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Dolhopiatenko H, Segovia-Martinez M, Nogueira W. The temporal mismatch across listening sides affects cortical auditory evoked responses in normal hearing listeners and cochlear implant users with contralateral acoustic hearing. Hear Res 2024; 451:109088. [PMID: 39032483 DOI: 10.1016/j.heares.2024.109088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 06/10/2024] [Accepted: 07/16/2024] [Indexed: 07/23/2024]
Abstract
Combining a cochlear implant with contralateral acoustic hearing typically enhances speech understanding, although this improvement varies among CI users and can lead to an interference effect. This variability may be associated with the effectiveness of the integration between electric and acoustic stimulation, which might be affected by the temporal mismatch between the two listening sides. Finding methods to compensate for the temporal mismatch might contribute to the optimal adjustment of bimodal devices and to improve hearing in CI users with contralateral acoustic hearing. The current study investigates cortical auditory evoked potentials (CAEPs) in normal hearing listeners (NH) and CI users with contralateral acoustic hearing. In NH, the amplitude of the N1 peak and the maximum phase locking value (PLV) were analyzed under monaural, binaural, and binaural temporally mismatched conditions. In CI users, CAEPs were measured when listening with CI only (CIS_only), acoustically only (AS_only) and with both sides together (CIS+AS). When listening with CIS+AS, various interaural delays were introduced between the electric and acoustic stimuli. In NH listeners, interaural temporal mismatch resulted in decreased N1 amplitude and PLV. Moreover, PLV is suggested as a more sensitive measure to investigate the integration of information between the two listening sides. CI users showed varied N1 latencies between the AS_only and CIS_only listening conditions, with increased N1 amplitude when the temporal mismatch was compensated. A tendency towards increased PLV was also observed, however, to a lesser extent than in NH listeners, suggesting a limited integration between electric and acoustic stimulation. This work highlights the potential of CAEPs measurement to investigate cortical processing of the information between two listening sides in NH and bimodal CI users.
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Affiliation(s)
- Hanna Dolhopiatenko
- Medical University Hannover, Cluster of Excellence 'Hearing4all', Hannover, Germany
| | | | - Waldo Nogueira
- Medical University Hannover, Cluster of Excellence 'Hearing4all', Hannover, Germany.
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Alemu RZ, Papsin BC, Harrison RV, Blakeman A, Gordon KA. Head and Eye Movements Reveal Compensatory Strategies for Acute Binaural Deficits During Sound Localization. Trends Hear 2024; 28:23312165231217910. [PMID: 38297817 PMCID: PMC10832417 DOI: 10.1177/23312165231217910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 10/17/2023] [Accepted: 11/14/2023] [Indexed: 02/02/2024] Open
Abstract
The present study aimed to define use of head and eye movements during sound localization in children and adults to: (1) assess effects of stationary versus moving sound and (2) define effects of binaural cues degraded through acute monaural ear plugging. Thirty-three youth (MAge = 12.9 years) and seventeen adults (MAge = 24.6 years) with typical hearing were recruited and asked to localize white noise anywhere within a horizontal arc from -60° (left) to +60° (right) azimuth in two conditions (typical binaural and right ear plugged). In each trial, sound was presented at an initial stationary position (L1) and then while moving at ∼4°/s until reaching a second position (L2). Sound moved in five conditions (±40°, ±20°, or 0°). Participants adjusted a laser pointer to indicate L1 and L2 positions. Unrestricted head and eye movements were collected with gyroscopic sensors on the head and eye-tracking glasses, respectively. Results confirmed that accurate sound localization of both stationary and moving sound is disrupted by acute monaural ear plugging. Eye movements preceded head movements for sound localization in normal binaural listening and head movements were larger than eye movements during monaural plugging. Head movements favored the unplugged left ear when stationary sounds were presented in the right hemifield and during sound motion in both hemifields regardless of the movement direction. Disrupted binaural cues have greater effects on localization of moving than stationary sound. Head movements reveal preferential use of the better-hearing ear and relatively stable eye positions likely reflect normal vestibular-ocular reflexes.
