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Holder JT, Henry MR, MacDonald AE, Gifford RH. Cochlear Implant Upper Stimulation Levels: eSRT vs. Loudness Scaling. Otol Neurotol 2023; 44:e667-e672. [PMID: 37621113 PMCID: PMC10637929 DOI: 10.1097/mao.0000000000003988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
OBJECTIVE To assess the difference in speech recognition and sound quality between programming upper stimulation levels using behavioral measures (loudness scaling) and electrically evoked stapedial reflex thresholds (eSRTs). STUDY DESIGN Double-blinded acute comparison study. SETTING Cochlear implant (CI) program at a tertiary medical center. PATIENTS Eighteen adult (mean age = 60 years) CI users and 20 ears. MAIN OUTCOME MEASURES Speech recognition scores and sound quality ratings. RESULTS Mean word and sentence in noise recognition scores were 8 and 9 percentage points higher, respectively, for the eSRT-based map. The sound quality rating was 1.4 points higher for the eSRT-based map. Sixteen out of 20 participants preferred the eSRT-based map. CONCLUSIONS Study results show significantly higher speech recognition and more favorable sound quality using an eSRT-based map compared with a loudness-scaling map using a double-blinded testing approach. Additionally, results may be understated as 18 of 20 ears had eSRTs measured before study enrollment. Results underscore the importance of incorporating eSRTs into standard clinical practice to promote best outcomes for CI recipients.
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Affiliation(s)
- Jourdan T Holder
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
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Holder JT, Holcomb MA, Snapp H, Labadie RF, Vroegop J, Rocca C, Elgandy MS, Dunn C, Gifford RH. Guidelines for Best Practice in the Audiological Management of Adults Using Bimodal Hearing Configurations. OTOLOGY & NEUROTOLOGY OPEN 2022; 2:e011. [PMID: 36274668 PMCID: PMC9581116 DOI: 10.1097/ono.0000000000000011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Clinics are treating a growing number of patients with greater amounts of residual hearing. These patients often benefit from a bimodal hearing configuration in which acoustic input from a hearing aid on 1 ear is combined with electrical stimulation from a cochlear implant on the other ear. The current guidelines aim to review the literature and provide best practice recommendations for the evaluation and treatment of individuals with bilateral sensorineural hearing loss who may benefit from bimodal hearing configurations. Specifically, the guidelines review: benefits of bimodal listening, preoperative and postoperative cochlear implant evaluation and programming, bimodal hearing aid fitting, contralateral routing of signal considerations, bimodal treatment for tinnitus, and aural rehabilitation recommendations.
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Affiliation(s)
| | | | | | | | | | - Christine Rocca
- Guy’s and St. Thomas’ Hearing Implant Centre, London, United Kingdom
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Mancini P, Mariani L, Nicastri M, Cavicchiolo S, Giallini I, Scimemi P, Zanetti D, Montino S, Lovo E, Di Berardino F, Trevisi P, Santarelli R. Cochlear implantation in children with Autism Spectrum Disorder (ASD): Outcomes and implant fitting characteristics. Int J Pediatr Otorhinolaryngol 2021; 149:110876. [PMID: 34385039 DOI: 10.1016/j.ijporl.2021.110876] [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: 01/13/2021] [Revised: 07/19/2021] [Accepted: 08/05/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Little is known regarding fitting parameters and receptive and expressive language development in cochlear-implanted children (CCI) with profound sensorineural hearing loss (SHL) who are diagnosed with Autism Spectrum Disorder (ASD). The aim of the study was to evaluate a group of ASD CCI users in order to describe their ASD clinical features and CCI outcomes; report on the average electrical charge requirements; and evaluate the possible correlations between electrical and psychophysical outcomes with ASD characteristics. MATERIALS AND METHODS A multicentre observational study of 22 ASD children implanted in four cochlear implant (CI) centers. Data concerning profound SHL diagnosis, ASD diagnosis, CI timing and CI compliance were collected. Sound Field (SF) was assessed through repeated behavioural measurements. Categories of Auditory Perception (CAP) and Categories of Language (CL) were used to evaluate speech perception and language skills at short (≤2 yrs), medium (5 yrs) and long term (>10 yrs) follow-up. Fitting parameters such as comfortable thresholds, pulse-width (pw, μsec) and clinical units converted into units of charge/phase were collected. The diagnosis of ASD was acquired by the referral neuropsychiatric department and severity was assessed through the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) and the Childhood Autism Rating Scale (CARS). RESULTS At the final follow-up session the median SF threshold for CI outcomes was 30 dB HL (min 15 - max 60). CAP score was extremely variable: 45.5% showed no improvement over time and only 22% of children reached CAP scores of 5-7. CL 45.5% showed no improvement over time and score was 1-2 in the majority of ASD children (72.7%), while only 18.2% reached the highest level of language skills. There were no statistically significant differences at each follow-up between subjects with or without comorbidities. CAP and CL were inversely correlated with DSM-V A and B domains, corresponding to lower speech and language scores in children with more severe ASD symptoms, and maintained their correlation at mid and long follow-ups whilst controlling for age at CI. Electrical charge requirements did not correlate with SF or age at implant but did inversely correlate with ASD severity. With regards to CI compliance: only 13.6% children (3) with severe DSM-V A/B levels and CARS score were partial/intermittent users. CONCLUSION The present study is a targeted contribution to the current literature to support clinical procedures for CI fitting and audiological follow-up in children with ASD. The findings indicate that the outcomes of CI use and the fitting procedures are both influenced by the severity of the ASD symptoms rather than the demographic variables or associated disorders.
