Self-report of cochlear implant use and satisfaction by prelingually deafened adults

Can Mandarin-speaking prelingual deaf adults benefit from cochlear implant?

BACKGROUND

With advances in cochlear implant (CI) technology, prelingual deaf adults may experience improved speech perception and quality of life (QoL). It is still a challenge for Mandarin-speaking CI user with tone recognition due to CI technology focused on intonation language.

OBJECTIVES

To evaluate the long-term post-CI auditory performance and social-emotional benefits in prelingual deaf Mandarin-speaking adults and the difference between them and post-lingual deaf adults.

MATERIAL AND METHODS

Fifty-five adult implanted ears were included (forty-six postlingual deaf group; nine prelingual deaf group). Post-CI long-term outcomes were using vowels, consonants, disyllabic words, Mandarin monosyllable words, categories of audiology performance, speech intelligibility rating, subjective social-emotional questionnaires.

RESULTS

Post-CI auditory performance and speech intelligibility of prelingual deafness adults was significantly inferior to that of those with postlingual deafness. However, both groups presented improved social-emotional benefits, with no significant difference between both groups.

CONCLUSIONS

Adult CI recipients who deaf before the age of 4 can experience benefits in social-emotional life functioning, regardless of their limited auditory performance and speech intelligibility. Therefore, prelingual Mandarin-speaking deaf adults, especially those using oral communication, can be considered as relative indications for cochlear implantation.

SIGNIFICANCE

To clarify and validate the benefits among Mandarin-speaking prelingual deaf adult recipients.

Cochlear Implant Outcomes: Quality of Life in Prelingually Deafened, Late-Implanted Patients

AIMS

Reevaluating and expanding cochlear implantation's (CI) indication while measuring the quality of life (QoL) outcomes regarding the parent's point of view of prelingually deafened, late-implanted patients, which are widely known to showcases a limited improvement in speech recognition.

MATERIALS AND METHODS

A retrospective descriptive and analytic study to assess QoL outcomes from CI in 64 early deafened, late-implanted patients, according to their parent's perspective, between January 2009 and December 2019, using the Nottingham Pediatric Cochlear Implant Program (Nottingham University Hospital, Nottingham, United Kingdom) "Children with cochlear implantation: parents perspective."

RESULTS

The most represented age interval is the 5 and 7 interval and the mean age is 10.09 years. There was no sex predominance, with rural origin and high school academicals level preponderance. Fourteen children had experienced neonatal icterus, eight had meningitis, and seven were the result of related marriage. The age of the first consultation was typically over 2 years old, with only 45 schooled children. Age had a significantly statistic correlation between Self-reliance and Well-being and happiness subscales. History of receiving aid and speech therapy has a clear correlation with Self-reliance, Well-being and happiness, and Communication and Education. Schooling statuses, sex, age of appearance, and communication mode were not correlated to any subscale score, and with the exception of Effect of implantation, all the other "Children with cochlear implantation: parent's perspective" subscales were intercorrelated.

CONCLUSION

Properly validated QoL assessments for CI are a must, as outcomes of CI expand beyond audiometric performances to include the improvement of QoL.

Functional Outcomes and Quality of Life after Cochlear Implantation in Patients with Long-Term Deafness

Background: Hearing-related quality of life (QoL) after cochlear implantation (CI) is as important as audiological performance. We evaluated the functional results and QoL after CI in a heterogeneous patient cohort with emphasis on patients with long-term deafness (>10 years). Methods: Twenty-eight patients (n = 32 implanted ears, within n = 12 long-term deaf ears) implanted with a mid-scala electrode array were included in this retrospective mono-centric cohort study. Speech intelligibility for monosyllables (SIM), speech reception thresholds (SRT50) and QoL with Nijmegen Cochlear Implant Questionnaire (NCIQ) were registered. Correlation of SIM and QoL was analyzed. Results: SIM and SRT50 improved significantly 12 months postoperatively up to 54.8 ± 29.1% and 49.3 ± 9.6 dB SPL, respectively. SIM progressively improved up to 1 year, but some early-deafened, late implanted patients developed speech understanding several years after implantation. The global and all subdomain QoL scores increased significantly up to 12 months postoperatively and we found a correlation of SIM and global QoL score at 12 months postoperatively. Several patients of the “poor performer” (SIM < 40%) group reported high improvement of hearing-related QoL. Conclusions: Cochlear implantation provides a benefit in hearing-related QoL, even in some patients with low postoperative speech intelligibility results. Consequently, hearing-related QoL scores should be routinely used as outcome measure beside standard speech understanding tests, as well. Further studies with a prospective multi-centric design are needed to identify factors influencing post-implantation functional results and QoL in the patient group of long-term deafness.

Identification and Discrimination of Sound Textures in Hearing-Impaired and Older Listeners

Sound textures are a broad class of sounds defined by their homogeneous temporal structure. It has been suggested that sound texture perception is mediated by time-averaged summary statistics measured from early stages of the auditory system. The ability of young normal-hearing (NH) listeners to identify synthetic sound textures increases as the statistics of the synthetic texture approach those of its real-world counterpart. In sound texture discrimination, young NH listeners utilize the fine temporal stimulus information for short-duration stimuli, whereas they switch to a time-averaged statistical representation as the stimulus' duration increases. The present study investigated how younger and older listeners with a sensorineural hearing impairment perform in the corresponding texture identification and discrimination tasks in which the stimuli were amplified to compensate for the individual listeners' loss of audibility. In both hearing impaired (HI) listeners and NH controls, sound texture identification performance increased as the number of statistics imposed during the synthesis stage increased, but hearing impairment was accompanied by a significant reduction in overall identification accuracy. Sound texture discrimination performance was measured across listener groups categorized by age and hearing loss. Sound texture discrimination performance was unaffected by hearing loss at all excerpt durations. The older listeners' sound texture and exemplar discrimination performance decreased for signals of short excerpt duration, with older HI listeners performing better than older NH listeners. The results suggest that the time-averaged statistic representations of sound textures provide listeners with cues which are robust to the effects of age and sensorineural hearing loss.

Systematic Review on Late Cochlear Implantation in Early-Deafened Adults and Adolescents: Clinical Effectiveness

OBJECTIVES

Cochlear implantation in early-deafened patients, implanted as adolescents or adults, is not always advised due to poor expected outcomes. In order to judge whether such reluctance is justified, the current systematic review aimed to gather all available evidence on postoperative outcomes obtained by early-deafened patients using a state-of-the art cochlear implant (CI).

DESIGN

Five electronic databases (PubMed, Embase, the Cochrane library, CINAHL, and PsycInfo) were systematically searched for studies in English, French, German, or Dutch, published between 2000 and September 2017. Studies that reported pre- and postoperative outcomes on any measure of speech or sound perception, audiovisual or subjective benefit (quality of life) were included. Study quality was assessed with the Institute of Health Economics quality appraisal tool for case series studies.

