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Gordon KA, Alemu R, Papsin BC, Negandhi J, Cushing SL. Effects of Age at Implantation on Outcomes of Cochlear Implantation in Children with Short Durations of Single-Sided Deafness. Otol Neurotol 2023; 44:233-240. [PMID: 36728258 PMCID: PMC9924958 DOI: 10.1097/mao.0000000000003811] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Children with single-sided deafness (SSD) show reduced language and academic development and report hearing challenges. We aim to improve outcomes in children with SSD by providing bilateral hearing through cochlear implantation of the deaf ear with minimal delay. STUDY DESIGN Prospective cohort study of 57 children with SSD provided with cochlear implant (CI) between May 13, 2013, and June 25, 2021. SETTING Tertiary children's hospital. PARTICIPANTS Children with early onset (n = 40) or later onset of SSD (n = 17) received CIs at ages 2.47 ± 1.58 years (early onset group) and 11.67 ± 3.91 years (late onset group) (mean ± SD). Duration of unilateral deafness was limited (mean ± SD = 1.93 ± 1.56 yr). INTERVENTION Cochlear implantation of the deaf ear. MAIN OUTCOMES/MEASURES Evaluations of device use (data logging) and hearing (speech perception, effects of spatial release from masking on speech detection, localization of stationary and moving sound, self-reported hearing questionnaires). RESULTS Results indicated that daily device use is variable (mean ± SD = 5.60 ± 2.97, range = 0.0-14.7 h/d) with particular challenges during extended COVID-19 lockdowns, including school closures (daily use reduced by mean 1.73 h). Speech perception with the CI alone improved (mean ± SD = 65.7 ± 26.4 RAU) but, in the late onset group, remained poorer than in the normal hearing ear. Measures of spatial release from masking also showed asymmetric hearing in the late onset group ( t13 = 5.14, p = 0.001). Localization of both stationary and moving sound was poor (mean ± SD error = 34.6° ± 16.7°) but slightly improved on the deaf side with CI use ( F1,36 = 3.95, p = 0.05). Decreased sound localization significantly correlated with poorer self-reported hearing. CONCLUSIONS AND RELEVANCE Benefits of CI in children with limited durations of SSD may be more restricted for older children/adolescents. Spatial hearing challenges remain. Efforts to increase CI acceptance and consistent use are needed.
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Affiliation(s)
- Karen A. Gordon
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto
- Archie’s Cochlear Implant Laboratory, The Hospital for Sick Children
- Department of Communication Disorders, The Hospital for Sick Children
| | - Robel Alemu
- Archie’s Cochlear Implant Laboratory, The Hospital for Sick Children
| | - Blake C. Papsin
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto
- Archie’s Cochlear Implant Laboratory, The Hospital for Sick Children
- Department of Otolaryngology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jaina Negandhi
- Archie’s Cochlear Implant Laboratory, The Hospital for Sick Children
| | - Sharon L. Cushing
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto
- Archie’s Cochlear Implant Laboratory, The Hospital for Sick Children
- Department of Otolaryngology, The Hospital for Sick Children, Toronto, ON, Canada
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Neonatal Deafening Selectively Degrades the Sensitivity to Interaural Time Differences of Electrical Stimuli in Low-Frequency Pathways in Rats. eNeuro 2023; 10:ENEURO.0437-22.2022. [PMID: 36609304 PMCID: PMC9850913 DOI: 10.1523/eneuro.0437-22.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/30/2022] [Accepted: 12/31/2022] [Indexed: 01/07/2023] Open
Abstract
We examined the effect of neonatal deafening on frequency-specific pathways for processing of interaural time differences (ITDs) in cochlear-implant stimuli. Animal studies have demonstrated differences in neural ITD sensitivity in the inferior colliculus (IC) depending on the intracochlear location of intracochlear stimulating electrodes. We used neonatally deafened (ND) rats of both sexes and recorded the responses of single neurons in the IC to electrical stimuli with ITDs delivered to the apical or basal cochlea and compared them with acutely deafened (AD) rats of both sexes with normal hearing (NH) during development. We found that neonatal deafness significantly impacted the ITD sensitivity and the ITD tuning patterns restricted to apically driven IC neurons. In ND rats, the ITD sensitivity of apically driven neurons is reduced to values similar to basally driven neurons. The prevalence of ITD-sensitive apical neurons with a peak-shaped ITD tuning curve, which may reflect predominant input from the medial superior olivary (MSO) complex, in ND rats was diminished compared with that in AD rats (67%, AD vs 40%, ND). Conversely, monotonic-type responses rarely occurred in AD rats (14%) but were approximately equally as prevalent as peak-type tuning curves in ND rats (42%). Nevertheless, in ND rats, the ITD at the maximum slope of the ITD tuning curve was still more concentrated within the physiological ITD range in apically driven than in basally driven neurons. These results indicate that the development of high ITD sensitivity processed by low-frequency pathways depends on normal auditory experience and associated biases in ITD tuning strategies.
