语后聋成人人工耳蜗植入后言语感知能力的测评

目的通过对植入人工耳蜗的语后聋成人听力言语感知能力的测评,探讨人工耳蜗对语后聋成人言语康复的作用.方法受试者为14名语后聋成人患者,男性9例,女性5例;耳蜗植入年龄22岁～67岁,平均46岁;耳聋时间6年-42年,平均16年.在人工耳蜗植入6个月、12个月及24个月时,进行开放性单词和短句言语感知测试.分别在三种模式下进行:只听模式(开放人工耳蜗)、听觉加视觉模式(开放人工耳蜗加唇读)及视觉模式(关闭人工耳蜗只用唇读).结果在听觉模式及听觉加视觉模式下,患者对单词和句子的正确感知随人工耳蜗使用时间而不断改善.术后6个月,听觉模式下的开放性单词和短句的正确感知率分别是38%和54%;听觉加视觉模式下的开放性单词和短句的正确感知率分别是70%和76%.术后24个月,听觉模式下的开放性单词和短句的正确感知率分别是65%和72%;听觉加视觉模式下的开放性单词和短句的正确感知率分别是84%和88%.结论人工耳蜗植入能显著改善语后聋成人的言语感知能力,并随着人工耳蜗使用时间的增加,言语感知能力逐渐得到提高.     

Changes in speech intelligibility of postlingually deaf adults after cochlear implantation.

OBJECTIVE: This study examines changes in the intelligibility of CVC words spoken by postlingually deafened adults after they have had 6 to 12 mo of experience with a cochlear implant. The hypothesis guiding the research is that the intelligibility of these speakers will improve after extended use of a cochlear implant. The paper also describes changes in CVC word intelligibility analyzed by phoneme class and by features. DESIGN: The speech of eight postlingually deaf adults was recorded before activation of the speech processors of their cochlear implants and at 6 mo and 1 yr after activation. Seventeen listeners with no known impairment of hearing completed a word identification task while listening to each implant user's speech in noise. The percent information transmitted by the speakers in their pre- and postactivation recordings was measured for 11 English consonants and eight vowels separately. RESULTS: An overall improvement in word intelligibility was observed: seven of the eight speakers showed improvement in vowel intelligibility and six speakers showed improvement in consonant intelligibility. However, the intelligibility of specific consonant and vowel features varied greatly across speakers. CONCLUSIONS: Extended use of a cochlear implant by postlingually deafened adults tends to enhance their intelligibility.     

The case for earlier cochlear implantation in postlingually deaf adults

Abstract

Objective: This paper aimed to estimate the difference in speech perception outcomes that may occur due to timing of cochlear implantation in relation to the progression of hearing loss. Design: Data from a large population-based sample of adults with acquired hearing loss using cochlear implants (CIs) was used to estimate the effects of duration of hearing loss, age, and pre-implant auditory skills on outcomes for a hypothetical standard patient. Study sample: A total of 310 adults with acquired severe/profound bilateral hearing loss who received a CI in Melbourne, Australia between 1994 and 2006 provided the speech perception data and demographic information to derive regression equations for estimating CI outcomes. Results: For a hypothetical CI candidate with progressive sensorineural hearing loss, the estimates of speech perception scores following cochlear implantation are significantly better if implantation occurs relatively soon after onset of severe hearing loss and before the loss of all functional auditory skills. Conclusions: Improved CI outcomes and quality of life benefit may be achieved for adults with progressive severe hearing loss if they are implanted earlier in the progression of the pathology.     

Quality of life in postlingually deaf patients following cochlear implantation

Most cochlear implant studies are focused on improvement of speech perception associated with implantation. The goal of this study was to assess the impact of cochlear implantation on quality of life changes in Spanish users. Thirty postlingually deaf patients fitted with a cochlear implant completed the Glasgow Benefit Inventory, a questionnaire dealing with communication abilities, and an open-ended questionnaire. The Glasgow Benefit Inventory revealed a positive effect in 93% of patients. The use of a cochlear implant significantly enhanced discrimination ability, telephone use and self-confidence. A high degree of satisfaction was achieved in all situations except with background noise. Ninety-six percent of patients would recommend the operation to a friend. A dramatic improvement in quality of life following cochlear implantation is revealed by a great majority of patients. The results cannot only be explained by enhancements to auditory perception.     