RESULTS

The systematic search and subsequent full-text evaluation identified 38 studies meeting the inclusion criteria. Only a limited number of studies were judged to be of high quality according to the Institute of Health Economics tool, with lack of (clear) presentation of relevant study information being a recurring problem. Twenty-five studies presented viable outcomes on open-set speech understanding in quiet: mean postoperative scores obtained with CI remained below 50% for the vast majority of studies; significant postoperative improvements were found in 16 studies, although this number might have been higher if appropriate statistical testing had been performed in all studies. Eight studies observed increased audiovisual performance after implantation, which was statistically significant in six studies. A validated measure of hearing-related quality of life was used in only 5 of the 16 studies assessing subjective outcomes, showing significant postoperative improvements for most questionnaire domains. The relation between auditory and subjective outcomes was assessed in two studies, with contradictory results.

CONCLUSIONS

The current review showed that late cochlear implantation in early-deafened subjects resulted in significantly improved open-set speech perception, audiovisual speech perception, and (hearing-related) quality of life in the majority of the studies involved. Nonetheless, more and especially higher-quality research is needed in order to gain a more detailed understanding of the outcomes of cochlear implantation in this population.

Predicting Performance and Non-Use in Prelingually Deaf and Late-Implanted Cochlear Implant Users

OBJECTIVE

To analyze postoperative hearing performance and independent predictors of speech perception and to assess cochlear implant nonuse in adults with prelingual deafness who received an implant during adulthood.

DESIGN

Retrospective cohort study including all prelingually deaf adults who received a cochlear implant at the University Medical Center Utrecht between 2000 and 2013.

SETTING

Tertiary referral center.

PATIENTS

Included were a total of 48 prelingually deaf patients diagnosed with severe to profound sensorineural hearing loss before the age of 2 years who received their implants during adulthood.

MAIN OUTCOME MEASURES

Postoperative monosyllabic word and sentence recognition scores.

RESULTS

The average maximum postoperative monosyllabic word score for all subjects was 25% correct. Preoperative speech perception and the extent of preoperative residual hearing were both positive independent predictors of postoperative speech recognition, explaining 47% of the variance. Almost half of the population experienced only little (27%) or no benefit (21%) of their implants in daily communication. These patients were more likely to have either no or only low-frequency residual hearing. Eventually, all subjects without any benefit became non-user.

CONCLUSIONS

Postoperative performance of adult, prelingually deaf cochlear implant candidates, with long-term deafness is dependent on their preoperative speech perception and residual hearing. Candidates who have negligible residual hearing are expected to have no or only limited postoperative benefit of their implants and are at risk of becoming nonusers.

Verbal Learning and Memory in Early-Implanted, Prelingually Deaf Adolescent and Adult Cochlear Implant Users

Purpose The purpose of this study was to investigate the information-processing strategies of early-implanted, prelingually deaf cochlear implant (CI) users with the California Verbal Learning Test-Second Edition (CVLT-II; Delis, Kramer, Kaplan, & Ober, 2000 ), a well-established normed measure of verbal learning and memory used in neuropsychological assessments of memory loss. Method Verbal learning and memory skills were compared in 20 older adolescent and young adult prelingually deaf long-term early-implanted CI users and their 24 normal hearing (NH) peers using the CVLT-II, a widely used multitrial free recall test of verbal learning and memory. Results On average, CI users recalled fewer words than their NH peers across the immediate, delayed, and cued recall trials of the CVLT-II but were comparable to their NH peers on yes/no recognition memory. CI users showed little evidence of semantic clustering of words during free recall but greater serial clustering compared to their NH peers, suggesting fundamental disturbances in automatic semantic activation of words from long-term memory. No differences were found in verbal memory between CI users and their NH peers on measures of retroactive interference and encoding/retrieval interactions. Performance on the 2nd word list of the CVLT-II (List B) and amount of semantic clustering of words during recall were correlated with sentence recognition in the CI group. Conclusion Study findings demonstrate significant differences in free recall performance and information-processing strategies that early-implanted, prelingually deaf CI users use to encode, organize, store, and retrieve spoken words in conventional verbal list learning paradigms, compared to their NH peers. Because verbal learning and memory are core foundational processes routinely used in daily functioning for a wide range of neurocognitive and language processing operations, these findings suggest potential domains for assessment and novel interventions to promote the development of optimal outcomes in prelingually deaf early-implanted long-term CI users.

Cochlear implant in prelingually deafened oralist adults: speech perception outcomes, subjective benefits and quality of life improvement

The aim of this study is to report our results in a group of prelingually deafened adults, who followed an oralist rehabilitation programme, and submitted to cochlear implant at our institution. We evaluated 30 prelingually deafened adult patients, 18 males and 12 females, median age 35 years, of a group of 36 prelingually deafened adult patients consecutively submitted to unilateral cochlear implantation at the ENT Unit of the University of Pisa. After implantation, patients achieved significant benefits in terms of speech perception skills, including the ability to have telephone conversations in some cases, quality of life and their own perception of disability. According to literature data, the results herein reported are quite variable but generally satisfactory. Procedures other than traditional speech perception measures should be used to evaluate the benefits of cochlear implant in such patients, to compressively evaluate the global benefits, not only in terms of speech perception, but also in terms of quality of life and daily life.

Late Cochlear Implantation in Early-Deafened Adults: A Detailed Analysis of Auditory and Self-Perceived Benefits

OBJECTIVES

It is known that early-deafened cochlear implant (CI) users are a very heterogeneously performing group. To gain more insight into this population, this study investigated (1) postoperative changes in auditory performance over time based on various outcome measures, focusing on poor performers, (2) self-perceived outcomes, (3) relations between auditory and self-perceived outcomes, and (4) preimplantation factors predicting postoperative outcomes.

METHODS

Outcomes were assessed prospectively in a group of 27 early-deafened, late-implanted CI users, up to 3 years after implantation. Outcome measures included open-set word and sentence recognition, closed-set word recognition, speech tracking and a questionnaire on self-perceived outcomes. Additionally, the relative influence of 8 preimplantation factors on CI outcome was assessed with linear regression analyses.

RESULTS

Significant improvements were found for auditory performance measures and most of the questionnaire domains. Significant changes of the closed-set word test, speech tracking and questionnaire were also found for a subgroup of poor performers. Correlations between auditory and self-perceived outcomes were weak and nonsignificant. Preoperative word recognition and preoperative hearing thresholds, both for the implanted ear, were significant predictors of postoperative outcome in the multivariable regression model, explaining 63.5% of the variation.

CONCLUSIONS

Outcome measurement in this population should be adjusted to the patients' individual performance level and include self-perceived benefit. There is still a need for more knowledge regarding predictors of CI outcomes in this group, but the current study suggests the importance of the preoperative performance of the ear to be implanted.

Intelligibility of the Patient's Speech Predicts the Likelihood of Cochlear Implant Success in Prelingually Deaf Adults

OBJECTIVES

The objective of this study was to determine the validity and clinical applicability of intelligibility of the patient's own speech, measured via a Vowel Identification Test (VOW), as a predictor of speech perception for prelingually deafened adults after 1 year of cochlear implant use. Specifically, the objective was to investigate the probability that a prelingually deaf patient, given a VOW score above (or below) a chosen cutoff point, reaches a postimplant speech perception score above (or below) a critical value. High predictive values for VOW could support preimplant counseling and implant candidacy decisions in individual patients.

