Result on speech perception after conversion from Spectra® to Freedom®

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.

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.

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.

Cochlear implant (CI) is the main intervention option for people with severe and profound sensorineural hearing loss.The purpose of this study was to investigate the auditory performance of a group of prelingually deafened paediatric cochlear implant users using direct speech perception measures (objective) and a parental questionnaire (subjective) and to identify significant demographic factors that might contribute to their performance. A total of 48 children from the Cochlear Implant Program under the Malaysian Ministry of Health with hearing age of 12 to 89 months (mean = 42.60 ± 19.46 months) participated in this study. The speech perception test was conducted using selected tests from the Malay version of the Evaluation of Auditory Response to Speech (EARS) while parental views of the children’s performance were collected using the Malay version of the Parents’ Evaluation of Aural/Oral Performance of Children (PEACH) questionnaire. The recorded speech stimuli were presented to the children in a free field at approximately 65 dB SPL in a sound treated room. The speech perception test results were then categorized using the Malay version of the Categories of Auditory Performance Index (My-CAPI) with 10 categories ranging from ‘0’ to ‘9’. Results showed that most of the children (N = 20, 41.7%) were performing at category 2 of My-CAPI (limited closed set speech perception) with three children achieved the maximum category 9 (advanced open-set sentences in noise). Communication mode was the only demographic factor that significantly correlated with the My-CAPI and PEACH scores (p < 0.01). Pearson correlation coefficient showed a strong relationship between the PEACH scores and My-CAPI levels (p < 0.01; r = 0.71) suggesting that the PEACH questionnaire can be used as an indicator of the auditory performance if the speech perception tests cannot be performed. The findings suggest that the majority of the CI children tested in this study had not achieved satisfactory auditory performance and that the use of oral communication mode was the main factor associated with better auditory outcomes. DOI : http://dx.doi.org./10.17576/JSKM-2017-1502-08

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.

Speech perception plays a significant role in the development of speech and language ability in children with hearing loss. There are various speech perception tests with the specific protocol to administer and score. Auditory evoked potential is an objective measure used for assessing hearing acuity in young children. Higher cortical evoked potential test provides an effective indication of the physiological status of auditory cortex. CEAP can be obtained in young children with assistive devices. The present research study aims to investigate whether latency and amplitude of aided cortical evoked potential can predict Speech perception score in cochlear implant users. 52 cochlear implant users and 102 typical children were tested. The mean age for children using cochlear implant was 8.05 years, standard deviation 1.4. The normal hearing group had a mean age of 8.12 years and standard deviation 1.46. Cochlear implant users were having at least 15 active electrodes. Speech stimulus was used with 100 ms duration, 20 ms rise/fall, 20 ms plateau tones. The inter-stimulus interval was kept at 1125 ms. During statistical analysis of data, CEAP P1 latencies and speech perception scores were found to be related. A further regression equation was obtained. The present study reveals speech stimuli can evoke distinct neural response patterns from auditory cortex. The present research study also helps in understanding the neural processing of speech in individuals with hearing impairment using Cochlear implant. Statistical analysis of data CEAP P1 latency and speech perception score regression equation were obtained. The result reveals that speech stimuli can evoke distinct neural response patterns from auditory cortex. CEAP finding support speech perception ability and auditory evoked potential help to the study of neural processing of speech in individuals with the cochlear implant. The evoked potential and speech perception ability has a significant relation between them.

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.

Introduction: Benefits of bilateral cochlear implants (CI) may be compromised by delays to implantation of either ear. This study aimed to evaluate the effects of sequential bilateral CI use in children who received their first CI at young ages, using a clinical set-up. Methods: One-channel cortical auditory evoked potentials and speech perception in quiet and noise were evoked at repeated times (0, 3, 6, 12 months of bilateral CI use) by unilateral and bilateral stimulation in 28 children with early-onset deafness. These children were unilaterally implanted before 3.69 years of age (mean ± SD of 1.98 ± 0.73 years) and received a second CI after 5.13 ± 2.37 years of unilateral CI use. Comparisons between unilaterally evoked responses were used to measure asymmetric function between the ears and comparisons between bilateral responses and each unilateral response were used to measure the bilateral benefit. Results: Chronic bilateral CI promoted changes in cortical auditory responses and speech perception performance; however, large asymmetries were present between the two unilateral responses despite ongoing bilateral CI use. Persistent cortical differences between the two sides at 1 year of bilateral stimulation were predicted by increasing age at the first surgery and inter-implant delay. Larger asymmetries in speech perception occurred with longer inter-implant delays. Bilateral responses were more similar to the unilateral responses from the first rather than the second CI. Conclusion: These findings are consistent with the development of the aural preference syndrome and reinforce the importance of providing bilateral CIs simultaneously or sequentially with very short delays.

