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PubMed1994

Surgical treatment and rehabilitation of prelingually and perilingually deafened children and adults with the nucleus multichannel cochlear implant.

We began our program in September 1992, using the Nucleus 22 Channel Cochlear Implant. To date, we have operated on four patients, one child with congenital hearing loss, two prelinguistically deaf adults and one perilingually deaf adult. Our results have shown a significant increase in auditory and speech reception and perception skills in the child. The perilingually deaf adult is able to understand speech in open set speech discrimination testing and, although we do not expect open set speech discrimination in the prelinguistically deaf adults, to date their results have been satisfactory. The two prelingually deaf adults are in an audiological rehabilitation program. Their response in prosodic aspects of speech and lipreading ability with sound have improved significantly. The only surgical complication was an infection of the flap in the child, but it was treated satisfactorily with i.v. penicillin.

Adult↗
PubMed2001

Pediatric cochlear implantation: the parents' perspective.

OBJECTIVE: To analyze parental views on cochlear implantation, before and in the years following implantation, to determine whether the results from the intervention met their expectations. DESIGN: Prospective longitudinal study to assess parental perspectives of an unselected group of children with cochlear implantation. SETTING: Tertiary referral pediatric cochlear implant center in the United Kingdom. SUBJECTS: Forty-three parents of children with cochlear implantation. INTERVENTION: A specifically designed questionnaire was administered to assess preimplant expectations and observed changes and concerns at 1, 2, and 3 years following implantation. Three key domains were evaluated: (1) communication with others, (2) listening to speech without lipreading, and (3) the development of speech and language. RESULTS: Preoperative expectations were met or surpassed at each of the follow-up intervals. In the area of communication, 35 (81%) parents expected a definite improvement preoperatively, and 3 years following implantation, 42 (98%) actually saw such an improvement. The respective numbers in the area of listening to speech were 15 (35%) and 38 (88%), and for speech development, 37 (86%) and 37 (86%). Speech development was the major area of concern at all intervals. CONCLUSION: This study demonstrates the ability of cochlear implantation to meet or surpass parental expectations in 3 important outcome domains: communication, listening to speech, and the development of speech and language.

Child↗
PubMed1981

Speech perception with hearing aids and cochlear implants.

A battery of tests using speech materials was developed to evaluate the auditory perception skills of five subjects with profound postlingual hearing loss. Two of the subjects wore hearing aids, and three subjects used cochlear implants. Responses of the two subjects with hearing aids were consistently superior to those of the subjects with implants, and one of the three subjects with implants consistently performed better than the other two. The subjects with implants displayed wide variations in response, indicating the necessity of evaluating each implant prosthesis as it was used by a given subject. In addition to tests of auditory speech perception, a measure of lipreading ability with amplification provided useful information.

Adult↗
PubMed2000

[Ambulatory rehabilitation after cochlear prosthesis implantation].

BACKGROUND AND OBJECTIVE: This study compares the results of the outpatient-based program of the Cochlear Implant Center Ruhr with inpatient-based rehabilitation, which is almost exclusively performed in Germany. PATIENTS/METHODS: The Department of Otorhinolaryngology at the University of Essen in Germany provided 52 patients with either 22- or 24-channel Nucleus cochlear implants from March 1996 to July 1999. Almost all patients (n = 49) were rehabilitated on an outpatient basis, which is the standard in many cochlear implant centers outside Germany. RESULTS: The longest follow-up period at the University of Essen Department of Otorhinolaryngology was 36 months. Minor complications occurred in 10% of the patients. After 24 months, the first three implanted patients were able to discriminate 100% of numbers and over 60% of syllables in the Freiburg speech discrimination test. The patients who developed an understanding of open speech were able to discriminate 31 words per minute with cochlear implant and without lipreading after 24 months. Children were seen to double their Schmid-Giovannini scores at 6 months postimplantation. CONCLUSIONS: The Essen outpatient-based cochlear implant program demonstrates results in speech development and speech understanding equal to those of centers providing inpatient rehabilitation. A special advantage is continuous rehabilitation with professionals known to the child for several years. In children especially, exhaustive commuting reduces school attendance and is a burden on the accompanying guardians. As an inpatient, however, the child is torn from his familiar environment. Parents with several children have particular difficulties in accompanying their child and indeed this may not always be possible.

