SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
In all of our cases, phonetic discrimination has been obtained without the help of lip-reading. Speech intelligibility is generally better in postlingual deafness that in prelingual deafness. We believe this method, despite the size of the external transmitter, is best for rehabilitation of totally deaf patients.
This paper describes a case study of a single deaf individual who has been using a vibrotactile aid for approximately 13 years. He has acquired the ability to lip-read speakers in three languages, using the speech-analyzing device that he and his collaborators have developed. The report describes his communicative abilities with and without the aid in his native language, which is Russian, and in English and Hebrew. When he was tested with the De Filippo-Scott connected-discourse tracking technique, the aid produced a considerable improvement in performance over that for unaided lipreading. The amount of improvement was a function of several factors, in particular his unaided lipreading rates for the different languages.
To obtain some speech discrimination without lip reading it is necessary to elicit different frequency sound sensations in the totally deaf cochlea. Thus, electrically proofs compartments must be created all along the cochlear keyboard. The placement of twelve intracochlear electrodes is greatly facilitated by using our electrode-bearer, which is introduced through the round window by a posterior tympanotomy approach. However, partial or complete ossification of the cochlea may sometimes necessitate the use of our first technique of placement of electrodes one by one with Silastic pieces through twelve cochlear fenestrations. The indications for implanting depend on certain immutable criteria (total deafness, auditory response to electrical stimulation of the round window, patient's motivation), but other criteria are also described and discussed (socialization level, cochlear ossification, and preoperative electrophysiologic data). Associated handicaps (autism, blindness, tetraplegia) are not contraindications and often represent supplementary reasons for implantation.
Our choice of a unicanal extracochlear implant is characterized by a reasonable attitude and simplicity. Simplicity and reason, because the already existing experiments show that in the field of cochlear implants there is no correlation a priori between the satisfaction of the research worker developing a complex electronic system in the laboratory and the satisfaction of the patient benefiting from such a system. Furthermore, the extracochlear implant respects and conserves the anatomical structure of the cochlea. It does not compromise future interventions. A replacement could be carried out in the future should a more perfected system be invented. The latter argument is particularly useful if a child is being considered for an implant. All patients with implants benefit from the following results: the satisfaction of hearing their own voice again, a better control of the voice (loudness and intensity), comprehension is facilitated (lip reading and noise perception), end of the sensation of isolation. The first results obtained are very encouraging. We find it most essential to continue our work in the same manner and with an inter-University working group (GRIC). The standardisation of results of the various teams involved seems to be imperative. We conclude by the following: At the present state of our knowledge, the unicanal extracochlear implant seems to be a reasonable solution and a realistic approach in the rehabilitation of total bilateral deafness.
The implantation of an electrode into the cochlea of profoundly hearing-impaired adults now promises to be a viable alternative for rehabilitation. In this article we describe six different kinds of cochlear implants, the single-channel devices developed in Los Angeles, Stanford, and Vienna, and the multichannel devices developed in Melbourne, San Francisco, and Utah. We then present results from our own patients implanted with the Los Angeles, Vienna, and Melbourne cochlear implants. All systems provide information about environmental sounds and prosody, which can improve lip-reading ability. Only our patients implanted with the Melbourne system have been able to recognize words in unknown sentences, although others have reported such spectacular performance with single-channel devices. We stress the importance of recorded tests, of material that is unfamiliar to the patient, and of avoiding multiple presentations of the test material.
Most cases of total deafness are due to destruction of Corti's organ leaving some of the auditory nerve fibres untouched. When these fibres are electrically stimulated the patient may perceive sounds the pitch of which depends upon the location of the stimulated nerve-endings along the cochlea. An intracochlear electronic device with 12 electrodes implanted in different areas and driven from outside by a portable radiofrequency emitter provides the patient with new hearing and some speech intelligibility. After several months' training words and sentences can be recognized without having recourse to lip reading. Performances depend upon a variety of factors, many of which can be determined prior to implantation. The long-term results obtained in 54 totally deaf patients are reported.
