Handling of the MED-EL TEMPO+ ear-level speech processor by paediatric cochlear implant users and their parents

MED-EL launched the first ear-level speech processor offering a high-rate CIS+ strategy, the TEMPO+, in 1999. Studies have already demonstrated improved speech perception, sound quality and ability to enjoy music with the TEMPO+ due to the new CIS+ speech-coding strategy, when compared to the body-worn processor. In this study we evaluated responses from parents of young children about ease of handling and usage of the TEMPO+, and satisfaction with the TEMPO+ and its performance. Overall, 65 custom-designed questionnaires were analysed. The results showed that MED-EL cochlear implant users felt comfortable manipulating the dials and switches, changing the battery pack, using external sources of input and using the accessories provided. These results confirm the suitability of the TEMPO+ for infants and toddlers.     

Handling of the MED-EL TEMPO+ ear-level speech processor by paediatric cochlear implant users and their parents

MED-EL launched the first ear-level speech processor offering a high-rate CIS+ strategy, the TEMPO+, in 1999. Studies have already demonstrated improved speech perception, sound quality and ability to enjoy music with the TEMPO+ due to the new CIS+ speech-coding strategy, when compared to the body-worn processor. In this study we evaluated responses from parents of young children about ease of handling and usage of the TEMPO+, and satisfaction with the TEMPO+ and its performance. Overall, 65 custom-designed questionnaires were analysed. The results showed that MED-EL cochlear implant users felt comfortable manipulating the dials and switches, changing the battery pack, using external sources of input and using the accessories provided. These results confirm the suitability of the TEMPO+ for infants and toddlers.     

Handling of the TEMPO+ behind-the-ear speech processor by MED-EL cochlear implant users

Abstract

MED-EL launched its ear-level speech processor, the TEMPO+, in 1999. Studies have already demonstrated improved speech perception, sound quality and the ability to enjoy music with the TEMPO+ due to the new CIS+ speech-coding strategy. This study evaluated responses to 185 questionnaires about ease of handling and usage of the TEMPO+, opinion of and satisfaction with the TEMPO+ and its performance, as well as satisfaction with accessories. There was particular interest in seeing if the TEMPO+ was suitable for use with children. Results showed that MED-EL cochlear implant users felt comfortable manipulating the dials and switches, changing the battery pack, using external sources of input and with provided accessories. Overall, there was satisfaction with the TEMPO+. Notably, one third of respondents were under the age of 10. Results show the suitability of the TEMPO+ behind-the-ear speech processor for young children.     

Handling of the TEMPO+ behind-the-ear speech processor by MED-EL cochlear implant users

MED-EL launched its ear-level speech processor, the TEMPO+, in 1999. Studies have already demonstrated improved speech perception, sound quality and the ability to enjoy music with the TEMPO+ due to the new CIS+ speech-coding strategy. This study evaluated responses to 185 questionnaires about ease of handling and usage of the TEMPO+, opinion of and satisfaction with the TEMPO+ and its performance, as well as satisfaction with accessories. There was particular interest in seeing if the TEMPO+ was suitable for use with children. Results showed that MED-EL cochlear implant users felt comfortable manipulating the dials and switches, changing the battery pack, using external sources of input and with provided accessories. Overall, there was satisfaction with the TEMPO+. Notably, one third of respondents were under the age of 10. Results show the suitability of the TEMPO+ behind-the-ear speech processor for young children.     

Recent results with the MED-EL COMBI 40+ cochlear implant and TEMPO+ behind-the-ear processor

Cochlear implantation is a viable treatment for patients with severe to profound hearing loss. We report the results of speech perception tests (numbers, monosyllables, and sentence tests) achieved with MED-EL's COMBI40+ (C40+) cochlear implant after 12 months of use. These findings, which were taken from a larger German study, were similar to those of other studies of the C40+ implant. We also compared the differences in speech perception observed with the CIS PRO+ body-worn speech processor and the newer TEMPO+ behind-the-ear speech processor. Although these results were similar with respect to most of the measured parameters, the TEMPO+ processor had a distinct advantage during tests in noise.     