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Longitudinal Effects of Simultaneous and Sequential Bilateral Cochlear Implantation on Cortical Auditory-Evoked Potentials Recorded at Cz in a Large Cohort of Children. Ear Hear 2023; 44:92-108. [PMID: 36174206 DOI: 10.1097/aud.0000000000001275] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Auditory development after bilateral cochlear implantation in children has been measured using source localization of multi-channel late latency responses. It is not clear, however, whether this development can be tracked using a more clinically feasible method of recording from one active recording electrode placed at mid-line center of the head (Cz). DESIGN In this prospective cohort study, cortical auditory-evoked potential responses (CAEPs) were recorded from Cz referenced to each earlobe (Cz-CAEP) from 222 children with bilateral cochlear implant (CI); 128 (mean ± SD age: 2.78 ± 3.30 years) received both CIs in the same surgery (simultaneous group) and 94 (aged 7.72 ± 4.45 years) received a second CI after 4.21 ± 2.98 years of unilateral CI use. We sought to (1) identify cortical development over the first couple of years of bilateral CI use; (2) measure known asymmetries in auditory development between the CIs; and (3) detect the effects of bilateral rather than unilateral CI use. 4556 Cz-CAEPs were recorded across the cohort over 33.50 ± 7.67 months duration of bilateral CI use. Given concerns related to peak picking, amplitude areas were measured across two response time windows (50 to 199 ms and 200 to 400 ms). RESULTS Results indicated that small response amplitudes occur at initial CI use and amplitudes increase in the negative or positive direction rapidly over the first months of CI use in both time windows. Asymmetries between Cz-CAEPs evoked by each CI were found in the sequential group and reduced with bilateral CI use, particularly in the first time window; these differences increased with longer inter-implant delay. Bilaterally evoked Cz-CAEPs were larger in amplitude than unilateral responses from either CI in the simultaneous group. In the sequential group, bilateral responses were similar to responses from the first implanted side but increased in relative amplitude with bilateral CI use. The Cz-CAEP measures were not able to predict asymmetries or bilateral benefits in speech perception measures. CONCLUSIONS The Cz-CAEP was able to indicate cortical detection of CI input and showed gross morphological changes with bilateral CI use. Findings indicate Cz-CAEPs can be used to identify gross changes in auditory development in children with bilateral CIs, but they are less sensitive to tracking the remaining abnormalities that are measured by multi-channel CAEPs and speech perception testing.
