Aaron C. Moberly

Word learning in deaf children with cochlear implants: effects of early auditory experience

Word-learning skills were tested in normal-hearing 12- to 40-month-olds and in deaf 22- to 40-month-olds 12 to 18 months after cochlear implantation. Using the Intermodal Preferential Looking Paradigm (IPLP), children were tested for their ability to learn two novel-word/novel-object pairings. Normal-hearing children demonstrated learning on this task at approximately 18 months of age and older. For deaf children, performance on this task was significantly correlated with early auditory experience: Children whose cochlear implants were switched on by 14 months of age or who had relatively more hearing before implantation demonstrated learning in this task, but later implanted profoundly deaf children did not. Performance on this task also correlated with later measures of vocabulary size. Taken together, these findings suggest that early auditory experience facilitates word learning and that the IPLP may be useful for identifying children who may be at high risk for poor vocabulary development.

Comparison of Long-term Quality-of-Life Outcomes in Vestibular Schwannoma Patients

Objective To compare long-term quality-of-life outcomes in vestibular schwannoma patients managed with observation, microsurgery, or stereotactic radiation. Study Design ross-sectional survey with retrospective chart review. Setting Tertiary care center. Subjects and Methods The Penn Acoustic Neuroma Quality of Life (PANQOL) survey was mailed to 600 patients treated for vestibular schwannoma. Patients were separated by treatment and subsequently subdivided by years of follow-up (0-5, 6-10, and >10 years). Composite quality-of-life (cQOL) scores and subscores for hearing, balance, facial nerve, pain, anxiety, energy, and general health were calculated. Scores were compared among treatment groups as a whole, among treatment groups at each time interval, and within treatment groups over time using a 2-tailed analysis of variance and paired t test. Results The survey return rate was 49%, and the mean follow-up was 7.9 years. The only significant difference in cQOL occurred at 0 to 5 years, where stereotactic radiation scores were better than both microsurgery and observation (P = .009). No significant differences were detected in cQOL after 5 years. Within the radiation group, cQOL was significantly lower at 6 to 10 years than at 0 to 5 years (P = .013). At no point was cQOL for stereotactic radiation less than that for observation or microsurgery. Conclusions Long-term (>5 years) quality-of-life outcomes measured by the PANQOL in vestibular schwannoma patients show no significant differences between stereotactic radiation, observation, and microsurgical intervention. Studies are needed to fully evaluate very-long-term QOL for patients with vestibular schwannoma.

Do Adults With Cochlear Implants Rely on Different Acoustic Cues for Phoneme Perception Than Adults With Normal Hearing

PURPOSE Several acoustic cues specify any single phonemic contrast. Nonetheless, adult, native speakers of a language share weighting strategies, showing preferential attention to some properties over others. Cochlear implant (CI) signal processing disrupts the salience of some cues: In general, amplitude structure remains readily available, but spectral structure less so. This study asked how well speech recognition is supported if CI users shift attention to salient cues not weighted strongly by native speakers. METHOD Twenty adults with CIs participated. The /bɑ/-/wɑ/ contrast was used because spectral and amplitude structure varies in correlated fashion for this contrast. Adults with normal hearing weight the spectral cue strongly but the amplitude cue negligibly. Three measurements were made: labeling decisions, spectral and amplitude discrimination, and word recognition. RESULTS Outcomes varied across listeners: Some weighted the spectral cue strongly, some weighted the amplitude cue, and some weighted neither. Spectral discrimination predicted spectral weighting. Spectral weighting explained the most variance in word recognition. Age of onset of hearing loss predicted spectral weighting but not unique variance in word recognition. CONCLUSION The weighting strategies of listeners with normal hearing likely support speech recognition best, so efforts in implant design, fitting, and training should focus on developing those strategies.

