CI user, local host, and remote expert each completed a questionnaire on their experience. In all, 33 remote programming sessions were carried out, resulting in 99 completed questionnaires. The overwhelming majority of study participants responded positively to all aspects of remote programming. CI users were satisfied with the results in 96.9% of the programming sessions; 100% of participants would use remote programming again. Although technical problems were encountered, they did not cause the sessions to be considerably longer than face-to-face sessions.

Validation of a Cochlear Implant Patient-Specific Model of the Voltage Distribution in a Clinical Setting

PubMed Central

Nogueira, Waldo; Schurzig, Daniel; Büchner, Andreas; Penninger, Richard T.; Würfel, Waldemar

2016-01-01

Cochlear Implants (CIs) are medical implantable devices that can restore the sense of hearing in people with profound hearing loss. Clinical trials assessing speech intelligibility in CI users have found large intersubject variability. One possibility to explain the variability is the individual differences in the interface created between electrodes of the CI and the auditory nerve. In order to understand the variability, models of the voltage distribution of the electrically stimulated cochlea may be useful. With this purpose in mind, we developed a parametric model that can be adapted to each CI user based on landmarks from individual cone beam computed tomography (CBCT) scans of the cochlea before and after implantation. The conductivity values of each cochlea compartment as well as the weighting factors of different grounding modes have also been parameterized. Simulations were performed modeling the cochlea and electrode positions of 12 CI users. Three models were compared with different levels of detail: a homogeneous model (HM), a non-patient-specific model (NPSM), and a patient-specific model (PSM). The model simulations were compared with voltage distribution measurements obtained from the backward telemetry of the 12 CI users. Results show that the PSM produces the lowest error when predicting individual voltage distributions. Given a patient-specific geometry and electrode positions, we show an example on how to optimize the parameters of the model and how to couple it to an auditory nerve model. The model here presented may help to understand speech performance variability and support the development of new sound coding strategies for CIs. PMID:27933290

[The Freiburg monosyllable word test in postoperative cochlear implant diagnostics].

PubMed

Hey, M; Brademann, G; Ambrosch, P

2016-08-01

The Freiburg monosyllable word test represents a central tool of postoperative cochlear implant (CI) diagnostics. The objective of this study is to test the equivalence of different word lists by analysing word comprehension. For patients whose CI has been implanted for more than 5 years, the distribution of suprathreshold speech intelligibility outcomes will also be analysed. In a retrospective data analysis, speech understanding for 626 CI users word correct scores were evaluated using a total of 5211 lists with 20 words each. The analysis of word comprehension within each list shows differences in mean and in the kind of distribution function. There are lists which show a significant difference of their mean word recognition to the overall mean. The Freiburg monosyllable word test is easy to administer at suprathreshold speech level for CI recipients, and typically has a saturation level above 80 %. The Freiburg monosyllable word test can be performed successfully by the majority of CI patients. The limited balance of the test lists elicits the conclusion that an adaptive test procedure with the Freiburg monosyllable test does not make sense. The Freiburg monosyllable test can be restructured by resorting all words across lists, or by omitting individual words of a test list to increase the reliability of the test. The results show that speech intelligibility in quiet should also be investigated in CI recipients al levels below 70 dB.

Initial Results With Image-guided Cochlear Implant Programming in Children.

PubMed

Noble, Jack H; Hedley-Williams, Andrea J; Sunderhaus, Linsey; Dawant, Benoit M; Labadie, Robert F; Camarata, Stephen M; Gifford, René H

2016-02-01

Image-guided cochlear implant (CI) programming can improve hearing outcomes for pediatric CI recipients. 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. Although 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. Previous studies have shown that IGCIP can significantly improve hearing outcomes for adults with CIs. The IGCIP technique was tested for 21 ears of 18 pediatric CI recipients. Participants had long-term experience with their CI (5 mo to 13 yr) and ranged in age from 5 to 17 years old. Speech understanding was assessed after approximately 4 weeks of experience with the IGCIP map. 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. Our results indicate that image guidance significantly improves hearing and QOL outcomes for pediatric CI recipients.

Cochlear Implants Special Issue Article: Vocal Emotion Recognition by Normal-Hearing Listeners and Cochlear Implant Users

PubMed Central

Luo, Xin; Fu, Qian-Jie; Galvin, John J.

2007-01-01

The present study investigated the ability of normal-hearing listeners and cochlear implant users to recognize vocal emotions. Sentences were produced by 1 male and 1 female talker according to 5 target emotions: angry, anxious, happy, sad, and neutral. Overall amplitude differences between the stimuli were either preserved or normalized. In experiment 1, vocal emotion recognition was measured in normal-hearing and cochlear implant listeners; cochlear implant subjects were tested using their clinically assigned processors. When overall amplitude cues were preserved, normal-hearing listeners achieved near-perfect performance, whereas listeners with cochlear implant recognized less than half of the target emotions. Removing the overall amplitude cues significantly worsened mean normal-hearing and cochlear implant performance. In experiment 2, vocal emotion recognition was measured in listeners with cochlear implant as a function of the number of channels (from 1 to 8) and envelope filter cutoff frequency (50 vs 400 Hz) in experimental speech processors. In experiment 3, vocal emotion recognition was measured in normal-hearing listeners as a function of the number of channels (from 1 to 16) and envelope filter cutoff frequency (50 vs 500 Hz) in acoustic cochlear implant simulations. Results from experiments 2 and 3 showed that both cochlear implant and normal-hearing performance significantly improved as the number of channels or the envelope filter cutoff frequency was increased. The results suggest that spectral, temporal, and overall amplitude cues each contribute to vocal emotion recognition. The poorer cochlear implant performance is most likely attributable to the lack of salient pitch cues and the limited functional spectral resolution. PMID:18003871

Language acquisition after cochlear implantation of congenitally deaf children: Effect of age at implantation

NASA Astrophysics Data System (ADS)

Svirsky, Mario; Holt, Rachael

2005-04-01

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.

Parental perspectives of children using cochlear implant.

PubMed

Stefanini, Marcela Roselin; Morettin, Marina; Zabeu, Julia Speranza; Bevilacqua, Maria Cecília; Moret, Adriane Lima Mortari

2014-01-01

To evaluate the parents' perspective with regard to evolution of their child with cochlear implant (CI). This was a cross-sectional prospective study conducted at the Centro de Pesquisas Audiológicas of Hospital de Reabilitação de Anomalias Craniofaciais of Universidade de São Paulo. The selection of the sample was performed from the spontaneous demand, among the months from July to December 2011. The final sample comprised 50 parents or guardians of children using CI, with minimum 1 year and maximum of 3 years of device use. The translated and adapted to Brazilian Portuguese version of the questionnaire "Perspectives of parents of children with cochlear implants" was applied. This instrument consists of 74 questions and allows quantification of the parents' perspective on subscales that illustrate the situation of the child and family. Each question has five options scored from one to five responses. The Spearman test for comparison of results between the subscales was applied. The social relationships, self-sufficiency, and communication subscales showed the highest mean score, whereas the worst score was for child support subscale, reflecting the independence and autonomy of the patients. The correlation between the child subscales was realized, and the results showed themselves significant and positive for communication subscale of communication with all others subscales. The family subscales also had a positive correlation with the communication, education, and self-sufficiency. These results demonstrate that parents have good expectations regarding communication, independence, and social participation of children after CI surgery, and this questionnaire is a useful tool for use in clinical practice.

Intracochlear Pressure Transients During Cochlear Implant Electrode Insertion.

PubMed

Greene, Nathaniel T; Mattingly, Jameson K; Banakis Hartl, Renee M; Tollin, Daniel J; Cass, Stephen P

2016-12-01

Cochlear implant (CI) electrode insertion into the round window induces pressure transients in the cochlear fluid comparable to high-intensity sound transients. Many patients receiving a CI have some remaining functional hearing at low frequencies; thus, devices and surgical techniques have been developed to use this residual hearing. To maintain functional acoustic hearing, it is important to retain function of any hair cells and auditory nerve fibers innervating the basilar membrane; however, in a subset of patients, residual low-frequency hearing is lost after CI insertion. Here, we test the hypothesis that transient intracochlear pressure spikes are generated during CI electrode insertion, which could cause damage and compromise residual hearing. Human cadaveric temporal bones were prepared with an extended facial recess. Pressures in the scala vestibuli and tympani were measured with fiber-optic pressure sensors inserted into the cochlea near the oval and round windows, whereas CI electrodes (five styles from two manufacturers) were inserted into the cochlea via a round window approach. Pressures in the scala tympani tended to be larger in magnitude than pressures in the scala vestibuli, consistent with electrode insertion into the scala tympani. CI electrode insertion produced a range of pressure transients in the cochlea that could occur alone or as part of a train of spikes with equivalent peak sound pressure levels in excess of 170 dB sound pressure level. Instances of pressure transients varied with electrode styles. Results suggest electrode design, insertion mechanism, and surgical technique affect the magnitude and rate of intracochlear pressure transients during CI electrode insertion. Pressure transients showed intensities similar to those elicited by high-level sounds and thus could cause damage to the basilar membrane and/or hair cells.

Intracochlear pressure transients during cochlear implant electrode insertion

PubMed Central

Greene, Nathaniel T.; Mattingly, Jameson K.; Banakis Hartl, Renee M.; Tollin, Daniel J.; Cass, Stephen P.

2016-01-01

Hypothesis Cochlear implant (CI) electrode insertion into the round window induces pressure transients in the cochlear fluid comparable to high intensity sound transients. Background Many patients receiving a CI have some remaining functional hearing at low frequencies, thus devices and surgical techniques have been developed to utilize this residual hearing. To maintain functional acoustic hearing, it is important to retain function of any hair cells and auditory nerve fibers innervating the basilar membrane; however, in a subset of patients, residual low frequency hearing is lost following CI insertion. Here, we test the hypothesis that transient intracochlear pressure spikes are generated during CI electrode insertion, which could cause damage and compromise residual hearing. Methods Human cadaveric temporal bones were prepared with an extended facial recess. Pressures in the scala vestibuli (PSV) and tympani (PST) were measured with fiber-optic pressure sensors inserted into the cochlea near the oval and round windows while CI electrodes (five styles from two manufacturers) were inserted into the cochlea via a round window approach. Results PST tended to be larger in magnitude than PSV, consistent with electrode insertion into the scala tympani. CI electrode insertion produced a range of pressure transients in the cochlea that could occur alone or as part of a train of spikes with equivalent peak sound pressure levels in excess of 170dB SPL. Instances of pressure transients varied with electrode styles. Conclusions Results suggest electrode design, insertion mechanism, and surgical technique affect the magnitude and rate of intracochlear pressure transients during CI electrode insertion. Pressure transients showed intensities similar to those elicited by high level sounds and thus could cause damage to the basilar membrane and/or hair cells. PMID:27753703

Brain Network Regional Synchrony Analysis in Deafness

PubMed Central

Xu, Lei; Liang, Mao-Jin

2018-01-01

Deafness, the most common auditory disease, has greatly affected people for a long time. The major treatment for deafness is cochlear implantation (CI). However, till today, there is still a lack of objective and precise indicator serving as evaluation of the effectiveness of the cochlear implantation. The goal of this EEG-based study is to effectively distinguish CI children from those prelingual deafened children without cochlear implantation. The proposed method is based on the functional connectivity analysis, which focuses on the brain network regional synchrony. Specifically, we compute the functional connectivity between each channel pair first. Then, we quantify the brain network synchrony among regions of interests (ROIs), where both intraregional synchrony and interregional synchrony are computed. And finally the synchrony values are concatenated to form the feature vector for the SVM classifier. What is more, we develop a new ROI partition method of 128-channel EEG recording system. That is, both the existing ROI partition method and the proposed ROI partition method are used in the experiments. Compared with the existing EEG signal classification methods, our proposed method has achieved significant improvements as large as 87.20% and 86.30% when the existing ROI partition method and the proposed ROI partition method are used, respectively. It further demonstrates that the new ROI partition method is comparable to the existing ROI partition method. PMID:29854776

Influence of Linguistic Environment on Children's Language Development: Flemish versus Dutch Children

ERIC Educational Resources Information Center

Wiefferink, C. H.; Spaai, G. W. G.; Uilenburg, N.; Vermeij, B. A. M.; De Raeve, L.

2008-01-01

In the present study, language development of Dutch children with a cochlear implant (CI) in a bilingual educational setting and Flemish children with a CI in a dominantly monolingual educational setting is compared. In addition, we compared the development of spoken language with the development of sign language in Dutch children. Eighteen…

The Pattern and Degree of Capsular Fibrous Sheaths Surrounding Cochlear Electrode Arrays

PubMed Central

Ishai, Reuven; Herrmann, Barbara S.; Nadol, Joseph B.; Quesnel, Alicia M.

2017-01-01

An inflammatory tissue reaction around the electrode array of a cochlear implant (CI) is common, in particular at the electrode insertion region (cochleostomy) where mechanical trauma often occurs. However, the factors determining the amount and causes of fibrous reaction surrounding the stimulating electrode, especially medially near the perimodiolar location, are unclear. Temporal bone (TB) specimens from patients who had undergone cochlear implantation during life with either Advanced Bionics (AB) Clarion TM or HiRes90KTM (Sylmar, CA, USA) or Cochlear TM Nucleus (Sydney, Australia) devices were evaluated. The thickness of the fibrous tissue surrounding the electrode array of both types of CI devices at both the lower (LB) and upper (UB) basal turns of the cochlea was quantified at three locations: the medial, inferior, and superior aspects of the sheath. Fracture of the osseous spiral lamina and/or marked displacement of the basilar membrane were interpreted as evidence of intracochlear trauma. In addition, post-operative word recognition scores, duration of implantation, and post-operative programming data were evaluated. Seven TBs from six patients implanted with AB devices and five TBs from five patients implanted with Nucleus devices were included. A fibrous capsule around the stimulating electrode array was present in all twelve specimens. TBs implanted with AB device had a significantly thicker fibrous capsule at the medial aspect than at the inferior or superior aspects at both locations (LB and UB) of the cochlea (Wilcoxon signed-ranks test, p<0.01). TBs implanted with a Nucleus device had no difference in the thickness of the fibrous capsule surrounding the track of the electrode array (Wilcoxon signed-ranks test, p>0.05). Nine of fourteen (64%) basal turns of the cochlea (LB and UB of seven TBs) implanted with AB devices demonstrated intracochlear trauma compared to two of ten (20%) basal turns of the cochlea (LB and UB of five TBs) with Nucleus devices, (Fisher exact test, p<0.05). There was no significant correlation between the thickness of the fibrous tissue and the duration of implantation or the word recognition scores (Spearman rho, p=0.06, p=0.4 respectively). Our outcomes demonstrated the development of a robust fibrous tissue sheath medially closest to the site of electric stimulation in cases implanted with the AB device electrode, but not in cases implanted with the Nucleus device. The cause of the asymmetric fibrous sheath may be multifactorial including insertional trauma, a foreign body response, and/or asymmetric current flow. PMID:28216124

Safety, reliability, and operability of cochlear implant electrode arrays coated with biocompatible polymer.

PubMed

Kinoshita, Makoto; Kikkawa, Yayoi S; Sakamoto, Takashi; Kondo, Kenji; Ishihara, Kazuhiko; Konno, Tomohiro; Pawsey, Nick; Yamasoba, Tatsuya

2015-04-01

Polymer-coated electrodes can reduce surgically-induced trauma associated with the insertion of a cochlear implant (CI) electrode array. To evaluate if insertion trauma in CI surgery can be reduced by using electrode arrays coated with 2-methacryloyloxyethyl phosphorylcholine (MPC) polymer. We analyzed characteristics of the Contour Advance electrode arrays coated with MPC polymer. To assess surgical trauma during electrode insertion, polymer-coated or uncoated (n = 5 each) animal electrode arrays were implanted in guinea pig cochleae and operability and electrophysiological and histological changes were assessed. Under light and scanning electron microscopy, polymer-coated electrodes did not appear different from uncoated electrodes, and no change was observed after mechanical stressing of the arrays. Electrode insertion was significantly easier when polymer-coated electrodes were used. Auditory brainstem response (ABR) thresholds did not differ between groups, but p1-n1 amplitudes of the coated group were larger compared with the uncoated group at 32 kHz at 28 days after surgery. The survival of outer hair cells and spiral ganglion cells was significantly greater in the polymer-coated group.

Binaural hearing with electrical stimulation

PubMed Central

Kan, Alan; Litovsky, Ruth Y.

2014-01-01

Bilateral cochlear implantation is becoming a standard of care in many clinics. While much benefit has been shown through bilateral implantation, patients who have bilateral cochlear implants (CIs) still do not perform as well as normal hearing listeners in sound localization and understanding speech in noisy environments. This difference in performance can arise from a number of different factors, including the areas of hardware and engineering, surgical precision and pathology of the auditory system in deaf persons. While surgical precision and individual pathology are factors that are beyond careful control, improvements can be made in the areas of clinical practice and the engineering of binaural speech processors. These improvements should be grounded in a good understanding of the sensitivities of bilateral CI patients to the acoustic binaural cues that are important to normal hearing listeners for sound localization and speech in noise understanding. To this end, we review the current state-of-the-art in the understanding of the sensitivities of bilateral CI patients to binaural cues in electric hearing, and highlight the important issues and challenges as they relate to clinical practice and the development of new binaural processing strategies. PMID:25193553

Evaluation of a Test Battery to Assess Perception of Music in Children With Cochlear Implants.