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Vicente LC, Polonenko MJ, Gordon KA, Silva LTDN, Costa OA, Alvarenga KF. Effects of Sequential Bilateral Cochlear Implantation in Children: Evidence from Speech-Evoked Cortical Potentials and Tests of Speech Perception. Audiol Neurootol 2022; 27:282-296. [PMID: 35584640 DOI: 10.1159/000521600] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 12/16/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Benefits of bilateral cochlear implants (CI) may be compromised by delays to implantation of either ear. This study aimed to evaluate the effects of sequential bilateral CI use in children who received their first CI at young ages, using a clinical set-up. METHODS One-channel cortical auditory evoked potentials and speech perception in quiet and noise were evoked at repeated times (0, 3, 6, 12 months of bilateral CI use) by unilateral and bilateral stimulation in 28 children with early-onset deafness. These children were unilaterally implanted before 3.69 years of age (mean ± SD of 1.98 ± 0.73 years) and received a second CI after 5.13 ± 2.37 years of unilateral CI use. Comparisons between unilaterally evoked responses were used to measure asymmetric function between the ears and comparisons between bilateral responses and each unilateral response were used to measure the bilateral benefit. RESULTS Chronic bilateral CI promoted changes in cortical auditory responses and speech perception performance; however, large asymmetries were present between the two unilateral responses despite ongoing bilateral CI use. Persistent cortical differences between the two sides at 1 year of bilateral stimulation were predicted by increasing age at the first surgery and inter-implant delay. Larger asymmetries in speech perception occurred with longer inter-implant delays. Bilateral responses were more similar to the unilateral responses from the first rather than the second CI. CONCLUSION These findings are consistent with the development of the aural preference syndrome and reinforce the importance of providing bilateral CIs simultaneously or sequentially with very short delays.
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Affiliation(s)
- Leticia Cristina Vicente
- Department of Audiology and Speech-Language Pathology, Bauru School of Dentistry-University of São Paulo, São Paulo, Brazil,
| | - Melissa Jane Polonenko
- Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karen Ann Gordon
- Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Orozimbo Alves Costa
- Department of Audiology and Speech-Language Pathology, Bauru School of Dentistry-University of São Paulo, São Paulo, Brazil.,Cochlear Implant Program, The Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, São Paulo, Brazil
| | - Kátia Freitas Alvarenga
- Department of Audiology and Speech-Language Pathology, Bauru School of Dentistry-University of São Paulo, São Paulo, Brazil.,Cochlear Implant Program, The Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, São Paulo, Brazil
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Han JH, Lee J, Lee HJ. Ear-Specific Hemispheric Asymmetry in Unilateral Deafness Revealed by Auditory Cortical Activity. Front Neurosci 2021; 15:698718. [PMID: 34393711 PMCID: PMC8363420 DOI: 10.3389/fnins.2021.698718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/12/2021] [Indexed: 12/14/2022] Open
Abstract
Profound unilateral deafness reduces the ability to localize sounds achieved via binaural hearing. Furthermore, unilateral deafness promotes a substantial change in cortical processing to binaural stimulation, thereby leading to reorganization over the whole brain. Although distinct patterns in the hemispheric laterality depending on the side and duration of deafness have been suggested, the neurological mechanisms underlying the difference in relation to behavioral performance when detecting spatially varied cues remain unknown. To elucidate the mechanism, we compared N1/P2 auditory cortical activities and the pattern of hemispheric asymmetry of normal hearing, unilaterally deaf (UD), and simulated acute unilateral hearing loss groups while passively listening to speech sounds delivered from different locations under open free field condition. The behavioral performances of the participants concerning sound localization were measured by detecting sound sources in the azimuth plane. The results reveal a delayed reaction time in the right-sided UD (RUD) group for the sound localization task and prolonged P2 latency compared to the left-sided UD (LUD) group. Moreover, the RUD group showed adaptive cortical reorganization evidenced by increased responses in the hemisphere ipsilateral to the intact ear for individuals with better sound localization whereas left-sided unilateral deafness caused contralateral dominance in activity from the hearing ear. The brain dynamics of right-sided unilateral deafness indicate greater capability of adaptive change to compensate for impairment in spatial hearing. In addition, cortical N1 responses to spatially varied speech sounds in unilateral deaf people were inversely related to the duration of deafness in the area encompassing the right auditory cortex, indicating that early intervention would be needed to protect from maladaptation of the central auditory system following unilateral deafness.
