Taina Välimaa

Cochlear implant patients and quality of life

During the last two decades, cochlear implants have been available for profoundly hearing-impaired patients who do not benefit from conventional hearing aids. The quality of life of these implantees has not been extensively studied, and has not been studied at all in Finland. To assess their quality of life, the Nottingham Health Profile questionnaire was sent to all adult implanted patients in Finland. Implantees tended to have more favourable average pain, emotional reaction and mobility indexes in each age group studied than the average population. Social isolation seemed to be more common in the youngest and oldest age groups of implantees. Apparently, implantees are physically healthier than the average population. However, a bias caused by the strict selection of implant candidates cannot be excluded.

Parents' Views on Changes in Their Child's Communication and Linguistic and Socioemotional Development After Cochlear Implantation

Our aim was to obtain versatile information on the communication and socioemotional development of implanted children in their everyday environment. We studied 18 children implanted unilaterally at the mean age of 3 years 4 months. All had normal nonverbal intelligence, but 8 (44%) had concomitant problems. Their parents filled out semistructured questionnaires at 6 months and then annually 1-5 years after activation. Parents reported a change from use of signs to speech, and changes in the childrens vocal behavior and spoken language development. They also reported that children had calmed down and showed an increased sense of self-confidence and safety with an expanded social life. The greatest changes started to take place 1 year after implantation. Five years after implantation, two thirds of children were judged to be as independent as their age peers. We conclude that changes in communication pave the way to benefits in psychosocial development after implantation.

Cochlear implants and GSM phones

Use of a telephone and GSM phones, in particular, was assessed by means of a postal interview sent to all adult Finnish implantees. The response rate was very high (87%). Fifty-one of the 61 respondents used a telephone and 27/61 also used a mobile phone, usually a digital phone. Two GSM phone models from Nokia (3110 and 6110) were tested with three different cochlear implant systems used by nine patients. Definite differences between the processors were found. Nucleus Spectra (two implantees) could not be used with any of the GSM phones under any test condition. Nucleus SPrint was incompatible with both GSM phone models in a poor field, while GSM phone model 6110 could be used in a good field. The Med-El Combi 40+ processor was compatible with both GSM models tested under any condition.

Speech perception and functional benefit after cochlear implantation: a multicentre survey in Finland

This study was done to survey the effect of cochlear implantation on hearing level, speech perception and listening performance in Finnish-speaking adults. The subjects of the study comprise 67 adults. Pure-tone thresholds (0.125-8 kHz), word recognition and listening performance were studied before and after implantation. After switch-on of the implant, the median values of PTA 0.5-4 kHz in the sound field were fairly stable across the evaluation period. Three months after switch-on of the implant, the mean word recognition score was 54%. There was clear improvement in the mean word recognition scores over a longer period of time, the mean score being 71% 24 months after switch-on. Six months after switch-on, the majority of subjects (40/48) were able to recognize some speech without speechreading, and 26 of these 48 subjects were able to use the telephone with a known speaker, gaining good functional benefit from the implantation.

Macrostructure in the narratives of monolingual Finnish and bilingual Finnish-Swedish children

The narrative macrostructure of 16 Finnish–Swedish bilingual children (M age = 5 years, 8 months) was assessed in both of their languages. In the case of the Finnish language, the macrostructure was compared with that of 16 monolingual same-age peers. The narratives were analyzed for story structure, structural complexity, and internal state terms in two conditions (telling and retelling). There were no differences in macrostructure between the two languages of bilingual children, or between the monolingual and bilingual children. However, the results revealed differences between elicitation tasks. The story structure score for bilingual children was lower in a telling task than in a retelling task in Finnish. Further, the retelling task elicited higher structural complexity and more internal state terms, regardless of the language.

Speech perception after multichannel cochlear implantation in Finnish-speaking postlingually deafened adults

This study was done to examine the short-term and long-term effects of multichannel cochlear implantation on speech perception in Finnish-speaking adults. The subjects comprise 20 adults. Pure-tone thresholds (0.125-8 kHz), discrimination of phoneme quantity, sentence recognition, word recognition, phoneme recognition and listening performance were studied before and after implantation. After switch-on of the implant, the median pure-tone threshold values in the sound field were comparable to the level of mild hearing impairment. Most improvement in sentence recognition took place during the 6 months after the switch-on (mean score 74%). In word recognition, most improvement took place during the 12 months after the switch-on (mean score 66%), and clear improvement was noted even thereafter. In phoneme recognition, the performance of the subjects improved over the entire follow-up period, and 24 months after the switch-on the mean score was 52%. Individual variation was seen in the performance of the subjects. With 3 months of listening experience, all subjects were able to recognize some speech without speechreading, and they gained good functional benefit from the implant. The use of speech recognition tests with different degrees of difficulty is essential for the follow-up of adult cochlear implant subjects.

On the construction of a Finnish audiometric sentence test.

