Binaural Frequency Modulation Detection in School-Age Children, Young Adults, and Older Adults: Effects of Interaural Modulator Phase

Factors that influence outcomes and device use for pediatric cochlear implant recipients with unilateral hearing loss

Introduction

Candidacy criteria for cochlear implantation in the United States has expanded to include children with single-sided deafness (SSD) who are at least 5 years of age. Pediatric cochlear implant (CI) users with SSD experience improved speech recognition with increased daily device use. There are few studies that report the hearing hour percentage (HHP) or the incidence of non-use for pediatric CI recipients with SSD. The aim of this study was to investigate factors that impact outcomes in children with SSD who use CIs. A secondary aim was to identify factors that impact daily device use in this population.

Methods

A clinical database query revealed 97 pediatric CI recipients with SSD who underwent implantation between 2014 and 2022 and had records of datalogs. The clinical test battery included speech recognition assessment for CNC words with the CI-alone and BKB-SIN with the CI plus the normal-hearing ear (combined condition). The target and masker for the BKB-SIN were presented in collocated and spatially separated conditions to evaluate spatial release from masking (SRM). Linear mixed-effects models evaluated the influence of time since activation, duration of deafness, HHP, and age at activation on performance (CNC and SRM). A separate linear mixed-effects model evaluated the main effects of age at testing, time since activation, duration of deafness, and onset of deafness (stable, progressive, or sudden) on HHP.

Results

Longer time since activation, shorter duration of deafness, and higher HHP were significantly correlated with better CNC word scores. Younger age at device activation was not found to be a significant predictor of CNC outcomes. There was a significant relationship between HHP and SRM, with children who had higher HHP experiencing greater SRM. There was a significant negative correlation between time since activation and age at test with HHP. Children with sudden hearing loss had a higher HHP than children with progressive and congenital hearing losses.

Conclusion

The present data presented here do not support a cut-off age or duration of deafness for pediatric cochlear implantation in cases of SSD. Instead, they expand on our understanding of the benefits of CI use in this population by reviewing the factors that influence outcomes in this growing patient population. Higher HHP, or greater percentage of time spent each day using bilateral input, was associated with better outcomes in the CI-alone and in the combined condition. Younger children and those within the first months of use had higher HHP. Clinicians should discuss these factors and how they may influence CI outcomes with potential candidates with SSD and their families. Ongoing work is investigating the long-term outcomes in this patient population, including whether increasing HHP after a period of limited CI use results in improved outcomes.

Development of binaural temporal fine structure sensitivity in children

The highest frequency for which the temporal fine structure (TFS) of a sinewave can be compared across ears varies between listeners with an upper limit of about 1400 Hz for young normal-hearing adults (YNHA). In this study, binaural TFS sensitivity was investigated for 63 typically developing children, aged 5 years, 6 months to 9 years, 4 months using the temporal fine structure-adaptive frequency (TFS-AF) test of Füllgrabe, Harland, Sęk, and Moore [Int. J. Audiol. 56, 926-935 (2017)]. The test assesses the highest frequency at which an interaural phase difference (IPD) of ϕ° can be distinguished from an IPD of 0°. The values of ϕ were 30° and 180°. The starting frequency was 200 Hz. The thresholds for the children were significantly lower (worse) than the thresholds reported by Füllgrabe, Harland, Sęk, and Moore [Int. J. Audiol. 56, 926-935 (2017)] for YNHA. For both values of ϕ, the median age at which children performed above chance level was significantly higher (p < 0.001) than for those who performed at chance. For the subgroup of 40 children who performed above chance for ϕ = 180°, the linear regression analyses showed that the thresholds for ϕ = 180° increased (improved) significantly with increasing age (p < 0.001) with adult-like thresholds predicted to be reached at 10 years, 2 months of age. The implications for spatial release from masking are discussed.