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PubMed1997

Speech perception skills and speech production intelligibility in French children with prelingual deafness and cochlear implants.

OBJECTIVE: To examine speech perception and production intelligibility in French children with prelingual deafness who received multichannel cochlear implants. DESIGN: Within-subject, repeated-measures design for assessing speech perception and a cross-sectional design for assessing overall speech intelligibility. SETTING: A pediatric cochlear implant center. SUBJECTS: Sixty-four French children with prelingual deafness who received multichannel cochlear implants (mean age at time of implantation, 3 years 11 months) underwent assessment for speech perception. A subset of 16 children who received implants by 3 years of age underwent assessment for speech intelligibility. MAIN OUTCOME MEASURES: Speech perception skills were assessed using phoneme detection, closed-set word and sentence recognition, and modified open-set (MOS) recognition. Speech intelligibility was assessed by asking 50 listeners to identify recorded speech samples from the subjects. Dependent variables for the studies consisted of percent of correct items. RESULTS: After implantation, all children were able to detect phonemes by 3 months. Closed-set word and sentence identification reached 100% accuracy by 48 months (7 children with 4 years of implantation experience). Some children (8 of 48) demonstrated some MOS recognition after 1 year. Modified open-set recognition averaged 67.9% by 42 months (12 children available) and 80% by 48 months (7 children available). Overall speech intelligibility was 4.2% after 1 year, 30.7% after 2 years, 55.2% after 3 years, and 74.2% after 4 years. Within-subject comparison of MOS recognition and overall speech intelligibility scores revealed an insignificant trend for high perceptual performance to be associated with higher speech intelligibility scores (P = .17). There also was a tendency for higher performance to be associated with longer implantation experience. CONCLUSIONS: Speech perception scores appear to increase with increased experience using a cochlear implant. Overall speech intelligibility appears to steadily improve with increased experience and appears to be poorly related to perceptual performance on MOS recognition tasks.

Child, Preschool↗

PubMed2002

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.

Adolescent↗

PubMed1991

Electrode insertion trauma in cochlear implantation.

Residual hearing conservation may be important in cochlear implantation of children and of adults with disabling tinnitus responsive to extracochlear stimulation. Damage to the neural elements of the cochlea during electrode insertion may have a negative impact on residual hearing conservation. Histologic analysis of eight temporal bones with cochlear implants reveals trauma at essentially two locations: the round window insertion site and along the basal turn of the cochlea. In four of the bones, insertion at the round window resulted in damage to the osseous spiral lamina and the electrode was inserted through the scala media into the scala vestibuli. Evidence of secondary reactive osseous formation was also noted in these bones. This paper relates the surgical anatomy of the round window to histologic findings and microanatomical dissections. Recommendations for implantation surgery include creation of a cochleostomy by removal of the floor of the round window niche and a superior-to-inferior angle of electrode insertion.

Aged↗

PubMed2002

Song recognition and appraisal: a comparison of children who use cochlear implants and normally hearing children.

The purpose of this study was to compare song recognition and song appraisal of children (ages 8-15) who use cochlear implants and normally hearing children. The Iowa Music Perception and Appraisal Battery-Children's Version was developed to measure these differences. Fifteen children who use cochlear implants and 32 normally hearing children participated in this testing battery. The battery includes a Song Recognition Test, a Song Appraisal Test, and a Musical Background Questionnaire. The cochlear implant recipients were significantly less accurate (p <.0001) than normally hearing children on the Song Recognition Test. Cochlear implant recipients also demonstrated greater dislike than normally hearing children for all items on the Song Appraisal Test. Despite these differences, cochlear implant recipients were quite similar to normally hearing children in terms of self-reported informal musical involvement and music listening habits.

Adolescent↗

PubMed2005

Pediatric cochlear implantation: experience in Thai patients.

