Eberhard Seifert

Changes of voice and articulation in children with cochlear implants

OBJECTIVE The different speech sounds are formed by the primary voice signal and by the shape of the articulation tract. With this mechanism, specific overtones, the formants, are generated for each vowel. The objective of this study was to investigate the fundamental frequency (F0) of the voice signal and the first three formants (F1-F3) as a parameter of the articulation in prelingually deafened children at different timepoints after cochlear implantation (CI) compared with children with normal speech development. METHODS Using the Kay CSL 4300B, the fundamental frequency and the formants F1-F3 of the Swiss-German vowel /a/ were investigated at different timepoints after CI in 20 prelingually deafened children aged 3.8-10.2 years by means of spectrographic and linear predictive coding (LPC) analysis. RESULTS Children who had been operated before their fourth birthday showed no significant deviation in their fundamental frequency from age- and sex-matched peers, whereas a significant difference was documented in children who were older at the time of implantation. The first formant was very stable in every child and showed only discrete deviations from the normal range. The second and third formants, however, developed a broader scatter, but there was no systematic deviation of these formants to higher or lower values. The F1:F2 ratio was normal in children who were implanted at the age of up to 4 years and more centralized in children who were older at the time of implantation, as is known from the hearing impaired. CONCLUSIONS Our results indicate that prelingually deaf children who receive a cochlear implant before their fourth birthday attain a better acoustic control over their speech, normalizing their fundamental frequencies and improving their articulatory skills.

Intra- and intersubject comparison of cochlear implant systems using the Esprit and the Tempo+ behind-the-ear speech processor

A patient with bilateral profound deafness was implanted with a Nucleus CI24M cochlear implant (CI) and used an Esprit behind-the-ear (BTE) speech processor. Thirteen months later, the implant had to be removed because of a cholesteatoma. As the same electrode could not be reinserted, a Medel combi40s CI was implanted in the same ear, and the patient used a Tempo+ BTE processor. After 1 year of use of the Combi40s/Tempo+ system, speech recognition was better and was rated better subjectively than with the CI24M/Esprit system. Speech recognition and subjective ratings were also assessed for two matched groups of nine CI users each, using either an Esprit or a Tempo+ processor. On average, speech recognition scores were higher for the group of Tempo+ users, but the difference was not statistically significant. Users of the Esprit processors rated their device higher in terms of cosmetic appearance and comfort of wearing. Sumario: Un paciente eon una sordera profunda bilateral fue implantado con un sistema coclear (IC) Nucleus CI24M, con el que utilizó un procesador de lenguaje retroauricular (BTE) Esprit. Trece meses después, el implante fue removido debido a un colesteatoma. Dado que el mismo electrodo no podia ser reinsertado, se implantó en el mismo oido un IC Med-El Combi 40+, con el que el paciente utilizó un procesador retroauricular (BTE) Tempo+. Luego de un año de uso del sistema Combi 40/Tempo+ el reconocimiento del habla fue considerado subjetivamente mejor con éste que con el sistema CI24M/Esprit. Se evaluó el reconocimiento del habla y la apreciación subjetiva en dos grupos de nueve usuarios de IC, utilizando procesadores Esprit o Tempo+. En promedio, los puntajes de reconocimiento del habla fueron más altos para el grupo de usuarios del Tempo+, pero la diferencia no fue estadisticamente significativa. Los usuarios del procesador Esprit calificaron su dispositivo como mejor en términos de apariencia y de comodidad de uso.

The tolerance of ambiguity in late cochlear-implanted pre-lingually deaf juveniles

Objectives:  To examine the ambiguity tolerance, i.e. the ability to perceive new, contradictory and complex situations as positive challenges, of pre‐lingually deafened adolescents who received a cochlear implant after their eighth birthday and to identify those dimensions of ambiguity tolerance which correlate significantly with specific variables of their oral communication.

