Audiology and Hearing Science - American Cochlear Implant Alliance

Audiology and Hearing Science - American Cochlear Implant Alliance
Audiology and Hearing Science
Friday, December 12, 2014
Session 1: Anatomical and Physiological Issues Related to CI
ACI2014
Cochlear Physiology and Speech Perception Outcomes in a Pediatric Population
1,2
2
2
2
2
O. F. Adunka, MD,FACS , E. Formeister , W. H. Merwin , C. E. Iseli , H. F. Teagle,AuD , C. A.
2
2
Buchman , D. C. Fitzpatrick
2
University Of North Carolina At Chapel Hill, Department Of Otolaryngology/Head And Neck Surgery,
3
Chapel Hill, NC USA ; Ohio State University, Department of Otolaryngology - Head & Neck Surgery,
Columbus, OH USA
Topic: Audiology
Keywords: Objective Measures , Outcomes , Residual Hearing
Introduction: Speech perception performance following cochlear implantation (CI) varies substantially in
children. Although cochlear substrate prior to implantation is a presumed factor in implant outcomes this has
never been directly demonstrated. Objective: To use intraoperative round window (RW)
electrocochleography (ECoG) at the time of implantation as a quantitative measure of residual cochlear
physiology and to correlate the results with speech perception outcomes in a pediatric population.
Methods: The physiological metric used was the “total response” defined as the sum of responses across a
series of frequencies (250, 500, 750, 1000, 2000 and 4000 Hz) at 90 dB nHL (97-107 dB SPL). Stimuli were
delivered through insert earphones and recordings were made with a clinical ABR machine. Speech
perception was evaluated after at least 9 months of implant use with the phonetically balanced kindergarten
(PB-k) open set speech perception test. Because this test requires the subjects to be age and
developmentally advanced, the population studied had only a few children implanted under the age of two.
The PB-k scores were compared to ECoG total response and other clinical and bioaudiometric variables
using multiple linear regression analysis in order to construct a parsimonious model for predicting speech
outcomes in implanted children.
2
Results: Postoperative PB-k scores were significantly correlated with ECoG total response (r =0.34,
p=0.004). Other significant predictors of speech perception performance in univariate analyses included
residual hearing, duration of CI use and age at testing. When all four of these predictors were combined in a
multiple linear regression, only the ECoG total response remained significant. Hierarchical multiple linear
regression identified a model for speech perception performance that included pre-operative PTA, duration
of CI use, and ECoG total response that was able to predict about half of the variance in PB-k scores
2
(adjusted r =0.49, p=0.002).
Conclusion: Intraoperative ECoG recordings show a strong correlation between cochlear physiology and
speech performance in children, which has long been assumed but not previously measured. Among other
uses, the ability to account for a high degree of variance with a relatively simple measure can have a benefit
in many studies, because in the face of a large variance in outcomes a prohibitively large N may be required
to show a significant effect.
1
2
3
4
Cochlear Corporation , MED-EL Corporation , Advanced Bionics Corporation , Cochlear Corporation ,
5
Advanced Bionics Corporation
ACI2014
Electric Charge Requirements of Pediatric Nucleus Recipients with Normal and Abnormal Inner Ear
Anatomy
1
1
H. K. Slager,AuD , T. A. Zwolan, Ph.D.
1
University of Michigan, Otolaryngology, Ann Arbor, MI USA
Topic: Basic Research
Keywords: Anatomy, Sound Processing, Speech Coding
Introduction: Little data exists regarding average psychophysical responses and the stability of these
responses over time in children with normal or abnormal inner ear anatomy. One longitudinal study reported
that pediatric programming levels vary significantly across programming centers. This highlights the need to
collect data to aid clinicians in programming difficult to test populations. Objective: The aim of this study was
to calculate mean electric charge requirements and charge variability over time in children with normal and
abnormal inner ear anatomy.
Methods: This study was a retrospective review of pediatric Nucleus device recipients at a large tertiary
care clinic who underwent surgery prior to 60 months of age. Subjects included children with normal
or abnormal inner ear anatomy (Enlarged vestibular aqueduct (EVA), hypoplastic cochleae, incomplete
partition type I or II, common cavity, and narrow internal auditory canals). Psychophysical measurements
analyzed were threshold (T) and comfort (C) levels obtained at approximately 6 and 24 months postactivation. Threshold and comfort levels were converted to units of charge per phase (nC). Mean charge
requirement and variability over time was calculated for each anatomical subgroup. Mean charge
requirement for each subgroup was compared to data for children with normal anatomy and comparisons
were made across anatomical subgroups. Typical mapping parameters (strategy, pulse width, pulse rate,
maxima), number of useable electrodes, sound field detection thresholds, and demographic information
(pre-operative hearing thresholds, communication mode) for each subgroup were also analyzed and
compared.
Results: Mean electric charge requirements and variability over time for pediatric Nucleus device recipients
with normal cochleae, EVA, hypoplastic cochleae, incomplete partition type I and II, common cavity, and
narrow internal auditory canals will be presented. Data analytics will include comparison of electric charge
requirements of each anatomical subgroup versus normal cochlear anatomy, and comparison of electric
charge requirements across anatomical subgroups. Typical mapping parameters and demographic
information will be presented for each anatomical subgroup.
Conclusion: The determination of programming levels (T/C levels) can be difficult to accomplish in some
patients, particularly in young children and children with abnormal cochlear anatomy. Furthermore, little data
is available to aid clinicians in setting mapping parameters for children with abnormal cochlear
anatomy. This study provides mean threshold and comfort levels for a large group of pediatric Nucleus
cochlear implant recipients with normal or abnormal cochlear anatomy. This information is valuable
because it provides data that may aid audiologists in the clinical management of these challenging groups of
patients. More investigation is needed to correlate electric charge requirement with performance
outcomes.
1
2
3
Cochlear Americas , MedEl Corporation Advanced Bionics Corporation
ACI2014
The Effect of Bone Conduction Amplification on Speech and Language Abilities in Children
with Aural Atresia
1
J. Attaway, MA
1
Casa Colina Centers For Rehabilitation, Audiology, Pomona, CA USA
Topic: Rehabilitation/Educational Aspects
Keywords: Children and Recommended Rehabilitation , Rehabilitation for Children
Introduction: Currently there is no guideline regarding bone conduction amplification for children with
unilateral aural atresia. Research has suggested that delayed treatment for hearing loss can result in speech
and language impairments. The purpose of this study was to examine the relationship between bone
conduction amplification use and speech and language delays in children with aural atresia.
Methods: Male and female subjects, 16 total, were included in this study if they were between 3 and 6 years
of age and had unilateral or bilateral conductive hearing loss due to aural atresia. All subjects underwent an
audiology exam, which included an analysis of pure tone air and bone conduction, with speech thresholds
for each ear when possible using picture identification word recognition and tympanogram, and a speech
and language evaluation using the Preschool Language Scale 4 to assess language skills and the
Expressive and Receptive One-Word Picture Vocabulary Tests (EOWPVT, ROWPVT) for vocabulary skills.
A parent or legal guardian completed the Children’s Outcomes Worksheet.
Results: We found that subjects who were fit before the age of one show better compliance with use of
bone conduction amplification and exhibited fewer delays in speech and language abilities. Interestingly,
among those with speech and language delays those with right-sided atresia had significantly more severe
delays.
Conclusions: Findings from this study highlight a relationship between side of atresia, time of first fit with
bone conduction device, compliance in device use, and speech and language abilities in children with
atresia. In an effort to obtain a larger sample size we are expanding the study to include additional subjects
from another southern California speech and hearing center.
ACI2014
The Role of Hand-Dominance on Speech Intelligibility Performances in Patients with Unilateral
Cochlear Implantation
1
1
C. H. Raine, MD,BS,MS,FRCS , A. Goomany , M. S. Miah
1
Yorkshire Auditory Implant Service, Bradford, West Yorkshire United Kingdom
Topic: Rehabilitation/Educational Aspects
Keywords: Speech and Language Development with CI
Introduction: Hand-dominance may define which ear is responsible for transmission of speech, musical and
cognitive information. Efficacy of cochlear implantation (CI) is usually based on assessment of speech
intelligibility performances. This can be influenced by a number of factors including patients age, aetiology of
deafness, duration of deafness and cognitive function. Cerebral dominance has been suggested as an
important factor determining the side of implant surgery. Hand-dominance laterality is an indirect
determinant of cerebral dominance. Literature is very limited on the role of hand-dominance on efficacy of
unilateral CI surgery. Objective: To evaluate the role of hand-dominance on the efficacy of CI in relation to
the side of implantation based on outcomes of speech intelligibility performances.
