Can we Measure Speech Perception Ability Objectively in Young Children using Cochlear Implant?

Cochlear implants (CIs) give children with severe to profound hearing loss access to sound. There appears to be a dose effect of sound exposure on speech perception abilities as shown by the positive influence of early implantation and CI experience. The consistency in device use per day could also affect sound dose, potentially affecting perceptual abilities in children with CIs. The objectives of the present study were to identify the impact of consistency in device use on: (1) speech perception abilities and (2) asymmetry in speech perception abilities between bilateral CIs. Retrospective analysis. To achieve the first objective, data from 65 children (age range at speech test: 1.91-18.05 yrs) with one (unilaterally implanted or bimodal) or two CIs (sequentially or simultaneously implanted) were included. A subset of data from 40 children with bilateral CIs was included to achieve the second objective. Of the 40 children with two CIs, 15 received their CIs sequentially. Device use information was extracted from datalogs stored in personal speech processors using custom software. Speech perception scores per CI collected in quiet were also evaluated. Multiple regression was used to assess the impact of daily CI use, while controlling for factors previously identified to affect speech perception: age at speech test, length of pre-CI (acoustic) hearing experience, length of CI hearing experience, and order of CI for the first objective, and CI category (simultaneous/sequential implantation), interimplant delay, and length of CI experience for the second objective. On average, children wore their CIs for 11.59 ± 2.86 hours/day and, with one CI, exhibited 65.07 ± 22.64% accuracy on speech perception tests. Higher monaural speech perception scores were associated with longer everyday CI use and CI experience (p < 0.05). Among children with bilateral CIs, those with simultaneously implanted CIs and similar bilateral hearing experience demonstrated a small but significant right ear advantage with higher speech perception scores when using the right rather than left CI (mean difference = 4.55 ± 9.83%). The asymmetry in speech perception between CIs was larger and more variable in children who received their CIs sequentially (mean difference CI1-CI2 = 27.48 ± 24.87%). These asymmetries decreased with longer/consistent everyday use of the newer CI (p < 0.05). Yet, despite consistent everyday device use of the second CI (>12 hours/day), only a small proportion of children implanted sequentially (one out of seven children) achieved symmetrical function similar to children with simultaneously received bilateral CIs. Consistent everyday CI use contributes to higher speech perception scores. Although consistent CI use can help reduce the asymmetry in speech perception abilities of children with sequentially implanted CIs subsequent to interimplant delay, residual asymmetry often persists.

A cochlear implant (CI) is a hearing device introduced in the 1980s for profoundly deaf subjects who gained little or no benefit from powerful hearing aids. This device comprises an electrode array inserted in the cochlea, connected to an internal receiver, and an externally worn speech processor. The CI transforms acoustic signals into electrical currents which directly stimulate the auditory nerve. Since the early 1990s, cochlear implantation in children has been developing rapidly. Although it is still difficult to predict how a child will perform with a cochlear implant, the success of cochlear implantation can no longer be denied. In this paper, some recent papers and reports, and the results of the various Nijmegen cochlear implant studies, are reviewed. Issues about selection, examinations, surgery and the outcome are discussed. Overall, our results were comparable with those of other authors. It can be concluded that cochlear implantation is an effective treatment for postlingually deaf as well as prelingually (congenital or acquired) deaf children with profound bilateral sensorineural deafness.

The purposes of this study were to: 1) develop a scoring system to assess narrative ability in children; 2) evaluate the impact of auditory speech perception with a cochlear implant on narrative ability; and 3) evaluate the importance of narrative ability to reading comprehension in deaf children. Narrative productions prompted from an eight-picture sequence story were elicited from 8 and 9 yr olds; 87 who had at least 4 yr of cochlear implant experience and 28 who had normal hearing. The stories were transcribed and a scoring system for narrative ability was developed based on the use of complete narrative structure, conjunctions linking semantic relations, and referents that served to identify and distinguish characters in the narrative. Narrative ability scores of cochlear implant users were examined in relation to their age, IQ, speech perception, language, and reading test scores. In addition, narrative ability scores for children with normal hearing were compared with two groups of cochlear implant users, those with above average speech perception scores and those with below average speech perception scores. Within the sample of hearing-impaired children, narrative ability scores correlated significantly with speech perception, language syntax, and reading test scores. A multiple regression analysis was conducted to predict reading comprehension scores from four predictor variables (age, IQ, language syntax, and narrative ability). Results reflected the independent contribution of discourse-level language skills, as measured by the narrative ability score, as well as sentence-level language skills in predicting reading test scores. Analysis of stories obtained from 8- and 9-yr-old children with normal hearing revealed the classic pattern that included a high point, a resolution, and one or more evaluative statements. Their stories achieved cohesion from correct use of both conjunctions and referents. Deaf children who received above-average speech perception scores with a cochlear implant (i.e., scored above 48% on the Word Intelligibility by Picture Identification speech perception test) told narratives that were similar in structure and use of referents to those of age mates with normal hearing. Although their use of subordinate conjunctions was not as well developed as normal-hearing children, it was significantly above that of deaf children who received less speech perception benefit after a similar period of implant use. These below-average speech perceivers exhibited significantly poorer use of narrative structure and cohesive devices than either normal-hearing age mates or children who achieved above average speech perception with a cochlear implant. Narrative ability is an important predictor of reading comprehension ability in deaf children above and beyond IQ and syntactic competence. Children who receive a cochlear implant under 5 yr of age and obtain above average speech perception benefit from the device construct narratives that are similar in structure and cohesion to those of their hearing age mates by age 8 to 9.