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Affiliation(s)
- Ji-Hye Han
- Laboratory of Brain & Cognitive Sciences for Convergence Medicine, Hallym University College of Medicine, Anyang-si, South Korea
| | - Jihyun Lee
- Laboratory of Brain & Cognitive Sciences for Convergence Medicine, Hallym University College of Medicine, Anyang-si, South Korea
| | - Hyo-Jeong Lee
- Laboratory of Brain & Cognitive Sciences for Convergence Medicine, Hallym University College of Medicine, Anyang-si, South Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chuncheon-si, South Korea
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Effects of long-term unilateral cochlear implant use on large-scale network synchronization in adolescents. Hear Res 2021; 409:108308. [PMID: 34343851 DOI: 10.1016/j.heares.2021.108308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 06/25/2021] [Accepted: 06/29/2021] [Indexed: 11/20/2022]
Abstract
Unilateral cochlear implantation (CI) limits deafness-related changes in the auditory pathways but promotes abnormal cortical preference for the stimulated ear and leaves the opposite ear with little protection from auditory deprivation. In the present study, time-frequency analyses of event-related potentials elicited from stimuli presented to each ear were used to determine effects of unilateral CI use on cortical synchrony. CI-elicited activity in 34 adolescents (15.4±1.9 years of age) who had listened with unilateral CIs for most of their lives prior to bilateral implantation were compared to responses elicited by a 500Hz tone-burst in normal hearing peers. Phase-locking values between 4 and 60Hz were calculated for 171 pairs of 19-cephalic recording electrodes. Ear specific results were found in the normal hearing group: higher synchronization in low frequency bands (theta and alpha) from left ear stimulation in the right hemisphere and more high frequency activity (gamma band) from right ear stimulation in the left hemisphere. In the CI group, increased phase synchronization in the theta and beta frequencies with bursts of gamma activity were elicited by the experienced-right CI between frontal, temporal and parietal cortical regions in both hemispheres, consistent with increased recruitment of cortical areas involved in attention and higher-order processes, potentially to support unilateral listening. By contrast, activity was globally desynchronized in response to initial stimulation of the naïve-left ear, suggesting decoupling of these pathways from the cortical hearing network. These data reveal asymmetric auditory development promoted by unilateral CI use, resulting in an abnormally mature neural network.
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Deficient sensory and cognitive processing in children with cochlear implants: An event-related potential study. Hear Res 2021; 408:108295. [PMID: 34175588 DOI: 10.1016/j.heares.2021.108295] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 06/01/2021] [Accepted: 06/07/2021] [Indexed: 01/16/2023]
Abstract
Compared with children having normal hearing (NH), those with cochlear implants (CIs) perform poorly in spoken language comprehension which involves both low-level acoustic encoding and higher-level cognitive processing. Here, we performed an electroencephalography study to portray this brain dynamics of speech perception in CI children. We presented a Mandarin Chinese monosyllable or four-syllable idiom to CI and NH children, and infrequently varied its lexical tone to form a novel monosyllable or pseudo-idiom in an oddball paradigm. The tone contrast embedded in the monosyllables evoked similar mismatch negativities (MMNs) in CI and NH children at an early stage (~200 ms). However, the amplitude of the MMN evoked by the tone contrast in the idiom context was significantly lower in CI children than in NH children. Furthermore, robust late discriminative negativity (LDN) at a late stage (~500 ms) was found only in NH children, but not in CI children. The MMN and LDN findings indicate deficits of low-level acoustic encoding in a complex context (such as an idiom) and higher-level cognitive processing in CI children, respectively. Both deficient sensory and cognitive processing may contribute to the speech perception difficulties in CI children.
