Use of audiovisual information in speech perception by prelingually deaf children with cochlear implants: a first report.

OBJECTIVE: Although there has been a great deal of recent empirical work and new theoretical interest in audiovisual speech perception in both normal-hearing and hearing-impaired adults, relatively little is known about the development of these abilities and skills in deaf children with cochlear implants. This study examined how prelingually deafened children combine visual information available in the talker's face with auditory speech cues provided by their cochlear implants to enhance spoken language comprehension. DESIGN: Twenty-seven hearing-impaired children who use cochlear implants identified spoken sentences presented under auditory-alone and audiovisual conditions. Five additional measures of spoken word recognition performance were used to assess auditory-alone speech perception skills. A measure of speech intelligibility was also obtained to assess the speech production abilities of these children. RESULTS: A measure of audiovisual gain, "Ra," was computed using sentence recognition scores in auditory-alone and audiovisual conditions. Another measure of audiovisual gain, "Rv," was computed using scores in visual-alone and audiovisual conditions. The results indicated that children who were better at recognizing isolated spoken words through listening alone were also better at combining the complementary sensory information about speech articulation available under audiovisual stimulation. In addition, we found that children who received more benefit from audiovisual presentation also produced more intelligible speech, suggesting a close link between speech perception and production and a common underlying linguistic basis for audiovisual enhancement effects. Finally, an examination of the distribution of children enrolled in Oral Communication (OC) and Total Communication (TC) indicated that OC children tended to score higher on measures of audiovisual gain, spoken word recognition, and speech intelligibility. CONCLUSIONS: The relationships observed between auditory-alone speech perception, audiovisual benefit, and speech intelligibility indicate that these abilities are not based on independent language skills, but instead reflect a common source of linguistic knowledge, used in both perception and production, that is based on the dynamic, articulatory motions of the vocal tract. The effects of communication mode demonstrate the important contribution of early sensory experience to perceptual development, specifically, language acquisition and the use of phonological processing skills. Intervention and treatment programs that aim to increase receptive and productive spoken language skills, therefore, may wish to emphasize the inherent cross-correlations that exist between auditory and visual sources of information in speech perception.     

Cochlear implantation in prelingually deafened children with residual hearing

OBJECTIVE: The purpose of this study was to examine the speech perception skills of prelingually deafened French children with preoperative residual hearing who received multichannel cochlear implants. DESIGN: The design of the study incorporated a within-subject, repeated measures design for assessing speech perception skills. SETTING: Montpellier, Toulouse and Lyon Pediatric Cochlear Implant Centers. SUBJECTS: Seven prelingually deafened children demonstrating marginal benefit from conventional amplification prior to implantation with a Nucleus multichannel cochlear implant, served as subjects for the speech perception assessment (a speech recognition score less than 30% defines marginal benefit from acoustic amplification on open set materials). The mean age at implantation was 7 years, 9 months. OUTCOME MEASURES: Speech perception skills were assessed using open set materials and the MUSS and MAIS questionnaires. RESULTS: Open-set speech recognition averaged 21.4% before implantation, and 83.6% after 1 year's cochlear implant experience. All children demonstrated an open-set score over 60% after 12 months of CI use. MAIS test scores averaged 18.1/40 before implantation and 35.1/40 after 9 months of CI use. MUSS test scores averaged 24.4/40 before implantation and 34.1/40 after 9 months of CI use. CONCLUSIONS: Cochlear implantation should be considered for prelingually hearing impaired children demonstrating marginal benefit from hearing aids, with a speech recognition score less than 30% on open set materials, in order to improve their speech discrimination skills.     

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.     

人工耳蜗植入大龄青年听觉康复个案分析

目的通过1例人工耳蜗植入大龄青年听觉康复实践,探索成年听障患者人工耳蜗植入后听觉训练的方法,旨在为有一定听力语言基础大龄语前聋青年的人工耳蜗术后康复训练提供参考依据。方法采用业余指导的方法和技巧,以患者自主感受、反馈、纠错的康复训练形式为主,定时进行辅导和评估。结果经过4个月听觉康复训练,个案言语识别平均值从术前84．3%高到99．6％;选择性听取平均识别率从术前82％提高到100％。人工耳蜗与助听器同时配戴,听力补偿效果更佳。结论有一定听力语言基础、长期配戴助听器的大龄语前聋青年,在正确认识人工耳蜗期望值的基础上可植入人工耳蜗,经过正确的听力语言康复训练,可以达到听力重建的效果,提高其听辨能力和言语清晰度,增强适应社会环境及交往的能力。     

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.     