Methods: Post-lingually deafened patients with unilateral CI were studied. Data was collated from electronic
records and CI audit database. Patients were selected according to defined criteria. For uniformity, speech
intelligibility performances were assessed pre and post-operatively using the Bamford-Kowal-Bench (BKB)
sentences. For the purpose of this study, BKB scores at 12 months post-operatively were
analyzed. Statistical analysis was conducted using the Statistical Package for the Social Sciences (version
22.0.0).
Results: 294 patients met the study inclusion criteria with a median age of 54 years (range 16 - 89 years).
217 (73.8%) patients were right handed, 51 (17.3%) were left handed and 26 (8.8%) were excluded based
on hand-dominance alone (could not be assessed or mixed-handedness). Overall, 67% of patients had CI
on the dominant hand side and 33% on the non-dominant side for various reasons including patient
preference and clinical decision due to previous middle ear/mastoid surgery on the dominant side. The
mean post-operative BKB scores were 78% (right-sided CI, right-dominant), 83% (left-sided CI, leftdominant), 69% (left-sided CI, right-dominant) and 76% (right-sided CI, left-dominant). However, there was
no statistically significant difference between the groups (Kruskall-Wallis H=6.93, Chi-square p=0.074163,
p>0.05). Interestingly, there is significant difference in post-operative BKB scores between dominant sided
versus non-dominant sided CI in male patients (n=91, 87% vs n=51, 71%, p=0.0381) in contrast to female
patients (n=89, 74% vs n=37, 81%, p=0.0843), respectively. On univariate and multivariate analysis no
significant difference noted between dominant and non-dominant sides of implantation (p=0.079 and
p=0.471, respectively).
Conclusions: Hand-dominance is an important factor for decision making with regards to the side of CI from
patient’s perspective. However, from this study, it does not appear to affect the efficacy of CI assessed using
the BKB sentences for speech intelligibility performances. These findings may be of some use in the
management of children identified for unilateral CI surgery
ACI2014
Auditory Brainstem Development in Children Receiving Different Devices In A Simultaneous
Bilateral Implant Procedure
Stephanie. Jewell, BS1,Blake. C. Papsin, MD,BS,MS 1,2,Sharon. L. Cushing, MD,BS,MS 1,2, Karen. A. Gordon,
BS,MS,Ph.D 1,2,3
1
2
3
Hospital For Sick Children, University of Toronto, University of Toronto
Topic
Audiology
Keywords
Objective Measures
Introduction: Simultaneous bilateral cochlear implantation has been shown to support symmetric
development of the auditory brainstem when the same device is used bilaterally.
Objective: In the present study, we asked whether auditory brainstem development would be affected by
implantation of two different electrode arrays: a pre-curved array and a straight array with the same receiver
stimulator.
Methods: Twenty-eight children were implanted with a pre-curved array in one ear and a straight array from
the same manufacturer in the other in the same surgery. Electrically evoked auditory brainstem responses
(EABRs) were collected at three time-points: the first week post-activation, 3 to 6 months post-activation,
and 9 to 12 months post-activation. EABRs were evoked by biphasic single pulses delivered at 11Hz from
the apical electrode (#20) and measured at a midline cephalic location (Cz) referenced to each earlobe in
separate recording channels. Stimuli were provided at levels which were comfortably loud and evoked
equal amplitude wave eV amplitudes (peak to trough) from each side. Wave eV latencies and amplitudes
were marked and analyzed using repeated measures ANOVAs for time, device and ear
effects. Results: Stimulus protocols resulted in consistent EABR wave eV amplitudes which did not
significantly differ between devices (p<0.05) or change over time (p<0.05). EABR eV latency, on the other
hand, significantly decreased between initial measures (p<0.05) and follow up measures with no effects of
device or which ear was implanted with the straight array (p>0.05).
Conclusion: Despite the use of two different devices, children receiving bilateral cochlear implants
simultaneously show symmetric auditory brainstem development during initial stages of implant use. Further
analysis of this group will determine whether brainstem development varies with residual hearing and
surgical approach.
ACI2014
Etiology of Single Sided Deafness in Children with Congenital and Acquired Unilateral Deafness
1
1
1
1
R. L. Beck,Dr. med. , S. Arndt,Prof. Dr. , A. Aschendorff,Prof. Dr. , F. Hassepa Dr. med. , T. Wesarg,Dr.
1
1
ing. , R. Laszig,Prof. Dr. Dr. h.c.
1
Medical Center - University Of Freiburg, Department Of Oto-Rhino-Laryngology, Freiburg, Germany
Topic: Surgery/Medical
Keywords: New Indications, Young and Very Young Children , Inner Ear Malformation
Introduction: Cochlear implantation in adults affected by single sided deafness or asymmetric hearing loss
is on its way to become a standard of care due to the positive outcome documented. The effect of treatment
of the same disorder in children is still very unclear. The incidence of single sided deafness in children is
estimated between 0.04 to 5 % dependent on the age of hearing loss (congenital or peri-/postlingual) and
the spectrum of causative mechanisms is decisively different compared to adults. Previous studies found a
deficiency of the auditory nerve (hypoplasia or aplasia) in up to 18% of patients with bilateral deafness. The
aim of this study was to evaluate the etiology in children with congenital and acquired SSD.
Methods: 42 children presenting at a tertiary referral center 2009-2014 with congenital (n=20) or acquired
(n=22) unilateral deafness have been evaluated for cochlear implantation by electrophysiology (BERA,
electrocochleography, promontory test where applicable), audiometry and imaging (MRI, CT). Rehabilitation
by cochlear implantation has been performed, where agreed on by the legal guardians after extensive
counseling and if medically reasonable.
Results: The age at time of presentation varied greatly and ranged from 2-15.6 years for children with
congenital unilateral deafness and 4.9-18 years for acquired SSD (time of deafness 0.3-10 years). This is
noteworthy as we should be able to detect children with congenital unilateral deafness reasonably early by
NHS. 13 out of 20 congenitally deaf children show a hypoplastic or aplastic cochlear nerve and were not
deemed to be good candidates for rehabilitation by CI, CMV-infections where described in 3 children. The
causative agents were much more diverse in 22 children with acquired deafness: In 5 cases, a EVAsyndrome could be found, 4 suffered from labyrinthitis, 3 from mumps. 4 out of 4 guardians of eligible
congenital deaf children opted for CI (all have been implanted), 19 of 20 eligible children with acquired
deafness opted for CI (12 have been implanted; others are in the process to be implanted).
Conclusion: Analysis of CT and MRI scans is essential to diagnose the cause of unilateral deafness. This
holds true especially for children with congenital unilateral deafness as a very high percentage show
cochlear nerve deficiency. If rehabilitation by cochlear implant is an option to be considered, diagnosis and
counseling have to occur at an earlier age to yield optimal results.
ACI2014
Cochlear Implantation in Inner Ear Anomalies
1
1
M. Z. OZUER, MD , A. HANCER
1
Sifa University Medical Faculty, Otorhinolaryngology, Izmir, Turkey
Topic: Surgery/Medical
Keywords: Inner Ear Malformation, Medical/Surgical Issues
Introduction: In the past, CI in certain inner ear anomalies was used to be a contraindication, it has been
determined that these group of children benefit from CI. However, surgical risk factors and outcome of the
children need to be counseled with the parents.
Objective: To differentiate various inner ear anomalies with the aid of CT and MRI. Selection of electrode
array and planning surgery. To manage possible surgical complications.
Methods: The inner ear anomalies encountered were large vestibular aquaduct (LVA), incomplete partition
type I (IP-I) incomplete partition type II (IP-II), hypoplastic cochlea. Temporal CT and MRI were studied to
identify the anomalies.
Results: In IP-I patients we encountered severe gusher, in IP-II patients and LVA patients we encountered
oozing of CSF. The presence of these group of anomalies introduce additional risks of surgery and potential
complications. Therefore, it is important to diagnose the anomaly.. At the same time, the benefit of CI in
these group of patients limited.
Conclusion: Our experience, in inner ear anomalies surgical results, complications and hearing outcomes
will be discussed. The selection of electrode, CSF management, facial nerve course need to be planned
before surgery.
Session 2: Combining Electric and Acoustic Stimulation: Binaural Hearing and/or
Hearing Preservation
ACI2014
Bimodal Stimulation in Infants: Is There a Benefit to Language Development?
1
1
A. C. Moberly , S. Nittrouer
1
Ohio State University, Otolaryngology, Columbus, OH USA
Topic: Rehabilitation/Educational Aspects
Keywords: Children and Recommended Rehabilitation, Speech and Language Development with CI
Introduction: Simultaneous bilateral cochlear implantation is increasingly being performed in infants with
profound sensorineural hearing loss, with the assumption that bilateral electric hearing will optimize
language outcomes. However, many of these children likely have some low-frequency residual hearing that
may benefit from a period of bimodal stimulation (cochlear implant with contralateral hearing aid). This
presentation will review for clinicians the theoretical underpinnings of language development that may
benefit from bimodal stimulation. Language development data from an ongoing longitudinal study of children
who received cochlear implants will be presented.