DESIGN

One hundred and fifty-two adult cochlear implant candidates with prelingual hearing impairment or deafness took part as speakers in a VOW; 149 speakers completed the test successfully. Recordings of the speech stimuli, consisting of nonsense words of the form [h]-V-[t], where V represents one of 15 vowels/diphthongs ([(Equation is included in full-text article.)]), were presented to two normal-hearing listeners. VOW score was expressed as the percentage of vowels identified correctly (averaged over the 2 listeners). Subsequently, the 149 participants enrolled in the cochlear implant selection procedure. Extremely poor speakers were excluded from implantation, as well as patients who did not meet regular selection criteria as developed for postlingually deafened patients. From the 149 participants, 92 were selected for implantation. For the implanted group, speech perception data were collected at 1-year postimplantation.

RESULTS

Speech perception score at 1-year postimplantation (available for 77 of the 92 implanted participants) correlated positively with preimplant intelligibility of the patient's speech, as represented by VOW (r = 0.79, p < 0.00001): the more intelligible the patient's speech, the higher the predicted postimplant speech perception score. This correlation is explained by the hypothesis that the two variables have a common driving force, i.e., (in)adequacy of auditory speech input in the earliest years of life. With a 60% cutoff point, VOW can discriminate between individuals with "above-chance" postimplant speech perception and those with "chance level" postimplant speech perception with sensitivity and specificity of 0.84 and 0.86, respectively. The probability that a patient with a VOW score ≥ 60% achieves "above-chance" speech perception after implantation is 0.91. Conversely, the probability that a patient with VOW < 60% reaches "above-chance" speech perception is 0.25.

CONCLUSIONS

For prelingually deaf adults, intelligibility of the patient's speech-as represented by VOW-is a valid predictor of postimplant speech perception. A patient with a VOW score above a preset cutoff is much more likely to develop acceptable speech perception after implantation than a patient with a VOW score below that cutoff. The binary classification based on VOW and the associated probabilities of cochlear implant success in terms of speech perception can be used-in addition to existing criteria-to support the clinician in guiding patient expectations and in considering implant candidacy for individual patients.

The Relationship Between Environmental Sound Awareness and Speech Recognition Skills in Experienced Cochlear Implant Users

HYPOTHESIS

1) Environmental sound awareness (ESA) and speech recognition skills in experienced, adult cochlear implant (CI) users will be highly correlated, and, 2) ESA skills of CI users will be significantly lower than those of age-matched adults with normal hearing.

BACKGROUND

Enhancement of ESA is often discussed with patients with sensorineural hearing loss as a potential benefit of implantation and, in some cases, ESA may be a major motivating factor. Despite its ecological validity and patients' expectations, ESA remains largely a presumed skill. The relationship between ESA and speech recognition is not well-understood.

METHODS

ESA was assessed in 35 postlingually deaf, experienced CI users and a control group of 41 age-matched, normal hearing listeners using the validated, computerized familiar environmental sounds test-identification (FEST-I) and a diverse speech recognition battery. Demographic and audiological factors as well as nonverbal intelligence quotient (IQ)/nonverbal reasoning and spectral resolution were assessed.

RESULTS

Six of the 35 experienced CI users (17%) demonstrated FEST-I accuracy within the range of the NH controls. Among CI users all correlations between FEST-I accuracy and speech recognition scores were strong. Chronological age at the time of testing, duration of deafness, spectral resolution, and nonverbal IQ/nonverbal reasoning were strongly correlated with FEST-I accuracy. Partial correlation analysis showed that correlations between FEST-I and speech recognition measures remained significant when controlling for the demographic and audiological factors.

CONCLUSION

Our findings reinforce the hypothesis that ESA and speech perception share common underlying processes rather than reflecting truly separate auditory domains.

The relationship between the speech perception and the degree of satisfaction among adult users of cochlear implants

Introduction: In recent years, the benefits associated with the use of cochlear implants (CIs), especially with regard to speech perception, have proven to surpass those produced by the use of hearing aids, making CIs a highly efficient resource for patients with severe/profound hearing loss. However, few studies so far have assessed the satisfaction of adult users of CIs.

Objective: To analyze the relationship between the level of speech perception and degree of satisfaction of adult users of CI.

Method: This was a prospective cross-sectional study conducted in the Audiological Research Center (CPA) of the Hospital of Craniofacial Anomalies, University of São Paulo (HRAC/USP), in Bauru, São Paulo, Brazil. A total of 12 users of CIs with pre-lingual or post-lingual hearing loss participated in this study. The following tools were used in the assessment: a questionnaire, “Satisfaction with Amplification in Daily Life” (SADL), culturally adapted to Brazilian Portuguese, as well as its relationship with the speech perception results; a speech perception test under quiet conditions; and the Hearing in Noise Test (HINT)Brazil under free field conditions.

Results: The participants in the study were on the whole satisfied with their devices, and the degree of satisfaction correlated positively with the ability to perceive monosyllabic words under quiet conditions. The satisfaction did not correlate with the level of speech perception in noisy environments.

Conclusion: Assessments of satisfaction may help professionals to predict what other factors, in addition to speech perception, may contribute to the satisfaction of CI users in order to reorganize the intervention process to improve the users' quality of life.

The impact of cochlear implantation on cognition in older adults: a systematic review of clinical evidence

Background

Hearing loss is the third most prevalent chronic condition faced by older adults and has been linked to difficulties in speech perception, activities of daily living, and social interaction. Recent studies have suggested a correlation between severity of hearing loss and an individual’s cognitive function; however, a causative link has yet to be established. One intervention option for management of the most severe to profound hearing loss in older adults is cochlear implantation. We performed a review to determine the status of the literature on the potential influence of cochlear implantation on cognition in the older adult population.

Methods

Over 3800 articles related to cochlear implants, cognition, and older adults were reviewed. Inclusion criteria were as follows: (1) study population including adults > 65 years, (2) intervention with cochlear implantation, and (3) cognition as the primary outcome measure of implantation.

Results

Out of 3,886 studies selected, 3 met inclusion criteria for the review.

Conclusions

While many publications have shown that cochlear implants improve speech perception, social functioning, and overall quality of life, we found no studies in the English literature that have prospectively evaluated changes in cognitive function after implantation with modern cochlear implants in older adults. The state of the current literature reveals a need for further clinical research on the impact of cochlear implantation on cognition in older adults.

Delayed prelingual cochlear implantation in childhood and puberty

OBJECTIVE

To evaluate the results of delayed cochlear impantion performed in childhood and puberty in the light of speech language pathology assessments.

METHODS

Totally 49 children with prelingual profound hearing loss were included in the study. All children received a cochlear implant between the ages of 5 and 19 years (Group 1 aged between 5 and 9 years, group 2 aged between 10 and 14 years, group 3 aged between and 15 and 19 years). The MAIS, MUSS and PLS-4 scores of children were evaluated one month before, and one year and two years after the operation. The descriptive statistics included several independent variables; age of implantation; gender; trade name of the implant; preoperative duration of hearing aid use; preoperative special education, family support and additional handicap. These variables were categorical variables. We used repeated measures analysis of variance to test improvements in MAIS, MUSS and PLS scores, and whether this improvement depend on the independent variables. In addition, we also tested the interaction between time and the independent variables.

