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PubMed1986

The Vienna cochlear implant program.

The cochlear implant program in Vienna has now gathered 160 patient years of experience with 25 patients who have received an extracochlear implant prosthesis and 31 patients who have received an intracochlear implant prosthesis. The sound processor avoids the transformation of speech into pulses and provides a processed analog broad-band stimulation signal. Approximately one half of the patients are prelingually deaf. The selection criteria include electrical promontory stimulation and acoustic and electrical brain-stem audiometry. The rehabilitation program consisting of counseling, communication training, and auditory training is considered an important part of the program. The results are assessed using the Vienna Auditory Test battery. Sixty per cent of the postlingually deafened patients achieve some open-set speech understanding without lip-reading. Sixty-five per cent of the users show a substantial improvement in aided speech understanding versus lip-reading alone.

Audiometry, Evoked Response↗

PubMed1997

A hand held two-channel vibro-tactile speech communication aid for the deaf: characteristics and results.

The OSCAR-project (Optimal Speech Communication Assistance for Residual Abilities) within the TIDE frame is aiming at processing the speech signal in such a way so that it can be more effectively aurally perceived than with an ordinary hearing aid in case of a very small residual hearing. In case of total deafness the code will be tactile and in some cases a multi modal approach will be tried. One of the sub-results of the OSCAR-project is a hand held vibro-tactile speech communication aid for profoundly hard of hearing and deaf persons. The main idea of the aid is that it should not be a general tactile hearing aid, but rather give optimum tactile support to lip-reading in a close communication situation. It should be used when speech communication is necessary and other methods of communication i.e. sign language, lip-reading, reading and writing etc. does not work. The aid conveys two types of information via its two vibro-tactile transducers; the syllabic rhythm and frication. This paper describes some characteristics of the aid and some results.

Correction of Hearing Impairment↗

PubMed2006

Auditory performance of cochlear implant children aged 2-5 years.

OBJECTIVE: To assess the categories of auditory performance in prelingual deaf children after implantation. STUDY DESIGN: Prospective study MATERIAL AND METHOD: The present study consisted of one boy and four girls aged between 2 and 5 years old at the time of implantation. All subjects had bilateral profound sensorineural hearing loss and received no substantial benefit from amplification. Three subjects were implanted with Med-El combi 40+ with CIS strategy and two subjects received multichanal monopolar Nucleus 24 cochlear implant with ACE strategy. After implantation, all subjects undertook a program ofhabilitation at the Speech and Hearing Clinic Ramathibodi Hospital. The Categories of Auditory Performance (CAP) score was determined at regular intervals prior to implantation, immediately at the initial mapping (0) and 3, 6, 12 and 18 months after the implantation. RESULTS: The results showed that before implantation, only three children showed awareness of environment sounds, CAP score level 1, and that immediately after mapping, all of the children demonstrated awareness of the environmental sounds. Moreover, two of these children showed awareness of speech sounds, CAP score level 2. The CAP scores were gradually increased over a 12-month period. At the 12-month assessment interval, four children could discriminate two speech sounds, CAP score level 4 and one child understood phrases without lip reading, CAP score level 5. 18 months after of implantation, the CAP score for four children increased to level 5. One child understood conversation without lip reading with a familiar talker, CAP score level 6. Furthermore, children with congenital hearing loss who underwent implantation at a younger age received more benefit from the implantation. CONCLUSION: The CAP score was found to be a useful and sensitive tool to evaluate the outcome of auditory receptive abilities in young congenital deaf children who underwent cochlear implantation. The accessible outcome measurement will provide information for parents and professionals to obtain a hierarchical scale on which the children's auditory ability with other more formal measures may be inappropriate.

Child, Preschool↗

PubMed1995

Deafness in childhood: 3. