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PubMed2003

Conversational fluency of children who use cochlear implants.

PURPOSE: Children who have significant hearing loss often experience difficulty in engaging in everyday conversations. They may spend an inordinate amount of time in communication breakdown or in silence. The purpose of the present investigation was to assess the oral conversation fluency of young cochlear implant users using both objective and subjective measuring procedures. Conversational fluency relates to how smoothly a conversation unfolds. The children's performance was compared with that of children who have normal hearing, and related to other measures of communication skill and other child variables. DESIGN: One hundred eighty-one cochlear implant users and 24 children with normal hearing engaged in conversations with a clinician, using an oral mode of communication. Audio-video tapes of the conversations were analyzed to yield the following measures: percent of time the child and clinician spent trying to repair a breakdown in communication, percent of time the two spent sitting in silence, and the ratio between the amount of time the child spoke and the amount of time the clinician spoke. In addition, for the cochlear implant users, 10 judges viewed excerpts of the tapes and gave their impressions and reactions to the children and their conversations, using five-point rating scales. The objective and subjective measures were related to the children's speech intelligibility, mean length utterance, and speech recognition in both an auditory-only and auditory-plus-vision condition. RESULTS: The cochlear implant users spent significantly more time in communication breakdown and in silence than the children with normal hearing, and children who are in an educational placement that emphasizes oral communication spent less time in breakdown than children who are in educational placement that use both speech and sign. Speech intelligibility and receptive language were the best predictors of communication breakdown. Judges perceived children who spent less time in communication breakdown more favorably than children who spent more time, and reacted to them more positively. Finally, there was a high correlation between the subjective measures of the conversation and the objective measures. CONCLUSIONS: Educational programs should provide explicit instruction to promote conversational fluency. The results show a need for communication therapy, and suggest that the children will be perceived and reacted to more favorably if they learn how to manage communication difficulties. The results also support the need for extensive speech-language therapy for these children. The objective measures employed in this investigation appear to be a valid and useful means for assessing conversational fluency.

Canada↗

PubMed1999

Phonological representations in postlingual deaf subjects using a multichannel cochlear implant.

Our research is a first attempt to study phonological representations in postlingually deaf subjects using a multichannel cochlear implant. Before deafness, these subjects had developed normal language. The present study investigated how phonological representations are assessed through cochlear implant inputs by comparing priming within the auditory modality, and priming in a visual-auditory, cross-modal, condition. Two postlingually deafened adults participated in two lexical decision experiments where word primes were phonologically paired with a word target (e.g. vedette/dette), or a pseudoword target (e.g. banane/nane). The same word primes were also paired with non phonologically related target words (e.g. vedette/chat) and pseudowords (e.g. banane/repe). In addition, the same targets were used in phonologically-related pairs and in phonologically-unrelated ones. Results showed different priming effects for each patient. In one patient, priming was observed for word targets in the unimodal condition only. In the other patient, priming was observed for word targets and interference was observed for pseudoword targets in the cross-modal condition, whereas no effect was observed in the unimodal condition. In addition, this last patient made more errors for pseudowords than for words in the cross-modal condition. These results were interpreted as suggesting that lexical phonological representations participated to priming effects. Moreover, our results suggest that phonological word forms can be activated by visual primes via cochlear implants.

Adult↗

PubMed2002

Cochlear implants and infants: expectations and outcomes.

This study followed the communication and motor development of 3 profoundly deaf infants who underwent cochlear implantation. All infants were receiving auditory habilitation at the Sydney Cochlear Implant Centre, Australia, with the view to acquiring oral language skills and had English-speaking, hearing parents. Their progress was tracked with a battery of measurement tools before and after cochlear implantation. The results indicated noticeable growth in receptive language and motor skills after operation. Although expressive language improved, the rate of growth was much slower than changes in other areas. Although some areas of the subjects' communication skills remained delayed, the importance of tracking their progress according to their hearing age, as well as the chronological age, was evident.

Age Factors↗

PubMed1993

Speech intelligibility of children with cochlear implants, tactile aids, or hearing aids.