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Affiliation(s)
- Robel Z. Alemu
- Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, ON, Canada
- Institute of Medical Science, The University of Toronto, Toronto, ON, Canada
| | - Blake C. Papsin
- Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, ON, Canada
- Institute of Medical Science, The University of Toronto, Toronto, ON, Canada
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
- Department of Otolaryngology, The Hospital for Sick Children, Toronto, ON, Canada
- Program in Neuroscience and Mental Health, Research Institute, Toronto, ON, Canada
| | - Robert V. Harrison
- Institute of Medical Science, The University of Toronto, Toronto, ON, Canada
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
- Program in Neuroscience and Mental Health, Research Institute, Toronto, ON, Canada
| | - Al Blakeman
- Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, ON, Canada
| | - Karen A. Gordon
- Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, ON, Canada
- Institute of Medical Science, The University of Toronto, Toronto, ON, Canada
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
- Program in Neuroscience and Mental Health, Research Institute, Toronto, ON, Canada
- Department of Communication Disorders, The Hospital for Sick Children, Toronto, ON, Canada
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Anderson SR, Burg E, Suveg L, Litovsky RY. Review of Binaural Processing With Asymmetrical Hearing Outcomes in Patients With Bilateral Cochlear Implants. Trends Hear 2024; 28:23312165241229880. [PMID: 38545645 PMCID: PMC10976506 DOI: 10.1177/23312165241229880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 01/11/2024] [Accepted: 01/16/2024] [Indexed: 04/01/2024] Open
Abstract
Bilateral cochlear implants (BiCIs) result in several benefits, including improvements in speech understanding in noise and sound source localization. However, the benefit bilateral implants provide among recipients varies considerably across individuals. Here we consider one of the reasons for this variability: difference in hearing function between the two ears, that is, interaural asymmetry. Thus far, investigations of interaural asymmetry have been highly specialized within various research areas. The goal of this review is to integrate these studies in one place, motivating future research in the area of interaural asymmetry. We first consider bottom-up processing, where binaural cues are represented using excitation-inhibition of signals from the left ear and right ear, varying with the location of the sound in space, and represented by the lateral superior olive in the auditory brainstem. We then consider top-down processing via predictive coding, which assumes that perception stems from expectations based on context and prior sensory experience, represented by cascading series of cortical circuits. An internal, perceptual model is maintained and updated in light of incoming sensory input. Together, we hope that this amalgamation of physiological, behavioral, and modeling studies will help bridge gaps in the field of binaural hearing and promote a clearer understanding of the implications of interaural asymmetry for future research on optimal patient interventions.
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Affiliation(s)
- Sean R. Anderson
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
- Department of Physiology and Biophysics, University of Colorado Anschutz Medical School, Aurora, CO, USA
| | - Emily Burg
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lukas Suveg
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Ruth Y. Litovsky
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, USA
- Department of Surgery, Division of Otolaryngology, University of Wisconsin-Madison, Madison, WI, USA
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Anderson SR, Gallun FJ, Litovsky RY. Interaural asymmetry of dynamic range: Abnormal fusion, bilateral interference, and shifts in attention. Front Neurosci 2023; 16:1018190. [PMID: 36699517 PMCID: PMC9869277 DOI: 10.3389/fnins.2022.1018190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023] Open
Abstract
Speech information in the better ear interferes with the poorer ear in patients with bilateral cochlear implants (BiCIs) who have large asymmetries in speech intelligibility between ears. The goal of the present study was to assess how each ear impacts, and whether one dominates, speech perception using simulated CI processing in older and younger normal-hearing (ONH and YNH) listeners. Dynamic range (DR) was manipulated symmetrically or asymmetrically across spectral bands in a vocoder. We hypothesized that if abnormal integration of speech information occurs with asymmetrical speech understanding, listeners would demonstrate an atypical preference in accuracy when reporting speech presented to the better ear and fusion of speech between the ears (i.e., an increased number of one-word responses when two words were presented). Results from three speech conditions showed that: (1) When the same word was presented to both ears, speech identification accuracy decreased if one or both ears decreased in DR, but listeners usually reported hearing one word. (2) When two words with different vowels were presented to both ears, speech identification accuracy and percentage of two-word responses decreased consistently as DR decreased in one or both ears. (3) When two rhyming words (e.g., bed and led) previously shown to phonologically fuse between ears (e.g., bled) were presented, listeners instead demonstrated interference as DR decreased. The word responded in (2) and (3) came from the right (symmetric) or better (asymmetric) ear, especially in (3) and for ONH listeners in (2). These results suggest that the ear with poorer dynamic range is downweighted by the auditory system, resulting in abnormal fusion and interference, especially for older listeners.
