Better speech performance in cochlear implant patients with GJB2-related deafness.

OBJECTIVE: We applied mutation screening in seven cochlear implant users to identify those persons with GJB2-related deafness to determine whether etiology of deafness was predictive of speech performance after implantation. METHODS: Direct sequence of GJB2 was conducted over seven cochlear implant users with prelingual hearing impairment and their speech, language and cognitive performance was examined. RESULTS: The three persons with GJB2-related deafness had a mean vocabulary of 1243 words compared to a mean vocabulary of 195 words in the four children with GJB2-unrelated deafness, although the number of patients examined here was limited. The developmental quotient (DQ) of cognitive ability also was higher in those children with GJB2-related deafness. CONCLUSIONS: These preliminary results suggest that better speech performance after cochlear implantation may be observed in persons with GJB2-related deafness. In the future, detailed phenotypic studies and mutation screening for non-syndromic hearing loss may play an important role in the preoperative assessment of prelingually-deafened children.     

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.     

儿童人工耳蜗植入后的听觉言语康复

植入人工耳蜗为听力障碍儿童感知声音、重建听力奠定了良好基础，但是要使儿童在人工耳蜗植入后获得听觉言语康复必须经过长期的听觉培建，语言学习和语音异常矫治。     

人工耳蜗术后语音异常矫治

很多家长和训练者在聋儿接受人工耳蜗手术后急于让他们发音或把音发清楚，这是不符合听觉言语发展规律的。每个人言语的产生都需要有相当时间的听觉积累，在这个基础上才能模仿发音：而表达性语言的发展更需要以理解为前提。所以，初期训练中应以培养孩子的聆听能力和语言的理解积累为重点。     

Localization performance of unilateral cochlear implant users for speech, tones and noise

Bilateral cochlear implants aim to improve sound localization compared to monaural implants, among other potential benefits. Monaural cochlear implants should not support localization in the horizontal plane as there are no interaural level and time difference cues available, although some previous studies have suggested limited capability. As background to other studies of bilateral implantation, the localization abilities of 18 monaural cochlear implantees were investigated experimentally in an anechoic chamber, using various sound stimuli with different amounts of temporal information. The effects of head movement and reverberation were also investigated. Localization performance was found to be close to chance for all stimuli. It is confirmed that monaural cochlear implants are unable to support useful auditory sound localization, even when head movements are allowed.     

Localization performance of unilateral cochlear implant users for speech,tones and noise

Abstract

Bilateral cochlear implants aim to improve sound localization compared to monaural implants, among other potential benefits. Monaural cochlear implants should not support localization in the horizontal plane as there are no interaural level and time difference cues available, although some previous studies have suggested limited capability. As background to other studies of bilateral implantation, the localization abilities of 18 monaural cochlear implantees were investigated experimentally in an anechoic chamber, using various sound stimuli with different amounts of temporal information. The effects of head movement and reverberation were also investigated. Localization performance was found to be close to chance for all stimuli. It is confirmed that monaural cochlear implants are unable to support useful auditory sound localization, even when head movements are allowed.     

Residual speech recognition and cochlear implant performance: effects of implantation criteria.

OBJECTIVE: This study aimed to determine the effects of preoperative speech reception on postoperative speech recognition with a cochlear implant and to develop a statistical index allowing prediction of postoperative speech recognition before implantation. STUDY DESIGN: The study design was a retrospective case review with statistical modeling. SETTING: The study was conducted at a tertiary referral center with an associated Veteran's Administration hospital. PATIENTS: Postlingually deafened adults with and without residual speech reception participated. INTERVENTION: Cochlear implantation with Cochlear Corporation CI-22 and CI-24 devices was performed. MAIN OUTCOME MEASURES: Monosyllabic word recognition was measured. RESULTS: Duration of deafness and preoperative sentence recognition are both significant predictors of word recognition with a cochlear implant and can account for 80% of the variance in word recognition. CONCLUSIONS: Cochlear implant outcomes are variable but predictable within specific ranges.     

双侧人工耳蜗植入术后言语识别效果的评估

目的评估双侧人工耳蜗植入者汉语普通话短句、双音节词单音节词及汉语声调的识别效果,探索双侧人工耳蜗植入者双耳听觉产生的机制及对言语识别率的影响。方法选取双侧人工耳蜗植入患者6人,自制问卷收集受试者的基本信息并评估他们的主观听觉状况。首先测试受试者在使用双侧人工耳蜗（BCI）、单独使用一侧人工耳蜗（RCI/LCI）的听阈,随后测试他们在BCI和RCI/LCI两种听觉模式下的七音节短句、双音节词、声调、韵母、声母识别率,测试背景环境包括安静环境和嘈杂语噪声环境,言语信号强度为65dB SPL,固定信噪比为+10 dB SPL。随后将BCI和RCI/LCI两种听觉模式下的识别效果进行比较。结果除噪声状态下韵母识别测试中其余测试结果均为BCI言语识别率得分高于RCI/LCI。结论对于符合双侧人工耳蜗植入术适应证标准的患者而言,双侧植入人工耳蜗可以在不同程度上提高安静和噪声环境下的短句、双字词、声母、韵母及声调的识别率,降低其声场听阈。     