RESULTS

The preoperative MAIS, MUSS and language scores were significantly higher in older children compared to younger children (p<0.01). After two years these scores were similar between the all age groups (p>0.4). There was a significant age and time interaction (p=0.005). That is, improvement continued in all age groups in a parallel way and group 2 reached to the level of group 1 after two years. However, group 3 almost reached to a plateau level after two years. The family support was associated with the MAIS, MUSS and language scores of the patients (p=0.01), and there was a family support-time interaction (p<0.0001). In group 1 and 2, the way of communication shifted from total communication (lip reading, sign language, auditory) to auditory-verbal communication in a significant number of the patients (p<0.01). However, that change in the way of communication was not statistically significant in group 3 (p>0.05).

CONCLUSION

The decision of delayed cochlear implantation in children can be made in the light of following parameters. A good family support is most important. The patients must be wearing hearing aids regularly since early childhood, and preferably use the auditory verbal communication. Evaluation of the patient with MAIS, MUSS and PLS is important to understand the level of receptive and expressive communication level.

Cochlear implantation in late-implanted prelingually deafened adults: changes in quality of life

BACKGROUND

With expanding inclusion criteria for cochlear implantation, the number of prelingually deafened persons who are implanted as adults increases. Compared with postlingually deafened adults, this group shows limited improvement in speech recognition. In this study, the changes in health-related quality of life in late-implanted prelingually deafened adults are evaluated and related to speech recognition.

METHODS

Quality of life was measured before implantation and 1 year after implantation in a group of 28 prelingually deafened adults, who had residual hearing and who used primarily oral communication. Patients completed 3 questionnaires (Nijmegen Cochlear Implant Questionnaire, Glasgow Benefit Inventory, and Health Utility Index 3). Postoperative scores were compared with preoperative scores. Additionally, phoneme recognition scores were obtained preimplantation and 1 year postimplantation.

RESULTS

Quality of life improved after implantation: scores on the Nijmegen Cochlear Implant Questionnaire improved significantly in all subdomains (basic speech perception, advanced speech perception, speech production, self-esteem, activity, and social interaction), the total Glasgow Benefit Inventory score improved significantly, and the Health Utility Index 3 showed a significant improvement in the utility score and in the subdomains "hearing" and "emotion." Additionally, a significant improvement in speech recognition scores was found. No significant correlations were found between gain in quality of life and speech perception scores.

CONCLUSION

The results suggest that quality of life and speech recognition in prelingually deafened adults significantly improved as a result of cochlear implantation. Lack of correlation between quality of life and speech recognition suggests that in evaluating performance after implantation in prelingually deafened adults, measures of both speech recognition and quality of life should be used.

The effects of behavioral speech therapy on speech sound production with adults who have cochlear implants

PURPOSE

In this study, the authors examined the treatment efficacy of a behavioral speech therapy protocol for adult cochlear implant recipients.

METHOD

The authors used a multiple-baseline, across-behaviors and -participants design to examine the effectiveness of a therapy program based on behavioral principles and methods to improve the production of target speech sounds in 3 adults with cochlear implants. The authors included probe items in a baseline protocol to assess generalization of target speech sounds to untrained exemplars. Pretest and posttest scores from the Arizona Articulation Proficiency Scale, Third Revision (Arizona-3; Fudala, 2000) and measurement of speech errors during spontaneous speech were compared, providing additional measures of target behavior generalization.

RESULTS

The results of this study provided preliminary evidence supporting the overall effectiveness and efficiency of a behavioral speech therapy program in increasing percent correct speech sound production in adult cochlear implant recipients. The generalization of newly trained speech skills to untrained words and to spontaneous speech was demonstrated.

CONCLUSION

These preliminary findings support the application of behavioral speech therapy techniques for training speech sound production in adults with cochlear implants. Implications for future research and the development of aural rehabilitation programs for adult cochlear implant recipients are discussed.

Long term results in late implanted adolescent and adult CI recipients

The aim of the present study is to assess long-term outcomes of CI in prelingual deafened adolescents and adults, describing, where present, differences in performance, self perceived benefit and highlighting specific characteristics. Twenty-three patients were enrolled: 10 adolescents, 13 young adults. Each patient underwent speech perception/language development, psychological evaluation and structured interviews on self perception concerning CI. 70 % adolescents and 100 % adults used their cochlear implant for most of the day; two adolescents were partial users and one was a non-user. Adolescents' average word recognition and comprehension scores improved respectively from 7 to 29.8 % (p = 0.01) and 3 to 26 % (p = 0.1). Adults' average scores improved significantly from 1.5 to 41.9 % (p = 0.01) and from 18.5 to 52.7% (p = 0.001), respectively. None of the subjects showed a linguistic age adequate to the chronological one: average linguistic age was 7.6 years for adolescents and 19.3 for adults. Structured interviews showed improvement in self-esteem. Adults and most adolescents were fully or moderately satisfied with their implant. Cochlear implantation can be considered a valid option for the rehabilitation of highly motivated and well-selected pre-lingual deafened adolescents and adults. Although there is a substantial variability in both groups of patients and language skills are only marginally influenced by CI, there is still a significant improvement in speech perception. CI was described by both groups as having had a positive impact on their lives; nevertheless adolescents were the ones with a tendency to under-use CI, even those with better hearing outcomes.

Cochlear implant outcomes in adults and adolescents with early-onset hearing loss

OBJECTIVES

The aims of the study were to investigate (1) speech perception outcomes in people with an early-onset hearing loss (HL) who received a cochlear implant as an adolescent or adult, (2) prognostic factors associated with positive speech perception outcomes, and (3) self-report outcomes in these participants.

DESIGN

Outcomes for 38 implant recipients with a Nucleus device were investigated retrospectively. All participants were diagnosed with a bilateral HL at age #3 yr and were implanted at age 14 yr or older. Nineteen participants had confirmed bilateral, severe to profound HL at age #12 mo (prelingual); nine had confirmed bilateral, severe to profound HL at age.12 mo and #3 yr (perilingual); and the remaining 10 had a diagnosis of bilateral sensorineural HL at age #3 yr which progressed to severe to profound HL after 3 yrs of age (progressive). There were 24 females and 14 males, and the average age at implantation was 33 yr (range 5 14-65 yr). Closed-set and open-set speech perception tests administered pre- and postimplant were analyzed for all participants, in addition to self-report survey measures of benefit, satisfaction, and implant usage.

RESULTS

Participants were placed into one of five hierarchic categories of speech perception performance preimplantation and at 12 mo postimplantation. The categories ranged from sound detection only (category 1) to excellent open-set speech perception (category 5). To be in category 4 or 5, the participant had to score.30% words correct on a recorded version of either the Central Institute for the Deaf Everyday Sentence Lists or the City University of New York Sentences. Before implantation, two recipients (5%) were in category 4 or 5 compared with 20 (53%) at 12 mo postimplant. Consistent with previous studies, there was large intersubject variability in speech scores. Three factors accounted for 63% of the variance on open-set sentence test scores, postimplant: mode of communication in childhood (oral versus total communication/sign), stable as opposed to progressive loss, and time without a hearing aid on the implant ear. More than 80% of survey respondents used their device.8 hr a day, and 90% reported that their ability to understand speech with visual cues was "much better" with the implant. In addition, all reported being satisfied with the device.