Development of audiovisual comprehension skills in prelingually deaf children with cochlear implants

OBJECTIVE: The present study investigated the development of audiovisual comprehension skills in prelingually deaf children who received cochlear implants. DESIGN: We analyzed results obtained with the Common Phrases (Robbins et al., 1995) test of sentence comprehension from 80 prelingually deaf children with cochlear implants who were enrolled in a longitudinal study, from pre-implantation to 5 years after implantation. RESULTS: The results revealed that prelingually deaf children with cochlear implants performed better under audiovisual (AV) presentation compared with auditory-alone (A-alone) or visual-alone (V-alone) conditions. AV sentence comprehension skills were found to be strongly correlated with several clinical outcome measures of speech perception, speech intelligibility, and language. Finally, pre-implantation V-alone performance on the Common Phrases test was strongly correlated with 3-year postimplantation performance on clinical outcome measures of speech perception, speech intelligibility, and language skills. CONCLUSIONS: The results suggest that lipreading skills and AV speech perception reflect a common source of variance associated with the development of phonological processing skills that is shared among a wide range of speech and language outcome measures.     

Cochlear implant in patients with residual hearing

Objective: The postoperative speech perception abilities of severely hearing-impaired patients with multi-channel cochlear implant were compared with preoperative speech perception performance with conventional hearing aids. Methods: Cochlear implantation was performed in six severely to profoundly hearing-impaired patients. They had unaided pure-tone thresholds of 70–100-dB HL and aided thresholds of 35–90-dB HL in the better ear, but were not able to perceive speech sounds well with hearing aids. Results: Postoperatively, all the patients had significantly improved speech perception performance, exceeded the average skills of profoundly deaf cochlear implant users, and were able to communicate without writing. Conclusion: These results imply that cochlear implant may be indicated for severely to profoundly deaf subjects, if they receive little or no benefit from conventional hearing aids.     

Comparison of outcomes in children with hearing aids and cochlear implants

Abstract

Objectives

The purpose of this study was to document the performance of a group of children with moderately severe to severe hearing loss who use hearing aids on a range of speech recognition, speech–language, and literacy measures and to compare these results to children with severe to profound hearing loss, who have learned language through cochlear implants.

Methods

This study involved 41 children with bilateral sensorineural hearing impairment, aged 6–18 years. Twenty children had moderately severe/severe hearing loss and used hearing aids, and 21 had severe to profound hearing loss and used cochlear implants. Communication and academic skills were assessed using speech recognition tests and standardized measures of speech production, language, phonology, and literacy.

Results

The two groups did not differ in their open-set speech recognition abilities or speech production skills. However, children with hearing aids obtained higher scores than their peers with cochlear implants in the domains of receptive vocabulary, language, phonological memory, and reading comprehension. The findings also indicate that children with moderately severe or severe hearing loss can develop spoken language skills that are within the range expected for normal hearing children.

Conclusions

School-aged children with moderately severe and severe hearing loss performed better in several domains than their peers with profound hearing loss who received cochlear implants between age 2 and 5 years. Further research is required to evaluate the benefits of hearing aids and cochlear implants in children with hearing loss who are diagnosed and receive intervention within the first year of life.     

The influence of contextual information on the perception of speech by postlingually and prelingually profoundly hearing-impaired Hebrew-speaking adolescents and adults.

OBJECTIVE: To study linguistic context effects on speech perception by prelingually (N = 10) and postlingually (N = 10) hearing-impaired Hebrew-speaking adolescents and adults. DESIGN: Participants were cochlear implant surgery candidates with profound sensorineural hearing loss (95 dB HL+). Four levels of speech perception materials were presented through the auditory-visual modality: monosyllabic nonsense syllables (phonological content), monosyllabic meaningful words (semantic-lexical), sentences without presented topics (semantic-syntactic), and sentences with topics (topical). Data were analyzed via percentage correct recognition and via k andj factors (Boothroyd & Nittrouer, 1988). RESULTS: Both participant groups performed better when speech material having more contextual information was presented, with no significant intergroup differences. CONCLUSIONS: This similar usage of contextual information among prelingually and postlingually hearing-impaired participants is encouraging and suggests the role of factors other than age of onset.     