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Affiliation(s)
| | - Laura Mariani
- Department of Sense Organs, University Sapienza of Rome, Italy.
| | - Maria Nicastri
- Department of Sense Organs, University Sapienza of Rome, Italy
| | - Sara Cavicchiolo
- Audiology Unit, Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - Ilaria Giallini
- Department of Sense Organs, University Sapienza of Rome, Italy
| | - Pietro Scimemi
- Department of Neuroscience, University of Padua, Padua - UOSD Otolaryngology and Audiology, Santi Giovanni e Paolo Hospital, Venice, Italy
| | - Diego Zanetti
- Department of Specialistic Surgical Sciences, Foundation IRCCS Ca' Granda Maggiore Hospital, Milan, Italy
| | - Silvia Montino
- Department of Neuroscience, University of Padua, UOC Otolaryngology, Padua Hospital, Italy
| | - Elisa Lovo
- Department of Neuroscience, University of Padua, UOC Otolaryngology, Padua Hospital, Italy
| | - Federica Di Berardino
- Department of Specialistic Surgical Sciences, Foundation IRCCS Ca' Granda Maggiore Hospital, Milan, Italy
| | - Patrizia Trevisi
- Department of Neuroscience, University of Padua, UOC Otolaryngology, Padua Hospital, Italy
| | - Rosamaria Santarelli
- Department of Neuroscience, University of Padua, Padua - UOSD Otolaryngology and Audiology, Santi Giovanni e Paolo Hospital, Venice, Italy
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Martins KVC, Goffi-Gomez MVS, Tsuji RK, Bento RF. Do the minimum and maximum comfortable stimulation levels influence the cortical potential latencies or the speech recognition in adult cochlear implant users? Hear Res 2021; 404:108206. [PMID: 33677193 DOI: 10.1016/j.heares.2021.108206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/10/2021] [Accepted: 02/10/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Cochlear implants (CI) programming is based on both the measurement of the minimum levels required to stimulate the auditory nerve and the maximum levels to generate loud, yet comfortable loudness. Seeking for guidance in the adequacy of this programming, the cortical auditory evoked potentials (CAEP) have been gaining space as an important tool in the evaluation of CI users, providing information on the central auditory system. OBJECTIVE To evaluate the influence of mishandling of electrical stimulation levels on speech processor programming on hearing thresholds, speech recognition and cortical auditory evoked potential in adult CI users. MATERIAL AND METHODS This is a prospective cross-sectional study, with a sample of adult unilateral CI users of both sexes, aged at least 18 years, post-lingual deafness, with minimum experience of 12 months of device use. Selected subjects should have average free field hearing thresholds with cochlear implant equal to or better than 34 dBHL and monosyllable recognition different from 0%. Individuals who could not collaborate with the procedures or who had no CAEP recordings were excluded. Participants were routinely programmed, and the map was named MO (optimized original map). Then three experimentally wrong maps were made: optimized original map with 10 current units below the maximum comfort level (C), named MC- (map minus C); optimized original map with minus 10 current units at minimum threshold level (T), named MT- (map minus T) and optimized original map with 10 current units above minimum level (T), named MT + (map plus T). In all programs, participants underwent free-field auditory thresholds from 250Hz to 6000Hz, recorded sentences and monosyllabic recognition tests presented at 65dB SPL in quiet and in noise, and free field CAEP evaluation. All tests were performed in an acoustically treated booth, in a randomized order of map presentation. Data were compared by Wilcoxon test. RESULTS Thirty individuals were selected and signed an informed consent form. The MC- map provided worsening of all free field thresholds, quiet and noise speech recognition, and P1 wave latency delay with significant difference from the results with the MO map. The MT- map worsened the hearing thresholds and statistically significantly reduced the P2 wave latency; MT+ map improved free field thresholds except 6000Hz, worsening speech recognition, without statistical significance. CONCLUSIONS The results suggest that maximum levels below the optimal thresholds lead to worse cochlear implant performance in both hearing thresholds and speech recognition tests in quiet and noise, increasing CAEP component P1 latency. On the other hand, the manipulation of minimum threshold levels showed alteration in audibility without significant impact on speech recognition.
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Affiliation(s)
- Kelly Vasconcelos Chaves Martins
- Department of Otorhinolaryngology, University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, São Paulo, SP 05403-000, Brazil.
| | | | - Robinson Koji Tsuji
- Department of Otorhinolaryngology, University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, São Paulo, SP 05403-000, Brazil
| | - Ricardo Ferreira Bento
- Department of Otorhinolaryngology, University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, São Paulo, SP 05403-000, Brazil
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Saoji AA, Adkins WJ, Olund AP, Nelson-Bakkum ER, Koka K. Effect of exceeding compliance voltage on speech perception in cochlear implants. Hear Res 2020; 400:108112. [PMID: 33253993 DOI: 10.1016/j.heares.2020.108112] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 10/27/2020] [Accepted: 11/06/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES In cochlear implants, the maximum current I (Amperes) that can be delivered on a cochlear implant electrode is determined by V = I * R, where V = compliance voltage (Volts) and R = electrode impedance (Ohms). Generally, electrode impedances are measured during each clinical visit and are used to set electrical stimulation parameters in cochlear implants. However, electrode impedances can rise during the course of cochlear implant use and lead to electrical stimulation voltage requirements exceeding the maximum compliance voltage of the medical device. Electric stimulation requirements that exceed the compliance voltage lead to clipping of the biphasic electrical pulse (current going into the cochlea) and are known to adversely affect cochlear implant outcomes. DESIGN Thirteen (11 unilateral and 2 bilateral) Advanced Bionics cochlear implant patients with a HiRes 90k™ cochlear implant participated in this study. Speech perception scores were measured using the patient's baseline clinical program with the most comfortable loudness levels (M-levels) and the following four test programs: (1) stimulation clipped at 15% below clinical M-levels (15%C) (2) stimulation clipped at 30% below clinical M-levels (30%C) (3) M-levels decreased by 15% (15%M) and (4) M-levels decreased by 30% (30%C). Speech perception scores were measured using AzBio sentences presented at 60 dB SPL in quiet and in the presence of multi-talker babble (+10 dB SNR). RESULTS Relative to the clinical baseline program, speech perception scores with the four test programs decreased in both quiet and noisy listening conditions. In quiet, speech perception scores measured with the 30%M and 30%C programs were significantly (p < 0.001) poorer than the baseline program. No significant differences in speech perception scores were measured between the baseline and the 15%C or 15%M programs. In the noisy listening condition, speech perception scores were significantly poorer than the baseline program for the 15%C (p = 0.008), 30%C (p < 0.001), and 30%M (p < 0.001) programs. No significant differences in speech perception scores were obtained between the baseline and the 15%M program in the noisy listening condition. Speech perception scores measured with the 30%C program were significantly (p < 0.001) poorer than those with the 30%M program, suggesting that clipping was more detrimental than reducing electrical stimulation levels. CONCLUSION Small amounts (15%) of clipping can significantly decrease speech perception in the presence of background noise. Large amounts (30%) of both clipping and M-level reduction may lead to significantly poorer speech perception in quiet and in background noise. The decrease in speech perception scores can most likely be attributed to reduced volume and poorer spectro-temporal representation. Therefore, it is important to establish comfortably loud electrical stimulation levels without exceeding the compliance voltage to maximize cochlear implant outcomes.