An operation of the last ear should not be rejected completely, neither from the clinical nor from the audiological point of view. The special pathology of the ear should be considered critically. Many factors can influence the success of the surgical intervention. An exact and adequate diagnosis taking into consideration all the risk factors has to precede each intervention on the last ear. The personality of the patient and his psychological structure have an important influence on the final decision. The surgeon must be very thorough and careful in explaining the possible consequences of an operation. The intervention should be carried out by an experienced surgeon using a tried and proven method. In the case of operations that are neither threatening the life of the patient nor absolutely necessary from the medical point of view he should stop the intervention when--during the operation--the risk for the remaining hearing capacity results to be too high. In this situation the ear should be dried up and prepared for an hearing-aid. We should ever keep in mind that the hearing-aid even if the communication is not fully-satisfying--is better than an understanding by only lip-reading. The medical principle "nil nocere" is particularly important for the last ear.
Deaf patients depend on intermediate vision for interpersonal communication. Deaf presbyopes are at a particular disadvantage since they are usually corrected for near and far vision with bifocals without consideration of their intermediate vision. Progressive addition lenses were used in this study to provide an intermediate correction for a group of deaf presbyopes. The patients' communication ability was tested through Varilux II lenses and habitual bifocals on a series of standardized lip reading and sign language tests. The patients showed better visual communication skills with the progressive adds, a preference for the progressive adds, and the impression of better vision through the progressive addition lens as opposed to their habitual bifocals.
In principle, an acoustic contact with the environment can be achieved in all cochlear implant patients. However, the results vary greatly in our 37 surgically treated cases. On average, our patients can (1) perceive background noises, (2) recognize different human voices, (3) differentiate differences in pitch, (4) improve lip reading and (5) improve pronunciation appreciably. (6) In addition, closed speech is largely understood. Apart from these average values, we were able to observe a beginning of open speech in 20% of the cases (simple sentences from everyday speech). A precise statistical documentation is presented with an evaluation table we have elaborated. The results of comparison between the pre-lingual and post-lingual patients are analyzed statistically. The special significance of subjective evaluation of the advantages of cochlear implant on the part of the patients is pointed out. The lower age limit in our patient material is 10 years.
1. Replacement of a non-functioning cochlea by a prosthetic device appears to be quite feasible. 2. In their current form, such prostheses provide only a rudimentary auditory perception, permitting discrimination of some simple noises, but providing substantial aid in lip reading. Speech perception is limited to a few words. 3. Further improvements of the prosthesis must take the patho-physiological situation into account: (a) It will be necessary to establish connections between individual electrodes and limited groups of cochlear nerve fibers so as to achieve a correct space/time/amplitude distribution of the applied signals; (b) signal components which are to be transmitted to selected nerve-fiber groups have to be encoded in such a way that they can be correctly processed by those fibers. 4. Only the future will show if the current prosthesis can still be improved. Even if one assumes that substantial improvements can be made, it is doubtful that "normal" speech perception can be restored.
Although single-channel electrode arrays implanted in the scala tympani of deaf patients are useful as an aid to lip reading and for distinguishing some environmental sounds, they do not transmit intelligible speech. However, multichannel electrode arrays, which take advantage of the cochlea's tonotopic organization, may be capable of generating the complex patterns of neural activity necessary for speech discrimination. In this study, multichannel electrodes were implanted in the cochleas of four volunteers, with access to the connecting wires made through the skin via a percutaneous connector. The major portion of the data presented is from two of these subjects: one has been bilaterally deaf since birth and the other has been unilaterally deaf for 15 years. Preliminary results of experiments with two more recently implanted subjects are described as well as experiments with a fifth volunteer who was implanted with five electrodes by House in 1969. Data on pitch and loudness discrimination as well as the effects of stimulation parameters on threshold, impedance, and electrode interaction are presented. Place pitch and periodicity pitch were observed in all five volunteers. The results of pitch-matching experiments with the unilaterally deaf volunteer were consistent with tonotopic maps of the cochlea, and experiments indicated that a pitch continuum may be achieved by combining place and periodicity pitch modulation. Preliminary experiments in tune recognition with one subject demonstrate his ability to recognize simple melodies based on periodicity pitch cues. These results, coupled with the finding that subjective sensations remain stable over the long-term, support the feasibility of providing artificial hearing with a multichannel cochlear stimulation system.
