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PubMed2005

[Results of hearing perception after cochlear implantation in patients with auditory neuropathy].

INTRODUCTION: Results of hearing perception with patient with auditory and visual neuropathy combined with peripheral polyneuropathy one year after cochlear implantation are presented in this article. Visual problems and hearing loss were progressing during recent years leading to social problems and communication disability. Speech discrimination was much worse than could be suspected based on pure tone audiometry. Lack of benefit from hearing aids was also stated. METHODOLOGY: As the examination method free field speech audiometry was used based on Pruszewicz word tests and set of modified speech therapy tests TAPS II. Simple sentences, monosyllables and polysyllables words as well as logotoms perception and identification of music instruments sounds were estimated. MAIN RESULT: Progress of speech intelligibility in monosyllables test according to Pruszewicz in free field speech audiometry was stated, as well as better understanding of sentences, monosyllables and polysyllables words, and more precise recognition of music instruments sounds. MAIN CONCLUSION: In many sensory-neural profound hearing losses as well as auditory neuropathy cases good results may be obtained by cochlear implantation. Early diagnosis of auditory neuropathy is important because of proper management. Lack of benefit from hearing aids in such cases seems to be indication to cochlear implantation. In described case cochlear implantation improved hearing perception one year after using speech processor.

Adult↗

PubMed1998

Assessment of basal sound identification skills and communication abilities in profoundly deaf children fitted with hearing aids or a cochlear implant.

Basal auditory functions and early verbal communication skills were examined in young, profoundly deaf children with hearing aids or a cochlear implant. The hearing aid users (n = 23) were subdivided on the basis of their (unaided) hearing thresholds into: group A (pure tone average (PTA) at 0.5, 1 and 2 kHz: 90-100 dB HL); group B (PTA: 100-110 dB HL); and group C (PTA > 110 dB HL). All the children with a cochlear implant (n = 20) had a profound sensorineural hearing loss with a PTA that exceeded 120 dB HL. Functional hearing was evaluated by means of basal sound identification. The child's communication abilities with hearing aids or a cochlear implant were assessed using structured observations on the Scales of Early Communication Skills for Hearing Impaired Children. The basal auditory functions on a sound identification level improved over time in the cochlear implant users and groups A and B. Hardly any improvement was seen in group C. The performance of all the groups (either hearing aid or cochlear implant) on the Scales of Early Communication Skills for Hearing Impaired Children at 6 months after fitting the device and at later evaluations, was close to the average level for their age.

Audiometry, Pure-Tone↗

PubMed1984

Audiologic findings in a child with a single-channel cochlear implant.

Audiologic findings in a child who received a single-channel cochlear implant are presented. The measures used were threshold sensitivity to frequency-specific stimuli and results on various subtests from the Test of Auditory Comprehension (Trammel, 1976), the Monosyllable, Trochee, Spondee Test (Erber & Alencewicz, 1976), and the Minimal Auditory Capabilities Battery (Owens, Kessler, Telleen, & Schubert, 1981). The results for the implanted ear indicated uneven change in performance across measures compared to results with conventional amplification prior to receiving the implant. Performance of the implanted ear did not approach performance of the better contralateral ear. Observations by teachers and guardians indicated that there was no apparent change in auditory performance even after the cochlear implant had been worn for 6 months. Overall there was no evidence that the cochlear implant worn for 6 months provided any practical benefit to this child.

Auditory Threshold↗

PubMed2000

Preimplant measures of preverbal communicative behavior as predictors of cochlear implant outcomes in children.

OBJECTIVE: Comparison of preverbal communication behavior in young children before receiving cochlear implants with outcomes 3 yr after implantation on speech identification and speech production tasks, to assess whether outcomes can be predicted from characteristics inherent to the child before implantation. DESIGN: Video recordings of preverbal communicative behavior were examined before use of the implant to quantify turn-taking and demonstration of autonomy by the child. Speech identification ability was measured 3 yr after implantation based on the Iowa Closed-Set Speech Perception Sentence Test, continuous discourse tracking, and an observational measure of telephone use. Speech production ability was measured 3 yr after implantation by the Edinburgh Articulation Test. Associations between the preimplant measures and the 3-yr outcomes were assessed by correlation analysis of data from 33 children. RESULTS: The 3-yr performance measures of speech identification were correlated with the preimplant measure of autonomy. Telephone use and speech production ability were not significantly associated with the preimplant measures. CONCLUSIONS: Up to a fourth of the variance in speech identification performance 3 yr after cochlear implantation of young children may be predicted from characteristics that are inherent to the child before implantation. Those characteristics are represented by the demonstration of autonomy in preverbal communicative interactions, whether by means of vocalization or by gesture. If those characteristics are acquired during infancy, outcomes in children with auditory prostheses including cochlear implants may be enhanced by activities that encourage autonomy in early years.