Introduction:The ability to perceive speech is a key sign of language development and normal speech. The current study was designed to measure the speech perception abilities in children with cochlear implant both in subjective and objective mannersMaterials and Methods:The research has been reviewed and approved by Medical ethical Committee and Thai Clinical Trials registry Committee. Sixty children age range from five to eight years with a pre-lingual bilateral profound sensori-neural hearing loss, fitted with a cochlear implant for two years or more were included. They were divided into two equal groups {thirty children in each group}; group I with good progress in auditory training and language acquisition and group II with poor progress in auditory training and language acquisition. Speech perception abilities were evaluated subjectively via Speech perception tests and objectively by measuring cortical evoked potentials. The results of speech perception tests and cortical evoked potential were analyzed and correlated. Results:There was a statically significant difference in the mean & SD of speech perception test results and the aided P1 latency, amplitude of cortical evoked potential between the two groups. There was negative correlation between P1 latency and speech perception tests and a positive correlation between P1 amplitude and speech perception tests in both groups.Conclusions:The cortical evoked potential is correlated with the speech perception ability which can help in objective prediction of speech perception abilities in CI children.

Auditory cortical activity to different voice onset times in cochlear implant users

The aim of this study was to examine the role of fundamental frequency (F0) information in improving speech perception of individuals with a cochlear implant (CI) who use a contralateral hearing aid (HA). The authors hypothesized that in bilateral-bimodal (CI/HA) users the perception of natural prosody speech would be superior to the perception of speech with monotonic flattened F0 contour, whereas in unilateral CI users the perception of both speech signals would be similar. They also hypothesized that in the CI/HA listening condition the speech perception scores would improve as a function of the magnitude of the difference between the F0 characteristics of the target speech signal and the F0 characteristics of the competitors, whereas in the CI-alone condition such a pattern would not be recognized, or at least not as clearly. Two tests were administered to 29 experienced CI/HA adult users who, regardless of their residual hearing or speech perception abilities, had chosen to continue using an HA in the nonimplanted ear for at least 75% of their waking hours. In the first test, the difference between the perception of speech characterized by natural prosody and speech characterized by monotonic flattened F0 contour was assessed in the presence of babble noise produced by three competing male talkers. In the second test the perception of semantically unpredictable sentences was evaluated in the presence of a competing reversed speech sentence spoken by different single talkers with different F0 characteristics. Each test was carried out under two listening conditions: CI alone and CI/HA. Under both listening conditions, the perception of speech characterized by natural prosody was significantly better than the perception of speech in which monotonic F0 contour was flattened. Differences between the scores for natural prosody and for monotonic flattened F0 speech contour were significantly greater, however, in the CI/HA condition than with CI alone. In the second test, the overall scores for perception of semantically unpredictable sentences in the presence of all competitors were higher in the CI/HA condition in the presence of all competitors. In both listening conditions, scores increased significantly with increasing difference between the F0 characteristics of the target speech signal and the F0 characteristics of the competitor. The higher scores obtained in the CI/HA condition than with CI alone in both of the task-specific tests suggested that the use of a contralateral HA provides improved low-frequency information, resulting in better performance by the CI/HA users.

Background and Objectives：In this study, we evaluated the effect of bimodal hearing in the speech perception test and the increasing level of bimodal hearing over cochlear implantation in speech perception score regarding residual hearing. Subjects and Method：Nineteen prelingually deaf patients, who had used bimodal hearing over a period of 8 months, were divided in two groups in accordance to their low frequency residual hearing. The children were tested in open-set speech perception under +10 SNR and +20 SNR. The scores of bimodal hearing and unilateral cochlear implantation were compared by the Wilcoxon signed-rank test. Also, the increased level of speech perception scores of bimodal hearing over cochlear implantation alone were calculated using the formula, [bimodal score (%) - unilateral cochlear implantation (%)], and was compared between groups. Results：In pure tone audiometry under silent condition, the result of bimodal hearing was similar to unilateral cochlear implantation in magnitude in both groups. Under the noisy condition, both groups had better result in bimodal hearing in terms of speech perception. Also, the increased level was higher in bimodal hearing over unilateral cochlear implantation in the better residual hearing group. However, since the sample size was small enough, it is considered that there was no statistical significance. Conclusion：Cochlear implanted patients with residual hearing are expected to get better speech perception in noisy environment with bimodal hearing regardless of the level of residual hearing. (Korean J Otorhinolaryngol-Head Neck Surg 2009;52:29-35)