Patient Tolerance of the Flexible CO2 Laser for Office-based Laryngeal Surgery

OBJECTIVE The OmniGuide flexible carbon dioxide (CO(2)) laser can be readily used in the office but patient tolerance has not been established. The aim of this pilot study was to determine patient tolerance of the flexible CO(2) laser. As a reference point, the 585-nm pulsed-dye laser (PDL) was selected for comparison because it is the only office-based laser in which patient tolerance has specifically been studied. METHODS Prospective pilot study involving office-based surgery candidates with benign laryngeal pathology. Via flexible laryngoscopy, half of each lesion was treated with the CO(2) laser and the remaining half with the PDL, alternating the order of the lasers (to account for potential thermal injury from the first laser) and blinding the patient to treatment. Patients rated their discomfort immediately after each laser treatment and then completed postoperative questionnaires for discomfort and voice quality. RESULTS Ten patients with benign laryngeal disease were included. All patients tolerated the office-based laser surgeries without difficulty. The CO(2) laser was extremely well tolerated, with mean pain and burning scores of 2.0 and 2.3, respectively, on a scale of 1-10 (10 being intolerable pain). Postoperative pain questionnaires demonstrated minimal discomfort after the laser treatment. Those with resolution of laryngeal disease had significant voice improvement. CONCLUSION Flexible CO(2) laser laryngeal surgery is well tolerated in an office-based setting.

Improving speech-in-noise recognition for children with hearing loss: potential effects of language abilities, binaural summation, and head shadow.

Abstract Objective: This study examined speech recognition in noise for children with hearing loss, compared it to recognition for children with normal hearing, and examined mechanisms that might explain variance in childrens abilities to recognize speech in noise. Design: Word recognition was measured in two levels of noise, both when the speech and noise were co-located in front and when the noise came separately from one side. Four mechanisms were examined as factors possibly explaining variance: vocabulary knowledge, sensitivity to phonological structure, binaural summation, and head shadow. Study sample: Participants were 113 eight-year-old children. Forty-eight had normal hearing (NH) and 65 had hearing loss: 18 with hearing aids (HAs), 19 with one cochlear implant (CI), and 28 with two CIs. Results: Phonological sensitivity explained a significant amount of between-groups variance in speech-in-noise recognition. Little evidence of binaural summation was found. Head shadow was similar in magnitude for children with NH and with CIs, regardless of whether they wore one or two CIs. Children with HAs showed reduced head shadow effects. Conclusion: These outcomes suggest that in order to improve speech-in-noise recognition for children with hearing loss, intervention needs to be comprehensive, focusing on both language abilities and auditory mechanisms.

Ultrasound-Guided Needle Aspiration: Impact of Immediate Cytologic Review

To compare the diagnostic adequacy of ultrasound‐guided fine‐needle aspiration biopsy (USFNA) of the head and neck with immediate on‐site microscopic evaluation and feedback by a cytopathologist (IMMEDIATE) versus delayed examination without immediate feedback (DELAYED).

Cochlear Implants in Adults: Effects of Age and Duration of Deafness on Speech Recognition.

Objective: Unexplained outcome variability exists among adults with cochlear implants (CIs). Two significant predictors are age and duration of deafness, with older patients and those with longer durations of deafness generally demonstrating poorer speech recognition. However, these factors are often highly correlated. Thus, it is unclear whether poorer outcomes should be attributed primarily to age-related declines or to the experience of auditory deprivation. Our aim was to examine the effects of aging and duration of hearing loss on outcomes for postlingually deaf adults with CIs. Study Design: Retrospective review of adults who received CIs from 1983 to 2014. Setting: Tertiary adult CI program. Patients: Sixty-four adult patients with postlingual hearing loss beginning after age 12 years, full electrode insertion, normal cochlear anatomy, and availability of postoperative outcome measures. Intervention: Cochlear implantation with 12 months or greater of device use. Main Outcome Measures: Postoperative pure-tone averages (0.5, 1, 2, and 3 kHz) and recognition of words in sentences (Hearing in Noise Test and AzBio). Results: Age at postoperative testing had a negative partial correlation with AzBio scores, when controlling for duration of deafness, whereas duration of deafness had a positive partial correlation with AzBio scores, when controlling for age. No other effects were identified. Conclusion: Older age at testing was associated with poorer recognition of words in difficult sentences, suggesting that cognitive aging may negatively impact CI outcomes. Further studies are needed to examine how a long duration of auditory deprivation affects CI outcomes.

Word Recognition Variability With Cochlear Implants: "Perceptual Attention" Versus "Auditory Sensitivity".