SummaryElectrically Evoked Compound Action Potential is a measure of synchronous cochlear nerve fibers activity elicited by electrical stimulation of the cochlear implant. The electrophysiological nerve responses may contribute to explain the variability in individual performance of cochlear implant recipients.AimTo compare speech perception tests’ performances of cochlear implant users according to the presence or absence of intraoperative neural telemetry responses.Material and MethodProspective study design with 100 “Nucleus 24” cochlear implant users divided in two groups according to the presence or absence of intraoperative neural telemetry responses. Speech perception tests were performed after 6 months of continuous use of the device and compared among groups.ResultsIntraoperative action potentials were observed in 72 % of individuals. Open-set sentence test results were better in implant users who had neural telemetry responses when compared to implant users in whom this potential was absent (averages 82.8 % versus 41 %, p = 0.005). There was a strong association between post meningitis-related deafness and absence of intraoperative potentials.ConclusionThe absence of intraoperative neural telemetry responses was associated with worse performances in speech perception tests and meningitis as etiology of deafness. On the other hand, the presence of these potentials suggests excellent prognosis.

The aim of this study was to determine the improvement in speech recognition provided by a cochlear implant (CI) in conjunction with a hearing aid (HA) in the opposite ear. The study was a retrospective cohort study in the context of a university teaching hospital CI programme. Seven CI patients who still use their HA in the opposite ear were tested. The scores with the CI alone and the CI in conjunction with an HA were evaluated by using three speech perception tests in quiet (Freiburger Numbers, Freiburger Monosyllables, and Innsbrucker Sentence Test). In the majority of tests and subjects, the CI alone performed better than the HA alone, and the bimodal (CI+HA) condition was superior to the CI alone. On the sentence test, the patients as a group improved from 47-96% (mean: 79%; CI alone) to 50-100% (mean: 88.1%; CI+HA, pv<0.05). With the more difficult monosyllable test, the scores improved from 15-52% (mean: 37.2%; CI alone) to 15-82% (mean: 48.7%; CI+ HA, p<0.05). On the numbers test, scores increased from 65-98% (mean: 83%; CI alone) to 75-98% (mean: 88.7%; CI+ HA, p<0.05). All patients in this study were implanted in the poorer ear. The results of the present study suggest the advantage of CI usage in conjunction with an HA in the opposite ear.

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.

Background and ObjectivesZZVarious speech perception tests have been developed for children with hearing loss (HL) in Korea, although they are not standardized yet. This study aims to examine the actual condition of speech perception tests for children with HL in Korea. Subjects and MethodZZSurvey questionnaires and speech perception tests for children with HL were collected from 24 cochlear implant (CI) centers between March and July 2009. The speech perception tests were classified according to target ages, speech stimulus levels, and response formats. We interviewed speech therapists who had developed monosyllabic word (MW) tests, and gathered source materials, considerations, and limitations of the MW tests. We also analyzed vocabulary familiarity and phonetic balancing of words in the most commonly used MW tests. ResultsZZThirty-eight kinds of speech perception tests for children with HL were collected from 24 CI centers. Among these tests, open-set MW tests and sentence tests were used in all centers. Speech therapists responsible for developing MW tests had selected words from textbooks, storybooks, and spontaneous speech data to secure vocabulary familiarity and phonetic balancing within each list. Four commonly used MW tests revealed that vocabulary familiarity was compatible with commonly used MW in preschoolers and demonstrated a similar trend in phoneme frequencies. ConclusionZZThe results of this study showed that current speech perception tests for children with HL should be verified, revised, and standardized in an experimental setting. Korean J Otorhinolaryngol-Head Neck Surg 2010;53:534-46 Key WordsZZHearing loss·Cochlear implant·Children·Speech perception test.

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.

Speech audiometry plays an important role for hearing evaluation in children. Hearing impaired children, such as those with cochlear implant (CI) who frequently undergo testing, learn the test words by heart. Furthermore, the standard tests use words of former time. Using the most frequently words of modern children's literature a speech assessment test was developed for children between 1 to 8 years. The material was first evaluated on normal hearing children. In a second step the phoneme and word perception scores of 35 CI children were measured using 60 - 100 dB SPL according to the most comfortable level (MCL) in free sound field. The performance-intensity function for the single words were highly comparable with those of the Freiburger or Göttinger speech perception test. The average speech reception threshold in CI children was 44 % (test I), 36 % (test II), 63 % (test III) and 69 % (test IV), respectively. Compared to the Mainzer and Göttinger speech perception test the new words were more difficult to understand than those of the known tests. However, a statistically significant difference could be noted only for test II. The new developed "Würzburger speech perception test" appears to be a useful additional tool for the evaluation of hearing impaired children in addition to the standard test procedures.

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.