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Affiliation(s)
- Aniket A Saoji
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, 200 1st St SW, Rochester, MN 55905, United States.
| | - Weston J Adkins
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, 200 1st St SW, Rochester, MN 55905, United States
| | - Amy P Olund
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, 200 1st St SW, Rochester, MN 55905, United States
| | - Erin R Nelson-Bakkum
- Department of Clinical Research, Advanced Bionics LLC, Valencia, CA 91354, United States
| | - Kanthaiah Koka
- Department of Research and Technology, Advanced Bionics LLC, Valencia, CA 91354, United States
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Martins KVC, Goffi-Gomez MVS. The influence of stimulation levels on auditory thresholds and speech recognition in adult cochlear implant users. Cochlear Implants Int 2020; 22:42-48. [PMID: 32972324 DOI: 10.1080/14670100.2020.1822495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objective: This study aims to evaluate the influence of minimum and maximum stimulation levels on auditory thresholds and speech recognition abilities in adult cochlear implant users. Method: Fifteen adults implanted with a Cochlear® device with over 12 months listening experience. Participants underwent routine programming for optimization of minimum (T) and maximum comfort (C) stimulation levels, which was saved in Program 1 (MO). Three further maps were constructed artificially adjusting the measured levels: Program 2 - MO with 10 fewer electrical current units at C level (MC-); Program 3 - MO with 10 fewer electric current units at T level (MT-); and Program 4 - MO with 10 more electric current units at T level (MT+). Sound field thresholds, recorded sentence recognition and monosyllable tests were presented in quiet and in noise. Results: There were significantly better thresholds at 1, 3, 4, and 6 kHz frequencies in MT+ and worse in MC-. A statistically significant difference was observed for sentences in quiet and monosyllables in quiet and noise with changing C levels, with worsening of the results for MC- program. Conclusion: The results suggest that T levels above the behavioural threshold provided an improvement in sound field thresholds but did not influence performance on speech recognition tests in quiet and in noise. In contrast, C levels below the behavioural comfort level worsened sound field thresholds and led to poorer performance in tests of sentence recognition in quiet and monosyllable recognition in quiet and in noise.
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Affiliation(s)
- Kelly Vasconcelos Chaves Martins
- Department of Otorhinolaryngology, University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, São Paulo, SP 05403-000, Brazil
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Abstract
OBJECTIVES A positive relation between audibility and speech understanding has been established for cochlear implant (CI) recipients. Sound field thresholds of 20 dB HL across the frequency range provide CI users the opportunity to understand soft and very soft speech. However, programming the sound processor to attain good audibility can be time-consuming and difficult for some patients. To address these issues, Advanced Bionics (AB) developed the SoftVoice algorithm designed to remove system noise and thereby improve audibility of soft speech. The present study aimed to evaluate the efficacy of SoftVoice in optimizing AB CI recipients' soft-speech perception. DESIGN Two studies were conducted. Study 1 had two phases, 1A and 1B. Sixteen adult, AB CI recipients participated in Study 1A. Acute testing was performed in the unilateral CI condition using a Harmony processor programmed with participants' everyday-use program (Everyday) and that same program but with SoftVoice implemented. Speech recognition measures were administered at several presentation levels in quiet (35 to 60 dB SPL) and in noise (60 dB SPL). In Study 1B, 10 of the participants compared Everyday and SoftVoice at home to obtain feedback regarding the use of SoftVoice in various environments. During Study 2, soft-speech perception was acutely measured with Everyday and SoftVoice for 10 participants using the Naida CI Q70 processor. Results with the Harmony (Study 1A) and Naida processors were compared. Additionally, Study 2 evaluated programming options for setting electrode threshold levels (T-levels or Ts) to improve the usability of SoftVoice in daily life. RESULTS Study 1A showed significantly higher scores with SoftVoice than Everyday at soft presentation levels (35, 40, 45, and 50 dB SPL) and no significant differences between programs at a conversational level (60 dB SPL) in quiet or in noise. After take-home experience with SoftVoice and Everyday (Study 1B), 5 of 10 participants reported preferring SoftVoice over Everyday; however, 6 reported bothersome environmental sound when listening with SoftVoice at home. Results of Study 2 indicated similar soft-speech perception between Harmony and Naida processors. Additionally, implementing SoftVoice with Ts at the manufacturer's default setting of 10% of Ms reduced reports of bothersome environmental sound during take-home experience; however, soft-speech perception was best with SoftVoice when Ts were behaviorally set above 10% of Ms. CONCLUSIONS Results indicate that SoftVoice may be a potential tool for optimizing AB users' audibility and, in turn, soft-speech perception. To achieve optimal performance at soft levels and comfortable use in daily environments, setting Ts must be considered with SoftVoice. Future research should examine program parameters that may benefit soft-speech perception when used in combination with SoftVoice (e.g., increased input dynamic range).
