Intervention for a Child with Auditory Neuropathy/Dys-synchrony

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.

Among 80 prelingually deafened children who underwent cochlear implant at Okayama University Hospital, two auditory neuropathy/auditory dys-synchrony (AN/AD) cases with cochlear implant were identifi ed from review of medical records. These two cases fi rst demonstrated stable responses with distortion product otoacoustic emission, although later the response disappeared. In spite of the presence of AN/AD, the language development of these cases was quite satisfactory so far. Herein, we report the clinical course and language development of these auditory neuropathy cases with cochlear implant.

Figure 2: Verbotonal training allows a child to hear her own voice using a microphone and headphones and to feel speech through the soundboard on her wrist.Neuroplasticity allows patients' brains to restructure themselves when the optimal frequency response (OFR) with hearing devices and regular auditory therapy are provided. But are we doing enough to facilitate this restructuring? Verbotonal rehabilitation, an auditory-based strategy that maximizes listening skills of those with hearing impairment and other communications disorders, simultaneously allows the development of intelligible spoken language through binaural listening. The verbotonal system includes diagnostic therapy, habilitation, rehabilitation, speech disorders, and foreign languages. First introduced in 1967 at the University of Tennessee, Knoxville, the method quickly expanded worldwide due to positive clinical outcomes, but clinicians still may not be taking advantage of some tools to improve word understanding for patients using hearing aids and cochlear implants. THE VIBROTACTILE PHASE What's the difference between the infant, child, and adult brain? Under age 5, a child can learn to speak two languages fluently. After puberty, a teenager has an adult brain, and it's difficult for him to learn a second language. Vibrotactile learning is optimal below age 2, which is why it is best to place hearing aids and cochlear implants in children under 5. Hearing specialists must adapt their strategy to infant, child, and adult brains. All infants learn from vibrotactile and proprioceptive input; the fetus feels and hears his mother's body and speech rhythms. After birth, the infant first feels and then hears through wide bandwidths of 2 Hz to 20,000 Hz. Verbotonal always begins with this wideband amplification regardless of the patient's age. At birth, vibrotactile and proprioceptive senses are more dominant than auditory senses, which strengthen as the child's brain develops. Verbotonal rehabilitation takes advantage of the early dominant vibrotactile sense with body movements to develop sound awareness using a VTU speech vibrator with a common bone vibrator. (Figure 1.) The vibrator responds from 2 Hz to 1000 Hz, and is attached to the infant's wrist or to a speech board. Using a speech vibrator, speech board, and headphone during therapy, a child can feel and hear his parent's voice and via a special microphone, a child can hear his own voice. (Figure 2.)Figure 1: Verbotonal rehabilitation takes advantage of the early dominant vibrotactile sense with body movements to develop sound awareness using a VTU speech vibrator with a common bone vibrator.Early vibrotactile input will establish sound awareness, and prepare the child's brain to accept speech through hearing aids, cochlear implants, or both. Most infants go through a preimplant evaluation stage where hearing aids are fitted bilaterally. With effective training, some infants can continue with hearing aids while others will need binaural cochlear implants as soon as possible. Developing a successful training program, however, takes careful planning. SPEECH, RHYTHM, INTONATION Hearing aids and cochlear implants should be adjusted to include low speech frequencies so the patient can hear the octave changes when a speaker's words have an emotional pitch. Changing vocal pitch adds meaning to speech, and is essential to word understanding. Verbotonal therapy sets hearing aids and cochlear implants to include speech frequencies below 300 Hz with a speech vibrator. A cochlear implant electrode at 188 Hz or lower is set to stimulate the client's neural reserve in the cochlea. Seven perceptual parameters are used for error analysis and correction. (Table 1.) Begin with speech modifications and move on to body movements. These corrections may be difficult at first, but because the hearing specialist has normal speech patterns, he can effectively correct errors. Infants and children may have balance and coordination problems so vestibular function should be assessed when possible. Reporting optimal octaves for each of the 40 phonemes is a helpful tool for analyzing perceptual errors, such as why a patient with a certain audiometric pattern makes a particular mistake. Optimal octaves also provide a foundation for the tonality perceptual continuum.Table 1: Body movements and speech modifications based on the parameters.OPTIMAL FREQUENCY RESPONSE The optimal frequency response changes with brain maturation and the progress patients make with therapy. Some clients may always need the speech vibrator while others will progress with only auditory input. The verbotonal clinician uses the VLU by changing the center frequency, bandwidth, and slopes to 0, 6, 12, 18, 20, or 60 dB/octave. Once the client's brain is trained under the OFR with the verbotonal system, the OFR is shifted toward an optimal hearing aid setting. As Robert Martin, PhD, noted in his March Hearing Journal column, patients will often comment during training, “If I could only hear like this with my hearing aids.” (See FastLinks.) With digital hearing aids and cochlear implants, gain needs to be adjusted independently in each of the 10 to 15 frequency bands to create the optimal frequency response. The