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PubMed1994

Cochlear implants for congenitally deaf adolescents: is open-set speech perception a realistic expectation?

The prognosis for benefit from use of cochlear implants in congenitally deaf adolescents, who have a long duration of profound deafness prior to implantation, has typically been low. Speech perception results for two congenitally deaf patients implanted as adolescents at the University of Melbourne/Royal Victorian Eye and Ear Hospital Clinic show that, after 12 months of experience, both patients had significant open-set speech discrimination scores without lipreading. These results suggest that although benefits may in general be low for congenitally deaf adolescents, individuals may attain significant benefits to speech perception after a short period of experience. Prospective patients from this group should therefore be considered on an individual basis with regard to prognosis for benefit from cochlear implantation.

Adolescent↗

PubMed1997

Stress experienced by parents of children with cochlear implants compared with parents of deaf children and hearing children.

OBJECTIVE: To compare the stress experienced by parents of children with cochlear implants with that experienced by parents of deaf children and hearing children. STUDY DESIGN: The Parenting Stress Index and problem-oriented interviews were used with the parents of these three groups of children. RESULTS: Parents of deaf children were found to experience greater levels of stress than parents in the other two groups. CONCLUSION: Parents of children with cochlear implants experience about the same level of stress as parents of hearing children.

Child↗

PubMed2006

An exploration of demographic bias in a questionnaire survey of hearing-impaired children: implications for comparisons of children with and without cochlear implants.

OBJECTIVES: Responders to questionnaire surveys, who are self-selecting, are generally accepted to be unrepresentative of the total available population, at least in demographic terms. Since demographic and other variables are known to be predictive of outcome, it is important to understand the extent of that unrepresentativeness when using survey data to report comparisons of outcome. This paper aims (i) to evaluate the extent to which a sample of hearing-impaired children surveyed by postal questionnaire was representative of the population of hearing-impaired children in the United Kingdom (UK), and (ii) to identify demographic differences between children with and without cochlear implants. METHODS: Data from a previously reported total ascertainment of hearing-impaired children in the UK which identified 17,160 with permanent bilateral hearing impairment >40 dB HL were compared with data collected by postal questionnaire for a sample of 3224 children, including 527 with cochlear implants. RESULTS: The sampled children were similar to the ascertained population in gender, age at onset of hearing impairment, and number of additional disabilities, but came from more recent birth cohorts and from more affluent families. Compared with profoundly impaired non-implanted children, implanted children had greater degrees of hearing loss, fewer additional disabilities, a later age of onset, were younger, came from more affluent families, were more likely to use spoken language at home, and to be taught using spoken language only. CONCLUSIONS: Comparisons of outcomes and generalisation of results require adjustment for relevant variables to avoid confounding estimates of the effectiveness of interventions including cochlear implantation.

Adolescent↗

PubMed2000

Our decision on a cochlear implant.

This essay sets forth why we, the hearing parents of a profoundly deaf child, have chosen not to seek a cochlear implant for our daughter. In controversial matters, participants in a debate should set forth, as best they can, their prejudices and biases (which are not necessarily bad things), thereby allowing others to assess the degree, if any, to which their positions might be based on feelings (however understandable) vs. facts. I do so in this essay first by describing who we are and how we view deafness and Deaf culture, and then by discussing our daughter Margaret and how we see her being affected by our decision about cochlear implantation. I then briefly consider some unconvincing reasons offered against implants, and conclude with a few thoughts on the decision process.

Attitude to Health↗

PubMed1991

Multichannel cochlear implantation in children: a summary of current work at the University of Melbourne.

This paper summarizes research work relating to multichannel cochlear implantation in children at the University of Melbourne. Ongoing safety studies relating to the implantation of young children are discussed. Results of these studies suggest that special design considerations are necessary for a prosthesis to be implanted in children under the age of 2 years. Results of clinical assessment of implanted children and adolescents are also discussed in terms of speech perception, speech production, and language development, and some possible predictive factors are suggested. Preliminary data suggests that a high proportion of young children can achieve open-set speech perception with the cochlear implant given appropriate training and support. Initial results with adults using new speech processing hardware and a new coding scheme are also presented. These suggest that improved speech perception in quiet and competing noise is possible with the new system.

