Effects of fine structure and extended low frequencies in pediatric cochlear implant recipients

Objective

In recent years, new speech coding strategies have been developed with the aim of improving the transmission of temporal fine structure to cochlear implant recipients. This study reports on the implementation of one such strategy (fine structure processing, FSP) in children.

Methods

This was a prospective study investigating the upgrade to a new speech processor. The upgrade used a repeated measures design with an alternating order of conditions (A-B-A-B design). Twelve pre- and perilingually deaf children with MED-EL C40+ cochlear implants were enrolled in the study. Patients were upgraded from their Tempo+ speech processor, which used continuous interleaved sampling (CIS) in combination with a frequency spectrum of 200-8500 Hz, to an Opus speech processor, which used FSP with an extended frequency spectrum of 70-8500 Hz. The primary means of testing was an HSM (Hochmair, Schulz and Moser) sentence test at 65 and 80 dB in quiet. In addition, the “Mainzer Kindersprachtest” (Mainz audiometric speech test for children) was applied at 65 and 70 dB.

Results

When the new FSP speech processor was used together with the extended low frequency range, HSM sentence tests at 65 and 80 dB resulted in scores indicating statisticially significant improvements of 7.1 and 9.9 percentage points, respectively. Scores in the “Mainzer Kindersprachtest” at 65 and 70 dB indicated statistically significant improvements of 9.3 and 6.1 percentage points, respectively.

Conclusions

The present study clearly shows that children benefit from the fine structure speech coding strategy in combination with an extended frequency spectrum in the low frequencies, as is offered by the Opus speech processors. This should be taken into consideration when fitting pre- and perilingually deaf children implanted almost a decade previously.     

Clinical Trial Results with the MED-EL Fine Structure Processing Coding Strategy in Experienced Cochlear Implant Users

Objectives: To assess the subjective and objective performance of the new fine structure processing strategy (FSP) compared to the previous generation coding strategies CIS+ and HDCIS. Methods: Forty-six adults with a minimum of 6 months of cochlear implant experience were included. CIS+, HDCIS and FSP were compared in speech perception tests in noise, pitch scaling and questionnaires. The randomized tests were performed acutely (interval 1) and again after 3 months of FSP experience (interval 3). The subjective evaluation included questionnaire 1 at intervals 1 and 3, and questionnaire 2 at interval 2, 1 month after interval 1. Results: Comparison between FSP and CIS+ showed that FSP performed at least as well as CIS+ in all speech perception tests, and outperformed CIS+ in vowel and monosyllabic word discrimination. Comparison between FSP and HDCIS showed that both performed equally well in all speech perception tests. Pitch scaling showed that FSP performed at least as well as HDCIS. With FSP, sound quality was at least as good and often better than with HDCIS. Conclusions: Results indicate that FSP performs better than CIS+ in vowel and monosyllabic word understanding. Subjective evaluation demonstrates strong user preferences for FSP when listening to speech and music.     

Comparison of two cochlear implant coding strategies on speech perception

Objective: Assess whether differences in speech perception are observed after exclusive listening experience with high-definition continuous interleaved sampling (HDCIS) versus fine structure processing (FSP) coding strategies.

Methods: Subjects were randomly assigned at initial activation of the external speech processor to receive the HDCIS or FSP coding strategy. Frequency filter assignments were consistent across subjects. The speech perception test battery included CNC words in quiet, HINT sentences in quiet and steady noise (+10?dB SNR), AzBio sentences in quiet and a 10-talker babble (+10?dB SNR), and BKB-SIN. Assessment intervals included 1, 3, and 6 months post-activation.

Results: Data from 22 subjects (11 with HDCIS and 11 with FSP) were assessed over time. Speech perception performance was not significantly different between groups.

Discussion: Speech perception performance was not significantly different after 6 months of listening experience with the HDCIS or FSP coding strategy.     