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Wolter NE, Gordon KA, Campos J, Vilchez Madrigal LD, Papsin BC, Cushing SL. Impact of the sensory environment on balance in children with bilateral cochleovestibular loss. Hear Res 2020; 400:108134. [PMID: 33310565 DOI: 10.1016/j.heares.2020.108134] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 11/01/2020] [Accepted: 11/24/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of the present study was to determine the role of auditory and visual sensory input on balance in children with bilateral cochlevestibular loss. The prevalence of vestibular impairment, and specifically bilateral vestibular loss (BVL) in children with sensorineural hearing loss (SNHL) is high and children with profound cochleovestibular loss (SNHL-BVL) have impaired balance (Suarez et al., 2007; Suarez et al., 2019). Given that both hearing and vestibular impairments are often congenital or acquired in early life, it remains difficult to tease out the individual developmental impact of either one on balance and spatial awareness in children who experience both of these sensory deficits. While cochlear implants (CI) can provide or restore access to sound in children with SNHL-BVL, there is currently no vestibular prosthetic available for clinical use in this population. These children may also use their intact sensory inputs (i.e. vision) to a greater extent to support balance. Alternately, restoring or providing access to sound may, on its own, help these children to balance better. We hypothesized that balance in children with SNHL-BVL who use bilateral CIs is: 1) improved in the presence of directional sound and 2) impaired when visual cues are dynamic (moving) rather than static. METHODS Balance was assessed in 18 children with SNHL-BVL and 34 typically developing children with intact vestibular function and normal hearing by performing the Bruininks-Oseretsky Test of Motor Proficiency-2 (BOT-2) balance subtest in a virtual-reality simulator under 4 sensory conditions of graded complexity. Randomized conditions combined 2 auditory (moving directional street sounds vs. directionless static white noise) and 2 visual (dynamic street scene vs. stationary street scene) stimuli designed to recreate a "real-world" busy downtown street. Balance ability in children with SNHL-BVL was also compared with CI on and off. RESULTS As expected and similar to previous work, balance was significantly worse in the children with SNHL-BVL compared to typically developing children in all sensory conditions (p<0.0001). As a group, the mean balance skills of the children with SNHL-BVL were equivalent to that of a 4.4-year-old child despite being much older (mean age =13.8 years). Balance ability improved slightly but significantly when children with SNHL-BVL had access to any sound through their CI (p=0.047) and was positively correlated with duration of implant use (p=0.02). Balance ability did not change further in the presence of moving directional sounds compared to static white noise (p=0.42), or when coupled to a moving visual environment (p=0.32) in children with SNHL-BVL, however opposite to what was hypothesized, in the typically developing group, there was a decrement in performance that occurred in the presence of moving directional sound compared to directionless, static white noise (p=0.02). CONCLUSIONS Balance ability in children with SNHL-BVL who use bilateral CI was, as expected, poorer than their typically developing peers in all sensory conditions but improved slightly when they had access to any sound through their implants, with this benefit increasing as duration of implant use increased. This suggests that providing sound inputs through bilateral CIs positively affects balance in children with SNHL-BVL where vestibular and/or auditory inputs are compromised. This benefit was achieved even with auditory inputs that were devoid of moving directional cues (i.e. directionless static white noise) and is consistent with poor spatial hearing in children using bilateral CI.
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Affiliation(s)
- Nikolaus E Wolter
- Toronto Rehabilitation Institute (Institution where work was conducted) iDAPT Challenging Environmental Assessment Laboratory, 550 University Avenue, Toronto, Ontario M5G 2A2, Canada; Archie's Cochlear Implant Laboratory, Hospital for Sick Children, 555 University Avenue, Rm 6184, Toronto, Ontario M5G 1×8, Canada; Department Otolaryngology- Head and Neck Surgery, University of Toronto, 190 Elizabeth St., Rm 3S-438 , Toronto, Ontario M5G 2N2, Canada.
| | - Karen A Gordon
- Toronto Rehabilitation Institute (Institution where work was conducted) iDAPT Challenging Environmental Assessment Laboratory, 550 University Avenue, Toronto, Ontario M5G 2A2, Canada; Archie's Cochlear Implant Laboratory, Hospital for Sick Children, 555 University Avenue, Rm 6184, Toronto, Ontario M5G 1×8, Canada; Department Otolaryngology- Head and Neck Surgery, University of Toronto, 190 Elizabeth St., Rm 3S-438 , Toronto, Ontario M5G 2N2, Canada.