Residual speech perception and cochlear implant performance in postlingually deafened adults

OBJECTIVE: This study aimed at testing the post-hoc validity of the previously reported predictive index for postoperative cochlear implant performance, based on preoperative duration of deafness, and speech reception. STUDY DESIGN: Adult patients with postlingual severe to profound hearing loss, who were implanted with Cochlear Corporation CI-22 and CI-24 devices were included in this study. We studied the relationship between their postoperative word recognition scores and preoperative factors, namely, duration of deafness, and sentence recognition. We used the same predictive index reported in the previous study to predict their postoperative scores and test the model's agreement with the actual performance. RESULTS: We found that postoperative performance as measured by CNC word scores had an inverse relationship with the duration of deafness, and a direct correlation with the preoperative performance on CID sentence recognition tests. A nonlinear term [Duration / (1+CID)] was shown to improve the correlation coefficient of our predictive index. CONCLUSION: Some predictability of cochlear implant outcome is possible depending on the preoperative duration of deafness and speech recognition abilities. Preoperative residual speech recognition acts as a "trophic factor" that protects the spiral ganglion and/ or the central auditory pathways from degeneration. In other words, it improves the expected postoperative word scores.     

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 (0.125-8kHz), 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.     

Changes in speech breathing following cochlear implant in postlingually deafened adults

Three postlingually deafened adults who received cochlear implants read passages before and after their prostheses were activated while their lung volumes were measured with an inductive plethysmograph that transduced the cross-sectional areas of the speaker's chest and abdomen. Lung volumes at the initiation and termination of the speakers' expiratory limbs, their average air flow, and the volume of air they expended per syllable were derived from tracings of calibrated lung volume displayed by computer. The activation of the speakers' cochlear prostheses was followed in every case by a significant change in average airflow, which rose for two subjects with initially low flow rates and fell for one subject who had a much higher average preimplant flow rate. These changes in average flow rate were accompanied by corresponding changes in volume of air expended per syllable, statistically reliable in two of the three cases. There were no significant changes in the levels at which speakers initiated their expiratory limbs, but one speaker, after his prosthesis was activated, reliably increased the level of air in his lungs at the end of expiratory limbs to an average value that no longer required him to draw on expiratory reserve volume.     

成人语后聋患者人工耳蜗植入适应证探讨

目的:探讨语后聋患者人工耳蜗植入的手术适应证及人工耳蜗在语后聋患者言语康复和社会活动中的作用.方法:5例语后聋患者手术年龄为19～58岁(中位年龄26岁).5例患者均手术植入Cochlear 24R人工耳蜗.术后4周开机,随访1年,调查采用听觉行为分级标准(CAP)和言语识别率分级标准(SIR),由1名研究者完成随访,随访涉及听力水平、言语交流能力2个方面的内容.结果:5例患者术后1年0.5、1.0、2.0、4.0 kHz助听听阈均在25～45 dB;CAP平均3.4,SIR平均2.4.2例患者言语分辨能力及情感交流能力无明显提高,其余3例患者交流能力均有不同程度提高.结论:对于不同原因所致的语后聋患者,正确选择手术适应证,均能使之从人工耳蜗植入术中不同程度获益,提高其独立生活能力及自信心.     