slope toward low frequencies is an important adjustment for the wide flat frequency and bimodal (discontinuous) responses on the VTU and the hearing aid response. In 1972, Guberina constructed eight nonsense syllables as logatomes: /bru-bru, mu-mu, bu-bu, vo-vo, la-la, ke-ke, shi-shi, and si-si/. Asp developed a shortened three logatome test —/mu-mu, la-la, si-si/ — to evaluate detection and perception through VTU, hearing aids, and cochlear implants. Most often it is used without amplification in distance evaluation. Can the client repeat si-si correctly without using amplification or visual cues? If not, he has a high-frequency hearing loss. This is an effective screening tool for the tonality perceptual continuum. TONALITY PERCEPTUAL CONTINUUM The tonality perceptual continuum (TPC) is based on filtered optimal-octaves and the spectral pitch (tonality) of each phoneme. The TPC ranges from low to mid to high tonality. Verbotonal uses a phoneme, logatome, and word or sentence that is homogenous in tonality. For instance, /i/, /si-si/, cease, and “she is my sister” are all homogenous and in high tonality. At the low end of the tonality continuum are /u/, /mu-mu/, moon, and “mama blew a bubble.” Remember, the tonality continuum represents the frequencies on the cochlear continuum. If an error occurs in a lower tonality than the target tonality, change the optimum frequency response by adding high frequencies, reducing low frequencies, or both. Use the continuum for correcting errors. Phoneme and logatome testing are preferred because they minimize client guessing. The phoneme /i/ minimizes guessing but a word or a sentence includes guessing. Because the word level is important, we've included a list of homogenous tonality words in five categories: low, low-mid, mid, mid-high, and high. (Table 2.) These test words can be presented inside or outside the sound booth. Note that adding more gain in the high-frequency region may not always be the solution when a patient makes an error. With digital technology, the OFR can be used by altering the gain in individual frequency bands until good results are obtained. The prescribed frequency response is a starting point; the client's preference is key.Table 2: Homogenous tonality words.Conversational speaker-to-listener distance is three feet; the speech level is 65 dB SPL (50 dB HL) at the listener's ear. At two inches, the speech level is 95 dB SPL (80 dB HL). Use this as a reference. The hearing specialist must keep his normal speaking loudness at different distances to be effective. This takes discipline and training. Outside the booth, doubling the distance between the clinician and the client's ear reduces the speech signal by 6 dB; half the distance increases it 6 dB. With a tape line on the floor, increase the distance gradually until the client misses a word, then decrease the distance until the client correctly repeats it. This will help the client manage louder or softer speech and distances. Closer distances increase loudness and reduce the effect of noise and reverberation. MAKING UP FOR LOST TIME Placing hearing aids or cochlear implants at age 1 means the infant missed a whole year not hearing. How do we make up for lost time? Will he always be behind? Verbotonal uses intensive vibrotactile, proprioceptive, and body movement training to treat the infant because he needs to hear and feel speech all the time. Some hearing specialists use aided pure-tone thresholds within 20 dB HL to indicate normal hearing, but it's not that simple. Current thinking holds that normal cochlear implant thresholds mean normal hearing. That is, once the implant is programmed, the client will hear like normal hearing people. If this were true, the hearing specialist's job would be easy. Ironically, cochlear implants have created a need for effective habilitation or rehabilitation. Diagnostic therapy involves evaluation for implant candidacy, examination of speech recognition through hearing aids, preimplant counseling, initial programming of the implants, counseling, and the client repeating words, sentences, and paragraphs. As an option, verbotonal treatment includes perceptual parameters, tonality error analysis, and correction with a speech vibrator to feel and hear speech. OVERCOMING OBSTACLES Implementing verbotonal therapy is not without financial obstacles. Medicare and private insurers offer low reimbursement for aural rehabilitation and cochlear implant programming. Habilitation and rehabilitation therapy should already be included in the initial or follow-up hearing aid or cochlear implant visit. While using the verbotonal system will add 30 to 40 minutes to the visit, the patient will be satisfied with the new optimum frequency response, and will refer others to your clinic. The initial financial setback will provide an opportunity for increased earnings if the practitioner improves his client's word understanding. Remember, the best form of advertisement is good hearing aid or cochlear implant results. The Hearing Journal article, “Retraining the brain when hearing aids aren't enough,” noted that digital hearing aid technology has advanced, but the technology itself has not been able to resolve all the communication problems of the hearing impaired. (See FastLinks.) Whether the hearing specialist uses advanced hearing aid technology or cochlear implants, these devices are only a remediation tool for the defective peripheral hearing organ to send information to the brain. Unless we as hearing health care providers modify our thinking to change the way we practice, we are not doing enough to serve our clients. FastLinks • Read Dr. Robert Martin's Nuts and Bolts column on word understanding at http://bit.ly/WordUnderstanding. • Read “Retraining the brain when hearing aids aren't enough” at http://bit.ly/HJRetraining. • Comment about this article by writing to [email protected]. • Follow us on Twitter at twitter.com/hearingjournal.

