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Farag HM, Osman DM, Safwat RF. Language profile of children with cochlear implants: comparative study about the effect of age of cochlear implantation and the duration of rehabilitation. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08689-8. [PMID: 38755508 DOI: 10.1007/s00405-024-08689-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/15/2024] [Indexed: 05/18/2024]
Abstract
PURPOSE The analysis of different language domains and exploration of variables that affect the outcomes of cochlear implantation would help to document the efficacy of cochlear implantation and intervention programs. The aim of this work was to examine the language profile of children with Cochlear Implants (CI) and to assess the effect of age at the time of cochlear implantation and the impact of duration of rehabilitation on the development of linguistic abilities for cochlear implanted children. METHODS The study was conducted on 46 Arabic speaking children using unilateral CI who are receiving regular post-cochlear auditory and language rehabilitation in the phoniatrics unit, Kasr Alaini hospital. A Proficient Preschooler Language Evaluation (APPEL TOOL) was applied for the assessment of different language domains. RESULTS Children who received post implant rehabilitation for ≥ 2 years showed significant improvement in all subtests' scores of APPEL tool than children who received same rehabilitation for ≤ 1 year. There was no significant difference of language scores between children who have received CI before age of 3 years and those who have been implanted after age of 3 years. CONCLUSION This study showed that the language profile of CI children was beneficially affected by the longer duration of therapy post implantation.
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Affiliation(s)
- Heba Mahmoud Farag
- Phoniatrics, Phoniatric Unit, ENT Department, Faculty of Medicine, Cairo University, King Faisal Street, 300, Giza, 12511, Egypt.
| | - Dalia Mostafa Osman
- Phoniatrics, Phoniatric Unit, ENT Department, Faculty of Medicine, Cairo University, King Faisal Street, 300, Giza, 12511, Egypt
| | - Rasha Farouk Safwat
- Phoniatrics, Phoniatric Unit, ENT Department, Faculty of Medicine, Cairo University, King Faisal Street, 300, Giza, 12511, Egypt
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Esser J, Walger M, Pollet N, Klußmann JP, Ruge M, Goldbrunner R, Lüers JC. [Vestibular Schwannoma: Factors in Therapy Decision-Making]. Laryngorhinootologie 2024; 103:176-186. [PMID: 38128578 DOI: 10.1055/a-2222-0878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
The treatment of vestibular schwannomas (VS) has always posed a challenge for physicians. Three essential treatment principles are available: wait-and-scan, surgery, and stereotactic radiotherapy. In addition to the type of treatment, decisions must be made regarding the optimal timing of therapy, the combination of different treatment modalities, the potential surgical approach, and the type and intensity of radiation. Factors influencing the therapy decision include tumor location and size or stage, patient age, comorbidities, symptoms, postoperative hearing rehabilitation options, patient preferences, and, not least, the experience of the surgeons and the personnel and technical capabilities of the clinical site. This article begins with a brief overview of vestibular schwannomas, then outlines the fundamental interdisciplinary treatment options, and finally discusses the ENT (ear, nose, and throat)-relevant factors in the therapy decision.
