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PubMed1989

[Modification of speech encoding process of single channel cochlear implant utilizing digital delay circuit].

Speech perception by single channel cochlear implant can be improved to some extent by modifying the encoding process of the speech signals. The principle of our encoding strategy is to present speech signals with appropriate delay time for lower frequency components of the speech sound, while without delay for higher frequency components. This is based on a cochlear physiology that higher frequency sounds are perceived earlier than lower frequency sounds, since the former is perceived at the basal turn and the latter at the apical turn. The following tests were performed without the aid of lip reading in the two patients implanted with a single channel cochlear implant of 3M-House design. Lower frequency components of the speech signals were digitally delayed with a Sony SDP-777 ES surround processor. The results indicated that the optimal delay time for identification of /i/, /e/ and /u/ needed longer delay time, while that of /a/ and /o/ need shorter delay time, corresponding to the difference between the first and second formant of each vowel. Comparison of vowel perception with and without delay coding showed that vowel identification with delay coding was superior to that without it; 30% vs. 16% in case 1, and 48% vs. 30% in case 2.

Adult↗

PubMed1992

[The effects of early manual instruction on the oral language development of two deaf children].

The speech and language training for deaf children at our clinic is performed using a multisensory method, which consists of reception and expression training for sign language and fingerspelling as well as auditory training, lip reading, and written language training (the Kanazawa Method). We have already reported that acquisition of written language is not dependent on oral language, and that written language is easier to learn than oral language for deaf children. In the present investigation, we analyzed the acquisition of comprehensible and expressive vocabulary in sign language and fingerspelling. The subjects were two children congenitally deaf at levels higher than 105dB. Recorded language samples by the age of 48 months were analyzed. Acquisition of sign language was found to be significantly easier than acquisition of oral language. The development of expressive noun words, function words, and Wh-question words in sign language at the early period was almost equivalent to that of hearing peers, and then the sign language appeared transfer to the oral language. These results suggest that early presentation of sign language with written and oral language is effective in the acquisition of communicative attitudes, function words and interrogative sentences which are most difficult for the hearing-impaired. It was shown that early presentation of sign language with written and oral language serves to promote acquisition of oral language.

Child↗

PubMed1996

[Cochlear implant in a child with acquired deafness].

The auditory training course of a 3-year-5-month-old child with acquired deafness who received a Nucleus 22 channel implant is reported. Soon after switching it on, her response was not very clear. There was good subsequent progress in auditory discrimination, whereas the patient's major communication strategy preoperatively had been manual, lip-reading, and written language. Her vowel discrimination score reached 100% in 8 months. The patient's articulation and speech intonation has also improved, and her auditory reception of environmental sounds has also shown relative improvement.

Child, Preschool↗

PubMed2004

Communicating about health care: observations from persons who are deaf or hard of hearing.

BACKGROUND: Achieving patient-centered care requires effective communication between physicians and patients. Persons who are deaf or hard of hearing face considerable barriers to communicating with physicians. OBJECTIVE: To understand perceptions of health care experiences and suggestions for improving care among deaf or hard-of-hearing individuals. DESIGN: 4 semistructured group interviews, 2 conducted in American Sign Language (for deaf individuals) and 2 using Communication Access Realtime Translation (for hard-of-hearing individuals). Men and women were interviewed separately. Tapes of interviews were transcribed verbatim for analysis. SETTING: Greater Boston, Massachusetts, and Washington, DC, in 2001. PARTICIPANTS: 14 deaf adults (23 to 51 years of age) and 12 hard-of-hearing adults (30 to 74 years of age). MEASUREMENTS: Commonly expressed themes or views organized around dimensions of communication. RESULTS: Concerns coalesced around 6 broad themes: conflicting views between physicians and patients about being deaf or hard of hearing; different perceptions about what constitutes effective communication (such as lip reading, writing notes, and sign language interpreter); medication safety and other risks posed by inadequate communication; communication problems during physical examinations and procedures; difficulties interacting with office staff, including in waiting rooms; and problems with telephone communication, such as lengthy message menus. Participants offered extensive suggestions for improvements, starting with clinicians' asking patients about their preferred communication approach. Having patients repeat critical health information (such as medication instructions) can identify potentially dangerous miscommunication. CONCLUSIONS: As the population ages, physicians will encounter many more persons with hearing limitations. Physicians are not reimbursed for making some accommodations, such as hiring sign language interpreters. However, ensuring effective communication is essential to safe, timely, efficient, and patient-centered care.

