Il tempo di parlare e segnare

Introduction: Cochlear implantation allows auditory stimulation in individuals with bilateral profound hearing loss with limited benefits from conventional hearing aids. This device facilitates language development in children with profound sensorineural congenital hearing loss. The language development of children who use cochlear implants has differences when compared with that of normal-hearing children. This study investigated the linguistic performance of children who use cochlear implant over time and the influence of age at implantation on the results. Materials and methods: Study on the spoken language development in children with profound sensorineural congenital hearing loss implanted between 19 to 60 months of age in Centro Hospitalar de Coimbra. The evaluation instrument was a Portuguese Language Development Test (Teste de Avaliacao da Linguagem na Crianca). The participants were divided into 4 groups, based on age at implantation: before 25 months, from 25 to 36 months, from 37 to 48 months and after 48 months of age. Results: A comparison was made between the results of the four implanted children groups, as well as with normative data available for the test used. The implanted group that showed the best final results and the evolution curve most similar to that of the normative data was the group implanted before 25 months of age. No statistically significant differences were found between the studied groups. Conclusion: The collected data indicates a positive effect of early implantation on language development. The obtained results are in agreement with the literature. New studies should include more individuals and the evaluation of other aspects of child development.

Introduction In this paper, I examine the practices of representing Deaf ‘voices’’ to hearing audiences in two recent US television crime dramas. More literally I look at how American Sign Language is framed and made visible on the screen through various production decisions. Drawing examples from an episode of CSI: New York that aired in December 2006 and an episode of Law and Order: Criminal Intent that aired in April 2007, I examine how the practices of filming Deaf people and the use of American Sign Language intersect with the production of a Deaf ‘voice’ on the screen. The problem of representing a Deaf ‘voice’ on the screen is akin to the problem of representing other minority languages. Film and television producers in the United States have to make choices about whether the majority audience of English speakers will have access to the minority language or not. In the face of this dilemma media producers have taken several approaches: subtitling foreign speech, translating foreign speech through other characters, or leaving the language inaccessible except to those who use it. The additional difficulty with representing national sign languages is that both the language and the recording medium are visual. Sometimes, filmmakers make the choice of leaving some portions of the signed dialogue inaccessible to a non-signing hearing audience. On the one hand this choice could indicate a devaluing of the signed communication, as its specific content is considered irrelevant to the plot. On the other hand it could indicate that Deaf people have a right to be visible on television using their own language without accommodating hearing people. A number of choices made in the filming and editing can subtly undermine positive representations of Deaf ‘voices’ particularly to a Deaf audience. These choices often construct an image of sign languages as objectified, exoticised, disjointed, incomplete, or a code for spoken language. Simple choices such as using simultaneous speaking and signing by Deaf characters, cropping the scene, translating or not translating the dialogue have powerful implications for the ways that Deaf ‘voices’ are becoming more visible in the 21st century. Typical filming and editing conventions effectively silence the Deaf ‘voice.’ Over 20 years ago, in the comprehensive book, Hollywood Speaks: Deafness and the Film Entertainment Industry (1988), Schuchman’s complaint that the filming and editing techniques of the day often did not attend to preserving the visibility and comprehensibility of sign language eon the screen, still applies today. As editing techniques have evolved over the years, fr om reliance on wide and medium shots to frequent intercutting of close-ups, the tendency to cut sign language off the screen, and out of the comprehensible view of the audience, may have even increased. Recent Portrayals of Deaf People on Television During one television season in the United States between August 2006 and April 2007, 30 episodes of six different serial television programs portrayed signing Deaf characters. Three of these programs had on-going Deaf characters that appeared in a number of episodes throughout the season, while three other programs portrayed Deaf people in a one-off episode with a Deaf theme. Initial air date for the season Program and Season # of Episodes 1 14 Aug. 2006 Weeds, Season 2 5 2 20 Sep. 2006 Jericho, Season 1 13 3 28 Jan. 2007 The L Word, Season 4 9 Table 1. Dramas with Ongoing Deaf Characters during the 2006-2007 USA Television Season Initial air date Program, Season, Episode Episode Title 1 13 Dec. 2006 CSI: New York, Season 3, Episode 12 “Silent Night” 2 3 Apr. 2007 Law and Order: Criminal Intent, Season 6, Episode 18 "Silencer" 3 12 Apr. 2007 Scrubs, Season 6, Episode 16 “My Words of Wisdom” Table 2. One-off Episodes with Signing Deaf Characters during the 2006-2007 USA Television Seasons Ironically, although the shows with ongoing characters sometimes allow the Deafness of the character to be incidental to the character, it is only the one-off crime dramas that