To investigate the music perception skills of adult cochlear implant (CI) users in comparison with hearing aid (HA) users who have similar levels of hearing impairment. It was hypothesized that the HA users would perform better than the CI recipients on tests involving pitch, instrument, and melody perception, but similarly for rhythm perception. Fifteen users of the Nucleus CI system and 15 HA users participated in a series of music perception tests. All subjects were postlingually deafened adults, with the HA subjects being required to meet the current audiological criteria for CI candidacy. A music test battery was designed for the study incorporating four major tasks: (1) discrimination of 38 pairs of rhythms; (2) pitch ranking of one-octave, half-octave, and quarter-octave intervals; (3) instrument recognition incorporating three subtests, each with 12 different instruments or ensembles; and (4) recognition of 10 familiar melodies. Stimuli were presented via direct audio input at comfortable presentation levels. The test battery was administered to each subject on two separate occasions, approximately 4 mo apart. The results from the rhythm test were 93% correct for the CI group and 94% correct for the HA group; these scores were not significantly different. For the pitch test, there was a significant difference between the HA group and the CI group (p < 0.001), with higher mean scores recorded by the HA group for all three interval sizes. The CI subject group was unable to rank pitches a quarter-octave apart, only scoring at chance level for this interval size. In the instrument recognition test, although there was no significant difference between the mean scores of the two groups, both groups obtained significantly higher scores for the subtest incorporating single instrument stimuli than those incorporating multiple instrumentations (p < 0.001). In the melody test, there was a significant difference between the implantees' mean score of 52% correct and the HA group's mean of 91% (p < 0.001). As hypothesized, results from the two groups were almost identical for the rhythm test, with the HA group performing significantly better than the CI group on the pitch and melody tests. However, there was no difference between the groups in their ability to identify musical instruments or ensembles. The results of this study indicate that HA users with similar levels of hearing loss perform at least equal to, if not better than, CI users on these music perception tests. However, despite the differences between scores obtained by the CI and HA subject groups, both these subject groups were largely unable to achieve accurate or effective music perception, regardless of the device they used.