Adult↗
PubMed1983

Speech signal presentation to the totally deaf.

We have developed a system for single-channel electrical stimulation of the totally deaf. The patient wears a removeable electrode assembly which stimulates the cochlear promontory and can be inserted and removed like the earmould of a hearing aid. This approach minimises the risk of mechanical or electro-chemical damage to structures within the cochlea. Charge-balanced stimulation is used to present those speech pattern elements that are matched to the patients' lipreading needs and their new sensory abilities. Objective tests show improvements both in patients' perceptive and productive abilities.

Cochlear Implants↗
PubMed2004

Factors influencing audiovisual fission and fusion illusions.

Information processing in auditory and visual modalities interacts in many circumstances. Spatially and temporally coincident acoustic and visual information are often bound together to form multisensory percepts [B.E. Stein, M.A. Meredith, The Merging of the Senses, A Bradford Book, Cambridge, MA, (1993), 211 pp.; Psychol. Bull. 88 (1980) 638]. Shams et al. recently reported a multisensory fission illusion where a single flash is perceived as two flashes when two rapid tone beeps are presented concurrently [Nature 408 (2000) 788; Cogn. Brain Res. 14 (2002) 147]. The absence of a fusion illusion, where two flashes would fuse to one when accompanied by one beep, indicated a perceptual rather than cognitive nature of the illusion. Here we report both fusion and fission illusions using stimuli very similar to those used by Shams et al. By instructing subjects to count beeps rather than flashes and decreasing the sound intensity to near threshold, we also created a corresponding visually induced auditory illusion. We discuss our results in light of four hypotheses of multisensory integration, each advocating a condition for modality dominance. According to the discontinuity hypothesis [Cogn. Brain Res. 14 (2002) 147], the modality in which stimulation is discontinuous dominates. The modality appropriateness hypothesis [Psychol. Bull. 88 (1980) 638] states that the modality more appropriate for the task at hand dominates. The information reliability hypothesis [J.-L. Schwartz, J. Robert-Ribes, P. Escudier, Ten years after Summerfield: a taxonomy of models for audio-visual fusion in speech perception. In: R. Campbell (Ed.), Hearing by Eye: The Psychology of Lipreading, Lawrence Earlbaum Associates, Hove, UK, (1998), pp. 3-51] claims that the modality providing more reliable information dominates. In strong forms, none of these three hypotheses applies to our data. We re-state the hypotheses in weak forms so that discontinuity, modality appropriateness and information reliability are factors which increase a modality's tendency to dominate. All these factors are important in explaining our data. Finally, we interpret the effect of instructions in light of the directed attention hypothesis which states that the attended modality is dominant [Psychol. Bull. 88 (1980) 638].

Acoustic Stimulation↗
PubMed2002

A comparison of bound and unbound audio-visual information processing in the human cerebral cortex.

Human speech has auditory (heard speech) and visual (seen speech) qualities. The neural representation of audiovisual integration in speech was investigated using functional magnetic resonance imaging (fMRI). Ten subjects were imaged while viewing a face in four different conditions: with speech and mouth movements synchronized, with speech and mouth movements desynchronized, during silent speech, or while viewing a static face. Subtractions of the different sets of images showed that lipreading primarily activated the STG/STS. Synchronized audio-visual speech and desynchronized audio-visual speech activated similar areas. Regions activated more in the synchronized versus the desynchronized conditions were considered to be those involved in cross-modal integration. One dominant activation focus was found near the left claustrum, a subcortical region. A region-of-interest analysis of the STS and parietal areas found no difference between audio-visual conditions. However, this analysis found that synchronized audio-visual stimuli led to a higher signal change in the claustrum region. This study extends previous results, using other sensory combinations, and other tasks, indicating involvement of the claustrum in sensory integration.

Acoustic Stimulation↗
PubMed2004

An investigation of telephone use among cochlear implant recipients.