show Deaf people relating with one another as members of a vibrant community and culture based in sign language. Often, in the ongoing series, the characters remain isolated from the Deaf community and their interactions with other Deaf people are sparse or non-existent. For example, out of the 27 episodes with an ongoing Deaf character only two episodes of The L-Word have more than one Deaf character portrayed. In both Weeds and The L-Word the Deaf character is the love interest of one of the hearing characters, while in Jericho, the Deaf character is the sister of one of the main hearing characters. In these episodes though some of realities about Deaf people’s lives are touched on as they relate to the hearing characters, the reality of signing Deaf people’s social lives in the Deaf community is left absent and they are depicted primarily interacting with hearing people. The two episodes, from CSI: New York, and Law and Order: Criminal Intent, focus on the controversial theme of cochlear implants in the Deaf community. Though it is true that generally the signing Deaf community in the U.S.A. sees cochlear implants as a threat to their community, there is no record of this controversy ever motivating violent criminal acts or murder as portrayed in these episodes. In the episode of CSI: New York entitled “Silent Night” a conflict between a young Deaf man and Deaf woman who were formerly romantically involved is portrayed. The murdered young woman who comes from a Deaf family does not want her Deaf baby to have a cochlear implant while the killer ex-boyfriend who has a cochlear implant believes that it is the best option for his child. The woman’s Deaf parents are involved in the investigation. The episode of Law and Order: Criminal Intent, entitled “Silencer,” is also ultimately about a conflict between a Deaf man and a Deaf woman over cochlear implants. In the end, it is revealed that the Deaf woman is exploring the possibility of a cochlear implant. Her boyfriend projecting the past hurt of his hearing sister leaving him behind to go off and live her own life, doesn’t want his girlfriend to leave him once she gains more hearing. So he shoots the cochlear implant surgeon in the hand to prevent him from being able to perform the surgery. Then he accidentally kills him by crushing his voice box to prevent him from screaming. Analyzing Two Crime Dramas In both television dramas, the filmmakers use both sound and video editing techniques to mark the experiential difference between hearing and Deaf characters. In comparing the two dramas two techniques are evident : muting/distorting sounds and extreme close-ups on lips talking or hands signing. Though these techniques may heighten awareness of deaf experience to a non-signing audience they also point to a disabling stereotyping of the experience of being Deaf as lacking — framing their experience as hearing loss rather than Deaf gain (Bauman & Murray; Shakespeare 199). By objectifying sign language through extreme close ups American Sign Language is portrayed as something strange and unusual that separates Deaf signers from hearing speakers. The auditory silences can either jolt the hearing non-signer into awareness of the sensory aspect of sound that is missing or it can jolt them into awareness of the visual world that they often don’t really see. In the opening few scenes of the episodes both CSI: New York and Law and Order: Criminal Intent use sound editing alternately muting or distorting sounds as they cut between a ‘deaf’ auditory perspective and a ‘hearing’ perspective on the action as it unfolds. Even though the sound editing does play a part in the portrayal of Deaf people’s experience as lacking sound, the more important aspects of film production to attend to are the visual aspects where Deaf people are seen authentically signing in their own language. Scene Analysis Methodology In taking a closer look at a scene from each episode we can see exactly how the filming and editing techniques work to create an image of sign language. I have chosen comparable scenes where a Deaf individual is interviewed or interrogated by the police using a sign language interpreter. In each scene it can be assumed that all the communication is happening in both English and ASL through an interpreter, so at all times some signing should be occurring. In transcribing the scenes, I noted each point when the editor spliced different camera shots adjacent to each other. Because of the different visual aesthetics in each program where one relied heavily on continuous panning shots, I also noted where the camera shifted focus from one character to another marking the duration of screen time for each character. This allowed for a better comparison between the two programs. In my transcripts, I included both glosses of the ASL signs visible on the screen as well as the flow of the spoken English on the audio track. This enabled me to count how many separate shifts in character screen time segments contained signing and how much of these contained completely visible signing in medium shots. CSI:NY Witness Interview Scene In the first signing scene, Gina (played by Marlee Matlin) is brought in for an interview with Detective Taylor and a uniformed officer interpreter. The scene opens with a medium shot on Detective Taylor as he asks her, “What do you think woke you up?” The shot cuts to an extreme close up of her face and hands and pans to only the hands

The Shape of Air: American Sign Language as Narrative Prosthesis in 21st Century North American Media

(2010). Linguistic Assessment Tools for the Digisonic® Dual Electric-Acoustic Speech Processor. Cochlear Implants International: Vol. 11, Proceedings of the 9th European Symposium on Paediatric Cochlear Implantation, Warsaw, 2009, pp. 306-311.