PubMed

Roy, Alexis T; Scattergood-Keepper, Lindsay; Carver, Courtney; Jiradejvong, Patpong; Butler, Caty; Limb, Charles J

2014-06-01

A number of studies have investigated music perception in adult cochlear implant (CI) users. However, little is known about how pediatric CI users perceive and process music, in part because suitable methods for assessing music perception in this population are lacking. Therefore, we developed the Music in Children With Cochlear Implants (MCCI) battery to assess music perception in pediatric CI users younger than 9 years. To pilot test the MCCI on a group of pediatric CI users to determine its feasibility for measuring music perception and to compare performance of CI users with that of normal-hearing (NH) control participants. The pilot test was conducted in an academic tertiary care center. The MCCI evaluated rhythm, pitch, melody, harmony, and timbre perception. For each section, 10 pediatric CI users and 10 NH controls were presented with a pair of stimuli that possibly varied along a single musical element (eg, rhythm). Participants were required to indicate whether the stimuli in the pair were the same or different. Administration of the MCCI. Percentage correct on each section of the MCCI and the aggregate score of all sections by group. The MCCI provided a basic characterization of musical perceptual abilities. In the aggregate, NH controls significantly outperformed CI users in music perception (mean [SD] accuracy for CI users vs NH controls: rhythm, 73% [20%] vs 78% [20%]; pitch, 84% [12%] vs 91% [13%]; melody, 65% [16%] vs 75% [18%]; harmony, 74% [13%] vs 75% [14%]; and timbre, 80% [17%] vs 90% [12%]; repeated-measures analysis of variance, F1,17 = 9.3; P < .01). Despite obtaining lower accuracies than NH controls, however, the CI users achieved above-chance accuracy in all sections of the MCCI (1-sample t test, P < .01), including pitch-based sections that are traditionally difficult for CI users. These results suggest that CI users can make use of temporal and spectral cues to discriminate between musical stimuli, although not to the extent of their NH peers. The MCCI provided an efficient and user-friendly assessment of music perception in pediatric CI users. This test battery may serve as a valuable tool to evaluate music perceptual abilities of pediatric CI users and measure the effects of interventions.

Longterm infrared neural stimulation in the chronic implanted cat

NASA Astrophysics Data System (ADS)

Matic, Agnella Izzo; Robinson, Alan M.; Young, Hunter K.; Badofsky, Ben; Rajguru, Suhrud M.; Richter, Claus-Peter

2013-03-01

Among neural prostheses cochlear implants (CIs) are considered the most successful devices. They restore some hearing to 210,000 severe-to-profound hearing impaired people. Despite the devices' success, the performance of the implanted individuals in noisy environments is poor and music perception is rudimentary. It has been argued that increasing the number of independent channels for stimulation can improve the performance of a CI user in challenging hearing environments. An optical method, stimulating neurons with infrared radiation, has been suggested as a novel approach to increase the number of independent channels. Infrared neural stimulation (INS) works through the deposition of heat into the tissue. Thermal damage is therefore a potential risk, particularly for longterm exposure. To verify the efficacy and safety of INS, cats were implanted for about 4 weeks and were continuously stimulated daily for 6-8 hours. Cochlear function did not change during the stimulation, and histology did not reveal signs of damage. Tissue growth following the implantation was largely localized at the cochleostomy.

The role of the salience network in processing lexical and nonlexical stimuli in cochlear implant users: an ALE meta-analysis of PET studies.

PubMed

Song, Jae-Jin; Vanneste, Sven; Lazard, Diane S; Van de Heyning, Paul; Park, Joo Hyun; Oh, Seung Ha; De Ridder, Dirk

2015-05-01

Previous positron emission tomography (PET) studies have shown that various cortical areas are activated to process speech signal in cochlear implant (CI) users. Nonetheless, differences in task dimension among studies and low statistical power preclude from understanding sound processing mechanism in CI users. Hence, we performed activation likelihood estimation meta-analysis of PET studies in CI users and normal hearing (NH) controls to compare the two groups. Eight studies (58 CI subjects/92 peak coordinates; 45 NH subjects/40 peak coordinates) were included and analyzed, retrieving areas significantly activated by lexical and nonlexical stimuli. For lexical and nonlexical stimuli, both groups showed activations in the components of the dual-stream model such as bilateral superior temporal gyrus/sulcus, middle temporal gyrus, left posterior inferior frontal gyrus, and left insula. However, CI users displayed additional unique activation patterns by lexical and nonlexical stimuli. That is, for the lexical stimuli, significant activations were observed in areas comprising salience network (SN), also known as the intrinsic alertness network, such as the left dorsal anterior cingulate cortex (dACC), left insula, and right supplementary motor area in the CI user group. Also, for the nonlexical stimuli, CI users activated areas comprising SN such as the right insula and left dACC. Previous episodic observations on lexical stimuli processing using the dual auditory stream in CI users were reconfirmed in this study. However, this study also suggests that dual-stream auditory processing in CI users may need supports from the SN. In other words, CI users need to pay extra attention to cope with degraded auditory signal provided by the implant. © 2015 Wiley Periodicals, Inc.

Magnet dislocation: an increasing and serious complication following MRI in patients with cochlear implants.

PubMed

Hassepass, F; Stabenau, V; Arndt, S; Beck, R; Bulla, S; Grauvogel, T; Aschendorff, A

2014-07-01

Cochlear implantation (CI) represents the gold standard in the treatment of children born deaf and postlingually deafened adults. Initial magnetic resonance imaging (MRI) was contraindicated in CI users. Meanwhile, there are specific recommendations concerning MRI compatibility depending on the type of CI system and the device manufacturer. Some CI systems are even approved for MRI with the internal magnet left in place. The aim of this study was to analyze all magnet revision surgeries in CI patients at one CI center and the relationship to MRI scans over time. Between 2000 and 2013, a total of 2027 CIs were implanted. The number of magnet dislocation (MD) surgeries and their causes was assessed retrospectively. In total 12 cases of MD resulting from an MRI scan (0.59 %) were observed, accounting for 52.2 % of all magnetic revision surgeries. As per the labeling, it was considered safe to leave the internal magnet in place during MRI while following specific manufacturer recommendations: MRI intensity of 1.5 Tesla (T) and compression head bandage during examination. A compression head bandage in a 1.5 T MRI unit does not safely prevent MD and the related serious complications in CI recipients. We recommend a Stenvers view radiograph after MRI with the internal magnet in place for early identification of MD, at least in the case of pain during or after MRI examination. MRI in CI patients should be indicated with restraint and patients should be explicitly informed about the possible risks. Recommendations regarding MRI compatibility and the handling of CI patients issued with MRI for the most common CI systems are summarized. © Georg Thieme Verlag KG Stuttgart · New York.

[Emotional response to music by postlingually-deafened adult cochlear implant users].

PubMed

Wang, Shuo; Dong, Ruijuan; Zhou, Yun; Li, Jing; Qi, Beier; Liu, Bo

2012-10-01

To assess the emotional response to music by postlingually-deafened adult cochlear implant users. Munich music questionnaire (MUMU) was used to match the music experience and the motivation of use of music between 12 normal-hearing and 12 cochlear implant subjects. Emotion rating test in Musical Sounds in Cochlear Implants (MuSIC) test battery was used to assess the emotion perception ability for both normal-hearing and cochlear implant subjects. A total of 15 pieces of music phases were used. Responses were given by selecting the rating scales from 1 to 10. "1" represents "very sad" feeling, and "10" represents "very happy feeling. In comparison with normal-hearing subjects, 12 cochlear implant subjects made less active use of music for emotional purpose. The emotion ratings for cochlear implant subjects were similar to normal-hearing subjects, but with large variability. Post-lingually deafened cochlear implant subjects on average performed similarly in emotion rating tasks relative to normal-hearing subjects, but their active use of music for emotional purpose was obviously less than normal-hearing subjects.

Surgical treatment of vertigo in cochlear implantees by electrode resealing.

PubMed

Karimi, Dania; Mittmann, Philipp; Ernst, Arneborg; Todt, Ingo

2017-10-01

Our present findings demonstrate that resealing to cover the electrode is an effective method to treat vertigo after CI. An insufficient cochleostomy sealing can be regarded as a cause of postoperatively newly occuring vertigo after CI. A transtympanic revision is a promising treatment option in cases of post-operative dizziness. Intoduction: A well-known and frequently reported complication after cochlear implantation is the appearance of postoperative vertigo symptoms. The aim of the present study was to observe if the postoperatively new occurrence of vertigo can be treated by resealing of the round window patch after cochlear implantation. A retrospective analysis revealed that 10 patients underwent revision surgery transtympanally. Vertigo was assessed preoperatively and directly postoperatively and after 6 month after revision surgery by using the Dizziness Handycap Inventory (DHI). The most common symptom was rotating vertigo. A spontanous nystagmus was seen in four cases. No nystagmus was found after the revision surgery. In three cases, the onset of dizziness was associated with an event (sneezing, otitis media, climbing a mountain). A preoperative CT showed insuspectible results in seven patients but revealed pathologies two patients. Vertigo was improved significantly in six patients, and three of them were symptom-free.

A Stereo Music Preprocessing Scheme for Cochlear Implant Users.

PubMed

Buyens, Wim; van Dijk, Bas; Wouters, Jan; Moonen, Marc

2015-10-01

Listening to music is still one of the more challenging aspects of using a cochlear implant (CI) for most users. Simple musical structures, a clear rhythm/beat, and lyrics that are easy to follow are among the top factors contributing to music appreciation for CI users. Modifying the audio mix of complex music potentially improves music enjoyment in CI users. A stereo music preprocessing scheme is described in which vocals, drums, and bass are emphasized based on the representation of the harmonic and the percussive components in the input spectrogram, combined with the spatial allocation of instruments in typical stereo recordings. The scheme is assessed with postlingually deafened CI subjects (N = 7) using pop/rock music excerpts with different complexity levels. The scheme is capable of modifying relative instrument level settings, with the aim of improving music appreciation in CI users, and allows individual preference adjustments. The assessment with CI subjects confirms the preference for more emphasis on vocals, drums, and bass as offered by the preprocessing scheme, especially for songs with higher complexity. The stereo music preprocessing scheme has the potential to improve music enjoyment in CI users by modifying the audio mix in widespread (stereo) music recordings. Since music enjoyment in CI users is generally poor, this scheme can assist the music listening experience of CI users as a training or rehabilitation tool.

Information Theoretic Evaluation of a Noiseband-Based Cochlear Implant Simulator

PubMed Central

Aguiar, Daniel E.; Taylor, N. Ellen; Li, Jing; Gazanfari, Daniel K.; Talavage, Thomas M.; Laflen, J. Brandon; Neuberger, Heidi; Svirsky, Mario A.

2015-01-01

Noise-band vocoders are often used to simulate the signal processing algorithms used in cochlear implants (CIs), producing acoustic stimuli that may be presented to normal hearing (NH) subjects. Such evaluations may obviate the heterogeneity of CI user populations, achieving greater experimental control than when testing on CI subjects. However, it remains an open question whether advancements in algorithms developed on NH subjects using a simulator will necessarily improve performance in CI users. This study assessed the similarity in vowel identification of CI subjects and NH subjects using an 8-channel noise-band vocoder simulator configured to match input and output frequencies or to mimic output after a basalward shift of input frequencies. Under each stimulus condition, NH subjects performed the task both with and without feedback/training. Similarity of NH subjects to CI users was evaluated using correct identification rates and information theoretic approaches. Feedback/training produced higher rates of correct identification, as expected, but also resulted in error patterns that were closer to those of the CI users. Further evaluation remains necessary to determine how patterns of confusion at the token level are affected by the various parameters in CI simulators, providing insight into how a true CI simulation may be developed to facilitate more rapid prototyping and testing of novel CI signal processing and electrical stimulation strategies. PMID:26409068

Trends in cochlear implants.

PubMed

Zeng, Fan-Gang

2004-01-01

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.

Working memory in Farsi-speaking children with normal development and cochlear implant.

PubMed

Soleymani, Zahra; Amidfar, Meysam; Dadgar, Hooshang; Jalaie, Shohre

2014-04-01

Working memory has an important role in language acquisition and development of cognition skills. The ability of encoding, storage and retrieval of phonological codes, as activities of working memory, acquired by audition sense. Children with cochlear implant experience a period that they are not able to perceive sounds. In order to assess the effect of hearing on working memory, we investigated working memory as a cognition skill in children with normal development and cochlear implant. Fifty students with normal hearing and 50 students with cochlear implant aged 5-7 years participated in this study. Children educated in the preschool, the first and second grades. Children with normal development were matched based on age, gender, and grade of education with cochlear implant. Two components of working memory including phonological loop and central executive were compared between two groups. Phonological loop assessed by nonword repetition task and forward digit span. To assess central executive component backward digit span was used. The developmental trend was studied in children with normal development and cochlear implant as well. The effect of age at implantation in children with cochlear implants on components of working memory was investigated. There are significant differences between children with normal development and cochlear implant in all tasks that assess working memory (p < 0.001). The children's age at implantation was negatively correlated with all tasks (p < 0.001). In contrast, duration of usage of cochlear implant set was positively correlated with all tasks (p < 0.001). The comparison of working memory between different grades showed significant differences both in children with normal development and in children with cochlear implant (p < 0.05). These results implied that children with cochlear implant may experience difficulties in working memory. Therefore, these children have problems in encoding, practicing, and repeating phonological units. The results also suggested working memory develops when the child grows up. In cochlear implant children, with decreasing age at implantation and increasing their experience in perceiving sound, working memory skills improved. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Implicit sequence learning in deaf children with cochlear implants.

PubMed

Conway, Christopher M; Pisoni, David B; Anaya, Esperanza M; Karpicke, Jennifer; Henning, Shirley C

2011-01-01

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 more global changes in neurocognitive function. In this paper, we investigate implicit sequence learning abilities in deaf children with CIs using a novel task that measured learning through improvement to immediate serial recall for statistically consistent visual sequences. The results demonstrated two key findings. First, the deaf children with CIs showed disturbances in their visual sequence learning abilities relative to the typically developing normal-hearing children. Second, sequence learning was significantly correlated with a standardized measure of language outcome in the CI children. These findings suggest that a period of auditory deprivation has secondary effects related to general sequencing deficits, and that disturbances in sequence learning may at least partially explain why some deaf children still struggle with language following cochlear implantation. © 2010 Blackwell Publishing Ltd.

Imitative Production of Rising Speech Intonation in Pediatric Cochlear Implant Recipients

PubMed Central

Peng, Shu-Chen; Tomblin, J. Bruce; Spencer, Linda J.; Hurtig, Richard R.

2011-01-01

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 were extracted from annual evaluation sessions. These utterances were perceptually judged by adult NH listeners in regard with intonation contour type (non-rise, partial-rise, or full-rise) and contour appropriateness (on a 5-point scale). Fundamental frequency, intensity, and duration properties of each utterance were also acoustically analyzed. Results Adult NH listeners' judgments of intonation contour type and contour appropriateness for each CI participant 's utterances were highly positively correlated. The pediatric CI recipients did not consistently use appropriate intonation contours when imitating a yes–no question. Acoustic properties of speech intonation produced by these individuals were discernible among utterances of different intonation contour types according to NH listeners' perceptual judgments. Conclusions These findings delineated the perceptual and acoustic characteristics of speech intonation imitated by prelingually deafened children and young adults with a CI. Future studies should address whether the degraded signals these individuals perceive via a CI contribute to their difficulties with speech intonation production. PMID:17905907

Verbal Processing Speed and Executive Functioning in Long-Term Cochlear Implant Users

PubMed Central

Pisoni, David B.; Kronenberger, William G.

2015-01-01

Purpose The purpose of this study was to report how verbal rehearsal speed (VRS), a form of covert speech used to maintain verbal information in working memory, and another verbal processing speed measure, perceptual encoding speed, are related to 3 domains of executive function (EF) at risk in cochlear implant (CI) users: verbal working memory, fluency-speed, and inhibition-concentration. Method EF, speech perception, and language outcome measures were obtained from 55 prelingually deaf, long-term CI users and matched controls with normal hearing (NH controls). Correlational analyses were used to assess relations between VRS (articulation rate), perceptual encoding speed (digit and color naming), and the outcomes in each sample. Results CI users displayed slower verbal processing speeds than NH controls. Verbal rehearsal speed was related to 2 EF domains in the NH sample but was unrelated to EF outcomes in CI users. Perceptual encoding speed was related to all EF domains in both groups. Conclusions Verbal rehearsal speed may be less influential for EF quality in CI users than for NH controls, whereas rapid automatized labeling skills and EF are closely related in both groups. CI users may develop processing strategies in EF tasks that differ from the covert speech strategies routinely employed by NH individuals. PMID:25320961

Processing of Acoustic Cues in Lexical-Tone Identification by Pediatric Cochlear-Implant Recipients

PubMed Central

Peng, Shu-Chen; Lu, Hui-Ping; Lu, Nelson; Lin, Yung-Song; Deroche, Mickael L. D.

2017-01-01

Purpose The objective was to investigate acoustic cue processing in lexical-tone recognition by pediatric cochlear-implant (CI) recipients who are native Mandarin speakers. Method Lexical-tone recognition was assessed in pediatric CI recipients and listeners with normal hearing (NH) in 2 tasks. In Task 1, participants identified naturally uttered words that were contrastive in lexical tones. For Task 2, a disyllabic word (yanjing) was manipulated orthogonally, varying in fundamental-frequency (F0) contours and duration patterns. Participants identified each token with the second syllable jing pronounced with Tone 1 (a high level tone) as eyes or with Tone 4 (a high falling tone) as eyeglasses. Results CI participants' recognition accuracy was significantly lower than NH listeners' in Task 1. In Task 2, CI participants' reliance on F0 contours was significantly less than that of NH listeners; their reliance on duration patterns, however, was significantly higher than that of NH listeners. Both CI and NH listeners' performance in Task 1 was significantly correlated with their reliance on F0 contours in Task 2. Conclusion For pediatric CI recipients, lexical-tone recognition using naturally uttered words is primarily related to their reliance on F0 contours, although duration patterns may be used as an additional cue. PMID:28388709

The Benefits of Residual Hair Cell Function for Speech and Music Perception in Pediatric Bimodal Cochlear Implant Listeners.