言语编码策略升级对成年人工耳蜗使用者听觉效果影响的研究

目的　探讨言语编码策略升级对有经验人工耳蜗使用者听觉效果的影响趋势,以期为临床制定有效的人工耳蜗言语编码策略升级方案提供参考依据。方法　采用噪声下汉语普通话声调识别测试、普通话噪声下言语识别测试以及自行编制的声音质量自评问卷,对13例有经验成年人工耳蜗使用者言语编码策略升级后的声调识别能力、短句分辨能力以及声音质量和聆听感受进行3个月连续观测。以使用日常言语编码策略（即CIS+策略）的测试结果为参考值,以新言语编码策略（即精细结构编码策略）的测试 结果为目标值,分析言语编码策略升级对成年人工耳蜗使用者听觉效果的影响。结果　①声调识别能力：各测试阶段两种编码策略的声调识别测试成绩无显著差异,随着精细结构编码策略使用经验增加,测试成绩呈明显改善趋势[F（3,36）=5.201,P =0.004];②短句分辨能力：各测试阶段两种编码策略的言语识别测试成绩无显著差异,随精细结构编码策略使用经验增加,测试成绩略有提高[F（3,36）=2.450,P =0.079];③声音质量自评：更换言语编码策略对本组受试者的声音质量和聆听感受无不利影响（P =0.083）。随着精细结构编码策略使用经验增加,受试者认为声音质量更“饱满、丰富”、聆听感受更“容易、轻松”。结论　言语编程策略升级未对有经验人工耳蜗使用者的言语识别能力造成不良影响且存在潜在的改善作用。在临床工作中可参考患者主观意愿确定是否升级言语编程策略。     

Speech recognition outcomes in Mandarin-speaking cochlear implant users with fine structure processing

Conclusion: Mandarin-speaking adults can use the Fine Structure Processing (FSP) coding strategy as well as the Continuous Interleaved Sampling (CIS+) coding strategy. No loss in performance was observed after switch-over. Tone identification improves over time with the FSP coding strategy, which is of benefit to tonal-language users. After some time, fine structure was preferred.

Objective: This study aimed to determine speech perception, tone perception, and the subjective preferences of Mandarin-speaking adults who received the FSP coding strategy, at upgrade from the CIS?+?coding strategy.

Methods: Thirteen Mandarin-speaking subjects were tested at switch-over from CIS?+?to the FSP coding strategy ～1-month after switch-over, 2-months after switch-over, and 3-months after switch-over with the Mandarin Hearing in Noise Test (M-HINT), the Mandarin Tone Identification in Noise Test (M-TINT), and a visual analogue scale assessing Sound and Speech Assessment (SSA).

Results: There were no significant differences in the M-HINT between presentation levels (62?dB SPL vs 65?dB SPL), over time, nor when compared to the CIS?+?coding strategy. Tone perception improved significantly over time with the FSP coding strategy. Subjects rated the FSP coding strategy with the OPUS 2 as significantly more ‘full’ and ‘rich’ than with the CIS?+?coding strategy after 3-months.     

Fine structure processing improves telephone speech perception in cochlear implant users

The objective of this study was to compare telephone speech perception and subjective preferences in cochlear implant users with two different speech-processing strategies: high-definition continuous interleaved sampling (HDCIS) and fine structure processing (FSP). A randomized double-blind study was designed for intra-individual comparison of HDCIS and FSP. Twenty-five post-lingually deafened patients with either the PulsarCI¹⁰⁰ or SonataTI¹⁰⁰ and Opus2 acoustic processor were tested consecutively with both coding strategies, assigned in a random order. Disyllabic word speech perception was tested 6 weeks after each fitting under the following conditions: landline use with (LWN) and without (LWoN) background noise, mobile use with (MWN), and without (MWoN) background noise and mobile use with a Bluetooth magnetic field transmitter necklace (MB). Changes in health-related quality of life (QoL) were assessed using the Glasgow Benefit Inventory (GBI) and Faber’s questionnaire. Personal preferences between strategies were surveyed upon completion of the study. All subjects included in this study performed better with FSP in the landline tests. There was an improvement of 11.5 % in LWN use (p = 0.014; CI 95 % = 3–20 %) and 10 % in LWoN use (p = 0.001; CI 95 % = 5–15 %). MWoN showed an improvement of 6.3 % with FSP (p = 0.03; CI 95 % = 0–13 %). MB tests showed an improvement of 11 % with FSP (p < 0.05; CI 95 % = 1.5–22 %). Quality of life was significantly better using FSP. Eighty-four percent of participants preferred FSP. The FSP speech coding strategy improved the speech recognition of cochlear implant users when using the telephone compared to HDCIS. Cochlear implantation with FSP coding improved QoL.     