OBJECTIVE: This study was to evaluate the result of cochlear implantation in Thai pediatric patients from 1999-2003. DESIGN: A prospective, open-labeled study. SETTING: University teaching hospital. MATERIAL AND METHOD: Long term surgical and audiologic results comparison after cochlear implantation in 2 cases with Mondini anomality, 7 normal cochlea cases and a case of post meningitis post lingual child. MAIN OUTCOME MEASURES: Speech perception tests battery. RESULTS: Among 10 children, 8 were implanted with Nucleus 22/24; the other two were implanted with Med-el device system. The pre-operated cochlea in 2 cases showed Mondini deformity; both had gushers during the operation with a good outcome. The other 8 cases had normal cochlea although one was deaf from bacterial meningitis. There were 3 re-implantations. Speech production and perception was improved faster in the two children implanted with Med-el than those implanted with Nucleus devices. CONCLUSION: Cochlear implantation in Mondini cases can be successful in speech production and perception. Speech perception ability depended on the age of implantation and preoperative rehabilitation.

Adolescent↗

PubMed2002

Cantonese tone perception ability of cochlear implant children in comparison with normal-hearing children.

BACKGROUND AND OBJECTIVE: Cantonese is a tone language. A change in the fundamental frequency pattern within the same phonemic segment causes a change in the lexical meaning. The present study examined the Cantonese tone perception ability of cochlear implant children in comparison with normal-hearing children. It was hypothesized that cochlear implant children follow a similar pattern of tone perception development, as do normal children. METHOD: 225 normal-hearing and 15 hearing-impaired children with cochlear implants were recruited. The high level (tone 1), high rising (tone 2) and low falling (tone 4) were the target tones examined. The three tones were arranged into tone pairs for identification. Each pair shared exactly the same segmental information but differed only in tones (e.g. /sy/ in tones 1 and 2 meaning 'book' and 'mouse', respectively). Subjects were required to point to the corresponding pictures after the live voice presentations. RESULTS: for each tone pair, each subject was awarded a score representing the proportion of stimuli pairs that were correctly discriminated by the subject. The average scores in the normal-hearing and hearing-impaired groups were 0.92 and 0.64, respectively. The normal group had the lowest average score in tone 2/tone 4 (0.87) while the hearing-impaired group performed the worst in tone 1/tone 2 (0.53) perception between the three tone contrasts. CONCLUSIONS: the normal-hearing group performed significantly better than the hearing-impaired group in basic Cantonese tone perception. The pattern of tone perception development of cochlear implant children did not seem to follow that of normal children. Contributing factors on the tone perception performance of the cochlear implant children were subject's age, duration of special training, and durations of wearing the hearing aid and the cochlear implant.

Audiometry, Pure-Tone↗

PubMed2005

Rescuing the imperiled cochlear implant: a report of four cases.

OBJECTIVE: To report experience with exposed cochlear implants in patients with risk factors that may contribute to flap failure. STUDY DESIGN: Retrospective review. SETTING: University-based tertiary referral center. PATIENTS: Four patients with exposed cochlear implants who presented with various risk factors that compromise healing. INTERVENTION: After beginning antibiotic therapy, we took steps to correct the thyroid levels and blood glucose levels when indicated. We administered hyperbaric oxygen therapy in one case. At surgery, we debrided all devitalized and infected tissue. In one case, it was necessary to obliterate the mastoid bowl and relocate the device to a different site around the ear. In all four cases, we covered the implant with well-vascularized rotation flaps. MAIN OUTCOME MEASURES: Wound healing, resolution of infection, and preservation of implant function. RESULTS: In each case, the infection cleared and the implant covered. Nevertheless, one of the patients suffered implant failure 6 months after salvage surgery, and another suffered implant failure 3 years after salvage. CONCLUSION: All exposed or infected implants need not be removed. By using sound wound handling technique and by optimizing the patient's medical status, many exposed implants can be salvaged.

Aged↗

PubMed2004

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.

Age Factors↗

PubMed2004

[Clinical review of cochlear implant in 533 cases].