Introduction: Cochlear implants have proved their clinical efficacy and have overcome a routine treatment for profound sensorineural impairment. More than thirty years pass since the first cochlear implant was used. These years, and the increasing number of implanted devices, have shown however some limitations and technical failures. These electronic device failures are unpredictable and sometimes difficult to diagnose. Description of two cases: The authors present two cases to illustrate failures of the intracochlear device. Both cases required a cochlear reimplantation surgery. Discussion and conclusion: There are multiple causes for intracochlear device’s failure. Management of implant failures, including revision surgeries, is becoming an increasingly important part of cochlear implant program activity.

TRABECULAR BONE MICROARTCHITECTURE IN ASSOCIATION WITH SYSTEMIC AND LOCAL FACTORS AS POTENTIAL PREDICTORS OF IMPLANT FAILURE By Diego A. Camacho DMD A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science in Dentistry at Virginia Commonwealth University Virginia Commonwealth University, 2016 Major Director: Thomas C. Waldrop DDS, MS, Professor and Director, Graduate Periodontics Clinicians have described the success rates of dental implants. The use of implants is projected to increase in the future. With a 5-10% failure rate, it is unclear the exact factors that are associated with implant failures. To improve upon these success rates, it is critical to understand parameters associated with implant failure including: periodontitis, peri-implantitis, systemic diseases, site preparation, dental history of the implant site, bone quality, materials, occlusion, and treatment timelines. While bone quality is associated with failure, objective measures to assess bone quality and characteristics are scarce. Therefore, the aim of this study is

The development of safe implants is one of the key priorities of biomedical engineering. Healthcare professionals are trying to create new and sophisticated strategies to improve and support people with disabilities using implants. The research described in this thesis focuses on developing a power supply from a wireless source for implants that will also serve as a wireless data telemetry channel for communication purposes. The design analysis of inductive coupled biomedical implant is expanded. The proposed method of powering the implant is a Class-E amplifier. An analytic approach is given in relation to tuning the class-E amplifier to maximize power transfer. This thesis culminates in specific recommendations for system level design including coil design, miniaturisation, coupling distance, stability of power supplies, consistent energy transfer and the ensuing electromagnetic exposure. The telemetry system for data transfer between implants and outside world has been also studied. This bio-telemetry system setup should ensure an optimal data rate, proper energy levels, low error rates, and a reliable power source. The efficiency of the system is crucial for these implants, and the use of efficient and low power consumption amplifiers and modulation schemes has been discussed in detail. The advantages of Pulse Width Modulated – Amplitude Shift Keying (PWM-ASK for short) are presented in comparison to current modulation schemes used in nowadays implants. Beside inductive coupled implants, this thesis also introduces a study of designing a wireless powered biomedical implant using capacitive coupling. A comparison between inductive and capacitive coupling is presented, while considering biotelemetry and power efficiency. A capacitive coupled biomedical implant is demonstrated through mathematical terms and simulations.

EDITORS' INTRODUCTION In the early years of its publication, the American Journal of Otology published articles featuring some of the most notable otology and neurotology programs in the country and the world. Over the years that journal has grown, changed names, and developed a second (fully open access) journal. At the same time, the subspecialties of Otology and Neurotology have changed and grown. With the advent of more formal certification and the need for an increasing number of specialty trained surgeons as well as other hearing, balance, and skull base professionals, the number of notable programs has dramatically increased both inside and outside the United States. Each of these programs is dedicated to providing quality patient care, performing cutting edge research, and training the next generation of both surgeons and scientists that will help lead our specialty in the future. As we launch the newest addition to the family of journals that started with the American Journal of Otology, we wanted to revive the tradition that started with the American Journal of Otology. The Journal's editorial board has formed a special group of individuals to consider which programs to highlight with each issue of the journal. Programs can be featured for a variety of achievements in the past or in the present and can be self-nominated or nominated by the committee. As we launch this series, the obvious first choice was to start where this all started, and it is our pleasure to begin this series with a look at the birthplace of the American Journal of Otology. We hope our readers find these historical looks insightful but also utilize these historical profiles as a method to help our current and future programs to evolve into even better institutions for future generations. HISTORY The Otology Group was founded in a small building in Nashville, TN, on State Street (Fig. 1), as a private practice by Michael E. Glasscock III, M.D. (1933–2018) in 1970. Nearly 51 years later, The Otology Group at Vanderbilt celebrates its anniversary as one of the largest, most innovative centers for skull base surgery, speech and hearing sciences, and neurotologic education. The historic reputation of The Otology Group of Vanderbilt transcends generations of fellows and faculty members and the group remains deeply rooted in the same fundamentals and principles from which it was founded.FIG. 1.: The small building of which The Otology Group was founded on State Street, Nashville, TN, by Dr Michael E. Glasscock III, M.D., in 1970.Michael E. Glasscock III, M.D. (Fig. 2) was a world-renowned clinician dedicated to patient and physician education (1). In 1980, He founded the American Journal of Otology, now known as Otology and Neurotology. He also founded the nonprofit organization, the EAR Foundation, dedicated to educating patients and physicians on ear and hearing disorders. In his career, he published nearly 250 peer-reviewed articles and was the editor of Surgery of the Ear. In conjunction with his partner, C. Gary Jackson, M.D., they possessed a passion for educating fellows and this passion continues to resonate within the fellowship and will do so for years to come. Dr Glasscock had sincere respect for his patients and strived to provide them with unrivaled state-of-the-art care. He was known for "doing things my way," and such mentality (and bravado) paved the way for center that exists today.FIG. 2.: Michael E. Glasscock III, M.D. (1933–2018).The Vanderbilt Bill Wilkerson Center (Fig. 3) was founded in 1951 by Dr Wesley Wilkerson, and named in honor of his son, Bill Wilkerson who was killed in Germany in 1945 during WWII. Wesley Wilkerson was an otolaryngologist in Nashville with a passion for pediatric hearing loss and chartered the Tennessee Hearing and Speech Foundation. In 1997, the Bill Wilkerson Center merged with Vanderbilt University Medical Center (VUMC). The Center was under the leadership for many years by Freeman O'Connell, Ph.D., then Fred Bess, Ph.D. (1978–2009) and is now under the leadership of Anne Marie Tharpe, Ph.D. (2009–current). Partnered with the Vanderbilt Department of Otolaryngology, the combined departments are now known as the Vanderbilt Bill Wilkerson Center for Otolaryngology and Communication Sciences. The Department of Otolaryngology, Head and Neck Surgery was reorganized in1985 and was led by Robert H. Ossoff, M.D. (1985–2009), Roland Eavey, M.D. (2000–2021) and is now under the leadership of Eben Rosenthal, M.D. (2021–present). The Department is ranked highly by external rankings nationwide and holds a strong reputation in both clinical care, research, and resident/fellow training (2). In 2004, the private practice which Mike Glasscock founded, The Otology Group, merged with the Vanderbilt Department of Otolaryngology, forming what is now known as The Otology Group of Vanderbilt. Within the Center is housed, in addition to The Otology Group of Vanderbilt, the Departments of Otolaryngology and Hearing and Speech Sciences, The Mama Lere Hearing School, The Pi Beta Phi Rehabilitative Institute, The Temporal Bone Lab, The Cochlear Implant Research Lab, The Balance Disorders Clinic, and The National Center for Childhood Deafness and Family Communication.FIG. 3.: The Vanderbilt Bill Wilkerson Center as it exists today and the home of The Otology Group at Vanderbilt, The Departments