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PubMed1991

Bilateral electrical stimulation of a congenitally-deaf ear and of an acquired-deaf ear.

Two identical multichannel intracochlear prostheses were implanted in the same patient. The first prosthesis, implanted in the congenitally-deaf right ear, elicited clear sound perception but no speech recognition. After 2 years, a second prosthesis, implanted in the acquired-deaf left ear, enabled the patient to understand speech without lip-reading. Brainstem and middle-latency evoked potentials were similar with electrical stimulation of both ears and resembled those evoked by acoustic stimuli in subjects with normal hearing. Cortical electric and magnetic responses differed for right- and left-sided electrical stimulation suggesting that stimulation of the congenitally-deaf ear elicited an abnormal activation of the auditory cortex. These results suggest that only cortical responses were affected by the different histories of deafness of the ears.

Cochlear Implants↗
PubMed1995

Cochlear implantation improves hearing in the contralateral ear.

The electrical stimulation of deaf ears by cochlear implants (CI) improved contralateral hearing in seven patients: 5 intracochlear (IC) (analogue processor) and 2 extracochlear (EC) (digital processor) implants. Our patients obtained best speech discrimination scores (98% + 2%, n = 11) when lip reading and CI were combined with a high-power hearing aid fitted into the contralateral ear. Contralateral hearing improvement was 10-15 dB sound pressure level (SPL) at frequencies up to 4000 Hz; hearing in a previously totally deaf ear recovered 4-6 months after CI. The phenomenon was independent of the type of speech-encoding (analogue or digital). Five out of 6 reimplanted patients who first received an 8-channel digital-pulsatile EC reported better speech discrimination after the second CI, when IC devices were implanted with analogue speech processors. These results suggest that EC implantation should be considered in childhood as a first choice, since i) It does not exclude the possibility of a second IC implantation with the same success rate as for the first; ii) The inner ear sensory epithelium remains intact after EC implantation, and consequently, if any regenerating process takes place in the implanted ear due to electrical stimulation it may provide more physiological hearing later on.

Audiometry, Pure-Tone↗
PubMed1997

Central auditory information processing in patients with bilateral auditory cortex lesions.

Severe auditory cognitive disorders in 10 patients who had bilateral lesions either to the auditory cortex and/or auditory radiations were studied audiologically with special attention to residual hearing. This auditory cognitive problem is called "auditory agnosia or cortical deafness". Our study revealed that auditory information processing for pure tones, monosyllable discrimination, environmental sound perception, and auditory comprehension is commonly but differently affected by bilateral lesions of auditory cortex or auditory radiation. In summary, these patients can discriminate loudness of pure tones and some environmental sounds but cannot clearly perceive any sounds of monosyllables and sentences. Generally their residual hearing is useful for auditory awareness and is often enhanced by lip reading.

Adult↗
PubMed1982

Pure-tone and speech intelligibility disturbances in patients with ototoxic disorders.

The prevalence and severity of hearing impairment caused by ototoxic drugs are surprisingly high. This emphasizes the importance of the questions arising from the treatment. In 33.7% of the cases, the hearing impairment caused by ototoxic antibiotics was of severe degree and in 25.4%, it was extremely severe. Parenteral, topical or oral administration of aminioglycoside antibiotics is dangerous. Because of the very poor speech intelligibility, most probably not only the spiral organ but the vestibulocochlear nerve and the higher auditory pathways are also affected by these antibiotics. In some cases, the severe distortion in sound perception cannot be compensated even by a hearing aid of the best quality, and lip-reading which was advised occasionally was without any result. To prevent these toxic effects, these drugs should be administered very parsimoniously and then under very strict conditions and close control.

Aminoglycosides↗
PubMed1988

Age-related hearing difficulties. I. Hearing impairment, disability, and handicap--a controlled study.