CONCLUSION

These results indicate that a cochlear implant should be considered as an option for adults and adolescents with early-onset HL. The majority of participants gained benefit from the device and were satisfied with it. In addition, a substantial number gained good open-set speech perception ability, postimplant. Recipients who used oral communication in childhood, had a progressive loss, and wore a hearing aid on the implant ear up to the time of surgery were more likely to obtain better speech perception outcomes.

Cochlear implantation in children with postlingual hearing loss

OBJECTIVES/HYPOTHESIS

Although it is clear that early auditory stimulation through cochlear implantation (CI) has been shown to improve speech and language development trajectories for children with prelingual hearing loss, data supporting implantation in postlingual children are mostly lacking. The purpose of this study was to characterize speech perception abilities following CI in a group of children with previously well-developed language abilities.

STUDY DESIGN

Retrospective analysis.

METHODS

Twenty-eight hearing-impaired children who received CIs were selected for study based on the presence of well-developed spoken language skills before implantation. Fifteen children with prelingual hearing loss served as a control group. Speech perception skills were assessed using developmentally appropriate measures.

RESULTS

Children with postlingual hearing loss showed a statistically significant improvement in open-set speech perception scores as early as 6 months following CI, whereas prelingual children demonstrated significant improvements only after 24 months of use. Despite these early disparities in performance, the two groups were similar 36 months after implantation and beyond (60 months of implant use).

CONCLUSIONS

Children with well-developed language abilities before CI showed substantial (and statistically significant) early improvements in open-set speech perception abilities following implantation that continued beyond 2 years of follow-up. These results suggest that postlingual children are excellent candidates for CI.

Speech intelligibility as a predictor of cochlear implant outcome in prelingually deafened adults

OBJECTIVES

Among adult patients with prelingual deafness, interindividual variability in speech perception outcome after cochlear implantation is generally large. It was hypothesized that the intelligibility of the patient's own speech may be predictive of speech perception with a cochlear implant. The objectives were (1) to provide a validation of a new test battery as a measurement tool for intelligibility using a group of prelingually deafened patients; (2) to investigate the validity of the test battery as a predictor of postimplant speech perception, based on preliminary data with a cochlear implant from a subgroup of patients; and (3) to investigate the validity of the test battery as a predictor of postimplant health-related quality of life (HRQoL) for the same subgroup of patients.

DESIGN

Twenty-five adult cochlear implant candidates with prelingual deafness participated in this study. Average age at onset of deafness was 8 mos (range 0 to 4 yrs). Speech samples from the participants were recorded and presented to two normal-hearing listeners. Results from the seven intelligibility tests in the battery were subjected to analyses of reliability and validity. Furthermore, the multiple test outcomes were submitted to a Principal Component Analysis to investigate the possibility of summarizing the data. Subsequently, from the group of 25 participants, 9 participants with above-average intelligibility were selected for implantation. Speech perception data with a cochlear implant from the nine implantees were collected at 12 mos postimplantation, as well as HRQoL data. Predictive validity of the intelligibility test battery was determined, using the postimplant data as the criterion.

RESULTS

Results from the 25 participants averaged over listeners showed that all tests in the battery had good reliability and validity as measures of intelligibility. Principal Component Analysis showed that the multiple test outcomes could be summarized by a single underlying variable. Despite the early age at onset of deafness, the subgroup of nine participants who received a cochlear implant included several good performers in terms of speech perception with the implant. The intelligibility test battery summary score had good validity as a predictor of postimplant outcome: the more intelligible the participant's speech, the better his or her speech perception outcome with the cochlear implant. Availability of effective auditory input in early life may be the fundamental factor underlying the potential for speech perception with a cochlear implant in later life. The intelligibility test battery can be reduced to a single test to minimize testing time without negatively affecting its predictive validity. Predictive validity of the intelligibility test battery can be generalized to HRQoL outcomes of cochlear implantation, provided these outcomes are concerned with speech processing abilities.

CONCLUSIONS

The new test battery (or its reduced version), used as a measure of intelligibility, is a promising tool for guiding cochlear implant candidacy decisions and counseling for individual patients with prelingual deafness. Because intelligibility has superior predictive power in comparison to age at onset of deafness, the latter should be discarded as an exclusion criterion for cochlear implantation.

Delayed cochlear implantation in adults with prelingual severe-to-profound hearing loss

OBJECTIVES

To evaluate the results of late cochlear implantation in prelingually deaf patients with significant residual hearing loss and to evaluate patient factors relevant to postoperative auditory outcomes in this patient group.

STUDY DESIGN

Analysis of results of cochlear implantation using postoperative speech perception test scores per each condition.

SETTING

Tertiary referral center.

PATIENTS

Thirty-two subjects with severe to profound hearing loss that developed before the age of 4.

INTERVENTIONS

Subjects were implanted at a mean age of 24.8 years (range, 16-44) with Nucleus CI24 (n = 18, 56%), Clarion HiRes 90K (n = 11, 34%), and Medel PULSA (n = 3, 10%) device. Details of etiology, duration of deafness, hearing aid history, hearing thresholds before operation, communication mode, and educational environment were investigated. Speech perception tests were performed preoperatively and 12 months after the operation.

MAIN OUTCOME MEASURES

Postoperative speech perception test scores between different options within patient group.

RESULTS

: The results showed significant improvement in open set speech perception (sentence) scores after the implantation (mean scores from 7.0 to 46.7, p < 0.05). Preoperative hearing of better ear and preoperative speech perception scores correlated with postoperative performances (r = -0.70 and r = 0.46, respectively, p < 0.05). Education and communication mode were also closely related to postoperative performances. In the group with poorer performances, preoperative hearing thresholds were significantly worse than those with better performances, and a larger portion of those patients attended special schools and used sign language.

CONCLUSION

We found that residual auditory capacity in the better ear is an important factor in predicting outcomes after cochlear implantation in patients with prelingual hearing loss.

Cochlear implantation in late-implanted adults with prelingual deafness

PURPOSE

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.

MATERIALS AND METHODS

Thirty-eight adults participated. Four self-report questionnaires were used at 2 points in time: before and after CI.

RESULTS

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.

CONCLUSIONS

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.

Cochlear implant-mediated perception of nonlinguistic sounds

OBJECTIVES

The overwhelming majority of test measures to assess cochlear implant (CI) candidacy, efficacy, and progress are based on speech perception. Nonlinguistic sounds, such as alerting and nonspeech human generated sounds, have received comparatively little attention, despite their central importance for daily living and environmental sound awareness. The purposes of this study were to develop and validate a beta test measure of nonlinguistic sound perception and to assess performance in CI users.

DESIGN

A beta test of nonlinguistic sound perception, referred to as the NonLinguistic Sounds Test (NLST) was developed. The NLST consists of 50 sound tokens distributed over five categories (animal, human nonspeech, mechanical/alerting, nature, and musical instruments). Both closed-set (category identification) and open-set (token identification) nonlinguistic sound perceptions were examined. Twenty-two postlingually deafened CI users (mean age, 59.4 +/- 10 yrs) were evaluated using common speech perception test measures (Hearing In Noise test and Consonant-Nucleus-Consonant words) and the NLST following a pilot study in which nonlinguistic sound tokens used were selected or eliminated.

