Deborah Ballantyne

Cochlear Implants in Special Cases: Deafness in the Presence of Disabilities and/or Associated Problems

The aim of the present study is to construct a reference model with the indication for the attitude, the requirements and the resources needed in order to be able to deal with deafness in the presence of disabilities or associated problems. The study group consisted of 13 adults and 18 children affected by profound deafness, with associated problems and disabilities, who were implanted with Clarion® and Med-El® devices. Selection criteria for candidacy to cochlear implantation and counselling, hospitalization, fitting and speech therapy/rehabilitation are described. Findings were assessed evaluating: (i) use of acoustic feedback, on the ground of Erbers model; (ii) self-sufficiency: assessed by a questionnaire; and (iii) social and family relationships: qualitative judgment based on direct observation, analysis of drawings and structured interviews with family teachers and therapists. The whole group showed benefit from cochlear implantation, with particular satisfaction for post-lingual deaf-blind adults, as well as for subjects with associated psychopathologies and mental retardation. In conclusion, cochlear implants can improve life quality in profoundly deaf subjects with associated disabilities, increasing both listening and communication skills as well as self-sufficiency while family and social relationships tend to remain stable.

Delayed loss of residual hearing in Clarion® cochlear implant users

Hearing threshold has been measured in a group of patients following cochlear implantation with a Clarion device for the last eight years. The patients had received either a pre-curved carrier or the Hi-Focus I plus Electrode Positioner System (EPS). The assessment was carried out within the first post-operative week as well as at a later stage, between six and 87 months, post-operatively. Residual hearing thresholds were still measurable early after surgery in 24.5 per cent of the patients, without differences between the two different Clarion models. However, the number of subjects with measurable hearing dropped to 16.3 per cent as observed when hearing was measured at a later stage, with an equal distribution between the two groups of patients. From this study it has been possible to observe that only a limited number of patients maintain residual hearing after Clarion cochlear implantation, and that this tends to decrease further over time. Nevertheless, the performance of these patients for speech tests did not appear to be affected by deterioration of the pure-tone auditory threshold.

Short-term study of the effect of speech coding strategy on the auditory performance of pre- and post-lingually deafened adults implanted with the Clarion CII®

Objective The auditory performance of cochlear implantees is linked to numerous variables, such as audiological characteristics, age and type of speech coding strategy. In recent years, many different ways of processing sounds have been developed, with possible implications for auditory performance. The purpose of this study was to evaluate the intra-individual differences of patients for speech perception tasks in quiet and in noise as a result of switching from a standard strategy [Continuous Interleaved Sampling (CIS)/Simultaneous Analog Strategy (SAS)] to Hi-Resolution (HiRes). Material and Methods A total of 14 post-lingual adults implanted with the Clarion CII® were selected for trials. At switch-on, six patients chose a CIS strategy and eight an SAS strategy. After an average period of 9.3 months, all patients were switched over to HiRes. All patients were tested (open-set mode) with bisyllabic words and sentences, in both quiet and noise [speech/noise ratio (SNR)=+10]. Testing was carried out after an initial period with the CIS/SAS strategy and 3 months after switching over to HiRes. Results After switch-over a significant improvement was seen for both speech in quiet (words +25.2%, sentences +10.8%) and speech in noise (words 44.8%, sentences 45.4%). Conclusion Despite individual differences, all patients improved their performance with HiRes use, the greatest improvements being seen under unfavourable listening conditions (SNR=+10). Subjective improvements in speech discrimination and overall sound quality perception were reported even after the first week of HiRes use.

Implementation of perceptual channels in children implanted with a HiRes 90K device

Conclusions: The increased spectral resolution that characterizes the HiRes 120 device contributes to improvement of performance. Discrimination and identification in noise are consistent with reports of improved perception under everyday listening situations. Objectives: This work focuses on speech perception findings after implementation of current steering in HiResolution strategy of children implanted with Clarion HiRes 90K. Subjects and methods: Comparison was made between three groups of children: standard HiRes control group, a second group switched over from HiRes to HiRes 120 and the third group switched on with HiRes 120. Children were tested before and 12 months after implementation of HiRes 120. A standard test battery was administered to obtain a speech perception development profile. The Auditory Speech Sound Evaluation (A§E) test was carried out to evaluate discrimination and identification of phonemes in quiet and in noise. Results: The HiRes and HiRes 120 switch-over groups showed quite similar results for speech perception in quiet. However, the HiRes 120 switch-over group achieved these results within a shorter time after conversion. Switch-on children showed improvement in all speech perception categories, reaching approximately 60% recognition and 30% comprehension in quiet. Results for A§E discrimination scores in quiet and noise showed a clear improvement for both HiRes 120 switch-on and switch-over groups compared with the HiRes group.