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Wathour J, Govaerts PJ, Deggouj N. From manual to artificial intelligence fitting: Two cochlear implant case studies. Cochlear Implants Int 2019; 21:299-305. [PMID: 31530099 DOI: 10.1080/14670100.2019.1667574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To assess whether CI programming by means of a software application using artificial intelligence (AI), FOX®, may improve cochlear implant (CI) performance. Patients: Two adult CI recipients who had mixed auditory results with their manual fitting were selected for an AI-assisted fitting. Even after 17 months CI experience and 19 manual fitting sessions, the first subject hadn't developed open set word recognition. The second subject, after 9 months of manual fitting, had developed good open set word recognition, but his scores remained poor at soft and loud presentation levels. Main outcome measure(s): Cochlear implant fitting parameters, pure tone thresholds, bisyllabic word recognition, phonemic discrimination scores and loudness scaling curves. Results: For subject 1, a first approach trying to optimize the home maps by means of AI-proposed adaptations was not successful whereas a second approach based on the use of Automaps (an AI approach based on universal, i.e. population based group statistics) during 3 months allowed the development of open set word recognition. For subject 2, the word recognition scores improved at soft and loud intensities with the AI suggestions. The AI-suggested modifications seem to be atypical. Conclusions: The two case studies illustrate that adults implanted with manual CI fitting may experience an improvement in their auditory results with AI-assisted fitting.
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Affiliation(s)
- Justine Wathour
- Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, Brussels, 1200, Belgium
| | | | - Naïma Deggouj
- Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, Brussels, 1200, Belgium
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Falcón González JC, Borkoski Barreiro S, Ramos De Miguel A, Ramos Macías A. Improvement of speech perception in noise and quiet using a customised Frequency-Allocation Programming (FAP) method. ACTA ACUST UNITED AC 2019; 39:178-185. [PMID: 31131837 PMCID: PMC6536028 DOI: 10.14639/0392-100x-2013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 09/14/2018] [Indexed: 11/23/2022]
Affiliation(s)
| | | | - A Ramos De Miguel
- Psychoacoustic and Balance Research Laboratory, Las Palmas University Hospital, Spain
| | - A Ramos Macías
- Otorhinolaryngology Department, Las Palmas University Hospital, Spain
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Nunn TB, Jiang D, Green T, Boyle PJ, Vickers DA. A systematic review of the impact of adjusting input dynamic range (IDR), electrical threshold (T) level and rate of stimulation on speech perception ability in cochlear implant users. Int J Audiol 2019; 58:317-325. [DOI: 10.1080/14992027.2018.1564844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Terry B. Nunn
- University College London Ear Institute, London, UK
- Guy’s and St Thomas’ NHS Trust, Hearing Implant Centre, London, UK
| | - Dan Jiang
- Guy’s and St Thomas’ NHS Trust, Hearing Implant Centre, London, UK
| | - Tim Green
- Department of Speech Hearing and Phonetic Sciences, University College London, London, UK
| | - Patrick J. Boyle
- Advanced Bionics GmbH, European Research Centre, Hannover, Germany
| | - Deborah A. Vickers
- Department of Speech Hearing and Phonetic Sciences, University College London, London, UK
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DiNino M, O'Brien G, Bierer SM, Jahn KN, Arenberg JG. The Estimated Electrode-Neuron Interface in Cochlear Implant Listeners Is Different for Early-Implanted Children and Late-Implanted Adults. J Assoc Res Otolaryngol 2019; 20:291-303. [PMID: 30911952 PMCID: PMC6513958 DOI: 10.1007/s10162-019-00716-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 03/03/2019] [Indexed: 12/01/2022] Open
Abstract
Cochlear implant (CI) programming is similar for all CI users despite limited understanding of the electrode-neuron interface (ENI). The ENI refers to the ability of each CI electrode to effectively stimulate target auditory neurons and is influenced by electrode position, neural health, cochlear geometry, and bone and tissue growth in the cochlea. Hearing history likely affects these variables, suggesting that the efficacy of each channel of stimulation differs between children who were implanted at young ages and adults who lost hearing and received a CI later in life. This study examined whether ENI quality differed between early-implanted children and late-implanted adults. Auditory detection thresholds and most comfortable levels (MCLs) were obtained with monopolar and focused electrode configurations. Channel-to-channel variability and dynamic range were calculated for both types of stimulation. Electrical field imaging data were also acquired to estimate levels of intracochlear resistance. Children exhibited lower average auditory perception thresholds and MCLs compared with adults, particularly with focused stimulation. However, neither dynamic range nor channel-to-channel threshold variability differed between groups, suggesting that children’s range of perceptible current was shifted downward. Children also demonstrated increased intracochlear resistance levels relative to the adult group, possibly reflecting greater ossification or tissue growth after CI surgery. These results illustrate physical and perceptual differences related to the ENI of early-implanted children compared with late-implanted adults. Evidence from this study demonstrates a need for further investigation of the ENI in CI users with varying hearing histories.