Evidence-based guidelines for recommending cochlear implantation for postlingually deafened adults

Abstract

Objective: Adult selection criteria for cochlear implantation have been developed based on analysis of the post-operative performance of a large group of postlingually deafened adults. Original criteria published in 2004 were reviewed and amended to reflect outcomes currently being achieved by implant recipients. Design: Retrospective review of 12-month post-operative speech perception performance of adults implanted at the Eye and Ear Hospital, Melbourne, Australia. Study sample: A total of 382 postlingually deafened adults, using a Freedom, Nucleus 5, or CI422 Slim Straight cochlear implant were used to create a comparative set of data. Results: Revised guidelines suggest that adults with postlingual hearing loss can now be considered cochlear implant candidates if they obtain scores of up to 55% for open-set phonemes in quiet in the ear to be implanted. Functional benefit may vary depending on the recipients’ contralateral hearing. Conclusions: This study supports the provision of cochlear implants to candidates with significant residual hearing when at least one ear meets the criterion outlined above. Patient-specific counseling is required to ensure the potential to benefit predicted by the current model is acceptable to the individual patient and their family. Counseling regarding functional benefit must take into consideration hearing in the contralateral ear.     

Predicting speech perception outcomes following cochlear implantation in adults with unilateral deafness or highly asymmetric hearing loss

Objective: Unilateral deafness and highly asymmetric hearing loss can impair listening abilities in everyday situations, create substantial audiological handicap, and reduce overall quality of life. Preliminary evidence suggests that cochlear implantation may be effective in reversing some of these detrimental effects. Patient-level data from existing studies were re-analysed to explore potential factors that may be predictive of improved speech perception scores following implantation.

Methods: Logistic regression modelling examined whether improved speech perception following implantation under various listening conditions was related to the duration of deafness of the severe-to-profoundly deaf ear and/or the level of hearing in the better ear.

Results: Patients with a shorter duration of deafness were more likely to improve in listening conditions that created a less favourable SNR at the implanted ear than the non-implanted ear. Those with more residual hearing in the better ear were more likely to improve in the listening condition that created a less favourable SNR at that ear.

Discussion: The analysis suggests that characteristics of both ears may be relevant when seeking to identify those candidates who are likely to obtain benefit to speech perception following cochlear implantation.     

语前聋儿童人工耳蜗术后语音识别研究

目的对语前聋人工耳蜗植入患儿的语音识别情况进行研究,初步探讨耳蜗植入者的语音识别情况及其影响因素。方法实验对象包括40名植入语前聋人工耳蜗儿童及20名听力正常儿童,采用口语给声、开集测试的方式测试其韵母及声母识别率,研究植入年龄和教育交流方式对结果的影响。结果（1）耳蜗植入儿童的韵母识别率高于其声母识别率;（2）3岁前植入的儿童的语音识别率高于3岁后的植入儿童,且植入年龄与语音识别率呈负相关;（3）采用听觉口语法的儿童比采用综合交流法的儿童,具有更好的语音识别率。结论对于耳蜗植入儿童而言,声母比韵母更难掌握;植入时间较早、利用口语交流的儿童可以从人工耳蜗中获得更多的益处。     

Speech perception skills of deaf infants following cochlear implantation: a first report

OBJECTIVE: We adapted a behavioral procedure that has been used extensively with normal-hearing (NH) infants, the visual habituation (VH) procedure, to assess deaf infants' discrimination and attention to speech. METHODS: Twenty-four NH 6-month-olds, 24 NH 9-month-olds, and 16 deaf infants at various ages before and following cochlear implantation (CI) were tested in a sound booth on their caregiver's lap in front of a TV monitor. During the habituation phase, each infant was presented with a repeating speech sound (e.g. 'hop hop hop') paired with a visual display of a checkerboard pattern on half of the trials ('sound trials') and only the visual display on the other half ('silent trials'). When the infant's looking time decreased and reached a habituation criterion, a test phase began. This consisted of two trials: an 'old trial' that was identical to the 'sound trials' and a 'novel trial' that consisted of a different repeating speech sound (e.g. 'ahhh') paired with the same checkerboard pattern. RESULTS: During the habituation phase, NH infants looked significantly longer during the sound trials than during the silent trials. However, deaf infants who had received cochlear implants (CIs) displayed a much weaker preference for the sound trials. On the other hand, both NH infants and deaf infants with CIs attended significantly longer to the visual display during the novel trial than during the old trial, suggesting that they were able to discriminate the speech patterns. Before receiving CIs, deaf infants did not show any preferences. CONCLUSIONS: Taken together, the findings suggest that deaf infants who receive CIs are able to detect and discriminate some speech patterns. However, their overall attention to speech sounds may be less than NH infants'. Attention to speech may impact other aspects of speech perception and spoken language development, such as segmenting words from fluent speech and learning novel words. Implications of the effects of early auditory deprivation and age at CI on speech perception and language development are discussed.     