Adolescent↗

PubMed1997

Comparative psychophysical evaluation in cochlear implantation: electrical and magnetic stimulation.

Transtympanic electrical stimulation, either in the form of round window or promontory placement of electrode prior to cochlear implantation is an accepted and commonly used psychophysical tool. Certain response parameters have been identified as predictors of outcome. This study compared the subjective auditory responses generated by promontory electrical stimulation (PES) with those from two noninvasive modalities, namely peritympanic electrical stimulation (PTES) and transcranial magnetic stimulation (TMS). Ten postlingually deafened adult cochlear implant candidates were studied. Standard psychophysical parameters were obtained from patients undergoing PES and PTES. A more subjective form of evaluation was conducted for TMS. Subsequently, nine patients received the multichannel Nucleus (Cochlear Corp., Denver, CO, U.S.A.) implant and one patient a Clarion (Advanced Bionics, Sylmar, CA, U.S.A.) implant. Compared with PES. PTES elicited increased threshold responses with similar dynamic ranges between 50 and 400 Hz of stimulation. The differences were, by and large, insignificant. PTES appeared to be a useful alternative in selected individuals owing to its noninvasiveness. TMS, on the other hand, was incapable of clearly inducing auditory percepts. It also produced concomitant facial and trigeminal stimulation, limiting its potential use as a prognostic tool.

Adult↗

PubMed1994

Results from four cochlear implant patients with Usher's syndrome.

Individual results are presented of 4 patients with Usher's syndrome type 1 who received a cochlear implant. Both single-channel and multichannel implants were used. Because of implant failure, one of the single-channel systems was replaced by a Nucleus multichannel system. Results are compared to the results of 5 other prelingually deaf cochlear implant users. The performance of the patients with Usher's syndrome on suprasegmental and segmental speech perception tests and on a connected discourse tracking task did not differ significantly from the performance of the other prelingually deaf patients. A significant improvement over time was found at the suprasegmental level for the combined group of Usher's and other patients. No obvious differences were found between the scores from the patients with a single-channel and the patients with a multichannel device. The rehabilitation of the Usher's patients required very little extra effort in comparison with that of the other prelingually deaf patients; all patients reported considerable advantages in hearing abilities and social life.

Adolescent↗

PubMed1992

Consonant recognition by some of the better cochlear-implant patients.

Fifty-four of the better cochlear-implant patients from Europe and the United States were tested on two consonant recognition tests using nonsense syllables. One was produced in an accent appropriate for their own language by a male and a female talker. Recorded tokens of /ibi, idi, igi, ipi, iti, iki, ifi, ivi, ifi, isi, izi, imi, ini/ were presented. With the French syllables, six patients with the Chorimac device averaged 18% correct (6%-29%). With the German syllables, nine patients with the 3M/Vienna device averaged 34% correct (17%-44%), ten patients with the Nucleus device (tested in Hannover) averaged 31% correct (19%-42%), and ten patients with the Duren/Cologne device averaged 27% correct (10%-56%). With the English syllables, ten patients with the Nucleus device (tested in the United States) averaged 42% correct (29%-62%), and nine patients with the Symbion device averaged 46% correct (31%-69%). An information-transmission analysis and sequential information-transfer analysis of the confusions suggested that different implants provided differing amounts of feature information. The place of articulation feature was typically the most difficult to code for all implants. In the second test a male and a female talker recorded the stimuli /ibi, idi, igi, imi, ini, ifi, isi, izi/ in a single manner that was appropriate for all three languages. Six patients with the Chorimac device averaged 27% (13%-48%), ten patients with the Duren/Cologne implant averaged 29% (15%-75%), ten patients with the Nucleus device (tested in Hannover) averaged 40% (25%-58%), ten patients with the Nucleus device (tested in the United States) averaged 49% (40%-60%), nine patients with the Symbion device averaged 61% (40%-75%), and nine patients with the 3M/Vienna device averaged 41% (29%-52%) correct.

Cochlear Implants↗

PubMed2006

Measuring health-related quality of life after pediatric cochlear implantation: a systematic review.