Emotional and analytic music perception in cochlear implant users after optimizing the speech processor

The present study examined transmitters that regulate commissural inhibition. Extracellular spikes of a single vestibular neuron were recorded in decerebrated cats. Multibarreled electrodes were filled with transmitter candidates (GABA and glycine), their specific antagonists (bicuculline, strychnine) and 2 M NaCl for extracellular recording. After isolation of a type I neuron, chemicals were iontophoretically applied to examine their effects on the activity of the neuron. The results were as follows. Commissural inhibition caused by electrical stimulation of the contralateral labyrinth was not abolished by the application of strychnine (a glycine antagonist), but was abolished by bicuculline (a GABA antagonist). Commissural inhibition was not abolished by phaclofen. Some bicuculline-sensitive neurons, with a short-latency commissural inhibition (presumably disynaptic inhibition), showed spacial summation when the conditioning stimulation (contralateral vestibular nerve stimulation) was applied with the test stimulation (vestibular nucleus stimulation). It was concluded that commissural inhibition was activated by the GABA_A receptor, but not by the GABA_B receptor, that the inhibitory type I neurons located in the contralateral vestibular nucleus were GABAergic, and that inhibitory type II neurons were also GABAergic neurons.     

Comparing eSRT and eCAP measurements in pediatric MED-EL cochlear implant users

Introduction: Electrically evoked compound action potentials (eCAP) and electrically evoked stapedius reflexes are the most frequently used objective measurements for programming a cochlear implant (CI) audio processor. Objective methods are particularly beneficial for children and CI users that encounter difficulties in providing feedback. In this study, we compared the threshold and the slope of the eCAP amplitude growth function with the electrically evoked stapedius reflex threshold (eSRT) in pediatric CI users. Furthermore, the duration times required to perform eCAP and eSRT recordings were compared.

Methods: During a regular fitting session, 52 pediatric CI users with recordable eSRTs having MED-EL devices (MED-EL GmbH, Innsbruck, Austria) were programmed using the eSRT fitting method. The eCAP thresholds and the slopes of the amplitude growth function were measured across one apical, one medial, and one basal electrode contact.

Results: There was a weak to medium correlation between eCAP thresholds and eSRTs. The eCAP threshold profile did not correlate with the eSRT profile. Typically ECAP thresholds were at a lower stimulation charge than eSRTs with only 4/152 being higher. An eCAP threshold was found on 152/156 electrode contacts with eSRTs. On average, the eCAP measurements took 4.2 times longer to record per electrode than eSRT measurements (median durations 35?s vs. 120?s).

Conclusion: eSRTs were significantly higher than eCAP thresholds and eSRT and eCAP profiles were generally different from each other reducing the clinical relevance of eCAP testing for setting MCLs across the array. Additionally, the eSRT measurements were faster to record than the eCAP threshold and slope determination measurements.     

Open-set speech perception in adult cochlear implant users with ossified cochleae

Abstract

This study describes open-set speech recognition in cochlear implant subjects with ossified cochleae and compares it to a control group with open cochleae. Twenty-one postlingually deafened adults with a Med-El Combi 40/40+GB splitelectrode implant were matched to patients using a Med-El cochlear implant with a standard electrode. Speech recognition was assessed over an 18-month period. Splitelectrode patients improved significantly over time, but their scores were significantly lower and increased significantly slower than those of controls. Of 14 patients with a duration of deafness less than 20 years, average sentence test scores were 50%, and average monosyllabic word test scores were 31%. This study provides evidence that cochlear implantation is beneficial to patients with ossified cochleae, but early implantation is advisable.     

Open-set speech perception in adult cochlear implant users with ossified cochleae

This study describes open-set speech recognition in cochlear implant subjects with ossified cochleae and compares it to a control group with open cochleae. Twenty-one postlingually deafened adults with a Med-El Combi 40/40+GB split- electrode implant were matched to patients using a Med-El cochlear implant with a standard electrode. Speech recognition was assessed over an 18-month period. Split- electrode patients improved significantly over time, but their scores were significantly lower and increased significantly slower than those of controls. Of 14 patients with a duration of deafness less than 20 years, average sentence test scores were 50%, and average monosyllabic word test scores were 31%. This study provides evidence that cochlear implantation is beneficial to patients with ossified cochleae, but early implantation is advisable.     

Evaluation of simplified programs using the MED-EL C40+ cochlear implant

Abstract

The present study evaluated the benefit possible from a cochlear implant (CI) using a simplified map (with a set of default parameters), rather than the conventional approach of producing a ‘customized map’ from electrode-specific psychophysical measures. Young children are sometimes initially provided with such maps and the aim was to gain an insight into what level of benefit they might provide. Maps with upper stimulation levels set equally across the array (i.e. ‘flat’ maps) were compared with normal ‘customized’ maps in established adult users of the MED-EL C40+ device. Speech discrimination was significantly poorer for the flat maps overall (mean of 72.7% for customized map, and 60.5% for flat map) and loudness balance estimates showed a range of degrees of imbalance. These results suggest that flat maps may provide paediatric CI users with useful levels of performance when psychophysical or objective measures cannot be obtained. The poorer performance with the flat map suggests that customized maps should be fit as soon as possible to provide paediatric patients with the maximum benefit of the CI device.