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Affiliation(s)
- Sean R. Anderson
- Waisman Center, University of Wisconsin-Madison, Madison, WI, United States
| | - Frederick J. Gallun
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR, United States
| | - Ruth Y. Litovsky
- Waisman Center, University of Wisconsin-Madison, Madison, WI, United States
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, United States
- Department of Surgery, Division of Otolaryngology, University of Wisconsin-Madison, Madison, WI, United States
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Pieper SH, Hamze N, Brill S, Hochmuth S, Exter M, Polak M, Radeloff A, Buschermöhle M, Dietz M. Considerations for Fitting Cochlear Implants Bimodally and to the Single-Sided Deaf. Trends Hear 2022; 26:23312165221108259. [PMID: 35726211 PMCID: PMC9218456 DOI: 10.1177/23312165221108259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/28/2022] [Accepted: 05/02/2022] [Indexed: 11/16/2022] Open
Abstract
When listening with a cochlear implant through one ear and acoustically through the other, binaural benefits and spatial hearing abilities are generally poorer than in other bilaterally stimulated configurations. With the working hypothesis that binaural neurons require interaurally matched inputs, we review causes for mismatch, their perceptual consequences, and experimental methods for mismatch measurements. The focus is on the three primary interaural dimensions of latency, frequency, and level. Often, the mismatch is not constant, but rather highly stimulus-dependent. We report on mismatch compensation strategies, taking into consideration the specific needs of the respective patient groups. Practical challenges typically faced by audiologists in the proposed fitting procedure are discussed. While improvement in certain areas (e.g., speaker localization) is definitely achievable, a more comprehensive mismatch compensation is a very ambitious endeavor. Even in the hypothetical ideal fitting case, performance is not expected to exceed that of a good bilateral cochlear implant user.
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Affiliation(s)
- Sabrina H. Pieper
- Department of Medical Physics and Acoustic, University of Oldenburg, Oldenburg, Germany
- Cluster of Excellence Hearing4all, University of Oldenburg, Oldenburg, Germany
| | - Noura Hamze
- MED-EL Medical Electronics GmbH, Innsbruck, Austria
| | - Stefan Brill
- MED-EL Medical Electronics Germany GmbH, Starnberg, Germany
| | - Sabine Hochmuth
- Division of Otorhinolaryngology, University of Oldenburg, Oldenburg, Germany
| | - Mats Exter
- Cluster of Excellence Hearing4all, University of Oldenburg, Oldenburg, Germany
- Hörzentrum Oldenburg gGmbH, Oldenburg, Germany
| | - Marek Polak
- MED-EL Medical Electronics GmbH, Innsbruck, Austria
| | - Andreas Radeloff
- Cluster of Excellence Hearing4all, University of Oldenburg, Oldenburg, Germany
- Division of Otorhinolaryngology, University of Oldenburg, Oldenburg, Germany
- Research Center Neurosensory Science, University of Oldenburg, Oldenburg, Germany
| | | | - Mathias Dietz
- Department of Medical Physics and Acoustic, University of Oldenburg, Oldenburg, Germany
- Cluster of Excellence Hearing4all, University of Oldenburg, Oldenburg, Germany
- Research Center Neurosensory Science, University of Oldenburg, Oldenburg, Germany
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Bilateral Cochlear Implants or Bimodal Hearing for Children with Bilateral Sensorineural Hearing Loss. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021; 8:385-394. [PMID: 33815965 DOI: 10.1007/s40136-020-00314-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Purpose of review This review describes speech perception and language outcomes for children using bimodal hearing (cochlear implant (CI) plus contralateral hearing aid) as compared to children with bilateral CIs and contrasts said findings with the adult literature. There is a lack of clinical evidence driving recommendations for bimodal versus bilateral CI candidacy and as such, clinicians are often unsure about when to recommend a second CI for children with residual acoustic hearing. Thus the goal of this review is to identify scientific information that may influence clinical decision making for pediatric CI candidates with residual acoustic hearing. Recent findings Bilateral CIs are considered standard of care for children with bilateral severe-to-profound sensorineural hearing loss. For children with aidable acoustic hearing-even in just the low frequencies-an early period of bimodal stimulation has been associated with significantly better speech perception, vocabulary, and language development. HA audibility, however, is generally poorer than that offered by a CI resulting in interaural asymmetry in speech perception, head shadow, as well as brainstem and cortical activity and development. Thus there is a need to optimize "two-eared" hearing while maximizing a child's potential with respect to hearing, speech, and language while ensuring that we limit asymmetrically driven auditory neuroplasticity. A recent large study of bimodal and bilateral CI users suggested that a period of bimodal stimulation was only beneficial for children with a better-ear pure tone average (PTA) ≤ 73 dB HL. This 73-dB-HL cutoff applied even to children who ultimately received bilateral CIs. Summary Though we do not yet have definitive guidelines for determining bimodal versus bilateral CI candidacy, there is increasing evidence that 1) bilateral CIs yield superior outcomes for children with bilateral severe-to-profound hearing loss and, 2) an early period of bimodal stimulation is beneficial for speech perception and language development, but only for children with better-ear PTA ≤ 73 dB HL. For children with residual acoustic hearing, even in just the low-frequency range, rapid sequential bilateral cochlear implantation following a trial period with bimodal stimulation will yield best outcomes for auditory, language, and academic development. Of course, there is also an increasing prevalence of cochlear implantation with acoustic hearing preservation allowing for combined electric and acoustic stimulation even following bilateral implantation.