Methods: Fifty-five children who received cochlear implants while under the age of 3 years were
included. Language development data were examined for these children, now having just finished second
grade (age 8 ½ years). Twenty-six of these children experienced at least one year of bimodal stimulation
around the time of receiving their implants. All children were assessed using measures of phonological
processing, working memory, vocabulary knowledge, word reading, reading comprehension, grammar
abilities, and nonword recognition. Results were compared between the children who experienced a period
of bimodal stimulation around the time of implantation (Bimodal) and those who did not (CI-only).
Results: The Bimodal group had better average scores than the CI-only group for all language measures
assessed. The groups were found to be equal on average socioeconomic status and age of identification of
hearing loss. Average age of receiving first implant was slightly later for the Bimodal group. Pre-implant
pure tone average (PTA) was slightly better for children with Bimodal experience (97 dB HL) versus CI-only
(107 dB HL); however, further analysis showed no effect of pre-implant PTA on language measures.
Conclusion: A period of bimodal stimulation for infants receiving cochlear implants appears to provide an
advantage for language development, even on measures of language collected after second grade. This
advantage is likely due to the fact that bimodal stimulation provides more refined spectral signals, even if
only in the low frequencies. This spectral structure most likely facilitates development of well-defined
phonological categories, which is essential to acquisition of higher-order language abilities. These findings,
along with an understanding of the theoretical underpinnings of language development, suggest the need for
further examination of the benefits of a period of bimodal stimulation for children receiving cochlear
implants.
ACI2014
Changes in Perceived Listening Effort and Difficulty with Bimodal Stimulation
1
H. W. Siburt, Ph.D.,AuD
1
University Of South Florida, Communication Sciences And Disorders/Behavioral And Community
Sciences, Tampa, FLORIDA USA
Topic: Audiology
Keywords: Bimodal Hearing , Contralateral Hearing Aid Use , Outcomes
Introduction: This double blind study investigated the effects of hearing aid programming in bimodal
listeners.
Objective: The purpose of this study was to explore the effectiveness of bimodal programming methods in
adult cochlear implant recipients, and determine if programming the hearing aid with a low frequency
emphasis changes ones speech in noise, music and prosody perception.
Methods: This study included 10 adults with bilateral sensorineural hearing loss, who are unilateral cochlear
implant recipients. All participants were experienced cochlear implant users (> 6 months). Participants
attended four study sessions each one month apart. During those sessions outcome testing was them
completed including the CNC, BKB-SIN, AZ-Bio, the UW-CAMP, and the Florida Affect Battery prosody
subtests. Effort and difficulty ratings are conducted after each test in all listening conditions throughout the
study using a visual analog scale. Following outcome testing a hearing aidwas provided fit with one of the
two study programming methods. The experimental fitting protocols used in this study are NAL-NL2 and a
Low Frequency emphasized program based on NAL-N2 with a 1000Hz upper frequency cut off.
Results: Effort: Analysis of effort ratings was completed using a mixed-effects linear model. There were no
associations between effort and listening condition indicated on the BKB-SIN, CNC, AZBIO and UWCAMP. Significant differences in effort were seen on the FAB. Listening condition was significantly
associated with effort on the EPD subset of the FAB. There were no associations between difficulty and
listening condition indicated on the BKB-SIN, CNC, and the AZBIO. Listening condition was marginally
associated with difficulty on the UW-CAMP. Listening condition was marginally associated with difficulty on
the NEPD subset of the FAB.
Conclusion: Results indicate significant bimodal benefit over the CI only condition in music and prosody
perception as well as a significant reduction in effort and difficulty. Bimodal benefit was observed with
objective measures of speech in noise, music and prosody. Additionally, the amount of perceived effort and
difficulty decreased significantly in the bimodal condition for all subjects on the prosody measures.
Furthermore, study results suggest a significant bimodal benefit for individuals with only minimal
measureable hearing thresholds. Although the current study was conducted using adult participants results
are applicable to all ages of cochlear implant recipients. This reduction when compared to listening with the
cochlear implant alone reflects the importance electro-acoustic simulation in areas outside of our traditional
speech perception measures. Determining clinical devices recommendations and programming methods to
reduce listening effort and difficulty allow reallocation of those efforts to learning and critical developmental
tasks in the pediatric population.
ACI2014
Benefit of Wireless Hearing Assistance Technologies Designed to Function with the Hearing Aid and
Implant Sound Processor of Bimodal Users
1
1
M. Morais-Duke,AuD , J. Wolfe
1
Hearts For Hearing, Audiology, Oklahoma City, OK USA
Topic: Audiology
Keywords: Bimodal Hearing
Introduction: Many cochlear implant recipients use a sound processor on the implanted ear and a hearing
aid on the opposite ear (i.e., bimodal users). Although bimodal use can improve performance in difficult
situations, many bimodal recipients still struggle in challenging situations. Hearing assistance technology
(HAT) has been shown to improve performance in these difficult situations, but until now, it has been quite
problematic to use HAT to simultaneously deliver audio signals of interest to both the hearing aid and the
implant sound processor. Objective: This study evaluated the potential benefits of wireless HAT systems
designed to deliver audio signals directly to a contemporary cochlear implant sound processor and a power
behind-the-ear hearing via proprietary 2.4 GHz digital wireless radio frequency (RF) transmission.
Methods: Ten bimodal cochlear implant recipients participated in this study. Speech recognition was
evaluated over a mobile telephone, in a noisy classroom, and over a television while subjects used their
hearing aids and cochlear implants alone and also as they used these devices along with wireless
HAT.
Speech recognition in the classroom was evaluated with AzBio Sentences presented at 65 dBA at
the location of the subject. A wireless digital RF remote microphone was placed eight inches directly in front
of the loudspeaker used to deliver the sentences. Classroom noise was presented from four loudspeakers
located in the corners of the room. Sentence recognition was evaluated in quiet and at multiple noise levels,
50, 55, 60, 65, 70, 75, and 80 dBA.
Speech recognition over a mobile telephone was evaluated with one
full list of recorded CNC words per condition. Word recognition was evaluated both in quiet and in the
presence of a 60 dBA classroom noise signal. Speech recognition over the television was evaluated with
the audio-visual version of the City University of New York sentences. The level of the sentences was 65
dBA at the subject location. Sentence recognition was measured in quiet and in the presence of classroom
noise at 60 dBA. In each of the aforementioned conditions, speech recognition was evaluated with use of
the participant’s hearing aid and cochlear implant alone and also with use of wireless HAT. Furthermore, a
battery of subjective questionnaires was administered to evaluate the potential benefit of use of these
hearing assistance technologies in real world settings. The questionnaires included the APHAB, the SSQ,
and survey designed by the examiners in this study.
Results: The bimodal users in this study realized a significant improvement in speech recognition in quiet
and in noise with use of the HAT.
Conclusion: Use of wireless HAT results in improvement of subjective and objective speech recognition in
quiet and in noise of bimodal users in challenging listening situations.
ACI2014
Cortical Benefits of Bimodal Hearing in Children with Asymmetric Hearing Loss
1,2
1,2
1,3
1,2,3
M. Polonenko, BS,MClSc , S. Jiwani , B. Papsin , K. Gordon
1
2
Hospital For Sick Children, Otolaryngology, Toronto, Ontario Canada ; University of Toronto, Institute Of
3
Medical Science, Toronto, Ontario Canada ; University of Toronto, Otolaryngology - Head And Neck
Surgery, Toronto, Ontario Canada
Topic: Audiology
Keywords: Bimodal Hearing , Objective Measures , Outcomes
Introduction: Unilateral cochlear implant (CI) use promotes speech and language development in children,
but does not preserve normal activity patterns in the developing auditory cortex. While these children were
traditionally left deprived of sound in the opposite non-implanted ear, many who have accessible acoustic
hearing on that side now use a hearing aid in order to hear from both ears. Although this combined electric
and acoustic (i.e., bimodal) hearing can restore bilateral stimulation, we are asking whether bimodal hearing
can prevent the abnormal reorganization seen in unilateral CI user± s and restore normal-like patterns of
cortical activity. Therefore, we aim to determine whether wearing a CI and a hearing aid can promote
normal-like cortical development of bilateral pathways in children with asymmetric hearing loss.