Child Behavior↗

PubMed2000

Changes in educational placement and speech perception ability after cochlear implantation in children.

OBJECTIVE: The purpose of this study was to evaluate the effect and relationship of paediatric cochlear implantation on educational placement and speech perception ability and to determine the effect of a multilingual background on educational placement and speech perception ability after cochlear implantation. DESIGN: This study consisted of a retrospective chart review of 83 implanted patients and a questionnaire sent to parents of 80 implanted children. SETTING: This study was conducted in a cochlear implant program at a tertiary care centre. METHODS AND OUTCOME MEASURES: From the chart review, the educational placements and speech perception scores of implanted children were determined before and after implantation. In the questionnaire, parents were asked about their preferred educational placement for their child, the language spoken at home, and their impressions of the chosen school program for their child. RESULTS: Of the children who were in nonmainstream school programs at implantation (n = 30), 50% moved toward mainstream with 9 (30%) reaching mainstream placement. Of the children who were preschool at implantation (n = 34), 24 (70%) were placed or planned to be placed in mainstream after implantation. The rate of improvement in speech perception ability was significantly higher in those children who moved toward or remained in mainstream than those who stayed at the same nonmainstream educational placement or moved away from mainstream. Children from a multilingual background were able to achieve similar educational placements and similar rates of progress of speech perception outcome as the only English-speaking children. CONCLUSIONS: Children with cochlear implants have increased educational opportunities, with those children in mainstream and those who have moved toward mainstream demonstrating improved progress in speech perception ability.

Child↗

PubMed1995

Relationships between speech production and speech perception skills in young cochlear-implant users.

The purpose of this investigation was to examine the relationships between young cochlear-implant users' abilities to produce the speech features of nasality, voicing, duration, frication, and place of articulation and their abilities to utilize the features in three different perceptual conditions: audition-only, vision-only, and audition-plus-vision. Subjects were 23 prelingually deafened children who had at least 2 years of experience with a Cochlear Corporation Nucleus cochlear implant, and an average of 34 months. They completed both the production and perception version of the Children's Audio--visual Feature Test, which is comprised of ten consonant--vowel syllables. An information transmission analysis performed on the confusion matrices revealed that children produced the place of articulation fairly accurately and voicing, duration, and frication less accurately. Acoustic analysis indicated that voiced sounds were not distinguished from unvoiced sounds on the basis of voice onset time or syllabic duration. Subjects who were more likely to produce the place feature correctly were likely to have worn their cochlear implants for a greater length of time. Pearson correlations revealed that subjects who were most likely to hear the place of articulation, nasality, and voicing features in an audition-only condition were also most likely to speak these features correctly. Comparisons of test results collected longitudinally also revealed improvements in production of the features, probably as a result of cochlear-implant experience and/or maturation.

Adolescent↗

PubMed1996

A follow-up study of long-term results after cochlear implantation in children and adolescents.

The time course of speech development in children after cochlear implantation may extend over many years, thus making long-term studies necessary to evaluate any outcome. We report our long-term results after cochlear implantation in children and adolescents. Mean follow-up was 28 months, ranging from 1 to 5 years. After at least 1 year of experience all children were found to benefit from their cochlear implants. The majority of children scored above chance in speech identification tasks requiring closed set word and sentence understanding). At the 4-year interval, all children tested including prelingually deaf children had developed open set sentence understanding. The most relevant factor accounting for differences in the results was the duration of implant use in all groups. Even beyond 3 years the results continued to improve. Peri- or postlingually deafened children tended to have favorable results. For prelingually deaf children, duration of deafness and age at implantation were correlated negatively with the results.

Adolescent↗

PubMed1995

The cochlear implant. A technology for the profoundly deaf.

The cochlear implant is a device that enables the profoundly deaf to hear. This article considers the nature of the technology, the need for rehabilitation programs for those who are implanted and the evidence of benefits from this approach. A preliminary economic assessment suggests that costs per QALY for this technology would be of the order of $ 14,000 for children and $ 22,000 for adults. Cochlear implantation appears to be superior to vibrotactile devices, and is an effective technology for appropriately selected persons.

Adult↗

PubMed2005

Paediatric cochlear implantation: the views of parents.

The purpose of this study was to understand the parental perspective on paediatric cochlear implantation over time. Face-to-face semi-structured interviews were conducted with 216 families of children who were implanted at the Nottingham Paediatric Cochlear Implant Programme between 1989 and 2002, and who were attending an appointment during the study period (July 2001 August 2002). The qualitative data revealed that time played an important role in family experiences of paediatric cochlear implantation. Expectations were continually revised throughout the process, as a result of new knowledge and new technological developments. The results show that outcomes are highly individualistic although parents had a shared hope of the implant enabling the child to function in a "hearing world"; that the biggest area of contention is in respect of their child's education; and that parents talked openly about constraints imposed on them by implantation. The vast majority of parents did not regret their decision to proceed with implantation.