PubMed

Cheng, Xiaoting; Liu, Yangwenyi; Wang, Bing; Yuan, Yasheng; Galvin, John J; Fu, Qian-Jie; Shu, Yilai; Chen, Bing

2018-01-01

The aim of this study was to investigate the benefits of residual hair cell function for speech and music perception in bimodal pediatric Mandarin-speaking cochlear implant (CI) listeners. Speech and music performance was measured in 35 Mandarin-speaking pediatric CI users for unilateral (CI-only) and bimodal listening. Mandarin speech perception was measured for vowels, consonants, lexical tones, and sentences in quiet. Music perception was measured for melodic contour identification (MCI). Combined electric and acoustic hearing significantly improved MCI and Mandarin tone recognition performance, relative to CI-only performance. For MCI, performance was significantly better with bimodal listening for all semitone spacing conditions ( p < 0.05 in all cases). For tone recognition, bimodal performance was significantly better only for tone 2 (rising; p < 0.05). There were no significant differences between CI-only and CI + HA for vowel, consonant, or sentence recognition. The results suggest that combined electric and acoustic hearing can significantly improve perception of music and Mandarin tones in pediatric Mandarin-speaking CI patients. Music and lexical tone perception depends strongly on pitch perception, and the contralateral acoustic hearing coming from residual hair cell function provided pitch cues that are generally not well preserved in electric hearing.

Direct recordings from the auditory cortex in a cochlear implant user.

PubMed

Nourski, Kirill V; Etler, Christine P; Brugge, John F; Oya, Hiroyuki; Kawasaki, Hiroto; Reale, Richard A; Abbas, Paul J; Brown, Carolyn J; Howard, Matthew A

2013-06-01

Electrical stimulation of the auditory nerve with a cochlear implant (CI) is the method of choice for treatment of severe-to-profound hearing loss. Understanding how the human auditory cortex responds to CI stimulation is important for advances in stimulation paradigms and rehabilitation strategies. In this study, auditory cortical responses to CI stimulation were recorded intracranially in a neurosurgical patient to examine directly the functional organization of the auditory cortex and compare the findings with those obtained in normal-hearing subjects. The subject was a bilateral CI user with a 20-year history of deafness and refractory epilepsy. As part of the epilepsy treatment, a subdural grid electrode was implanted over the left temporal lobe. Pure tones, click trains, sinusoidal amplitude-modulated noise, and speech were presented via the auxiliary input of the right CI speech processor. Additional experiments were conducted with bilateral CI stimulation. Auditory event-related changes in cortical activity, characterized by the averaged evoked potential and event-related band power, were localized to posterolateral superior temporal gyrus. Responses were stable across recording sessions and were abolished under general anesthesia. Response latency decreased and magnitude increased with increasing stimulus level. More apical intracochlear stimulation yielded the largest responses. Cortical evoked potentials were phase-locked to the temporal modulations of periodic stimuli and speech utterances. Bilateral electrical stimulation resulted in minimal artifact contamination. This study demonstrates the feasibility of intracranial electrophysiological recordings of responses to CI stimulation in a human subject, shows that cortical response properties may be similar to those obtained in normal-hearing individuals, and provides a basis for future comparisons with extracranial recordings.

Agile Development of Advanced Prototypes

DTIC Science & Technology

2014-11-01

prostheses: retinal implants, cochlear implants, and neuroprosthetics (EEG controlled artificial limbs); an interactive, virtual experience...demonstrations allowing users to experience, from a patient’s perspective life with three different prostheses: retinal implants, cochlear implants...three experiences were researched and developed. The applications are interactive demonstrations of retinal implants, cochlear implants, and

Cochlear Implants:System Design, Integration and Evaluation

PubMed Central

Rebscher, Stephen; Harrison, William V.; Sun, Xiaoan; Feng, Haihong

2009-01-01

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

Cochlear implant in Hong Kong Cantonese.

PubMed

Tang, S O; Luk, W S; Lau, C C; So, K W; Wong, C M; Yiu, M L; Kwok, C L

1990-11-01

Cochlear implant surgery was performed in four Cantonese-speaking postlingually deaf Chinese adults, using the House/3M single channel device. This article outlines the methodology, including preoperative assessment and postoperative rehabilitation; and explains the necessary modifications in speech and audiologic work-up in Cantonese-speaking patients. Salient features of Cantonese phonetics, especially its tonal characteristics, are described. The findings of the study are presented. The results of the cochlear implant would suggest a performance superior to that of the hearing aid. Furthermore, the cochlear implant is able to detect tonal cues. This quality of the cochlear implant may prove to be a valuable asset to a tonal language-speaking cochlear implantee.

Effect of technological advances on cochlear implant performance in adults.

PubMed

Lenarz, Minoo; Joseph, Gert; Sönmez, Hasibe; Büchner, Andreas; Lenarz, Thomas

2011-12-01

To evaluate the effect of technological advances in the past 20 years on the hearing performance of a large cohort of adult cochlear implant (CI) patients. Individual, retrospective, cohort study. According to technological developments in electrode design and speech-processing strategies, we defined five virtual intervals on the time scale between 1984 and 2008. A cohort of 1,005 postlingually deafened adults was selected for this study, and their hearing performance with a CI was evaluated retrospectively according to these five technological intervals. The test battery was composed of four standard German speech tests: Freiburger monosyllabic test, speech tracking test, Hochmair-Schulz-Moser (HSM) sentence test in quiet, and HSM sentence test in 10 dB noise. The direct comparison of the speech perception in postlingually deafened adults, who were implanted during different technological periods, reveals an obvious improvement in the speech perception in patients who benefited from the recent electrode designs and speech-processing strategies. The major influence of technological advances on CI performance seems to be on speech perception in noise. Better speech perception in noisy surroundings is strong proof for demonstrating the success rate of new electrode designs and speech-processing strategies. Standard (internationally comparable) speech tests in noise should become an obligatory part of the postoperative test battery for adult CI patients. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

Bilateral cochlear implantation in a patient with bilateral temporal bone fractures.

PubMed

Chung, Jae Ho; Shin, Myung Chul; Min, Hyun Jung; Park, Chul Won; Lee, Seung Hwan

2011-01-01

With the emphasis on bilateral hearing nowadays, bilateral cochlear implantation has been tried out for bilateral aural rehabilitation. Bilateral sensorineural hearing loss caused by head trauma can get help from cochlear implantation. We present the case of a 44-year-old man with bilateral otic capsule violating temporal bone fractures due to head trauma. The patient demonstrated much improved audiometric and psychoacoustic performance after bilateral cochlear implantation. We believe bilateral cochlear implantation in such patient can be a very effective tool for rehabilitation. Copyright © 2011 Elsevier Inc. All rights reserved.

Lack of financial barriers to pediatric cochlear implantation: impact of socioeconomic status on access and outcomes.

PubMed

Chang, David T; Ko, Alvin B; Murray, Gail S; Arnold, James E; Megerian, Cliff A

2010-07-01

(1) To analyze if socioeconomic status influences access to cochlear implantation in an environment with adequate Medicaid reimbursement. (2) To determine the impact of socioeconomic status on outcomes after unilateral cochlear implantation. Retrospective cohort study. University Hospitals Case Medical Center and Rainbow Babies and Children's Hospital (tertiary referral center), Cleveland, Ohio. Pediatric patients (age range, newborn to 18 years) who received unilateral cochlear implantation during the period 1996 to 2008. Access to cochlear implantation after referral to a cochlear implant center, postoperative complications, compliance with follow-up appointments, and access to sequential bilateral cochlear implantation. A total of 133 pediatric patients were included in this study; 64 were Medicaid-insured patients and 69 were privately insured patients. There was no statistical difference in the odds of initial cochlear implantation, age at referral, or age at implantation between the 2 groups. The odds of prelingual Medicaid-insured patients receiving sequential bilateral cochlear implantation was less than half that of the privately insured group (odds ratio [OR], 0.43; P = .03). The odds of complications in Medicaid-insured children were almost 5-fold greater than the odds for privately insured children (OR, 4.6; P = .03). There were 10 complications in 51 Medicaid-insured patients (19.6%) as opposed to 3 in 61 privately insured patients (4.9%). Medicaid-insured patients missed substantially more follow-up appointments overall (35% vs 23%) and more consecutive visits (1.9 vs 1.1) compared with privately insured patients. In an environment with adequate Medicaid reimbursement, eligible children have equal access to cochlear implantation, regardless of socioeconomic background. However, lower socioeconomic background is associated with higher rates of postoperative complications, worse follow-up compliance, and lower rates of sequential bilateral implantation, observed herein in Medicaid-insured patients. These findings present opportunities for cochlear implant centers to create programs to address such downstream disparities.

A Structural Equation Modeling Approach to Examining Factors Influencing Outcomes with Cochlear Implant in Mandarin-Speaking Children

PubMed Central

Chen, Yuan; Wong, Lena L. N.; Zhu, Shufeng; Xi, Xin

2015-01-01

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

Trends in Cochlear Implants

PubMed Central

Zeng, Fan-Gang

2004-01-01

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

Challenging aspects of contemporary cochlear implant electrode array design.

PubMed

Mistrík, Pavel; Jolly, Claude; Sieber, Daniel; Hochmair, Ingeborg

2017-12-01

A design comparison of current perimodiolar and lateral wall electrode arrays of the cochlear implant (CI) is provided. The focus is on functional features such as acoustic frequency coverage and tonotopic mapping, battery consumption and dynamic range. A traumacity of their insertion is also evaluated. Review of up-to-date literature. Perimodiolar electrode arrays are positioned in the basal turn of the cochlea near the modiolus. They are designed to initiate the action potential in the proximity to the neural soma located in spiral ganglion. On the other hand, lateral wall electrode arrays can be inserted deeper inside the cochlea, as they are located along the lateral wall and such insertion trajectory is less traumatic. This class of arrays targets primarily surviving neural peripheral processes. Due to their larger insertion depth, lateral wall arrays can deliver lower acoustic frequencies in manner better corresponding to cochlear tonotopicity. In fact, spiral ganglion sections containing auditory nerve fibres tuned to low acoustic frequencies are located deeper than 1 and half turn inside the cochlea. For this reason, a significant frequency mismatch might be occurring for apical electrodes in perimodiolar arrays, detrimental to speech perception. Tonal languages such as Mandarin might be therefore better treated with lateral wall arrays. On the other hand, closer proximity to target tissue results in lower psychophysical threshold levels for perimodiolar arrays. However, the maximal comfort level is also lower, paradoxically resulting in narrower dynamic range than that of lateral wall arrays. Battery consumption is comparable for both types of arrays. Lateral wall arrays are less likely to cause trauma to cochlear structures. As the current trend in cochlear implantation is the maximal protection of residual acoustic hearing, the lateral wall arrays seem more suitable for hearing preservation CI surgeries. Future development could focus on combining the advantages of both types: perimodiolar location in the basal turn extended to lateral wall location for higher turn locations.

Consequences of Stimulus Type on Higher-Order Processing in Single-Sided Deaf Cochlear Implant Users.

PubMed

Finke, Mareike; Sandmann, Pascale; Bönitz, Hanna; Kral, Andrej; Büchner, Andreas

2016-01-01

Single-sided deaf subjects with a cochlear implant (CI) provide the unique opportunity to compare central auditory processing of the electrical input (CI ear) and the acoustic input (normal-hearing, NH, ear) within the same individual. In these individuals, sensory processing differs between their two ears, while cognitive abilities are the same irrespectively of the sensory input. To better understand perceptual-cognitive factors modulating speech intelligibility with a CI, this electroencephalography study examined the central-auditory processing of words, the cognitive abilities, and the speech intelligibility in 10 postlingually single-sided deaf CI users. We found lower hit rates and prolonged response times for word classification during an oddball task for the CI ear when compared with the NH ear. Also, event-related potentials reflecting sensory (N1) and higher-order processing (N2/N4) were prolonged for word classification (targets versus nontargets) with the CI ear compared with the NH ear. Our results suggest that speech processing via the CI ear and the NH ear differs both at sensory (N1) and cognitive (N2/N4) processing stages, thereby affecting the behavioral performance for speech discrimination. These results provide objective evidence for cognition to be a key factor for speech perception under adverse listening conditions, such as the degraded speech signal provided from the CI. © 2016 S. Karger AG, Basel.

Auditory skills, language development, and adaptive behavior of children with cochlear implants and additional disabilities

PubMed Central

Beer, Jessica; Harris, Michael S.; Kronenberger, William G.; Holt, Rachael Frush; Pisoni, David B.

2012-01-01

Objective The objective of this study was to evaluate the development of functional auditory skills, language, and adaptive behavior in deaf children with cochlear implants (CI) who also have additional disabilities (AD). Design A two-group, pre-test versus post-test design was used. Study sample Comparisons were made between 23 children with CIs and ADs, and an age-matched comparison group of 23 children with CIs without ADs (No-AD). Assessments were obtained pre-CI and within 12 months post-CI. Results All but two deaf children with ADs improved in auditory skills using the IT-MAIS. Most deaf children in the AD group made progress in receptive but not expressive language using the Preschool Language Scale, but their language quotients were lower than the No-AD group. Five of eight children with ADs made progress in daily living skills and socialization skills; two made progress in motor skills. Children with ADs who did not make progress in language, did show progress in adaptive behavior. Conclusions Children with deafness and ADs made progress in functional auditory skills, receptive language, and adaptive behavior. Expanded assessment that includes adaptive functioning and multi-center collaboration is recommended to best determine benefits of implantation in areas of expected growth in this clinical population. PMID:22509948

Reproduction of auditory and visual standards in monochannel cochlear implant users.

PubMed

Kanabus, Magdalena; Szelag, Elzbieta; Kolodziejczyk, Iwona; Szuchnik, Joanna

2004-01-01

The temporal reproduction of standard durations ranging from 1 to 9 seconds was investigated in monochannel cochlear implant (CI) users and in normally hearing subjects for the auditory and visual modality. The results showed that the pattern of performance in patients depended on their level of auditory comprehension. Results for CI users, who displayed relatively good auditory comprehension, did not differ from that of normally hearing subjects for both modalities. Patients with poor auditory comprehension significantly overestimated shorter auditory standards (1, 1.5 and 2.5 s), compared to both patients with good comprehension and controls. For the visual modality the between-group comparisons were not significant. These deficits in the reproduction of auditory standards were explained in accordance with both the attentional-gate model and the role of working memory in prospective time judgment. The impairments described above can influence the functioning of the temporal integration mechanism that is crucial for auditory speech comprehension on the level of words and phrases. We postulate that the deficits in time reproduction of short standards may be one of the possible reasons for poor speech understanding in monochannel CI users.

Early Vocabulary Development in Children with Bilateral Cochlear Implants

ERIC Educational Resources Information Center

Välimaa, Taina; Kunnari, Sari; Laukkanen-Nevala, Päivi; Lonka, Eila

2018-01-01

Background: Children with unilateral cochlear implants (CIs) may have delayed vocabulary development for an extended period after implantation. Bilateral cochlear implantation is reported to be associated with improved sound localization and enhanced speech perception in noise. This study proposed that bilateral implantation might also promote…

Head Shadow, Squelch, and Summation Effects with an Energetic or Informational Masker in Bilateral and Bimodal CI Users

ERIC Educational Resources Information Center

Pyschny, Verena; Landwehr, Markus; Hahn, Moritz; Lang-Roth, Ruth; Walger, Martin; Meister, Hartmut

2014-01-01

Purpose: The objective of the study was to investigate the influence of noise (energetic) and speech (energetic plus informational) maskers on the head shadow (HS), squelch (SQ), and binaural summation (SU) effect in bilateral and bimodal cochlear implant (CI) users. Method: Speech recognition was measured in the presence of either a competing…

Static and dynamic posture control in postlingual cochlear implanted patients: effects of dual-tasking, visual and auditory inputs suppression

PubMed Central

Bernard-Demanze, Laurence; Léonard, Jacques; Dumitrescu, Michel; Meller, Renaud; Magnan, Jacques; Lacour, Michel

2014-01-01

Posture control is based on central integration of multisensory inputs, and on internal representation of body orientation in space. This multisensory feedback regulates posture control and continuously updates the internal model of body's position which in turn forwards motor commands adapted to the environmental context and constraints. The peripheral localization of the vestibular system, close to the cochlea, makes vestibular damage possible following cochlear implant (CI) surgery. Impaired vestibular function in CI patients, if any, may have a strong impact on posture stability. The simple postural task of quiet standing is generally paired with cognitive activity in most day life conditions, leading therefore to competition for attentional resources in dual-tasking, and increased risk of fall particularly in patients with impaired vestibular function. This study was aimed at evaluating the effects of postlingual cochlear implantation on posture control in adult deaf patients. Possible impairment of vestibular function was assessed by comparing the postural performance of patients to that of age-matched healthy subjects during a simple postural task performed in static (stable platform) and dynamic (platform in translation) conditions, and during dual-tasking with a visual or auditory memory task. Postural tests were done in eyes open (EO) and eyes closed (EC) conditions, with the CI activated (ON) or not (OFF). Results showed that the postural performance of the CI patients strongly differed from the controls, mainly in the EC condition. The CI patients showed significantly reduced limits of stability and increased postural instability in static conditions. In dynamic conditions, they spent considerably more energy to maintain equilibrium, and their head was stabilized neither in space nor on trunk: they behaved dynamically without vision like an inverted pendulum while the controls showed a whole body rigidification strategy. Hearing (prosthesis on) as well as dual-tasking did not really improve the dynamic postural performance of the CI patients. We conclude that CI patients become strongly visual dependent mainly in challenging postural conditions, a result they have to be awarded of particularly when getting older. PMID:24474907

Static and dynamic posture control in postlingual cochlear implanted patients: effects of dual-tasking, visual and auditory inputs suppression.