Methods: Eight children with asymmetric hearing loss received bimodal input for 2.0 ± 0.4 years. Etiology of
hearing loss included one child with a diagnosis of bacterial meningitis, two with cochleovestibular
abnormality, one with mastoiditis, and four of unknown origin. We recorded electroencephalographic
measures of cortical activity across 64-cephalic electrodes evoked by 250Hz acoustic clicks and biphasic
electric pulses in 36ms trains presented at a rate of 1Hz. To assess whether bimodal stimulation promotes
normal-like cortical activity patterns, we are using a beamformer imaging tool developed in our laboratory to
suppress the CI artifact and localize underlying neural activity (dipoles) of the cortical waveforms.
Results: Preliminary results indicate that bimodal stimulation evokes a variety of waveforms of different
morphologies when evoked by electric versus acoustic stimulation. Differences in the strength and location
of dipole activity will be measured, and the hemispheric lateralization and aural preferences will be
calculated for electric and acoustic stimulation.
Conclusion: Evoked cortical activity patterns will illustrate whether bimodal stimulation in children with
asymmetric hearing loss can promote auditory cortical development in the bilateral auditory pathways.
1
COI: Cochlear Corporation
ACI2014
The Use of an Integrated Electric-Acoustic Sound Processor in Children with Low Frequency
Residual Hearing
1
1
S. Neumann,AuD , J. Wolfe
1
Hearts For Hearing, Audiology, Oklahoma City, OK USA
Topic: Technology
Keywords: EAS , Cochlear Implant Hardware
Introduction: The acoustic cues of speech, spoken from a whisper to a shout, occur over a range
frequencies (i.e. 250-8000 Hz) and intensities that fluctuate from softer than 50 dB SPL to as loud as 80 dB
SPL (Pearsons et al., 1977). The primary goal of any auditory sensory device is to provide an audible and
comfortable speech signal to the individual wearing the device. The benefits of utilizing low frequency
hearing in combination with electric stimulation through an integrated sound processor have been well
documented within the literature for adults. Having access to an integrated sound processor in the pediatric
population may not only improve the overall speech and hearing performance associated with electricacoustic (EAS) hearing, but it may also improve wearing compliance. The benefits of binaural low frequency
hearing may include improved localization, speech understanding in complex listening environments as well
as reverberation (Dunn et al., 2010; Gifford et al., 2010; Gifford et al., 2014, 2013). Historically, fitting options
for EAS hearing have been limited and often cumbersome for the pediatric population requiring amplification
of residual low frequency hearing through a conventional in the ear hearing aid in combination with the
external cochlear implant sound processor. Objective: The objective of this study was to evaluate the
performance and wearing satisfaction of pediatric recipients who utilize an integrated sound processor.
Methods: Eight pediatric subjects aged 7 to 16 years old (mean = 9 years old) who presented with
functional low frequency hearing were fitted with an integrated EAS sound processor. To assess the
importance of low frequency hearing, test metrics included evaluation of AzBio sentences in quiet (50 and
60 dBA presentation levels) and in noise (+5 dB and +10 dB SNR) with electric only hearing and with use of
EAS stimulation. The CHILD, LIFE, and SSQ questionnaires were also administered to evaluate subjective
benefit in everyday life.
Results: Results indicate statistically significant improvements in speech perception and subjective
satisfaction while utilizing the integrated EAS sound processor relative to use of electric-only hearing.
Conclusion: EAS, as delivered by the integrated sound processor, is a viable option for pediatric recipients
who possess residual low-frequency hearing.
ACI2014
Evaluation of the Hybrid Cochlear Implant System: Clinical Trial Results
1
W. H. Shapiro,AuD
1
New York University School Of Medicine, NYU Cochlear Implant Center, New York, NY USA
Topic: Technology
Keywords: EAS
Introduction: Results of a multicenter clinical trial evaluating the hybrid cochlear implant (CI) system in the
United States will be presented. The first of its kind, FDA approved, hybrid cochlear implant system
facilitates high-frequency electric stimulation through the hybrid implant, while amplifying low-frequency
acoustic information through an integrated electric – acoustic sound processor. Objective: The objective of
this multicenter pivotal study was to evaluate the safety and effectiveness of the hybrid cochlear implant
system for the treatment of sensorineural hearing loss, characterized by a normal to moderate range in the
low frequencies and a severe to profound loss in the high frequencies
Methods: Fifty subjects were implanted with the hybrid cochlear implant system across 10 implanting
centers in the United States. To assess the importance of maintaining low frequency hearing while restoring
access to high frequency hearing, test metrics included: CNC Words, AzBio Sentences in noise (+5 dB
SNR), music perception and subjective measures on satisfaction. Additionally, for the first time in a multicenter cochlear implant study, hearing thresholds were monitored longitudinally
Results: Results indicate statistically significant pre- to postoperative improvements in speech perception
and subjective satisfaction while in the everyday listening condition. Music perception performance
remained unchanged from the preoperative condition of best fit hearing aids indicating that the low
frequency cues for music perception were preserved. Audiometrically, a majority of subjects (90%)
maintained levels of measureable hearing. For subjects who were able to utilize the integrated sound
processor, a significant increase in speech perception performance was observed when acoustic information
was combined with electric stimulation. For those who did not utilize the integrated sound processor, speech
perception performance significantly exceeded the preoperative condition with hearing aids.
Conclusion: Electric-acoustic stimulation, as delivered by a hybrid cochlear implant system, is a viable
option for individuals with residual low-frequency hearing and severe to profound high-frequency hearing
loss. Results indicate that a cochlear implant electrode array can be inserted within the cochlea while
maintaining useful levels of acoustic low-frequency hearing in a majority of individuals.
1
COI: Cochlear Americas
ACI2014
Mechanisms Involved in Loss of Residual Hearing Post Implantation
1
1
A. Eshraghi, MD, FACS, C. Gupta, Ph.D. , J. Mittal, MS
1
University Of Miami Miller School Of Medicine, Otolaryngology, Miami, FL USA
Topic: Basic Research
Keywords: Drug Delivery, The Cochlea
Introduction: Loss of residual hearing post implantation involve trauma to macroscopic elements of the
cochlea and program cell death of sensory cells
Objective: To dissect molecular mechanisms involved in loss of residual hearing post CI and identify
therapeutic actions
Methods: In-vitro and animal model of cochlear implantation were used to evaluate mechanisms involved in
apoptosis of hair cells and support cells post implantation
Results: Multiple pathways are involved in cell death of sensory cells. These pathways are different in
support cells as compared to hair cells.
Conclusion: Preservation of residual hearing is possible by developing appropriate drug therapies that
interfere with program cell death pathways.
Session 3: Advancements in Technology & Programming
ACI2014
Benefit of a Wireless Hearing Assistance Technology for Understanding Speech over the Television
1
1
J. A. Wolfe, Ph.D. , M. Morais-Duke,AuD
1
Hearts For Hearing, Audiology, Oklahoma City, OK USA
Topic: Audiology
Keywords: Assistive Listening Devices
Introduction: Cochlear implant recipients often report difficulty understanding speech from the
television. There are no published studies that have examined the benefit of using a wireless hearing
assistance technology (HAT) designed to improve speech understanding over the television. Objective: This
study assessed the ability of implant recipients to understand speech from a television with and without a
proprietary HAT designed for use with the television. This HAT device wirelessly transmits the audio signal
from the television directly to a receiver integrated into the recipient’s sound processor via proprietary 2.4
GHz digital wireless radio frequency (RF) transmission.
Methods: The recognition of speech from a television was evaluated for 15 unilateral and bilateral cochlear
implant users. Performance was assessed while they used their sound processor alone and also as they
used their sound processor with a wireless HAT device designed to directly transmit the audio signal of the
television directly to the participants’ sound processor. Sentence recognition was assessed in two
conditions: 1) the sound processor alone with everyday processing enabled, and 2) the sound processor
and use of a digital wireless RF HAT system designed for use with the television. The accessory mixing
ratio of the processor was set to 1:1 for both conditions. The settings of the HAT device were set to the
manufacturer’s default parameters. All assessments were completed in a living room-type environment.
The speech signal was presented from a High Definition LED 37-inch television located directly in front of
the subjects (0-degree azimuth). Classroom noise was presented from four loudspeakers located in the
corners of the room. The level of the speech signal was 65 dBA at the location of the subject. Sentence
recognition was evaluated in quiet and in the presence of the competing noise signal. Two full lists (12
sentences each) of audio-visual version of City University of New York (CUNY) sentences were presented in
each test condition. This study included four conditions: 1)Use of the cochlear implant sound processor
alone in quiet 2)Use of the cochlear implant sound processor and the HAT device in quiet 3)Use of the
cochlear implant sound processor alone in noise 4)Use of the cochlear implant sound processor and the
HAT device in noise
Results: Repeated measures analysis of variance was used to analyze the data collected in this study. This
analysis indicated that speech recognition in quiet and in noise was significantly better with use of the
wireless HAT system when compared to performance with the cochlear implant sound processor alone.