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Affiliation(s)
- Mishaela DiNino
- Department of Psychology, Carnegie Mellon University, 5000 Forbes, Ave., Pittsburgh, PA, 15213, USA.
| | - Gabrielle O'Brien
- Department of Speech and Hearing Sciences, University of Washington, 1417 NE 42nd St., Box 354875, Seattle, WA, 98105, USA
| | - Steven M Bierer
- Department of Speech and Hearing Sciences, University of Washington, 1417 NE 42nd St., Box 354875, Seattle, WA, 98105, USA
| | - Kelly N Jahn
- Department of Speech and Hearing Sciences, University of Washington, 1417 NE 42nd St., Box 354875, Seattle, WA, 98105, USA
| | - Julie G Arenberg
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, 243 Charles St., Boston, MA, 02114, USA
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Entwisle LK, Warren SE, Messersmith JJ. Cochlear Implantation for Children and Adults with Severe-to-Profound Hearing Loss. Semin Hear 2018; 39:390-404. [PMID: 30374210 DOI: 10.1055/s-0038-1670705] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Cochlear implants (CIs) have proven to be a useful treatment option for individuals with severe-to-profound hearing loss by providing improved access to one's surrounding auditory environment. CIs differ from traditional acoustic amplification by providing information to the auditory system via electrical stimulation. Both postlingually deafened adults and prelingually deafened children can benefit from a CI; however, outcomes with a CI can vary. Numerous factors can impact performance outcomes with a CI. It is important for the audiologist to understand what factors might play a role and impact performance outcomes with a CI so that they can effectively counsel the recipient and their family, as well as establish appropriate and realistic expectations with a CI. This review article will discuss the CI candidacy process, CI programming and postoperative follow-up care, as well as considerations across the lifespan that may affect performance outcomes with a CI.
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Affiliation(s)
- Lavin K Entwisle
- Department of Communication Sciences and Disorders, University of South Dakota, Vermillion, South Dakota.,Department of Otolaryngology, New York University School of Medicine, New York, New York
| | - Sarah E Warren
- School of Communication Sciences and Disorders, University of Memphis, Memphis, Tennessee
| | - Jessica J Messersmith
- Department of Communication Sciences and Disorders, University of South Dakota, Vermillion, South Dakota
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Banda González RI, Castillo Castillo S, Roque Lee G. [Parameter fitting for cochlear implant]. BOLETIN MEDICO DEL HOSPITAL INFANTIL DE MEXICO 2018; 74:65-69. [PMID: 29364817 DOI: 10.1016/j.bmhimx.2016.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 09/06/2016] [Accepted: 10/19/2016] [Indexed: 11/25/2022] Open
Abstract
Programming a patient with cochlear impant follows a standardized and individualized protocol, although there is a percentage of users in which, for some reason, it is not possible to establish appropriate levels of stimulation. In these patients, the audiologist has to make adjustments in some special parameters such as a change in the strategy, stimulation rate, pulse width, among others, in order to obtain an auditory performance as expected.
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Electrically Evoked Auditory Event-Related Responses in Patients with Auditory Brainstem Implants: Morphological Characteristics, Test-Retest Reliability, Effects of Stimulation Level, and Association with Auditory Detection. Ear Hear 2018; 37:634-649. [PMID: 27579988 DOI: 10.1097/aud.0000000000000342] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to (1) characterize morphological characteristics of the electrically evoked cortical auditory event-related potentials (eERPs) and explore the potential association between onset eERP morphology and auditory versus nonauditory stimulation; (2) assess test-retest reliability of onset eERPs; (3) investigate effects of stimulation level on onset eERPs; and (4) explore the feasibility of using the onset eERP to estimate the lowest stimulation level that can be detected for individual stimulating electrodes in patients with auditory brainstem implants (ABIs). DESIGN Study participants included 5 children (S1 to S5) and 2 adults (S6 to S7) with unilateral Cochlear Nucleus 24M ABIs. Pediatric ABI recipients ranged in age from 2.6 to 10.2 years (mean: 5.2 years) at the time of testing. S6 and S7 were 21.2 and 24.6 years of age at the time of testing, respectively. S6 and S7 were diagnosed with neurofibromatosis II (NF2) and implanted with an ABI after a surgical removal of the tumors. All pediatric subjects received ABIs after being diagnosed with cochlear nerve deficiency. The lowest stimulation level that could be detected (behavioral T level) and the estimated maximum comfortable level (C level) was measured for individual electrodes using clinical procedures. For electrophysiological measures, the stimulus was a 100-msec biphasic pulse train that was delivered to individual electrodes in a monopolar-coupled stimulation mode at stimulation levels ranging from subthreshold to C levels. Electrophysiological recordings of the onset eERP were obtained in all subjects. For studies evaluating the test-retest reliability of the onset eERP, responses were measured using the same set of parameters in two test sessions. The time interval between test sessions ranged from 2 to 6 months. The lowest stimulation level that could evoke the onset eERP was defined as the objective T level. RESULTS Onset eERPs were recorded in all subjects tested in this study. Inter- and intrasubject variations in morphological characteristics of onset eERPs were observed. Onset eERPs with complex waveforms were recorded for electrodes that evoked nonauditory sensations, based on feedback from subjects, as well as for electrodes without any indications of nonauditory stimulations. Onset eERPs in patients with ABIs demonstrated good test-retest reliability. Increasing stimulation levels resulted in increased eERP amplitudes but showed inconsistent effects on response latencies in patients with ABIs. Objective and behavioral T levels were correlated. CONCLUSIONS eERPs could be recorded in both non-NF2 and NF2 patients with ABIs. eERPs in both ABI patient groups show inter- and intrasubject variations in morphological characteristics. However, onset eERPs measured within the same subject in this study tended to be stable across study sessions. The onset eERP can potentially be used to estimate behavioral T levels in patients with ABIs. Further studies with more adult ABI recipients are warranted to investigate whether the onset eERP can be used to identify electrodes with nonauditory stimulations.