Speech and music perception with the new fine structure speech coding strategy: preliminary results

Conclusions. Taking into account the excellent results with significant improvements in the speech tests and the very high satisfaction of the patients using the new strategy, this first implementation of a fine structure strategy could offer a new quality of hearing with cochlear implants (CIs). Objective. This study consisted of an intra-individual comparison of speech recognition, music perception and patient preference when subjects used two different speech coding strategies with a MedEl Pulsar CI: continuous interleaved sampling (CIS) and the new fine structure processing (FSP) strategy. In contrast to envelope-based strategies, the FSP strategy also delivers subtle pitch and timing differences of sound to the user and is thereby supposed to enhance speech perception in noise and increase the quality of music perception. Patients and methods. This was a prospective study assessing performance with two different speech coding strategies. The setting was a CI programme at an academic tertiary referral centre. Fourteen post-lingually deaf patients using a MedEl Pulsar CI with a mean CI experience of 0.98 years were supplied with the new FSP speech coding strategy. Subjects consecutively used the two different speech coding strategies. Speech and music tests were performed with the previously fitted CIS strategy, immediately after fitting with the new FSP strategy and 4, 8 and 12 weeks later. The main outcome measures were individual performance and subjective assessment of two different speech processors. Results. Speech and music test scores improved statistically significantly after conversion from CIS to FSP strategy. Twelve of 14 patients preferred the new FSP speech processing strategy over the CIS strategy.     

Performance of compressed analogue (CA) and continuous interleaved sampling (CIS) coding strategies for cochlear implants in quiet and noise

Speech understanding with compressed analogue (CA) and continuous interleaved sampling (CIS) coding strategies for cochlear implants was compared in quiet and in noise at signal-to-noise ratios (SNRs) of 15, 10 and 5 dB. The speech recognition of three experienced users of the Ineraid cochlear implant (CA coding strategy) was assessed using a set of sentence, vowel and consonant tests. Three weeks after the fitting of a CIS processor, the tests were repeated with the new device. Speech recognition scores for the sentence and consonant tests tended to be higher with the CIS processor in no or little noise, but lower in the test situations with less favourable SNRs, when compared to the CA processor (average score differences for the consonant test: +7.8% correct at 15 dB SNR; -6.8% correct at 5 dB SNR; p = 0.05). Results for the vowel test were slightly lower on average for the CIS processing strategy at all SNRs. A possible explanation for the differences in performance between CIS and CA in the consonant and sentence tests at different SNRs is the generally higher free-field threshold associated with the CA coding strategy, which may act as a single-channel noise suppression.     

Speech and music perception with the new fine structure speech coding strategy: preliminary results

CONCLUSIONS: Taking into account the excellent results with significant improvements in the speech tests and the very high satisfaction of the patients using the new strategy, this first implementation of a fine structure strategy could offer a new quality of hearing with cochlear implants (CIs). OBJECTIVE: This study consisted of an intra-individual comparison of speech recognition, music perception and patient preference when subjects used two different speech coding strategies with a MedEl Pulsar CI: continuous interleaved sampling (CIS) and the new fine structure processing (FSP) strategy. In contrast to envelope-based strategies, the FSP strategy also delivers subtle pitch and timing differences of sound to the user and is thereby supposed to enhance speech perception in noise and increase the quality of music perception. PATIENTS AND METHODS: This was a prospective study assessing performance with two different speech coding strategies. The setting was a CI programme at an academic tertiary referral centre. Fourteen post-lingually deaf patients using a MedEl Pulsar CI with a mean CI experience of 0.98 years were supplied with the new FSP speech coding strategy. Subjects consecutively used the two different speech coding strategies. Speech and music tests were performed with the previously fitted CIS strategy, immediately after fitting with the new FSP strategy and 4, 8 and 12 weeks later. The main outcome measures were individual performance and subjective assessment of two different speech processors. RESULTS: Speech and music test scores improved statistically significantly after conversion from CIS to FSP strategy. Twelve of 14 patients preferred the new FSP speech processing strategy over the CIS strategy.     

