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PubMed1984

Preliminary assessment of the Los Angeles, Vienna and Melbourne cochlear implants.

We tested four patients using the single-channel cochlear implant from Los Angeles, three patients using the single-channel cochlear implant from Vienna, and two patients using the multichannel cochlear implant from Melbourne. Tests from the MAC battery and the Iowa Cochlear Implant Battery were used. Most patients were able to identify some environmental sounds. Three of the patients had difficulty distinguishing between male and female voices, and three could not distinguish between a noise and a voice. All patients had difficulty discriminating between unknown speakers of the same sex. A four-choice spondee test in noise showed that all patients suffered drastically from background noise. In all cases there was an improvement in lipreading ability with the implant. On a sentence test with a contextual cue seven patients got some words with sound alone. Results obtained with the multichannel implant are superior on several tasks, but we have tested too few patients to allow us any firm conclusions.

Auditory Perception↗
PubMed1984

Cochlear implant: our preliminary experience.

We have performed cochlear implants on 16 patients (12 cases with the plug type electrodes and 4 cases with the coil type electrodes) with analogue single channel electroacoustic stimulators. The follow-up period was 8 months to 3 years. The selection of patients, operative approach and the results of these cases are presented. Our present cochlear implant can bring the totally sensory deaf patient back to the world of sound but the sounds heard are distorted so they are unable to discriminate speech, although it improves their lipreading capacity and sense of safety. The results are encouraging but much more is to be desired and further research and investigation are required.

Adolescent↗
PubMed1983

On learning to speak.

Every language, spoken or signed, deploys a large lexicon, made possible by permutation and combination of a small set of linguistic elements. In speech, rapid interleaving of the gestures that form these elements (consonants and vowels) leads to a complex acoustic signal in which the boundaries between elements are lost. However, for the child learning to speak, the initial task is not to recover these elements, but simply to imitate the sound pattern that it hears. Studies of "lipreading" in adults and infants suggest that imitation is mediated by an amodal representation, closely related to the dynamics of articulation, and that a left-hemisphere perceptuo-motor mechanism specialized to make use of this representation develops during the first six months of life. By drawing on this specialized mechanism, the infant learns the recurrent patterns of acoustic structure and articulatory gesture from which linguistic segments must be presumed to emerge.

Dominance, Cerebral↗
PubMed1983

[Current stage of rehabilitation of totally deaf persons using cochlear implantation].

Up to now the results obtained with the "Vienna Cochlear Implant" have been encouraging. All our patients achieved acoustic orientation, the majority improved in lipreading ability and many patients achieved a good standard of open speech understanding. Furthermore, our results show that implants can be worn over a long time without causing any side effects.

Acoustic Stimulation↗
PubMedDate not supplied

Speech and language development in a parent-infant total communication program.

In the program described, the use of total communication (TC) did not impede speech development in preschool deaf children. Evidence indicates that sign language facilitated the young hearing-impaired child's acquisition of communicative oral speech. Exposure to sign language combined with speech enhanced the meaningfulness of residual hearing and lipreading. Milestones in sign language acquisition paralleled the milestones of spoken language. Young hearing-impaired TC children appeared to learn and express more language at an earlier age than is typical of orally trained hearing-impaired children. This implies that their cognition may not be as severely inhibited because their language acquisition is less severely delayed. This should have favorable consequences for later educational and social development. The families In the TC program were able to normalize their child-rearing activities and relationships.

Child Language↗
PubMed1981

Four years of experience with cochlear prostheses.