Introduction There are very few studies comparing speech perception abilities of children using bimodal hearing over monaural cochlear implant and factors related to benefit of bimodal hearing. The aim of this study is to compare speech perception abilities of children using bimodal fitting versus children using cochlear implant alone and explore factors related to benefit of bimodal hearing. Materials and Methods In the present study, 20 cochlear implantees with the hearing age range of 3 to 8 years were included. Speech perception performance was assessed by means of Parent’s Evaluation of Aural/Oral Performance of Children scale and early speech perception (ESP) test: Pattern Perception Words, Monosyllabic Words, Bisyllabic, and Trisyllabic Words Identification test. ESP test was carried out in two conditions cochlear implant with hearing aid in opposite ear (CIHA), bimodal, and cochlear implant (CI) alone. Aided audiometry was also carried out in above mentioned two conditions. Results and Discussion On aided audiometry test, aided thresholds were improved by 5 to 6 dB in CIHA condition as compared to CI alone condition in 14 out of 20 children. Whereas on speech perception test, there was a significant improvement of 15 to 20% on domains of ESP test in these children. Factors such as implant age, chronological age, and number of hours of hearing aid usage were not significantly associated with benefit. Nevertheless aided threshold at 4,000 Hz was found to be significantly associated with bimodal benefit. Conclusion Bimodal hearing is beneficial in most of the children than monaural hearing through cochlear implant.

This is a pilot study that aims (1) to help design a protocol for fitting and optimizing cochlear implants and hearing aids, (2) to help design a test battery that can help monitor children's progress and (3) to assess the benefit of using a cochlear implant with a contralateral hearing aid. Seven children between the ages of seven and 15 years completed the study. None of them had worn a contralateral hearing aid (HA) since cochlear implantation (five to seven years after implantation). The Listening Inventory for Education (LIFE), Life Situation Questionnaire (LSQ), and Client Orientated Scale of Improvement for Children (COSI-C) questionnaires together with subject's feedback were used as subjective measures, and speech perception tests – the City of New York (sentences list) (CUNY) and Bamford-Kowal-Bench (sentences list) (BKB) depending on child's speech perception skills – in quiet and in noise were used as objective measures. The results showed mixed subjective feedback, even though objectively all children improved their speech perception scores when wearing cochlear implants and hearing aids. The COSI-C proved to be the most successful tool to collect feedback from parents. Copyright © 2007 John Wiley & Sons, Ltd.

To evaluate the results of late cochlear implantation in prelingually deaf patients with significant residual hearing loss and to evaluate patient factors relevant to postoperative auditory outcomes in this patient group. Analysis of results of cochlear implantation using postoperative speech perception test scores per each condition. Tertiary referral center. Thirty-two subjects with severe to profound hearing loss that developed before the age of 4. Subjects were implanted at a mean age of 24.8 years (range, 16-44) with Nucleus CI24 (n = 18, 56%), Clarion HiRes 90K (n = 11, 34%), and Medel PULSA (n = 3, 10%) device. Details of etiology, duration of deafness, hearing aid history, hearing thresholds before operation, communication mode, and educational environment were investigated. Speech perception tests were performed preoperatively and 12 months after the operation. Postoperative speech perception test scores between different options within patient group. : The results showed significant improvement in open set speech perception (sentence) scores after the implantation (mean scores from 7.0 to 46.7, p < 0.05). Preoperative hearing of better ear and preoperative speech perception scores correlated with postoperative performances (r = -0.70 and r = 0.46, respectively, p < 0.05). Education and communication mode were also closely related to postoperative performances. In the group with poorer performances, preoperative hearing thresholds were significantly worse than those with better performances, and a larger portion of those patients attended special schools and used sign language. We found that residual auditory capacity in the better ear is an important factor in predicting outcomes after cochlear implantation in patients with prelingual hearing loss.