The purpose of this study was to examine telephone use among cochlear implant recipients. A questionnaire was constructed and mailed to 803 adults who received a Clarion cochlear implant system manufactured by Advanced Bionics Corporation. Questionnaire recipients were implanted at least 12 months prior to receiving the questionnaire (i.e., they were implanted in 1998 or 1999). Approximately 60% (n = 478) responded, of whom 70% (n = 336) were considered "telephone users" (i.e., they answered the telephone and/or initiated calls). Telephone users were significantly younger and had significantly more daily hours of cochlear implant use than nonusers. Not surprisingly, there were differences between groups with respect to method of communication (i.e., more users employed oral communication, while more nonusers employed both oral and manual communication) and ability to understand words without lipreading (i.e., more users were able to understand). Thirty-seven percent of the telephone users were male, and 63% were female. The average age was 51.8 years (SD = 15.5). Ninety-five percent of users initiated calls to family and friends, 65% made appointments by phone, and approximately 50% asked for information about a product or service and conducted business over the phone. Over 95% of users could identify a dial tone, a busy signal, and voices. The average telephone use per week was 5.4 hr. Approximately 85% indicated that they were able to interact with strangers on the telephone within 5 months of receiving the sound processor. Approximately 30% communicated via a cellular phone for personal use. The findings of this survey suggest an increase in cochlear implant users' telephone use relative to a decade earlier. Advances in cochlear implant and telephone technologies are 2 of several factors that may contribute to the changes observed.

Adult↗
PubMed2003

Talker and lexical effects on audiovisual word recognition by adults with cochlear implants.

The present study examined how postlingually deafened adults with cochlear implants combine visual information from lipreading with auditory cues in an open-set word recognition task. Adults with normal hearing served as a comparison group. Word recognition performance was assessed using lexically controlled word lists presented under auditory-only, visual-only, and combined audiovisual presentation formats. Effects of talker variability were studied by manipulating the number of talkers producing the stimulus tokens. Lexical competition was investigated using sets of lexically easy and lexically hard test words. To assess the degree of audiovisual integration, a measure of visual enhancement, R(a), was used to assess the gain in performance provided in the audiovisual presentation format relative to the maximum possible performance obtainable in the auditory-only format. Results showed that word recognition performance was highest for audiovisual presentation followed by auditory-only and then visual-only stimulus presentation. Performance was better for single-talker lists than for multiple-talker lists, particularly under the audiovisual presentation format. Word recognition performance was better for the lexically easy than for the lexically hard words regardless of presentation format. Visual enhancement scores were higher for single-talker conditions compared to multiple-talker conditions and tended to be somewhat better for lexically easy words than for lexically hard words. The pattern of results suggests that information from the auditory and visual modalities is used to access common, multimodal lexical representations in memory. The findings are discussed in terms of the complementary nature of auditory and visual sources of information that specify the same underlying gestures and articulatory events in speech.

Adult↗
PubMed1992

Cochlear implants in children, adolescents, and prelinguistically deafened adults: speech perception.

A group of 10 children, adolescents, and prelinguistically deafened adults were implanted with the 22-electrode cochlear implant (Cochlear Pty Ltd) at the University of Melbourne Cochlear Implant Clinic and have used the prosthesis for periods from 12 to 65 months. Postoperative performance on the majority of closed-set speech perception tests was significantly greater than chance, and significantly better than preoperative performance for all of the patients. Five of the children have achieved substantial scores on open-set speech tests using hearing without lipreading. Phoneme scores in monosyllabic words ranged from 30% to 72%; word scores in sentences ranged from 26% to 74%. Four of these 5 children were implanted during preadolescence (aged 5:5 to 10:2 years) and the fifth, who had a progressive loss, was implanted during adolescence (aged 14:8 years). The duration of profound deafness before implantation varied from 2 to 8 years. Improvements were also noted over postoperative data collection times for the younger children. The remaining 5 patients who did not demonstrate open-set recognition were implanted after a longer duration of profound deafness (aged 13:11 to 20:1 years). The results are discussed with reference to variables that may affect implant performance, such as age at onset of loss, duration of profound loss, age at implantation, and duration of implantation. They are compared with results for similar groups of children using hearing aids and cochlear implants.

Adolescent↗
PubMed1984

The cochlear prosthesis. Bringing the world of sound to the deaf.

The complexity of coding in the auditory nerve makes it unlikely that a prosthesis for deaf persons can exactly duplicate the normal function of the ear. With recent advances, however, cochlear prostheses can perform some of the frequency-analysis functions of the normal ear. Cochlear prostheses are effective aids to lipreading and allow recognition of some sounds without visual cues, thus enhancing the profoundly deaf person's communication skills substantially.