PubMed

Bernard-Demanze, Laurence; Léonard, Jacques; Dumitrescu, Michel; Meller, Renaud; Magnan, Jacques; Lacour, Michel

2013-01-01

Posture control is based on central integration of multisensory inputs, and on internal representation of body orientation in space. This multisensory feedback regulates posture control and continuously updates the internal model of body's position which in turn forwards motor commands adapted to the environmental context and constraints. The peripheral localization of the vestibular system, close to the cochlea, makes vestibular damage possible following cochlear implant (CI) surgery. Impaired vestibular function in CI patients, if any, may have a strong impact on posture stability. The simple postural task of quiet standing is generally paired with cognitive activity in most day life conditions, leading therefore to competition for attentional resources in dual-tasking, and increased risk of fall particularly in patients with impaired vestibular function. This study was aimed at evaluating the effects of postlingual cochlear implantation on posture control in adult deaf patients. Possible impairment of vestibular function was assessed by comparing the postural performance of patients to that of age-matched healthy subjects during a simple postural task performed in static (stable platform) and dynamic (platform in translation) conditions, and during dual-tasking with a visual or auditory memory task. Postural tests were done in eyes open (EO) and eyes closed (EC) conditions, with the CI activated (ON) or not (OFF). Results showed that the postural performance of the CI patients strongly differed from the controls, mainly in the EC condition. The CI patients showed significantly reduced limits of stability and increased postural instability in static conditions. In dynamic conditions, they spent considerably more energy to maintain equilibrium, and their head was stabilized neither in space nor on trunk: they behaved dynamically without vision like an inverted pendulum while the controls showed a whole body rigidification strategy. Hearing (prosthesis on) as well as dual-tasking did not really improve the dynamic postural performance of the CI patients. We conclude that CI patients become strongly visual dependent mainly in challenging postural conditions, a result they have to be awarded of particularly when getting older.

[Receptive and expressive speech development in children with cochlear implant].

PubMed

Streicher, B; Kral, K; Hahn, M; Lang-Roth, R

2015-04-01

This study's aim is the assessment of language development of children with Cochlea Implant (CI). It focusses on receptive and expressive language development as well as auditory memory skills. Grimm's language development test (SETK 3-5) evaluates receptive, expressive language development and auditory memory. Data of 49 children who received their implant within their first 3 years of life were compared to the norms of hearing children at the age of 3.0-3.5 years. According to the age at implantation the cohort was subdivided in 3 groups: cochlear implantation within the first 12 months of life (group 1), during the 13th and 24th months of life (group 2) and after 25 or more months of life (group 3). It was possible to collect complete data of all SETK 3-5 subtests in 63% of the participants. A homogeneous profile of all subtests indicates a balanced receptive and expressive language development. Thus reduces the gap between hearing/language age and chronological age. Receptive and expressive language and auditory memory milestones in children implanted within their first year of life are achieved earlier in comparison to later implanted children. The Language Test for Children (SETK 3-5) is an appropriate test procedure to be used for language assessment of children who received a CI. It can be used from age 3 on to administer data on receptive and expressive language development and auditory memory. © Georg Thieme Verlag KG Stuttgart · New York.

Remote programming of cochlear implants: a telecommunications model.

PubMed

McElveen, John T; Blackburn, Erin L; Green, J Douglas; McLear, Patrick W; Thimsen, Donald J; Wilson, Blake S

2010-09-01

Evaluate the effectiveness of remote programming for cochlear implants. Retrospective review of the cochlear implant performance for patients who had undergone mapping and programming of their cochlear implant via remote connection through the Internet. Postoperative Hearing in Noise Test and Consonant/Nucleus/Consonant word scores for 7 patients who had undergone remote mapping and programming of their cochlear implant were compared with the mean scores of 7 patients who had been programmed by the same audiologist over a 12-month period. Times required for remote and direct programming were also compared. The quality of the Internet connection was assessed using standardized measures. Remote programming was performed via a virtual private network with a separate software program used for video and audio linkage. All 7 patients were programmed successfully via remote connectivity. No untoward patient experiences were encountered. No statistically significant differences could be found in comparing postoperative Hearing in Noise Test and Consonant/Nucleus/Consonant word scores for patients who had undergone remote programming versus a similar group of patients who had their cochlear implant programmed directly. Remote programming did not require a significantly longer programming time for the audiologist with these 7 patients. Remote programming of a cochlear implant can be performed safely without any deterioration in the quality of the programming. This ability to remotely program cochlear implant patients gives the potential to extend cochlear implantation to underserved areas in the United States and elsewhere.

Music mixing preferences of cochlear implant recipients: a pilot study.

PubMed

Buyens, Wim; van Dijk, Bas; Moonen, Marc; Wouters, Jan

2014-05-01

Music perception and appraisal are generally poor in cochlear implant recipients. Simple musical structures, lyrics that are easy to follow, and clear rhythm/beat have been reported among the top factors to enhance music enjoyment. The present study investigated the preference for modified relative instrument levels in music with normal-hearing and cochlear implant subjects. In experiment 1, test subjects were given a mixing console and multi-track recordings to determine their most enjoyable audio mix. In experiment 2, a preference rating experiment based on the preferred relative level settings in experiment 1 was performed. Experiment 1 was performed with four postlingually deafened cochlear implant subjects, experiment 2 with ten normal-hearing and ten cochlear implant subjects. A significant difference in preference rating was found between normal-hearing and cochlear implant subjects. The latter preferred an audio mix with larger vocals-to-instruments ratio. In addition, given an audio mix with clear vocals and attenuated instruments, cochlear implant subjects preferred the bass/drum track to be louder than the other instrument tracks. The original audio mix in real-world music might not be suitable for cochlear implant recipients. Modifying the relative instrument level settings potentially improves music enjoyment.

A Longitudinal Study in Children with Sequential Bilateral Cochlear Implants: Time Course for the Second Implanted Ear and Bilateral Performance

ERIC Educational Resources Information Center

Reeder, Ruth M.; Firszt, Jill B.; Cadieux, Jamie H.; Strube, Michael J.

2017-01-01

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…

Importance of cochlear health for implant function.

PubMed

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

2015-04-01

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 . Copyright © 2014 Elsevier B.V. All rights reserved.

A comparison between neural response telemetry via cochleostomy or the round window approach in cochlear implantation.

PubMed

Hamerschmidt, Rogério; Schuch, Luiz Henrique; Rezende, Rodrigo Kopp; Wiemes, Gislaine Richter Minhoto; Oliveira, Adriana Kosma Pires de; Mocellin, Marcos

2012-01-01

There are two techniques for cochlear implant (CI) electrode placement: cochleostomy and the round window (RW) approach. This study aims to compare neural response telemetry (NRT) results immediately after surgery to check for possible differences on auditory nerve stimulation between these two techniques. This is a prospective cross-sectional study. Twenty-three patients were enrolled. Six patients underwent surgery by cochleostomy and 17 had it through the RW approach. Mean charge units (MCU) for high frequency sounds: patients submitted to the RW approach had a mean value of 190.4 (± 29.2) while cochleostomy patients averaged 187.8 (± 32.7); p = 0.71. MCU for mid frequency sounds: patients submitted to the RW approach had a mean value of 192.5 (± 22) while cochleostomy patients averaged 178.5 (± 18.5); p = 0.23. MCU for low frequency sounds: patients submitted to the RW approach had a mean value of 183.3 (± 25) while cochleostomy patients averaged 163.8 (± 19.3); p = 0.19. This study showed no differences in the action potential of the distal portion of the auditory nerve in patients with multichannel cochlear implants submitted to surgery by cochleostomy or through the RW approach, using the implant itself to generate stimuli and record responses. Both techniques equally stimulate the cochlear nerve. Therefore, the choice of approach can be made based on the surgeon's own preference and experience.

Preserved Acoustic Hearing in Cochlear Implantation Improves Speech Perception

PubMed Central

Sheffield, Sterling W.; Jahn, Kelly; Gifford, René H.

2015-01-01

Background With improved surgical techniques and electrode design, an increasing number of cochlear implant (CI) recipients have preserved acoustic hearing in the implanted ear, thereby resulting in bilateral acoustic hearing. There are currently no guidelines, however, for clinicians with respect to audio-metric criteria and the recommendation of amplification in the implanted ear. The acoustic bandwidth necessary to obtain speech perception benefit from acoustic hearing in the implanted ear is unknown. Additionally, it is important to determine if, and in which listening environments, acoustic hearing in both ears provides more benefit than hearing in just one ear, even with limited residual hearing. Purpose The purposes of this study were to (1) determine whether acoustic hearing in an ear with a CI provides as much speech perception benefit as an equivalent bandwidth of acoustic hearing in the non-implanted ear, and (2) determine whether acoustic hearing in both ears provides more benefit than hearing in just one ear. Research Design A repeated-measures, within-participant design was used to compare performance across listening conditions. Study Sample Seven adults with CIs and bilateral residual acoustic hearing (hearing preservation) were recruited for the study. Data Collection and Analysis Consonant-nucleus-consonant word recognition was tested in four conditions: CI alone, CI + acoustic hearing in the nonimplanted ear, CI + acoustic hearing in the implanted ear, and CI + bilateral acoustic hearing. A series of low-pass filters were used to examine the effects of acoustic bandwidth through an insert earphone with amplification. Benefit was defined as the difference among conditions. The benefit of bilateral acoustic hearing was tested in both diffuse and single-source background noise. Results were analyzed using repeated-measures analysis of variance. Results Similar benefit was obtained for equivalent acoustic frequency bandwidth in either ear. Acoustic hearing in the nonimplanted ear provided more benefit than the implanted ear only in the wideband condition, most likely because of better audiometric thresholds (>500 Hz) in the nonimplanted ear. Bilateral acoustic hearing provided more benefit than unilateral hearing in either ear alone, but only in diffuse background noise. Conclusions Results support use of amplification in the implanted ear if residual hearing is present. The benefit of bilateral acoustic hearing (hearing preservation) should not be tested in quiet or with spatially coincident speech and noise, but rather in spatially separated speech and noise (e.g., diffuse background noise). PMID:25690775

[The application of artificial neural network on the assessment of lexical tone production of pediatric cochlear implant users].

PubMed

Mao, Y T; Chen, Z M; Xu, L

2017-08-07

Objective: The present study was carried out to explore the tone production ability of the Mandarin-speaking children with cochlear implants (CI) by using an artificial neural network model and to examine the potential contributing factors underlining their tone production performance. The results of this study might provide useful guidelines for post-operative rehabilitation processes of pediatric CI users. Methods: Two hundred and seventy-eight prelingually deafened children who received unilateral CI participated in this study. As controls, 170 similarly-aged children with normal hearing (NH) were recruited. A total of 36 Chinese monosyllabic words were selected as the tone production targets. Vocal production samples were recorded and the fundamental frequency (F0) contour of each syllable was extracted using an auto-correlation algorithm followed by manual correction. An artificial neural network was created in MATLAB to classify the tone production. The relationships between tone production and several demographic factors were evaluated. Results: Pediatric CI users produced Mandarin tones much less accurately than did the NH children (58.8% vs. 91.5% correct). Tremendous variability in tone production performance existed among the CI children. Tones 2 and 3 were produced less accurately than tones 1 and 4 for both groups. For the CI group, all tones when in error tended to be judged as tone 1. The tone production accuracy was negatively correlated with age at implantation and positively correlated with CI use duration with correlation coefficients ( r ) of -0.215 ( P =0.003) and 0.203 ( P =0.005), respectively. Age was one of the determinants of tonal ability for NH children. Conclusions: For children with severe to profound hearing loss, early implantation and persistent use of CI are beneficial to their tone production development. Artificial neural network is a convenient and reliable assessment tool for the development of tonal ability of hearing-impaired children who are in the rehabilitation processes that focus on speech and language expression.

Phonemic accuracy development in children with cochlear implants up to five years of age by using Levenshtein distance.

PubMed

Faes, Jolien; Gillis, Joris; Gillis, Steven

2016-01-01

Phonemic accuracy of children with cochlear implants (CI) is often reported to be lower in comparison with normally hearing (NH) age-matched children. In this study, we compare phonemic accuracy development in the spontaneous speech of Dutch-speaking children with CI and NH age-matched peers. A dynamic cost model of Levenshtein distance is used to compute the accuracy of each word token. We set up a longitudinal design with monthly data for comparisons up to age two and a cross-sectional design with yearly data between three and five years of age. The main finding is that phonemic accuracy steadily increases throughout the period studied. Children with CI's accuracy is lower than that of their NH age mates, but this difference is not statistically significant in the earliest stages of lexical development. But accuracy of children with CI initially improves significantly less steeply than that of NH peers. Furthermore, the number of syllables in the target word and target word's complexity influence children's accuracy, as longer and more complex target words are less accurately produced. Up to age four, children with CI are significantly less accurate than NH children with increasing word length and word complexity. This difference has disappeared at age five. Finally, hearing age is shown to influence accuracy development of children with CI, while age of implant activation is not. This article informs the reader about phonemic accuracy development in children. The reader will be able to (a) discuss different metrics to measure phonemic accuracy development, (b) discuss phonemic accuracy of children with CI up to five years of age and compare them with NH children, (c) discuss the influence of target word's complexity and target word's syllable length on phonemic accuracy, (d) discuss the influence of hearing experience and age of implantation on phonemic accuracy of children with CI. Copyright © 2015 Elsevier Inc. All rights reserved.

Factors Affecting Outcomes in Cochlear Implant Recipients Implanted With a Perimodiolar Electrode Array Located in Scala Tympani.

PubMed

Holden, Laura K; Firszt, Jill B; Reeder, Ruth M; Uchanski, Rosalie M; Dwyer, Noël Y; Holden, Timothy A

2016-12-01

To identify primary biographic and audiologic factors contributing to cochlear implant (CI) performance variability in quiet and noise by controlling electrode array type and electrode position within the cochlea. Although CI outcomes have improved over time, considerable outcome variability still exists. Biographic, audiologic, and device-related factors have been shown to influence performance. Examining CI recipients with consistent array type and electrode position may allow focused investigation into outcome variability resulting from biographic and audiologic factors. Thirty-nine adults (40 ears) implanted for at least 6 months with a perimodiolar electrode array known (via computed tomography [CT] imaging) to be in scala tympani participated. Test materials, administered CI only, included monosyllabic words, sentences in quiet and noise, and spectral ripple discrimination. In quiet, scores were high with mean word and sentence scores of 76 and 87%, respectively; however, sentence scores decreased by an average of 35 percentage points when noise was added. A principal components (PC) analysis of biographic and audiologic factors found three distinct factors, PC1 Age, PC2 Duration, and PC3 Pre-op Hearing. PC1 Age was the only factor that correlated, albeit modestly, with speech recognition in quiet and noise. Spectral ripple discrimination strongly correlated with speech measures. For these recipients with consistent electrode position, PC1 Age was related to speech recognition performance. Consistent electrode position may have contributed to high speech understanding in quiet. Inter-subject variability in noise may have been influenced by auditory/cognitive processing, known to decline with age, and mechanisms that underlie spectral resolution ability.

Factors constraining the benefit to speech understanding of combining information from low-frequency hearing and a cochlear implant.

PubMed

Dorman, Michael F; Cook, Sarah; Spahr, Anthony; Zhang, Ting; Loiselle, Louise; Schramm, David; Whittingham, JoAnne; Gifford, Rene

2015-04-01

Many studies have documented the benefits to speech understanding when cochlear implant (CI) patients can access low-frequency acoustic information from the ear opposite the implant. In this study we assessed the role of three factors in determining the magnitude of bimodal benefit - (i) the level of CI-only performance, (ii) the magnitude of the hearing loss in the ear with low-frequency acoustic hearing and (iii) the type of test material. The patients had low-frequency PTAs (average of 125, 250 and 500 Hz) varying over a large range (<30 dB HL to >70 dB HL) in the ear contralateral to the implant. The patients were tested with (i) CNC words presented in quiet (n = 105) (ii) AzBio sentences presented in quiet (n = 102), (iii) AzBio sentences in noise at +10 dB signal-to-noise ratio (SNR) (n = 69), and (iv) AzBio sentences at +5 dB SNR (n = 64). We find maximum bimodal benefit when (i) CI scores are less than 60 percent correct, (ii) hearing loss is less than 60 dB HL in low-frequencies and (iii) the test material is sentences presented against a noise background. When these criteria are met, some bimodal patients can gain 40-60 percentage points in performance relative to performance with a CI. This article is part of a Special Issue entitled . Copyright © 2014 Elsevier B.V. All rights reserved.

Lexical and semantic ability in groups of children with cochlear implants, language impairment and autism spectrum disorder.