| | - Jennifer Campos
- Toronto Rehabilitation Institute (Institution where work was conducted) iDAPT Challenging Environmental Assessment Laboratory, 550 University Avenue, Toronto, Ontario M5G 2A2, Canada; Department of Psychology, University of Toronto, 100 St. George Street, 4th Floor, Sidney Smith Hall, Toronto, Ontario M5S 3G3, Canada.
| | - Luis D Vilchez Madrigal
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, 555 University Avenue, Rm 6184, Toronto, Ontario M5G 1×8, Canada; Department Otolaryngology- Head and Neck Surgery, University of Toronto, 190 Elizabeth St., Rm 3S-438 , Toronto, Ontario M5G 2N2, Canada; Otolaryngology Department, National Children's Hospital, San José, Costa Rica.
| | - Blake C Papsin
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, 555 University Avenue, Rm 6184, Toronto, Ontario M5G 1×8, Canada; Department Otolaryngology- Head and Neck Surgery, University of Toronto, 190 Elizabeth St., Rm 3S-438 , Toronto, Ontario M5G 2N2, Canada.
| | - Sharon L Cushing
- Toronto Rehabilitation Institute (Institution where work was conducted) iDAPT Challenging Environmental Assessment Laboratory, 550 University Avenue, Toronto, Ontario M5G 2A2, Canada; Archie's Cochlear Implant Laboratory, Hospital for Sick Children, 555 University Avenue, Rm 6184, Toronto, Ontario M5G 1×8, Canada; Department Otolaryngology- Head and Neck Surgery, University of Toronto, 190 Elizabeth St., Rm 3S-438 , Toronto, Ontario M5G 2N2, Canada.
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Zhang Z, Wei C, Zhang Y, Zeng Z, Cao K, Liu Y. Sequential Bilateral Cochlear Implantation With Prolonged Time Intervals. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:3195-3207. [PMID: 32857631 DOI: 10.1044/2020_jslhr-20-00140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose The aim of the study was to assess whether sequential cochlear implantation (CI) with a prolonged interimplant interval (M = 15.2 years) between the first and second CIs benefited speech recognition and health-related quality of life. Method This prospective study included 14 prelingually deafened participants who received their second CI after a prolonged interimplant interval (M = 15.2 years). Additionally, speech recognition ability over a 12-month period of bilateral implant use was investigated. The results of the speech recognition test in both quiet and noisy conditions were statistically analyzed for each CI alone and both CIs together. Nijmegen Cochlear Implant Questionnaire scores were also collected at activation and at 12 months after activation. Results Improvements in speech recognition ability were observed following the use of the first implant alone and with the use of both implants together; however, progress was much slower with the use of the second implant alone, following its introduction. Furthermore, a significant difference in the trajectory of speech recognition ability was observed between the first and the second implanted ear. According to Nijmegen Cochlear Implant Questionnaire scores, all participants benefitted from bilateral CI after 12 months. Conclusions Prolonged interimplant intervals resulted in asymmetrical speech recognition abilities. A significant improvement in the speech recognition scores was observed with the first implanted ear, and much slower progress was observed with the second implanted ear. However, the "poorer" second implanted ear could provide a considerable beneficial effect on the improved speech recognition and health-related quality of life with the bilateral CI. Supplemental Material https://doi.org/10.23641/asha.12861152.