Within the last four years, clinical as well as engineering experience has been gathered with 12 deaf persons who received several versions of an auditory prosthesis. Two years ago we settled on a system consisting of a versatile, passive 4-channel implant driving a scala tympani electrode, and a small external speech-processor. The main characteristics of the prosthetic hearing which can thus be established are: dynamic ranges vary between 12 and 20 dB, the number of discriminable amplitude steps within the dynamic range is comparable to that of a normal-hearing person; subjective pitch increases with stimulation frequency up to at least 1,000 Hz. Thresholds and dynamic ranges as well as a number of other characteristics remain stable over long periods of time. After an initial big step to good open speech understanding by one of our patients it could now be shown, that this patient is not an exemption. Several deaf patients participating in a series of speech tests have demonstrated that it is possible to reestablish some understanding of open speech through the use of the cochlear prosthesis without additional lipreading. A program has been established which aims at achieving experience with this prosthesis in a larger number of deaf people. The program includes: implant candidate selection, implantation, adjustment of speech-processor, hearing and speech rehabilitation, and the collection of comparative "psychoelectric" characteristics.

Adolescent↗
PubMed1995

Use of botulinum toxin to prevent facial nerve stimulation following cochlear implantation.

Facial nerve stimulation can develop because of the electric fields generated from an activated cochlear implant. This problem can usually be ameliorated by reducing or eliminating the current through the electrodes causing the undesirable stimulation. Occasionally there may be numerous electrodes that have to be deactivated in order to eliminate the facial nerve stimulation, and this may result in a marked reduction of auditory benefit to the cochlear implant user. Botulinum toxin causes transient neuromuscular blockade and has been shown to be effective in reducing or eliminating facial nerve hyperactivity due to a variety of causes. This report details the use of botulinum toxin in a patient with a cochlear implant who developed excessive facial nerve stimulation that necessitated the deactivation of 15 of the implant's 22 electrodes. After treatment with botulinum toxin, twice as many electrodes could be comfortably activated without causing facial nerve stimulation. The dynamic range was increased in 4 of the remaining 6 electrodes that were activated prior to treatment. The patient reported a marked improvement in sound quality and understanding of speech without lipreading as compared to her pretreatment performance. Treatment with botulinum toxin appears to be useful for patients who have excessive facial nerve stimulation after cochlear implantation.

Botulinum Toxins↗
PubMed1995

Improved electrotactile speech processor: Tickle Talker.

The Tickle Talker, an eight-channel electrotactile speech processor, has been developed from continuing research at the University of Melbourne. The development of the device has focused on production of reliable speech-processing hardware, design of cosmetically and ergonometrically acceptable electrode transducers, implementation of acute and chronic biomedical studies demonstrating device safety, design and testing of alternative speech-encoding strategies to provide benefit to speech perception and production, and design and testing of appropriate training methods for optimizing benefits. The Tickle Talker has been shown to provide benefits in supplementing lipreading or aided residual hearing for hearing-impaired adults and children. Improvements in speech processing have resulted in an increase in benefits to speech perception, and open the way for more flexible approaches to encoding speech input. Continuing development of the electrode circuitry has now produced a device that is robust and has an extended battery life. Safety studies have clearly demonstrated that there are no long-term contraindications to device use. The results suggest that the device has a role to play in rehabilitation programs for severely and profoundly hearing-impaired adults and children.

Deafness↗
PubMed1994

Subjective benefits reported by adult Nucleus 22-channel cochlear implant users.

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.

Adult↗
PubMed1994

[History of the development and functional description of the Nucleus cochlear implant].

For deaf children and adults who derive no significant benefit from conventional hearing aids the cochlear implant (CI) has become a clinically accepted alternative. More than 7,000 people worldwide, including over 2,000 children, have received the 22 channel Nucleus Mini System during the last decade. The functional principle of the CI is the translation of acoustic sound signals into electrical impulses for direct stimulation of the hearing nerve. The middle ear and the damaged sensory organ of the inner ear are completely bypassed. The function of the healthy ear is replaced by a microphone, an electronic speech processor, and stimulation electrodes. Approximately two thirds of the postlingually deafened CI users achieve open set speech understanding without lipreading through the Nucleus implant. The Nucleus system is a programmable digital device and is continuously being improved in terms of both performance and ease of use. It is the only CI system with FDA approval for use in both adults and children from 2 years of age. Over 100 European clinics in more than 20 countries are carrying out successful CI programs with the Nucleus device in compliance with strict pre- and postsurgical diagnostic and rehabilitative guidelines. In Austria it was introduced to the Landeskrankenanstalten Salzburg in 1992. A successful program, including specialized rehabilitation, is carried on in close cooperation with the world's largest Cochlear Implant Center in Hannover, Germany.

