PubMed · 5640958
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W Melnick. 1968. TTS with auditory task during exposure.. https://doi.org/10.1121/1.1910874
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Early education of children with hearing impairments has been carried out in the FRG for the past ca. 40 years using a variety of different educational concepts. One of these concepts is the natural auditory-verbal approach. By supporting the development of hearing, even amongst children with profound hearing impairments, it stakes the claim of being capable of initiating the children's development of natural auditory-verbal skills, which are then comparable to those of children with normal hearing. Nevertheless, to this date, no empirical study of the approach and its measure of success had ever been undertaken. During the course of this study, the measures involved in a hearing-oriented system of early education were comprehensively examined. The analysis was performed on the advancements made in the natural auditory-verbal skills of infants suffering a loss of hearing of 90 dB or more and who were educated in such a way. The study comprised 103 children with profound hearing impairments, who were younger than 24 months old at the time the study began. Their respective developments were followed in three separate surveys between 1996 and 1998. The results were analysed using bivariate as well as statistical correlation methods. The children's development is impeded by such factors as late initial diagnosis; delayed supply of hearing aids and late commencement of early education; poorly-adjusted hearing aids and short periods of wearing them. A system of early education that is only to a very limited degree hearing-oriented, and a family environment where little is spoken and where the child's auditory disability receives only scant attention, may also play a part. On the other hand, under favourable circumstances, even children with profound hearing-impairments may attain a development level of natural auditory-verbal skills which corresponds to that of children who can hear well-perhaps with a certain time-delay, and certainly involving a greater effort on the part of the children, but basically, in the same natural way and with a very similar quality of results. The early education system must urgently be improved by the introduction of screening for new-born infants. As far as devices are concerned, the cochlear-implant (CI) will very soon be standard equipment for infants with profound hearing-impairments. Within institutional facilities, there is a broad consensus that the goal of these measures consists of the development of speech communication skills in children. In practice, however, the strategies for realising this goal are not only very different, but also, partly, have downright counterproductive effects.
OBJECTIVE: Children with Large Vestibular Aqueduct Syndrome (LVAS) frequently develop speech and language skills prior to deterioration of their hearing. Operations designed to halt the progression of hearing loss have largely failed so the question of Cochlear Implantation in these children has arisen. It had been suggested that there would be technical difficulties in implanting these patients and, therefore, there had been an initial reluctance to proceed to implantation. The aim of the present paper is to assess surgical and functional outcomes in implanted children with LVAS and review the related literature. MATERIAL AND METHODS: From the 170 children assessed by MRI in the Nottingham Paediatric Cochlear Implant Programme, seven (4%) were identified as having LVAS. Four of these children were implanted and had at least 12 months follow up. Two of the children are on the waiting list for implantation and one child was not implanted because of absence of the cochlear nerve. Operative findings, complications and outcome measures were recorded. The auditory skills of the children were assessed before implantation and 1 year following implantation. A literature search was done to identify other series with experience in implanting children with LVAS. RESULTS: Full insertion of the electrode array was achieved in all our cases. After cochleostomy two patients experienced a mild CSF leak that was easily controlled by the muscle graft. On the first day post-operation two patients were nauseous and one had an episode of vomiting, however, all were discharged within 24 h of surgery. Initial outcome measures at 12 months post-implantation were encouraging showing significant progress in children's auditory skills. CONCLUSIONS: The results of the present study and the review of the literature suggest that LVAS is not a contraindication to implantation as initial concerns about severe perilymph leaks and surgical complications have proved to be unfounded. The post-operative progress of these children in listening skills also suggest that these children are suitable for cochlear implantation
OBJECTIVE: To evaluate the effects of using the Electrode Positioning System on psychophysical auditory thresholds, most comfortable loudness levels, and electric auditory brainstem response (EABR) thresholds in children with the Clarion version 1.2 cochlear implant. DESIGN: Retrospective analysis. SETTING: Academic tertiary care center. PATIENTS AND METHODS: Clinical records of a series of 25 children who received the Clarion version 1.2 cochlear implant at the University of Minnesota, Minneapolis, between January 1997 and August 1999 were examined. Measures evaluated were psychophysical thresholds (T-levels) and most comfortable loudness levels (M-levels) obtained at the 3-month posthookup audiologic evaluation and EABR thresholds obtained during implant surgery. Relevant threshold measures were available for 24 patients, 11 of whom had received the Clarion spiral electrode and electrode positioner (EP group) and 13 of whom had received the spiral electrode without positioner (non-EP group). The 3 measures (T-levels, M-levels, and EABR thresholds) were compared across groups. In addition, EABR thresholds were compared with T-levels and M-levels within groups. RESULTS: Mean T-levels and M-levels were significantly lower for the EP group than for the non-EP group, and interpatient variability for these measures was considerably smaller in the EP group. Electric auditory brainstem response thresholds were not significantly different for EP vs non-EP patients; however, EABR data were available for only a few non-EP patients. CONCLUSIONS: Use of the electrode positioner results in lower T-levels and M-levels in children with the Clarion version 1.2 cochlear implant, consistent with results of previous studies in adults, and reduces across-patient variability for these measures. It is unclear from the present data whether use of the electrode positioner systematically reduces intraoperative EABR thresholds.