Speech intelligibility was measured in 31 children who used the 3M/House single-channel implant (n = 12), the Nucleus 22-Channel Cochlear Implant System (n = 15), or the Tactaid II + two-channel vibrotactile aid (n = 4). The subjects were divided into subgroups based on age at onset of deafness (early or late). The speech intelligibility of the experimental subjects was compared to that of children who were profoundly hearing impaired who used conventional hearing aids (n = 12) or no sensory aid (n = 2). The subjects with early onset of deafness who received their single- or multichannel cochlear implant before age 10 demonstrated the highest speech intelligibility, whereas subjects who did not receive their device until after age 10 had the poorest speech intelligibility. There was no obvious difference in the speech intelligibility scores of these subjects as a function of type of device (implant or tactile aid). On the average, the postimplant or tactile aid speech intelligibility of the subjects with early onset of deafness was similar to that of hearing aid users with hearing levels between 100 and 110 dB HL and limited hearing in the high frequencies. The speech intelligibility of subjects with late onset of deafness showed marked deterioration after the onset of deafness with relatively large improvements by most subjects after they received a single- or multichannel implant. The one subject with late onset of deafness who used a tactile aid showed no improvement in speech intelligibility.

Age Factors↗

PubMed1999

Minimizing wound complications in cochlear implant surgery.

OBJECTIVE: An extended postauricular incision has replaced the standard C-shaped scalp flap for cochlear implant surgery at our institution. The postoperative wound complication rates of the two incisions were evaluated. STUDY DESIGN: This study was a retrospective case review. SETTING: This study was performed in a tertiary referral center. PATIENTS: A total of 256 adult and pediatric patients who underwent cochlear implantation during a 10-year period (1986 to 1996) were reviewed. MAIN OUTCOME MEASURE: Postoperative wound complications were identified. Major complications included flap necrosis, wound dehiscence with or without implant exposure, and wound infection requiring hospitalization. Hematoma, seroma, or superficial wound infections were considered minor complications. RESULTS: There were 6 major and 6 minor complications among 116 patients with the standard scalp flap (complication rate, 10.3%). There was only 1 minor complication among 140 implants using the postauricular incision (0.7%). CONCLUSION: The extended postauricular incision appears to significantly reduce the incidence of wound complications in cochlear implant surgery.

Adolescent↗

PubMed2006

Interpreting parental proxy reports of (health-related) quality of life for children with unilateral cochlear implants.

OBJECTIVE: To examine what factors are associated with EuroQol EQ-5D scores in children after unilateral cochlear implantation and to explore parental conceptualisations of health-related quality of life (HRQL) and quality of life (QoL). METHODS: Face to face interviews were conducted with the parents of 222 implanted children, in an attempt to elicit information on their child's HRQL and QoL. Post-implant, the child's HRQL was measured using the EQ-5D, completed by parental proxy. Regression analysis was undertaken in order to estimate the association between the child EQ-5D score and child characteristics, child performance, and parental characteristics, in order to assess the construct validity of the EQ-5D. HRQL was also measured using the EuroQol visual analogue scale (VAS), where the endpoints were the best and worst imaginable health state, and a VAS was also used to measure QoL (endpoints: best/worst imaginable QoL). Parents were asked to estimate scores on both these VAS measures both post-implantation and (retrospectively) pre-implantation. Throughout the HRQL and QoL elicitation process, subjects' comments, and observations were noted. RESULTS: Children who had an additional disability (p<0.001), were male (p<0.05) or had a lower level of auditory perception (p<0.001) were estimated to have lower EQ-5D scores, as were children whose parents who left school before age 18 years (p<0.05). According to the EuroQol VAS the mean difference between pre- and post-implantation score was 0.14, compared to 0.35 for the QoL VAS, demonstrating that parents tended not to see HRQL and QoL as equivalent. As 67% of parents deemed there to be no difference between the pre- and post-implant EuroQol VAS scores we also infer that the majority of parents rejected the notion of deafness being a HRQL issue. CONCLUSION: The evidence relating to the construct validity of the EQ-5D is variable-though it was able to discriminate between children with certain levels of auditory performance, it could not discriminate between children who differed in other ways. By limiting outcome from cochlear implantation to HRQL, as opposed to QoL, the benefits of cochlear implants are likely to be underestimated.

Child↗

PubMed2005

Transcanal cochlear implantation under monitored anesthesia care.