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Affiliation(s)
- Julia Esser
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf und Hals-Chirurgie, Universität zu Köln Medizinische Fakultät, Köln, DE 50937, Germany
| | - Martin Walger
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universität zu Köln Medizinische Fakultät, Köln, DE 50937, Germany
| | - Naomi Pollet
- Universität zu Köln, Medizinische Fakultät, Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf und Hals-Chirurgie, Uniklinik Köln, Köln, DE 50937, Germany
| | - Jens Peter Klußmann
- Klinik und Poliklinik für HNO-Heilkunde, Kopf- und Hals-Chirurgie, Universität zu Köln Medizinische Fakultät, Köln, DE 50937, Germany
| | - Maximilian Ruge
- Klinik für Stereotaxie und Funktionelle Neurochirurgie, Universität zu Köln Medizinische Fakultät, Köln, Germany
| | - Roland Goldbrunner
- Universität zu Köln, Medizinische Fakultät, Zentrum für Neurochirurgie, Klinik für Allgemeine Neurochirurgie, Universität zu Köln Medizinische Fakultät, Köln, Germany
| | - Jan Christoffer Lüers
- Klinik und Poliklinik für HNO-Heilkunde, Kopf- und Hals-Chirurgie, Universität zu Köln Medizinische Fakultät, Köln, Germany
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Hey M, Mewes A, Hocke T. Speech comprehension in noise-considerations for ecologically valid assessment of communication skills ability with cochlear implants. HNO 2023; 71:26-34. [PMID: 36480047 PMCID: PMC10409840 DOI: 10.1007/s00106-022-01232-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Nowadays, cochlear implant (CI) patients mostly show good to very good speech comprehension in quiet, but there are known problems with communication in everyday noisy situations. There is thus a need for ecologically valid measurements of speech comprehension in real-life listening situations for hearing-impaired patients. The additional methodological effort must be balanced with clinical human and spatial resources. This study investigates possible simplifications of a complex measurement setup. METHODS The study included 20 adults from long-term follow-up after CI fitting with postlingual onset of hearing impairment. The complexity of the investigated listening situations was influenced by changing the spatiality of the noise sources and the temporal characteristics of the noise. To compare different measurement setups, speech reception thresholds (SRT) were measured unilaterally with different CI processors and settings. Ten normal-hearing subjects served as reference. RESULTS In a complex listening situation with four loudspeakers, differences in SRT from CI subjects to the control group of up to 8 dB were found. For CI subjects, this SRT correlated with the situation with frontal speech signal and fluctuating interference signal from the side with R2 = 0.69. For conditions with stationary interfering signals, R2 values <0.2 were found. CONCLUSION There is no universal solution for all audiometric questions with respect to the spatiality and temporal characteristics of noise sources. In the investigated context, simplification of the complex spatial audiometric setting while using fluctuating competing signals was possible.
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Affiliation(s)
- Matthias Hey
- Department of Otorhinolaryngology, Head and Neck Surgery, Audiology, UKSH, Campus Kiel, Arnold-Heller-Straße 14, 24105, Kiel, Germany.
| | - Alexander Mewes
- Department of Otorhinolaryngology, Head and Neck Surgery, Audiology, UKSH, Campus Kiel, Arnold-Heller-Straße 14, 24105, Kiel, Germany
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Rieck JH, Beyer A, Mewes A, Caliebe A, Hey M. Extended Preoperative Audiometry for Outcome Prediction and Risk Analysis in Patients Receiving Cochlear Implants. J Clin Med 2023; 12:3262. [PMID: 37176702 PMCID: PMC10179556 DOI: 10.3390/jcm12093262] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/21/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND The outcome of cochlear implantation has improved over the last decades, but there are still patients with less benefit. Despite numerous studies examining the cochlear implant (CI) outcome, variations in speech comprehension with CI remains incompletely explained. The aim of this study was therefore to examine preoperative pure-tone audiogram and speech comprehension as well as aetiology, to investigate their relationship with postoperative speech comprehension in CI recipients. METHODS A retrospective study with 664 ears of 530 adult patients was conducted. Correlations between the target variable postoperative word comprehension with the preoperative speech and sound comprehension as well as aetiology were investigated. Significant correlations were inserted into multivariate models. Speech comprehension measured as word recognition score at 70 dB with CI was analyzed as (i) a continuous and (ii) a dichotomous variable. RESULTS All variables that tested preoperative hearing were significantly correlated with the dichotomous target; with the continuous target, all except word comprehension at 65 dB with hearing aid. The strongest correlation with postoperative speech comprehension was seen for monosyllabic words with hearing aid at 80 dB. The preoperative maximum word comprehension was reached or surpassed by 97.3% of CI patients. Meningitis and congenital diseases were strongly negatively associated with postoperative word comprehension. The multivariate model was able to explain 40% of postoperative variability. CONCLUSION Speech comprehension with hearing aid at 80 dB can be used as a supplementary preoperative indicator of CI-aided speech comprehension and should be measured regularly in the clinical routine. Combining audiological and aetiological variables provides more insights into the variability of the CI outcome, allowing for better patient counselling.