Adult↗
PubMed1993

[Auditory achievements of cochlear implantation].

The cochlear implant, which stimulates the auditory nerve electrically, is a rehabilitative solution for the severely deaf who cannot benefit from a hearing aid. The implant enables them to rejoin the world of sound from which they were disconnected. We present the process of auditory diagnosis which determines the patient's suitability for cochlear implantation, the implant's tuning program and the rehabilitation process it entails. Each of the 22 implanted electrodes is checked through a computer program, and the specifications of the electrical stimulation are established to provide the most comfortable hearing level for the implanted device. These stimulation specifications determine the number of active electrodes and the ideal stimulation model. During the 8-week hearing-training program which follows implantation, the patients acquaint themselves with the new world of sound through which they will communicate with their environment. Of the 16 implanted patients 7 heard only via the implant, without the aid of lipreading, a result which is considered excellent. These patients are able to talk on the telephone with the aid of the implant. 1 patient refused to use the implant, while the others have had good to moderate results. Noteworthy is the fact that even those with only moderate results greatly benefit from the implant, and are not willing to function without it for even a single day.

Adolescent↗
PubMed1996

Nucleus 22-channel cochlear mini-system implantations in Mandarin-speaking patients.

This article evaluates the benefits of the Mini System of the Nucleus 22-Channel Cochlear Implant on the speech perception and auditory functions of Mandarin-speaking patients. Tests adapted specifically for the assessment of a tonal language were administered in the best-aided condition preoperatively to four Mandarin-speakers. These scores were compared postoperatively with implant alone or with lipreading scores to quantify speech perception and auditory improvements resulting from the Nucleus 22 Mini-System cochlear implant. Four postlingually deafened adults underwent cochlear implant surgery using a Nucleus 22-Channel Mini-System Device via an inverted "U" postauricular incision and the posterior tympanotomy approach, without complications. After up to 2 years of rehabilitation, all four patients exhibited continuous improvement in both speech perception and auditory abilities over time. The improvements made by our Mandarin-speaking patients are comparable to studies on Western-language-speaking patients implanted with the same device, indicating that the Nucleus 22 Mini System enables profoundly and totally deaf patients to distinguish between the four separate tones present in Mandarin Chinese.

Adult↗
PubMed1977

Communicating with hearing-impaired patients.

ONE ASPECT OF ESTABLISHING EFFECTIVE COMMUNICATION BETWEEN PHYSICIANS AND PATIENTS HAS NOT RECEIVED ADEQUATE ATTENTION: the special needs and challenges presented by patients with impaired hearing. In this article the term "hearing impaired" is generic and is applied to both those persons who are commonly labeled "deaf" and those labeled "hard of hearing" as a result of a bilateral hearing loss. The general skills, both verbal and nonverbal, that a physician must have in order to communicate successfully with a hearing-impaired patient are in essence the same as those required for a hearing patient. Where the divergence occurs is not in the basic skills (empathy, probing and the like) but rather in the means of applying them. Communicating with a hearing-impaired patient makes the use of some combination of the following necessary: speech, hearing, speechreading (lipreading), writing, visual aids, visual language systems and the assistance of an interpreter.

Communication↗
PubMed1997

Speech perception results for children with implants with different levels of preoperative residual hearing.