PubMed

Löfkvist, Ulrika; Almkvist, Ove; Lyxell, Björn; Tallberg, Ing-Mari

2014-02-01

Lexical-semantic ability was investigated among children aged 6-9 years with cochlear implants (CI) and compared to clinical groups of children with language impairment (LI) and autism spectrum disorder (ASD) as well as to age-matched children with normal hearing (NH). In addition, the influence of age at implantation on lexical-semantic ability was investigated among children with CI. 97 children divided into four groups participated, CI (n=34), LI (n=12), ASD (n=12), and NH (n=39). A battery of tests, including picture naming, receptive vocabulary and knowledge of semantic features, was used for assessment. A semantic response analysis of the erroneous responses on the picture-naming test was also performed. The group of children with CI exhibited a naming ability comparable to that of the age-matched children with NH, and they also possessed a relevant semantic knowledge of certain words that they were unable to name correctly. Children with CI had a significantly better understanding of words compared to the children with LI and ASD, but a worse understanding than those with NH. The significant differences between groups remained after controlling for age and non-verbal cognitive ability. The children with CI demonstrated lexical-semantic abilities comparable to age-matched children with NH, while children with LI and ASD had a more atypical lexical-semantic profile and poorer sizes of expressive and receptive vocabularies. Dissimilar causes of neurodevelopmental processes seemingly affected lexical-semantic abilities in different ways in the clinical groups. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Language development in Japanese children who receive cochlear implant and/or hearing aid.

PubMed

Iwasaki, Satoshi; Nishio, Shinya; Moteki, Hideaki; Takumi, Yutaka; Fukushima, Kunihiro; Kasai, Norio; Usami, Shin-Ichi

2012-03-01

This study aimed to investigate a wide variety of factors that influence auditory, speech, and language development following pediatric cochlear implantation (CI). Prospective collection of language tested data in profound hearing-impaired children. Pediatric CI can potentially be effective to development of practical communication skills and early implantation is more effective. We proposed a set of language tests (assessment package of the language development for Japanese hearing-impaired children; ALADJIN) consisting of communication skills testing (test for question-answer interaction development; TQAID), comprehensive (Peabody Picture Vocabulary Test-Revised; PVT-R and Standardized Comprehension Test for Abstract Words; SCTAW) and productive vocabulary (Word Fluency Test; WFT), and comprehensive and productive syntax (Syntactic processing Test for Aphasia; STA). Of 638 hearing-impaired children recruited for this study, 282 (44.2%) with >70 dB hearing impairment had undergone CI. After excluding children with low birth weight (<1800 g), those with >11 points on the Pervasive Developmental Disorder ASJ Rating Scale for the test of autistic tendency, and those <2 SD on Raven's Colored Progressive Matrices for the test of non-verbal intelligence, 190 children were subjected to this set of language tests. Sixty children (31.6%) were unilateral CI-only users, 128 (67.4%) were CI-hearing aid (HA) users, and 2 (1.1%) were bilateral CI users. Hearing loss level of CI users was significantly (p<0.01) worse than that of HA-only users. However, the threshold level, maximum speech discrimination score, and speech intelligibility rating in CI users were significantly (p<0.01) better than those in HA-only users. The scores for PVT-R (p<0.01), SCTAW, and WFT in CI users were better than those in HA-only users. STA and TQAID scores in CI-HA users were significantly (p<0.05) better than those in unilateral CI-only users. The high correlation (r=0.52) has been found between the age of CI and maximum speech discrimination score. The scores of speech and language tests in the implanted children before 24 months of age have been better than those in the implanted children after 24 months of age. We could indicate that CI was effective for language development in Japanese hearing-impaired children and early CI was more effective for productive vocabulary and syntax. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Plasticity after pediatric cochlear implantation: Implication from changes in peripheral plasma level of BDNF and auditory nerve responses.

PubMed

Alemi, Razieh; Motassadi Zarandy, Masoud; Joghataei, Mohammad Taghi; Eftekharian, Ali; Zarrindast, Mohammad Reza; Vousooghi, Nasim

2018-02-01

Sensory neural hearing loss could lead to some structural and physiological changes in the auditory pathways, such as alteration in the expression of neurotrophins. These factors, especially Brain-Derived Neurotrophic Factor (BDNF), play an important role in synaptic functions and experience-related plasticity. Restoring cochlear function after hearing loss is possible through cochlear implantation (CI). Evaluation of the blood concentration changes of neurotrophins as prerequisites of plasticity could help scientists to determine the prognosis of CI as in the candidacy procedure or enhancing prosthesis function by adding the exact needed amount of BDNF to the electrode array. Here we have studied the plasma BDNF concentration before CI surgery and 6 months after using CI device in 15 pediatric CI recipients and compared this level with changes of BDNF concentration in 10 children who were using hearing aid (H.A). In addition, we searched for a possible correlation between post-surgery plasma BDNF concentration and electrical compound action potential (ECAP) and comfort-level (C-level) thresholds. Plasma BDNF concentration in children with CI increased significantly after CI surgery, while this difference in H.A group was not significant. Analysis of repeated measures of ECAP and C-level thresholds in CI group showed that there were some kinds of steadiness during follow- up sessions for ECAP thresholds in basal and E16 of middle electrodes, whereas C-level thresholds for all selected electrodes increased significantly up to six months follow-up. Interestingly, we did not find any significant correlation between post-surgery plasma BDNF concentration and ECAP or C-level threshold changes. It is concluded that changes in C-level threshold and steady state of ECAP thresholds and significant changes in BDNF concentration could be regarded as an indicator of experienced-related plasticity after CI stimulation. Copyright © 2017 Elsevier B.V. All rights reserved.

Cochlear implants in Waardenburg syndrome.

PubMed

Cullen, Robert D; Zdanski, Carlton; Roush, Patricia; Brown, Carolyn; Teagle, Holly; Pillsbury, Harold C; Buchman, Craig

2006-07-01

Waardenburg syndrome is an autosomal-dominant syndrome characterized by dystopia canthorum, hyperplasia of the eyebrows, heterochromia irides, a white forelock, and sensorineural hearing loss in 20% to 55% of patients. This patient population accounts for approximately 2% of congenitally deaf children. The purpose of this retrospective case review was to describe the outcomes for those children with Waardenburg syndrome who have undergone cochlear implantation. Pediatric cochlear implant recipients with documented evidence of Waardenburg syndrome underwent retrospective case review. All patients received their cochlear implants at the study institution followed by outpatient auditory habilitation. Charts were reviewed for etiology and duration of deafness, age at time of cochlear implantation, perioperative complications, duration of use, and performance outcomes. Results of standard tests batteries for speech perception and production administered as a part of the patients' auditory habilitation were reviewed. Seven patients with Waardenburg syndrome and cochlear implants were identified. The average age at implantation was 37 months (range, 18-64 months) and the average duration of use was 69 months (range, 12-143 months). All of these patients are active users of their devices and perform very well after implantation. There were no major complications in this small group of patients. Children with congenital sensorineural hearing loss without other comorbidities (e.g., developmental delay, inner ear malformations) perform well when they receive cochlear implantation and auditory habilitation. Patients with Waardenburg syndrome can be expected to have above-average performance after cochlear implantation.

Munich Music Questionnaire: adaptation into Brazilian Portuguese and application in cochlear implant users.

PubMed

Frederigue-Lopes, Natália Barreto; Bevilacqua, Maria Cecilia; Costa, Orozimbo Alves

2015-01-01

To translate the Munich Music Questionnaire (MUMU) to Brazilian Portuguese, to adapt it culturally, and to describe the results obtained among adult users of cochlear implant (CI). We translated the questionnaire to Brazilian Portuguese, reviewed the grammatical and idiomatic equivalences (back-translation), and adapted it from a linguistic and cultural perspective. The resulting version of this process was applied among adult CI users through direct interviews. The Brazilian Portuguese version of MUMU was applied to 19 adult CI users with postlingual hearing loss, who had been users of the device for at least one year. The answers to the questionnaire were analyzed by distribution of frequency and percentage of occurrence in each question. The results showed a decrease in the frequency of CI users that listen to music, comparing the period before hearing loss and after the CI. Regarding the role that music played in the life of each participant, the responses did not score change, so the music remained being an important factor in the life of the evaluated subjects, even after the CI. The subjective evaluation tool MUMU was translated and culturally adapted to the population studied. In Brazilian Portuguese, it was called Questionário de Música de Munique. The study showed its applicability in the daily monitoring of CI users, thus providing a profile of the activities related to music in everyday life.

Qualitative, multimethod study of behavioural and attitudinal responses to cochlear implantation from the patient and healthcare professional perspective in Australia and the UK: study protocol.

PubMed

Rapport, Frances; Bierbaum, Mia; McMahon, Catherine; Boisvert, Isabelle; Lau, Annie; Braithwaite, Jeffrey; Hughes, Sarah

2018-05-29

The growing prevalence of adults with 'severe or greater' hearing loss globally is of great concern, with hearing loss leading to diminished communication, and impacting on an individual's quality of life (QoL). Cochlear implants (CI) are a recommended device for people with severe or greater, sensorineural hearing loss, who obtain limited benefits from conventional hearing aids (HA), and through improved speech perception, CIs can improve the QoL of recipients. Despite this, utilisation of CIs is low. This qualitative, multiphase and multimethod dual-site study (Australia and the UK) explores patients' and healthcare professionals' behaviours and attitudes to cochlear implantation. Participants include general practitioners, audiologists and older adults with severe or greater hearing loss, who are HA users, CI users and CI candidates. Using purposive time frame sampling, participants will be recruited to take part in focus groups or individual interviews, and will each complete a demographic questionnaire and a qualitative proforma. The study aims to conduct 147 data capture events across a sample of 49 participants, or until data saturation occurs. Schema and thematic analysis with extensive group work will be used to analyse data alongside reporting of demographic and participant characteristics. Ethics approval for this study was granted by Macquarie University (HREC: 5201700539), and the study will abide by Australian National Health and Medical Research Council ethical guidelines. Study findings will be published through peer-reviewed journal articles, and disseminated through public and academic conference presentations, participant information sheets and a funders' final report. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Qualitative, multimethod study of behavioural and attitudinal responses to cochlear implantation from the patient and healthcare professional perspective in Australia and the UK: study protocol

PubMed Central

McMahon, Catherine

2018-01-01

Introduction The growing prevalence of adults with ‘severe or greater’ hearing loss globally is of great concern, with hearing loss leading to diminished communication, and impacting on an individual’s quality of life (QoL). Cochlear implants (CI) are a recommended device for people with severe or greater, sensorineural hearing loss, who obtain limited benefits from conventional hearing aids (HA), and through improved speech perception, CIs can improve the QoL of recipients. Despite this, utilisation of CIs is low. Methods and analysis This qualitative, multiphase and multimethod dual-site study (Australia and the UK) explores patients’ and healthcare professionals’ behaviours and attitudes to cochlear implantation. Participants include general practitioners, audiologists and older adults with severe or greater hearing loss, who are HA users, CI users and CI candidates. Using purposive time frame sampling, participants will be recruited to take part in focus groups or individual interviews, and will each complete a demographic questionnaire and a qualitative proforma. The study aims to conduct 147 data capture events across a sample of 49 participants, or until data saturation occurs. Schema and thematic analysis with extensive group work will be used to analyse data alongside reporting of demographic and participant characteristics. Ethics and dissemination Ethics approval for this study was granted by Macquarie University (HREC: 5201700539), and the study will abide by Australian National Health and Medical Research Council ethical guidelines. Study findings will be published through peer-reviewed journal articles, and disseminated through public and academic conference presentations, participant information sheets and a funders’ final report. PMID:29844099

Benefits of Localization and Speech Perception with Multiple Noise Sources in Listeners with a Short-electrode Cochlear Implant

PubMed Central

Dunn, Camille C.; Perreau, Ann; Gantz, Bruce; Tyler, Richard

2009-01-01

Background Research suggests that for individuals with significant low-frequency hearing, implantation of a short-electrode cochlear implant may provide benefits of improved speech perception abilities. Because this strategy combines acoustic and electrical hearing within the same ear while at the same time preserving low-frequency residual acoustic hearing in both ears, localization abilities may also be improved. However, very little research has focused on the localization and spatial hearing abilities of users with a short-electrode cochlear implant. Purpose The purpose of this study was to evaluate localization abilities for listeners with a short-electrode cochlear implant who continue to wear hearing aids in both ears. A secondary purpose was to document speech perception abilities using a speech in noise test with spatially-separate noise sources. Research Design Eleven subjects that utilized a short-electrode cochlear implant and bilateral hearing aids were tested on localization and speech perception with multiple noise locations using an eight-loudspeaker array. Performance was assessed across four listening conditions using various combinations of cochlear implant and/or hearing aid use. Results Results for localization showed no significant difference between using bilateral hearing aids and bilateral hearing aids plus the cochlear implant. However, there was a significant difference between the bilateral hearing aid condition and the implant plus use of a contralateral hearing aid for all eleven subjects. Results for speech perception showed a significant benefit when using bilateral hearing aids plus the cochlear implant over use of the implant plus only one hearing aid. Conclusion Combined use of both hearing aids and the cochlear implant show significant benefits for both localization and speech perception in noise for users with a short-electrode cochlear implant. These results emphasize the importance of low-frequency information in two ears for the purpose of localization and speech perception in noise. PMID:20085199

Benefits of localization and speech perception with multiple noise sources in listeners with a short-electrode cochlear implant.

PubMed

Dunn, Camille C; Perreau, Ann; Gantz, Bruce; Tyler, Richard S

2010-01-01

Research suggests that for individuals with significant low-frequency hearing, implantation of a short-electrode cochlear implant may provide benefits of improved speech perception abilities. Because this strategy combines acoustic and electrical hearing within the same ear while at the same time preserving low-frequency residual acoustic hearing in both ears, localization abilities may also be improved. However, very little research has focused on the localization and spatial hearing abilities of users with a short-electrode cochlear implant. The purpose of this study was to evaluate localization abilities for listeners with a short-electrode cochlear implant who continue to wear hearing aids in both ears. A secondary purpose was to document speech perception abilities using a speech-in-noise test with spatially separate noise sources. Eleven subjects that utilized a short-electrode cochlear implant and bilateral hearing aids were tested on localization and speech perception with multiple noise locations using an eight-loudspeaker array. Performance was assessed across four listening conditions using various combinations of cochlear implant and/or hearing aid use. Results for localization showed no significant difference between using bilateral hearing aids and bilateral hearing aids plus the cochlear implant. However, there was a significant difference between the bilateral hearing aid condition and the implant plus use of a contralateral hearing aid for all 11 subjects. Results for speech perception showed a significant benefit when using bilateral hearing aids plus the cochlear implant over use of the implant plus only one hearing aid. Combined use of both hearing aids and the cochlear implant show significant benefits for both localization and speech perception in noise for users with a short-electrode cochlear implant. These results emphasize the importance of low-frequency information in two ears for the purpose of localization and speech perception in noise.

Impaired Perception of Sensory Consonance and Dissonance in Cochlear Implant Users.

PubMed

Caldwell, Meredith T; Jiradejvong, Patpong; Limb, Charles J

2016-03-01

In light of previous research demonstrating poor pitch perception in cochlear implant (CI) users, we hypothesized that the presence of consonant versus dissonant chord accompaniment in real-world musical stimuli would not impact subjective assessment of degree of pleasantness in CI users. Consonance/dissonance are perceptual features of harmony resulting from pitch relationships between simultaneously presented musical notes. Generally, consonant sounds are perceived as pleasant and dissonant ones as unpleasant. CI users exhibit impairments in pitch perception, making music listening difficult and often unenjoyable. To our knowledge, consonance/dissonance perception has not been studied in the CI population. Twelve novel melodies were created for this study. By altering the harmonic structures of the accompanying chords, we created three permutations of varying dissonance for each melody (36 stimuli in all). Ten CI users and 12 NH listeners provided Likert scale ratings from -5 (very unpleasant) to +5 (very pleasant) for each of the stimuli. A two-way ANOVA showed main effects for Dissonance Level and Subject Type as well as a two-way interaction between the two. Pairwise comparisons indicated that NH stimuli pleasantness ratings decreased with increasing dissonance, whereas CI ratings did not. NH pleasantness ratings were consistently lower than CI ratings. For CI users, consonant versus dissonant chord accompaniment had no significant impact on whether a melody was considered pleasant or unpleasant. This finding may be partially responsible for the decreased enjoyment of many CI users during music perception and is another manifestation of impaired pitch perception in CI users.

Impact of Noise Reduction Algorithm in Cochlear Implant Processing on Music Enjoyment.

PubMed

Kohlberg, Gavriel D; Mancuso, Dean M; Griffin, Brianna M; Spitzer, Jaclyn B; Lalwani, Anil K

2016-06-01

Noise reduction algorithm (NRA) in speech processing strategy has positive impact on speech perception among cochlear implant (CI) listeners. We sought to evaluate the effect of NRA on music enjoyment. Prospective analysis of music enjoyment. Academic medical center. Normal-hearing (NH) adults (N = 16) and CI listeners (N = 9). Subjective rating of music excerpts. NH and CI listeners evaluated country music piece on three enjoyment modalities: pleasantness, musicality, and naturalness. Participants listened to the original version and 20 modified, less complex versions created by including subsets of musical instruments from the original song. NH participants listened to the segments through CI simulation and CI listeners listened to the segments with their usual speech processing strategy, with and without NRA. Decreasing the number of instruments was significantly associated with increase in the pleasantness and naturalness in both NH and CI subjects (p < 0.05). However, there was no difference in music enjoyment with or without NRA for either NH listeners with CI simulation or CI listeners across all three modalities of pleasantness, musicality, and naturalness (p > 0.05): this was true for the original and the modified music segments with one to three instruments (p > 0.05). NRA does not affect music enjoyment in CI listener or NH individual with CI simulation. This suggests that strategies to enhance speech processing will not necessarily have a positive impact on music enjoyment. However, reducing the complexity of music shows promise in enhancing music enjoyment and should be further explored.

Applying a subtraction technique to minimize cochlear implant artifact with soundfield and direct audio input stimulations.