Better defining best-aided condition: The role of hearing aids on cochlear implantation qualification rates.

Auditory neuropathy (AN) is a hearing disorder characterized by disruption of temporal coding of acoustic signals in the auditory nerve resulting from lesions involving auditory nerve fibers, the inner hair cells, or their synapses with auditory nerve terminals. Disruption of auditory nerve discharge underlies both the absence of auditory brainstem responses (ABRs) and impairment of speech perception. AN may be related to genetic disorders or result from a wide range of other etiologies. It can be identified either as an isolated disorder (isolated AN) or associated with multisystem involvement (non-isolated AN). Effectiveness and choice of assistive devices depend crucially upon etiology, site of lesion, and stage of the disease. Cochlear implants constitute an effective rehabilitative tool able to restore speech perception in many patients with genetic AN, especially those affected by the isolated form of the disorder. Some children with isolated AN have proved to be good hearing aid users, showing satisfactory open-set speech perception abilities in the aided condition. Over 50% of children discharged from neonatal intensive care units showing the electrophysiological profile of AN (absent ABRs, presence of otoacoustic emissions) benefit from hearing aid use, the provision of amplification resulting in remarkable improvement in speech perception. It can be concluded that differences in cochlear implant outcome or hearing aid use in patients with AN are related to the pathophysiological mechanisms underlying alteration of auditory nerve discharge associated with individual etiologies.

There are still debates about timing and effectiveness of cochlear implants (CI) in pediatric subjects with significant residual hearing who do not belong to traditional indication of CI. In this study, we aimed to investigate the outcomes of CI, specifically on improvement of pronunciation, among hearing-impaired children already with a substantial degree of language skills as evaluated by Categories of Auditory Perception (CAP) scores or sentence score. Our cohort comprised pediatric CI recipients from July 2018 through October 2020. Among them, cases with CAP scores of 5 or 6 preoperatively were defined as "borderline cases". We investigated prevalence and etiologies, and compared speech evaluation data preoperatively and postoperatively at three time points (3, 6 and 9-12 months after implantation). Among 86 pediatric CI recipients, 13 subjects (15.12%) had language development that reached CAP scores of 5 or 6 before implantation. Postoperative speech evaluation data 6 months after implantation revealed significant improvement of pronunciation (Urimal Test of Articulation and Phonation scores: UTAP), Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS) and word perception scores, but not of CAP and sentence perception scores. Notably, the significant improvement of pronunciation based on UTAP scores outstripped that of other speech parameters and this continued steadily up to one-year postoperatively. The result of the study serves as evidence for what to expect from cochlear implantation in hearing-impaired children who have already achieved a substantial degree of language development in terms of CAP scores or sentence perception scores, preoperatively.

A clinically focused music training program was developed, aimed at enhancing a listener's music appreciation levels. The program was pilot tested on 18 adult cochlear implant (CI) recipients and 13 adult hearing aid (HA) users, with each device group divided into a control and training group. The training groups were asked to use the program four times a week for 10 weeks. Both the training and control groups were assessed on their quality ratings of the musical stimuli as well as tests of instrument and style identification and pitch ranking, before and after the “training” period. In addition to examining the potential benefit of training on appreciation, we examined the relationship between appreciation and perceptual accuracy. The results showed that the training program improved CI recipients' quality ratings for ensemble stimuli, as well as both CI and HA users' subjective ratings of their music perception skills; however, there were no significant improvements for CI or HA users on the timbre identification or pitch ranking tasks. This suggests that CI recipients' music enjoyment can be improved with training, independent of perceptual accuracy. The pretraining baseline scores highlight that music appreciation and perception are two different issues, that everyday experience with the device does not improve music listening, and that music appreciation is still a significant issue for both CI and HA users.