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Affiliation(s)
| | - Annika Beyer
- Audiology, ENT Clinic, UKSH Kiel, 24105 Kiel, Germany; (A.B.); (A.M.); (M.H.)
| | - Alexander Mewes
- Audiology, ENT Clinic, UKSH Kiel, 24105 Kiel, Germany; (A.B.); (A.M.); (M.H.)
| | - Amke Caliebe
- Institute of Medical Informatics and Statistics, CAU Kiel, 24105 Kiel, Germany;
| | - Matthias Hey
- Audiology, ENT Clinic, UKSH Kiel, 24105 Kiel, Germany; (A.B.); (A.M.); (M.H.)
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Hey M, Mewes A, Hocke T. [Speech comprehension in noise-considerations for ecologically valid assessment of communication skills ability with cochlear implants. German version]. HNO 2022; 70:861-869. [PMID: 36301326 PMCID: PMC9691490 DOI: 10.1007/s00106-022-01234-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Nowadays, cochlear implant (CI) patients mostly show good to very good speech comprehension in quiet, but there are known problems with communication in everyday noisy situations. There is thus a need for ecologically valid measurements of speech comprehension in real-life listening situations for hearing-impaired patients. The additional methodological effort must be balanced with clinical human and spatial resources. This study investigates possible simplifications of a complex measurement setup. METHODS The study included 20 adults from long-term follow-up after CI fitting with postlingual onset of hearing impairment. The complexity of the investigated listening situations was influenced by changing the spatiality of the noise sources and the temporal characteristics of the noise. To compare different measurement setups, speech reception thresholds (SRT) were measured unilaterally with different CI processors and settings. Ten normal-hearing subjects served as reference. RESULTS In a complex listening situation with four loudspeakers, differences in SRT from CI subjects to the control group of up to 8 dB were found. For CI subjects, this SRT correlated with the situation with frontal speech signal and fluctuating interference signal from the side with R2 = 0.69. For conditions with stationary interfering signals, R2 values <0.2 were found. CONCLUSION There is no universal solution for all audiometric questions with respect to the spatiality and temporal characteristics of noise sources. In the investigated context, simplification of the complex spatial audiometric setting while using fluctuating competing signals was possible.
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Affiliation(s)
- Matthias Hey
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie; Audiologie, UKSH, Campus Kiel, Arnold-Heller-Straße 14, 24105, Kiel, Deutschland.
| | - Alexander Mewes
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie; Audiologie, UKSH, Campus Kiel, Arnold-Heller-Straße 14, 24105, Kiel, Deutschland
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Eichler T, Rötz W, Kayser C, Bröhl F, Römer M, Witteborg AH, Kummert F, Sandmeier T, Schulte C, Stolz P, Meyer K, Sudhoff H, Todt I. Algorithm-Based Hearing and Speech Therapy Rehabilitation after Cochlear Implantation. Brain Sci 2022; 12:580. [PMID: 35624970 PMCID: PMC9139523 DOI: 10.3390/brainsci12050580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/14/2022] [Accepted: 04/21/2022] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Due to the changes in the indication range for cochlear implants and the demographic development towards an aging society, more and more people are in receipt of cochlear implants. An implantation requires a close-meshed audiological and logopedic aftercare. Hearing therapy rehabilitation currently requires great personnel effort and is time consuming. Hearing and speech therapy rehabilitation can be supported by digital hearing training programs. However, the apps currently on the market are to a limited degree personalized and structured. Increasing digitalization makes it possible, especially in times of pandemics, to decouple hearing therapy treatment from everyday clinical practice. MATERIAL AND METHODS For this purpose, an app is in development that provides hearing therapy tailored to the patient. The individual factors that influence hearing outcome are considered. Using intelligent algorithms, the app determines the selection of exercises, the level of difficulty and the speed at which the difficulty is increased. RESULTS The app works autonomously without being connected to local speech therapists. In addition, the app is able to analyze patient difficulties within the exercises and provides conclusions about the need for technical adjustments. CONCLUSIONS The presented newly developed app represents a possibility to support, replace, expand and improve the classic outpatient hearing and speech therapy after CI implantation. The way the application works allows it to reach more people and provide a time- and cost-saving alternative to traditional therapy.