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Lee HJ, Smieja D, Polonenko MJ, Cushing SL, Papsin BC, Gordon KA. Consistent and chronic cochlear implant use partially reverses cortical effects of single sided deafness in children. Sci Rep 2020; 10:21526. [PMID: 33298987 PMCID: PMC7726152 DOI: 10.1038/s41598-020-78371-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/10/2020] [Indexed: 01/09/2023] Open
Abstract
Potentially neuroprotective effects of CI use were studied in 22 children with single sided deafness (SSD). Auditory-evoked EEG confirmed strengthened representation of the intact ear in the ipsilateral auditory cortex at initial CI activation in children with early-onset SSD (n = 15) and late-onset SSD occurring suddenly in later childhood/adolescence (n = 7). In early-onset SSD, representation of the hearing ear decreased with chronic CI experience and expected lateralization to the contralateral auditory cortex from the CI increased with longer daily CI use. In late-onset SSD, abnormally high activity from the intact ear in the ipsilateral cortex reduced, but responses from the deaf ear weakened despite CI use. Results suggest that: (1) cortical reorganization driven by unilateral hearing can occur throughout childhood; (2) chronic and consistent CI use can partially reverse these effects; and (3) CI use may not protect children with late-onset SSD from ongoing deterioration of pathways from the deaf ear.
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Affiliation(s)
- Hyo-Jeong Lee
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Rm 6D08, 555 University Ave, Toronto, ON, M5G 1X8, Canada
- Department of Communication Disorders, Hospital for Sick Children, Toronto, ON, Canada
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Daniel Smieja
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Rm 6D08, 555 University Ave, Toronto, ON, M5G 1X8, Canada
- Department of Communication Disorders, Hospital for Sick Children, Toronto, ON, Canada
| | - Melissa Jane Polonenko
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Rm 6D08, 555 University Ave, Toronto, ON, M5G 1X8, Canada
- Department of Communication Disorders, Hospital for Sick Children, Toronto, ON, Canada
| | - Sharon Lynn Cushing
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Rm 6D08, 555 University Ave, Toronto, ON, M5G 1X8, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, Toronto, ON, Canada
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Blake Croll Papsin
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Rm 6D08, 555 University Ave, Toronto, ON, M5G 1X8, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, Toronto, ON, Canada
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Karen Ann Gordon
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Rm 6D08, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
- Department of Communication Disorders, Hospital for Sick Children, Toronto, ON, Canada.
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, Toronto, ON, Canada.
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada.
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The Effect of Cochlear Implant Interval on Spoken Language Skills of Pediatric Bilateral Cochlear Implant Users. Otol Neurotol 2020; 40:e600-e605. [PMID: 31135675 DOI: 10.1097/mao.0000000000002245] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the effects of cochlear implant (CI) interval (time between CI surgeries) on receptive vocabulary and receptive language skills for children with bilateral CIs. STUDY DESIGN A prospective cross-sectional study design. SETTING Participants were recruited from, and tested at, oral schools for the deaf and pediatric audiology clinics across the United States. PATIENTS Eighty-eight children, 4 to 9 years of age, with bilateral CIs and known hearing histories. Twenty-three participants received CIs simultaneously and 65 received CIs sequentially. Of those implanted sequentially, 86% wore a hearing aid (HA) on the non-implanted ear during the CI interval. INTERVENTION Bilateral cochlear implantation. MAIN OUTCOME MEASURES Receptive vocabulary was measured via the Peabody Picture Vocabulary Test (PPVT). Receptive language skills were measured via the Clinical Evaluation of Language Fundamentals (CELF). RESULTS Multiple linear regression models indicate better receptive vocabulary and receptive language skills are associated with earlier ages at first CI (CI 1), but not with shorter CI intervals. CONCLUSIONS Early cochlear implantation (i.e., age at CI 1) is critical for better receptive vocabulary and receptive language skills. Shorter CI intervals are not associated with better receptive vocabulary and receptive language skills for these 88 children, who nearly all used bimodal hearing during the interval. Use of a HA at the non-implanted ear, before receipt of a second CI (CI 2), may mitigate the effects of early bilateral auditory deprivation.