OBJECTIVE: To summarize and analyze the etiology, surgical indications, operation methods and outcomes of cochlear implantation. METHODS: 533 cases (534 ears) with severe and profound hearing loss received cochlear implant, 489 were pre-lingual deafness and 38 cases were post-lingual deafness. Their ages at implant, 1 to approximately 3 were 167, approximately 5 were 77, approximately 7 were 73, approximately 14 were 136, approximately 17 were 28, >17 were 52. 76 cases (14. 3%) were found the middle and inner ear malformations. That included Mondini 26 in cases, Common cavity in 10 cases and Large vestibule aqueduct syndrome in 20 cases. The average pure tone threshold were 105.5 dB HL, ABR threshold were >95 dB nHL and 40 Hz threshold in 500 Hz were 101.7 dB. The devices they used were Nucleus 22M in 27 ears, 24M in 308 ears, 24R Contour in 131 ears and 24R ST in 21 ears; Med El C40+ in 44 ears; Clarion CI in 3 ears. Facial recess approach was performed in normal cases, and in Common cavity cases horizontal semicircular canal approach was used. Preoperative hearing and speech evaluations were done in most cases. RESULTS: In 26 Mondini case, gusher were happened in 20 cases. The insertion depth in normal cases: Nucleus were 30 bands, Med El were 31 mm. In Mondini cases, Nucleus were 28 bands. In Common cavity cases, Nucleus were 26 bands. Of 533 cases, The average of open set sentences discrimination of post-lingual deafness was 70%, the satisfaction rate of questionnaire for pre-lingual deafness under 17 years old was 94.7%. CONCLUSIONS: Cochlear implant is a useful method to restore the hearing of the patients with severe and profound hearing loss. It is important for the outcomes with proper preoperative assessment, surgery and postoperative speech and hearing evaluations.

Adolescent↗

PubMed1997

Further experience with a straight, vertical incision for placement of cochlear implants.

Experience with a straight, vertical incision for cochlear implantation in 168 patients of all ages is reported and comparison made with previous experience using a 'C' shaped incision in 173 patients with regard to complications encountered. With the straight incision the only complication was a wound infection which settled in one week; this is in contrast to the 'C' shaped incision, which was associated with a number of serious complications. The straight incision also compared favourably with the other incisions commonly used for cochlear implantation and appears to offer advantages over them.

Adolescent↗

PubMed1995

Clinical results for the DIGISONIC multichannel cochlear implant.

The DIGISONIC is a digitized 15-channel cochlear implant. A special version of this implant has been designed for use in the totally obstructed cochlea. This device has 10 separate electrodes that may be inserted, one by one, into 10 different holes drilled in the bony cochlea. The device's 128-point Fast Fourier Transform analysis supplies the patient with the entire set of the sound information between 100 and 7800 Hz. The stimulation rhythm is set at a programmable frequency among 125 and 400 Hz or slaved to the fundamental pitch frequency. The flexibility of the microprocessor makes it possible to select the best width and mean value of each frequency band for each electrode. Many speech-coding strategies may be easily programmed as a function of scientific desiderata. The authors present clinical results for the first 28 patients they treated with this cochlear implant.

Adolescent↗

PubMed2003

Measures of working memory span and verbal rehearsal speed in deaf children after cochlear implantation.

Large individual differences in spoken word recognition performance have been found in deaf children after cochlear implantation. Recently, Pisoni and Geers (2000) reported that simple forward digit span measures of verbal working memory were significantly correlated with spoken word recognition scores even after potentially confounding variables were statistically controlled for. The present study replicates and extends these initial findings to the full set of 176 participants in the CID cochlear implant study. The pooled data indicate that despite statistical "partialling-out" of differences in chronological age, communication mode, duration of deafness, duration of device use, age at onset of deafness, number of active electrodes, and speech feature discrimination, significant correlations still remain between digit span and several measures of spoken word recognition. Strong correlations were also observed between speaking rate and both forward and backward digit span, a result that is similar to previously reported findings in normal-hearing adults and children. The results suggest that perhaps as much as 20% of the currently unexplained variance in spoken word recognition scores may be independently accounted for by individual differences in cognitive factors related to the speed and efficiency with which phonological and lexical representations of spoken words are maintained in and retrieved from working memory. A smaller percentage, perhaps about 7% of the currently unexplained variance in spoken word recognition scores, may be accounted for in terms of working memory capacity. We discuss how these relationships may arise and their contribution to subsequent speech and language development in prelingually deaf children who use cochlear implants.

Child↗

PubMed1994

Electrically evoked auditory brain-stem response in pediatric patients with cochlear implants.

OBJECTIVE: To study the feasibility and clinical applicability of preoperative, transtympanic electrically evoked auditory brain-stem response (EABR) in a pediatric patient population with cochlear implants. DESIGN: A descriptive study using repeated measures analyses of variance to determine if EABR measures were affected by response configuration or cochlear status. SETTING: The operating room before cochlear implant surgery. PATIENTS: A population-based sample of 43 patients aged 2.5 to 14.5 years who were candidates for cochlear implantation. INTERVENTION: Stimuli consisting of brief balanced biphasic current pulses were provided by a transtympanically placed promontory needle electrode; EABR was recorded with subdermal needle electrodes on the forehead and contralateral mastoid. MAIN OUTCOME MEASURE: Presence or absence of postoperative electrical excitability with a cochlear implant. RESULTS: Electrically evoked auditory brain-stem responses were available from 41 of the 43 patients tested. Mean EABR threshold was 406.5 microA (SD = 118.1) for 31 patients with patent cochleas and 472 microA (SD = 91) for 10 patients with cochlear ossification. Mean wave V latency at threshold was 4.69 milliseconds (SD = 0.57). CONCLUSION: Preoperative EABR is an integral component of the preoperative selection process for pediatric patients with cochlear implants.

Adolescent↗

PubMed2005

Simultaneous cochlear implantation and translabyrinthine removal of vestibular schwannoma in an only hearing ear: report of two cases (neurofibromatosis type 2 and unilateral vestibular schwannoma).

OBJECTIVE: The goal is to confirm the effectiveness of cochlear implantation performed at the time of surgery for tumor removal, using a translabyrinthine approach. STUDY DESIGN: This is a retrospective case review of two cases of vestibular schwannoma (VS) in the only hearing ear in which a cochlear implant (CI) was placed simultaneous to removal of VS through a modified enlarged translabyrinthine approach. The aim of the study is to confirm the effectiveness in terms of hearing rehabilitation. SETTING: The study involved a tertiary referral center in a hospital setting. PATIENTS: The study includes a report of two cases: a case of a Neurofibromatosis Type 2 (NF2) patient who received a MEDEL COMBI 40+ CI after a translabyrinthine surgery for removal of a large (4.0 cm) cystic VS; and a patient with a 1.2 cm VS in the only hearing ear who was submitted to the same strategy and operation, using a Nucleus 24 Contour CI. INTERVENTIONS: The whole strategy used in the two mentioned cases is outlined, including decision making, surgical interventions, and hearing rehabilitation programs. MAIN OUTCOME MEASURES: Surgical and audiometric outcome of two patients who underwent VS resection through a translabyrinthine approach and simultaneous cochlear implantation are shown. RESULTS: Postoperative results demonstrate that a CI could be successful after a translabyrinthine surgery for VS, with hearing performances similar to the best postlingual implanted deaf adults of other origin. CONCLUSION: The present cases demonstrate that cochlear implantation can be successful after a translabyrinthine approach for VS, regardless of the tumor size, the kind of patient (NF2, unilateral VS), and the type of implant. The results also are suggestive that cochlear implantation is more successful if done concurrent with surgery for tumor removal and before hearing is completely lost.

Audiometry, Pure-Tone↗

PubMed2002

Binaural cochlear implants placed during the same operation.

OBJECTIVE: To evaluate the binaural listening advantages for speech in quiet and in noise and to localize sound when independently programmed binaural cochlear implants are used, and to determine whether ears with different hearing ability and duration of profound deafness perform differently with cochlear implants as well as to what extent preimplant psychophysical and physiologic assessment could be predictive of performance. STUDY DESIGN: Prospective study in which patients were prospectively selected to undergo bilateral implantation during a single surgical procedure at a tertiary referral center. All testing was performed with patients using their right, left, or both cochlear implants. Preimplant and intraoperative measures used electrical stimulation at the round window and stimulation through the cochlear implant. RESULTS: Bilateral implantation during the same operation did not cause any postoperative problems such as severe vertigo or ataxia. At 1 year, results of speech testing in quiet demonstrated a binaural advantage for 2 of 10 subjects. Speech-in-noise testing demonstrated that two implants were beneficial for two individuals. All subjects benefited from a head shadow effect when an ear with a better signal-to-noise ratio was available. The ability to localize sound was improved with binaural implants in all subjects. Preimplant psychophysical or physiologic measures were not predictive of eventual speech perception performance. CONCLUSION: Binaural cochlear implants can assist in the localization of sounds and have the potential in some individuals to improve speech understanding in quiet and in noise.