语前聋患者人工耳蜗植入术后听觉能力评估

目的通过对129例极重度语前聋患者人工耳蜗植入术后声母、韵母、单音节及双音节词识别能力的评估,研究人工耳蜗植入术后患者的听觉康复效果及相关影响因素。方法选用《听力障碍儿童听觉、语言能力评估标准及方法》作为测试材料,分别测试患者的声母、韵母、单音节词、双音节词识别率,用各分项评估结果的均值代表总体听觉能力,进而研究康复时间、植入年龄、术前配戴助听器经验及性别对听觉能力的影响。结果随着康复时间的延长,听觉能力各分项得分逐渐提高（P〈0．05）。术前、术后6个月及术后1年低龄组与大龄组间总体听觉能力差异有统计学意义（P〈0．05）,术后3个月两组间差异无统计学意义（P〉0．05）。人工耳蜗植入术前、术后3个月、6个月及1年,男、女组之间总体听觉能力差异无统计学意义（P〉0．05）,配戴助听器组与未配戴助听器组间总体听觉能力差异无统计学意义（P〉0．05）。结论人工耳蜗植入能提高语前聋患者的听觉能力。植入时间越长,听觉康复效果越好。植入时年龄越小,术后听觉能力进步越快。大龄语前聋患者植入人工耳蜗后听觉能力仍能获得一定的改善。术前短时间配戴助听器对于极重度语前聋患者术后听觉能力康复无明显帮助。     

Auditory sensory memory and working memory processes in children with normal hearing and cochlear implants

There can be wide variation in the level of oral/aural language ability that prelingually hearing-impaired children develop after cochlear implantation. Automatic perceptual processing mechanisms have come under increasing scrutiny in attempts to explain this variation. Using mismatch negativity methods, this study explored associations between auditory sensory memory mechanisms and verbal working memory function in children with cochlear implants and a group of hearing controls of similar age. Whilst clear relationships were observed in the hearing children between mismatch activation and working memory measures, this association appeared to be disrupted in the implant children. These findings would fit with the proposal that early auditory deprivation and a degraded auditory signal can cause changes in the processes underpinning the development of oral/aural language skills in prelingually hearing-impaired children with cochlear implants and thus alter their developmental trajectory.     

Analysis of narrative ability in children with cochlear implants

PURPOSE: The purposes of this study were to: 1) develop a scoring system to assess narrative ability in children; 2) evaluate the impact of auditory speech perception with a cochlear implant on narrative ability; and 3) evaluate the importance of narrative ability to reading comprehension in deaf children. DESIGN: Narrative productions prompted from an eight-picture sequence story were elicited from 8 and 9 yr olds; 87 who had at least 4 yr of cochlear implant experience and 28 who had normal hearing. The stories were transcribed and a scoring system for narrative ability was developed based on the use of complete narrative structure, conjunctions linking semantic relations, and referents that served to identify and distinguish characters in the narrative. Narrative ability scores of cochlear implant users were examined in relation to their age, IQ, speech perception, language, and reading test scores. In addition, narrative ability scores for children with normal hearing were compared with two groups of cochlear implant users, those with above average speech perception scores and those with below average speech perception scores. RESULTS: Within the sample of hearing-impaired children, narrative ability scores correlated significantly with speech perception, language syntax, and reading test scores. A multiple regression analysis was conducted to predict reading comprehension scores from four predictor variables (age, IQ, language syntax, and narrative ability). Results reflected the independent contribution of discourse-level language skills, as measured by the narrative ability score, as well as sentence-level language skills in predicting reading test scores. Analysis of stories obtained from 8- and 9-yr-old children with normal hearing revealed the classic pattern that included a high point, a resolution, and one or more evaluative statements. Their stories achieved cohesion from correct use of both conjunctions and referents. Deaf children who received above-average speech perception scores with a cochlear implant (i.e., scored above 48% on the Word Intelligibility by Picture Identification speech perception test) told narratives that were similar in structure and use of referents to those of age mates with normal hearing. Although their use of subordinate conjunctions was not as well developed as normal-hearing children, it was significantly above that of deaf children who received less speech perception benefit after a similar period of implant use. These below-average speech perceivers exhibited significantly poorer use of narrative structure and cohesive devices than either normal-hearing age mates or children who achieved above average speech perception with a cochlear implant. CONCLUSIONS: Narrative ability is an important predictor of reading comprehension ability in deaf children above and beyond IQ and syntactic competence. Children who receive a cochlear implant under 5 yr of age and obtain above average speech perception benefit from the device construct narratives that are similar in structure and cohesion to those of their hearing age mates by age 8 to 9.     