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Affiliation(s)
- Zhikai Zhang
- Department of Otolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing, China
| | - Chaogang Wei
- Department of Otolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing, China
| | - Yanmei Zhang
- Department of Otolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing, China
| | - Zhengang Zeng
- Department of Otolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing, China
| | - Keli Cao
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences Peking Union Medical College, Beijing, China
| | - Yuhe Liu
- Department of Otolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing, China
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Thakkar T, Anderson SR, Kan A, Litovsky RY. Evaluating the Impact of Age, Acoustic Exposure, and Electrical Stimulation on Binaural Sensitivity in Adult Bilateral Cochlear Implant Patients. Brain Sci 2020; 10:E406. [PMID: 32604860 PMCID: PMC7348899 DOI: 10.3390/brainsci10060406] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 06/15/2020] [Accepted: 06/19/2020] [Indexed: 01/10/2023] Open
Abstract
Deafness in both ears is highly disruptive to communication in everyday listening situations. Many individuals with profound deafness receive bilateral cochlear implants (CIs) to gain access to spatial cues used in localization and speech understanding in noise. However, the benefit of bilateral CIs, in particular sensitivity to interaural time and level differences (ITD and ILDs), varies among patients. We measured binaural sensitivity in 46 adult bilateral CI patients to explore the relationship between binaural sensitivity and three classes of patient-related factors: age, acoustic exposure, and electric hearing experience. Results show that ILD sensitivity increased with shorter years of acoustic exposure, younger age at testing, or an interaction between these factors, moderated by the duration of bilateral hearing impairment. ITD sensitivity was impacted by a moderating effect between years of bilateral hearing impairment and CI experience. When age at onset of deafness was treated as two categories (<18 vs. >18 years of age), there was no clear effect for ILD sensitivity, but some differences were observed for ITD sensitivity. Our findings imply that maximal binaural sensitivity is obtained by listeners with a shorter bilateral hearing impairment, a longer duration of CI experience, and potentially a younger age at testing. 198/200.
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Affiliation(s)
- Tanvi Thakkar
- Waisman Center, University of Wisconsin-Madison, Madison, WI 53705, USA; (T.T.); (S.R.A.)
| | - Sean R. Anderson
- Waisman Center, University of Wisconsin-Madison, Madison, WI 53705, USA; (T.T.); (S.R.A.)
| | - Alan Kan
- School of Engineering, Macquarie University, Sydney, NSW 2109, Australia;
| | - Ruth Y. Litovsky
- Waisman Center, University of Wisconsin-Madison, Madison, WI 53705, USA; (T.T.); (S.R.A.)
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Zhang H, Zhang J, Ding H, Zhang Y. Bimodal Benefits for Lexical Tone Recognition: An Investigation on Mandarin-speaking Preschoolers with a Cochlear Implant and a Contralateral Hearing Aid. Brain Sci 2020; 10:brainsci10040238. [PMID: 32316466 PMCID: PMC7226140 DOI: 10.3390/brainsci10040238] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 04/08/2020] [Accepted: 04/15/2020] [Indexed: 11/16/2022] Open
Abstract
Pitch perception is known to be difficult for individuals with cochlear implant (CI), and adding a hearing aid (HA) in the non-implanted ear is potentially beneficial. The current study aimed to investigate the bimodal benefit for lexical tone recognition in Mandarin-speaking preschoolers using a CI and an HA in opposite ears. The child participants were required to complete tone identification in quiet and in noise with CI + HA in comparison with CI alone. While the bimodal listeners showed confusion between Tone 2 and Tone 3 in recognition, the additional acoustic information from the contralateral HA alleviated confusion between these two tones in quiet. Moreover, significant improvement was demonstrated in the CI + HA condition over the CI alone condition in noise. The bimodal benefit for individual subjects could be predicted by the low-frequency hearing threshold of the non-implanted ear and the duration of bimodal use. The findings support the clinical practice to fit a contralateral HA in the non-implanted ear for the potential benefit in Mandarin tone recognition in CI children. The limitations call for further studies on auditory plasticity on an individual basis to gain insights on the contributing factors to the bimodal benefit or its absence.