Adult↗

PubMed2004

Case report: Cochlear implant magnet migration.

A 13-month-old cochlear implant recipient underwent routine device activation. Three months postoperatively, the patient sustained a fall with contact to the area of the implant without immediate complication. Ten months postoperatively, the position of the external coil appeared to have moved and the patient did not seem to be responding as well to sound. Audiological testing could not elicit normal device impedances. AP and lateral plain radiographs of the skull revealed migration of the internal magnet from its position within the internal coil to a position over the receiver/stimulator. This is the first known published case of cochlear implant magnet migration.

Cochlear Implants↗

PubMed1997

A pilot investigation of changes in laryngeal function pre and post cochlear implant surgery.

This pilot investigation was undertaken to determine if there were any measurable changes in laryngeal function when comparing pre and post operative status with regard to cochlear implant surgery. The subjects, all totally deafened adults with varying aetiologies, were unable to monitor speech/voice production acoustically prior to surgery. The study aimed to evaluate whether change was effected to laryngeal function, and therefore voice quality, once an auditory feedback loop had been re-established and no direct therapeutic intervention had taken place. All the subjects were implanted with a multi-channel cochlear implant device (Nucleus 22: SPEAK strategy). Results indicate that a significant change can be measured in laryngeal function when comparing pre and post operative status of cochlear implant surgery. Furthermore, the assessment of laryngeal function identifies the source of acoustic findings which facilitates effective management of voice quality during rehabilitation following cochlear implantation.

Adult↗

PubMed2002

Recent results with the MED-EL COMBI 40+ cochlear implant and TEMPO+ behind-the-ear processor.

Cochlear implantation is a viable treatment for patients with severe to profound hearing loss. We report the results of speech perception tests (numbers, monosyllables, and sentence tests) achieved with MED-EL's COMBI40+ (C40+) cochlear implant after 12 months of use. These findings, which were taken from a larger German study, were similar to those of other studies of the C40+ implant. We also compared the differences in speech perception observed with the CIS PRO+ body-worn speech processor and the newer TEMPO+ behind-the-ear speech processor. Although these results were similar with respect to most of the measured parameters, the TEMPO+ processor had a distinct advantage during tests in noise.

Adult↗

PubMed2001

Clinical application of magnetic resonance imaging in 30 cochlear implant patients.

OBJECTIVE: The goal of this investigation was to provide evidence that magnetic resonance imaging (MRI) can be performed safely and effectively on cochlear implant patients who require diagnosis of additional diseases. STUDY DESIGN: A retrospective study was performed over 5 years. In a total of 300 patients with cochlear implants at the authors' center, MRI was performed whenever it was medically indicated. SETTING: All patients underwent scanning in a Philips Gyroscan T10-NT MRI machine, using commercially available Powertrac 3000 software. PATIENTS: All patients with cochlear implants for whom MRI was indicated (n = 30) were included in this study. They had a wide variety of conditions necessitating MRI, including cervical discus prolapse, hypophyseal adenoma, epipharynx carcinoma, knee degeneration, parotid tumor, and preoperative evaluation for reimplantation and bilateral implantation. RESULTS: No adverse effects from the MRI were reported by any of the patients. The cochlear implants all retained their function. All images were of diagnostic value. Because of the MRI, the patients did not need to undergo additional, more invasive and expensive diagnostic procedures. Examples of MRI images from 5 patients are shown. CONCLUSIONS: MRI on cochlear implant patients, using the Med El Combi 40 and Nucleus mini 22 series at 1 Tesla, can be a safe procedure. Removal of any magnet is not necessary.

Calcinosis↗

PubMed2004

Speech perception and speech intelligibility in children after cochlear implantation.

OBJECTIVE: This study aimed to evaluate the long-term speech perception and speech intelligibility of congenitally and prelingually deaf children after cochlear implantation. It was a longitudinal study following 63 congenitally or prelingually deaf children up to 5 years after implantation. They each received a nucleus multichannel cochlear implant before they were 10 years old. METHODS: Perception is evaluated using the Test for the Evaluation of Voice Perception and Production (TEPP) and concerns closed- and open-set word and sentence perception without lip-reading. The intelligibility is classified according to the Speech Intelligibility Rating (SIR). The evaluations have been made every 3 months for 1 year, then at 18 months, 2 years, 3 years and 5 years after the cochlear implantation. RESULTS: After 5 years of implantation, the median percentage of closed-words speech perception (CSW) is 95.5%-93.67% for closed-sentence speech perception (CSS) and 76.3% for open-sentence speech perception (OSS); the median Speech Intelligibility Rating is 3.83. CONCLUSIONS: Congenitally and prelingually deaf children who receive cochlear implant before the age of 10 years develop speech perception and speech intelligibility abilities. The closed-set perception progresses quickly and seems to reaching a plateau at 5 years post implantation. The improvement of open-sentence perception is not significant until the first year post implantation. The speech intelligibility improves regularly the five first year post implantation.