Schooling and educational performance in children and adolescents wearing cochlear implants.

Abstract Objective The aim of the study was to assess the impact of cochlear implant use on schooling. Design Retrospective study which examined the educational characteristics, gap between chronological age and class attended, learning skills and quality of social interaction with peers and adults in 50 children with cochlear implants. Methods Structured interviews with parents, questionnaires for teachers, school report cards and psychometric tests. Results Majority of children attended state schools in mainstreamed classes; 88% had a support teacher and 86% followed Oral Communication. These children showed a smaller disparity (0.4 years) between their chronological age and class attended. No insufficient performers were seen in learning skills. Greater competence in linguistic and logical areas tended to correspond to more intensive rehabilitation. Children were cooperative, assertive with peers and grew fond of teachers and communication assistants. Conclusions Schooling proved to be satisfactory in prelingually deafened children and adolescents wearing cochlear implants. Copyright

Music perception in cochlear implant recipients: comparison of findings between HiRes90 and HiRes120

Conclusions. Increased spectral resolution via implementation of perceptual channels with HiRes120 (PSP) would seem to provide better perception of music than with standard HiRes, mainly from the point of view of music appreciation as recorded via the questionnaire. More specific tests are required for appreciation of timbre, preferably by application of protocols based on perceptual attributes using rating scales, which would not be biased by knowledge of music. Objective. The objective of this study was to verify the hypothesis whereby the implementation of perceptual channels in HiRes120 may lead to an improvement in the perception of music, owing to an increase in spectral resolution. Subjects and methods. Music perception was studied in 12 adult subjects, making a comparison between performance with HiRes90 and HiRes120 with perceptual channels. Quality of perception, loudness and rhythm were all assessed via a questionnaire. Further tests included timbre recognition trials and pitch ranking. Results. Whereas there was a significant improvement in appreciation of music as seen by the questionnaire, timbre and pitch trials seemed to be biased by various subjective factors and require further study using different criteria.

Adaptation of the STARR test for adult Italian population: A speech test for a realistic estimate in real-life listening conditions

Abstract Objectives: To introduce the Italian adaptation of the STARR test based on a roving-level adaptive method to mimic challenging real-life listening conditions for use in people with auditory prostheses. Design: Normative data were collected and interlist-variability, as well as learning effects, were investigated using a within-subject design with repeated measures. Study sample: A group of 32 normal-hearing (NH) adults participated in the study. Results: The average speech reception threshold (SRT) for NH subjects was −8.4 dB SNR. The variability of mean SRTs across test lists was relatively small (≤1 dB for all test lists). The statistically significant differences between lists were eliminated after applying correction factors. On the basis of variability for the corrected SRTs within each subject, a difference of 2.8 dB in SRT was meaningful for outcome comparisons using one test list per condition and 2 dB using two lists per condition. Statistical analysis did not show any significant learning effects. Conclusions: Findings in NH listeners suggested that the Italian STARR test could be a promising supplement to existing speech assessment tools. Further studies in populations with hearing impairment could contribute to cross-language studies.

The role of speech rate for Italian-speaking cochlear implant users: insights for everyday speech perception

Abstract This study investigated the effect of speech rate for Italian-speaking cochlear implant (CI) users with the aim of gaining insight into everyday listening situations where speaker’s rate may vary considerably together with speech level in fluctuating background noise. The test material was prepared by processing the Italian STARR test with temporal compression of sentence material. Twelve adult CI users were divided into two subgroups based on their STARR performance: good and poor performers. The effect of varying speech rate was remarkable for both subgroups. Good performers showed significant performance deterioration for the faster speech rate, whereas outcomes for poor performers improved significantly for the slower speech rate. Background noise is inevitable during daily life and CI users face a variety of speakers, so must cope with changes in both speech level and rate. Traditional tests with a single talker speaking very clearly while using a moderate to low speech rate may overestimate everyday speech perception for CI users. The use of tests that mimic everyday perception is of great importance and should become a routine part of audiometric measures for hearing impaired people.

Cochlear implantation in elderly: indication and results

Background There is a growing interest by clinical researchers on quality of life and outcomes of cochlear implant patients, particularly considering the extension of indication to the more elderly. This is especially related to the cost-benefit issues in patients were the benefit might be reduced by aging of the auditory system which is a more central process, together with general health problems which might be affected by any surgical procedure. Vermeire1 and co-authors have reported that although there is no difference between self-reported measure of benefit between patients implanted younger or older than 70 years, still 70-and-over had lower speech performance then younger participants. The aim of the study was to investigate the outcome of CI among elderly cochlear implant recipients.