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Affiliation(s)
- Hao Zhang
- Speech-Language-Hearing Center, School of Foreign Languages, Shanghai Jiao Tong University, Shanghai 200240, China; (H.Z.); (J.Z.)
| | - Jing Zhang
- Speech-Language-Hearing Center, School of Foreign Languages, Shanghai Jiao Tong University, Shanghai 200240, China; (H.Z.); (J.Z.)
| | - Hongwei Ding
- Speech-Language-Hearing Center, School of Foreign Languages, Shanghai Jiao Tong University, Shanghai 200240, China; (H.Z.); (J.Z.)
- Correspondence: (H.D.); (Y.Z.); Tel.: +1-612-624-7878 (Y.Z.)
| | - Yang Zhang
- Department of Speech-Language-Hearing Sciences, University of Minnesota, Minneapolis, MN 55455, USA
- Correspondence: (H.D.); (Y.Z.); Tel.: +1-612-624-7878 (Y.Z.)
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12
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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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13
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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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14
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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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15
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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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16
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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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17
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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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18
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Yamazaki H, Easwar V, Polonenko MJ, Jiwani S, Wong DDE, Papsin BC, Gordon KA. Cortical hemispheric asymmetries are present at young ages and further develop into adolescence. Hum Brain Mapp 2017; 39:941-954. [PMID: 29134751 DOI: 10.1002/hbm.23893] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 10/07/2017] [Accepted: 11/08/2017] [Indexed: 02/01/2023] Open
Abstract
Specialization of the auditory cortices for pure tone listening may develop with age. In adults, the right hemisphere dominates when listening to pure tones and music; we thus hypothesized that (a) asymmetric function between auditory cortices increases with age and (b) this development is specific to tonal rather than broadband/non-tonal stimuli. Cortical responses to tone-bursts and broadband click-trains were recorded by multichannel electroencephalography in young children (5.1 ± 0.8 years old) and adolescents (15.2 ± 1.7 years old) with normal hearing. Peak dipole moments indicating activity strength in right and left auditory cortices were calculated using the Time Restricted, Artefact and Coherence source Suppression (TRACS) beamformer. Monaural click-trains and tone-bursts in young children evoked a dominant response in the contralateral right cortex by left ear stimulation and, similarly, a contralateral left cortex response to click-trains in the right ear. Responses to tone-bursts in the right ear were more bilateral. In adolescents, peak activity dominated in the right cortex in most conditions (tone-bursts from either ear and to clicks from the left ear). Bilateral activity was evoked by right ear click stimulation. Thus, right hemispheric specialization for monaural tonal stimuli begins in children as young as 5 years of age and becomes more prominent by adolescence. These changes were marked by consistent dipole moments in the right auditory cortex with age in contrast to decreases in dipole activity in all other stimulus conditions. Together, the findings reveal increasingly asymmetric function for the two auditory cortices, potentially to support greater cortical specialization with development into adolescence.
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Affiliation(s)
- Hiroshi Yamazaki
- Archie's Cochlear Implant Laboratory, Department of Otolaryngology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Vijayalakshmi Easwar
- Archie's Cochlear Implant Laboratory, Department of Otolaryngology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Melissa Jane Polonenko
- Archie's Cochlear Implant Laboratory, Department of Otolaryngology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Salima Jiwani
- Archie's Cochlear Implant Laboratory, Department of Otolaryngology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Daniel D E Wong
- Archie's Cochlear Implant Laboratory, Department of Otolaryngology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Blake Croll Papsin
- Archie's Cochlear Implant Laboratory, Department of Otolaryngology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology, University of Toronto, Toronto, Ontario, Canada
| | - Karen Ann Gordon
- Archie's Cochlear Implant Laboratory, Department of Otolaryngology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
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19
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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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20
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Cortical Processing of Level Cues for Spatial Hearing is Impaired in Children with Prelingual Deafness Despite Early Bilateral Access to Sound. Brain Topogr 2017; 31:270-287. [DOI: 10.1007/s10548-017-0596-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 09/25/2017] [Indexed: 01/13/2023]
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