Conclusion: Use of a proprietary HAT technology featuring 2.4 GHz digital wireless radio frequency (RF)
transmission and designed for television use results in significant improvement in sentence recognition in
quiet and in noise.
ACI2014
Benefit of a Remote Microphone Technology Digital Wireless Radio Transmission for Understanding
Speech in Noise
1
1
1
M. Morais-Duke,AuD , M. Morais-Duke,AuD , J. Wolfe
1
Hearts For Hearing, Audiology, Oklahoma City, OK USA
Topic: Audiology
Keywords: Assistive Listening Devices
Introduction: Cochlear implant recipients frequently experience difficulty understanding speech in
noise. Use of remote microphone hearing assistance technology may improve implant recipients’
performance in noisy environments. Objective: This study assessed the ability of implant recipients to
understand speech in quiet and in noise with a proprietary remote microphone technology that features 2.4
GHz digital wireless radio frequency (RF) transmission and that was developed for use with a commercially
available cochlear implant sound processor.
Methods: Speech recognition of 15 cochlear implant users was evaluated while they used their sound
processor alone and also as they used their sound processor with a digital wireless microphone, a system
that uses digital RF transmission to wirelessly deliver a signal of interest captured at the microphone directly
to a 2.4 GHz antenna integrated into the sound processor. Sentence recognition was assessed in two
conditions: 1) the sound processor alone with everyday processing enabled, and 2) the sound processor
(with everyday processing enabled) and a digital wireless RF remote microphone system. The accessory
mixing was set to 1:1 for both conditions. The settings of the digital wireless RF remote microphone system
were set to the manufacturer’s default parameters. All assessments were completed in a classroom
environment (25’3’’ by 24’8’’ by 9’). The speech signal was presented from a loudspeaker located directly in
front of the subjects (0-degree azimuth). Classroom noise was presented from four loudspeakers located in
the corners of the room. The wireless remote microphone was placed 8 inches away from the center of the
diaphragm of the loudspeaker used to present the sentences. The level of the speech signal was 85 dBA at
the wireless remote microphone and 65 dBA at the location of the subject. Sentence recognition was
evaluated in quiet and at multiple noise levels, 50, 55, 60, 65, 70, 75, and 80 dBA. The aforementioned
noise levels were the same at the remote microphone and at the location of the subject. One full list of
AzBio sentences was presented in each test condition.
Results: Repeated measures analysis of variance was used to analyze the data collected in this study. This
analysis indicated that subjects experienced a substantial decrease in sentence recognition in the presence
of competing noise. However, speech recognition in quiet and in noise was significantly better with use of
the wireless remote microphone system when compared to performance with the cochlear implant sound
processor alone.
Conclusion: Use of a proprietary remote microphone technology featuring 2.4 GHz digital wireless radio
frequency (RF) transmission and designed for a commercial cochlear implant sound processor results in
significant improvement in sentence recognition in quiet and in noise in a classroom environment.
ACI2014
Adaptive Directional Microphone Benefit for Speech Understanding in Noise for Advanced Bionics
Recipients
1
1
1
J. Gilden , M. L. McDonald , S. Taxman
1
Houston Ear Research Foundation, Houston, TX USA
Topic: Audiology
Keywords: Outcomes , Fitting
Introduction: Speech understanding in background noise is a challenge for cochlear implant
recipients. Use of a proprietary advanced adaptive directional microphone (ADM) system that can be
activated when the user needs to hear a talker face-to-face in noisy situations is a new option available to
some implant recipients. The new ADM technology emphasizes sounds in front of the listener while
reducing noise at the side and back. This study is a part of an ongoing multi-center clinical study to
determine the benefits of this proprietary ADM in adult cochlear implant recipients. Objective: To
demonstrate the benefits of a proprietary ADM technology for understanding speech in noise when the
speaker is directly in front of the listener.
Methods: A within-subjects design evaluates speech understanding in noise with and without the
ADM. AzBio sentences were presented at 0-degree azimuth and continuous speech spectrum noise was
presented at 180-degree azimuth. Using their everyday listening program, subject AzBio sentence score
was obtained first in quiet. Then subjects were tested in noise to determine a signal-to-noise ratio (SNR)
that yielded approximately half of the score obtained in quiet. Subjects were tested again using the same
SNR with the ADM turned on. AzBio sentence scores in noise are compared between the everyday and
ADM conditions to determine the benefit of the ADM for understanding a speaker face-to-face in noise.
Results: Initial data reveal significant benefit of the ADM for speech understanding in noise. Benefit is
evident in unilateral and bilateral implant recipients as well as in bimodal listeners. Benefit is irrespective of
baseline performance.
Conclusion: The proprietary ADM affords listeners significant improvements in speech understanding in
noise. It offers another integrated option to help implant users manage hearing challenges encountered in
their daily lives.
ACI2014
Benefit of a Wireless Telephone Accessory Device for Understanding Speech over the Telephone
in Quiet and in Noise
1
1
M. Morais-Duke,AuD , J. Wolfe
1
Hearts For Hearing, Audiology, Oklahoma City, OK USA
Topic: Audiology
Keywords: Assistive Listening Devices
Introduction: Cochlear implant recipients frequently encounter difficulty understanding speech over the
telephone. There are no published studies examining the benefit cochlear implant recipients may receive
when using wireless hearing assistance technology (HAT) for telephone use. Objective: This study
assessed the ability of implant recipients to understand recorded speech over the telephone in quiet and in
noise with a proprietary wireless HAT designed for telephone use. This wireless HAT serves as an interface
to transmit signals to and from Bluetooth-enabled mobile telephones and delivers audio signals to and from
the recipient’s sound processor via proprietary 2.4 GHz digital wireless radio frequency (RF) transmission.
Methods: The speech recognition of 15 unilateral and bilateral cochlear implant users was evaluated while
they used a mobile telephone with their sound processor alone and also as they used their sound processor
with a digital wireless HAT, a system that uses digital RF transmission to wirelessly deliver audio signals of
interest from mobile telephones directly to a 2.4 GHz antenna integrated into the sound processor. Sentence
recognition was assessed in six conditions: 1)In quiet with the sound processor alone with the telephone
receiver held next to the microphone of the participant’s sound processor 2)In quiet with the sound
processor alone with the telephone receiver held next to the participant’s sound processor with the telecoil
enabled 3)In quiet with the audio signal from the telephone delivered to the participant’s sound processor
via digital RF transmission via the wireless HAT device 4)In noise with the sound processor alone with the
telephone receiver held next to the microphone of the participant’s sound processor 5)In noise with the
sound processor alone with the telephone receiver held next to the participant’s sound processor with the
telecoil enabled 6)In noise with the audio signal from the telephone delivered to the participant’s sound
processor via digital RF transmission via the wireless HAT device All assessments were completed in an
office-type environment. The speech signal was presented from a mobile telephone at the participant’s most
comfortable listening level. Classroom noise was presented at 60 dBA from four loudspeakers located in the
corners of the room. One full list of CNC words was presented in each test condition.
Results: Repeated measures analysis of variance was used to analyze the data collected in this study. This
analysis indicated that speech recognition in quiet and in noise improved significantly with the use of the
wireless HAT device. Bilateral implant recipients particularly showed a considerable improvement in word
recognition with use of the wireless HAT device.
Conclusion: Use of a proprietary wireless HAT device resulted in a significant improvement in word
recognition over the mobile telephone both in quiet and in noise.
1
COI: Cochlear
ACI2014
Technology for Improving Speech Understanding in Noise in Cochlear Implant Recipients
1
S. Agrawal, Ph.D.
1
Advanced Bionics, LLC, Valencia, CA USA
Topic: Technology
Keywords: Cochlear Implant Hardware , Sound Coding , Speech Coding Strategies
Introduction: While most Cochlear Implant (CI) recipients can hear remarkably well in quiet, understanding
speech in real world situations with multiple sound sources can be a significant challenge. One approach for
improving hearing in noisy situations is to improve the signal-to-noise ratio (SNR) by either reducing the
level of interfering sounds, enhancing the speech signal, or a combination of both. Objective: This study
evaluated the advantage offered by the following Advanced Bionics technology options for understanding
speech in noise as compared to a conventional omnidirectional microphone (omni-mic): (1) a microphone
that is placed near the opening of the ear canal (T-mic), thus providing access to the advantages offered by
the pinna, (2) a proprietary speech enhancement strategy (SES) that reduces gain in spectral channels with
steady state input, thereby reducing noise and enhancing speech, and (3) an adaptive directional
microphone (ADM) that reduces input from the back hemifield thereby enhancing the input from the front
hemifield.
Methods: Adult CI recipients with a range of baseline speech performance participated in the study.