PubMed

Atcherson, Samuel R; Damji, Zohra; Upson, Steve

2011-11-01

We explored the feasibility of a subtraction technique described by Friesen and Picton to remove the cochlear implant (CI) artifact to long duration stimuli in the soundfield and using direct input all through the participant's preferred MAP. Friesen and Picton previously explored this technique by recording cortical potentials in four CI users with 1000 pulse per second (pps) stimuli, bypassing the speech processor. Cortical auditory evoked potentials (N1-P2) to 1000 Hz tones were recorded from a post-lingually deafened adult with three different stimulus presentation setups: soundfield to processor T-mic (SF), soundfield to lapel mic (SF-LM), and direct input (DI). Stimuli were presented at 65 dB SPL(A). The SF setup required stabilizing the head to minimize changes in magnitude for the CI artifact. The SF-LM and DI setups did not require head stabilization, but were evaluated as alternatives to the SF setup. Clear N1-P2 responses were obtained with comparable waveform morphologies, amplitudes, and latencies despite some differences in the magnitude of the CI artifact for the different stimulus presentation setups. The results of this study demonstrate that subtraction technique is feasible for recording N1-P2 responses in CI users, though further studies are needed for the three stimulation setups.

Normal-Hearing Listeners’ and Cochlear Implant Users’ Perception of Pitch Cues in Emotional Speech

PubMed Central

Fuller, Christina; Gilbers, Dicky; Broersma, Mirjam; Goudbeek, Martijn; Free, Rolien; Başkent, Deniz

2015-01-01

In cochlear implants (CIs), acoustic speech cues, especially for pitch, are delivered in a degraded form. This study’s aim is to assess whether due to degraded pitch cues, normal-hearing listeners and CI users employ different perceptual strategies to recognize vocal emotions, and, if so, how these differ. Voice actors were recorded pronouncing a nonce word in four different emotions: anger, sadness, joy, and relief. These recordings’ pitch cues were phonetically analyzed. The recordings were used to test 20 normal-hearing listeners’ and 20 CI users’ emotion recognition. In congruence with previous studies, high-arousal emotions had a higher mean pitch, wider pitch range, and more dominant pitches than low-arousal emotions. Regarding pitch, speakers did not differentiate emotions based on valence but on arousal. Normal-hearing listeners outperformed CI users in emotion recognition, even when presented with CI simulated stimuli. However, only normal-hearing listeners recognized one particular actor’s emotions worse than the other actors’. The groups behaved differently when presented with similar input, showing that they had to employ differing strategies. Considering the respective speaker’s deviating pronunciation, it appears that for normal-hearing listeners, mean pitch is a more salient cue than pitch range, whereas CI users are biased toward pitch range cues. PMID:27648210

A comparison of vowel productions in prelingually deaf children using cochlear implants, severe hearing-impaired children using conventional hearing aids and normal-hearing children.

PubMed

Baudonck, Nele; Van Lierde, K; Dhooge, I; Corthals, P

2011-01-01

The purpose of this study was to compare vowel productions by deaf cochlear implant (CI) children, hearing-impaired hearing aid (HA) children and normal-hearing (NH) children. 73 children [mean age: 9;14 years (years;months)] participated: 40 deaf CI children, 34 moderately to profoundly hearing-impaired HA children and 42 NH children. For the 3 corner vowels [a], [i] and [u], F(1), F(2) and the intrasubject SD were measured using the Praat software. Spectral separation between these vowel formants and vowel space were calculated. The significant effects in the CI group all pertain to a higher intrasubject variability in formant values, whereas the significant effects in the HA group all pertain to lower formant values. Both hearing-impaired subgroups showed a tendency toward greater intervowel distances and vowel space. Several subtle deviations in the vowel production of deaf CI children and hearing-impaired HA children could be established, using a well-defined acoustic analysis. CI children as well as HA children in this study tended to overarticulate, which hypothetically can be explained by a lack of auditory feedback and an attempt to compensate it by proprioceptive feedback during articulatory maneuvers. Copyright © 2010 S. Karger AG, Basel.

A Music-Related Quality of Life Measure to Guide Music Rehabilitation for Adult Cochlear Implant Users.

PubMed

Dritsakis, Giorgos; van Besouw, Rachel M; Kitterick, Pádraig; Verschuur, Carl A

2017-09-18

A music-related quality of life (MuRQoL) questionnaire was developed for the evaluation of music rehabilitation for adult cochlear implant (CI) users. The present studies were aimed at refinement and validation. Twenty-four experts reviewed the MuRQoL items for face validity. A refined version was completed by 147 adult CI users, and psychometric techniques were used for item selection, assessment of reliability, and definition of the factor structure. The same participants completed the Short Form Health Survey for construct validation. MuRQoL responses from 68 CI users were compared with those of a matched group of adults with normal hearing. Eighteen items measuring music perception and engagement and 18 items measuring their importance were selected; they grouped together into 2 domains. The final questionnaire has high internal consistency and repeatability. Significant differences between CI users and adults with normal hearing and a correlation between music engagement and quality of life support construct validity. Scores of music perception and engagement and importance for the 18 items can be combined to assess the impact of music on the quality of life. The MuRQoL questionnaire is a reliable and valid measure of self-reported music perception, engagement, and their importance for adult CI users with potential to guide music aural rehabilitation.

Environmental Sound Training in Cochlear Implant Users

PubMed Central

Sheft, Stanley; Kuvadia, Sejal; Gygi, Brian

2015-01-01

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

Melodic interval perception by normal-hearing listeners and cochlear implant users

PubMed Central

Luo, Xin; Masterson, Megan E.; Wu, Ching-Chih

2014-01-01

The perception of melodic intervals (sequential pitch differences) is essential to music perception. This study tested melodic interval perception in normal-hearing (NH) listeners and cochlear implant (CI) users. Melodic interval ranking was tested using an adaptive procedure. CI users had slightly higher interval ranking thresholds than NH listeners. Both groups' interval ranking thresholds, although not affected by root note, significantly increased with standard interval size and were higher for descending intervals than for ascending intervals. The pitch direction effect may be due to a procedural artifact or a difference in central processing. In another test, familiar melodies were played with all the intervals scaled by a single factor. Subjects rated how in tune the melodies were and adjusted the scaling factor until the melodies sounded the most in tune. CI users had lower final interval ratings and less change in interval rating as a function of scaling factor than NH listeners. For CI users, the root-mean-square error of the final scaling factors and the width of the interval rating function were significantly correlated with the average ranking threshold for ascending rather than descending intervals, suggesting that CI users may have focused on ascending intervals when rating and adjusting the melodies. PMID:25324084

The ability of cochlear implant users to use temporal envelope cues recovered from speech frequency modulationa

PubMed Central

Won, Jong Ho; Lorenzi, Christian; Nie, Kaibao; Li, Xing; Jameyson, Elyse M.; Drennan, Ward R.; Rubinstein, Jay T.

2012-01-01

Previous studies have demonstrated that normal-hearing listeners can understand speech using the recovered “temporal envelopes,” i.e., amplitude modulation (AM) cues from frequency modulation (FM). This study evaluated this mechanism in cochlear implant (CI) users for consonant identification. Stimuli containing only FM cues were created using 1, 2, 4, and 8-band FM-vocoders to determine if consonant identification performance would improve as the recovered AM cues become more available. A consistent improvement was observed as the band number decreased from 8 to 1, supporting the hypothesis that (1) the CI sound processor generates recovered AM cues from broadband FM, and (2) CI users can use the recovered AM cues to recognize speech. The correlation between the intact and the recovered AM components at the output of the sound processor was also generally higher when the band number was low, supporting the consonant identification results. Moreover, CI subjects who were better at using recovered AM cues from broadband FM cues showed better identification performance with intact (unprocessed) speech stimuli. This suggests that speech perception performance variability in CI users may be partly caused by differences in their ability to use AM cues recovered from FM speech cues. PMID:22894230

Should children who use cochlear implants wear hearing aids in the opposite ear?

PubMed

Ching, T Y; Psarros, C; Hill, M; Dillon, H; Incerti, P

2001-10-01

The aim of this study was to investigate 1) whether a hearing aid needs to be adjusted differently depending on whether a child wears a cochlear implant or another hearing aid in the contralateral ear; 2) whether the use of a hearing aid and a cochlear implant in opposite ears leads to binaural interference; and 3) whether the use of a hearing aid and a cochlear implant in opposite ears leads to binaural benefits in speech perception, localization, and communicative functioning in real life. Sixteen children participated in this study. All children used a Nucleus 22 or Nucleus 24 cochlear implant system programmed with the SPEAK strategy in one ear. The hearing aid amplification requirements in the nonimplanted ear of these children were determined using two procedures. A paired comparison technique was used to identify the frequency response that was best for speech intelligibility in quiet, and a loudness balancing technique was used to match the loudness of speech in the ear with a hearing aid to that with a cochlear implant. Eleven of the 16 children participated in the investigation of binaural effects. Performance in speech perception, localization, and communicative functioning was assessed under four aided conditions: cochlear implant with hearing aid as worn, cochlear implant alone, hearing aid alone, and cochlear implant with hearing aid adjusted according to individual requirements. Fifteen of the 16 children whose amplification requirements were determined preferred a hearing aid frequency response that was within +/-6 dB/octave of the NAL-RP prescription. On average, the children required 6 dB more gain than prescribed to balance the loudness of the implanted ear for a speech signal presented at 65 dB SPL. For all 11 children whose performance was evaluated for investigating binaural effects, there was no indication of significantly poorer performance under bilaterally aided conditions compared with unilaterally aided conditions. On average, there were significant benefits in speech perception, localization, and aural/oral function when the children used cochlear implants with adjusted hearing aids than when they used cochlear implants alone. All individuals showed benefits in at least one of the measures. Hearing aids for children who also use cochlear implants can be selected using the NAL-RP prescription. Adjustment of hearing aid gain to match loudness in the implanted ear can facilitate integration of signals from both ears, leading to better speech perception. Given that there are binaural advantages from using cochlear implants with hearing aids in opposite ears, clinicians should advise parents and other professionals about these potential advantages, and facilitate bilateral amplification by adjusting hearing aids after stable cochlear implant MAPs are established.

Written Language Ability in Mandarin-Speaking Children with Cochlear Implants.

PubMed

Wu, Che-Ming; Ko, Hui-Chen; Chen, Yen-An; Tsou, Yung-Ting; Chao, Wei-Chieh

2015-01-01

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" (R (2) = 0.489) and "Semantics" (R (2) = 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.

Bilateral Versus Unilateral Cochlear Implantation in Adult Listeners: Speech-On-Speech Masking and Multitalker Localization.

PubMed

Rana, Baljeet; Buchholz, Jörg M; Morgan, Catherine; Sharma, Mridula; Weller, Tobias; Konganda, Shivali Appaiah; Shirai, Kyoko; Kawano, Atsushi

2017-01-01

Binaural hearing helps normal-hearing listeners localize sound sources and understand speech in noise. However, it is not fully understood how far this is the case for bilateral cochlear implant (CI) users. To determine the potential benefits of bilateral over unilateral CIs, speech comprehension thresholds (SCTs) were measured in seven Japanese bilateral CI recipients using Helen test sentences (translated into Japanese) in a two-talker speech interferer presented from the front (co-located with the target speech), ipsilateral to the first-implanted ear (at +90° or -90°), and spatially symmetric at ±90°. Spatial release from masking was calculated as the difference between co-located and spatially separated SCTs. Localization was assessed in the horizontal plane by presenting either male or female speech or both simultaneously. All measurements were performed bilaterally and unilaterally (with the first implanted ear) inside a loudspeaker array. Both SCTs and spatial release from masking were improved with bilateral CIs, demonstrating mean bilateral benefits of 7.5 dB in spatially asymmetric and 3 dB in spatially symmetric speech mixture. Localization performance varied strongly between subjects but was clearly improved with bilateral over unilateral CIs with the mean localization error reduced by 27°. Surprisingly, adding a second talker had only a negligible effect on localization.

The Contribution of Cognitive Factors to Individual Differences in Understanding Noise-Vocoded Speech in Young and Older Adults

PubMed Central

Rosemann, Stephanie; Gießing, Carsten; Özyurt, Jale; Carroll, Rebecca; Puschmann, Sebastian; Thiel, Christiane M.

2017-01-01

Noise-vocoded speech is commonly used to simulate the sensation after cochlear implantation as it consists of spectrally degraded speech. High individual variability exists in learning to understand both noise-vocoded speech and speech perceived through a cochlear implant (CI). This variability is partly ascribed to differing cognitive abilities like working memory, verbal skills or attention. Although clinically highly relevant, up to now, no consensus has been achieved about which cognitive factors exactly predict the intelligibility of speech in noise-vocoded situations in healthy subjects or in patients after cochlear implantation. We aimed to establish a test battery that can be used to predict speech understanding in patients prior to receiving a CI. Young and old healthy listeners completed a noise-vocoded speech test in addition to cognitive tests tapping on verbal memory, working memory, lexicon and retrieval skills as well as cognitive flexibility and attention. Partial-least-squares analysis revealed that six variables were important to significantly predict vocoded-speech performance. These were the ability to perceive visually degraded speech tested by the Text Reception Threshold, vocabulary size assessed with the Multiple Choice Word Test, working memory gauged with the Operation Span Test, verbal learning and recall of the Verbal Learning and Retention Test and task switching abilities tested by the Comprehensive Trail-Making Test. Thus, these cognitive abilities explain individual differences in noise-vocoded speech understanding and should be considered when aiming to predict hearing-aid outcome. PMID:28638329

Comparison of Social Interaction between Cochlear-Implanted Children with Normal Intelligence Undergoing Auditory Verbal Therapy and Normal-Hearing Children: A Pilot Study.

PubMed

Monshizadeh, Leila; Vameghi, Roshanak; Sajedi, Firoozeh; Yadegari, Fariba; Hashemi, Seyed Basir; Kirchem, Petra; Kasbi, Fatemeh

2018-04-01

A cochlear implant is a device that helps hearing-impaired children by transmitting sound signals to the brain and helping them improve their speech, language, and social interaction. Although various studies have investigated the different aspects of speech perception and language acquisition in cochlear-implanted children, little is known about their social skills, particularly Persian-speaking cochlear-implanted children. Considering the growing number of cochlear implants being performed in Iran and the increasing importance of developing near-normal social skills as one of the ultimate goals of cochlear implantation, this study was performed to compare the social interaction between Iranian cochlear-implanted children who have undergone rehabilitation (auditory verbal therapy) after surgery and normal-hearing children. This descriptive-analytical study compared the social interaction level of 30 children with normal hearing and 30 with cochlear implants who were conveniently selected. The Raven test was administered to the both groups to ensure normal intelligence quotient. The social interaction status of both groups was evaluated using the Vineland Adaptive Behavior Scale, and statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 21. After controlling age as a covariate variable, no significant difference was observed between the social interaction scores of both the groups (p > 0.05). In addition, social interaction had no correlation with sex in either group. Cochlear implantation followed by auditory verbal rehabilitation helps children with sensorineural hearing loss to have normal social interactions, regardless of their sex.

Effects of residual hearing on cochlear implant outcomes in children: A systematic-review.

PubMed

Chiossi, Julia Santos Costa; Hyppolito, Miguel Angelo

2017-09-01

to investigate if preoperative residual hearing in prelingually deafened children can interfere on cochlear implant indication and outcomes. a systematic-review was conducted in five international databases up to November-2016, to locate articles that evaluated cochlear implantation in children with some degree of preoperative residual hearing. Outcomes were auditory, language and cognition performances after cochlear implant. The quality of the studies was assessed and classified according to the Oxford Levels of Evidence table - 2011. Risk of biases were also described. From the 30 articles reviewed, two types of questions were identified: (a) what are the benefits of cochlear implantation in children with residual hearing? (b) is the preoperative residual hearing a predictor of cochlear implant outcome? Studies ranged from 04 to 188 subjects, evaluating populations between 1.8 and 10.3 years old. The definition of residual hearing varied between studies. The majority of articles (n = 22) evaluated speech perception as the outcome and 14 also assessed language and speech production. There is evidence that cochlear implant is beneficial to children with residual hearing. Preoperative residual hearing seems to be valuable to predict speech perception outcomes after cochlear implantation, even though the mechanism of how it happens is not clear. More extensive researches must be conducted in order to make recommendations and to set prognosis for cochlear implants based on children preoperative residual hearing. Copyright © 2017 Elsevier B.V. All rights reserved.

Auditory verbal habilitation is associated with improved outcome for children with cochlear implant.

PubMed

Percy-Smith, Lone; Tønning, Tenna Lindbjerg; Josvassen, Jane Lignel; Mikkelsen, Jeanette Hølledig; Nissen, Lena; Dieleman, Eveline; Hallstrøm, Maria; Cayé-Thomasen, Per

2018-01-01

To study the impact of (re)habilitation strategy on speech-language outcomes for early, cochlear implanted children enrolled in different intervention programmes post implant. Data relate to a total of 130 children representing two pediatric cohorts consisting of 94 and 36 subjects, respectively. The two cohorts had different speech and language intervention following cochlear implantation, i.e. standard habilitation vs. auditory verbal (AV) intervention. Three tests of speech and language were applied covering language areas of receptive and productive vocabulary and language understanding. Children in AV intervention outperformed children in standard habilitation on all three tests of speech and language. When effect of intervention was adjusted with other covariates children in AV intervention still had higher odds at performing at age equivalent speech and language levels. Compared to standard intervention, AV intervention is associated with improved outcome for children with CI. Based on this finding, we recommend that all children with HI should be offered this intervention and it is, therefore, highly relevant when National boards of Health and Social Affairs recommend basing the habilitation on principles from AV practice. It should be noted, that a minority of children use spoken language with sign support. For this group it is, however, still important that educational services provide auditory skills training.