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Affiliation(s)
- Theda Eichler
- Department of Otolaryngology, Head and Neck Surgery, Medical School OWL, Campus Bielefeld Mitte, Bielefeld University, 33604 Bielefeld, Germany; (W.R.); (H.S.); (I.T.)
| | - Wiebke Rötz
- Department of Otolaryngology, Head and Neck Surgery, Medical School OWL, Campus Bielefeld Mitte, Bielefeld University, 33604 Bielefeld, Germany; (W.R.); (H.S.); (I.T.)
| | - Christoph Kayser
- Faculty of Biology, Cognitive Neuroscience, Bielefeld University, 33615 Bielefeld, Germany; (C.K.); (F.B.)
| | - Felix Bröhl
- Faculty of Biology, Cognitive Neuroscience, Bielefeld University, 33615 Bielefeld, Germany; (C.K.); (F.B.)
| | - Michael Römer
- Faculty of Economics, Decision Analytics, Bielefeld University, 33615 Bielefeld, Germany; (M.R.); (A.H.W.)
| | - Arne Henning Witteborg
- Faculty of Economics, Decision Analytics, Bielefeld University, 33615 Bielefeld, Germany; (M.R.); (A.H.W.)
| | - Franz Kummert
- Research Institute for Cognition and Robotics, Bielefeld University, 33615 Bielefeld, Germany; (F.K.); (T.S.); (C.S.)
| | - Tobias Sandmeier
- Research Institute for Cognition and Robotics, Bielefeld University, 33615 Bielefeld, Germany; (F.K.); (T.S.); (C.S.)
| | - Christoph Schulte
- Research Institute for Cognition and Robotics, Bielefeld University, 33615 Bielefeld, Germany; (F.K.); (T.S.); (C.S.)
| | - Patricia Stolz
- Department of Design, University of Applied Science, 33619 Bielefeld, Germany; (P.S.); (K.M.)
| | - Katharina Meyer
- Department of Design, University of Applied Science, 33619 Bielefeld, Germany; (P.S.); (K.M.)
| | - Holger Sudhoff
- Department of Otolaryngology, Head and Neck Surgery, Medical School OWL, Campus Bielefeld Mitte, Bielefeld University, 33604 Bielefeld, Germany; (W.R.); (H.S.); (I.T.)
| | - Ingo Todt
- Department of Otolaryngology, Head and Neck Surgery, Medical School OWL, Campus Bielefeld Mitte, Bielefeld University, 33604 Bielefeld, Germany; (W.R.); (H.S.); (I.T.)