Adult↗
PubMed1997

Face processing by deaf ASL signers: evidence for expertise in distinguished local features.

Several previous studies have shown that ASL signers are 'experts' on at least one test of face processing: the Benton Test of Face Recognition, a discrimination task that requires subjects to select a target face from a set of faces shown in profile and/or in shadow. The experiments reported here were designed to discover why ASL signers have superior skill as measured by this test and to investigate whether enhanced performance extends to other aspects of face processing. Experiment 1 indicated that the enhancement in face-processing skills does not extend to recognition of faces from memory. Experiment 2 revealed that deaf and hearing subjects do not differ in their gestalt face-processing ability; they perform similarly on a closure test of face perception. Finally, experiment 3 suggested that ASL signers do exhibit a superior ability to detect subtle differences in facial features. This superior performance may be linked both to experience discriminating ASL grammatical facial expression and to experience with lipreading. We conclude that only specific aspects of face processing are enhanced in deaf signers: those skills relevant to detecting local feature configurations that must be generalized over individual faces.

Journal Article↗
PubMed1998

Vibrotactile speech tracking support: cognitive prerequisites.

Fourteen postlingually hearing-impaired participants took part in an intervention study on the potential benefit of three types of tactile aids (i.e., the Tactilator, Minivib 3, and the Tactaid 7). Although training by means of computerized tracking had substantial effects on speech tracking rate, no differential effects of type of aid emerged. However, a cognitive test battery revealed that training efficacy is directly dependent on the cognitive prerequisites of the individual speechreader. The speed with which an individual can make phonological judgments (i.e., rhyme judgments) and visual word decoding from lipreading proved to be critical cognitive skills. We conclude that these skills must be further assessed and taken into account when rehabilitation/training programs are launched.

Journal Article↗
PubMed1991

What can we learn about hearing aids from cochlear implants?

Cochlear implants have changed the rehabilitation of profoundly hearing-impaired patients. A wide range of performance is reported for postlingually deaf adult patients using multichannel (Nucleus and Inerad) cochlear implants. For the 63 patients described here, performance ranges from 0 to 62% correct word recognition, from 0 to 98% lipreading enhancement measured as a percentage of the possible enhancement, and from 0 to 98% on understanding words in sentences. Prelingually deaf children also show benefit from their cochlear implants, but they require more time to obtain benefit than postlingually deaf children and adults. Experience with cochlear implants has suggested a few observations that could be useful to hearing aid development, including: (1) field trials are essential; (2) signal processing should preserve and enhance frequency resolution; (3) the fitting process for a sophisticated hearing aid may require several days to adjust properly; (4) fitting algorithms should focus on individuals rather than averages; (5) patients will wear a larger device if their handicap is great enough and if the improvement is sufficient; and (6) patients should and will accept expensive hearing aids.

Adult↗
PubMed1992

The effects of limiting the number of Nucleus 22 cochlear implant electrodes programmed on speech perception.

The purpose of this double-blind study was to evaluate systematically the effects of varying programmed electrodes on speech perception. The performance of five subjects implanted with the Nucleus 22-electrode cochlear implant was compared on the Four-Choice Spondee test, the Central Institute for the Deaf Sentence test, and Speech Tracking across the following conditions: (1) five most apical electrodes eliminated from the subject's MAP (stimulus parameters); (2) five most basal electrodes eliminated from subject's MAP; (3) the middle five electrodes eliminated from subject's MAP; and (4) subject's current MAP. Statistically significant differences were found for the Four-Choice Spondee test and both the auditory-only and auditory-plus-lipreading Speech Tracking measures. Three subjects demonstrated poorer performance on all test measures when the five electrodes from the apical portion of the array were not programmed. Two subjects performed equally well, regardless of MAP condition. Group means for all test measures present a trend of consistently poorer performance when the -5 Apex MAPs were utilized. A subjective rating scale was consistent with the perceptual tests, with all subjects best liking their current MAP and least liking the -5 Apex MAP. Results suggest that for some subjects, a fixed place code may control their ability to use spectral information for speech discrimination. For these subjects, first formant information (F1) traditionally coded on the most apical electrodes could not be utilized as effectively when coded on the adjacent middle electrodes.

Acoustic Stimulation↗
PubMed1994

Cochlear implants for congenitally deaf adolescents: is open-set speech perception a realistic expectation?