Selecting electrode configurations for image-guided cochlear implant programming using template matching

NASA Astrophysics Data System (ADS)

Zhang, Dongqing; Zhao, Yiyuan; Noble, Jack H.; Dawant, Benoit M.

2017-03-01

Cochlear implants (CIs) are used to treat patients with severe-to-profound hearing loss. In surgery, an electrode array is implanted in the cochlea. After implantation, the CI processor is programmed by an audiologist. One factor that negatively impacts outcomes and can be addressed by programming is cross-electrode neural stimulation overlap (NSO). In the recent past, we have proposed a system to assist the audiologist in programming the CI that we call Image-Guided CI Programming (IGCIP). IGCIP permits using CT images to detect NSO and recommend which subset of electrodes should be active to avoid NSO. In an ongoing clinical study, we have shown that IGCIP leads to significant improvement in hearing outcomes. Most of the IGCIP steps are robustly automated but electrode configuration selection still sometimes requires expert intervention. With expertise, Distance-Vs-Frequency (DVF) curves, which are a way to visualize the spatial relationship learned from CT between the electrodes and the nerves they stimulate, can be used to select the electrode configuration. In this work, we propose an automated technique for electrode configuration selection. It relies on matching new patients' DVF curves to a library of DVF curves for which electrode configurations are known. We compare this approach to one we have previously proposed. We show that, generally, our new method produces results that are as good as those obtained with our previous one while being generic and requiring fewer parameters.

Effect of increased IIDR in the nucleus freedom cochlear implant system.

PubMed

Holden, Laura K; Skinner, Margaret W; Fourakis, Marios S; Holden, Timothy A

2007-10-01

The objective of this study was to evaluate the effect of the increased instantaneous input dynamic range (IIDR) in the Nucleus Freedom cochlear implant (CI) system on recipients' ability to perceive soft speech and speech in noise. Ten adult Freedom CI recipients participated. Two maps differing in IIDR were placed on each subject's processor at initial activation. The IIDR was set to 30 dB for one map and 40 dB for the other. Subjects used both maps for at least one month prior to speech perception testing. Results revealed significantly higher scores for words (50 dB SPL), for sentences in background babble (65 dB SPL), and significantly lower sound field threshold levels with the 40 compared to the 30 dB IIDR map. Ceiling effects may have contributed to non-significant findings for sentences in quiet (50 dB SPL). The Freedom's increased IIDR allows better perception of soft speech and speech in noise.

Deep brain stimulation with a pre-existing cochlear implant: Surgical technique and outcome.

PubMed

Eddelman, Daniel; Wewel, Joshua; Wiet, R Mark; Metman, Leo V; Sani, Sepehr

2017-01-01

Patients with previously implanted cranial devices pose a special challenge in deep brain stimulation (DBS) surgery. We report the implantation of bilateral DBS leads in a patient with a cochlear implant. Technical nuances and long-term interdevice functionality are presented. A 70-year-old patient with advancing Parkinson's disease and a previously placed cochlear implant for sensorineural hearing loss was referred for placement of bilateral DBS in the subthalamic nucleus (STN). Prior to DBS, the patient underwent surgical removal of the subgaleal cochlear magnet, followed by stereotactic MRI, frame placement, stereotactic computed tomography (CT), and merging of imaging studies. This technique allowed for successful computational merging, MRI-guided targeting, and lead implantation with acceptable accuracy. Formal testing and programming of both the devices were successful without electrical interference. Successful DBS implantation with high resolution MRI-guided targeting is technically feasible in patients with previously implanted cochlear implants by following proper precautions.

Central Auditory Processing of Temporal and Spectral-Variance Cues in Cochlear Implant Listeners

PubMed Central

Pham, Carol Q.; Bremen, Peter; Shen, Weidong; Yang, Shi-Ming; Middlebrooks, John C.; Zeng, Fan-Gang; Mc Laughlin, Myles

2015-01-01

Cochlear implant (CI) listeners have difficulty understanding speech in complex listening environments. This deficit is thought to be largely due to peripheral encoding problems arising from current spread, which results in wide peripheral filters. In normal hearing (NH) listeners, central processing contributes to segregation of speech from competing sounds. We tested the hypothesis that basic central processing abilities are retained in post-lingually deaf CI listeners, but processing is hampered by degraded input from the periphery. In eight CI listeners, we measured auditory nerve compound action potentials to characterize peripheral filters. Then, we measured psychophysical detection thresholds in the presence of multi-electrode maskers placed either inside (peripheral masking) or outside (central masking) the peripheral filter. This was intended to distinguish peripheral from central contributions to signal detection. Introduction of temporal asynchrony between the signal and masker improved signal detection in both peripheral and central masking conditions for all CI listeners. Randomly varying components of the masker created spectral-variance cues, which seemed to benefit only two out of eight CI listeners. Contrastingly, the spectral-variance cues improved signal detection in all five NH listeners who listened to our CI simulation. Together these results indicate that widened peripheral filters significantly hamper central processing of spectral-variance cues but not of temporal cues in post-lingually deaf CI listeners. As indicated by two CI listeners in our study, however, post-lingually deaf CI listeners may retain some central processing abilities similar to NH listeners. PMID:26176553

Cross-modal reorganization in cochlear implant users: Auditory cortex contributes to visual face processing.

PubMed

Stropahl, Maren; Plotz, Karsten; Schönfeld, Rüdiger; Lenarz, Thomas; Sandmann, Pascale; Yovel, Galit; De Vos, Maarten; Debener, Stefan

2015-11-01

There is converging evidence that the auditory cortex takes over visual functions during a period of auditory deprivation. A residual pattern of cross-modal take-over may prevent the auditory cortex to adapt to restored sensory input as delivered by a cochlear implant (CI) and limit speech intelligibility with a CI. The aim of the present study was to investigate whether visual face processing in CI users activates auditory cortex and whether this has adaptive or maladaptive consequences. High-density electroencephalogram data were recorded from CI users (n=21) and age-matched normal hearing controls (n=21) performing a face versus house discrimination task. Lip reading and face recognition abilities were measured as well as speech intelligibility. Evaluation of event-related potential (ERP) topographies revealed significant group differences over occipito-temporal scalp regions. Distributed source analysis identified significantly higher activation in the right auditory cortex for CI users compared to NH controls, confirming visual take-over. Lip reading skills were significantly enhanced in the CI group and appeared to be particularly better after a longer duration of deafness, while face recognition was not significantly different between groups. However, auditory cortex activation in CI users was positively related to face recognition abilities. Our results confirm a cross-modal reorganization for ecologically valid visual stimuli in CI users. Furthermore, they suggest that residual takeover, which can persist even after adaptation to a CI is not necessarily maladaptive. Copyright © 2015 Elsevier Inc. All rights reserved.

[Cochlear implantation in patients with Waardenburg syndrome type II].

PubMed

Wan, Liangcai; Guo, Menghe; Chen, Shuaijun; Liu, Shuangriu; Chen, Hao; Gong, Jian

2010-05-01

To describe the multi-channel cochlear implantation in patients with Waardenburg syndrome including surgeries, pre and postoperative hearing assessments as well as outcomes of speech recognition. Multi-channel cochlear implantation surgeries have been performed in 12 cases with Waardenburg syndrome type II in our department from 2000 to 2008. All the patients received multi-channel cochlear implantation through transmastoid facial recess approach. The postoperative outcomes of 12 cases were compared with 12 cases with no inner ear malformation as a control group. The electrodes were totally inserted into the cochlear successfully, there was no facial paralysis and cerebrospinal fluid leakage occurred after operation. The hearing threshold in this series were similar to that of the normal cochlear implantation. After more than half a year of speech rehabilitation, the abilities of speech discrimination and spoken language of all the patients were improved compared with that of preoperation. Multi-channel cochlear implantation could be performed in the cases with Waardenburg syndrome, preoperative hearing and images assessments should be done.

Hearing Preservation Outcomes After Cochlear Implantation Depending on the Angle of Insertion: Indication for Electric or Electric-Acoustic Stimulation.

PubMed

Helbig, Silke; Adel, Youssef; Leinung, Martin; Stöver, Timo; Baumann, Uwe; Weissgerber, Tobias

2018-06-15

This study reviewed outcomes of hearing preservation (HP) surgery depending on the angle of insertion (AOI) in a cochlear implant (CI) patient population who used electric stimulation (ES) or combined electric-acoustic stimulation (EAS). Retrospective case review. Tertiary referral university hospital. Ninety-one patients with different degrees of preoperative low-frequency residual hearing who underwent HP surgery with a free-fitting lateral-wall electrode array (MED-EL Flex) with lengths ranging from 20.0 to 31.5 mm. Cochlear implantation using HP surgery technique and subsequent fitting with CI speech processor for ES, or combined CI and hearing aid speech processor for EAS. Individual AOI were estimated using modified Stenvers' projection. Freiburg monosyllable test in quiet (free-field presentation at 65 dB SPL) and pure-tone averages for low frequencies (125, 250, and 500 Hz; PTAlow) were evaluated during a follow-up period of 12 months after implantation. Estimated AOIs showed bimodal distribution: shallow insertion (SI) with mean AOI of 377 degrees and deep insertion (DI) with mean AOI of 608 degrees. Speech test scores after 12 months were comparable between AOI groups, however, they were significantly different between stimulation types with better scores for EAS. Only ES showed a positive correlation (r = 0.293) between speech test score and AOI. When HP was possible, both SI and DI showed significant postoperative PTAlow shifts with mean of 17.8 and 21.6 dB, respectively. These were comparable between AOI groups and no significant shifts were observed in follow-up intervals. Audiometric indication for HP and subsequent EAS is proposed up to 65 dB HL at 500 Hz, and up to 87 dB HL for HP. CI candidates can benefit from HP surgery with deep insertion when only using ES due to insufficient residual hearing. Conversely, candidates with preoperative threshold up to 65 dB HL at 500 Hz could perform significantly better with EAS which requires shallow insertion.

The pattern and degree of capsular fibrous sheaths surrounding cochlear electrode arrays.

PubMed

Ishai, Reuven; Herrmann, Barbara S; Nadol, Joseph B; Quesnel, Alicia M

2017-05-01

An inflammatory tissue reaction around the electrode array of a cochlear implant (CI) is common, in particular at the electrode insertion region (cochleostomy) where mechanical trauma often occurs. However, the factors determining the amount and causes of fibrous reaction surrounding the stimulating electrode, especially medially near the perimodiolar location, are unclear. Temporal bone (TB) specimens from patients who had undergone cochlear implantation during life with either Advanced Bionics (AB) Clarion ™ or HiRes90K™ (Sylmar, CA, USA) devices that have a half-band and a pre-curved electrode, or Cochlear ™ Nucleus (Sydney, Australia) device that have a full-band and a straight electrode were evaluated. The thickness of the fibrous tissue surrounding the electrode array of both types of CI devices at both the lower (LB) and upper (UB) basal turns of the cochlea was quantified at three locations: the medial, inferior, and superior aspects of the sheath. Fracture of the osseous spiral lamina and/or marked displacement of the basilar membrane were interpreted as evidence of intracochlear trauma. In addition, post-operative word recognition scores, duration of implantation, and post-operative programming data were evaluated. Seven TBs from six patients implanted with AB devices and five TBs from five patients implanted with Nucleus devices were included. A fibrous capsule around the stimulating electrode array was present in all twelve specimens. TBs implanted with AB device had a significantly thicker fibrous capsule at the medial aspect than at the inferior or superior aspects at both locations (LB and UB) of the cochlea (Wilcoxon signed-ranks test, p < 0.01). TBs implanted with a Nucleus device had no difference in the thickness of the fibrous capsule surrounding the track of the electrode array (Wilcoxon signed-ranks test, p > 0.05). Nine of fourteen (64%) basal turns of the cochlea (LB and UB of seven TBs) implanted with AB devices demonstrated intracochlear trauma compared to two of ten (20%) basal turns of the cochlea (LB and UB of five TBs) with Nucleus devices, (Fisher exact test, p < 0.05). There was no significant correlation between the thickness of the fibrous tissue and the duration of implantation or the word recognition scores (Spearman rho, p = 0.06, p = 0.4 respectively). Our outcomes demonstrated the development of a robust fibrous tissue sheath medially closest to the site of electric stimulation in cases implanted with the AB device electrode, but not in cases implanted with the Nucleus device. The cause of the asymmetric fibrous sheath may be multifactorial including insertional trauma, a foreign body response, and/or asymmetric current flow. Copyright © 2017 Elsevier B.V. All rights reserved.

Meningitis following cochlear implantation: pathomechanisms, clinical symptoms, conservative and surgical treatments.

PubMed

Arnold, W; Bredberg, G; Gstöttner, W; Helms, J; Hildmann, H; Kiratzidis, T; Müller, J; Ramsden, R T; Roland, P; Walterspiel, J N

2002-01-01

Pneumococcal otogenic meningitis is a rare postsurgical complication that can develop following stapedectomy or after cochlear implantation. The bacterial infection can be fatal in some instances. A recent increase in the incidence of otogenic meningitis among cochlear implant wearers is of concern. The majority of meningitis cases are associated with a 2-component electrode manufactured by one cochlear implant company. The device with the added 'positioner' component has been withdrawn from the market (FDA Public Health Web Notification: Cochlear Implant Recipients may be at Greater Risk for Meningitis, Updated: August 29, 2002, www.fda.gov/cdrh/safety/cochlear.html). Not all cases have been subsequent to otitis media and symptoms have developed from less than 24 h up to a few years after implantation. The purpose of this paper is to review and discuss the pathogenesis, pathology/bacteriology and to elaborate on some clinical features of otogenic meningitis in implanted children and adults. Essential aspects of surgery, electrode design, and cochleostomy seal are discussed. Conclusions are drawn from the available data and recommendations are made for good practice in cochlear implantation and follow-up. Copyright 2002 S. Karger AG, Basel

Development of a software tool using deterministic logic for the optimization of cochlear implant processor programming.

PubMed

Govaerts, Paul J; Vaerenberg, Bart; De Ceulaer, Geert; Daemers, Kristin; De Beukelaer, Carina; Schauwers, Karen

2010-08-01

An intelligent agent, Fitting to Outcomes eXpert, was developed to optimize and automate Cochlear implant (CI) programming. The current article describes the rationale, development, and features of this tool. Cochlear implant fitting is a time-consuming procedure to define the value of a subset of the available electric parameters based primarily on behavioral responses. It is comfort-driven with high intraindividual and interindividual variability both with respect to the patient and to the clinician. Its validity in terms of process control can be questioned. Good clinical practice would require an outcome-driven approach. An intelligent agent may help solve the complexity of addressing more electric parameters based on a range of outcome measures. A software application was developed that consists of deterministic rules that analyze the map settings in the processor together with psychoacoustic test results (audiogram, A(section sign)E phoneme discrimination, A(section sign)E loudness scaling, speech audiogram) obtained with that map. The rules were based on the daily clinical practice and the expertise of the CI programmers. The data transfer to and from this agent is either manual or through seamless digital communication with the CI fitting database and the psychoacoustic test suite. It recommends and executes modifications to the map settings to improve the outcome. Fitting to Outcomes eXpert is an operational intelligent agent, the principles of which are described. Its development and modes of operation are outlined, and a case example is given. Fitting to Outcomes eXpert is in use for more than a year now and seems to be capable to improve the measured outcome. It is argued that this novel tool allows a systematic approach focusing on outcome, reducing the fitting time, and improving the quality of fitting. It introduces principles of artificial intelligence in the process of CI fitting.

Electric charge requirements of pediatric cochlear implant recipients enrolled in the Childhood Development After Cochlear Implantation study.

PubMed

Zwolan, Teresa A; O'Sullivan, Mary Beth; Fink, Nancy E; Niparko, John K

2008-02-01

To evaluate mapping characteristics of children with cochlear implants who are enrolled in the Childhood Development After Cochlear Implantation (CDACI) multicenter study. Longitudinal evaluation during 24 months of speech processor maps of children with cochlear implants prospectively enrolled in the study. Six tertiary referral centers. One hundred eighty-eight children enrolled in the CDACI study who were 5 years old or younger at the time of enrollment. Of these children, 184 received unilateral implants, and 4 received simultaneous bilateral implants. Children attended regular mapping sessions at their implant clinic as part of the study protocol. Maps were examined for each subject at 4 different time intervals: at device activation and 6, 12, and 24 months postactivation. Mean C/M levels (in charge per phase) were compared for 4 different time intervals, for 3 different devices, for 6 different implant centers, and for children with normal and abnormal cochleae. All 3 types of implant devices demonstrate significant increases in C/M levels between device activation and the 24-month appointment. Significant differences in mean C/M levels were noted between devices. Children with cochlear anomalies demonstrate significantly greater C/M levels than children with normal cochleae. The CDACI study has enabled us to evaluate the mapping characteristics of pediatric patients who use 3 different devices and were implanted at a variety of implant centers. Analysis of such data enables us to better understand the mapping characteristics of children with cochlear implants.

The effects of early auditory-based intervention on adult bilateral cochlear implant outcomes.