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Gorodensky JH, Alemu RZ, Gill SS, Sandor MT, Papsin BC, Cushing SL, Gordon KA. Binaural hearing is impaired in children with hearing loss who use bilateral hearing aids. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2019; 146:4352. [PMID: 31893744 DOI: 10.1121/1.5139212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 11/11/2019] [Indexed: 06/10/2023]
Abstract
This paper asked whether children fitted with bilateral hearing aids (BHA) develop normal perception of binaural cues which are the basis of spatial hearing. Data from children with BHA (n = 26, age = 12.6 ± 2.84 years) were compared to data from a control group (n = 12, age = 12.36 ± 2.83 years). Stimuli were 250 Hz click-trains of 36 ms and a 40 ms consonant-vowel /da/ at 1 Hz presented through ER3A insert-earphones unilaterally or bilaterally. Bilateral stimuli were presented at different interaural level difference (ILD) and interaural timing difference (ITD) conditions. Participants indicated whether the sound came from the left or right side (lateralization) or whether one sound or two could be heard (binaural fusion). BHA children lateralized ILDs similarly to the control group but had impaired lateralization of ITDs. Longer response times relative to controls suggest that lateralization of ITDs was challenging for children with BHA. Most, but not all, of the BHA group were able to fuse click and speech sounds similarly to controls. Those unable to fuse showed particularly poor ITD lateralization. Results suggest that ITD perception is abnormal in children using BHAs, suggesting persistent effects of hearing loss that are not remediated by present clinical rehabilitation protocols.
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Affiliation(s)
- Jonah H Gorodensky
- Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
| | - Robel Z Alemu
- Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
| | - Simrat S Gill
- Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
| | - Mark T Sandor
- Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
| | - Blake C Papsin
- Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
| | - Sharon L Cushing
- Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
| | - Karen A Gordon
- Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
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Davidson LS, Geers AE, Uchanski RM, Firszt JB. Effects of Early Acoustic Hearing on Speech Perception and Language for Pediatric Cochlear Implant Recipients. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:3620-3637. [PMID: 31518517 PMCID: PMC6808345 DOI: 10.1044/2019_jslhr-h-18-0255] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 12/14/2018] [Accepted: 06/19/2019] [Indexed: 06/10/2023]
Abstract
Purpose The overall goal of the current study was to identify an optimal level and duration of acoustic experience that facilitates language development for pediatric cochlear implant (CI) recipients-specifically, to determine whether there is an optimal duration of hearing aid (HA) use and unaided threshold levels that should be considered before proceeding to bilateral CIs. Method A total of 117 pediatric CI recipients (ages 5-9 years) were given speech perception and standardized tests of receptive vocabulary and language. The speech perception battery included tests of segmental perception (e.g., word recognition in quiet and noise, and vowels and consonants in quiet) and of suprasegmental perception (e.g., talker and stress discrimination, and emotion identification). Hierarchical regression analyses were used to determine the effects of speech perception on language scores, and the effects of residual hearing level (unaided pure-tone average [PTA]) and duration of HA use on speech perception. Results A continuum of residual hearing levels and the length of HA use were represented by calculating the unaided PTA of the ear with the longest duration of HA use for each child. All children wore 2 devices: Some wore bimodal devices, while others received their 2nd CI either simultaneously or sequentially, representing a wide range of HA use (0.03-9.05 years). Regression analyses indicate that suprasegmental perception contributes unique variance to receptive language scores and that both segmental and suprasegmental skills each contribute independently to receptive vocabulary scores. Also, analyses revealed an optimal duration of HA use for each of 3 ranges of hearing loss severity (with mean PTAs of 73, 92, and 111 dB HL) that maximizes suprasegmental perception. Conclusions For children with the most profound losses, early bilateral CIs provide the greatest opportunity for developing good spoken language skills. For those with moderate-to-severe losses, however, a prescribed period of bimodal use may be more advantageous for developing good spoken language skills.