To respond to the demands of clinical practice and the needs of rehabilitation, a Finnish audiometric sentence test is being developed. The test consists of 10 sets of 10 sentences, each set serving as an independent test. The test is scored by words (50 per set). Homogeneity between the sets was guaranteed by a number of linguistic and phonetic criteria, controlled by using the Virko© Sentence Analyzer, a programme especially constructed for the purpose. Recognition tests for the validation of the sentence sets were made with young normally hearing adults ( n = 70; age group 18-25 years). Psychometric recognition properties of the test are described. The selection process of the final 10 sentence sets is illustrated.

Speech perception and functional benefit after multichannel cochlear implantation.

This study was done to investigate the effect of a multichannel cochlear implant on speech perception and the functional benefit of cochlear implantation in Finnish-speaking postlingually deafened adults. Fourteen subjects were enrolled. Sentence and word recognition were studied with open-set tests auditorily only. One year after implantation, the listening performance was assessed by case histories and interviews. Before implantation for subjects with a hearing aid, the mean recognition score was 38% for sentences and 17% for words. One year after switching on the implant, the mean recognition score was 84% for sentences and 70% for words. Before implantation, the majority of the subjects were not aware of environmental sounds and only a few were able to recognize some environmental sounds. One year after switching on the implant, the majority of the subjects were able to use the telephone with a familiar speaker. All the subjects were able to recognize speech auditorily only and had thus gained good functional benefit from the implant.

Perceptions of parents and speech and language therapists on the effects of paediatric cochlear implantation and habilitation and education following it

BACKGROUND During the process of implantation, parents may have rather heterogeneous expectations and concerns about their childs development and the functioning of habilitation and education services. Their views on habilitation and education are important for building family-centred practices. AIMS We explored the perceptions of parents and speech and language therapists (SLTs) on the effects of implantation on the child and the family and on the quality of services provided. Their views were also compared. METHODS & PROCEDURES Parents and SLTs of 18 children filled out questionnaires containing open- and closed-ended questions at 6 months and annually 1-5 years after activation of the implant. Their responses were analysed mainly using data-based inductive content analysis. OUTCOMES & RESULTS Positive experiences outnumbered negative ones in the responses of both the parents and the SLTs surveyed. The parents were particularly satisfied with the improvement in communication and expanded social life in the family. These were the most prevalent themes also raised by the SLTs. The parents were also satisfied with the organization and content of habilitation. Most of the negative experiences were related to arrangement of hospital visits and the usability and maintenance of speech processor technology. Some children did not receive enough speech and language therapy, and some of the parents were dissatisfied with educational services. The habilitation process had generally required parental efforts at an expected level. However, parents with a child with at least one concomitant problem experienced habilitation as more stressful than did other parents. CONCLUSIONS & IMPLICATIONS Parents and SLTs had more positive than negative experiences with implantation. As the usability and maintenance of speech processor technology were often compromised, we urge implant centres to ensure sufficient personnel for technical maintenance. It is also important to promote services by providing enough information and parental support.

Comparison of the body-worn CIS-PRO + and the behind-the-ear-worn TEMPO + cochlear implant systems in Finnish-speaking adult CI users: any differences in results with experienced listeners?

CONCLUSION The results indicate that the need for upgrading the processor and/or speech coding strategy should be considered individually, if the processor and coding strategy are functioning properly and a good level of speech perception has been achieved. OBJECTIVES Our aim was to study the intra-individual differences of the body-worn CIS-PRO + and the behind-the-ear-worn TEMPO + cochlear implant systems used in the MED-EL Combi40/Combi40 + implants. SUBJECTS AND METHODS The hearing level, sentence, word and phoneme recognition of eight adult subjects were determined in an ABA study design. Additionally, a self-assessment questionnaire was used. Mean scores and 95% confidence intervals, and individual scores were analysed. RESULTS The subjects tended to score slightly better on word and phoneme recognition with CIS-PRO+ and CIS strategy than with TEMPO+ and CIS+, but there were no statistically significant differences. Subjectively the participants ranked speech perception and discussion in noise to be slightly easier with TEMPO+ and CIS+. Six of the eight subjects preferred TEMPO+ and CIS+ and two of eight preferred CIS-PRO+ with CIS or number-of-maxima.Conclusion. The results indicate that the need for upgrading the processor and/or speech coding strategy should be considered individually, if the processor and coding strategy are functioning properly and a good level of speech perception has been achieved. Objectives. Our aim was to study the intra-individual differences of the body-worn CIS-PRO+ and the behind-the-ear-worn TEMPO+ cochlear implant systems used in the MED-EL Combi40/Combi40+ implants. Subjects and methods. The hearing level, sentence, word and phoneme recognition of eight adult subjects were determined in an ABA study design. Additionally, a self-assessment questionnaire was used. Mean scores and 95% confidence intervals, and individual scores were analysed. Results. The subjects tended to score slightly better on word and phoneme recognition with CIS-PRO+ and CIS strategy than with TEMPO+ and CIS+, but there were no statistically significant differences. Subjectively the participants ranked speech perception and discussion in noise to be slightly easier with TEMPO+ and CIS+. Six of the eight subjects preferred TEMPO+ and CIS+ and two of eight preferred CIS-PRO+ with CIS or number-of-maxima.