The prognosis for benefit from use of cochlear implants in congenitally deaf adolescents, who have a long duration of profound deafness prior to implantation, has typically been low. Speech perception results for two congenitally deaf patients implanted as adolescents at the University of Melbourne/Royal Victorian Eye and Ear Hospital Clinic show that, after 12 months of experience, both patients had significant open-set speech discrimination scores without lipreading. These results suggest that although benefits may in general be low for congenitally deaf adolescents, individuals may attain significant benefits to speech perception after a short period of experience. Prospective patients from this group should therefore be considered on an individual basis with regard to prognosis for benefit from cochlear implantation.

Adolescent↗
PubMed2001

Audio-visual perception of sinewave speech in an adult cochlear implant user: a case study.

OBJECTIVE: The purpose of this case study was to investigate multimodal perceptual coherence in speech perception in an exceptionally good postlingually deafened cochlear implant user. His ability to perceive sinewave replicas of spoken sentences, and the extent to which he integrated sensory information from multimodal sources was compared with a group of adult normal-hearing listeners to determine the contribution of natural auditory quality in the use of electrocochlear stimulation. DESIGN: The patient, "Mr. S," transcribed sinewave sentences of natural speech under audio-only (AO), visual-only (VO), and audio-visual (A+V) conditions. His performance was compared with the data collected from 25 normal-hearing adults. RESULTS: Although normal-hearing participants performed better than Mr. S for AO sentences (65% versus 53% syllables correct), Mr. S was superior for VO sentences (43% versus 18%). For A+V sentences, Mr. S's performance was comparable with the normal-hearing group (90% versus 86%). An estimate of the amount of visual enhancement, R, obtained from seeing the talker's face showed that Mr. S derived a larger gain from the additional visual information than the normal-hearing controls (78% versus 59%). CONCLUSIONS: The findings from this case study of an exceptionally good cochlear implant user suggest that he is perceiving the sinewave sentences on the basis of coherent variation from multimodal sensory inputs, and not on the basis of lipreading ability alone. Electrocochlear stimulation is evidently useful in multimodal contexts because it preserves dynamic speech-like variation, despite the absence of speech-like auditory qualities.

Adult↗
PubMed2003

Factors associated with development of speech perception skills in children implanted by age five.

OBJECTIVE: This study investigated factors contributing to speech perception outcomes in children with prelingual deafness after 4 to 7 yr of multichannel cochlear implant use. The analysis controlled for the effects of child, family and implant characteristics so that educational factors most conducive to maximum implant benefit could be identified. DESIGN: One hundred eighty-one 8- and 9-yr-old children from across the US and Canada who received a cochlear implant by age 5 were administered a battery of speech perception tests. Type and amount of educational intervention since implantation constituted the independent variables. Characteristics of the child, the family, and the implant itself constituted intervening variables. A series of multiple regression analyses determined the amount of variance in speech perception ability accounted for by the intervening variables and the amount of additional variance attributable to independent variables. RESULTS: The children achieved an average level of about 50% open-set speech perception through listening alone and almost 80% through lipreading and listening together, but with scores for individual children ranging from 0 to 100% correct. Over half of the variance in speech perception scores was predicted by characteristics of the child, family, implant and educational program. Significant predictors of good speech perception included greater nonverbal intelligence, smaller family size, longer use of the updated SPEAK/CIS processing strategy, a fully active electrode array, greater electrical dynamic range between threshold and maximum comfort level, and greater growth of loudness with increasing stimulus intensity. After the variance due to these variables was controlled, the primary rehabilitative factor associated with good speech perception skill development was educational emphasis on oral-aural communication. CONCLUSIONS: Children with profound hearing loss achieved unprecedented levels of speech perception skill 4 to 7 yr after cochlear implantation. Use of an updated speech processor, such as SPEAK, contributed significantly to improved speech perception skills, even in children who were initially fitted with an earlier strategy, such as M-PEAK. In addition, the audiologist who programs the cochlear implant makes an important contribution to the child's successful outcome with the device. A well-fitted map, as evidenced by a wide dynamic range and optimal growth of loudness characteristics, contributed substantially to the child's ability to hear speech. Finally, the classroom communication mode used in the child's school affects speech perception outcome. Children whose educational program emphasized dependence on speech and audition for communication were better able to use the information provided by the implant to understand speech.

Canada↗