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Incerti PV, Ching TYC, Hou S, Van Buynder P, Flynn C, Cowan R. Programming characteristics of cochlear implants in children: effects of aetiology and age at implantation. Int J Audiol 2017; 57:S27-S40. [PMID: 28885072 DOI: 10.1080/14992027.2017.1370139] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We investigated effects of aetiology and age at implantation on changes in threshold (T) levels, comfortable (C) levels and dynamic range (DR) for cochlear implants (CIs) in children over the first five years of life. DESIGN Information was collected at 6 months post-activation of CIs, and at 3 and 5 years of age. STUDY SAMPLE One hundred and sixty-one children participating in the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study. RESULTS Children with neural and structural cochlear lesions had higher T-levels and C-levels as compared to those without these conditions. Parameter settings varied from manufacturer's defaults more often in the former than in the latter group. Investigation of the effect of age at implantation for children without neural and structural cochlear lesions showed that those implanted at ≤12 months of age had higher T-levels and narrower DR at 6 months post-activation, as compared to the later-implanted group. For both early- and later-implanted groups, the C-levels at 6 months post-activation were lower than those at age 3 and 5 years. There were no significant differences in T-levels, C-levels, or DR between age 3 and 5 years. CONCLUSIONS Aetiology and age at implantation had significant effects on T-levels and C-levels.
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Affiliation(s)
- Paola V Incerti
- a National Acoustic Laboratories, Australian Hearing Hub, Macquarie University , Sydney , Australia.,b The Hearing CRC , Melbourne , Australia ; and.,c The University of Melbourne , Melbourne , Australia
| | - Teresa Y C Ching
- a National Acoustic Laboratories, Australian Hearing Hub, Macquarie University , Sydney , Australia.,b The Hearing CRC , Melbourne , Australia ; and
| | - Sanna Hou
- a National Acoustic Laboratories, Australian Hearing Hub, Macquarie University , Sydney , Australia.,b The Hearing CRC , Melbourne , Australia ; and
| | - Patricia Van Buynder
- a National Acoustic Laboratories, Australian Hearing Hub, Macquarie University , Sydney , Australia.,b The Hearing CRC , Melbourne , Australia ; and
| | - Christopher Flynn
- a National Acoustic Laboratories, Australian Hearing Hub, Macquarie University , Sydney , Australia
| | - Robert Cowan
- b The Hearing CRC , Melbourne , Australia ; and.,c The University of Melbourne , Melbourne , Australia
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de Carvalho NG, Novelli CVL, Colella-Santos MF. Evaluation of speech in noise abilities in school children. Int J Pediatr Otorhinolaryngol 2017; 99:66-72. [PMID: 28688568 DOI: 10.1016/j.ijporl.2017.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/23/2017] [Accepted: 05/25/2017] [Indexed: 11/25/2022]
Abstract
This study aimed to analyze the perception of speech in noise in children with poor school performance and to compare them with children with good school performance, considering gender, age and ear side as variables. The intelligibility of speech was evaluated in school children utilizing the Brazilian Hearing in Noise Test (HINT) in the situations of quiet (Q), Left ear competitive noise (NL), Right Ear Competitive Noise (NR), as well as the global average of other hearing situations, denominated Noise Composite (NC). Ninety seven school children between the ages of 8 and 10 were recruited in five schools of São Paulo-Brazil; the control group (CG) consisted of 54 students (23 male/ 31 female) without language and/or speech difficulties and good school performance, and the study group (SG) consisted of 43 students (28 male/ 15 female) identified by their teachers as having poor school performance. The variables gender and ear side did not interfere in speech perception. The age variable influenced only the CG. The SG had worse performance than the CG in the Q, NF and NC conditions. NF was the most difficult for both groups. The perception of speech in noise was the worst in children with poor school performance. The variables gender and ear side did not interfere in speech perception. The age group variable influenced the performance of the group of children with good school performance, demonstrating a better ability in older children. The speech perception in noise ability is more difficult for both groups when the noise affects both ears.
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He S, Teagle HFB, Buchman CA. The Electrically Evoked Compound Action Potential: From Laboratory to Clinic. Front Neurosci 2017; 11:339. [PMID: 28690494 PMCID: PMC5481377 DOI: 10.3389/fnins.2017.00339] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 05/30/2017] [Indexed: 11/13/2022] Open
Abstract
The electrically evoked compound action potential (eCAP) represents the synchronous firing of a population of electrically stimulated auditory nerve fibers. It can be directly recorded on a surgically exposed nerve trunk in animals or from an intra-cochlear electrode of a cochlear implant. In the past two decades, the eCAP has been widely recorded in both animals and clinical patient populations using different testing paradigms. This paper provides an overview of recording methodologies and response characteristics of the eCAP, as well as its potential applications in research and clinical situations. Relevant studies are reviewed and implications for clinicians are discussed.
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Affiliation(s)
- Shuman He
- Center for Hearing Research, Boys Town National Research HospitalOmaha, NE, United States
| | - Holly F. B. Teagle
- Department of Otolaryngology—Head and Neck Surgery, University of North Carolina at Chapel HillChapel Hill, NC, United States
| | - Craig A. Buchman
- Department of Otolaryngology—Head and Neck Surgery, Washington UniversitySt. Louis, MO, United States
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Optimizations for the Electrically-Evoked Stapedial Reflex Threshold Measurement in Cochlear Implant Recipients. Ear Hear 2017; 38:255-261. [DOI: 10.1097/aud.0000000000000390] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Reynolds S, Miller Kuhaneck H, Pfeiffer B. Systematic Review of the Effectiveness of Frequency Modulation Devices in Improving Academic Outcomes in Children With Auditory Processing Difficulties. Am J Occup Ther 2016; 70:7001220030p1-7001220030p11. [PMID: 26709423 DOI: 10.5014/ajot.2016.016832] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This systematic review describes the published evidence related to the effectiveness of frequency modulation (FM) devices in improving academic outcomes in children with auditory processing difficulties. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards were used to identify articles published between January 2003 and March 2014. The Cochrane Population, Intervention, Control, Outcome, Study Design approach and the American Occupational Therapy Association process forms were used to guide the article selection and evaluation process. Of the 83 articles screened, 7 matched the systematic review inclusion criteria. Findings were consistently positive, although limitations were identified. Results of this review indicate moderate support for the use of FM devices to improve children's ability to listen and attend in the classroom and mixed evidence to improve specific academic performance areas. FM technology should be considered for school-age children with auditory processing impairments who are receiving occupational therapy services to improve functioning in the school setting.