of Otolaryngology and Hearing and Speech Sciences, The Mama Lere Hearing School, The Pi Beta Phi Rehabilitation Institute, Cochlear Implant Research Laboratory, The Temporal Bone Lab, The Balance Disorders Lab, and National Center for Childhood Deafness and Family Communications.CLINICAL ENTERPRISE Under Dr Glasscock III, M.D.'s guidance, The Otology Group evolved into one of the world's most preeminent centers for skull base, cochlear implants, and ear disorders. The group is now led by David S. Haynes, M.D., M.M.H.C., a direct trainee of Glasscock III, M.D. The group is composed of 5 additional faculty and 2 nurse practitioners, including Robert Labadie, M.D., Ph.D., Marc Bennett, M.D., M.M.H.C., Matthew O'Malley, M.D., Kareem Tawfik, M.D., Elizabeth Perkins, M.D., Ken Watford, D.N.P., A.P.R.N., and Emily Brignola, D.N.P., A.P.R.N., F.N.P.-C. As one of the oldest and largest neurotology practices in the country, the clinicians strive to provide innovate, evidence-based, and honorable patient care. The Otology Group at Vanderbilt clinical practice involves a wide range of surgical approaches and techniques aimed at providing care for the most complex tumors and ear-related disorders. This includes advanced approaches to the skull base, cochlear implantation, otologic surgery, repair of cerebrospinal fluid leaks, and surgical treatment of balance disorders including superior canal dehiscence and Meniere disease. VUMC was one of the first centers to adopt endoscopic ear surgery (led by Alejandro Rivas, M.D., now at Case Western Reserve University) and to begin an annual endoscopic ear course, educating our residents, fellows, and other otolaryngologists on the new techniques of endoscopic ear surgery. The Otology Group at Vanderbilt encompasses the renowned Skull Base Center and Hearing Implant Program, a premiere destination for patients from all over the world. The Skull Base Center upholds a strong and collaborative relationship with The Department of Neurological Surgery including neurosurgeons, Reid C. Thompson, M.D. (Chair), Lola B. Chambless, M.D., and Peter J. Morone, M.D., M.S.C.I. The Skull Base Center and Hearing Implant Programs provide multidisciplinary, coordinated care, allowing for a large number of patient visits and surgical procedures, while providing the highest quality patient care. We also have a monthly multidisciplinary aural atresia clinic attended by audiology, neurotology, facial plastics, and other specialists. In addition, we have multidisciplinary teams that care for Neurofibromatosis Type II, and pediatric hearing loss, led by Kareem Tawfik, M.D. and Elizabeth L. Perkins, M.D., respectively. In 2020, The Otology Group of Vanderbilt performed over 400 skull base consultations and 140 skull base procedures despite the challenges brought by a global pandemic. Nearly 1500 patients were evaluated in the Balance Disorders Lab in 2020. In addition, 300 patients underwent cochlear implantation both in 2019 and in 2020, making VUMC the largest cochlear implant center in the United States and one of the largest in the world. RESEARCH The Cochlear Implant Research Laboratory includes principal investigators René Gifford, Ph.D. and Robert Labadie, M.D., Ph.D., and other investigators who continue to lead in international cochlear implant research. Research at VUMC ranges from reports on clinical and surgical effectiveness and quality outcomes reviews, to randomized controlled trials, such as the impact of image-guided cochlear implant programming on pediatric speech development. Research is supported from departmental resources, industry sponsored trials, and extramural funding (3–6). Our departments are ranked no. 2 in the nation in National Institute of Health (NIH) research and recent recipients of a $3.1 million NIH grant. Our recent NIH funding includes analysis of pre- and postinsertion computed tomography scanning to accurately estimate the electrode position which is used in preoperative planning and postoperative cochlear implant mapping (Fig. 4A, B) (7,8).FIG. 4.: Computed tomography (CT) scan analysis of electrode array placement following cochlear implantation. A, CT scan analysis with a perimodiolar electrode array including the cochlear, vestibule, and semicircular canals. B, Closer visualization of the electrode array and cochlea allows for assessment of the electrode array position with the modiolus (yellow) and scala tympani (blue) and scala vestibuli (green).A highly integrated, multidisciplinary team consisting of audiologists, speech language pathologists, hearing scientists, computer science engineers, and surgeons has been facilitated by institutional resources. VUMC sits on the same campus as Vanderbilt University, allowing close collaboration with other departments primarily Department of Speech and Hearing Sciences, Electrical Engineering and Computer Sciences. Vanderbilt Institute for Surgery and Engineering arose from these collaborations and continues to develop innovative solutions for surgical procedures including skull base and cochlear implant procedures. Our colocation of services has also allowed for extensive optimization of clinical delivery that includes same-day work up and surgery for cochlear implants and bundled pricing for cochlear implant services, the first in the world (9). This collaborative environment motivates basic