Baseline performance in quiet was measured using Consonant-Nucleus-Consonant (CNC) words and AzBio
sentences in quiet. All participants had been implanted with a CI device that allowed access to various
combinations of the three technology options. Five test conditions were compared: (a) omni-mic only, (b)
omni-mic + SES (c) T-mic + SES (d) ADM alone , and (e) ADM + SES. Speech performance was evaluated
rigorously in several different noise types. Target signals were presented from 0? and noise from 90?, 180 ?
and 270?. Adaptive SNR (Hearing in Noise Test [HINT]) as well as fixed SNR testing methods were
used. In addition, subjective ratings were obtained to reflect the perceived difficulty of the listening tasks in
the various conditions.
Results: Improvements in speech understanding were observed with the evaluated technology options and
their combinations as compared to the omnidirectional microphone alone in the following order: ADM + SES
> ADM > T-mic + SES > omni-mic + SES > omni-mic only. Benefit was evident irrespective of the baseline
performance. Improvements also were noted in the perceived difficulty of the listening task. Performance
with certain SNR boosting options varied based on the noise type. Clinical recommendations will be offered
for using the technologies based on the listening environment.
Conclusion: CI recipients have access to technology options that can help them hear significantly better in
noisy situations. These options not only improve the ability to understand speech but also impact listening
effort. Clinicians should consider programming/activating these technologies to improve CI recipients’
communication in real world environments.
1
COI: Advanced Bionics, LLC
ACI2014
Value of Data Logging in Pediatric Cochlear Implant Recipients
1
E. Tournis,Au.D.
1
Ann & Robert H. Lurie Children's Hospital Of Chicago, Chicago, IL USA
Topic: Audiology
Keywords: Fitting, Objective Measures, Outcomes
Introduction: The amount of time a cochlear implant sound processor has been worn as well as the amount
of exposure to auditory information are two key contributors to a child’s success with a cochlear
implant. Historically, this information was obtained via anecdotal report from parents and
caregivers. However with the advent of new cochlear implant processors this information is now available
in the programming software via data logging. Data logging enables audiologists to obtain objective
information regarding the use patterns of their cochlear implant recipients. The processor stores information
regarding usage including the number of hours the device is powered on, the amount of time and number of
times the processor is turned on but the coil is off the head, and the environment the device is used in (quiet,
speech in quiet, speech in noise, music, etc.) Objective: The primary purpose of this study was a review of
the database of our large metropolitan pediatric Cochlear Implant Center to determine typical wearing
patterns for specific age groups. In addition, analysis regarding the amount of speech exposure and
accessory/FM usage will be completed.
Methods: Retrospective study of 50 pediatric implant recipients using a cochlear implant system containing
data logging. Demographic information, presence of co-occurring disabilities, auditory performance, and
data logging data will be extracted from the medical record and programming software. Data logs will be
analyzed regarding average use time, number of “coil offs”, speech exposure and accessory/FM usage.
Trends in regards to growth of auditory skills will be examined.
Results: This data will be presented along with any patterns observed according to chronological age, age
at implantation, presence of additional disabilities. Additionally, the details provided by data logging will be
analyzed to determine if there are any trends related to auditory skill development.
Conclusion: In conclusion data logging enables audiologists to obtain objective information regarding the
use patterns of their cochlear implant recipients. This additional information provides additional insight in to
patient progress and is useful as a counseling tool for parents.
1
COI: Cochlear Americas
ACI2014
Benefit of a Speech Enhancement Strategy and a Digital Adaptive Remote Microphone System for
Understanding Speech in Quiet and in Noise
1
1
M. Morais-Duke,AuD , J. Wolfe
1
Hearts For Hearing, Audiology, Oklahoma City, OK USA
Topic: Audiology
Keywords: Assistive Listening Devices
Introduction: Understanding speech in many real-world listening situations can be challenging for cochlear
implant recipients. Innovative sound-processing algorithms and assistive technologies offer implant
recipients the opportunity to communicate more effectively in noisy environments. Objective: This study
assessed the ability of 11 implant recipients to understand speech in a noisy environment with a speechenhancement sound processing strategy alone, a digital adaptive remote microphone system alone, and
both technologies together. The primary objective was to evaluate the potential benefit of a speech
enhancement signal processing scheme and a personal remote microphone system on speech recognition
in noise.
Methods: This study included 11 participants who were unilateral or bilateral CII/HiRes 90K implant
recipients. All subjects were fitted with a Naida CI Q70 processor, a T-Mic 2, and an integrated Roger 17
receiver on the implanted ear(s). Sound processor programs were created using their everyday sound
processing strategy and a speech-enhancement sound processing strategy. Each of these programs was
configured with 100% T-Mic2 microphone only input and also as a 50/50 audio mixing ratio, with the T-Mic2
and the Roger 17 serving as the two input sources. The programs with the 50/50 mixing ratio were used
during the test conditions incorporating the digital adaptive remote microphone system. Sentence
perception in quiet and in noise was evaluated using four sound-processing programs: Speechenhancement strategy OFF, digital adaptive remote microphone system OFF Speech-enhancement
strategy ON, digital adaptive remote microphone system OFF Speech-enhancement strategy OFF, digital
adaptive remote microphone system ON Speech-enhancement strategy ON, digital adaptive remote
microphone system ON Speech was presented from a loudspeaker located in front of the listener (0degree azimuth). The level of the speech signal was 85 dBA at the microphone of the adaptive digital
remote microphone system and 65 dBA at the location of the participant. Classroom noise was presented
from four loudspeakers (45-, 135-, 225-, and 315-degree azimuth) at 50, 55, 60, 65, 70, 75, and 80
dBA. For each test condition, one list of AzBio sentences was presented. For conditions involving the
digital adaptive remote microphone system, the receiver gain was left in the default mode.
Results: Repeated measures analysis of variance was used to analyze the data collected in this study. This
statistical analysis indicated that use of the speech-enhancement strategy and digital adaptive remote
microphone system alone and together improved the ability to understand sentences in quiet and in the
presence of classroom noise.
Conclusion: A speech-enhancement strategy and digital adaptive remote microphone system alone and
together can improve speech recognition of cochlear implant users both in quiet and in noisy environments.
Session 4: Audiological Assessment: Pediatric CI
ACI2014
Using Phoneme Perception Error Information to Modify Cochlear Implant Programming
1
2
2
J. R. Madell, Ph.D. , J. Hewitt,Au.D , L. Hewitt
1
2
Pediatric Audiology Consulting, Audiology, Brooklyn, NY USA ; Project Talk, Encinitas, CA USA
Topic: Audiology
Keywords: Fitting , Speech Test Theory , Outcomes
Introduction: The goal of cochlear implantation is to improve speech perception. While standard
programming techniques provide significant improvement, many CI users continue to have specific
phoneme perception errors which can be corrected by modifying CI I programming. A technique will be
described which evaluates an individual’s phoneme perception errors and uses error information to modify
the cochlear implant program
Methods: A medial consonant test is performed and errors recorded. Phoneme errors are analyzed and the
frequency band of each phoneme that is misheard is recorded using a frequency allocation table. A
determination is made about which frequency bands are not providing adequate information. The cochlear
implant program is analyzed evaluating the frequencies covered by each electrode and a determination is
made about which electrodes need to have levels modified. The CI program is modified and performance is
re-evaluated to determine if perception errors have been corrected. 103 subjects age from 2yrs 5 months to
49 yrs 6 months were evaluated
Results: All patient phoneme errors were reviewed. Errors were placed into one of three categories: errors
completely corrected after MAPping changes; errors not corrected after MAPping changes that did,
however, result in an appropriate approximation of the test phoneme; and errors that, even after MAPping
changes, resulted in neither a correction in phoneme perception nor an appropriate approximation for the
phoneme. Before any changes were made to their CI MAPs, the 103 subjects had a total of 1516 phoneme
perception errors. The phoneme correction rate was 66.03% when all approximations of a phoneme were
counted as incorrect. However, when appropriate approximations were counted in the corrections, the
correction rate increased to 81.46%. Although more than half of the phoneme errors were corrected, a
portion of the initial errors persisted.
Conclusion: The data collected on the phonemes indicates that the correction of phoneme perception
errors relies heavily on the manipulation of the formants that correspond to the targeted phoneme including
increases, decreases, increases and decreases in tandem. Data suggest the necessity of formant specific
changes. Information gained from testing before changes are made provides information as to which
formants will need adjustment. This study suggests that changes in electrical stimulation levels of those
electrodes which correspond to the specific formants of incorrectly perceived phonemes will improve speech
perception and remediate errors. In addition, this study suggests that the audiologist must consider the full
combination of increases, decreases, increases and decreases applied in tandem, electrode deactivation,
electrode activation, and pulse width changes to provide the greatest remediation.
ACI2014
Does Method of Presentation Impact Pediatric Word Recognition Scores: Monitored Live Voice
Versus Recorded Speech Materials?