Impact of early intervention on comprehensive language and academic achievement in Japanese hearing-impaired children with cochlear implants

New Multi-Center Clinical Trial to Address Cochlear Implantation of Children with Asymmetric Hearing Loss or Single-Sided Deafness

You have accessThe ASHA LeaderFeature1 Nov 2011Improving Hearing Aid Function in Noisy Situations Tamara StenderAuD, CCC-A Tamara Stender Google Scholar More articles by this author , AuD, CCC-A https://doi.org/10.1044/leader.FTR5.16132011.5 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In http://www.asha.org/Publications/leader/2011/111101/Improving-Hearing-Aid-Function-in-Noisy-Situations.htm Even with today’s sophisticated hearing aid advances in microphone directionality and noise-reduction circuitry (Chung, 2010), hearing-instrument users still experience difficulties in some challenging environments, such as in restaurants and at parties. Almost half of hearing-aid users who return their devices cite problems with hearing over background noise (Kochkin, 2007). It is no surprise that use in noisy situations is listed as one of the top 10 factors pertaining to hearing aid user dissatisfaction (Kochkin, 2010). Innovative approaches to facilitating hearing in noise, therefore, may further increase hearing- instrument users’ satisfaction. These approaches include strategic microphone placement in non- directional devices and the use of wireless accessories that stream the speaker’s voice directly to the listener’s hearing aids. Microphone Placement Strategic microphone placement taps the natural physical characteristics of the external ear to improve speech intelligibility. Outer ear structures have been shown to contribute to greater directivity toward the front than the rear (Ricketts, 2000; Shaw, 1974), which may translate to better speech understanding in noise in situations where the listener is facing the speaker. Conversely, when the microphone of a hearing instrument is positioned behind the ear, all pinna effects—including the ear’s natural directivity and protection from wind noise—are obliterated. However, moving the microphone inside the ear canal or even within the bowl of the concha maintains some of these favorable pinna effects, thereby naturally restoring some of the ear’s physiological ability to help the listener discriminate speech from noise. A relatively new hearing aid model on the market takes advantage of natural pinna effects ( Figure 1 [PDF], left panel). This form factor is similar to a conventional custom in-the-canal (ITC) device (right panel), except the microphone is removed from the shell and extends into the upper part of the concha. Removal of the microphone from the shell may allow for a smaller device or a larger vent. Yet since the microphone is still secured within the ear, natural directivity and spectral cues provided by the pinna are maintained (Van den Bogaert, Carette, & Wouters, 2011). A study at Walter Reed Army Medical Center revealed no significant difference in hearing-in-noise test results between this new custom form factor and a directional behind-the-ear hearing instrument (Cord & Block, 2011). In addition, the natural protection afforded by locating the microphone in the crevices of the outer ear (the concha) reduces the intensity of wind noise. Figure 2 [PDF] shows a spectrogram of wind noise measured in a hearing instrument with the microphone located within the concha (left panel) and with the microphone behind the ear (right panel). Red areas indicate the areas of highest energy across the frequency range due to wind noise. Accessories Another approach to improving speech in noise is the use of wireless accessories to stream the speaker’s voice directly to the hearing instruments. One of these approaches is a wireless hearing aid accessory that communicates through Bluetooth technology to the mobile phone (or Bluetooth-enabled landline phone). Bluetooth is an open technology that uses radio frequencies in the 2.4-GHz range to send data wirelessly over a limited distance. After pairing the accessory to the Bluetooth-ready phone and the hearing aids, the user is able to conduct phone conversations at a more favorable signal-to-noise ratio than without the accessory. In addition, the conversation is streamed simultaneously to both hearing aids, providing the additional benefit of binaural listening adjusted to the user’s hearing thresholds for each ear. Another wireless accessory is a personal wireless microphone that speakers can clip onto their clothing. Akin to a separate FM system that uses a transmitter and a receiver or boots that attach to the hearing instrument(s), this technology effectively improves the signal-to-noise ratio for the listener, especially in an environment with background noise. New direct wireless transmission, however, requires no