Hearing results of stapedotomy and malleo-vestibulopexy in congenital hearing loss

Aims

To analyze hearing results of surgical treatment of hearing loss associated with the congenital stapes ankylosis with or without malformations of ossicular chain.

Study design

Retrospective chart review.

Methods

The charts of 1369 stapedotomies performed by senior author (JH) from 1991 to 2006 were reviewed. In 40 cases operative findings were consistent with isolated congenital stapes fixation or associated with middle ear malformations. The modified stapedotomy technique was employed in 33 cases and malleo-vestibulopexy was used in 7 cases. Operative findings were standardized according to Cremers’ classification. The outcomes of 40 surgeries were analyzed according to the 1995 AAO-HNS Committee on Hearing and Equilibrium guidelines. High frequency hearing results on 4, 8 and 12 kHz were reported in addition to standard frequencies. Results of stapedotomies and malleo-vestibulopexies were calculated separately. Surgical complications were described.

Results

The mean post-operative air conduction (AC) was 33 dB, bone conduction (BC) 22 dB and speech reception thresholds (SRT) 31 dB. Closure of the air-bone gap (ABG) to within 10 dB was achieved in 24/40 (60%) of cases. Lack of improvement was observed in 3/40 (8%) patients. In 26/32 (81%) of cases with potential for bilaterally serviceable hearing it was achieved. In 24/40 (60%) of cases symmetrical hearing with interaural difference of less than 10 dB was demonstrated.

Conclusion

Significant hearing gain in patients with congenital stapes ankylosis makes surgical treatment a valuable adjunct or an alternative to hearing aids in selected cases.     

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.     

BAHA results in children at one year follow-up: A prospective longitudinal study

Objective

To evaluate audiometric and clinical results of children fitted with a bone-anchored hearing aid with specific emphasis on speech discrimination in different sound environments after one year of use.

Methods

We performed a prospective longitudinal study. Seventeen patients between the ages of 5 and 18 years old were included. All patients underwent a complete tonal and vocal evaluation at four pre-determined intervals between the pre-operative period and one-year of bone-anchored hearing aid (BAHA) use. Basic pure-tone average and speech reception threshold were measured in different sound environments. Speech discrimination improvement was tested with the voice originating from the side of the BAHA-fitted ear and with the voice originating from a source directly in front of the patient. These measures were repeated with confounding noise facing the patient then from the side of the affected ear. All tonal and vocal evaluations were performed pre-operatively, the day of processor insertion, 6 months and 12 months after processor insertion.A variance analysis was performed to compare differences in hearing gain with BAHA over time.

Results

Hearing gain with BAHA was clinically and statistically significant at all intervals. Conventional tonal evaluation revealed significantly improved hearing gain after BAHA insertion compared with pre-operative testing with BAHA (26.3 dB vs. 17.3 dB), and this improvement was maintained at one year (27.9 dB). Speech discrimination gain at one year was better than immediately post-insertion (21.9% vs. 11.7%). Maximal gain with BAHA was found with the voice originating from the side of the affected ear and with confounding noise facing the patient (27.1% at one year), whereas the least gain was found in a silent room with the voice coming from straight ahead (11.9% at one year).

Conclusions

Pure-tone average gain at one year post-insertion was similar to immediate post-insertion gain. BAHA aids speech discrimination most when the voice originates from the side of the affected ear with confounding noise facing the patient. Speech discrimination gain improves with time, suggesting an underlying learning process. The best BAHA gain in speech discrimination occurred with background noise.     