1
A. Biever,Au.D.
1
Rocky Mountain Ear Center, Englewood, CO USA
Topic: Audiology
Keywords: Outcomes
Introduction: In the adult literature, administering recorded speech materials is recommended for best
practices speech audiometry. In fact, research has shown that the use of monitored live voice (MLV) for
adult word recognition can yield discrepancies up to 80-percentage points as compared to scores obtained
with recorded stimuli (Roeser and Clark, 2008). In the pediatric population, the use of recorded speech
materials is also recommended and will similarly improve test-retest reliability, however, many clinicians
continue to report preference for MLV for assessing speech perception. Objective: To determine whether
there is a difference in children’s performance on word and sentences assessed using live voice and
recorded speech measures.
Methods: This study utilized a combination of retrospective and prospective data explored within subject
performance for recorded versus monitored-live-voice presentation methods on pediatric word and sentence
measures. Eighteen pediatric cochlear implant recipients between the ages of 4 and 17 were administered
recorded and monitored-live-voice word and/or sentence measures at 60 dBA during a single test
session. The difference score was calculated for word and sentence measures allowing a comparison
across conditions. Due to the retrospective nature of the design presentation order was not randomized.
Results: On average, the recorded word scores were 12-percentage points lower than those obtained via
MLV, regardless of whether the recorded words were administered first or second. There was a significant
difference between recorded word and MLV word scores as revealed by repeated measures analysis of
variance F(1,17)=44.785, p<0.001.
Conclusion: Further prospective studies are needed to determine whether these trends continue with
randomization in a larger population. Nevertheless, the results of this project suggest that the use of MLV
for the assessment of speech perception in the pediatric Audiology clinic will overinflate children’s
performance and runs the risk of failing to identify poorer or at-risk performance.
ACI2014
Relationship Between Sensation Level and Optimal Speech Perception Performance in Normal
Hearing and Hard-of-Hearing Infants
1
1
1
2
1
K. M. Uhler, MA,Ph.D. , S. Claycomb,AuD , S. Elam,AuD , A. Biever,AuD , T. Fredrickson
1
2
University Of Colorado Denver, Otolaryngology And Audiology, Aurora, CO USA ; Rocky Mountain Ear
Center, Denver, CO USA
Topic: Audiology
Keywords: Outcomes , Objective Measures
Introduction: Infants with hearing loss (HL) are often identified within the first few months of life and fit with
amplification. Currently little is known about the auditory perceptual development of infants/toddlers with HL
and there is a need for a normed clinical tool to examine speech perception for infants with HL and normal
hearing (NH). The investigation of speech perception in early amplified infants/toddlers is relatively new
since EHDI or UNHS. Visual reinforcement infant speech discrimination (VRISD) has been used to learn
much of what we know about development of speech perception in NH children and is being applied for the
deaf and hard-of-hearing (DHH) population. This study examined one aspect of assessing infant speech
perception: the optimal sensation level (dB SL).
Objective: To determine the dB SL that maximizes performance in both NH and HH listeners using VRISD
for two sound contrasts (/a-i/ and /ba-da/). A second objective was to examine if a different presentation
level is necessary for different speech sound contrasts when assessing infant speech perception using the
VRISD paradigm.
Methods: VRISD utilizes a conditioned head turn paradigm, VRISD, was used to examine infants’ ability to
discriminate the two speech sounds. Prior to initiation of VRISD testing, thresholds were established using
VRA and the same-recorded speech stimuli (/a/, /i/, /b/, and /d/) in order to calculate sensation level (dB SL)
of the stimuli. The SL was calculated by subtracting the threshold obtained for each speech sound from 50,
60, and 70 dBA.
Results: There were 22 NH participants and 13 HH participants (7 with hearing aids and 3 with cochlear
implants). Generalized estimating equation (GEE) model demonstrated a significant effect for both contrast
/a-i/ and /ba-da/ (p=.006) and level (50, 60, and 70 dBA) (p=.001), but there was not a significant interaction
between the two. There was a greater probability of mastery as level increased; this probability was greater
for the /a-i/ contrast when compared to /ba-da/ contrast. After controlling for level, the /a-i/ contrast was
associated with an 8 times greater likelihood of mastery than /ba-da/ (odds ratio=8).
Conclusion: This study demonstrated that NH infants required a greater intensity level than adults to
discriminate speech sounds similar to Nozza, (1987). The dB SL required for infants with hearing loss was
smaller. These findings illustrate the importance of assessing different intensity levels to study an infant’s
ability to discriminate speech contrasts. Contrast selection should be carefully considered due to the
difference in ease of discrimination of /a-i/ versus /ba-da/.
ACI2014
Children with Cochlear Implants and Normal Hearing Peers: Effect of Presentation Format and
Signal-to-Noise Ratio on Performance of Speech Recognition
3
3
2
V. D. Driscoll, MA , A. E. Welhaven , J. Oleson , K. I. Kirk
1
University Of Iowa, Department Of Otolaryngology--Head And Neck Surgery, Iowa City, IA
2
USA; University Of Illinois At Urbana-Champaign, Department Of Speech And Hearing Science,
3
Champaign, IL USA; University Of Iowa, Department Of Biostatistics, Iowa City, IA USA
Topic: Rehabilitation/Educational Aspects
Keywords: Children and Recommended Rehabilitation , Social Situation of implanted children
Introduction: Clinical testing of children’s speech understanding is often conducted in quiet, sound-treated
booth. Such test conditions do not accurately reflect the listening demands of real-world conditions. Often,
listeners can combine visual information found in speech, such as lip and facial movements, to aid in
perceptual accuracy. It has been suggested that younger children receive less benefit from the addition of
visual speech cues compared to older children. In a study by Diamond et al., (2013), age effects were found
TM
for children with normal hearing (NH) who completed the MLST-C in seven signal-to-noise ratios (SNR)
ranging from -10 to 5 dB. Presentation format was also found to affect performance. Similar measures have
not yet been evaluated with children who have cochlear implants (CIs).
Method: Nineteen pediatric CI users (4-16 years) and 35 NH children (5-12 years) completed testing on the
TM
MLST-C , repeating sentences presented in either Audio only (A) or Audio-visual (AV) presentation in five
SNRs: -10, -5, 0, 5, 10 dB. Participants repeated sentences presented by male and female talkers and were
scored on accuracy of three keywords. Outcome was evaluated as a function of age, group membership
(CI/NH), presentation format (A/AV), SNR and interactions of variables.
Results: Group, SNR, presentation format, and age were all found to be significant predictors in the logistic
regression model as well as interactions of SNR*group, age*group and SNR*age. Children with normal
hearing were significantly more accurate than those with CIs across all SNR levels; older children within
each group showed better performance and were able to demonstrate greater performance accuracy in
difficult listening conditions. For example, using SNR= 0 and an age of 10 years, the odds of a NH child
scoring correctly in the AV format is 3.4 times higher than just A while a child with a CI has an odds that is
only 1.13 times higher in AV than A.
Conclusion: Children with CIs are at a disadvantage in noisy listening conditions and do not consistently
utilize the cues available to them via lip-reading, as observed in the smaller improvement compared to NH
peers. Utilizing these cues may require direction, as they may not know to pair them for additional listening
information. Effects of device configuration (unilateral, bilateral, bimodal and hybrid) will be discussed as it
relates to performance.
ACI2014
Redefining the Borders: The Benefits of Stretching the Criteria for Pediatric CI
1
1,2
Y. Abrahams, BA,BHlthSc, MCllinAud , A. Davis
1
2
The Shepherd Centre, Newtown, NSW Australia ; Macquarie University, Macquarie Park, NSW Australia
Topic: Rehabilitation/Educational Aspects
Keywords: Speech and Language Development with CI , Children and Recommended Rehabilitation
Introduction: Over the past 10 years there has been a significant shift in the audiological and functional
listening criteria that would suggest a child will have improved access to sound with a CI. In an integrated CI
program that is embedded in a comprehensive early intervention service the opportunity exists to closely
monitor the progress of children with different levels of hearing and different hearing devices, and how the
ever improving outcomes for children with CIs has driven shifts in candidacy criteria. Objective: This
retrospective study reviews the changing criteria in a pediatric CI program over the past 3 years, and the
impact on speech, language and listening outcomes. Additionally, medical, audiological and psychosocial
outcomes are reviewed and compared to those of children using traditional amplification.
Methods: A retrospective review was conducted to identify the candidacy criteria, medical,surgical and long
term listening speech and language outcomes with respect to listening, speech, language and the family
factors for 148 implant procedures over 3 years. This review provided clarity on the current criteria for
pediatric cochlear implant evaluation in 2014
Results: Audiological criteria have been gradually shifting over the past 3 years. Children with more residual
hearing are now being considered appropriate candidates for implantation and are showing improved postoperative listening skills and when compared to children using traditional amplification. Surgical and medical
aspects of cochlear implantation have not shown any significant change in the impact on the individual or
their post-operative residual hearing. Other characteristics are emerging as likely outcomes such as reduced
listening effort and improved confidence.