OBJECTIVE: Given the associated risk of general anesthesia in elderly patients with cardiovascular disease, the authors set out to determine the feasibility of transcanal cochlear implantation under local anesthesia with monitored anesthesia care. METHODS: A 70-year-old man with a history of coronary artery bypass grafting, diabetes mellitus, and an American Society of Anesthesiologists Class III cardiac status underwent cochlear implantation under local with monitored anesthesia care. RESULT: With the described technique and regimen of intravenous remifentanil and dexmedetomidine, the patient tolerated the 60-minute procedure without tachycardia, hyper- or hypotension, or cardiac ischemia. CONCLUSION: Cochlear implantation using the pericanal electrode technique performed under local anesthesia with monitored anesthesia care is possible in patients at risk for undergoing general anesthesia for cochlear implantation.

Aged↗

PubMed2000

The development of speech perception in children using cochlear implants: effects of etiologic factors and delayed milestones.

HYPOTHESIS: Speech perception outcomes for cochlear implantation of children vary over a wide range, and it is hypothesized that central pathologic states associated with certain causes of hearing impairment account for a substantial part of the variance. STUDY DESIGN: A retrospective analysis was carried out to ascertain the relationships between speech perception, etiologic factors, and central pathologic states as indicated by preoperative delayed motor milestones and/or cognitive delays. SETTING: Data were obtained from the pre- and postoperative records of patients attending a hospital cochlear implant clinic. PATIENTS: Results for 75 consecutive patients up to age 5 years who underwent implantation were included in the study. INTERVENTION: Patients received a 22-electrode cochlear prosthesis and were seen by the clinic for regular tune-up and assessments. Home- and school-based habilitation was recommended by the clinic. MAIN OUTCOME MEASURES: Speech perception measures were classified on a five-point scale to allow for different evaluation procedures at different ages and developmental stages. RESULTS: The incidence of motor and cognitive delays were fairly evenly spread across etiologic factors, except for cytomegalovirus, which had a much higher than average incidence. Children with motor and/or cognitive delays were significantly slower than other children in the development of speech perception skills after implantation. Etiologic factors did not have a statistically significant effect on speech perception outcome. CONCLUSIONS: It is likely that central pathologic states account for a substantial part of the variance among children using cochlear implants. Specific indicators of central pathologic states should be used to assess a child's prognosis in preference to less specific information based on etiologic factors alone.

Child, Preschool↗

PubMed2004

The influence of potentially limiting factors on paediatric outcomes following cochlear implantation.

OBJECTIVE: Children with isolated hearing impairment who have received cochlear implant at the optimal age mostly achieve remarkable results that are assessed by objective speech perception and production measurements. Different outcomes may be expected in case of conditions which may have a negative impact on postoperative performance. The aim of this study was to assess the influence of potentially limiting factors on postimplant outcomes. METHODS: Four groups of examinees (11 in total) were involved by the study: (A) four children with additional disabilities, (B) three children with cochlear malformation and/or ossification, (C) three reimplanted children, (D) a child with retrocochlear (cochlear nerve) pathology. Hearing, speech perception and production were examined by pure tone audiogram, speech audiogram, categories of auditory performance, speech intelligibility rating, listening progress profile, and monosyllabic trochee polysyllable test. Postoperative positive life changes were assessed by a questionnaire. RESULTS: Group A: perception skills better than expected, less satisfactory speech development. Group B: good sound perception, poor understanding. Group C: after reimplantation undisturbed conditions for continuation of optimal rehabilitation course. Group D: unsatisfactory results of pure tone hearing as well as speech perception and production. CONCLUSION: In spite of unfavourable conditions all examinees, except a child with retrocochlear pathology, were found to have a considerable benefit after cochlear implantation (with regard to obvious heterogeneity within each group). Evaluation of success, especially in children with multiple handicaps, also has to include subjective indicators of positive life changes, even those not directly associated with hearing.

Audiometry, Pure-Tone↗

PubMed2004

An investigation into the effect of limiting the frequency bandwidth of speech on speech recognition in adult cochlear implant users.