Objectives: Cochlear implantation does not automatically result in robust spoken language understanding for postlingually deafened adults. Enormous outcome variability exists, related to the complexity of understanding spoken language through cochlear implants (CIs), which deliver degraded speech representations. This investigation examined variability in word recognition as explained by “perceptual attention” and “auditory sensitivity” to acoustic cues underlying speech perception. Design: Thirty postlingually deafened adults with CIs and 20 age-matched controls with normal hearing (NH) were tested. Participants underwent assessment of word recognition in quiet and perceptual attention (cue-weighting strategies) based on labeling tasks for two phonemic contrasts: (1) “cop”–“cob,” based on a duration cue (easily accessible through CIs) or a dynamic spectral cue (less accessible through CIs), and (2) “sa”–“sha,” based on static or dynamic spectral cues (both potentially poorly accessible through CIs). Participants were also assessed for auditory sensitivity to the speech cues underlying those labeling decisions. Results: Word recognition varied widely among CI users (20 to 96%), but it was generally poorer than for NH participants. Implant users and NH controls showed similar perceptual attention and auditory sensitivity to the duration cue, while CI users showed poorer attention and sensitivity to all spectral cues. Both attention and sensitivity to spectral cues predicted variability in word recognition. Conclusions: For CI users, both perceptual attention and auditory sensitivity are important in word recognition. Efforts should be made to better represent spectral cues through implants, while also facilitating attention to these cues through auditory training.

Low-frequency signals support perceptual organization of implant-simulated speech for adults and children

Abstract Objective: Using signals processed to simulate speech received through cochlear implants and low-frequency extended hearing aids, this study examined the proposal that low-frequency signals facilitate the perceptual organization of broader, spectrally degraded signals. Design: In two experiments, words and sentences were presented in diotic and dichotic configurations as four-channel noise-vocoded signals (VOC-only), and as those signals combined with the acoustic signal below 0.25 kHz (LOW-plus). Dependent measures were percent correct recognition, and the difference between scores for the two processing conditions given as proportions of recognition scores for VOC-only. The influence of linguistic context was also examined. Study sample: Participants had normal hearing. In all, 40 adults, 40 seven-year-olds, and 20 five-year-olds participated. Results: Participants of all ages showed benefits of adding the low-frequency signal. The effect was greater for sentences than words, but no effect of diotic versus dichotic presentation was found. The influence of linguistic context was similar across age groups, and did not contribute to the low-frequency effect. Listeners who had poorer VOC-only scores showed greater low-frequency effects. Conclusion: The benefit of adding a low-frequency signal to a broader, spectrally degraded signal derives in some part from its facilitative influence on perceptual organization of the sensory input.

Chorda tympani and facial nerve neurofibroma presenting as chronic otomastoiditis.

A28-year-old woman was referred for left-sided conductive hearing loss and chronic otitis media. Physical examination was significant for an opacified, intact, retracted left tympanic membrane. Facial nerve function was intact with House-Brackmann grade I/VI. Audiometry revealed moderate left-sided conductive hearing loss. A computerized tomography (CT) scan showed a nonenhancing soft tissue lesion within the left mastoid and epitympanum with ossicular erosion, suggesting a chronic infection or cholesteatoma. Intraoperatively, during a canal wall-up mastoidectomy, a mass of fibrous tissue was encountered on the medial surface of the incus. A frozen-section biopsy revealed “benign nervous tissue.” The facial nerve was thickened from the stylomastoid foramen through the tympanic portion of the nerve. The chorda tympani was markedly enlarged because of tumor infiltration. This portion of tumor rejoined the main mass in the epitympanum, with the facial recess preserved (Fig 1). Nerve stimulation along the course of the facial nerve caused robust contraction of the ipsilateral face; the portion of tumor involving the chorda tympani did not stimulate. The tumor was decompressed 180° along its entire intratemporal course and was left intact. The malleus and incus were partially eroded and were removed. A temporalis fascia graft was placed, covering the tumorous nerves and creating an aerated mesotympanum. Postoperatively, the patient did well with House-Brackmann grade I/VI facial nerve function and no dysgeusia. Final pathologic analysis revealed “neurofibroma.” The patient had no family history of neurofibromatosis, and magnetic resonance imaging of the patient’s central nervous system showed no synchronous lesions. Close clinical follow-up will continue until facial nerve paralysis develops, at which time resection of the neurofibroma with cable grafting of the facial nerve will be performed.