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Hey M, Böhnke B, Mewes A, Munder P, Mauger SJ, Hocke T. Speech comprehension across multiple CI processor generations: Scene dependent signal processing. Laryngoscope Investig Otolaryngol 2021; 6:807-815. [PMID: 34401506 PMCID: PMC8356868 DOI: 10.1002/lio2.564] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/19/2021] [Accepted: 04/06/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES In clinical practice, characterization of speech comprehension for cochlear implant (CI) patients is typically administered by a set of suprathreshold measurements in quiet and in noise. This study investigates speech comprehension of the three most recent cochlear implant sound processors; CP810, CP910, and CP1000 (Cochlear Limited). To compare sound processor performance across generations and input dynamic range changes, the state-of-the art signal processing technologies available in each sound processor were enabled. Outcomes will be assessed across a range of stimulation intensities, and finally analyzed with respect to normal hearing listeners. METHODS In a prospective study, 20 experienced postlingually deafened CI patients who received a Nucleus CI in the ENT department of the University Hospital of SH in Kiel were recruited. Speech comprehension was measured in quiet at 40, 50, and 65 dBSPL with monosyllabic words as well as by speech reception threshold for two-digit numbers. In noise, speech reception thresholds were measured with the adaptive German matrix test with speech and noise in front. RESULTS We found that high levels of open-set speech comprehension are achieved at suprathreshold presentation levels in quiet. However, results at lower test levels have remained mostly unchanged for tested sound processors with default dynamic range. Expanding the lower limit of the acoustic input dynamic range yields better speech comprehension at lower presentation levels. In noise the application of ForwardFocus improves the speech reception. Overall, a continuous improvement for speech perception across three generations of CI sound processors was found. CONCLUSIONS Findings motivate further development of signal pre-processing, an additional focus of clinical work on lower stimulation levels, and automation of ForwardFocus. LEVEL OF EVIDENCE 2.
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Völter C, Schirmer C, Röber M, Hinsen D, Dazert S, Bilda K. [New ways in hearing rehabilitation after cochlear implantation]. HNO 2021; 69:42-51. [PMID: 32856120 PMCID: PMC7806537 DOI: 10.1007/s00106-020-00914-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Abstract
INTRODUCTION After cochlear implantation, auditory and speech training is usually necessary. Up until now, this has been performed on an out- or inpatient basis in direct contact with a therapist. Due to technical advances but also particularly because of an increasing use of digital media and a desire for mobility and independence, the demand for digital training programs is increasing in the field of hearing rehabilitation. MATERIALS AND METHODS In a first step, the most important elements of auditory training were determined on the basis of commonly used auditory and speech processing models, and the core features of a computer-based teletherapeutic hearing platform were defined. This process considered motivational elements and adaptive mechanisms as regularly used in educational and speech and language therapy. In a second step, an initial prototype of the "train2hear" teletherapeutic hearing platform was developed by an interdisciplinary research team. RESULTS The core of the train2hear platform is an initial analysis according to the International Classification of Functioning, Disability, and Health (ICF), on the basis of which an individual training plan is designed. Various adaptive mechanisms enable the level of difficulty to be continually adapted to the individual user's learning progress. A videoconference tool enables contact between the patient and the therapist. CONCLUSION The train2hear platform represents a first prototype of a computer-based auditory rehabilitation program in German. Further evaluation and development in a clinical study are needed to determine the feasibility and efficacy of the platform.
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Affiliation(s)
- C Völter
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie der Ruhr-Universität Bochum, Katholisches Klinikum Bochum gGmbh, Bleichstr. 15, 44787, Bochum, Deutschland.
| | - C Schirmer
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie der Ruhr-Universität Bochum, Katholisches Klinikum Bochum gGmbh, Bleichstr. 15, 44787, Bochum, Deutschland.,Kampmann Hörsysteme, Bochum, Deutschland
| | - M Röber
- Hochschule für Gesundheit (hsg), Bochum, Deutschland
| | - D Hinsen
- Hochschule für Gesundheit (hsg), Bochum, Deutschland
| | - S Dazert
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie der Ruhr-Universität Bochum, Katholisches Klinikum Bochum gGmbh, Bleichstr. 15, 44787, Bochum, Deutschland
| | - K Bilda
- Hochschule für Gesundheit (hsg), Bochum, Deutschland
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Glaubitz C, Lehmann EK, Weber L, Kulke AM, Hoppe U. [Auditory group therapy in adult cochlear implant rehabilitation]. HNO 2019; 67:612-619. [PMID: 31065763 DOI: 10.1007/s00106-019-0672-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Auditory training is an established intervention in adult cochlear implant (CI) aural rehabilitation. In most cases, training is implemented in an individual therapy setting. Increasing patient numbers and the associated time-economic and cost-related demands as well as psychosocial and communicative aspects support the use of aural group interventions. OBJECTIVES This study aimed 1) to describe concepts and contents of group interventions for adult CI users and 2) to present results of a questionnaire-based evaluation. METHODS Group interventions have been offered at the CI Centre Erlangen CICERO for several years. In Auditory Training Groups, exercises have priority, while Thematic Group Workshops focus on psychosocial aspects and provide information for the participants. The Auditory Training Groups were evaluated based on a patient questionnaire. Additionally, the reliability of the questionnaire was analyzed. RESULTS The median overall satisfaction of CI users participating in Auditory Training Groups was rated as good. Training of speech perception in noise as well as communicative exchange are of great importance for CI users. They rated the therapeutic design as very good to good. Reliability analysis showed significant positive intercorrelations of the questionnaire items. CONCLUSION Group interventions are well accepted by CI users and represent a useful complement to individual therapy during the rehabilitation process. As group interventions place special demands on patients and therapists, structured and well-proven concepts should be used in practice.