Audiometry, Speech↗

PubMed1995

Success of children with cochlear implants in mainstream educational settings.

The availability of cochlear implant technology has made mainstreaming a more reachable social and academic goal for profoundly deaf children. Traditionally, the profoundly deaf child has required more self-contained education. It has been the hard-of-hearing child who reached the mainstream education classroom during the elementary years. Cochlear implant recipients, implanted early and receiving appropriate educational services that maximize learning across all domains, have shown a significant trend toward moving from a more self-contained to a less restrictive educational environment. Children with implants are making these transitions earlier than the larger majority of profoundly deaf children using traditional amplification.

Child↗

PubMed2005

Mitek QuickAnchor fixation of cochlear implants using a minimal access technique.

RATIONALE: In children with thick cortical bone, surgical exposure for cochlear implant fixation is difficult when using a minimal access technique. We report our experience in these children using the Mitek QuickAnchor system. METHODS: A retrospective review of all children undergoing cochlear implantation over a 12-month period was performed to identify those children in which a Mitek QuickAnchor was used. Measurements of cortical bone thickness at the receiver-stimulator well site were obtained from pre-operative CT scans of temporal bones of all children. The application of the Mitek QuickAnchor system was also reviewed. RESULTS: Cochlear implant fixation using the Mitek QuickAnchor system was performed in 14 children (mean age 12 years) during the study period. The mean cortical bone thickness was 5.6mm in patients receiving the Mitek QuickAnchor system and 3.2mm in patients undergoing conventional fixation. The difference in cortical thickness was highly statistically significant. Successful secure fixation was obtained in all cases. CONCLUSIONS: The Mitek QuickAnchor system provides an effective method of cochlear implant fixation when using a minimal access technique in children with thick cortical bone.

Child↗

PubMed2005

The influence of cochlear implantation on some voice parameters.

OBJECTIVE: Some of the voice characteristics of deaf people differ considerably from those of speakers with normal hearing. After a cochlear implantation, auditory control of voice production is possible and the quality of the voice is improved. The aim of this study was to investigate the changes in some of the voice parameters in deaf children after cochlear implantation. METHODS: Thirty-one prelingually deafened children implanted unilaterally at the age of 2.5-13 years were included in the study. For all of the children an acoustic analysis (Multi-Dimensional Voice Program, Kay Elemetrics Corp., USA) of the Slovene vowel 'a' was performed before cochlear implantation and 6, 12 and 24 months after the implantation. The fundamental frequency (F0), jitter, shimmer and noise-to-harmonic ratio (NHR) were compared before and after the implantation. The results of the acoustic analyses were compared for the children who were implanted before or at the age of 4 years and the children who were implanted after the age of 4 years. RESULTS: After the cochlear implantation the fundamental frequency did not change significantly. However, an improvement was noticed in the measurements of jitter (p=0.006) and shimmer (p=0.021) as early as 6 months after the implantation. The noise-to-harmonic ratio improved (p=0.013) 24 months after the implantation. The children implanted before or at the age of 4 years showed a significant improvement in jitter (p=0.003) and shimmer (p=0.004) as early as 6 months and in noise-to-harmonic ratio (p=0.021) 12 months after the implantation. In the children implanted after the age of 4 years the only significant change was detected in F0 (p=0.045), 12 months after the implantation, and in Shimmer (p=0.017), 24 months after the implantation. CONCLUSION: The results of the present study have confirmed that cochlear implantation enables auditory moment-to-moment control of pitch and loudness. The determination of jitter and shimmer in the vowel 'a' sample proved to be a good and early indicator of improved phonation control, even in young children. The deaf children who were implanted before the age of 4 years improved their voice control more quickly and to a greater extent than the children implanted after the age of 4 years.

Adolescent↗

PubMed1991

Functional use of the Nucleus 22-channel cochlear implant in the elderly.

A questionnaire was sent to 101 Nucleus 22-channel cochlear implant recipients aged 65 years and older to investigate the perceived impact of cochlear implantation on their quality of life. The questionnaire was designed to gain insight into the patient's daily use of the Nucleus implant. Sixty-seven questionnaires were returned over a 3-month period. The results of the survey showed that elderly cochlear implant patients obtained similar benefits to younger adult patients who were implanted with the same device. We believe that the results of this study will aid other centers when counseling elderly patients on the expected daily functional benefits of this device.

Aged↗