Predictors of cochlear implant performance

Open set speech understanding with cochlear implants, without speechreading, is nowadays a common finding. However, there is a large variation in speech understanding between cochlear implant users. We tried to find pre-operative parameters which predicted the post-operative results. Thirty-seven adult post-lingually deafened Nucleus cochlear implant users with a mean age of 46 years (range 16 68) and a mean duration of deafness of 15 years (range 1.5-47) were studied. Pre-operatively, we performed pure-tone audiometry, round window and ear canal electrical stimulation, psychological tests and imaging. Additionally, we measured pre-operatively speech understanding in the auditory, the visual and the audiovisual conditions with several tests which were also administered after 6 and 12 months' implant experience. Correlation analysis between the pre-operative variables and the post-operative factors showed that duration of deafness and residual hearing are the most important predictors. The temporal difference limen in pre-operative round window electrical stimulation is a secondary predictor.     

Audiovisual speech perception in elderly cochlear implant recipients

OBJECTIVES/HYPOTHESIS: This study examined the speech perception skills of a younger and older group of cochlear implant recipients to determine the benefit that auditory and visual information provides for speech understanding. STUDY DESIGN: Retrospective review. METHODS: Pre- and postimplantation speech perception scores from the Consonant-Nucleus-Consonant (CNC), the Hearing In Noise sentence Test (HINT), and the City University of New York (CUNY) tests were analyzed for 34 postlingually deafened adult cochlear implant recipients. Half were elderly (i.e., >65 y old) and other half were middle aged (i.e., 39-53 y old). The CNC and HINT tests were administered using auditory-only presentation; the CUNY test was administered using auditory-only, vision-only, and audiovisual presentation conditions RESULTS: No differences were observed between the two age groups on the CNC and HINT tests. For a subset of individuals tested with the CUNY sentences, we found that the preimplantation speechreading scores of the younger group correlated negatively with auditory-only postimplant performance. Additionally, older individuals demonstrated a greater reliance on the integration of auditory and visual information to understand sentences than did the younger group CONCLUSIONS: On average, the auditory-only speech perception performance of older cochlear implant recipients was similar to the performance of younger adults. However, variability in speech perception abilities was observed within and between both age groups. Differences in speechreading skills between the younger and older individuals suggest that visual speech information is processed in a different manner for elderly individuals than it is for younger adult cochlear implant recipients.     

Results of speech perception and speech production training for three prelingually deaf patients using a multiple-electrode cochlear implant.

Five studies were conducted to measure changes in the perception and production of selected speech targets, with training, in three prelingually deaf patients. The two adults and one adolescent were implanted with the Cochlear (Nucleus) multiple-electrode prosthesis. The studies were perception and production of nasal consonants; perception of syllable-final consonants; perception and production of alveolar consonants; auditory-visual perception of alveolar consonants; and perception and production of vowels. Perceptual data were collected in the audition (implant)-alone condition, except for the auditory-visual perception of alveolar consonants where the audition-alone, vision-alone, and auditory-visual conditions were used. Speech perception data in the audition-alone condition were also collected from four postlingually deaf adult implant patients, without training, to indicate differences between the two classes of patients. The three prelingually deaf patients generally showed some improvements in speech production. In perception, improvements were recorded only for individual patients in some studies. The performance of the adolescent was better than that of the two adults in all cases. The perceptual performance of the postlingually deaf patients was superior to that of the prelingually deaf patients in all cases.     

语前聋儿童人工耳蜗植入效果的评估

目的探索语前聋儿童人工耳蜗植入效果的评估方法.方法受试者为18名接受人工耳蜗植入的语前聋儿童,耳蜗植入时平均年龄6岁.按人工耳蜗使用时间长短分为四个阶段进行评估:第一阶段18名患儿,使用人工耳蜗1～12个月;第二阶段12名,使用人工耳蜗13～24个月;第三阶段8名,使用人工耳蜗25～36个月;第四阶段6名,使用人工耳蜗在36个月以上.描述性分析,以问卷的形式了解儿童在人工耳蜗植入后声音接受、言语表达及行为等方面的变化;言语测试,进行言语识别能力和发声能力测试.结果第一阶段患儿,能够感知和辨别来自家庭和环境中的声音;第二阶段患儿,封闭项词识别率是51%,开放项词识别开始启动;第三阶段患儿,封闭项词识别率达到72%,开放项词识别率是40%,能正确发出的单词数是42%;第四阶段患儿,封闭项词识别率和开放项词识别率分别达到84%和53%,能正确发出的单词数达62%,部分患儿已有自发的口语表达.结论人工耳蜗植入对语前聋患儿的言语发育有帮助,患儿的言语能力随着人工耳蜗使用时间的推移不断进步.     

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。     

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.     

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.