The study compares the audiological profile of a group of first-time applicants for hearing aids, a group of re-applicants and a group of non-complainers, aged 70-75 years (n = 71). In spite of overlap in range, a significant difference in thresholds and discrimination was found. The lip-reading capacity was well preserved in the elderly, but showed a significant correlation to the general health condition. The audiological benefit of hearing-aids did not increase with early fitting. General satisfaction with life was independent of satisfaction with hearing; two thirds of the patients were satisfied with their aids and used them regularly. The rest were dissatisfied and used them less than once a week. The aids were most systematically used to watch TV. Pure-tone average and handicap scaling were compared as guidelines for hearing-aid fitting. The most powerful tool to identify those in need of hearing-aids was handicap scaling based on interviews concerning self-assessed hearing difficulties.

Aged↗
PubMedDate not supplied

Cochlear implants in China.

China has approximately 6 million totally deaf people according to an official survey conducted in 1990, although the actual number is probably higher. A primary cause of deafness is the use of ototoxic drugs. There does not appear to be any emergent deaf culture in China at present. As the only available medical device that can restore partial hearing to a totally deaf person, the cochlear implant has been in development in China since 1979. This paper provides an overview of cochlear implants in China and is based on a review of published materials, visits to research institutes and hospitals, and personal communication with Chinese colleagues. As of 1993, about 1,000 deaf people, including 50 children below age 12 years, have received four types of single-electrode cochlear implants that were developed and fabricated by institutions in China. These single-electrode devices have provided an aid to lip reading, but are no longer in use due to their inability to produce open-set speech recognition. Present implant research in China focuses on development of multi-electrode devices. Basic research in electrical stimulation is relatively lacking and standardized audiological evaluation for cochlear implant effectiveness needs to be developed. The present economic growth and legal system reform in China, combined with advances in implant technology, may make it possible to produce an affordable yet effective cochlear implant system. This paper discusses cochlear implants only in China, but the social and economic factors are similar in many developing countries in Asia, South America, Eastern Europe, and Africa, where a low-cost, high-performance cochlear implant system is also needed.

Child↗
PubMed1984

Extracochlear electrical stimulation.

Extracochlear electrical stimulation was carried out in 7 patients. We used square-wave signals. Electrode positions at the oval and round window showed the lowest current thresholds. The threshold of sound sensations elicited by electrical stimulation was higher in the high frequency than in the low frequency range. All 7 patients had hearing sensations for electrical stimulation with frequencies from 75 Hz to 1 000 Hz, 4 of them to 3 000 Hz. Varying the frequency of the electric signals gave variations of pitch sensation. A higher input amplitude gave variation in pitch sensation in some patients even if the electric frequency remained constant, at least for frequencies below 500 Hz. It seems possible to give prosodic information by transforming the speech from a microphone into electric pulses. This may be especially valuable information of the intelligibility of speech when combined with lip reading.

Auditory Threshold↗
PubMed1997

A randomized, controlled trial of the efficacy of a communication course for first time hearing aid users.

Many centres include a communication course as part of their auditory rehabilitation. These usually take the form of a small group and include discussion of the effects of hearing loss, use of the hearing aid, hearing tactics and lip reading. To investigate the efficacy of such a rehabilitation programme a randomized, controlled trial of a communication course was undertaken. All subjects were first time hearing aid users; handicap was measured using the Quantified Denver Scale of Communication Function (QDS) at the time of hearing aid fitting, and then 13 weeks later. All subjects had a hearing aid follow-up appointment, but the treatment group (n = 22) also underwent a four-week communication course, while the control group (n = 25) had no further rehabilitation. The reduction in handicap measured by the change in QDS was significantly greater for the treatment group than for the control group (Mann Whitney U test, tied p value = 0.014). This indicates that such a communication course is efficacious in reducing handicap. Further research is required to identify the populations that will benefit most from such a course.

Aged↗
PubMed1988

The tactile acoustic monitor as an aid for post-lingually totally deafened adults: a pilot study.

Two women with a total acquired hearing loss who had previously derived no benefit from hearing aids were fitted with the tactile acoustic monitor (TAM) (Summers et al., 1981). Speech perceptual and productive abilities were assessed using a variety of tests prior to TAM fitting, at the time of fitting and after one month of daily use but without detailed training. Self-report and questionnaire data were also obtained. Results indicated that the TAM aided the detection but not recognition of environmental sounds. Lip-reading was not improved, and there was a worrying trend toward the use of an elevated voice pitch with changes in voice quality including increased occurrence of creaky voice.