additional boots or receivers for the listener. This technological advancement means reduced cost and hassle for the hearing-instrument user. Additional methods of promoting speech intelligibility in noise—in addition to hearing aid algorithms—may be necessary to reduce the return rate and the number of hearing aids stored in the drawer. With strategic microphone placement, which allows for natural directivity and wind noise protection in non-directional hearing instruments, and wireless technology that directly streams a more favorable signal-to-noise ratio, hearing in noise may become easier for hearing-instrument users. References Bluetooth. (2011, June 20). InWikipedia, The Free Encyclopedia.Retrieved 15:41, June 21, 2011, fromhttp://en.wikipedia.org/w/index.php?title=Bluetooth&oldid=435265724. Google Scholar Chung K. (2010). Reducing noise interference: Strategies to enhance hearing aid performance.The ASHA Leader, 15(4), 10–13. Google Scholar Cord M., & Block K. (2011, March). Efficacy of the remote microphone hearing aid for novice hearing aid users.Presented at Joint Defense Veteran Audiology Conference (JDVAC), San Diego, CA. Google Scholar Hearing Industries Association (HIA) (2010). Statistical reporting program.Washington, DC. Google Scholar Kochkin S. (2010). MarkeTrak VIII: Customer satisfaction with hearing aids is slowly increasing.Hearing Journal, 63(1), 11–19. Google Scholar Kochkin S. (2007). MarkeTrak VII: Obstacles to adult non-user adoption of hearing aids.Hearing Journal, 60(4), 27–43. Google Scholar Nilsson M., Soli S. D., & Sullivan J. A. (1994). Development of the Hearing in Noise Test for the measurement of speech reception thresholds in quiet and in noise.Journal of the Acoustical Society of America, 95(2), 1085–1099. CrossrefGoogle Scholar Ricketts T. (2000). Directivity quantification in hearing aids: fitting and measurements effects.Ear & Hearing, 21(1), 45–58. Google Scholar Shaw E. A. G. (1974). Transformation of sound pressure level from the free field to the eardrum in the horizontal plane.Journal of the Acoustical Society of America, 56(6), 1848–1861. Google Scholar Van den Bogaert T., Carette E., & Wouters J. (2011). Sound source localization using hearing aids with microphones placed behind-the-ear, in-the-canal, and in-the-pinna.International Journal of Audiology, 50(3), 164–176. Google Scholar Author Notes is a senior audiologist in Global Audiology for GN ReSound Group. Her research interests include hearing aid benefit and satisfaction, and the use of signal processing and other methods to improve speech discrimination in noise. Contact her at[email protected]. 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There is a critical need to understand better speech and language development in bilingual children learning two spoken languages who use cochlear implants (CIs) and hearing aids (HAs). The paucity of knowledge in this area poses a significant barrier to providing maximal communicative outcomes to a growing number of children who have a hearing loss (HL) and are learning multiple spoken languages. In fact, the number of bilingual individuals receiving CIs and HAs is rapidly increasing, and Hispanic children display a higher prevalence of HL than the general population of the United States. In order to serve better bilingual children with CIs and HAs, appropriate and effective therapy approaches need to be designed and tested, based on research findings. This study investigated the effects of supporting both the home language (Spanish) and the language of the majority culture (English) on language outcomes in bilingual children with HL who use CIs and HAs as compared to their bilingual peers who receive English-only support. Retrospective analyses of language measures were completed for two groups of Spanish- and English-speaking bilingual children with HL who use CIs and HAs matched on a range of demographic and socio-economic variables: those with dual-language support versus their peers with English-only support. Dependent variables included scores from the English version of the Preschool Language Scales, 4th Edition. Bilingual children who received dual-language support outperformed their peers who received English-only support at statistically significant levels as measured by Total Language and Expressive Communication as raw and language age scores. No statistically significant group differences were found on Auditory Comprehension scores. In addition to providing support in English, encouraging home language use and providing treatment support in the first language may help rather than hinder development of both English and the home language in bilingual children with HL who use CIs and HAs. In fact, dual-language support may yield better overall and expressive English language outcomes than English-only support for this population.