Conclusion: Rather than being the sole qualifying criteria, a child’s audiological results are just one
component of the information driving a family to consider CI. The value of the description ‘borderline’ needs
to be reconsidered as it is defined differently by different clinicians and at different points in history, and this
has proved only to add confusion for families and professionals. Instead the focus needs to be on functional
listening and access to sound, and professionals need to keep abreast of the shifting criteria for CI with
respect to possible outcomes in order to ensure candidates are obtaining the best access to sound that
technology can provide.
ACI2014
Evaluation and Results of Implanted Children When They Have Reach 12 Years of Age
1
1
1
1
A. Ramos , J. Falcón González , n Ramos De Miguel , S. Borkoski Barreiro
1
Complejo Hospitalario Universitario Insular Materno Infantil De Gran Canaria, ENT, Las Palmas, LAS
PALMAS DE GRAN CANARIA Spain
Topic: Audiology
Keywords: Young and Very Young Children , Outcomes , Fitting
Introduction: Children worldwide acquire the basic vocabulary and essential grammar of their mother
language during the first four years of life. It is thought that the end of the sensitive phase for language
acquisition occurs around twelve to thirteen years of age. Among the benefits of bilateral cochlear
implantation is an improved sound localization and better speech understanding in noise. The objective is to
evaluate auditory and linguistic results in children implanted when they were 1 to 5 years old, when they
have reached 12 years of age. We studied the benefits of sequential bilateral implantation.
Methods: Observational, cross-sectional, descriptive study. 57 implanted children of 12 years of age. Each
subject passed a free-field tone audiometry and speech tests in silence and noise. Language proficiency
was assessed with the “Bateria de Lenguaje Objetiva y Criterial” (BLOC) in its screening version.
Results: The scores of disyllabic and common sentences tests, with and without noise, are similar for the
group implanted when they were 1-2 years old than for the group implanted when they were 3-5 years old.
Bilateral implanted children under 2 years of age and with a short inter-implant time obtained statistically
significant results in the two bi-syllabic and sentences in quiet (p=0.006) and in noise (p=0.045). As for the
language proficiency test, children implanted between the ages 1-2 have better results than thons implanted
between 3 and 5 years of age (p<0.05).
Conclusion: The disyllabic and sentence tests in quiet and in noise are better in all patients implanted
below 2 years of age with respect to those implanted above 3 years of age. For the group of sequentially
implanted children, those implanted below 2 years and with an inter implant period smaller or equal to 4
years, results in speech perception of disyllabic words in quiet, and sentences with and without noise are
statistically significant with respect to those from children implanted above this age and with an inter-implant
period bigger than 4 years Ramos Macías et al. studied 90 children and demonstrated that a simultaneous
or short inter implant period bilateral implantation allows the acquisition of binaurality. In more demanding
tests, such as the disyllabic words in noise test, sequentially implanted children with an inter-implant time
period smaller or equal to 4 years and implanted below 2 years of age show statistically significant better
results. Our results show that unilateral and bilateral implanted children whose first implantation was before
2 years of age have better results with respect to children implanted above 3 years of age. Children with
prelingual deafness implanted before 2 years of age have higher benefits in language development and
proficiency when they reach 12 years of age than those implanted later. Children implanted below 2 years of
age and with a short inter-implant time acquire binaurality.
ACI2014
Managing Unilateral Hearing Loss in Infants: Why One Ear is Not Enough
1
1,2
Y. Abrahams, BA,BHlthSc, MCllinAud , A. Davis
1
2
The Shepherd Centre, Newtown, NSW Australia ; Macquarie University, Macquarie Park, NSW Australia
Topic: Audiology
Keywords: Outcomes , Residual Hearing , Young and Very Young Children
Introduction: The risk of difficulties arising from unilateral hearing impairment is well documented. For
audiologists and allied professionals, the immediate challenge is in demonstrating benefit of fitting hearing
devices and accessing early intervention services when faced with families with very young paediatric clients
Objective: This study aims to determine the current state of children with unilateral hearing impairment in a
single early intervention service, and reviews device use, age at device fitting, and results on formal
assessment.
Methods: Demographic information, formal speech and language assessment results, auditory skills and
diagnostic results from regular Auditory-Verbal Therapy sessions recorded on file were reviewed. Parents
were interviewed about their perceptions of the information provided at the time of diagnosis and the
availability of services, devices and support for children with unilateral hearing impairment. Particular
attention was paid to children who received a cochlear implant with unilateral hearing loss in order to
articulate the candidacy criteria and likely outcomes of this procedure. Tools and approaches for therapy
were also reviewed.
Results: Of the children enrolled in early intervention aged 0-6 years, 16% had a unilateral hearing
impairment of some type/degree. Devices used included no device, devices to contralaterally reroute the
signal, acoustic hearing aids and cochlear implants. Outcomes across the group were excellent; however
parent report of the guidance and information they received was varied. All reported concern about the lack
of action following on from such early diagnosis and limitation of options.
Conclusion: In any environment where universal newborn hearing screening continues to identify unilateral
hearing loss specific and appropriate management needs to be consistently offered and professionals at all
points in the service chain need to understand and articulate the likely impact and need for audiological
management, device use and early intervention. Consideration needs to be given to the appropriate therapy
tools and techniques and the impact on listening in complex environments that may not be measureable
until children reach school age.
ACI2014
Preliminary Findings on Spectral and Temporal Resolution in Cochlear Implanted Infants
1,2
2,3
1,3
D. L. Horn, MD,MS , L. Werner , J. T. Rubinstein
1
University Of Washington, Department Of Otolaryngology - Head And Neck Surgery, Seattle, WA USA
2
3
; University Of Washington, Speech And Hearing Sciences, Seattle, WA USA ; Virginia Merrill Bloedel
Hearing Research Center, Seattle, WA USA
Topic: Basic Research
Keywords: Maturation and Plasticity of The Auditory System
Introduction: For profoundly deaf infants, cochlear implantation (CI) is an established treatment to enable
acquisition of speech perception and spoken-language skills. While a number of studies have investigated
speech discrimination, language, and speech production gains in these infants, little is known about how
basic auditory sensitivities develop in these patients. This gap in knowledge is important to address if we are
to understand how early atypical auditory experience with a CI impacts development of the auditory
system. As a first step toward this goal, auditory abilities of cochlear implanted infants were examined using
two psychoacoustic measures previously shown to be related to speech understanding in post-lingually deaf
adult CI users. One test assessed spectral resolution while the other assessed temporal resolution. Due to
the fact that spectral and temporal resolution mature during the first 6-7 months of life in normal hearing
infants, it was hypothesized that a similar trajectory will be seen in cochlear implanted infants. Objective: To
compare spectral and temporal resolution in cochlear implanted listeners from two groups: post-lingually
deaf long-term adult CI users and prelingually deaf infants with cochlear implants.
Methods: Spectral resolution was assessed using spectral ripple discrimination (SRD). Listeners
discriminated broadband noises with amplitude modulated (or “rippled”) spectra which differed in phase by
90 degrees. At two fixed ripple depths (10dB and 20dB), ripple density was varied to obtain the highest
density (in ripples per octave) that could be discriminated (the SRD threshold). Temporal resolution was
assessed using amplitude modulation detection (AMD). Listeners discriminated broadband noises
containing temporal amplitude modulations from unmodulated noises. At two fixed modulation rates (10Hz
and 100 or 150Hz) modulation depth was varied to obtain the lowest depth at which unmodulated and
modulated noises could be discriminated. Infants and adults were both tested using an identical observerbased psychoacoustic procedure (OPP) that has been widely used in psychoacoustic experiments with
infants and toddlers. Stimuli were presented at 65dB in soundfield to CI listeners using their preferred clinical
processor and (for bilaterally implanted patients) their first and/or best side only.
Results: Preliminary results show that cochlear implanted infants performed similarly to post-lingually deaf
adult CI users on SRD and AMD tasks.
Conclusion: Though preliminary, these findings support the hypothesis that basic spectral and temporal
resolution matures early in cochlear implanted infants. Future research will standardize the post-implant
interval of testing in infants to 3 and 7 months to see if psychoacoustic measures mature during this
timeframe. SRD and AMD thresholds will be compared to later spoken-language abilities measured at 1
year post-implantation.
Was this manual useful for you? yes no
Thank you for your participation!

* Your assessment is very important for improving the work of artificial intelligence, which forms the content of this project

Download PDF

advertisement