Aged↗
PubMed1989

Non-invasive electrical stimulation of the ear canal as a communication aid in acquired total deafness.

Some profoundly deafened patients, who cannot be helped by sound amplification, claim to perceive auditory sensations when alternating currents up to 100 Hz are passed through electrodes applied to the skin of the external ear canal. A portable speech processor has been developed which supplies this current. The signal is a balanced square wave, the frequency of which is proportional to the first formant frequency. The amplitude is proportional to the intensity of voiced sounds. In order to fit the narrow frequency and dynamic range of the electrical stimulus, the speech processor produces a downward frequency transposition and strong limitation of the dynamic range. The device has been tested for (1) discrimination of environmental sounds; (2) question/statement discrimination; (3) identification of vowels and consonants in vowel/consonant/vowel context; (4) lip-reading with and without the prosthesis.

Adult↗
PubMed1990

A procedure for measuring auditory and audio-visual speech-reception thresholds for sentences in noise: rationale, evaluation, and recommendations for use.

The strategy for measuring speech-reception thresholds for sentences in noise advocated by Plomp and Mimpen (Audiology, 18, 43-52, 1979) was modified to create a reliable test for measuring the difficulty which listeners have in speech reception, both auditorily and audio-visually. The test materials consist of 10 lists of 15 short sentences of homogeneous intelligibility when presented acoustically, and of different, but still homogeneous, intelligibility when presented audio-visually, in white noise. Homogeneity was achieved by applying phonetic and linguistic principles at the stage of compilation, followed by pilot testing and balancing of properties. To run the test, lists are presented at signal-to-noise ratios (SNRs) determined by an up-down psychophysical rule so as to estimate auditory and audio-visual speech-reception thresholds, defined as the SNRs at which the three content words in each sentence are identified correctly on 50% of trials. These thresholds provide measures of a subject's speech-reception abilities. The difference between them provides a measure of the benefit received from vision. It is shown that this measure is closely related to the accuracy with which subjects lip-read words in sentences with no acoustical information. In data from normally hearing adults, the standard deviations (s.d.s) of estimates of auditory speech reception threshold in noise (SRTN), audio-visual SRTN, and visual benefit are 1.2, 2.0, and 2.3 dB, respectively. Graphs are provided with which to estimate the trade-off between reliability and the number of lists presented, and to assess the significance of deviant scores from individual subjects.

Adolescent↗
PubMed1991

Comparative speech recognition results in eight subjects using two different coding strategies with the Nucleus 22 channel cochlear implant.

This study was designed to compare the results of several speech tests administered to eight subjects who used two types of speech-coding strategies with the Nucleus 22 channel cochlear implant. The subjects had an average experience of 40 months with the F0F1F2 coding strategy implemented in their previous wearable speech processor. Three subjects were good performers (showing significant open-set understanding without lip-reading) and five were moderate performers (not able to do speech-tracking by auditory means alone). All subjects were evaluated again after 1 month and 6 months of experience with the MULTIPEAK coding strategy of the miniature speech processor. The test materials included vowel and consonant identification, monosyllabic words, everyday sentences and numbers in noise. All eight subjects showed an improvement on more than three of five measures. The group of moderate performers showed a larger improvement in vowel (+16%) and consonant (+17%) identification scores than the group of good performers. For the open-set sentence test, the better patients were able to increase their score from 52% to 80% correct; two of the moderate performers did not improve. Six subjects achieved significantly higher scores at moderate signal-to-noise ratios (up to 10 dB S/N) in the (Freiburger) number test. Results of information transmission analysis are also discussed.

Acoustic Stimulation↗
PubMed1992

Abstract versus modality-specific memory representations in processing auditory and visual speech.

Serial recall of lip-read, auditory, and audiovisual memory lists with and without a verbal suffix was examined. Recency effects were the same in the three presentation modalities. The disrupting effect of a suffix was largest when it was presented in the same modality as the list items. The results suggest that abstract linguistic as well as modality-specific codes play a role in memory for auditory and visual speech.