Adult↗

PubMedDate not supplied

Changes in vowel quality after cochlear implantation.

Since auditory feedback is partially restored after cochlear implantation, the aim of the present study was to investigate features of vowels, which reflect improvements in speech production. Ten postlingually deafened subjects (5 male/5 female) were recorded reading a German text before and 3 and 12 months after implantation, respectively. Selected vowels were analysed regarding the fundamental frequency (F(0)), the formant frequencies (F(1), F(2), F(3)) and the vowel space (difference between F(1) and F(2) in hertz). The F(0) decreased only descriptively after 3 and 12 months, respectively. F(1) of the vowel /e/ was significantly lower after 12 months (411 +/- 20 compared to 349 +/- 25 Hz, p < or = 0.05) and for /o/ after 3 months (446 +/- 29 compared to 408 +/- 31 Hz, p < or = 0.05) for the male patients: their vowel space also expanded significantly for the vowel /o/ (372 +/- 37 compared to 467 +/- 32 Hz, p < or = 0.05) after 12 months. Regained auditory feedback after cochlear implantation had an effect on the improvement of the production of vowels.

Adolescent↗

PubMed2002

Effects of hyperbaric exposure on the integrity of the internal components of commercially available cochlear implant systems.

HYPOTHESIS: This study investigated whether pressure changes common to scuba diving and to hyperbaric oxygen therapy would not cause crush damage or leakage from critical seals in commercially available cochlear implants. BACKGROUND: The implanted packages of cochlear implants are susceptible to electrical failure caused by leakage from critical seals and to crush injury when exposed to changing barometric pressures encountered in recreational diving and in hyperbaric oxygen therapy. METHODS: Six Clarion 1.2, eight MED-EL Combi-40+, six Nucleus CI22M, and six Nucleus CI24M cochlear implants underwent three exposures at 165 feet of seawater (FSW) (6 ata abs), 99 FSW (4 ata abs), and 60 FSW (2.8 ata abs), simulating rates in accordance with U.S. Navy dive tables for nondecompression dives. Dives to 45 FSW (2.4 ata abs) simulated wound therapy. Before each dive began, after each dive, and after completion of the dive protocol, each device underwent telemetry and electrical integrity checks. All implants were returned to their respective factories for final electrical and quality control testing. RESULTS: All 26 devices completed the dive protocol. One Nucleus CI24M implant had a fault recorded at electrode lead 18 on predive and final product testing, which was absent during interval dive measurements. All 26 devices passed final electrical and quality control testing. In addition, the six Clarion units passed repeat helium leak testing. CONCLUSION: The implanted components of the Clarion 1.2, MED-EL Combi-40+, and Nucleus CI22M and CI24M were safely subjected to repeated pressure changes up to 6 atm abs, equivalent to 165 feet of seawater, without electrical failure from leakage at critical seals or crush damage.

Cochlear Implants↗

PubMed2004

Recurrent acute otitis media associated meningitis in a patient with a contralateral cochlear implant and bilateral cochleovestibular dysplasia.

OBJECTIVE: To illustrate that a patient with a cochlear implant may be at increased risk of meningitis secondary to developmental anatomic abnormality associated with the underlying sensorineural hearing loss, as opposed to the implant itself. METHODS: Case report. RESULTS: Our 12-year-old patient has bilateral cochlear dysplasia, profound sensorineural hearing loss and no prior history of recurrent acute otitis media or meningitis. He underwent a left cochlear implant at 8 years of age and subsequently experienced three episodes of right acute otitis media and meningitis over the next 4 years. Middle ear exploration revealed a cerebrospinal fluid leak. A right radical mastoidectomy with closure of the external auditory canal, removal of the tympanic membrane, malleus, and incus, closure of the Eustachian tube, and obliteration of the mastoid and middle ear with abdominal fat has prevented further episodes. CONCLUSION: Meningitis in a patient with a cochlear implant is not necessarily related to the implant.

Acute Disease↗