New cochlear implant coding strategy for tonal language speakers

Accurate pitch perception on the basis of fundamental frequency patterns is essential for the processing of lexical tones in tonal languages such as Cantonese. Speech intelligibility in Cantonese-speaking CI recipients was compared using current signal processing strategies, which typically result in poor pitch perception, and a new strategy, known as the multi-channel envelope modulation (MEM) strategy, was designed to enhance temporal periodicity cues to the fundamental frequency. Performance of nine postlingually hearing-impaired adult cochlear implant users was measured twice using each strategy, initially after a four week trial, and again after two weeks of use with each strategy. Speech intelligibility in speech-spectrum shaped noise was measured using the Cantonese hearing in noise test. A fixed noise level of 65 dB A was used and the signal-to-noise ratios were fixed at either +10, +15, or +20 dB, depending on the baseline performance of individual subjects using the clinical processor. Self-reported benefit in 18 listening situations and overall preference for strategies were obtained at the end of these trial periods. Results showed poorer speech intelligibility with CIS while results obtained using ACE and MEM were comparable. Unfamiliar place coding might have contributed to poorer performance using CIS. Self-reported benefit across strategies did not differ in most listening situations. Participants preferred ACE for listening overall in daily situations, and a few preferred MEM in noise. Whilst the results did not demonstrate any advantages for speech recognition in noise when using MEM compared to ACE, no degradation in performance was observed. This implies that the form of processing employed by MEM retains similar segmental information to that provided by ACE and that potentially, future variations/optimizations of MEM may lead to some improvement in tone perception.     

Auditory brainstem implant outcomes and MAP parameters: report of experiences in adults and children

The auditory brainstem implant (ABI) was first developed to help neurofibromatosis type 2 patients. Recently, its use has been recently extended to adults with non-tumor etiologies and children with profound hearing loss who were not candidates for a cochlear implant (CI). Although the results has been extensively reported, the stimulation parameters involved behind the outcomes have received less attention.

Objective

The aim of this study is to describe the audiologic outcomes and the MAP parameters in ABI adults and children at our center.

Methods

Retrospective chart review. Five adults and four children were implanted with the ABI24M from September 2005 to June 2009. In the adult patients, four had Neurofibromatosis type 2, and one had postmeningitic deafness with complete ossification of both cochleae. Three of the children had cochlear malformation or dysplasia, and one had complete ossified cochlea due to meningitis. Map parameters as well as the intraoperative electrical auditory brainstem responses were collected. Evaluation was performed with at least six months of device use and included free-field hearing thresholds, speech perception tests in the adult patients and for the children, the Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS) and (ESP) were used to evaluate the development of auditory skills, besides the MUSS to evaluate.

Results

The number of active electrodes that did not cause any non-auditory sensation varied from three to nineteen. All of them were programmed with SPEAK strategy, and the pulse widths varied from 100 to 300 μs. Free-field thresholds with warble tones varied from very soft auditory sensation of 70 dBHL at 250 Hz to a pure tone average of 45 dBHL. Speech perception varied from none to 60% open-set recognition of sentences in silence in the adult population and from no auditory sensation at all to a slight improvement in the IT-MAIS/MAIS scores.

Conclusion

We observed that ABI may be a good option for offering some hearing attention to both adults and children. In children, the results might not be enough to ensure oral language development. Programming the speech processor in children demands higher care to the audiologist.     

Spatial hearing of normally hearing and cochlear implanted children

Objective

Spatial hearing uses both monaural and binaural mechanisms that require sensitive hearing for normal function. Deaf children using either bilateral (BCI) or unilateral (UCI) cochlear implants would thus be expected to have poorer spatial hearing than normally hearing (NH) children. However, the relationship between spatial hearing in these various listener groups has not previously been extensively tested under ecologically valid conditions using a homogeneous group of children who are UCI users. We predicted that NH listeners would outperform BCI listeners who would, in turn, outperform UCI listeners.

Methods

We tested two methods of spatial hearing to provide norms for NH and UCI using children and preliminary data for BCI users. NH children (n = 40) were age matched (6-15 years) to UCI (n = 12) and BCI (n = 6) listeners. Testing used a horizontal ring of loudspeakers within a booth in a hospital outpatient clinic. In a ‘lateral release’ task, single nouns were presented frontally, and masking noises were presented frontally, or 90° left or right. In a ‘localization’ task, allowing head movements, nouns were presented from loudspeakers separated by 30°, 60° or 120° about the midline.

Results

Normally hearing children improved with age in speech detection in noise, but not in quiet or in lateral release. Implant users performed more poorly on all tasks. For frontal signals and noise, UCI and BCI listeners did not differ. For lateral noise, BCI listeners performed better on both sides (within ∼2 dB of NH), whereas UCI listeners benefited only when the noise was opposite the unimplanted ear. Both the BCI and, surprisingly, the UCI listeners performed better than chance at all loudspeaker separations on the ecologically valid, localization task. However, the BCI listeners performed about twice as well and, in two cases, approached the performance of NH children.