Adult↗
PubMed1997

Cultural and linguistic factors in audiovisual speech processing: the McGurk effect in Chinese subjects.

The "McGurk effect" demonstrates that visual (lip-read) information is used during speech perception even when it is discrepant with auditory information. While this has been established as a robust effect in subjects from Western cultures, our own earlier results had suggested that Japanese subjects use visual information much less than American subjects do (Sekiyama & Tohkura, 1993). The present study examined whether Chinese subjects would also show a reduced McGurk effect due to their cultural similarities with the Japanese. The subjects were 14 native speakers of Chinese living in Japan. Stimuli consisted of 10 syllable (/ba/, /pa/, /ma/, /wa/, /da/, /ta/, /na/, /ga/, /ka/, /ra/) pronounced by two speakers, one Japanese and one American. Each auditory syllable was dubbed onto every, visual syllable within one speaker, resulting in 100 audiovisual stimuli in each language. The subjects' main task was to report what they thought they had heard while looking at and listening to the speaker while the stimuli were being uttered. Compared with previous results obtained with American subjects, the Chinese subjects showed a weaker McGurk effect. The results also showed that the magnitude of the McGurk effect depends on the length of time the Chinese subjects had lived in Japan. Factors that foster and alter the Chinese subjects' reliance on auditory information are discussed.

Adult↗
PubMed1999

[The prognostic value preoperative promontory testing in Japanese cochlear implant patients].

The prognostic value of preoperative promontory testing was evaluated in Japanese cochlear implant patients. Promontory testing consisted of measurement of electrical thresholds (T), uncomfortable level (UCL), dynamic range (DR), gap detection (GAP), and temporal difference limen (TDL). Patients' performances were measured at 3 months (n = 46) and 1 year (n = 20) postoperatively, using a standard Japanese audiologic test battery without lip-reading. This study included only postlingual deaf patients who received the Nucleus multichannel cochlear implant. Wide DRs at low frequencies (50,100,200 Hz) and good GAP detection (< 20 ms) emerged as excellent preoperative predictors of the 3-month postoperative performances (P < 0.05). In contrast, any measurements could not serve as a good predictor of the 1-year performances. These results suggest that the preoperative promontory testing provides useful information only for early postoperative performances but that it could not predict the final language performances.

Adolescent↗
PubMed2000

[Management of the acoustic tumor in an only/better hearing ear].

Because profound bilateral hearing impairment is a catastrophic event, the management and care of an individual with an 8th nerve lesion in an only/better hearing ear remains a significant challenge for both patient and physician. Current options regarding the treatment of the acoustic tumor in an only/better hearing ear include: observation, attempted hearing preservation surgery and stereotactically guided radiation therapy. In this article, we present 3 cases of acoustic tumor within the internal auditory canal in an only/better hearing ear diagnosed by gadolinium-enhanced MRI and discuss the recommendations, especially observation, available in the care of these cases. In one patient, hearing disturbance caused by the tumor in a better hearing ear made the patient quite depressive and desperate. One of the most important consideration is for the physician to provide the patient with adequate informed consent regarding the possibility of profound bilateral hearing loss caused by either the natural growth or surgical removal of the tumor in the future, and alternative methods of communication with others such as: hearing aid and lip reading, cochlear implant and brainstem implant.

Aged↗
PubMed2001

[Speech perception ability in a patient with a 8-channel auditory brainstem implant].

Auditory brainstem implant (ABI) is a central prosthesis that directly stimulates the cochlear nucleus in the brainstem for those who have interrupted auditory nerves and cannot benefit from the cochlear implantation. Speech perception in a recipient of the Nuclues 8 channel ABI, the first in Japan, is reported. A 25-year-old man with bilateral acoustic nerve tumors postlingually deafened due to tumor resection received auditory sensations with 5 channels. The correct answer using a coding strategy, SPEAK, was 35% for 5 vowels and 36% for 5 monosyllables. The use of ABI also improved his lip-reading ability on monosyllables and open-set words. This indicated that he benefited from ABI, although it was limited. Even after 1 year and 3 months of follow-up, he had no serious side effects such an infection or implant rejection.

Adult↗