Language development in deaf infants following cochlear implantation

OBJECTIVE: To evaluate the benefits of cochlear implantation in infancy and compare them to those obtained in children implanted at a slightly older age. MATERIAL AND METHODS: Using standard language measurement tools, including the Grammatical Analysis of Elicited Language--Presentence Level (GAEL-P) and the Reynell Developmental Language Scales, progress was documented in a child who received a cochlear implant in infancy and compared to that achieved in children implanted at older ages. A new measurement tool, the Visual Habituation Procedure, was used to document early skills and the results were compared to those obtained in normal-hearing infants. RESULTS: By the age of 2 years the subject implanted in infancy achieved scores on the GAEL-P which were nearly equivalent to those achieved at the age of 5 1/2 years by children implanted at later ages. Age-equivalent scores on the Reynell Developmental Language Scales were achieved by the subject implanted in infancy and the ability to discriminate speech patterns was demonstrated using the Visual Habituation Procedure. CONCLUSION: This report demonstrates enhanced language development in an infant who received a cochlear implant at the age of 6 months.     

The effects of age of cochlear implantation on speech perception outcomes in prelingually deaf children.

We have made a retrospective analysis on 70 prelingually deaf children (78% congenital; age range 2-15 years) followed for up to 5 years post-implant during which both closed set speech perception tests (TAC, WIPI) and open set tasks (PBK, GASP) were administered. We used a binary partitioning algorithm to optimally divide our dataset on the basis of age at implantation This technique achieves an optimal split when the heterogeneity of the data is most reduced (maximal drop in deviance). For the closed set speech perception tests (TAC and WIPI) partitioning best divided-out data at age 4.4 years. For the open set tests optimal division was at a higher age of implantation (GASP word, 5.6 years; PBK word, 8.4 years). Using these partitioning values, we have found statistically significant differences between rate of improvement of scores in the younger implanted children compared with those implanted later.     

Speech perception in elderly patients following cochlear implantation

CONCLUSIONS: Elderly patients benefit from cochlear implantation in terms of speech perception and quality of life. Age alone should be no contraindication for implantation. OBJECTIVE: There have been concerns whether elderly patients may perform poorly after cochlear implantation due to degenerative processes in the central and peripheral auditory systems. The purpose of this study was to analyze the benefits of cochlear implantation in elderly patients in comparison to younger recipients. MATERIAL AND METHODS: We examined 26 postlingually deafened adults aged > 65 years who received a cochlear implant at our center regarding preoperative findings, comorbidities, postoperative complications and quality of life. Speech perception was assessed by means of multi- and monosyllabic word recognition and compared to the results obtained by younger patients. RESULTS: The surgical procedure was well tolerated by all patients without notable perioperative complications. In terms of speech perception, no significant differences between the elderly patients and younger recipients were noted. All patients found that cochlear implantation had a positive impact on their quality of life.     

Speech perception in elderly patients following cochlear implantation

Conclusions. Elderly patients benefit from cochlear implantation in terms of speech perception and quality of life. Age alone should be no contraindication for implantation. Objective. There have been concerns whether elderly patients may perform poorly after cochlear implantation due to degenerative processes in the central and peripheral auditory systems. The purpose of this study was to analyze the benefits of cochlear implantation in elderly patients in comparison to younger recipients. Material and methods. We examined 26 postlingually deafened adults aged?>?65 years who received a cochlear implant at our center regarding preoperative findings, comorbidities, postoperative complications and quality of life. Speech perception was assessed by means of multi- and monosyllabic word recognition and compared to the results obtained by younger patients. Results. The surgical procedure was well tolerated by all patients without notable perioperative complications. In terms of speech perception, no significant differences between the elderly patients and younger recipients were noted. All patients found that cochlear implantation had a positive impact on their quality of life.     