PubMed

Lim, Stacey R

2017-09-01

The goal of this exploratory study was to determine the types of improvement that sequentially implanted auditory-verbal and auditory-oral adults with prelingual and childhood hearing loss received in bilateral listening conditions, compared to their best unilateral listening condition. Five auditory-verbal adults and five auditory-oral adults were recruited for this study. Participants were seated in the center of a 6-loudspeaker array. BKB-SIN sentences were presented from 0° azimuth, while multi-talker babble was presented from various loudspeakers. BKB-SIN scores in bilateral and the best unilateral listening conditions were compared to determine the amount of improvement gained. As a group, the participants had improved speech understanding scores in the bilateral listening condition. Although not statistically significant, the auditory-verbal group tended to have greater speech understanding with greater levels of competing background noise, compared to the auditory-oral participants. Bilateral cochlear implantation provides individuals with prelingual and childhood hearing loss with improved speech understanding in noise. A higher emphasis on auditory development during the critical language development years may add to increased speech understanding in adulthood. However, other demographic factors such as age or device characteristics must also be considered. Although both auditory-verbal and auditory-oral approaches emphasize spoken language development, they emphasize auditory development to different degrees. This may affect cochlear implant (CI) outcomes. Further consideration should be made in future auditory research to determine whether these differences contribute to performance outcomes. Additional investigation with a larger participant pool, controlled for effects of age and CI devices and processing strategies, would be necessary to determine whether language learning approaches are associated with different levels of speech understanding performance.

A comparison of speech intonation production and perception abilities of Farsi speaking cochlear implanted and normal hearing children.

PubMed

Moein, Narges; Khoddami, Seyyedeh Maryam; Shahbodaghi, Mohammad Rahim

2017-10-01

Cochlear implant prosthesis facilitates spoken language development and speech comprehension in children with severe-profound hearing loss. However, this prosthesis is limited in encoding information about fundamental frequency and pitch that are essentially for recognition of speech prosody. The purpose of the present study is to investigate the perception and production of intonation in cochlear implant children and comparison with normal hearing children. This study carried out on 25 cochlear implanted children and 50 children with normal hearing. First, using 10 action pictures statements and questions sentences were extracted. Fundamental frequency and pitch changes were identified using Praat software. Then, these sentences were judged by 7 adult listeners. In second stage 20 sentences were played for child and he/she determined whether it was in a question form or statement one. Performance of cochlear implanted children in perception and production of intonation was significantly lower than children with normal hearing. The difference between fundamental frequency and pitch changes in cochlear implanted children and children with normal hearing was significant (P < 0/05). Cochlear implanted children performance in perception and production of intonation has significant correlation with child's age surgery and duration of prosthesis use (P < 0/05). The findings of the current study show that cochlear prostheses have limited application in facilitating the perception and production of intonation in cochlear implanted children. It should be noted that the child's age at the surgery and duration of prosthesis's use is important in reduction of this limitation. According to these findings, speech and language pathologists should consider intervention of intonation in treatment program of cochlear implanted children. Copyright © 2017 Elsevier B.V. All rights reserved.

Hearing rehabilitation with a binaural cochlear implant in a patient with Erdheim-Chester disease.

PubMed

Querat, Charlotte; Thai-Van, Hung; Durand, Denis Vital; Cotton, François; Gallego, Stéphane; Truy, Eric

2015-09-01

Erdheim-Chester disease (ECD) is a rare non-Langerhans form of histiocytosis. This paper reports an exceptional case of bilateral neural involvement, responsible for profound hearing loss. Bilateral cochlear implantation was performed. We present a 57-year-old man affected by ECD with profound bilateral hearing loss. The patient underwent cochlear implantation with a binaural Digisonic(®) cochlear implant, 7 years after the initial diagnosis. Speech intelligibility rose to a plateau after about 6 months of cochlear implant use. The average outcome of speech intelligibility over time was 55% for dissyllabic words without lip reading, and 70% for sentences. Perception score decreased before the patient died from ECD. A description of the ECD and its otological manifestations is presented. This paper reports the effective hearing rehabilitation of profound bilateral hearing loss by the means of a binaural Digisonic(®) cochlear implant.

The Hearing Outcomes of Cochlear Implantation in Waardenburg Syndrome.

PubMed

Koyama, Hajime; Kashio, Akinori; Sakata, Aki; Tsutsumiuchi, Katsuhiro; Matsumoto, Yu; Karino, Shotaro; Kakigi, Akinobu; Iwasaki, Shinichi; Yamasoba, Tatsuya

2016-01-01

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.

The Hearing Outcomes of Cochlear Implantation in Waardenburg Syndrome

PubMed Central

Koyama, Hajime; Kashio, Akinori; Sakata, Aki; Tsutsumiuchi, Katsuhiro; Matsumoto, Yu; Karino, Shotaro; Kakigi, Akinobu; Iwasaki, Shinichi; Yamasoba, Tatsuya

2016-01-01

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

Preliminary assessment of the feasibility of using AB words to assess candidacy in adults.

PubMed

Vickers, Deborah A; Riley, Alison; Ricaud, Rebecca; Verschuur, Carl; Cooper, Stacey; Nunn, Terry; Webb, Kath; Muff, Joanne; Harris, Frances; Chung, Mark; Humphries, Jane; Langshaw, Alison; Poynter-Smith, Emma; Totten, Catherine; Tapper, Lynne; Ridgwell, Jillian; Mawman, Deborah; de Estibariz, Unai Martinez; O'Driscoll, Martin; George, Nicola; Pinto, Francesca; Hall, Anne; Llewellyn, Carol; Miah, Razun; Al-Malky, Ghada; Kitterick, Pádraig T

2016-04-01

Adult cochlear implant (CI) candidacy is assessed in part by the use of speech perception measures. In the United Kingdom the current cut-off point to fall within the CI candidacy range is a score of less than 50% on the BKB sentences presented in quiet (presented at 70 dBSPL). The specific goal of this article was to review the benefit of adding the AB word test to the assessment test battery for candidacy. The AB word test scores showed good sensitivity and specificity when calculated based on both word and phoneme scores. The word score equivalent for 50% correct on the BKB sentences was 18.5% and it was 34.5% when the phoneme score was calculated; these scores are in line with those used in centres in Wales (15% AB word score). The goal of the British Cochlear Implant Group (BCIG) service evaluation was to determine if the pre-implant assessment measures are appropriate and set at the correct level for determining candidacy, the future analyses will determine whether the speech perception cut-off point for candidacy should be adjusted and whether other more challenging measures should be used in the candidacy evaluation.

Fitting prelingually deafened adult cochlear implant users based on electrode discrimination performance.

PubMed

Debruyne, Joke A; Francart, Tom; Janssen, A Miranda L; Douma, Kim; Brokx, Jan P L

2017-03-01

This study investigated the hypotheses that (1) prelingually deafened CI users do not have perfect electrode discrimination ability and (2) the deactivation of non-discriminable electrodes can improve auditory performance. Electrode discrimination difference limens were determined for all electrodes of the array. The subjects' basic map was subsequently compared to an experimental map, which contained only discriminable electrodes, with respect to speech understanding in quiet and in noise, listening effort, spectral ripple discrimination and subjective appreciation. Subjects were six prelingually deafened, late implanted adults using the Nucleus cochlear implant. Electrode discrimination difference limens across all subjects and electrodes ranged from 0.5 to 7.125, with significantly larger limens for basal electrodes. No significant differences were found between the basic map and the experimental map on auditory tests. Subjective appreciation was found to be significantly poorer for the experimental map. Prelingually deafened CI users were unable to discriminate between all adjacent electrodes. There was no difference in auditory performance between the basic and experimental map. Potential factors contributing to the absence of improvement with the experimental map include the reduced number of maxima, incomplete adaptation to the new frequency allocation, and the mainly basal location of deactivated electrodes.

Binaural release from masking with single- and multi-electrode stimulation in children with cochlear implantsa)

PubMed Central

Todd, Ann E.; Goupell, Matthew J.; Litovsky, Ruth Y.

2016-01-01

Cochlear implants (CIs) provide children with access to speech information from a young age. Despite bilateral cochlear implantation becoming common, use of spatial cues in free field is smaller than in normal-hearing children. Clinically fit CIs are not synchronized across the ears; thus binaural experiments must utilize research processors that can control binaural cues with precision. Research to date has used single pairs of electrodes, which is insufficient for representing speech. Little is known about how children with bilateral CIs process binaural information with multi-electrode stimulation. Toward the goal of improving binaural unmasking of speech, this study evaluated binaural unmasking with multi- and single-electrode stimulation. Results showed that performance with multi-electrode stimulation was similar to the best performance with single-electrode stimulation. This was similar to the pattern of performance shown by normal-hearing adults when presented an acoustic CI simulation. Diotic and dichotic signal detection thresholds of the children with CIs were similar to those of normal-hearing children listening to a CI simulation. The magnitude of binaural unmasking was not related to whether the children with CIs had good interaural time difference sensitivity. Results support the potential for benefits from binaural hearing and speech unmasking in children with bilateral CIs. PMID:27475132

Melodic Contour Identification and Music Perception by Cochlear Implant Users

PubMed Central

Galvin, John J.; Fu, Qian-Jie; Shannon, Robert V.

2013-01-01

Research and outcomes with cochlear implants (CIs) have revealed a dichotomy in the cues necessary for speech and music recognition. CI devices typically transmit 16–22 spectral channels, each modulated slowly in time. This coarse representation provides enough information to support speech understanding in quiet and rhythmic perception in music, but not enough to support speech understanding in noise or melody recognition. Melody recognition requires some capacity for complex pitch perception, which in turn depends strongly on access to spectral fine structure cues. Thus, temporal envelope cues are adequate for speech perception under optimal listening conditions, while spectral fine structure cues are needed for music perception. In this paper, we present recent experiments that directly measure CI users’ melodic pitch perception using a melodic contour identification (MCI) task. While normal-hearing (NH) listeners’ performance was consistently high across experiments, MCI performance was highly variable across CI users. CI users’ MCI performance was significantly affected by instrument timbre, as well as by the presence of a competing instrument. In general, CI users had great difficulty extracting melodic pitch from complex stimuli. However, musically-experienced CI users often performed as well as NH listeners, and MCI training in less experienced subjects greatly improved performance. With fixed constraints on spectral resolution, such as it occurs with hearing loss or an auditory prosthesis, training and experience can provide a considerable improvements in music perception and appreciation. PMID:19673835

Recognition and Comprehension of "Narrow Focus" by Young Adults With Prelingual Hearing Loss Using Hearing Aids or Cochlear Implants.

PubMed

Segal, Osnat; Kishon-Rabin, Liat

2017-12-20

The stressed word in a sentence (narrow focus [NF]) conveys information about the intent of the speaker and is therefore important for processing spoken language and in social interactions. The ability of participants with severe-to-profound prelingual hearing loss to comprehend NF has rarely been investigated. The purpose of this study was to assess the recognition and comprehension of NF by young adults with prelingual hearing loss compared with those of participants with normal hearing (NH). The participants included young adults with hearing aids (HA; n = 10), cochlear implants (CI; n = 12), and NH (n = 18). The test material included the Hebrew Narrow Focus Test (Segal, Kaplan, Patael, & Kishon-Rabin, in press), with 3 subtests, which was used to assess the recognition and comprehension of NF in different contexts. The following results were obtained: (a) CI and HA users successfully recognized the stressed word, with the worst performance for CI; (b) HA and CI comprehended NF less well than NH; and (c) the comprehension of NF was associated with verbal working memory and expressive vocabulary in CI users. Most CI and HA users were able to recognize the stressed word in a sentence but had considerable difficulty understanding it. Different factors may contribute to this difficulty, including the memory load during the task itself and linguistic and pragmatic abilities. https://doi.org/10.23641/asha.5572792.

Effects of lexical characteristics and demographic factors on mandarin chinese open-set word recognition in children with cochlear implants.

PubMed

Liu, Haihong; Liu, Sha; Wang, Suju; Liu, Chang; Kong, Ying; Zhang, Ning; Li, Shujing; Yang, Yilin; Han, Demin; Zhang, Luo

2013-01-01

The purpose of this study was to examine the open-set word recognition performance of Mandarin Chinese-speaking children who had received a multichannel cochlear implant (CI) and examine the effects of lexical characteristics and demographic factors (i.e., age at implantation and duration of implant use) on Mandarin Chinese open-set word recognition in these children. Participants were 230 prelingually deafened children with CIs. Age at implantation ranged from 0.9 to 16.0 years, with a mean of 3.9 years. The Standard-Chinese version of the Monosyllabic Lexical Neighborhood test and the Multisyllabic Lexical Neighborhood test were used to evaluate the open-set word identification abilities of the children. A two-way analysis of variance was performed to delineate the lexical effects on the open-set word identification, with word difficulty and syllable length as the two main factors. The effects of age at implantation and duration of implant use on open-set, word-recognition performance were examined using correlational/regressional models. First, the average percent-correct scores for the disyllabic "easy" list, disyllabic "hard" list, monosyllabic "easy" list, and monosyllabic "hard" list were 65.0%, 51.3%, 58.9%, and 46.2%, respectively. For both the easy and hard lists, the percentage of words correctly identified was higher for disyllabic words than for monosyllabic words, Second, the CI group scored 26.3%, 31.3%, and 18.8 % points lower than their hearing-age-matched normal-hearing peers for 4, 5, and 6 years of hearing age, respectively. The corresponding gaps between the CI group and the chronological-age-matched normal-hearing group were 47.6, 49.6, and 42.4, respectively. The individual variations in performance were much greater in the CI group than in the normal-hearing group, Third, the children exhibited steady improvements in performance as the duration of implant use increased, especially 1 to 6 years postimplantation. Last, age at implantation had significant effects on postimplantation word-recognition performance. The benefit of early implantation was particularly evident in children 5 years old or younger. First, Mandarin Chinese-speaking pediatric CI users' open-set word recognition was influenced by the lexical characteristics of the stimuli. The score was higher for easy words than for hard words and was higher for disyllabic words than for monosyllabic words, Second, Mandarin-Chinese-speaking pediatric CI users exhibited steady progress in open-set word recognition as the duration of implant use increased. However, the present study also demonstrated that, even after 6 years of CI use, there was a significant deficit in open-set, word-recognition performance in the CI children compared with their normal-hearing peers. Third, age at implantation had significant effects on open-set, word-recognition performance. Early implanted children exhibited better performance than children implanted later.

Evaluating cochlear implant trauma to the scala vestibuli.

PubMed

Adunka, O; Kiefer, J; Unkelbach, M H; Radeloff, A; Gstoettner, W

2005-04-01

Placement of cochlear implant electrodes into the scala vestibuli may be intentional, e.g. in case of blocked scala tympani or unintentional as a result of trauma to the basilar membrane or erroneous location of the cochieostomy. The aim of this study was to evaluate the morphological consequences and cochlear trauma after implantation of different cochlear implant electrode arrays in the scala vestibuli. Human temporal bone study with histological and radiological evaluation. Twelve human cadaver temporal bones were implanted with different cochlear implant electrodes. Implanted bones were processed using a special method to section undecalcified bone. Cochlear trauma and intracochlear positions. All implanted electrodes were implanted into the scala vestibuli using a special approach that allows direct scala vestibuli insertions. Fractures of the osseous spiral lamina were evaluated in some bones in the basal cochlear regions. In most electrodes, delicate structures of the organ of Corti were left intact, however, Reissner's membrane was destroyed in all specimens and the electrode lay upon the tectorial membrane. In some bones the organ of Corti was destroyed. Scala vestibuli insertions did not cause severe trauma to osseous or neural structures, thus preserving the basis for electrostimulation of the cochlea. However, destruction of Reissner's membrane and impact on the Organ of Corti can be assumed to destroy residual hearing.

Considerations for Pediatric Cochlear Implant Recipients With Unilateral or Asymmetric Hearing Loss: Assessment, Device Fitting, and Habilitation.

PubMed

Greaver, Laura; Eskridge, Hannah; Teagle, Holly F B

2017-06-13

The purpose of this clinical report is to present case studies of children who are nontraditional candidates for cochlear implantation because they have significant residual hearing in 1 ear and to describe outcomes and considerations for their audiological management and habilitation. Case information is presented for 5 children with profound hearing loss in 1 ear and normal or mild-to-moderate hearing loss in the opposite ear and who have undergone unilateral cochlear implantation. Pre- and postoperative assessments were performed per typical clinic routines with modifications described. Postimplant habilitation was customized for each recipient using a combination of traditional methods, newer technologies, and commercial materials. The 5 children included in this report are consistent users of their cochlear implants and demonstrate speech recognition in the implanted ear when isolated from the better hearing ear. Candidacy criteria for cochlear implantation are evolving. Children with single-sided deafness or asymmetric hearing loss who have traditionally not been considered candidates for cochlear implantation should be evaluated on a case-by-case basis. Audiological management of these recipients is not vastly different compared with children who are traditional cochlear implant recipients. Assessment and habilitation techniques must be modified to isolate the implanted ear to obtain accurate results and to provide meaningful therapeutic intervention.

Factors influencing speech perception in noise for 5-year-old children using hearing aids or cochlear implants.

PubMed

Ching, Teresa Yc; Zhang, Vicky W; Flynn, Christopher; Burns, Lauren; Button, Laura; Hou, Sanna; McGhie, Karen; Van Buynder, Patricia

2017-07-07

We investigated the factors influencing speech perception in babble for 5-year-old children with hearing loss who were using hearing aids (HAs) or cochlear implants (CIs). Speech reception thresholds (SRTs) for 50% correct identification were measured in two conditions - speech collocated with babble, and speech with spatially separated babble. The difference in SRTs between the two conditions give a measure of binaural unmasking, commonly known as spatial release from masking (SRM). Multiple linear regression analyses were conducted to examine the influence of a range of demographic factors on outcomes. Participants were 252 children enrolled in the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study. Children using HAs or CIs required a better signal-to-noise ratio to achieve the same level of performance as their normal-hearing peers but demonstrated SRM of a similar magnitude. For children using HAs, speech perception was significantly influenced by cognitive and language abilities. For children using CIs, age at CI activation and language ability were significant predictors of speech perception outcomes. Speech perception in children with hearing loss can be enhanced by improving their language abilities. Early age at cochlear implantation was also associated with better outcomes.