RESULTS

The NLST was easily administered to all 22 CI subjects. An overall token identification score of 49 +/- 13.5% correct was obtained across all five categories. CI users were able to identify the correct category for 71 +/- 11.5% of tokens. A moderate correlation between speech perception and accuracy of nonlinguistic identification was found (r = 0.519, p = 0.016).

CONCLUSIONS

The results suggest that nonlinguistic sounds are difficult for CI users to perceive. The categorization and identification scores suggest that sounds with harmonic structure or sounds with repetitive temporal structure are easier for CI users to perceive. A further developed clinical version of the NLST may be a useful clinical test to measure CI performance and progress, and perception of nonlinguistic sounds should receive greater attention during postimplant auditory rehabilitation.

Perception of speech by prelingual pre-adolescent and adolescent cochlear implant users

This study was undertaken to assess the speech perception benefits, 24 months after cochlear implantation (CI), in 20 young people (age at CI, 8-18.5 years) with prelingual profound hearing loss, in addition to the use of a proposed CI candidacy assessment profile. Speech perception was evaluated in terms of word and sentence perception before CI, and at six-monthly intervals for two years after CI. Before undergoing CI, all participants were tested on a pre-implantation assessment profile. Compared to the pre-CI findings, group results over 24 months post-CI demonstrated improved speech perception abilities reaching, on average, 46% for word recognition, 71.3% for sentences in quiet, and 33.6% for sentences in noise. Pre-CI profile scores correlated significantly with all speech perception results obtained 24 months after CI. Thus, despite their relatively late ages at implantation, all participants showed gradually improving performance in speech perception. The results showed a high variability in the outcomes of the participants. The pre-CI profile appeared to be useful in formulating realistic expectations of CI outcome during pre-implantation consultations, suggesting that expectations can and should be managed according to each patient's pre-implantation assessment.

Speech perception and auditory performance in finnish adult cochlear implant users

OBJECTIVE

This study aimed at investigating the association between speech perception and categories of auditory performance (mCAP) in everyday life for adult cochlear implant users.

DESIGN

A prospective repeated measures design over a two-year follow-up period was used.

METHODS

The speech perception and auditory performance of 19 Finnish-speaking adults were assessed before implantation and 1, 3, 6, 12 and 24 months after switching on the implant. Spearman's rank order correlation coefficients (r(s)) were calculated between mCAP and sentence, word, syllable, vowel and consonant recognition. Pearson's product moment correlation coefficients (r) were calculated among the speech perception results.

RESULTS

The correlation between mCAP and the speech perception results was high and statistically significant (r(s) = 0.81-0.85, p 0.0001), as well as the correlation among the speech perception tests (r = 0.79-0.92, p 0.0001).

CONCLUSIONS

The speech perception tests used may be considered as good describers of everyday performance of the subjects of this investigation.

Identification of environmental sounds with varying spectral resolution

OBJECTIVES

This study investigated the identification of familiar environmental sounds with varying spectral resolution to establish (1) the number of frequency channels needed to perceive a large heterogeneous set of familiar environmental sounds, (2) the role of cross-channel asynchrony in identification performance, and (3) the acoustic correlates of the spectral resolution required for identification.

DESIGN

In experiment 1, 60 normal-hearing listeners identified environmental sounds in a 60-alternative closed--set response task as a function of six spectral resolution conditions (i.e., 2, 4, 8, 16, 24, and 32 frequency channels) obtained with an envelope-vocoder. In experiment 2, identification accuracy for varying amounts of cross-channel asynchrony was determined for sounds with preserved and degraded fine spectral structure in 10 normal-hearing listeners. Experiment 3 examined identification performance of 72 listeners across six spectral resolution conditions as in experiment 1, but using three different signal processing methods designed to minimize cross-channel asynchrony across channels. Follow-up acoustic and discriminant analyses were carried out to identify parameters that can distinguish environmental sounds based on required spectral resolution.

RESULTS

Identification accuracy tended to improve with increasing spectral resolution reaching the maximum of 76%. However, in experiment 1, performance did not change significantly beyond eight channels, whereas identification accuracy of some sounds declined with increasing spectral resolution. In experiment 2, increases in cross-channel asynchrony for sounds with preserved fine spectra had a small, but significant negative effect on identification. However, minimizing the amount of asynchrony had no significant effect on the overall identification of spectrally degraded sounds in experiment 3. Acoustic analysis indicated several spectral and temporal measures that differed significantly between sounds that required eight or fewer channels and those that required 16 or more channels for 70% correct identification. Discriminant analysis revealed that the sounds could be classified into high- and low-required spectral resolution groups with 83% accuracy based on only two acoustic parameters: the number of bursts in the envelope and the standard deviation of spectral centroid velocity.

CONCLUSIONS

Increasing spectral resolution generally had a positive effect on identification of familiar environmental sounds. However, across conditions performance accuracy remained well-below that of control stimuli with preserved fine spectra, despite becoming asymptotic above eight channels. Cross-channel asynchrony introduced during vocoder processing, although detrimental for some sounds, was not a major factor that prevented further improvement in overall accuracy. A spectral resolution greater than 32 channels, along with additional fine spectral and temporal information may be required for identification of a number of environmental sounds. This study provides a preliminary basis for optimizing environmental sound perception by cochlear implant users by highlighting the role of several acoustic factors important for environmental sound identification.

Cochlear Implant Outcomes and Quality of Life in Adults with Prelingual Deafness

OBJECTIVES

To evaluate sound and speech perception and quality of life in prelingually deafened adults implanted with state of the art devices. To investigate which patient factors influence postoperative performance.

STUDY DESIGN

Prospective intervention study.

METHODS

Eight prelingually deafened subjects (with onset of severe hearing impairment before the age of 4 years and functioning in an oral-aural setting) participated in this study. Subjects were implanted at a mean age of 36 (range, 21-55) years with a CII or 90 K cochlear implant (Advanced Bionics Corp.). All subjects completed standard speech perception tests as well as quality of life measures (Health Utility Index Mark-II, Nijmegen Cochlear Implant Questionnaire, visual analogue scale for subject's hearing and health) at different points in time. Postoperative scores were compared with each other and with the baseline preoperative scores. The relationship between nine patient variables and the postoperative consonant-vowel-consonant (CVC) phoneme score was also investigated.

RESULTS

Significant improvement was measured for CVC word and phoneme scores and several quality of life measures. Postoperative speech perception correlated with a new and promising factor named quality of a patient's own speech production (QoSP).

CONCLUSION

With state of the art implants, speech perception and quality of life do improve in prelingually deafened adults. More importantly, the prognostic value of QoSP should be investigated further.