Connexin-associated deafness and speech perception outcome of cochlear implantation

OBJECTIVE: To compare performance after cochlear implantation in children with mutations in connexin (Cx) 26 (GJB2) or Cx30 (GJB6) and children with deafness of unknown etiology. DESIGN: Genetic analysis and speech perception evaluation was performed in the children with and without Cx mutations who had undergone cochlear implantation. Speech perception performance was retrospectively analyzed 6, 12, 24, 36, and 48 months after implantation. Test material was selected according to the child's age and cognitive and language abilities. SETTING: The study took place at speech and hearing and genetic centers of a hospital in the central part of Israel and the genetics departments of 3 additional centrally located hospitals. PATIENTS: A total of 30 children who had undergone cochlear implantation were selected for the study, with control patients matched according to age at implantation, duration of implant use, and mode of communication. There was no evidence for additional disabilities or handicaps in either group. MAIN OUTCOME MEASURES: Speech perception measurements included a questionnaire, as well as closed and open-set tests. RESULTS: Overall, the 2 groups showed significant improvement in speech perception results after implantation. Four years after implantation, both groups achieved mean open-set speech perception scores of approximately 60%, 75%, and 90% for monosyllabic, 2 syllables, and words in sentences tests, respectively. CONCLUSIONS: There were no apparent differences in speech perception performance after implantation between the children with Cx mutations and children with deafness of unknown etiology. These data have important implications as a prognostic indicator when counseling candidates for cochlear implantation.     

Speech perception and speech intelligibility in children after cochlear implantation

OBJECTIVE: This study aimed to evaluate the long-term speech perception and speech intelligibility of congenitally and prelingually deaf children after cochlear implantation. It was a longitudinal study following 63 congenitally or prelingually deaf children up to 5 years after implantation. They each received a nucleus multichannel cochlear implant before they were 10 years old. METHODS: Perception is evaluated using the Test for the Evaluation of Voice Perception and Production (TEPP) and concerns closed- and open-set word and sentence perception without lip-reading. The intelligibility is classified according to the Speech Intelligibility Rating (SIR). The evaluations have been made every 3 months for 1 year, then at 18 months, 2 years, 3 years and 5 years after the cochlear implantation. RESULTS: After 5 years of implantation, the median percentage of closed-words speech perception (CSW) is 95.5%-93.67% for closed-sentence speech perception (CSS) and 76.3% for open-sentence speech perception (OSS); the median Speech Intelligibility Rating is 3.83. CONCLUSIONS: Congenitally and prelingually deaf children who receive cochlear implant before the age of 10 years develop speech perception and speech intelligibility abilities. The closed-set perception progresses quickly and seems to reaching a plateau at 5 years post implantation. The improvement of open-sentence perception is not significant until the first year post implantation. The speech intelligibility improves regularly the five first year post implantation.     

成人语后聋患者人工耳蜗植入前后言语韵律的分析

目的探讨人工耳蜗植入对成人语后聋患者言语韵律的影响。方法受试者为9名成人语后聋接受人工耳蜗植入的患者和9名听力正常者。用于分析的言语材料为一段含情感表达的短文。听感知评估的评委由4名言语病理学家组成,4级评估标准(0级正常;3级重度紊乱),评估参数:言语韵律的总印象及言语的音调、响度、节律、节奏和语速。客观检测采用法国科学院语言-言语研究所开发的“SESANE-PROSODIE”软件对录制的言语材料进行分析,检测下列参数:基频变化系数、平均音强、停顿次数,停顿时程、重读音节时程和语速。结果成人语后聋患者在耳蜗植入前均有不同程度的亩语韵律紊乱,表现为音调变化小、响度弱、语速慢、节律和节奏紊乱。耳蜗植入后患者的言语韵律都有不同程度的改善,客观检测结果显示患者亩语的基频变化范围增大、音强提高、语速加快、停顿次数减少、停顿时程和重读音节时程缩短。结论成人语后聋患者存在有言语韵律的失调(素乱);人工耳蜗植入能改善患者的言语韵律。