Communication development in young deaf children: review of the video analysis method

It is widely recognised that preverbal communication skills underpin development of spoken language. This historical review outlines the establishment of a quantitative methodology for assessing preverbal communication skills in children with hearing aids and cochlear implants. The method is shown to be reliable and free from observer bias. The review also summarises findings from a series of cross-sectional and longitudinal observational studies utilising the methodology. Profoundly deaf young children, either with cochlear implants or successful users of hearing aids, show similar patterns of preverbal communication development that contrast with those of unsuccessful hearing-aid users. Preverbal measures obtained 12 months after implantation are predictive of late performance on speech perception tasks. Moreover, there is a significant association between the preverbal measure of 'autonomy' obtained before implantation and later speech perception performance. This latter finding has important theoretical implications for understanding of language development and suggests that intervention that promotes autonomy in adult-child interaction may lead to improved outcomes. Such intervention could be commenced as soon as deafness is discovered.     

青少年语前聋患者人工耳蜗植入后生活质量评估

目的 评估青少年语前聋患者人工耳蜗植入术后家庭及个人的生活质量,并比较术前交流方式对其影响.方法 回顾性分析21例语前聋人工耳蜗植入青少年患者的临床资料,按照术前交流方式分为非言语组(10例)和言语组(11例),采用听力植入体使用儿童的家庭生活质量(children using hearing implants quality of life,CuHI Qol)及Nijmegen 人工耳蜗植入量表(Nijmegen cochlear implant questionnaire,NCIQ)对两组患者植入人工耳蜗前后进行评分,比较两组患者得分差异.结果 21例患者人工耳蜗植入术后的CuHI Qol平均得分51.71%±8.9%,较术前(42.14%±6.04%)有明显提高(P<0.001),其中言语组对家庭的影响方面术后得分与非言语组差异无统计学意义(P>0.05),父母的期望及生活质量两方面言语组得分均高于非言语组(P<0.05);术后NCIQ评估言语组平均得分(51.00±0.51%)高于非言语组(31.5%±5.55%),差异有统计学意义(P<0.001);在高级声音感知、言语能力和社会交流方面言语组得分高于非言语组(P<0.05),在基本声音感知、自信心及活动能力方面两组得分差异无统计学意义(P>0.05).结论 语前聋青少年人工耳蜗植入术后生活质量可获得明显改善,术前的交流方式可影响术后的康复效果,术前使用言语交流的患者术后可以获得更好的生活质量.     

Utility of bilateral acoustic hearing in combination with electrical stimulation provided by the cochlear implant

Abstract

Objective: The aim of the study was to quantify the benefit provided by having access to amplified acoustic hearing in the implanted ear for use in combination with contralateral acoustic hearing and the electrical stimulation provided by the cochlear implant. Design: Measures of spatial and non-spatial hearing abilities were obtained to compare performance obtained with different configurations of acoustic hearing in combination with electrical stimulation. In the combined listening condition participants had access to bilateral acoustic hearing whereas the bimodal condition used acoustic hearing contralateral to the implanted ear only. Experience was provided with each of the listening conditions using a repeated-measures A-B-B-A experimental design. Study sample: Sixteen post-linguistically hearing-impaired adults participated in the study. Results: Group mean benefit was obtained with use of the combined mode on measures of speech recognition in coincident speech in noise, localization ability, subjective ratings of real-world benefit, and musical sound quality ratings. Conclusions: Access to bilateral acoustic hearing after cochlear implantation provides significant benefit on a range of functional measures.     

Is psychological status a determinant of speech perception outcomes in highly selected good adolescent cochlear implant users?