Adult↗

PubMed2000

[Aging and deafness].

The hearing loss that appears with ageing or presbyacusis should not lead to withdrawal from communication an elderly person. The disorder should be recognised early. The first warning sign is difficulty for understanding in a noisy environment. When an individual indicates this problem, measurements of auditory functions should first be made and regular followed-up should be scheduled or therapeutic measures taken. Such measures generally include a hearing aid that amplifies the affected frequencies and speech therapy to learn lip reading. Some patients may profit from psychological follow-up during this new learning process. The family physician is crucial in the rehabilitation in encouraging the patient to seek medical help as soon as hearing loss begins.

Aged↗

PubMed2000

Perception of facial features and face-to-face communications in space.

This paper examines how human face-to-face communications may be compromised by exposure to the microgravity environment of space. Although efficient face-to-face communications are acknowledged to be essential for astronauts to work safely and effectively, the space environment causes facial edema, and allows speakers and listeners to confront one another in multiple orientations that can potentially interfere with many important non-linguistic communication cues. In addition, high background noises in space shuttles and stations can mask auditory messages. Currently, the effects of spaceflight on the ability to identify facial features, to read lips, to integrate visual and auditory sensory information, and to interpret spoken messages in noisy environments while the speakers are at various orientations with respect to the listeners, are virtually unknown. Ground-based experiments conducted in our laboratory with computer-displayed facial images presented at various orientations have suggested how non-linguistic cues may be degraded by changes in the retinal orientations of facial images. The results of our ground-based studies illustrating impaired recognition of facial features in non-erect images are described, their implications for effective face-to-face communications among astronauts in space are discussed, and two experiments that can quantify the effects of microgravity on face-to-face communications in space are outlined.

Adult↗

PubMed2000

[Results and experiences with 55 cochlear implantations].

INTRODUCTION: The etiology of deafness in deaf people is defects in the cochlea hair cells. Cochlear implant treatment gives deaf born and patients with acquired deafness the possibility to reestablish or obtain hearing by electric stimulation of the cochlear nerve. In this paper the results of treatment of 35 adults and 20 children are reported. METHOD: The candidates for cochlear implant treatment are extensively investigated before the decision is made to operate. The operative treatment takes place under general anaesthesia and the operative technique is outlined. In the treatment of the deaf, different types of implants and stimulation strategies have been used. The effect of treatment is considered by hearing test and evaluation of speech. RESULTS: Nine of the adults obtained a hearing quality that made using a telephone possible. Almost all adults can by the combination of cochlear implant and lip reading perform a normal conversation. The results in the deaf born children are obtained slowly as the deaf born have to develop hearing and speech from zero. All the treated children have improved possibilities of communication. DISCUSSION: Cochlear implant treatment of deaf people now seems well established both internationally and nationally in Denmark. Cochlear implant equipment has improved considerably throughout the past years and that it today is possible to establish hearing in deaf born or patients with acquired deafness can be considered as one of the greatest developments in otology, maybe the greatest.

Adolescent↗

PubMed1999

[The clinic application of multichannel cochlear implant with eleven cases reported].

OBJECTIVE: To review the effects of profound sensorineural deaf patients who were implanted multichannel cochlear. METHOD: Eleven profound deaf patients (6 prelingually deaf and 5 postlingually deaf) were implanted with twenty-two (model Minisystem 22) and twenty-four (model Nucleus 24) channel cochlear. Mapping of cochlear speech processor was done in 1 to 1.5 months after operation. RESULT: All of 11 patients obtained the hearing. The patients with postlingually deaf can dialog and communicate with telephone after a simple language training without lip reading training. These patients achieved the best results, they not only stepped in sound world but also obtained a normal living and work. In the prelingually deaf patients, they got hold of incoordinate progress in speech ability after assess and speech training. CONCLUSION: The multichannel cochlear implant had good effects in profound deaf patients, especial in postlingually deaf patients and younger children.

Adolescent↗

PubMed2003

Petrous bone fractures in children: risk of meningitis, and indication for early Cochlear implant?