Sumario

El presente estudio evaluó el posible beneficio de un implante coclear (IC) usando un mapa simplificado (con un set preestablecido de parámetros), en vez del enfoque convencional para hacer “mapas a la medida” a partir de mediciones electrofisiológicas específicas. Los niños pequeños reciben a veces inicialmente este tipo de mapas con el objetivo de ganar conciencia sobre el nivel de beneficio que pueden proveer. Los mapas con niveles de estimulación elevados, similares en todos sus puntos (p. Ej. mapas “planos”) se compararon con mapas normales “a la medida” de usuarios adultos del MED-EL 40. La discriminación del lenguaje fue de manera global significativamente más pobre con los mapas planos (media de 72.7% con mapas a la medida y 60.5% con mapas planos) y la estimación del balance de intensidad subjetiva mostró rangos de niveles no balanceados. Estos resultados sugieren que los mapas planos pueden dar a niños usuarios de IC, niveles útiles de rendimiento cuando no pueden obtenerse mediciones psicofísicas u objetivas. El rendimiento más pobre con mapas planos sugiere que los mapas a la medida deben adaptarse apenas sea posible, para que los niños tengan el máximo beneficio de su IC.     

Psychophysical metrics and speech recognition in cochlear implant users

Intersubject variability in perception is a prominent characteristic of people with cochlear implants. This study characterized intersubject differences using simple metrics based on psychophysical measures: maximum comfortable loudness levels (C levels) and dynamic ranges (DRs). In a group of 17 subjects, we assessed across-site variation (ASV) and across-site mean (ASM) values of C levels and DRs for bipolar (BP) and monopolar (MP) stimulation, and examined the relation of these metrics to speech recognition across subjects. Significant negative correlations with speech recognition were found for ASVs of C levels for BP stimulation; i.e., subjects with high ASVs of BP C levels had poor speech recognition. Positive correlations with speech recognition were found for ASMs of C levels and ASMs of DRs for both BP and MP stimulation; i.e., subjects with high mean C levels and large mean DRs had better speech recognition. Thus, these psychophysical metrics are effective for diagnosis of individual differences in performance of subjects with cochlear implants. Furthermore, they point to some potentially useful treatment procedures. Copyright (c) 2005 S. Karger AG, Basel.     

Non-auditory stimulation in adult cochlear implant users

This is a retrospective case review of all 163 adults to have received multichannel cochlear implants on the Manchester University/Manchester Royal Infirmary programme between 1988 and 1998. The aims were to investigate the incidence of unwanted non-auditory effects of electrical stimulation (NAS) of the cochlea, and to try to identify any factors that seemed to be related to these effects. The effectiveness of programming strategies in eliminating unwanted effects was also studied. Most of the devices were Nucleus CI 22M or CI 24M. The remainder were Med-el Combi 40 or Combi 40+. NAS occurred in 23.9% of implantees. There were 20 cases of facial nerve stimulation (12.3%), 18 cases of pain in the ear or throat (11.0%) and one case of vestibulospinal spinal stimulation (0.6%). Two aetiologies were significantly associated with NAS. Otosclerosis tended to be associated with facial nerve stimulation and skull base fracture was associated with pain. Pain was associated with electrodes stimulated in the base turn of the cochlea and facial nerve stimulation tended to occur with more distally situated electrodes, close to labyrinthine segment of the nerve. There was no association with one particular make of device. The T and C levels for the rogue electrodes were in the normal range. It is concluded that the unwanted effects result from shorting of current through areas of low electrical resistance in the temporal bone. A number of different strategies were employed to prevent the effect, including alteration of current levels, removal of electrodes from the map and changing the stimulation mode, and this was successfully achieved in all cases. There was no difference between the performance of patients who had had NAS and those who had not, as assessed on open-set BKB sentence scores.     

Non-auditory stimulation in adult cochlear implant users

Abstract

This is a retrospective case review of all 163 adults to have received multichannel cochlear implants on the Manchester University/Manchester Royal Infirmary programme between 1988 and 1998. The aims were to investigate the incidence of unwanted non-auditory effects of electrical stimulation (NAS) of the cochlea, and to try to identify any factors that seemed to be related to these effects. The effectiveness of programming strategies in eliminating unwanted effects was also studied. Most of the devices were Nucleus CI 22M or CI 24M. The remainder were Med-el Combi 40 or Combi 40+. NAS occurred in 23.9% of implantees. There were 20 cases of facial nerve stimulation (12.3%), 18 cases of pain in the ear or throat (11.0%) and one case of vestibulospinal spinal stimulation (0.6%). Two aetiologies were significantly associated with NAS. Otosclerosis tended to be associated with facial nerve stimulation and skull base fracture was associated with pain. Pain was associated with electrodes stimulated in the base turn of the cochlea and facial nerve stimulation tended to occur with more distally situated electrodes, close to labyrinthine segment of the nerve. There was no association with one particular make of device. The T and C levels for the rogue electrodes were in the normal range. It is concluded that the unwanted effects result from shorting of current through areas of low electrical resistance in the temporal bone. A number of different strategies were employed to prevent the effect, including alteration of current levels, removal of electrodes from the map and changing the stimulation mode, and this was successfully achieved in all cases. There was no difference between the performance of patients who had had NAS and those who had not, as assessed on open-set BKB sentence scores.     

Speech understanding in quiet and noise in bilateral users of the MED-EL COMBI 40/40+ cochlear implant system

OBJECTIVE: The purpose of the study was to investigate speech understanding in quiet and noise in subjects bilaterally implanted with multi-channel cochlear implants. DESIGN: Nine adults bilaterally implanted with MED-EL implants were included in the study. The subjects were tested in three conditions: with both implants, with the right implant only, and with the left implant only. Speech tests included monosyllables in quiet and sentences in noise (10 dB signal to noise ratio). Speech was presented from the front, and noise was presented from either 90 degrees or 270 degrees azimuth. RESULTS: All subjects reported benefit from bilateral stimulation. Speech scores for all subjects were higher with bilateral than with unilateral stimulation. The average score across subjects for sentence understanding was 31.1 percentage points higher with both cochlear implants compared with the cochlear implant ipsilateral to the noise, and 10.7 percentage points higher with both cochlear implants compared with the cochlear implant contralateral to the noise. The average score for recognition of monosyllabic words was 18.7 percentage points higher with both cochlear implants than with one cochlear implant. All of these differences in average scores were significant at the 5% level. CONCLUSIONS: Bilateral cochlear implantation provides a significant benefit in speech understanding in both quiet and noise.     

Initial information on adjustment of speech processor of the cochlear implant

Adjustment of a speech processor of the cochlear implant is the first procedure in rehabilitation of patients after cochlear implantation. Influence of setting understated and overstated threshold levels of current perception on processing of a speech signal was studied. The results of the study show that only precise estimation of current perception threshold and comfortable loudness allow transmitting maximal acoustic information for each patient.     

Auditory cortical activation and speech perception in cochlear implant users

Cochlear implantation is generally accepted as a successful means of restoring auditory sensation to profoundly deaf individuals. Although most patients can expect a satisfactory outcome following implantation, some have poor speech perception outcomes. This investigation used [18F]-fluorodeoxyglucose positron emission tomography to measure cortical activity resulting from auditory stimulation in seven 'good' and four 'poor' cochlear implant recipients. Activations were significantly greater in both the primary and association cortices in the good compared with the poor implant users. We suggest that the ability to access the more specialised speech processing abilities of the auditory association cortices helps determine outcome following cochlear implantation.     

Contribution of speech rate to speech perception in multichannel cochlear implant users

This study describes the effect of speech rate (fast, 11 syllables per second; medium, 9 syllables per second; slow, 6 syllables per second) on speech perception in 10 cochlear implant users. The speech perception performance was evaluated on the basis of the percentage score of syllables that were correctly recalled in sentences composed of 4 to 6 words. The percentage scores at the fast, medium, and slow speech rates were 15.7%, 39.0%, and 56.0%, respectively. The effect of speech rate slowing was significant (p < .0001). Variations in the effect of speech rate slowing were observed in the cochlear implant users. The improvement of speech perception by speech rate slowing was significantly (p < .005) related to the word test score and the score at the fast speech rate. The results reveal that the rate of speech is an important factor in improving the speech perception of cochlear implant users.