Ersilia Bosco

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.

Speech perception results in children implanted with Clarion devices: Hi-Resolution and Standard Resolution modes.

Conclusions Formal testing showed that HiRes users seem to make significant use of acoustic information. Furthermore, from observations reported by experienced care-givers, for example, family, teachers and speech therapists, these children learn a lot from their surrounding environment. Incidental learning, which takes place when acquiring skills or knowledge through naturally occurring events, is a key become available to these deaf paediatric cochlear implant recipients. Objective To compare speech perception skills in children with a Clarion® cochlear implant using different speech coding strategies, such as continuous interleaved sampling (CIS), simultaneous analogue stimulation (SAS) and Hi-Resolution (HiRes)™. Material and methods The study population comprised 40 children, 17 implanted with a Clarion Hi-Focus 1.2 and 23 with a Clarion CII. All children were pre-lingually deaf and differed in terms of age and cause of deafness. All children had undergone a trial (minimum 6 months) with hearing aids before implantation. Children implanted with a Clarion 1.2 were either CIS or SAS users [Standard Resolution mode (SRM) group]; children implanted with a Clarion CII were Hi-Resolution users [Hi-Resolution mode (HRM) group]. Findings were assessed according to Erbers hierarchical model (detection, discrimination, identification, recognition and comprehension), making use of a battery of speech perception tests calibrated to the age of the child. Further information concerning use of the implant in everyday situations was obtained by means of the Meaningful Auditory Integration Scale (MAIS) questionnaire, which was administered to the parents. Tests were carried out prior to each fitting session, at switch-on and then at 3, 6, 9 and 12 months. Findings at pre-implantation and at 12 months follow-up were collected for both the SRM and HRM groups. Speech perception results were analysed for the SRM and HRM groups, independent of age at implantation, for five subgroups of children according to the paediatric test battery in use and for two subgroups of children, one< and one >5 years of age. Results Clarion-implanted children using the Hi-Resolution strategy can develop better speech perception skills at 12 months post-implantation compared to children fitted with the SAS or CIS strategy. SAS or CIS users implanted before the age of 5 years tend to achieve better results at 1 year follow-up than children implanted later. In contrast, in Hi-Resolution users, a trend towards better results for recognition and comprehension tasks was observed in children implanted after 5 years of age.

Follow-up of Cochlear Implant Use in Patients Who Developed Bacterial Meningitis Following Cochlear Implantation†

Objectives/Hypothesis: The present study is a long‐term follow‐up of speech perception outcomes and cochlear implant use in three cases of meningitis that occurred after cochlear implantation.

Long-Term Follow-Up of Implanted Children with Cytomegalovirus-Related Deafness

Objective: To evaluate, with a long-term follow-up, the speech perception and language development in children with cytomegalovirus (CMV)-related deafness after cochlear implantation. Study Design: A retrospective study on CMV-related profound deafness and cochlear implantation was performed from 1995 to 2010. Six children with an average follow-up of 10 years were included in this research. Medical history, imaging, cognitive delay, speech perception and production data were reviewed. Results: Two of the 6 patients developed a functional language with the use of phrases and word sequences based on morphological and syntactic rules; the others demonstrated the development of a preverbal or transitional language with the use of single words only. Conclusion: Patients with CMV-related deafness benefit from cochlear implantation; however, the expectations of the parents must be evaluated in a series of counseling efforts prior to the surgery.

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

Adequate formal language performance in unilateral cochlear implanted children: is it indicative of complete recovery in all linguistic domains? Insights from referential communication.

OBJECTIVES Referential communication (RC) is a key element in achieving a successful communication. This case series aimed to evaluate RC in children with unilateral cochlear implants (CIs) with formal language skills within the normal range. METHODS AND MATERIALS A total of 31 children with CIs, with language development within the normal range, were assessed using the Pragmatic Language Skills test (MEDEA). RESULTS Of the children with CIs, 83.9% reached performance levels appropriate for their chronological ages. The results confirmed a positive effect of cochlear implantation on RC development, although difficulties remained in some CI users. CONCLUSIONS The outcomes emphasize the need to pay greater attention to the pragmatic aspects of language, assessing them with adequate testing in the early phase after cochlear implantation. Clear knowledge of childrens communicative competence is the key in optimizing their communicative environments in order to create the basis for future successful interpersonal exchanges and social integration.

'Small group' rehabilitation in adolescent coclear implant users : aims, method and results

The aim was to extend the linguistic, social and cognitive aspects of communication skills. The method was to use meaningful contexts and to attribute new significance to errors. Methods used were phonetic games (to improve speech production) and exercises (to increase reading and writing skills). The results after 18 months of group rehabilitation are presented.

Contents Vol. 17, 2012

Maurizio Barbara, Rome Olivier Bertrand, Bron F. Owen Black, Portland Th omas Brandt, München Barbara Canlon, Stockholm John P. Carey, Baltimore Douglas A. Cotanche, Boston Cor W.R.J. Cremers, Nijmegen Norbert Dillier, Zürich Robert Dobie, Sacramento Manuel Don, Los Angeles Jill B. Firszt, St. Louis Andrew Forge, London Bernard Fraysse, Toulouse Rick Friedman, Los Angeles Bruce J. Gantz, Iowa City Pablo Gil-Loyzaga, Madrid Anthony W. Gummer, Tübingen James W. Hall III, Gainesville Joseph W. Hall III, Chapel Hill Michael Halmagyi, Camperdown Rudolf Häusler, Bern Vicente Honrubia, Los Angeles Gary D. Housley, Auckland Karl-Bernd Hüttenbrink, Köln Pawel J. Jastreboff , Atlanta Margaret A. Kenna, Boston Philippe P. Lefebvre, Liège Bernd Lütkenhöner, Münster Linda L. Luxon, London Geoff rey A. Manley, Oldenburg Alessandro Martini, Padova Jennifer R. Melcher, Boston Brian C.J. Moore, Cambridge David R. Moore, Nottingham Cynthia C. Morton, Boston Donata Oertel, Madison Kaoru Ogawa, Tokyo Stephen J. O’Leary, Parkville Alan R. Palmer, Nottingham Lorne S. Parnes, London, Ont. Jean-Luc Puel, Montpellier Ramesh Rajan, Monash Yehoash Raphael, Ann Arbor J. Th omas Roland, Jr., New York John J. Rosowski, Boston Rudolf Rübsamen, Leipzig Mario A. Ruggero, Evanston Leonard P. Rybak, Springfi eld Richard J. Salvi, Buff alo Robert V. Shannon, Los Angeles Guido F. Smoorenburg, Besse sur Issole Haim Sohmer, Jerusalem Olivier Sterkers, Clichy Istvan Sziklai, Debrecen Peter R. Th orne, Auckland Shin-ichi Usami, Matsumoto P. Ashley Wackym, Portland Tatsuya Yamasoba, Tokyo Fan-Gang Zeng, Irvine The Science of Hearing and Balance