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Affiliation(s)
- Stacey Reynolds
- Stacey Reynolds, PhD, OTR/L, is Associate Professor, Department of Occupational Therapy, Virginia Commonwealth University, Richmond;
| | - Heather Miller Kuhaneck
- Heather Miller Kuhaneck, PhD, OTR/L, FAOTA, is Associate Professor, Department of Occupational Therapy, Sacred Heart University, Fairfield, CT
| | - Beth Pfeiffer
- Beth Pfeiffer, PhD, OTR/L, BCP, is Associate Professor, Department of Rehabilitation Sciences, Temple University, Philadelphia, PA
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van der Beek FB, Briaire JJ, van der Marel KS, Verbist BM, Frijns JHM. Intracochlear Position of Cochlear Implants Determined Using CT Scanning versus Fitting Levels: Higher Threshold Levels at Basal Turn. Audiol Neurootol 2016; 21:54-67. [PMID: 26891130 DOI: 10.1159/000442513] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 11/17/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES In this study, the effects of the intracochlear position of cochlear implants on the clinical fitting levels were analyzed. DESIGN A total of 130 adult subjects who used a CII/HiRes 90K cochlear implant with a HiFocus 1/1J electrode were included in the study. The insertion angle and the distance to the modiolus of each electrode contact were determined using high-resolution CT scanning. The threshold levels (T-levels) and maximum comfort levels (M-levels) at 1 year of follow-up were determined. The degree of speech perception of the subjects was evaluated during routine clinical follow-up. RESULTS The depths of insertion of all the electrode contacts were determined. The distance to the modiolus was significantly smaller at the basal and apical cochlear parts compared with that at the middle of the cochlea (p < 0.05). The T-levels increased toward the basal end of the cochlea (3.4 dB). Additionally, the M-levels, which were fitted in our clinic using a standard profile, also increased toward the basal end, although with a lower amplitude (1.3 dB). Accordingly, the dynamic range decreased toward the basal end (2.1 dB). No correlation was found between the distance to the modiolus and the T-level or the M-level. Furthermore, the correlation between the insertion depth and stimulation levels was not affected by the duration of deafness, age at implantation or the time since implantation. Additionally, the T-levels showed a significant correlation with the speech perception scores (p < 0.05). CONCLUSIONS The stimulation levels of the cochlear implants were affected by the intracochlear position of the electrode contacts, which were determined using postoperative CT scanning. Interestingly, these levels depended on the insertion depth, whereas the distance to the modiolus did not affect the stimulation levels. The T-levels increased toward the basal end of the cochlea. The level profiles were independent of the overall stimulation levels and were not affected by the biographical data of the patients, such as the duration of deafness, age at implantation or time since implantation. Further research is required to elucidate how fitting using level profiles with an increase toward the basal end of the cochlea benefits speech perception. Future investigations may elucidate an explanation for the effects of the intracochlear electrode position on the stimulation levels and might facilitate future improvements in electrode design.
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Affiliation(s)
- Feddo B van der Beek
- Department of Otolaryngology, Medical Spectrum Twente, Enschede, The Netherlands
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Khater A, El Shennaway A, Anany A. Improvement of cochlear implant performance: changes in dynamic range. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2015. [DOI: 10.4103/1012-5574.152706] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bartov T, Most T. Song recognition by young children with cochlear implants: comparison between unilateral, bilateral, and bimodal users. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2014; 57:1929-1941. [PMID: 24801662 DOI: 10.1044/2014_jslhr-h-13-0190] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 03/21/2014] [Indexed: 06/03/2023]
Abstract
PURPOSE To examine song identification by preschoolers with normal hearing (NH) versus preschoolers with cochlear implants (CIs). METHOD Participants included 45 children ages 3;8-7;3 (years;months): 12 with NH and 33 with CIs, including 10 with unilateral CI, 14 with bilateral CIs, and 9 bimodal users (CI-HA) with unilateral CI and contralateral hearing aid. Preschoolers were asked to identify children's songs presented via 5 versions: (a) full (lyrics sung with piano accompaniment); (b) a cappella (only lyrics); (c) melodic (matching main melodic contour); (d) tonal (only pitch information); and (e) rhythmic (only song's rhythm). RESULTS The NH group surpassed all CI groups at identifying songs via melodic and tonal versions, but no significant differences emerged between the NH group and any CI group via full, a cappella, or rhythmic versions. Among the CI groups, no significant differences emerged via melodic or rhythmic versions, but bimodal users performed significantly better than bilateral users via the tonal version. Chronological age and duration of CI use correlated significantly with identification via the rhythmic version. CONCLUSION Bimodal users showed an advantage in identifying songs in the tonal version through use of complementary information.
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Battmer RD, Borel S, Brendel M, Buchner A, Cooper H, Fielden C, Gazibegovic D, Goetze R, Govaerts P, Kelleher K, Lenartz T, Mosnier I, Muff J, Nunn T, Vaerenberg B, Vanat Z. Assessment of ‘Fitting to Outcomes Expert’ FOX™with new cochlear implant users in a multi-centre study. Cochlear Implants Int 2014; 16:100-9. [DOI: 10.1179/1754762814y.0000000093] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Norrix LW, Velenovsky DS. Auditory neuropathy spectrum disorder: a review. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2014; 57:1564-1576. [PMID: 24686491 DOI: 10.1044/2014_jslhr-h-13-0213] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE Auditory neuropathy spectrum disorder, or ANSD, can be a confusing diagnosis to physicians, clinicians, those diagnosed, and parents of children diagnosed with the condition. The purpose of this review is to provide the reader with an understanding of the disorder, the limitations in current tools to determine site(s) of lesion, and management techniques. METHOD This article is a review of what is known about ANSD. It includes descriptions of assessment tools, causes of ANSD, and patient management techniques. CONCLUSIONS This review is a guide to audiologists, speech-language pathologists, and early interventionists who work with individuals diagnosed with ANSD and/or their families. It highlights the need for more precise tools to describe the disorder in order to facilitate decisions about interventions and lead to better predictions of outcome.