Cognitive Predictors of Improvements in Adults’ Spoken Word Recognition Six Months after Cochlear Implant Activation

This study investigated whether cognitive measures obtained prior to cochlear implant surgery activation could predict improvements in spoken word recognition in adult cochlear implant recipients 6 months after activation. In addition to noncognitive factors identified by previous studies (i.e. younger age, shorter duration of hearing loss), the present results indicated that improvement in spoken word recognition was associated with higher verbal learning scores and better verbal working memory. Contrary to expectation, neither general cognitive ability nor processing speed was significantly correlated with outcome at 6 months. Multiple regression analyses revealed that a combination of verbal learning scores and lip-reading skill accounted for nearly 72% of the individual differences in improvement in spoken word recognition (i.e. the variance in spoken word recognition scores at 6 months that remained unexplained after controlling for baseline spoken word recognition scores). These findings have relevance for research on auditory processing with cochlear implants as well as implications for clinical interventions.

[Subjetive benefits and limitations in relation with the cochlear implant reported by adolescent and adult patients]

OBJECTIVE

To identify the subjetive benefits and limitations of the pre and postlingually adolescent and adult patients of the cochlear implants program at Clinical Hospital San Cecilio (Granada).

MATERIAL AND METHODS

Cross-sectional study of 60 pre and postlingually deaf patients who received cochlear implant with more than 12 years and at least a year of experience. A open-ended questionnaire was used to value their subjetive experience. A descriptive analysis was made and we applied the square Chi and Mann-Withney tests.

RESULTS

The average implant usage per day was greater in the postlingually patients (14.6 hours) that in the prelingually (10.4 hours). Between the acoustic benefits, both more frequent were the perception of environmental sounds and the possibility of to converse easier, specially with one or two persons. The benefit more indicated by the patients was the improvement in its mood. The perception in noise situations was the difficulty more indicated by all patients. The problems, in relation with the device, more frequently indicated were the size and the weight.

CONCLUSION

the cochlear implant provides subjetive benefits to the patients that complement their improvement in perception of the oral language and facilitate the re/integration of the deaf patients at his work and in his social life. Therefore, the speech perception tests must be complemented with another type of materials to value the result of the cochlear implant and then we will can to speak of success or failure.

Improved Speech Perception in Adult Congenitally Deafened Cochlear Implant Recipients

OBJECTIVE

To determine whether congenitally deafened adults achieve improved speech perception when auditory and visual speech information is available after cochlear implantation.

STUDY DESIGN

Repeated-measures single subject analysis of speech perception in visual-alone, auditory-alone, and audiovisual conditions.

SETTING

Neurotologic private practice and research institute.

SUBJECTS

Eight subjects with profound congenital bilateral hearing loss who underwent cochlear implantation as adults (aged 18-55 years) between 1995 and 2002 and had at least 1 year of experience with the implant.

MAIN OUTCOME MEASURES

Auditory, visual, and audiovisual speech perception.

RESULTS

The median for speech perception scores were as follows: visual-alone, 25.9% (range, 12.7-58.1%); auditory-alone, 5.2% (range, 0-49.4%); and audiovisual, 50.7% (range, 16.5-90.8%). Seven of eight subjects did as well or better in the audiovisual condition than in either auditory-alone or visual-alone conditions alone. Three subjects had audiovisual scores greater than what would be expected from a simple additive effect of the information from the auditory-alone and visual-alone conditions alone, suggesting a superadditive effect of the combination of auditory-alone and visual-alone information. Three subjects had a simple additive effect of speech perception in the audiovisual condition.

CONCLUSION

Some congenitally deafened subjects who undergo implantation as adults have significant gains in speech perception when auditory information from a cochlear implant and visual information by lipreading is available. This study shows that some congenitally deafened adults are able to integrate auditory information provided by the cochlear implant (despite the lack of auditory speech experience before implantation) with visual speech information.

Bioengineering Solutions for Hearing Loss and Related Disorders

Advances in digital signal processing, microelectronics, and power technology have produced devices that have contributed significantly to the quality of life and communication abilities of individuals with hearing impairment and tinnitus. Future technological developments will expand the benefits of current devices and offer new treatments for otologic disorders.

Pediatric Cochlear Implant Patient Performance as a Function of Age at Implantation

OBJECTIVE

The objective of this study was to examine the effect that age at implantation has on performance of children who received multichannel cochlear implants.

STUDY DESIGN

This is a retrospective study of 295 children who were broken down into 5 age groups based on age at implantation: 1-3 years, 3-5 years, 5-7 years, 7-9 years, and 9-11 years. Speech perception test scores obtained 12, 24, and 36 months postactivation were compared for the 5 groups using repeated-measures analysis of variance.

SETTING

This study was carried out at a tertiary academic medical center.

PATIENTS

Subjects consisted of 295 children who ranged in age from 12 months to 10 years 11 months at the time they obtained their cochlear implant.

INTERVENTION

All patients received their cochlear implant at a single implant facility.

MAIN OUTCOME MEASURES

Performance on several speech perception tests was compared 12, 24, and 36 months postactivation. Performance was evaluated as a function of age at implantation.

RESULTS

Patients in all 5 groups demonstrated improved scores when compared with scores obtained preoperatively with hearing aids. Repeated-measures analysis of variance (ANOVA) revealed a significant group by time interaction for 3 of the 5 measures. For all three of these measures, children implanted at younger ages demonstrated greater gains in speech perception over time than children implanted at older ages.

CONCLUSIONS

These results are in agreement with those of previous studies indicating that early implantation facilitates improved development of speech perception skills in profoundly deaf children.

Pediatric cochlear implantation-I : Candidacy

The cochlear implant is a successful means of intervention to facilitate the perception of sound and oral communication for children with severe to profound sensorineural hearing loss. Often, the cochlear implantation process is viewed as being limited to a surgical procedure, rather than an entire process of medical, audiological, psychosocial, educational and therapeutic, management. In India, cochlear implantation is available in only a few large cities. Here, the otolaryngologist will direct the cochlear implant programme. Besides determination of medical candidacy, device implantation and medical management, the otolaryngologist is responsible to ensure that other aspects of cochlear implant management are implemented. This paper, the first of two that describe the multidisciplinary, team approach of the Pediatric Cochlear Implant Program of The Children's Hospital of Philadelphia (CHOP), in Pennsylvania, USA, discusses the non-medical aspects of cochlear implant candidacy. A second article will follow that covers post-implantation follow- up. The various speech tests used at CHOP for assessment are based on the English language. They may be translated into the regional Indian languages where the assessment and training can be carried out accordingly.

Cochlear implantation for adolescents and adults with prelinguistic deafness

OBJECTIVE

Previous studies have suggested that individuals with long-term prelinguistic deafness who receive cochlear implants show little improvement in speech recognition skills. The purpose of this study was to examine the auditory functioning of individuals with prelinguistic deafness who received cochlear implants after the age of 12.

STUDY DESIGN AND SETTING

A retrospective study of open-set speech recognition was undertaken for 15 patients (adolescents and adults) with prelinguistic deafness who underwent implantation in the Ottawa Cochlear Implant Program. The results of open-set speech perception tests, both words and sentences, were reviewed to assess auditory functioning after implantation. Qualitative data using the Performance Inventory for Profound and Severe Loss questionnaire were also collected for the adults.

RESULTS AND DISCUSSION

The results of this study indicate that individuals with long-term prelinguistic deafness can achieve significant open-set speech understanding with a cochlear implant, although there is a wide range of performance across patients. The results ranged from 0% to 74% for words and 0% to 98% for sentences.