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Affiliation(s)
- C Glaubitz
- Hals-Nasen-Ohren-Klinik, Kopf- und Halschirurgie, Universitätsklinikum Erlangen, Waldstraße 1, 91054, Erlangen, Deutschland.
| | - E K Lehmann
- Hals-Nasen-Ohren-Klinik, Kopf- und Halschirurgie, Universitätsklinikum Erlangen, Waldstraße 1, 91054, Erlangen, Deutschland
| | - L Weber
- Hals-Nasen-Ohren-Klinik, Kopf- und Halschirurgie, Universitätsklinikum Erlangen, Waldstraße 1, 91054, Erlangen, Deutschland
| | - A-M Kulke
- Hals-Nasen-Ohren-Klinik, Kopf- und Halschirurgie, Universitätsklinikum Erlangen, Waldstraße 1, 91054, Erlangen, Deutschland
| | - U Hoppe
- Hals-Nasen-Ohren-Klinik, Kopf- und Halschirurgie, Universitätsklinikum Erlangen, Waldstraße 1, 91054, Erlangen, Deutschland
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Abstract
: Auditory evoked potentials (AEP) are highly demanded during the whole process of equipping patients with cochlear implants (CI). They play an essential role in preoperative diagnostics, intraoperative testing, and postoperative monitoring of auditory performance and success. The versatility of AEP's is essentially enhanced by their property to be evokable by acoustic as well as electric stimuli. Thus, the electric responses of the auditory system following acoustic stimulation and recorded by the conventional surface technique as well as by transtympanic derivation from the promontory (Electrocochleography [ECochG]) are used for the quantitative determination of hearing loss and, additionally, electrically evoked compound actions potentials (ECAP) can be recorded with the intracochlear electrodes of the implant just adjacent to the stimulation electrode to check the functional integrity of the device and its coupling to the auditory system. The profile of ECAP thresholds is used as basis for speech processor fitting, the spread of excitation (SOE) allows the identification of electrode mislocations such as array foldover, and recovery functions may serve to optimize stimulus pulse rate. These techniques as well as those relying on scalp surface activity originating in the brainstem or the auditory cortex accompany the CI recipient during its whole life span and they offer valuable insights into functioning and possible adverse effects of the CI for clinical and scientific purposes.
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Hoth S, Baljić I. Current audiological diagnostics. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2017; 16:Doc09. [PMID: 29279727 PMCID: PMC5738938 DOI: 10.3205/cto000148] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Today's audiological functional diagnostics is based on a variety of hearing tests, whose large number takes account of the variety of malfunctions of a complex sensory organ system and the necessity to examine it in a differentiated manner and at any age of life. The objective is to identify nature and origin of the hearing loss and to quantify its extent as far as necessary to dispose of the information needed to initiate the adequate medical (conservative or operational) treatment or the provision with technical hearing aids or prostheses. Moreover, audiometry provides the basis for the assessment of impairment and handicap as well as for the calculation of the degree of disability. In the present overview, the current state of the method inventory available for practical use is described, starting from basic diagnostics over to complex special techniques. The presentation is systematically grouped in subjective procedures, based on psychoacoustic exploration, and objective methods, based on physical measurements: preliminary hearing tests, pure tone threshold, suprathreshold processing of sound intensity, directional hearing, speech understanding in quiet and in noise, dichotic hearing, tympanogram, acoustic reflex, otoacoustic emissions and auditory evoked potentials. Apart from a few still existing gaps, this method inventory covers the whole spectrum of all clinically relevant functional deficits of the auditory system.