Cochlear Implantation is a recognized procedure for acoustical rehabilitation of the profoundly or totally deaf unable to effectively use a traditional hearing aid. Since 1989, 30 patients (27 postlingual and 3 perilingual) have been operated on by the senior Author with the implantation of a multichannel device: Med-El (3 cases), Clarion (3 case) and Nucleus Mini-22 (24 cases). The first 24 Nucleus cases, with a multipeak speechcoding strategy, are the object of this retrospective report. Selection of patients was performed according to an international protocol which includes PTA and Speech Audiometry, CT and/or MRI imaging of the ear, the Promontorial Test, an evaluation of lip reading ability, a psychological evaluation, a trial with two recent and currently available aids. The operation was carried out under general anesthesia. An extended endaural approach was adopted. The internal package of the device was firmly seated onto the temporalis squama and the electrode array was introduced into the tympanic cleft via a posterior tympanotomy. The electrode system was inserted into the scala tympani through a cochleotomy drilled out at the anteroinferior border of the round window. The whole system was fixed to the bony walls of the mastoid and squama using an ionomeric bone bonding agent. Starting at the second postoperative month and up to the 24th month of utilization of the device, each patient was evaluated with regard to his or her ability to recognize environmental sounds, to detect prosody transitions and to understand speech with and without visual cues. Selected tests, either close or open set, were used from the MAC and the Iowa Cochlear Implant Battery, as well as the Helen test. Telephone conversation was also evaluated. Results were very encouraging in all cases, showing that the multichannel cochlear device provides the properly selected patient a substantial auditory rehabilitation allowing him or her to understand speech in most instances without any visual cue.
This study examined differential performance of normally hearing subjects using a tactile device on the dominant versus non-dominant hand. The study evaluated whether tactual sensitivity for non-speech stimuli was greater for the dominant hand as compared with the non-dominant hand, and secondly, whether there was an advantage for speech presented tactually to the dominant hand, resulting from a preferential pathway to the language processing area in the left cerebral hemisphere. Evaluations of threshold pulse width, dynamic ranges, paired electrode identification, and a closed-set tactual pattern discrimination test battery showed no difference in tactual sensitivity measures between the two hands. Speech perception was assessed with closed sets of vowels and consonants and with open-set Harvey Gardner (HG) words and Arthur Boothroyd (AB) words. Group mean scores were higher in each of the tactually aided conditions as compared with the unaided conditions for speech tests, with the exception of AB words in the tactile plus lip-reading plus audition/lip-reading plus audition condition on the right hand. Overall mean scores on the closed-set vowel test and on open-set HG and AB words were significantly higher for the tactually aided condition as compared with the unaided condition. Comparison of performance between the dominant and non-dominant hand showed a significant advantage for the dominant hand on the closed-set vowel test only. No significant differences between hands in either tactually aided or unaided conditions were evident for any of the other speech perception tests. Factors influencing this result could have been variations in degree of difficulty of the tests, the amount of training subjects received, or the training strategy employed. Although an advantage to presenting speech through the dominant hand may exist, it is unlikely to be great enough to outweigh possible restrictions on everyday use.
A questionnaire was mailed to a consecutive series of 23 adult, postlingually deafened, Nucleus 22-channel, cochlear implant recipients and their relatives to evaluate subjective benefits of cochlear implantation. All implantees had used their device for a minimum of 6 months. Responses were received from 20 implantees (87%) and 17 relatives (74%). Substantial improvements were reported by the respondents in speech recognition with lipreading, voice quality, independence, and communication confidence. Slightly less benefit was noted in speech recognition without lip reading. Respondents noted an increased recognition of environmental sounds and a reduction in tinnitus. Overall, 85% of implantees and 94% of their relatives were moderately to very satisfied with the device, and most indicated that they would recommend the device for others. Satisfaction correlated well with independence and confidence. Poor correlations were found between satisfaction and objective scores of sentence recognition, both in audition-only and audition-plus-vision conditions.