The case of a 5 year old boy who had a right petrous bone fracture with right CSF otorrhea and deafness is reported. This child presented, three years after the trauma, a right side otitis media, complicated by meningitis and pneumococcal sepsis, which might have as consequence a left side deafness. The bilateral deafness and the early possibility for cochlear ossification made us decide rapidly on a cochlear implant. Benjamin was then operated for a left side cochlear implant 40 days after contracting meningitis. Two months later, this boy was able to understand a speech without lip reading. Current concepts in the management of petrous bone fractures with CSF otorrhea are reviewed in this report. We also discussed prophylactic attitudes to adopt to reduce the risk of post temporal bone fracture meningitis.

Accidental Falls↗

PubMed2004

Adaptation of neuromagnetic N1 responses to phonetic stimuli by visual speech in humans.

The technique of 306-channel magnetoencephalogaphy (MEG) was used in eight healthy volunteers to test whether silent lip-reading modulates auditory-cortex processing of phonetic sounds. Auditory test stimuli (either Finnish vowel /ae/ or /ø/) were preceded by a 500 ms lag by either another auditory stimulus (/ae/, /ø/ or the second-formant midpoint between /ae/ and /ø/), or silent movie of a person articulating /ae/ or /ø/. Compared with N1 responses to auditory /ae/ and /ø/ when presented without a preceding stimulus, the amplitudes of left-hemisphere N1 responses to the test stimuli were significantly suppressed both when preceded by auditory and visual stimuli, this effect being significantly stronger with preceding auditory stimuli. This suggests that seeing articulatory gestures of a speaker influences auditory speech perception by modulating the responsiveness of auditory-cortex neurons.

Acoustic Stimulation↗

PubMed2006

Speech discrimination and intelligibility: outcome of deaf children fitted with hearing aids or cochlear implants.

We retrospectively studied outcome of a sample of 36 congenitally deaf children who were fitted with either a conventional hearing aid (HA, N = 14) or a cochlear implant (CI, N = 22), and who received many years of audio-phonatory training by our multi-disciplinary team. In order to rate speech discrimination perception, we developed a new metric of speech discrimination performance based on several existing discrimination tests for the French language. Speech perception skills were measured with and without lip-reading cues. We also studied the evolution of auditory capacity in real-life situations, and the evolution of the intelligibility of spoken language during a five year period. To rate auditory capacity and speech intelligibility, we used commonly used metrics: CAP and SIR. During the five successive years of observation, CAP and SIR scores improve for both the HA and CI children. Improvement, however, is more pronounced for the CI children. At the end of the 5-years period, CAP and SIR scores of CI children are significantly higher than those of HA children. Our study is one of few that evaluates outcome of HA and CI fitting with age matched congenitally deaf children anno 2000.

Adolescent↗

PubMed1991

[The "Ineraid" multichannel cochlear implant].

In Geneva from 1985 to November 1990, we have implanted 21 Ineraid TM multichannel-cochlear implants in 18 totally deaf patients. On the basis of our experience we have divided the patients in 2 categories: optimal cases and difficult cases. Optimal cases had post lingual deafness and adequate anatomical conditions for implantation. They all recovered understanding of free running speech without lip-reading. Difficult cases had ossified cochlea or pre-and-perilingual deafness: results are variable and less predictable. The cochlear implant is both an artificial sense organ and a prosthetic device. With the aid of the prothesis the patient can hear. When the processor stops functionning the patient is again totally deaf. Implanted deaf patients require life-long technical and medical support.

Cochlear Implants↗

PubMed1991

Speech-perception aids for hearing-impaired people: current status and needed research. Working Group on Communication Aids for the Hearing-Impaired.

Both the overall aging of the population and its exposure to higher noise levels have increased the tendency to hearing loss and the importance of improved hearing aids for speech perception. This article reviews improvements in conventional electroacoustic hearing aids, as well as recently developed alternative classes of speech-perception aids, including surgically implanted cochlear stimulators, and vibrotactile, electrocutaneous and optical stimulating devices. It is concluded that the most effective aid for the vast majority of hearing-impaired persons is, and will remain for the immediate future, the electroacoustic hearing aid. In those cases for which no benefit is demonstrated for the electroacoustic aid, generally meaning persons with profound hearing loss, either the cochlear implant or a tactile aid may provide some improvement in the understanding of speech. In rare cases, some speech understanding in the absence of lip reading is achieved by patients with cochlear implants, for unexplained reasons. This and other pressing questions about speech processing need to be addressed by the research community if more effective aids are to be developed for the use of the 36.5 million hearing-impaired persons expected in the U.S. by the year 2050.

Aged↗

PubMed1989

[Results of rehabilitation of patients after cochlear implantation of a single-channel extracochlear neuroprosthesis manufactured in Czechoslovakia].

The authors present an account of the results of rehabilitation of the first three subjects after cochlear implantation of a Czechoslovak single-channel neuroprosthesis. The results of rehabilitation were evaluated by means of specially designed videotests and audiotests to make the results comparable with results of neuroprostheses implanted abroad. Based on these tests--in particular MSD--they reached the unequivocal conclusion that the results of cochlear implantation of the Czechoslovak extracochlear neuroprosthesis, as far as rehabilitation is concerned, compare favourably with results achieved by other neuroprosthesis of this type. In all three patients the neuroprosthesis mediates to the patients information on the presence of sound, in many instances it makes identification of this sound possible. In combination with lip-reading the patients are able without major problems to communicate with the environment. Resocialization of the operated patients was achieved.

Adult↗

PubMed1989

[Auditory and communication learning in patients with cochlear implants].

Nowadays the cochlear implant (CI) offers a new method of hearing, especially for deaf patients who do not benefit from conventional hearing aids. However, it may be difficult to get used to this kind of hearing advice. CI users have special problems in interpreting strange acoustic sensations and relating them to auditory features of language and noise they knew before the onset of deafness. An interdisciplinary approach is very important for rehabilitation. Beside otological examination and the surgical implantation, audiological assessment is needed for the correct adjustment of the speech processor and for measurement of performance. Also auditory management and counselling of deaf patients is an important part of CI rehabilitation. A learning programme in hearing and communicating ("hearing training") is offered to CI users that takes account of different linguistic levels. Auditory learning by the use of CI is based on different abilities of the deaf patient, of which the most important are speech skills and learning capacity. Although success rates vary, it certainly improves speech intelligibility during lip reading, communication behaviour, and recognition of environmental noise. The latter ability improves orientation in the acoustic surroundings. CI rehabilitation may improve the psychosocial attitude of the deaf.

Cochlear Implants↗

PubMed1978

Peripheral auditory processing in normal and abnormal ears: physiological considerations for attempts to compensate for auditory deficits by acoustic and electrical prostheses.

The processing of complex acoustic signals, such as speech, by the normal peripheral auditory system is described in terms of the properties of individual cochlear nerve fibres and the effects of lateral inhibition in the cochlear nucleus. The implications of the peripheral filtering of signals is indicated in psychophysical terms. In cochlear pathology, these filtering characteristics deteriorate, and the implications arising from the consequent deterioration in auditory frequency selectivity are outlined for the coding of loudness and for the analysis of speech. These considerations suggest theoretically ideal methods of compensation for recruitment by multichannel instantaneous compression, and for deterioration in format analysis by dichotic frequency partition. Finally, the implications for a minimal design for artificial electrical multi-electrode array stimulation of the cochlea in order to impart speech information to the profoundly deaf, are explored. Single wire stimulation, on the other hand, should be able to impart useful prosodic and minimal speech feature information to aid in lip reading and in the acquisition of speech.

Animals↗

PubMed1987

The UCSF/Storz cochlear implant: patient performance.

Clinical trials of the UCSF/Storz multichannel cochlear implant were initiated in February 1985, under the sponsorship of Storz Instrument Company. This four-channel device uses simultaneous bipolar, radial stimulation and a vocoder-based speech processing scheme. To date, eighteen patients have been implanted with the UCSF/Storz implant at four clinical centers in the United States. Based on data accumulated through June 1986, fifteen of these patients had received their speech processors and were given at least an initial evaluation of their performance with the implant. Results have been very encouraging, with all but two of these patients obtaining some degree of open-set auditory-only speech recognition. Most patients have demonstrated improvement over time without extensive rehabilitative intervention and all patients have attained an enhancement in lip-reading ability, as measured with a tracking procedure. According to a self-rated performance scale, all patients have experienced improvement in general communicative function since receiving the implant.

Adult↗

PubMed1988

[Clinical results of the multielectrode cochlear implant in the rehabilitation of 27 cases of acquired total deafness].

Multi-electrode cochlear implants allow verbal discrimination without lip reading in a manner dependent directly on the liminal threshold value during the preoperative electrical stimulation of round window test, and the quality of socialization and motivation of the patient. Overall auditory performances of 27 patients rehabilitated in this way are reviewed and compared with those obtained by other teams and other apparatuses.

Adult↗