The purpose of this study was to investigate the effect of the limited-frequency bandwidth employed by telephones (300-3400Hz) on speech recognition in adult cochlear implant users. The Four Alternative Auditory Feature (FAAF) test was used in four conditions: unfiltered and in three filtered conditions of 300-4500Hz, 300-3400Hz and 300-2500Hz. Ten subjects implanted with the Nucleus C124M device and 10 normal-hearing listeners were assessed to examine differences between word discrimination scores in each condition. Scores obtained from the 300-3400-Hz and 300-2500-Hz filtered conditions were significantly worse than those with unfiltered speech for the cochlear implant subjects, decreasing by 17.7% and 21.4%, respectively, from scores with unfiltered speech. By contrast, the normal-hearing listeners did not experience difficulties in discriminating between words in any of the conditions. Analysis of the word errors demonstrated that the reduction in implant subject scores with bandwidth arose from errors in place of articulation. Filtering speech in this way has a significant effect on speech recognition for cochlear implant subjects but not normal-hearing listeners. Hence, the limitations of the normal telephone bandwidth can be expected to have a negative effect on speech recognition for cochlear implant users using the telephone.

Adult↗

PubMed2000

[3D CISS, 3D MP-PAGE and 2D TSE for the preoperative MRI prior to cochlear implantation].

PURPOSE: The aim of this study was to determine the presurgical predictive value of high resolution MRI in patients scheduled for cochlear implantation. METHOD AND MATERIAL: The presurgical MRI (3D CISS, 3D MP-RAGE with and without i.v. contrast medium, 2D TSE) findings of 54 patients and the intraoperative situation reported by the surgeon were compared retrospectively. The surgical and functional success of the cochlear implantation was evaluated. RESULTS: We found a high degree of correlation between MRI and intraoperative findings concerning the patency of the whole cochlea and anomalies as well as in the diagnosis of pathology of the cochlear, vestibular and facial nerves and in anomalies of the internal auditory canal. However, in four out of 54 patients there was a false negative prediction regarding the patency of the cochlea. The sensitivity was 50% (4/8), the specificity 100% (46/46). Concerning the surgical success the accuracy was 100%. In all patients MRI gave sufficient anatomical information to the surgeon concerning the jugular bulb and the facial nerve. CONCLUSION: A high-resolution MRI protocol consisting of coronal 2D T2w TSE, 3D T2*w transverse CISS; plain and contrast enhanced sagittal T1w 3D MP-RAGE is recommended for the evaluation of candidates scheduled for cochlear implantation.

Adolescent↗

PubMed1994

Reliability of the promontory stimulation test for the preoperative evaluation of cochlear implants: a comparison with the round window stimulation test.

The electrical stimulatory threshold of the preoperative promontory stimulation test (PST) was compared with the postoperative threshold of the electrode following cochlear implantation. Postoperative results from warble-tone audiometry, the vowel recognition test, the consonant recognition test, and the speech tracking test, which employed a speech processor, were similarly evaluated. In certain patients who responded insufficiently to the PST, an exploratory tympanotomy under local anesthesia was performed prior to cochlear implantation, and stimulatory threshold was measured with an electrode placed directly on the round window [round window stimulation test (RWST)]. No correlation was found between the PST results and the postoperative performance of the cochlear implant. The RWST was determined to be better than the PST in the evaluation of cochlear implant performance.

Adult↗

PubMed1999

Tinnitus, cochlear implants and how they affect patients.

The relationship between tinnitus and cochlear implantation is an important issue that needs to be established because it may affect implant use. In this study 99 patients over 15 years of age completed pre- and post-cochlear implantation questionnaires, and underwent performance testing. The findings show that after implantation, there was marked suppression of tinnitus in both implanted and contralateral ears whilst the implant was off, and this was further enhanced when the implant was switched on. These effects are probably a combination of local and central factors. Presence of tinnitus, before or after implantation, had no detrimental effects on performance. In conclusion, providing all other factors permit, this study recommends implanting the ear with the worst tinnitus.

Adult↗

PubMed1999

Hearing ability by telephone of patients with cochlear implants.

We investigated the telephone communication ability of patients with cochlear implants who could understand conversations in natural voice without difficulty. The hearing ability of those patients with telephone adapters, which usually are used to reduce noise level in the telephone and to record into a tape recorder, was also investigated. Vowel-confusion, consonant-confusion, and speech-tracking test results of patients listening to voices by telephone and by telephone adapter were compared with those of patients listening to natural, nontelephone voices. The average score of the speech-tracking test with natural voice was 111.5 phrases per 5 minutes. This score dropped to 62.4 by telephone. However, with a telephone adapter, the score of the speech-tracking test was 109.3 phrases per 5 minutes. This was almost the same score as that of the natural voice. So, generally speaking, the telephone communication ability of cochlear implant patients was not good enough. However, hearing ability with a telephone adapter came close to hearing ability during natural speech.