Chronic suppurative otitis media (CSOM) with or without cholesteatoma is a frequent chronic inflammatory condition in children, which may lead to severe hearing loss that affects speech development. Treatment of recurrent CSOM associated with unserviceable hearing requires a specialized approach with regard to disease eradication and hearing rehabilitation. In this study, we investigated the advantages of subtotal petrosectomy (SP) combined with cochlear implantation (CI) in children with CSOM associated with unserviceable hearing and describe our experience with regard to the efficacy of this method, together with a literature review. SP with sequential or simultaneous CI was performed in three children (four ears), and postoperative audiometric data were recorded. The study included two male and one female patient. Mean age at the time of SP was 10.75 years (7-13 years). Sequential implantation was performed in three ears. Facial nerve palsy occurred after SP in one patient. The latest word recognition scores of Cases 1, 2, and 3 were 80% (at 60 dB), 75% (at 60 dB), and 70% (at 50 dB) and 90% (at 50 dB), respectively. SP with CI may be safe and reliable in children with CSOM associated with unserviceable hearing.

This study aimed to describe the pragmatic behaviours of persons with adult-onset hearing loss (AHL) and to compare the behaviours underlying conversational abilities of hearing aid (HA) users to those of cochlear implant (CI) recipients using the Pragmatic Protocol described by Prutting and Kirchner (1987). The Pragmatic Protocol comprises 30 parameters that are organized in three aspects: verbal, paralinguistic and non-verbal dimensions. Thirty-five hearing aid users and 25 cochlear implant recipients were videotaped in a naturalistic setting during conversation with a partner. Fourteen (41%) of the HA users displayed normative pragmatic behaviour, in contrast to the CI recipients, among whom only 4 (16%) showed normative pragmatic behaviour, a significant difference (t=2.25, df=57, p =0.014. 1-tailed). When comparison was restricted to participants that displayed pragmatic inappropriateness, the two groups showed a similar pattern of inappropriate behaviour. Inappropriateness was observed in Vocal intensity (49%), Repair/revision (37%), Vocal quality (31%), intelligibility (27%), Feedback to speaker (25%), Pause time (24%) and Interruption/overlap (20%). Although the HA and the CI groups showed a similar pragmatic profile, there were quantitative and some qualitative differences between the two groups. Pragmatic behaviour was more appropriate in the HA group than in the CI user group. The pragmatic profile indicated that the adults with AHL show a wide variety of appropriate pragmatic behaviours and a specific profile of inappropriate pragmatic behaviours. The profile was centred on the paralinguistic and interactive pragmatic parameters, while the verbal and nonverbal aspects were found appropriate.

Purpose: This study investigates the social support in both elderly who wear hearing aids and elderly who do not report any hearing loss.Methods: The study subjects were 48 seniors age 65 or older who wore hearing aids and 48 seniors who did not wear hearing aids. A Lubben social network scales survey was conducted. The Korean Version of International Outcome Inventory for Hearing Aids, Puretone Audiometry, and Word Recognition Score tests were carried out on the elderly who were wearing hearing aids.Results: A statistical analysis represented that the total social support scores were not significantly different between the two groups. Of all the social support factors, social network was statistically significant between the groups (p &lt; 0.05), but social support was not statistically significant. The correlation between social support and the degree of hearing loss was not statistically significant. Further, there were no significant relationships found for the social support of older adults’ wearing hearing aids and satisfaction with hearing overall, and the level of social support.Conclusion: The results of the study indicated that users hearing aid users have a smaller social network than those who do not wear hearing aids. However, this result can be interpreted as an independent factor regarding satisfaction with hearing aid use and the degree of hearing. As a follow-up study, it will be necessary to proceed to study the diversity of the background factors for those elderly who do have hearing loss.