OBJECTIVE: The measurement of health-related quality of life (HRQL) in children presents conceptual and methodological challenges owing to the multidimensionality of the required information and limitations in patient self-report. HRQL results provide a broad measure of treatment impact from the patient and family perspective and are crucial to guiding clinical and policy decisions. The objective of this study was to evaluate how HRQL in children with cochlear implants has been measured in published studies in order to draw conclusions that could inform future investigations of this area of clinical research. METHODS: We searched PubMed, EMBASE, CINAHL, PsychoInfo, and Web of Science databases using a defined search string and hand-searched reference lists of relevant articles and personal files. Retrieved citations were reviewed in two stages, a title and abstract screen followed by review of the full-length article. Inclusion criteria for studies were: (1) original peer-reviewed research article; (2) enrolled subjects <18 years old with cochlear implants; (3) use of a HRQL instrument that incorporated components of physical, mental, and social health; and (4) in English. Data from full-length articles were extracted by a single-investigator. RESULTS: We retrieved 671 citations with our search strategy, and 10 citations were found to be eligible for inclusion. All studies used a cross-sectional design, and three types of HRQL instruments were used: generic questionnaires, ad hoc instruments designed specifically for the purposes of the study, and the parents views and experiences with pediatric CI questionnaire. Heterogeneity in study design and instruments prevented a quantitative, meta-analysis of the data. CONCLUSIONS: Studies that used well-validated, generic HRQL instruments supported conclusions that were less subject to potential bias from the perspective of the clinician investigator. Most studies did not use well-defined cohorts with respect to age at implantation and duration of implant use, and conclusions in these studies were also subject to potential bias. No well-validated, deafness-specific HRQL instruments are currently available. Future research should be done with existing, generic HRQL instruments and with strict study inclusion criteria. Suggested generic HRQL instruments are discussed.

Adolescent↗

PubMed1994

[Preoperative diagnosis in children with congenital and acquired deafness with reference to cochlear implants].

Total deafness in children can be covered with cochlear implants. There are only few general guidelines which have to take into considerations. We have not the same diagnostic tools available like in adults. More than in adults an individual decision has to be made in children. To provide children with an intracochlear multichannel device it has to be organized a sufficient working system of rehabilitation.

Audiometry, Evoked Response↗

PubMed2000

Speech perception after multichannel cochlear implantation in Finnish-speaking postlingually deafened adults.

This study was done to examine the short-term and long-term effects of multichannel cochlear implantation on speech perception in Finnish-speaking adults. The subjects comprise 20 adults. Pure-tone thresholds (0.125-8kHz), discrimination of phoneme quantity, sentence recognition, word recognition, phoneme recognition and listening performance were studied before and after implantation. After switch-on of the implant, the median pure-tone threshold values in the sound field were comparable to the level of mild hearing impairment. Most improvement in sentence recognition took place during the 6 months after the switch-on (mean score 74%). In word recognition, most improvement took place during the 12 months after the switch-on (mean score 66%), and clear improvement was noted even thereafter. In phoneme recognition, the performance of the subjects improved over the entire follow-up period, and 24 months after the switch-on the mean score was 52%. Individual variation was seen in the performance of the subjects. With 3 months of listening experience, all subjects were able to recognize some speech without speechreading, and they gained good functional benefit from the implant. The use of speech recognition tests with different degrees of difficulty is essential for the follow-up of adult cochlear implant subjects.

Adult↗

PubMed2000

Mathematical modeling of vowel perception by users of analog multichannel cochlear implants: temporal and channel-amplitude cues.