Cochlear Implants↗

PubMed2003

Language development of a multiply handicapped child after cochlear implantation.

The presence of additional handicaps in hearing-impaired children makes the prediction of language ability after cochlear implantation unreliable. Only limited follow-up data on developmental improvement after implantation among multiply handicapped children is available. The present study reports the course of development (audiological and linguistic) after cochlear implantation in one subject with moderate mental retardation. Preoperatively, his language development showed 34 months delay when compared to chronological age. The difference had shortened to 23 months by 2 years post-surgery. The subject's cognitive delay had not changed upon 2-year follow-up. The cochlear implant can be credited to his improvement in language development.

Child↗

PubMed2003

[Cochlear implantation (problems, methods, perspectives)].

We suppose that topical problems of cochlear implantation comprise preoperative diagnosis of the acoustic nerve condition, programmimg of the speech processor using objective evaluation of acoustic function, design of new strategies of stimulation of speech processors and criteria of choice for existing strategies. In solving the above problems, the following methods are of special importance: registration of electrically evoked potential of acoustic nerve action (EPAN), registration of electrically evoked acoustic potentials (EAEP), registration of electrically evoked reflex of the musculus stapedius (ERMS). 27 patients with cochlear implants were examined to evaluate the above methods in terms of speech prosesses programming. The findings enable the conclusion that all three methods can be successively used in programming of the speech processor. While EPAN and EAEP can be used for approximate estimation of sensation threshold, ERMS registration is highly effective for determinaion of maximal comfortable level of stimulation.

Cochlear Implantation↗

PubMed2000

Preoperative cochlear implant imaging: is magnetic resonance imaging enough?

OBJECTIVE: To investigate the accuracy of magnetic resonance imaging (MRI) as a preoperative imaging technique for cochlear implant candidates. STUDY DESIGN: Retrospective, blinded. SETTING: Tertiary medical center. PATIENTS: 31 cochlear implant candidates with various causes of hearing loss. INTERVENTION: Cochlear implant patients received preoperative high-resolution temporal bone computed tomography (CT), and high-resolution T2-weighted fast spin echo MRI (FSE-MRI). The images were read independently of each other and in a blinded manner by two neuroradiologists. The imaging results were also correlated with intraoperative findings. MAIN OUTCOME MEASURES: Lack of agreement between the findings for either imaging technique; also, lack of agreement between imaging findings and intraoperative findings. RESULTS: FSE-MRI is equal to CT imaging in the detection of abnormalities of cochlear patency. It is better than CT imaging in detecting cochlear dysplasia and large vestibular aqueducts, and in determining the presence of the cochlear nerve. CONCLUSION: FSE-MRI is accurate in predicting inner ear anomalies and obstruction of the cochlear lumen. It also adds information not gathered from CT imaging, such as the presence and size of the cochlear nerve.

Cochlear Implantation↗

PubMed2004

[Obliterated cochlea in Cogan's syndrome -- implications for cochlear implant surgery].

BACKGROUND: Acute, often bilateral deafness in Cogan's syndrome or other autoimmune diseases is caused by autoimmune mediated inflammatory attack on the membranous labyrinth. Auditory rehabilitation in case of bilateral deafness can be achieved by cochlear implant surgery. METHODS: A retrospective analysis of all patients suffering from Cogan's syndrome that had received a cochlear implant, was carried out. RESULTS: 6 of 295 adult patients (2.6 %) that had received a cochlear implant, had become deaf due to Cogan's syndrome. Partial obliteration or ossifikation was encountered in all cases and influenced surgical procedure. In one case a fibrous obliteration of the scala tympani was found 8 weeks after acute onset of complete deafness. CONCLUSIONS: The course of obliteration is unknown. With regard to our results a fibrous obliteration may occur as early as 8 weeks after complete deafness. This has to be considered in counseling of patients. Only early cochlear implant surgery facilitates best possible rehabilitation results.

Adult↗