Rapid development of cortical auditory evoked potentials after early cochlear implantation

The aim of our research was to estimate the time course of development and plasticity of the human central auditory pathways following cochlear implantation. We recorded cortical auditory-evoked potentials in 3-year-old congenitally deaf children after they were fitted with cochlear implants. Immediately after implantation cortical response latencies resembled those of normal-hearing newborns. Over the next few months, the cortical evoked responses showed rapid changes in morphology and latency that resulted in age-appropriate latencies by 8 months after implantation. Overall, the development of cortical response latencies for the implanted children was more rapid than for their normal-hearing age-matched peers. Our results demonstrate a high degree of central auditory system plasticity during early human development.

Delayed implantation in congenitally deaf children and adults

OBJECTIVE

To determine the efficacy of cochlear implants with current processing strategies in children and adults with long-term congenital deafness, and to determine whether the growth of auditory perceptual skills in these patients is similar to the data reported for patients who have undergone implantation with earlier devices and coding strategies.

STUDY DESIGN

A prospective study of children and adults fulfilling the study inclusion criteria.

SETTING

University medical center.

PATIENTS

Thirty-five congenitally deaf children who received implants after the age of 8 years and 14 congenitally deaf adults who received implants as adults participated in this study. Length of device use ranged from 6 months to 3 years.

MAIN OUTCOME MEASURES

Open set phoneme, word recognition tests, and sentence recognition tests were administered in quiet and noise auditory only conditions preoperatively and postoperatively. Changes in test scores were examined by paired t tests, and differences between groups were compared by Student's t tests. Spearman correlation coefficients were calculated to identify associations between scores and subject characteristics. A two-sided alpha of less than 0.05 was considered statistically significant.

RESULTS

The results indicated significant improvement in open set speech perception skills in the children after implantation; the adults demonstrated improved mean scores on both word and sentence recognition. A shorter length of deafness correlated with better postoperative performance, but all subjects continued to improve over time. The improvement in test scores was similar between the devices, and no significant differences were detected between the different processing strategies.

CONCLUSION

Children and adults with long-term congenital deafness can obtain considerable open set speech understanding after implantation. Length of deafness (age at implantation), length of device use, and mode of communication contribute to outcome.

Self-reports about tinnitus and about cochlear implants

OBJECTIVE

Analyze literature on self-report outcomes in two areas of audiological rehabilitation: 1) tinnitus and 2) cochlear implant hearing aids.

DESIGN

1) Tinnitus: survey of features in the development of self-report approaches and of formal scales used in assessment of tinnitus disability and handicaps. 2) Cochlear implants: summary of the literature using self-report approaches to cochlear implant experience that indicates points of theoretical significance.

RESULTS

1) Major features of tinnitus are: a) disabilities such as interference with and distortion of normal auditory perception; b) handicaps such as emotional distress, interference with sleep, and with personal and social life. Nonauditory factors-chronic depression, high self-focused attention-mediate the degree of experienced tinnitus handicap. 2) People with prelingual loss of hearing report that a cochlear implant primarily enables improved detection and discrimination of environmental sound; those with postlingual loss find that an implant in addition provides improved speech recognition.

CONCLUSIONS

1) Coping with tinnitus is influenced by the personal resources that can be brought to bear on the experience, highlighting a general point that any rehabilitation outcome is not only a matter of acoustical solutions. By the same token, tinnitus can be easier to cope with if its "psychoacoustic presence" can be diminished by some form of masking. 2) Cochlear implants fitted in childhood that do not provide meaningful input signals in real-world settings may be rejected in adolescence. 3) "Hearing," as a capacity, does not have a fixed worth. Different circumstances mean it will be taken as desirable or as delivering torment (extreme tinnitus, e.g.). Its value will also vary depending on the extent of a person's access to spoken language (aiding in very early childhood, e.g.).

Empowering the deaf. Let the deaf be deaf

Deafness is often regarded as just a one and only phenomenon. Accordingly, deaf people are pictured as a unified body of people who share a single problem. From a medical point of view, we find it usual to work with a classification of deafness in which pathologies attributable to an inner ear disorder are segregated from pathologies attributable to an outer/middle ear disorder. Medical intervention is thus concerned more with the origin, degree, type of loss, onset, and structural pathology of deafness than with communicative disability and the implications there may be for the patient (mainly dependency, denial of abnormal hearing behaviour, low self esteem, rejection of the prosthetic help, and the breakdown of social relationships). In this paper, we argue that hearing loss is a very complex phenomenon, which has many and serious consequences for people and involves many factors and issues that should be carefully examined. The immediate consequence of deafness is a breakdown in communication whereby the communicative function needs to be either initiated or restored. In that sense, empowering strategies--aimed at promoting not only a more traditional psychological empowerment but also a community one--should primarily focus on the removal of communication barriers.

Neuronal responses in cat primary auditory cortex to electrical cochlear stimulation. III. Activation patterns in short- and long-term deafness

The effects of auditory deprivation on the spatial distribution of cortical response thresholds to electrical stimulation of the adult cat cochlea were evaluated. Threshold distributions for single- and multiple-unit responses from the middle cortical layers were obtained on the ectosylvian gyrus in three groups of animals: adult, acutely implanted animals ("acute group"); adult animals, 2 wk after deafening and implantation ("short-term group"); adult, neonatally deafened animals ("long-term group") implanted after 2-5 years of deafness. For all three groups, we observed similar patterns of circumscribed regions of low response thresholds in the region of primary auditory cortex (AI). A dorsal and a ventral region of low response thresholds were found separated by a narrow, anterior-posterior strip of elevated thresholds. The two low-threshold regions in the acute and the short-term group were arranged cochleotopically. This was reflected in a systematic shift of the cortical locations with minimum thresholds as a function of cochlear position of the radial and monopolar stimulation electrodes. By contrast, the long-term deafened animals maintained only weak or no signs of cochleotopicity. In some cases of this group, significant deviations from a simple tri-partition of the dorsoventral axis of AI was observed. Analysis of the spatial extent of the low-threshold regions revealed that the activated area in acute cases was significantly smaller than the long- and the short-term cases for both dorsal and ventral AI. There were no significant differences in the rostrocaudal extent of activation between long- and short-term deafening, although the total activated area in the short-term cases was larger than in long-term deafened animals. The width of the narrow high-threshold ridge that separated the dorsal and ventral low-threshold regions was the widest for the acute cases and the narrowest for the short-term deafened animals. The findings of relative large differences in cortical response distributions between the acute and short-term animals suggests that the effects observed in long-term deafened animals are not solely a consequence of loss of peripheral innervation density. The effects may reflect electrode-specific effects or reorganizational changes based on factors such as differences in excitatory and inhibitory balance.

Implantation of patients with prelingual long-term deafness

The purpose of this paper is to provide performance data on long-term congenitally and prelingually deafened children and adults who are implanted with the CLARION Multi-Strategy Cochlear Implant and who use the Continuous Interleaved Sampler (CIS) speech processing strategy. Open-set speech perception was assessed preoperatively and postoperatively with word and sentence recognition tests. Results indicate that a majority of subjects showed improvement from preoperative performance to the last available postoperative evaluation. These results represent a change from previously reported data on a similar population who used earlier speech processing strategies.