A "multidimensional phoneme identification" (MPI) model is proposed to account for vowel perception by cochlear implant users. A multidimensional extension of the Durlach-Braida model of intensity perception, this model incorporates an internal noise model and a decision model to account separately for errors due to poor sensitivity and response bias. The MPI model provides a complete quantitative description of how listeners encode and combine acoustic cues, and how they use this information to determine which sound they heard. Thus, it allows for testing specific hypotheses about phoneme identification in a very stringent fashion. As an example of the model's application, vowel identification matrices obtained with synthetic speech stimuli (including "conflicting cue" conditions [Dorman et al., J. Acoust. Soc. Am. 92, 3428-3432 (1992)] were examined. The listeners were users of the "compressed-analog" stimulation strategy, which filters the speech spectrum into four partly overlapping frequency bands and delivers each signal to one of four electrodes in the cochlea. It was found that a simple model incorporating one temporal cue (i.e., an acoustic cue based only on the time waveforms delivered to the most basal channel) and spectral cues (based on the distribution of amplitudes among channels) can be quite successful in explaining listener responses. The new approach represented by the MPI model may be used to obtain useful insights about speech perception by cochlear implant users in particular, and by all kinds of listeners in general.

Cochlear Implantation↗

PubMed1993

Facial nerve injury in cochlear implantation.

We present eight cases of FN dysfunction after cochlear implantation. Four mechanisms of injury are proposed. The most common injury occurs from the heat of a bur shaft rotating over the FN in the facial recess. Several suggestions are made to help prevent the type of injuries we have seen. Preoperative imaging and intraoperative FN monitoring may be of general assistance in avoiding injuries to the FN, especially in cases of revision surgery and congenital malformations.

Adolescent↗

PubMedDate not supplied

Experiences with the cochlear implant in preschool children.

Years of experience with the cochlear implant in profoundly deaf adults led to a decision to attempt to extend the benefits of this device to children. As of March 15, 1983, 43 deaf children ranging in age from 2.7 to 17.5 years have been implanted. Seventeen of these are children under 6 years of age. All had worn hearing aids but demonstrated little or no benefit from them. Auditory thresholds with the implant are significantly better than those obtained unaided and with hearing aids. Although a longer period of experience is required, the preschool-aged children can eventually make the same auditory discriminations as older children and adults. Long-term impact on speech and language development remains to be determined, but there is already evidence for significant improvement in these areas.

Adolescent↗

PubMed1994

[Cochlear implants for adult prelingually deaf patients].

We have performed cochlear implants on 6 adult prelingually deaf patients and obtained the following results. 1) The speech comprehension ability of the adult prelingually deaf patients was poorer than in postlingually deaf patients, but some patients showed better results than expected. 2) The adult prelingually deaf patients required a longer period of rehabilitation than the postlingually deaf patients. There were considerable variations in performance among the adult prelingually deaf patients.

Adult↗

PubMed1991

Effect of age at onset of deafness on children's speech perception abilities with a cochlear implant.

The speech perception abilities of 37 children with cochlear implants (single-channel or multichannel) were examined as a function of age at onset of deafness. There was no significant difference in the speech perception abilities of implanted children who were born deaf and those of implanted children who lost their hearing during the first 3 years of life. In contrast, the performance of children whose age at onset of deafness was 5 years or later was significantly better than that of the children with congenital or early-acquired deafness on tests of stress pattern categorization, closed-set word identification, open-set identification of common phrases, and lipreading enhancement.

Age Factors↗

PubMed1994

[The first experience in diagnosis and rehabiliation in patients with cochlear implant "Nuclear Mini System 22"].

The first qualification for cochlear implant "Nucleus" was performed on the basis of audiological tests. Next stage was conversation with a patient and his family about motivation of longterm rehabilitation. Then the two very important investigations were carried out--the computer tomography which showed inner ear structure, and electric promotory test. In rehabilitation process original "Nucleus" partially modified and Polish linguistic articulation lists were used.

Adult↗

PubMed1988

Multichannel cochlear implantation: Utah-design.

The Utah-design multichannel cochlear implant consists of six intracochlear monopolar electrodes, one promontory electrode, and an indifferent electrode. Connection of the intracochlear system to the external sound processor is via a percutaneous pedestal system. Four of the intracochlear electrodes receive simultaneous stimulation. Twenty patients implanted at the University of Utah with more than 1 year of sound processor use were evaluated for the study. All patients wear their sound processors on a daily basis. Seven of the 20 are able to use the telephone without special devices. Nineteen patients were tested with open set CID sentences with an average 42.2% response. A comparison was made between live voice and taped voice open-set spondee word list performance, showing slightly better overall performance with live voice.

Adult↗