Conclusion

Children using either UCI or BCI have useful spatial hearing. BCI listeners gain benefits on both sides, and localize better, but not as well as NH listeners.     

The family oriented musical training for children with cochlear implants: Speech and musical perception results of two year follow-up

Objective

The purpose of this study is to determine whether children can gain benefit from training on pitch and music perception. Our main goals were to prepare a tool for training pitch and rhythm perception and evaluate musical attitude in children, to determine whether pitch and rhythm perception improve more rapidly through training and to assess the impact of training on speech perception.

Method

A family centred habilitation program based on musical training is developed. Nine newly implanted children who were switched on in HiRes and trained from the outset and 9 children using HiRes strategy who did not receive training both undergo assessments to determine pitch and rhythm perception skills and speech perception assessments. Music group was formed by the children who were implanted consecutively. As a control group, children who are being followed for another study which examines “the changes of sound quality perception, speech understanding, speech production, and communication mode” are included. The speech perception test battery contains a comprehensive range of age appropriate tasks covering detection, discrimination, identification, recognition and comprehension abilities. Also meaningful auditory integration scale (MAIS) or infant-toddler MAIS (if more appropriate) and the meaningful use of speech scale (MUSS) were administered in order to collect information about children's use of sound in everyday situations such as device bounding, alerting to sound and deriving meaning from auditory stimuli. Musical training program was based on a take-home electric keybord which is used for listening to different pairs of notes. For this study, three octaves and one extra note at the high end of the keyboard were used. Children were expected to discriminate a pair of notes. Assessments of speech perception at pre-implant, 1-,3-,6-,12-,24-months post switch-on. By the end of the first and second years, parents were given the ‘musical stages questionnaire’ which covers some of the key areas of musical development to compare both groups’ musical development.

Results

Children who were involved in music study demonstrated significant familiarity in both determining pitch differences. No significant difference was found between music group compared with the non-trained group in terms of speech perception (p > 0.05). However, by the end of 3rd month, music group came into prominence particularly at the rate of being linguistically/developmentally ready to carry out formal modified open-set speech perception evaluation (p < 0.05). Both groups seemed to be developed similarly in sound awareness and general reaction, differentiating melody, dynamic, rhythmical changes and emotional aspects of musical development (p > 0.05) whereas music group had more exposure to music at the end of the first year (p < 0.05). However, by the end of the second year music group developed more than the control group in all aspects of musical skills (p < 0.05).

Conclusion

Music training program helps appreciation of music and may enhance their progress in other auditory domains after cochlear implantation in children. While, effects of the musical training program on daily listening attitudes and social aspects such as closer parent-child relationship were significantly observed future training programs that should strive to improve satisfaction with music listening and its effect on auditory perception.     

Comparison of the TEMPO+ ear-level speech processor and the cis pro+ body-worn processor in adult MED-EL cochlear implant users

A study was conducted to compare the new MED-EL TEMPO+ ear-level speech processor with the CIS PRO+ body-worn processor in the COMBI 40/COMBI 40+ implant system. Speech tests were performed in 46 experienced subjects in two test sessions approximately 4 weeks apart. Subjects were switched over from the CIS PRO+ to the TEMPO+ in the first session and used only the TEMPO+ in the time between the two sessions. Speech tests included monosyllabic word tests and sentence tests via the telephone. An adaptive noise method was used to adjust each subject's scores to approximately 50%. Additionally, subjects had to complete a questionnaire based on their 4 weeks of experience with the TEMPO+. The speech test results showed a statistically significant improvement in the monosyllabic word scores with the TEMPO+. In addition, in the second session, subjects showed a significant improvement when using the telephone with the TEMPO+, indicating some learning in this task. In the questionnaire, the vast majority of subjects found that the TEMPO+ allows equal or better speech understanding and rated the sound quality of the TEMPO+ higher. All these objective and subjective results indicate the superiority of the TEMPO+ and are mainly attributed to a new coding strategy called CIS+ and its implementation in the TEMPO+. In other words, based on the results of this study, it appears that after switching over from the CIS PRO+ to the TEMPO+, subjects are able to maintain or even improve their own speech understanding capability.     