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Affiliation(s)
| | | | | | - Jill B. Firszt
- Washington University School of Medicine in St. Louis, MO
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11
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Gordon K, Kral A. Animal and human studies on developmental monaural hearing loss. Hear Res 2019; 380:60-74. [DOI: 10.1016/j.heares.2019.05.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 11/26/2022]
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12
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Qiao Y, Li X, Shen H, Zhang X, Sun Y, Hao W, Guo B, Ni D, Gao Z, Guo H, Shang Y. Downward cross-modal plasticity in single-sided deafness. Neuroimage 2019; 197:608-617. [DOI: 10.1016/j.neuroimage.2019.05.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/21/2019] [Accepted: 05/10/2019] [Indexed: 10/26/2022] Open
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13
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Polonenko MJ, Papsin BC, Gordon KA. Cortical plasticity with bimodal hearing in children with asymmetric hearing loss. Hear Res 2019; 372:88-98. [DOI: 10.1016/j.heares.2018.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 01/12/2018] [Accepted: 02/09/2018] [Indexed: 11/17/2022]
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Purcell PL, Edwards TC, Wisneski M, Chan DK, Ou H, Horn DL, Skirko JR, Sie KCY. Unilateral Hearing Loss in Youth: Development of Candidate Items for a Condition-Specific Validated Instrument. Otolaryngol Head Neck Surg 2018; 159:1043-1050. [PMID: 30149769 DOI: 10.1177/0194599818797092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE This study interviewed youth with unilateral hearing, utilizing their responses to generate candidate items for a condition-specific patient-reported instrument. STUDY DESIGN Mixed methods, cross-sectional. SETTING Tertiary care children's hospital. PARTICIPANTS AND METHODS Youth with unilateral hearing loss and normal hearing in the contralateral ear were identified and recruited for participation through query of an audiometric database and through hearing loss clinics. Interviews with the youth were qualitatively analyzed to identify common themes and generate items related to functional impact. A multi-institutional expert panel reviewed items with prespecified item selection criteria. Participants rated items for impact on daily life. For preliminary criterion validity assessment, statistical analyses explored correlations between functional scores and type and severity of hearing loss. RESULTS Thirty-nine youth aged 9 to 18 years with unilateral hearing loss participated; 31% used a hearing device. Fifteen youth participated in interviews; thematic analysis, item crafting, and expert panel item review resulted in 41 items. Twenty-six youth responded to the items, reporting low functional scores in the domains of sound localization, ear positioning, and noise environment. They reported better levels of function in carrying out group conversations, focusing on schoolwork, and feeling safe during activities. Multivariate linear regression found that youth scored 0.4 points (or approximately 8%) lower on the functional impact scale with every 20-dB HL increase in pure tone average in the abnormal ear. CONCLUSION Youth with unilateral hearing loss report functional impact, particularly related to sound localization, ear positioning, and noise environment; therefore, they may benefit from a condition-specific functional assessment instrument.
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Affiliation(s)
- Patricia L Purcell
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Todd C Edwards
- Department of Health Services, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Meghan Wisneski
- Department of Pediatric Audiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Dylan K Chan
- Division of Pediatric Otolaryngology, UCSF Benioff Children's Hospital, San Francisco, California, USA
| | - Henry Ou
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Washington, Seattle, Washington, USA.,Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
| | - David L Horn
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Washington, Seattle, Washington, USA.,Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Jonathan R Skirko
- Division of Pediatric Otolaryngology, Primary Children's Hospital/University of Utah, Salt Lake City, Utah, USA
| | - Kathleen C Y Sie
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Washington, Seattle, Washington, USA.,Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
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Polonenko MJ, Papsin BC, Gordon KA. Limiting asymmetric hearing improves benefits of bilateral hearing in children using cochlear implants. Sci Rep 2018; 8:13201. [PMID: 30181590 PMCID: PMC6123397 DOI: 10.1038/s41598-018-31546-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 08/17/2018] [Indexed: 11/08/2022] Open
Abstract
Neurodevelopmental changes occur with asymmetric hearing loss, limiting binaural/spatial hearing and putting children at risk for social and educational challenges. These deficits may be mitigated by providing bilateral hearing in children through auditory prostheses. Effects on speech perception and spatial hearing were measured in a large cohort of >450 children who were deaf and used bilateral cochlear implants or bimodal devices (one cochlear implant and a contralateral hearing aid). Results revealed an advantage of bilateral over unilateral device use but this advantage decreased as hearing in the two ears became increasingly asymmetric. Delayed implantation of an ear with severe to profound deafness allowed asymmetric hearing, creating aural preference for the better hearing ear. These findings indicate that bilateral input with the most appropriate device for each ear should be provided early and without delay during development.
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Affiliation(s)
- Melissa Jane Polonenko
- Institute of Medical Science, The University of Toronto, Toronto, ON, M5S 1A8, Canada.
- Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada.
| | - Blake Croll Papsin
- Institute of Medical Science, The University of Toronto, Toronto, ON, M5S 1A8, Canada
- Department of Otolaryngology - Head & Neck Surgery, The University of Toronto, Toronto, ON, M5G 2N2, Canada
- Otolaryngology - Head & Neck Surgery, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
| | - Karen Ann Gordon
- Institute of Medical Science, The University of Toronto, Toronto, ON, M5S 1A8, Canada
- Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
- Department of Otolaryngology - Head & Neck Surgery, The University of Toronto, Toronto, ON, M5G 2N2, Canada
- Otolaryngology - Head & Neck Surgery, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
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Abstract
OBJECTIVES To assess acceptance of a cochlear implant (CI) by children with single-sided deafness (SSD) as measured by duration of CI use across daily listening environments. DESIGN Datalogs for 7 children aged 1.1 to 14.5 years (mean ± SD: 5.9 ± 5.9 years old), who had SSD and were implanted in their deaf ear, were anonymized and extracted from their CI processors. Data for all available follow-up clinical appointments were included, ranging from two to six visits. Measures calculated from each datalog included frequency and duration of time the coil disconnected from the internal device, average daily CI use, and both duration (hr/day) and percentage of CI use (% daily use) in different intensity ranges and environment types. Linear mixed effects regression analyses were used to evaluate the relationships between CI experience, daily CI use, frequency of coil-offs, and duration of coil-off time. Nonlinear regression analyses were used to evaluate CI use with age in different acoustic environments. RESULTS Children with SSD used their CI on average 7.4 hr/day. Older children used their CI for longer periods of the day than younger children. Longitudinal data indicated consistent CI use from the date of CI activation. Frequency of coil-offs reduced with CI experience, but did not significantly contribute to hours of coil-off time. Children used their CI longest in environments that were moderately loud (50 to 70 dB A) and classified as containing speech-in-noise. Preschoolers tended to spend less time in quiet but more time in music than infants/toddlers and adolescents. CONCLUSIONS Children with SSD consistently use their CI upon activation in a variety of environments commonly experienced by children. CI use in children with SSD resembles reported bilateral hearing aid use in children but is longer than reported hearing aid use in children with less severe unilateral hearing loss, suggesting that (1) the normal-hearing ear did not detract from consistent CI use; and (2) a greater asymmetry between ears presents a significant impairment that may facilitate device use to access bilateral sound.
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Polonenko MJ, Gordon KA, Cushing SL, Papsin BC. Cortical organization restored by cochlear implantation in young children with single sided deafness. Sci Rep 2017; 7:16900. [PMID: 29203800 PMCID: PMC5715123 DOI: 10.1038/s41598-017-17129-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 11/22/2017] [Indexed: 11/23/2022] Open
Abstract
Early treatment of single sided deafness in children has been recommended to protect from neurodevelopmental preference for the better hearing ear and from social and educational deficits. A fairly homogeneous group of five young children (≤3.6 years of age) with normal right sided hearing who received a cochlear implant to treat deafness in their left ears were studied. Etiology of deafness was largely cytomegalovirus (n = 4); one child had an enlarged vestibular aqueduct. Multi-channel electroencephalography of cortical evoked activity was measured repeatedly over time at: 1) acute (0.5 ± 0.7 weeks); 2) early chronic (1.1 ± 0.2 months); and 3) chronic (5.8 ± 3.4 months) cochlear implant stimulation. Results indicated consistent responses from the normal right ear with marked changes in activity from the implanted left ear. Atypical distribution of peak amplitude activity from the implanted ear at acute stimulation marked abnormal lateralization of activity to the ipsilateral left auditory cortex and recruitment of extra-temporal areas including left frontal cortex. These abnormalities resolved with chronic implant use and contralateral aural preference emerged in both auditory cortices. These findings indicate that early implantation in young children with single sided deafness can rapidly restore bilateral auditory input to the cortex needed to improve binaural hearing.
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Affiliation(s)
- Melissa Jane Polonenko
- Institute of Medical Sciences, The University of Toronto, Toronto, ON, M5S 1A8, Canada.
- Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada.