OBJECTIVE: The main purpose of this study was to assess the relationship between the speech perception skills and state-trait anxiety in cochlear implant user adolescents who were highly selected good candidates. The impact of preoperative speech perception ability on postoperative speech perception and state-trait anxiety status were also examined. SUBJECTS AND METHODS: The subjects for this study were 25 consecutively chosen congenitally profoundly deaf adolescents (12 boys, 13 girls) who received nucleus multi channel cochlear implants and were followed for at least a year at Hacettepe University. Daily Sentences in Turkish and State-Trait Anxiety Inventories (STAI) were administered to subjects after 12-72 months (mean: 35.28+/-18.27) of implant use. RESULTS: The trait and state anxiety scores were matched with the relative rank of normal hearing subjects' trait-state anxiety scores and the analysis of post-implant state-trait anxiety findings shows that both state and trait anxiety scores were widespread but still in normal range. The correlation between trait, state anxiety scores and speech perception ability was not statistically significant in adolescent cochlear implant users. However, their preoperative speech perception scores were significantly correlated with their postoperative speech perception abilities. CONCLUSION: The majority of adolescents, in this study, achieved varying degrees of open-set speech recognition and made greater gains than their previous auditory experience with hearing aids. Also, the indirect positive effects of early identification-amplification, communication therapy and counseling programs on their personal well-being is clearly observed from the outcomes of their state and trait anxiety scores. As a result of correlating the trait and state anxiety levels with pre- and post-implant speech perception skills, a significant negative correlation was expected. However, no statistical correlation was found between speech perception skills and the psychological outcomes. This result may be the indicator of the positive effect of the early habilitation-parental support and cochlear implant on the quality of life as the adolescents involved in this study were developmentally and audiologically ready for implantation. The present study provides understanding of the audiological and social-emotional influences of early identification and habilitation programs on adolescents with cochlear implants.     

Changes in interpersonal communication in pre- and perilingually deafened children after cochlear implantation

People with deep prelingual deafness cannot fluently use oral language as a basic mode of communication. Hearing impaired subjects elaborated their own mode of communication. Cochlear implants as a surgical mode of deafness treatment may create a new chance for prelingually deaf children to develop vocal speech. The aim of this study was to assess changes in interpersonal mode of communication in pre- and perilingually deaf children after cochlear implantation. It was observed, that cochlear implantation stimulates development of oral language. The possibility of hearing perception of oral language it is a chance for a child for fully participation in life of hearing societies.     

38例人工耳蜗植入儿童康复效果及其影响因素研究

目的通过对38例7岁以下语前聋植入人工耳蜗儿童进行分阶段的听觉言语康复效果评估,探讨经过1年术后康复,植入人工耳蜗儿童的听觉言语康复效果及其影响因素。方法本研究采用评估词表、标准评估程序及希内智力测试标准,对植入人工耳蜗的38例语前聋聋儿进行听觉、言语,智力评估,同时采用f检验和单因素方差分析检验康复各个阶段聋儿的听觉言语能力是否存在差异。结果听觉识别率平均值由康复训练3个月的44．2％上升至12个月的88．0％,语言平均年龄由康复训练3个月的1．1岁上升至12个月的2．7岁,统计表明差异显著（P〈0．01）。结论经过1年系统的术后康复,聋儿在听觉能力和语言能力上较术前均有显著提高,人工耳蜗术后康复具有普遍有效性。在术后康复中,年龄、智力、随读家长类型及其文化程度等是影响术后康复效果的重要因素。     

10例人工耳蜗植入儿童术后听觉、言语及学习能力发展研究

目的探讨1～7岁听障儿童植入人工耳蜗后听觉言语康复进展情况。方法在标准声场对10例儿童进行人工耳蜗术后声场听阈测试。利用听障儿童听觉言语康复评估词表在开机后3．6．9、12个月分别进行听觉言语康复评估。采用希-内学习能力测试或格蕾费斯儿童精神发育测试量表进行学习能力评估。结果随着术后康复时间的增加,10名儿童的听觉、言语、学习能力评估成绩逐步提高,提高速度和幅度存在个体差异。结论人工耳蜗植入有助于重度、极重度听障儿童的听力语言康复。术后儿童听觉言语的发展受年龄、智力、耳聋病因及术前助听器配戴情况等因素的影响。     

不同训练方法对人工耳蜗植入儿童术后康复效果影响的比较研究

目的：考察3种训练方法对人工耳蜗植入儿童术后康复效果的影响。方法随机选取2～7岁人工耳蜗植入儿童106人,其中34人接受综合感官训练法、36人接受音素辨听训练法、36人接受听觉口语训练法。采用《听障儿童听觉语言能力评估标准及方法》对所有听障儿童进行评估。结果不同训练方法对听障儿童的听觉、语言能力具有显著影响（P〈0.05）。结论综合感官训练法能在一定程度上帮助听障儿童提高语言能力,但听觉能力发展效果不佳;音素辨听训练法可促进听障儿童的细致辨听能力,但语言能力发展有限;听觉口语训练法能使听障儿童的听觉和言语能力得到均衡发展。