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Buechner A, Vaerenberg B, Gazibegovic D, Brendel M, De Ceulaer G, Govaerts P, Lenarz T. Evaluation of the ‘Fitting to Outcomes eXpert’ (FOX®) with established cochlear implant users. Cochlear Implants Int 2014; 16:39-46. [DOI: 10.1179/1754762814y.0000000085] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Houston DM, Bergeson TR. Hearing versus Listening: Attention to Speech and Its Role in Language Acquisition in Deaf Infants with Cochlear Implants. LINGUA. INTERNATIONAL REVIEW OF GENERAL LINGUISTICS. REVUE INTERNATIONALE DE LINGUISTIQUE GENERALE 2014; 139:10-25. [PMID: 24729634 PMCID: PMC3979557 DOI: 10.1016/j.lingua.2013.08.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The advent of cochlear implantation has provided thousands of deaf infants and children access to speech and the opportunity to learn spoken language. Whether or not deaf infants successfully learn spoken language after implantation may depend in part on the extent to which they listen to speech rather than just hear it. We explore this question by examining the role that attention to speech plays in early language development according to a prominent model of infant speech perception - Jusczyk's WRAPSA model - and by reviewing the kinds of speech input that maintains normal-hearing infants' attention. We then review recent findings suggesting that cochlear-implanted infants' attention to speech is reduced compared to normal-hearing infants and that speech input to these infants differs from input to infants with normal hearing. Finally, we discuss possible roles attention to speech may play on deaf children's language acquisition after cochlear implantation in light of these findings and predictions from Jusczyk's WRAPSA model.
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Affiliation(s)
- Derek M Houston
- Department of Otolaryngology - Head & Neck Surgery, Indiana University School of Medicine
| | - Tonya R Bergeson
- Department of Otolaryngology - Head & Neck Surgery, Indiana University School of Medicine
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Cone B, Whitaker R. Dynamics of infant cortical auditory evoked potentials (CAEPs) for tone and speech tokens. Int J Pediatr Otorhinolaryngol 2013; 77:1162-73. [PMID: 23722003 PMCID: PMC3700622 DOI: 10.1016/j.ijporl.2013.04.030] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 04/19/2013] [Accepted: 04/20/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Cortical auditory evoked potentials (CAEPs) to tones and speech sounds were obtained in infants to: (1) further knowledge of auditory development above the level of the brainstem during the first year of life; (2) establish CAEP input-output functions for tonal and speech stimuli as a function of stimulus level and (3) elaborate the data-base that establishes CAEP in infants tested while awake using clinically relevant stimuli, thus providing methodology that would have translation to pediatric audiological assessment. Hypotheses concerning CAEP development were that the latency and amplitude input-output functions would reflect immaturity in encoding stimulus level. In a second experiment, infants were tested with the same stimuli used to evoke the CAEPs. Thresholds for these stimuli were determined using observer-based psychophysical techniques. The hypothesis was that the behavioral thresholds would be correlated with CAEP input-output functions because of shared cortical response areas known to be active in sound detection. DESIGN 36 infants, between the ages of 4 and 12 months (mean=8 months, s.d.=1.8 months) and 9 young adults (mean age 21 years) with normal hearing were tested. First, CAEPs amplitude and latency input-output functions were obtained for 4 tone bursts and 7 speech tokens. The tone bursts stimuli were 50 ms tokens of pure tones at 0.5, 1.0, 2.0 and 4.0 kHz. The speech sound tokens, /a/, /i/, /o/, /u/, /m/, /s/, and /∫/, were created from natural speech samples and were also 50 ms in duration. CAEPs were obtained for tone burst and speech token stimuli at 10 dB level decrements in descending order from 70 dB SPL. All CAEP tests were completed while the infants were awake and engaged in quiet play. For the second experiment, observer-based psychophysical methods were used to establish perceptual threshold for the same speech sound and tone tokens. RESULTS Infant CAEP component latencies were prolonged by 100-150 ms in comparison to adults. CAEP latency-intensity input output functions were steeper in infants compared to adults. CAEP amplitude growth functions with respect to stimulus SPL are adult-like at this age, particularly for the earliest component, P1-N1. Infant perceptual thresholds were elevated with respect to those found in adults. Furthermore, perceptual thresholds were higher, on average, than levels at which CAEPs could be obtained. When CAEP amplitudes were plotted with respect to perceptual threshold (dB SL), the infant CAEP amplitude growth slopes were steeper than in adults. CONCLUSIONS Although CAEP latencies indicate immaturity in neural transmission at the level of the cortex, amplitude growth with respect to stimulus SPL is adult-like at this age, particularly for the earliest component, P1-N1. The latency and amplitude input-output functions may provide additional information as to how infants perceive stimulus level. The reasons for the discrepancy between electrophysiologic and perceptual threshold may be due to immaturity in perceptual temporal resolution abilities and the broad-band listening strategy employed by infants. The findings from the current study can be translated to the clinical setting. It is possible to use tonal or speech sound tokens to evoke CAEPs in an awake, passively alert infant, and thus determine whether these sounds activate the auditory cortex. This could be beneficial in the verification of hearing aid or cochlear implant benefit.
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Affiliation(s)
- Barbara Cone
- University of Arizona, Department of Speech, Language and Hearing Sciences, PO Box 210071, Tucson, AZ 85721, United States.
| | - Richard Whitaker
- Hearing Science of Rancho Cucamonga 6283 Grove Avenue Suite 104 Rancho Cucamonga, CA 91730 909-920-9906
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