discoveries which can then be clinically translated to improve individual outcomes. Efforts to use our electronic medical record and artificial intelligence to better coordinate clinical care and discovery is being explored by Matthew O'Malley, M.D., and will help to define our future. EDUCATION The Vanderbilt Bill Wilkerson Center is not only home to the Otology Group of Vanderbilt clinical practice but also houses our Temporal Bone lab (Fig. 5) and our research facilities. The Otology Group of Vanderbilt accepts 1 fellow per year into the neurotology program for a complement of 2 who join the neurotology service with 3 otolaryngology residents. Through the generous support of Michael E. Glasscock III, M.D. and Mr Herbert O. Christopher, the fellowship is enabled to pursue educational, academic, and research endeavors that will improve patient outcomes. Keeping with the theme of physician education, the first temporal bone lab was built in 1970 by Michael E. Glasscock III, M.D., with Jack Urban. The Otology Group of Vanderbilt continues to host multiple workshops and continuing medical education (CME) courses. This includes the annual temporal bone course, with the 85th version being held in the Fall of 2021 and the 7th annual Endoscopic Ear Course held next spring. In addition, an annual CME Otolaryngology course is held in Vail, CO, providing neurotologic education to neurotologists, otolaryngologists, and resident trainees. We also host an in-house resident/fellow temporal bone and endoscopic courses spanning 6 weeks led by Marc Bennett, M.D.FIG. 5.: The VUMC temporal bone lab resides in the Bill Wilkerson Center. The group hosts an annual temporal bone course, with nearly 300 participants in the virtual course in Fall 2020. VUMC indicates Vanderbilt University Medical Center.Fellow and resident education is ubiquitous, with weekly grand rounds on Friday mornings and weekly dedicated neurotology lectures on Thursday mornings led by prominent speakers within the field. Stepping beyond medical education, a leadership course is instituted throughout the year covering topics such as operations, cost accounting, organizational structure, strategy, and leadership (10). Multidisciplinary care is executed through many conferences for both skull base and cochlear implant recipients. The cochlear implant conference is held monthly and attended by audiologists, speech language pathologists, surgeons, social workers, administrative team members, implant research team members, and the cochlear implant coordinator. The monthly skull base conference is attended by neurotology faculty and fellows, neurosurgeons, radiologists, radiation oncologists, skull base coordinators, and research team members. Keeping with the Glasscock scholarly mission, The Otology Group at Vanderbilt takes considerable pride in the education of fellows and residents. This education begins with otologic surgery but transcends into every aspect of being a clinician and a leader. Fellows are "raised" to emulate the Glasscock mentality of prioritizing patient care and practicing with honor and integrity. Previous graduates and current fellows are customarily found at the podium at national and international conferences (Fig. 6) with nearly 30 to 34 peer-reviewed publications per year and over 90 scientific presentations at meetings, courses, and workshops annually. Prior fellows have held leadership positions in multiple international organizations including the American Neurotologic Society, the American Otologic Society, Triological Society, The Collegium Oto-Rhino-Laryngologicum Amicitiae Sacrum, the American Cochlear Implant Alliance, and many others. The fellows graduate with extensive operative and clinical experience, moving on to flourish within the field as division directors and chairpersons, academic deans, successful private practitioners, and academic leaders. This year, the Otology Group at Vanderbilt will proudly graduate its 73rd fellow in neurotology. Built on the legacy of Michael E. Glasscock III, M.D., the Otology Group at Vanderbilt will continue to strive for excellence in research, education, leadership training, and constantly seek innovation and improvement in patient care.FIG. 6.: The Otology Group will graduate its 73rd fellow in the upcoming year, as shown in this group composite. In the center of the composite proudly pictures the faculty mentors and Michael E. Glasscock III, M.D.As a rapidly growing department, The Otology Group at Vanderbilt is committed to providing care for all populations and modeling diversity. Such vision is facilitated through expanding care to remote populations involving telehealth, expedited and personalized care, and physician outreach. The group fosters diversity and equality through onboarding international faculty and fellows who reflect the increasingly diverse society we serve. CONCLUSION The Otology Group at Vanderbilt has strived from its inception to provide the highest quality patient care and to train the best neurotologic surgeons to become leaders in our field. We aspire to discover and provide novel and innovative treatments that will improve the lives of our patients. Education of patients, practicing physicians, and physicians in training remains an essential component of our group. As we celebrate our 51st year, our values remain stronger than ever.