| | - Karen Ann Gordon
- Institute of Medical Sciences, The University of Toronto, Toronto, ON, M5S 1A8, Canada
- Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
- Department of Otolaryngology - Head & Neck Surgery, The University of Toronto, Toronto, ON, M5G 2N2, Canada
- Otolaryngology - Head & Neck Surgery, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
| | - Sharon Lynn Cushing
- Institute of Medical Sciences, The University of Toronto, Toronto, ON, M5S 1A8, Canada
- Department of Otolaryngology - Head & Neck Surgery, The University of Toronto, Toronto, ON, M5G 2N2, Canada
- Otolaryngology - Head & Neck Surgery, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
| | - Blake Croll Papsin
- Institute of Medical Sciences, The University of Toronto, Toronto, ON, M5S 1A8, Canada
- Department of Otolaryngology - Head & Neck Surgery, The University of Toronto, Toronto, ON, M5G 2N2, Canada
- Otolaryngology - Head & Neck Surgery, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
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18
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Binaural integration: a challenge to overcome for children with hearing loss. Curr Opin Otolaryngol Head Neck Surg 2017; 25:514-519. [DOI: 10.1097/moo.0000000000000413] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Polonenko MJ, Papsin BC, Gordon KA. Delayed access to bilateral input alters cortical organization in children with asymmetric hearing. NEUROIMAGE-CLINICAL 2017; 17:415-425. [PMID: 29159054 PMCID: PMC5683809 DOI: 10.1016/j.nicl.2017.10.036] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 10/25/2017] [Accepted: 10/31/2017] [Indexed: 11/19/2022]
Abstract
Bilateral hearing in early development protects auditory cortices from reorganizing to prefer the better ear. Yet, such protection could be disrupted by mismatched bilateral input in children with asymmetric hearing who require electric stimulation of the auditory nerve from a cochlear implant in their deaf ear and amplified acoustic sound from a hearing aid in their better ear (bimodal hearing). Cortical responses to bimodal stimulation were measured by electroencephalography in 34 bimodal users and 16 age-matched peers with normal hearing, and compared with the same measures previously reported for 28 age-matched bilateral implant users. Both auditory cortices increasingly favoured the better ear with delay to implanting the deaf ear; the time course mirrored that occurring with delay to bilateral implantation in unilateral implant users. Preference for the implanted ear tended to occur with ongoing implant use when hearing was poor in the non-implanted ear. Speech perception deteriorated with longer deprivation and poorer access to high-frequencies. Thus, cortical preference develops in children with asymmetric hearing but can be avoided by early provision of balanced bimodal stimulation. Although electric and acoustic stimulation differ, these inputs can work sympathetically when used bilaterally given sufficient hearing in the non-implanted ear.
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Affiliation(s)
- Melissa Jane Polonenko
- Institute of Medical Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada; Neurosciences & Mental Health, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.
| | - Blake Croll Papsin
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON M5G 2N2, Canada; Otolaryngology - Head & Neck Surgery, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Karen Ann Gordon
- Institute of Medical Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada; Neurosciences & Mental Health, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON M5G 2N2, Canada; Otolaryngology - Head & Neck Surgery, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
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Audiological Outcomes and Map Characteristics in Children With Perimodiolar and Slim Straight Array Cochlear Implants in Opposite Ears. Otol Neurotol 2017; 38:e320-e326. [DOI: 10.1097/mao.0000000000001539] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Litovsky RY, Gordon K. Bilateral cochlear implants in children: Effects of auditory experience and deprivation on auditory perception. Hear Res 2016; 338:76-87. [PMID: 26828740 PMCID: PMC5647834 DOI: 10.1016/j.heares.2016.01.003] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 01/07/2016] [Accepted: 01/11/2016] [Indexed: 11/29/2022]
Abstract
Spatial hearing skills are essential for children as they grow, learn and play. These skills provide critical cues for determining the locations of sources in the environment, and enable segregation of important sounds, such as speech, from background maskers or interferers. Spatial hearing depends on availability of monaural cues and binaural cues. The latter result from integration of inputs arriving at the two ears from sounds that vary in location. The binaural system has exquisite mechanisms for capturing differences between the ears in both time of arrival and intensity. The major cues that are thus referred to as being vital for binaural hearing are: interaural differences in time (ITDs) and interaural differences in levels (ILDs). In children with normal hearing (NH), spatial hearing abilities are fairly well developed by age 4-5 years. In contrast, most children who are deaf and hear through cochlear implants (CIs) do not have an opportunity to experience normal, binaural acoustic hearing early in life. These children may function by having to utilize auditory cues that are degraded with regard to numerous stimulus features. In recent years there has been a notable increase in the number of children receiving bilateral CIs, and evidence suggests that while having two CIs helps them function better than when listening through a single CI, these children generally perform worse than their NH peers. This paper reviews some of the recent work on bilaterally implanted children. The focus is on measures of spatial hearing, including sound localization, release from masking for speech understanding in noise and binaural sensitivity using research processors. Data from behavioral and electrophysiological studies are included, with a focus on the recent work of the authors and their collaborators. The effects of auditory plasticity and deprivation on the emergence of binaural and spatial hearing are discussed along with evidence for reorganized processing from both behavioral and electrophysiological studies. The consequences of both unilateral and bilateral auditory deprivation during development suggest that the relevant set of issues is highly complex with regard to successes and the limitations experienced by children receiving bilateral cochlear implants. This article is part of a Special Issue entitled .
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Affiliation(s)
- Ruth Y Litovsky
- University of Wisconsin-Madison, 1500 Highland Ave, Madison, WI, 53705, United States.
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