ObjectivesThis study examined the relationships between electrophysiological measures of the electrically evoked auditory brainstem response (EABR) with speech perception measured in quiet after cochlear implantation (CI) to identify the ability of EABR to predict postoperative CI outcomes.MethodsThirty-four patients with congenital prelingual hearing loss, implanted with the same manufacturer’s CI, were recruited. In each participant, the EABR was evoked at apical, middle, and basal electrode locations. The following EABR measures were analyzed: wave III and V input/output (I/O) function, latency, threshold, threshold0.5 μV and Gibson scoring. Patients’ speech perception abilities were assessed using the Mandarin Speech Perception (MSP) materials presented in quiet. The Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) were also used to assess CI outcomes. A regression model was developed to explore the relationship between EABR and each speech measure, to identify parameters with significant predictive ability.ResultsA significantly shorter eV latency, lower eV threshold, lower eV threshold0.5 μV and steeper I/O slopes for both eV and eIII were observed when these responses were evoked at the apical electrode, compared to the middle and basal positions. Implantation age was significantly negatively correlated with bisyllables recognition rate (R2 = 0.20, p = 0.0194). The eIII slope at the apical site and the eV slope at the basal site demonstrated the highest R2 values in positive correlation with CAP, both with R2 = 0.09. Among the EABR parameters, the regression models based on MSP bisyllables recognition rate, basal eV latency, eV thresholds and threshold0.5 μV recorded at the apical and middle positions were statistically significant.ConclusionsOur study identified an apex-to-base gradient in EABR responsiveness following prolonged CI use. The threshold and I/O slopes of EABR appear to be informative predictors of speech perception performance in CI users, especially in the low-to-middle frequency range. However, further validation is needed.

There is increasing evidence from animal studies for plasticity of auditory function. This has prompted research to determine whether such plastic changes occur in adults and children with hearing disorders. Behavioural measures such as speech perception scores do show improvements after hearing aid fitting and cochlear implantation. Several studies have also shown changes in cortical auditory evoked potentials after cochlear implantation and after auditory training. These studies indicate that improvements in speech perception ability are associated with changes in the central auditory system, particularly at the cortical level.

Cochlear Implantation in Adults With Single-Sided Deafness: A Systematic Review and Meta-analysis.

Mucopolysaccharidosis IVA (OMIM 253000; also known as Morquio A syndrome) is associated with skeletal, airway, and hearing abnormalities. Cochlear implantation is an effective intervention for patients with severe-to-profound hearing loss. Patients can gain substantial improvement in auditory performance, speech perception, and their quality of life from cochlear implantation. Although severe progressive sensorineural hearing loss is a common feature of mucopolysaccharidosis IVA, no detailed description of cochlear implantation for mucopolysaccharidosis IVA has been reported. To review the effectiveness and special considerations associated with cochlear implantation in patients with mucopolysaccharidosis IVA, we here report the case of cochlear implantation in mucopolysaccharidosis IVA by a multidisciplinary team. A retrospective chart review was conducted on a 34-year-old female with mucopolysaccharidosis IVA, who received a cochlear implant. Audiometric thresholds, speech perception scores, and cochlear implant processor mapping information were reviewed during the first 12 months following cochlear implantation. The results of audiological tests indicate improved hearing thresholds as well as remarkable enhancement of speech perception skills over 12 months of cochlear implant use. Cochlear implantation improved auditory performance in a mucopolysaccharidosis IVA patient with postlingually severe-to-profound sensorineural hearing loss. The benefits of cochlear implantation could be meaningful for other Morquio patients with progressive hearing loss, although the risks of surgery and anesthesia should be carefully considered by a multidisciplinary team of experts during the cochlear implant candidacy process.

Cochlear implant (CI) candidacy and postoperative outcomes are assessed using sets of speech perception tests that vary from center to center, limiting comparisons across institutions and time periods. The objective of this study was to determine if scores on one speech perception test could be reliably predicted from scores on another test. Arizona Biomedical (AzBio) Sentence Test, Consonant-Nucleus-Consonant word (CNCw), and Hearing in Noise Test (HINT) scores in quiet for the implanted ear were collected for individuals who received a CI between 1985 and 2019. Scores collected during the same testing session were analyzed using Bland-Altman plots to assess agreement between testing methods. Simple linear regression with logit transformation was used to generate predictive functions and 95% confidence intervals for expected mean and individual scores. Single academic medical center. A total of 1,437 individuals with a median age of 59.9 years (range, 18-95 yr) and 46% (654 of 1,437) male. N.A. Agreement as a function of test score, mean, variance, and correlation coefficients. A total of 2,052 AzBio/CNCw, 525 AzBio/HINT, and 7,187 CNCw/HINT same-session score pairings were identified. Pairwise test comparisons demonstrated limited agreement between different tests performed in the same session, and a score correlation between different speech tests revealed large variances. Transformation functions between test batteries were predictive of mean scores but performed poorly for prediction of individual scores. Point-wise comparisons of scores across CI test batteries should be used with caution in clinical and research settings.