The Gift: Cochlear Implant Brings A Year of Change

While cochlear implants (CIs) have transformed the lives of hundreds of thousands of profoundly deaf individuals worldwide, the ability of individual patients to understand speech through their CI varies widely. The longitudinal study reported in this thesis aimed to investigate the role of cortical function and plasticity in helping to predict and explain variability in individual CI outcome. Speech-evoked cortical activations, measured using functional near-infrared spectroscopy (fNIRS), and behavioural measures of speech perception were acquired in adult CI recipients before implantation through to six months after CI activation. As anticipated, cochlear implantation enabled the significant recovery of auditory speech perception over the first six months of CI use, yet individual performance varied widely across CI users. fNIRS enabled the measurement of speech-evoked cortical activations from bilateral superior temporal cortex (STC) that were free from CI-generated artefacts. Cortical activation to visual speech measured before implantation was able to significantly predict future CI outcome measured following six months of CI use. This pre-implant measure of brain activity provided unique predictive value above that of well-established clinical characteristics, including the age-at-onset and duration of deafness. When examining changes in cortical activation from before to after implantation, a greater increase in STC activation to visual speech was found to be related to better CI outcome. These visual-related changes also predicted changes in STC activation to auditory speech. These results highlight the importance of visual speech cues and coupling between the auditory and visual modalities during the recovery of auditory function with a CI. Together, the findings demonstrate the potential of fNIRS as a brain-imaging tool that is uniquely well-suited for use in cochlear implantation. Future applications of this technology could help to explain individual variability in CI success and to deliver more accurate clinical prognoses for CI candidates.

To evaluate the quality of life after cochlear implantation in adult cochlear implant recipients and to assess the applicability of Nijmegen Cochlear implant Questionnaire (NCIQ). Thirty-two postlingually deaf patients, 19 males and 13 females, underwent cochlear implantation with the age at operation of 35.27 (18-66) during the period from 1996 to the end of 2006. NCIQ was used to investigate the application of the equipment, hearing ability, and emotional exchange ability. All of the patients used their cochlear implants for 16 h every day on average with an experience in using such implant of more than 6 months. Improvement was seen in sound recognition, speech recognition, confidence, daily life, social exchange, and emotional behavior ability at different degrees. The improvement of confidence was very obvious. The speech communication ability of those with a hearing deprivation time longer than 5 years was lower than that of those with a shorter hearing deprivation time. Age and educational level did not influence the efficiency. Cochlear implantation is a cost effective intervention in the postlingually deaf adults. NCIQ test can be used to evaluate the quality of life among postlingually deaf adult cochlear implant recipients in China.

Objective To investigate the preoperative evaluation methods of multi-channel cochlear implantation in prelinguistic deaf patients with central nervous system diseases,and explore the outcomes of speech rehabilitation.Methods Multi-channel cochlear implantation was conducted in 23 prelinguistic deaf patients with central nervous system diseases,admitted to our hospital from January 1996 to January 2009.Of the 23 patients,13 had white matter abnormalities,4 pallium dysplasia,2 hydrocephalus,2 congenital temporal lobe cyst,1 Tourette syndrome and 1 Down's syndrome.Another 30 prelinguistic deaf patients without central nervous diseases and performed cochlear implantation at the same period were chosen as control group.Preoperative hearing and imaging data,developmental assessments,implantation methods and postoperative outcomes of patients from these two groups were compared.Results These 23 patients were reconstructed hearing successfully after cochlear implantation without serious complications; postoperative mean thresholds in sound field 6 months after the surgery were (42.89±3.5) dBHL,which were significantly higher than those in control group ([32.4±4.5] dBHL,P＜0.05); the mean value of speech discrimination rate in close-set word list one year after the surgery was (65.18 ±3.1)％,which was significantly lower than that in control group ([81.63±3.7]％,P＜0.05).Outcomes of hearing-speech rehabilitation were good,but the patients with serious white matter abnormalities and pallium dysplasia had a lower hearing-speech rehabilitation rate than the other patients.Conclusion Cochlear implantation can be performed safely and effectively in patients with central nervous diseases after comprehensive pre-operative imaging and audiological evaluation are performed;type and severity of the central diseases can affect postoperative rehabilitation. Key words: Cochlear implantation; Central nervous disease; Rehabilitation

Team Hearing

Cochlear Implants Present and Future

Access to Justice: An SLP’s Guide to Helping Persons with Complex Communication Needs Voice Their Case