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Affiliation(s)
- Sebastian Hoth
- Functional Area of Audiology, Department of Otolaryngology, University of Heidelberg, Germany
| | - Izet Baljić
- Department of Otolaryngology, HELIOS Hospital of Erfurt, Germany
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Abstract
BACKGROUND Computer-based auditory training programmes seem to be a useful tool in the process of auditory rehabilitation after cochlear implantation (CI). Currently, little is known about the learning mechanism and efficiency of such programs. The aim of the study was to evaluate a specific auditory training programme for phoneme discrimination in experienced CI listeners. MATERIALS AND METHODS A total of 15 CI adult listeners with more than 2 years' CI experience participated in the auditory training. Over a period of 3 weeks they were instructed to train their phoneme discrimination via computer twice a week. Training material consisted of special syllables for consonants (vCv) and vowels (cVc) discrimination. RESULTS The discrimination abilities for consonants and vowels improved significantly over the training period for training group participants, whereas the changes for the consonants were higher. In addition, the improvement for voiced and unvoiced consonants was significant. CONCLUSION Computerised auditory training with phonemes improves CI listeners' discrimination abilities for consonants and vowels.
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[The Freiburg speech intelligibility test : A pillar of speech audiometry in German-speaking countries]. HNO 2017; 64:540-8. [PMID: 27259640 DOI: 10.1007/s00106-016-0150-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The Freiburg speech intelligibility test according to DIN 45621 was introduced around 60 years ago. For decades, and still today, the Freiburg test has been a standard whose relevance extends far beyond pure audiometry. It is used primarily to determine the speech perception threshold (based on two-digit numbers) and the ability to discriminate speech at suprathreshold presentation levels (based on monosyllabic nouns). Moreover, it is a measure of the degree of disability, the requirement for and success of technical hearing aids (auxiliaries directives), and the compensation for disability and handicap (Königstein recommendation). In differential audiological diagnostics, the Freiburg test contributes to the distinction between low- and high-frequency hearing loss, as well as to identification of conductive, sensory, neural, and central disorders. Currently, the phonemic and perceptual balance of the monosyllabic test lists is subject to critical discussions. Obvious deficiencies exist for testing speech recognition in noise. In this respect, alternatives such as sentence or rhyme tests in closed-answer inventories are discussed.
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Theelen–van den Hoek FL, Boymans M, van Dijk B, Dreschler WA. Adjustments of the amplitude mapping function: Sensitivity of cochlear implant users and effects on subjective preference and speech recognition. Int J Audiol 2016; 55:674-87. [DOI: 10.1080/14992027.2016.1202454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - Monique Boymans
- Clinical and Experimental Audiology, Academic Medical Center, Amsterdam, The Netherlands and
| | | | - Wouter A. Dreschler
- Clinical and Experimental Audiology, Academic Medical Center, Amsterdam, The Netherlands and
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Abstract
The investigation of speech intelligibility under quiet and noisy conditions is essential to evaluate the auditory and verbal rehabilitation of cochlear implant patients. A set of audiological tests is introduced that has been validated and optimized by empirical investigations in adult cochlear implant users. The Kiel logatom test, the Freiburg speech intelligibility test and the adaptive measurement of speech perception threshold in noise with the Oldenburg sentence test are methods suggested for clinical use, which are also applicable for scientific investigations. The test battery provides results that can be interpreted by every professional involved in the rehabilitation process of cochlear implant patients.
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