A comparison of the consonant production between Dutch children using cochlear implants and children using hearing aids

Objectives

The main purpose of the present study was to compare the consonant error patterns of Dutch prelingually deaf CI children with prelingually hearing-impaired hearing aid (HA) children. The authors hypothesized that subjects using conventional hearing aids would have poorer consonant production skills. Additionally, the impact of the age at implantation (CI) and the degree of hearing loss (HA) was determined.

Methodology

This is a comparative study of 29 prelingually deaf CI children (m.a. 9;0 y) and 32 prelingually hearing-impaired HA children (m.a. 9;11 y) who received their first hearing aid before the age of 2 years. Nineteen CI children were implanted before the age of 5 years. Nine HA children had thresholds above 90 dB (range: 91-105 dB), 15 between 70 and 90 dB (range: 72-90 dB) and 8 below 70 dB (range: 58-68 dB). Speech samples of all the children were elicited by means of a picture naming test and were video-recorded for further phonetic and phonological analysis.

Results

Considerably more phonetic and phonologic errors were observed in the HA children with thresholds above 70 dB (range: 72-105 dB). No notable differences could be found between deaf CI children and HA children with thresholds below 70 dB. Even children implanted after the age of 5 years showed significantly fewer phonetic and phonological errors than HA children.

Conclusion

The consonant production of implanted children is more adequate than the consonant production of HA children with a hearing loss of 70 dB or more. In addition, the results also indicate that even after the age of 5 years, implantation can still have an advantageous effect on a child's consonant production.     

Infants versus older children fitted with cochlear implants: performance over 10 years

Objectives

To investigate the efficacy of cochlear implants (CIs) in infants versus children operated at later age in term of spoken language skills and cognitive performances.

Method

The present prospective cohort study focuses on 19 children fitted with CIs between 2 and 11 months (X = 6.4 months; SD = 2.8 months). The results were compared with two groups of children implanted at 12-23 and 24-35 months. Auditory abilities were evaluated up to 10 years of CI use with: Category of Auditory Performance (CAP); Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS); Peabody Picture Vocabulary Test (PPVT-R); Test of Reception of Grammar (TROG) and Speech Intelligibility Rating (SIR). Cognitive evaluation was performed using selected subclasses from the Griffiths Mental Development Scale (GMDS, 0-8 years of age) and Leiter International Performance Scale-Revised (LIPS-R, 8-13 years of age).

Results

The infant group showed significantly better results at the CAP than the older children from 12 months to 36 months after surgery (p < .05). Infants PPVT-R outcomes did not differ significantly from normal hearing children, whereas the older age groups never reached the values of normal hearing peers even after 10 years of CI use. TROG outcomes showed that infants developed significantly better grammar skills at 5 and 10 years of follow up (p < .001). Scores for the more complex subtests of the GMDS and LIPS-R were significantly higher in youngest age group (p < .05).

Conclusion

This study demonstrates improved auditory, speech language and cognitive performances in children implanted below 12 months of age compared to children implanted later.     

Abutment-free bone-anchored hearing devices in children: Initial results and experience

Objectives

Bone-anchored implantable hearing devices are widely accepted as a surgical option for certain types of hearing loss in both adults and children. Most commercially available devices involve a percutaneous abutment to which a sound processor attaches. The rate of complications with such bone conduction systems is greater than 20%. Most complications arise from the abutment. Recently, the Sophono (Boulder, CO) Alpha 1, an abutment-free system, has been introduced.

Study design and methods

We conducted a retrospective chart review of the first five patients who underwent implantation with the Sophono abutment-free bone conduction hearing system with the Alpha 1 processor at our institution and report here on these patients’ pre- and postoperative audiometric data and clinical courses.

Results

Average improvement in pure-tone average was 32 dB hearing loss and average improvement in speech response threshold was 28 dB hearing loss. All patients were responding in the normal to mild hearing loss range in the operated ear after device activation. Average improvement across individual frequencies was between 17 and 37 dB (SD 5.5–11 dB).

Conclusion

Our audiometric results to date are promising and have been consistent with published data on other bone-anchored hearing devices.