OBJECTIVE: Many reports have established that hearing-impaired children using the Nucleus 22-channel cochlear implant may show both significant benefits to lipreading and significant scores on open-set words and sentences using electrical stimulation only. These findings have raised questions about whether severely or severely-to-profoundly deaf children should be candidates for cochlear implants. To study this question, postoperative results for implanted children with different levels of preoperative residual hearing were evaluated in terms of speech perception benefits. STUDY DESIGN/SETTING: A retrospective study of the first 117 children, sequentially, to undergo implantation in the Melbourne and Sydney Cochlear Implant Clinics was undertaken. All children had been assessed by and received their implants in a tertiary referral centre. MAIN OUTCOME MEASURES: To assess aided residual hearing, the children were grouped into four categories of hearing on the basis of their aided residual hearing thresholds measured preoperatively. To assess benefits, the scores of children on standard speech perception tests were reviewed. As different tests were used for children with different ages and language skills, children were grouped into categories according to the level of postoperative speech perception benefit. RESULTS: The results showed that children in the higher categories of aided preoperative residual hearing showed significant scores on open-set word and sentence perception tests using the implant alone. For children in lower categories of aided residual hearing, results were variable within the groups. More than 90% of children with implants with aided residual hearing thresholds in the speech range above 1 kHz achieved open-set understanding of words and sentences. CONCLUSION: While the results of this preliminary study confirm previous findings of differential outcomes for children with different levels of preoperative residual hearing, they suggest that children with severe to profound hearing impairments should be considered for cochlear implantation.

Auditory Threshold↗
PubMed2004

Bimodal speech perception in infant hearing aid and cochlear implant users.

OBJECTIVES: To determine the feasibility of replicating prior bimodal perception findings with hearing-impaired infants during their preimplant, hearing aid trial, and postimplant experiences; secondarily, to determine the point in development at which these infants were able to match phonetic information in the lips and voice for the vowels /a/ and /i/. METHODS: A total of 10 infants with hearing loss, aged 4 to 24 months, were assessed at least once prior to cochlear implantation and previous to implant stimulation. The Split-Screen Preferential Looking Procedure was used to evaluate the bimodal perception skills of these infants. RESULTS: Examples of individual bimodal perception data and preliminary group data are presented. A difference in performance across preimplant and postimplant test sessions was noted for the individuals and the group. CONCLUSION: These data provide evidence that the infants' audibility levels were improved by their cochlear implants, which may have contributed to their evolving ability to match phonetic information in the lips and voice.

Cochlear Implants↗
PubMed2004

Mode of communication and classroom placement impact on speech intelligibility.

OBJECTIVE: To examine the impact of classroom placement and mode of communication on speech intelligibility scores in children aged 8 to 9 years using multichannel cochlear implants. DESIGN: Classroom placement (special education, partial mainstream, and full mainstream) and mode of communication (total communication and auditory-oral) reported via parental rating scales before and 4 times after implantation were the independent variables. Speech intelligibility scores obtained at 8 to 9 years of age were the dependent variables. PARTICIPANTS: The study included 131 congenitally deafened children between the ages of 8 and 9 years who received a multichannel cochlear implant before the age of 5 years. RESULTS: Higher speech intelligibility scores at 8 to 9 years of age were significantly associated with enrollment in auditory-oral programs rather than enrollment in total communication programs, regardless of when the mode of communication was used (before or after implantation). Speech intelligibility at 8 to 9 years of age was not significantly influenced by classroom placement before implantation, regardless of mode of communication. After implantation, however, there were significant associations between classroom placement and speech intelligibility scores at 8 to 9 years of age. Higher speech intelligibility scores at 8 to 9 years of age were associated with classroom exposure to normal-hearing peers in full or partial mainstream placements than in self-contained, special education placements. CONCLUSIONS: Higher speech intelligibility scores in 8- to 9-year-old congenitally deafened cochlear implant recipients were associated with educational settings that emphasize oral communication development. Educational environments that incorporate exposure to normal-hearing peers were also associated with higher speech intelligibility scores at 8 to 9 years of age.

Child↗