Encouragement to Increase the Use of Psychosocial Skills in the Diagnosis and Therapy of Patients With Functional Dysphonia

Clinicians believe that psychosocial factors play a causal role in the etiology of many forms of functional dysphonia (FD). But for decades, all attempts to confirm such causation have failed. This paper aims to show the logic of this failure, to discuss the possibilities of employing psychology in therapy nonetheless, and to encourage clinicians to use their psychosocial knowledge and skills. The failure to confirm psychic and social factors as causal in the etiology of FD is basically a consequence of a principal shortcoming of evidence-based medicine (EBM). As the gold standard for validity, reliability, and objectivity in medical research, EBM is based on calculability and hence the processing of quantitative data. But life paths and life situations are best or sometimes only expressible in qualitative, experiential, and idiographic terms. Thus EBM-guided evaluation undervalues most psychosocial studies. This report of an experienced multidisciplinary voice team proposes alternative pathways for integrating psychosocial knowledge into the diagnosis and the treatment of FD. The difference between the fields of activity of psychotherapists and speech-language pathologists is discussed, and the latter group is shown the potential benefits of using more of their psychosocial knowledge and skills.

Dancing Jaw and Dancing Eyes.

A man in his early 30s experienced infratentorial bleeding of unknown etiology. Two weeks after this occurrence, he manifested rhythmic horizontal jaw and eye movements (Video). About 5 weeks after the patient’s hemorrhage he was observed to have pendular nystagmus and soft-palate oscillations with a frequency of 3 Hz. Fiberoptic laryngoscopy examination revealed rhythmic movements of the pharynx, root of the tongue, and plicae aryepiclotticae (Video). A diagnosis of oculopalatal tremor was made on the basis of the clinical observations. Findings from the magnetic resonance imaging examination done 8 weeks after the patient’s initial brainstem injury revealed bilateral T2-weighted hyperintense signal changes at the level of the lower olivary nuclei and of the inferior cerebellar peduncles (Figure), corresponding to a disruption of the inhibitory dentato-rubro-olivary pathway (the so-called GuillainMollaret triangle).1 The combination of oculopalatal tremor and unusual rhythmic jaw movements may be explained by the common developmental anatomy of the structures involved in these effects. During embryonic development, the first pharyngeal arch gives rise to the oral jaw muscles and to the trigeminal nerve.2 The cranial nerves derived from the other pharyngeal arches also may be affected and contribute to the oculopalatal tremor; indeed, we observed a progression of the affected cranial nerves beginning with the trigeminal nerve and spreading downward to the glossopharyngeal and vagus nerves. This accorded with a worsening of the patient’s dysarthria over time. His oscillopsia and dysarthria diminished on treatment with gabapentin.3 In conclusion, the typical clinical presentation of oculopalatal tremor was announced by the atypical, rhythmic jaw movements occurring 3 weeks earlier.

Improvement in speech understanding and user satisfaction after upgrading from the Medel Tempo+ to the OPUS2 speech processor.

The usefulness of a given cochlear implant system (CI) for a user depends on a numbe r of features of the CI system itself, as well as the results obtained with that system. Among others, speech understanding in quiet and in noise, the subjectively perceived sound quality, and the size, weight and appearance of the device are important factors relating to user satisfaction (Helms et al., 2001; Kompis et al., 2002). In 2007, Medel Inc. (Innsbruck, Austria) introduced a new head-level speech processor named Opus2. This speech processor can be used together with the Combi40+ or the Pulsar cochlear implants of the same manufacturer. The Opus2 is currently replacing the older Tempo+ speech processor, which was introduced in 1999 (Kompis et al., 2002; Arnoldner et al., 2007). When compared to the older Tempo+, the OPUS2 has several new features. Among others, a new coding strategy called fine structure processing (FSP) (Arnoldner et al., 2007) is now available along with the CIS+ coding strategy already available in the Tempo+ (Kompis, 2009). With the exception of the on-off-switch, all controls have been moved from the housing to a remote control device called ‘fine-tuner’. As a new and additional feature, a telephone coil has been built into the OPUS2. In this ongoing study, we are interested to learn, how users performances and their subjective assessments change with the upgrade from a Tempo+ to an OPUS2 speech processor.