Hearing and understanding are two related, yet different processes. Hearing is the perception of sound. It can be of enormous value to patients with severely impaired hearing, as it facilitates acoustic orientation. An understanding of speech, however, remains virtually impossible for most of these patients. Nevertheless, early habituation to their acoustic situation makes lip-reading much easier, thus enabling conversations to be possible in good listening environments. Severely impaired patients, however, are still not in a position to follow conversation in larger groups. Even with hearing aids and the deployment of the latest technology, sufficient help is not always given. Before making a decision on the use of these technical aids, the ENT specialist should discuss the needs of the particular individual with the hearing-aid specialist. Provided that residual hearing can be used to understand speech with the help of a hearing aid, intracochlear implantation of an electronic prosthesis is not indicated. A cochlear implant is indicated when there is a complete hearing loss on both sides. Such a profound loss means that sufficient understanding of speech is no longer possible, even with the assistance of the latest hearing aids. For most adults, deafness is a postlingual phenomenon. Adults who were born deaf or who lost their hearing in childhood tend to be unsuitable for cochlear implantation. Up to the age of six years, however, children born deaf can benefit considerably from a cochlear implant. Children who are provided with a cochlear implant shortly after becoming deaf also have a good chance of being capable of learning and understanding speech.
Providing patients with hearing aids in the former German Democratic Republic was carried out in audiological centers by otolaryngologists and authorized audiologic-phonatric assistants. The available selection of hearing aids was limited. A randomized group of 119 patients rehabilitated with hearing aids was examined. The current study includes persons older than 65 years. In 78.4% of the patients treated, the quality of life was improved with the hearing aids. In contrast, the other patients reported the aids to be useless. Nearly 90% of all patients had no problems in managing their hearing aids. About 75% of the patients used the hearing aid the whole day. In addition to the hearing aid prescribed, 33 patients also have had to read lips and only a combination of both allows these patients to have adequate communication. Patients reported that 80% of the hearing aids worked well or were rarely out of order. Further, 68% of the people questioned reported a positive attitude of their fellow citizens. Only 6% mentioned that the use of hearing aids to treat presbycusis disturbed social communications. Since hearing loss can be progressive and to avoid interference in early rehabilitation, frequent follow-ups by otorhinolaryngologists are required. The evaluation of patients with hearing disorders requires the collaboration of physicians and hearing aid acousticians in order to give patients the most information and understanding of their deafness.
Extensive ossification of the cochlea is a common finding in patients with total deafness caused by meningitis, labyrinthitis, or otosclerosis. When the cochlea is totally ossified, the prognosis for achieving free-running speech without lip reading is poor. However, subtotal ossification with residual cochlear patency in the upper basal turn, the middle turn, or the apical turn can be maximally exploited by selective insertion of electrodes. Results can be surprisingly adequate in spite of the poor anatomic conditions. Computed tomography and exploratory cochleotomy, in which electrically evoked auditory brainstem responses are elicited and recorded by intracochlear stimulation are good diagnostic indicators of ossification and residual auditory nerve excitability. "Apical cochleostomy" is an adequate procedure to help penetrate the basal turn in retrograde insertion of the cochlear implant electrode array. Results of this study indicate that the surgical technique and placement of the Ineraid electrode array play a major role in the ability of the patient to achieve understanding of free-running speech.
Deafness affects 1.8 million people in the United States. The special comminication problems of deaf people may lead to serious misunderstandings, particularly during a medical evaluation. Patients with no residual hearing usually read lips with only 40 percent accuracy. Furthermore, physicians may have great difficulty understanding the deaf patient's impaired speech and faulty written English. Underestimating the patient's intelligence, the doctor may give reassurances or oversimplified explanations. The purposes of this paper are to clarify the reasons for the speech and language problems of deaf people and to dispel some common misconceptions about deafness and sign language. Recommendations are given for improving doctor-patient communication.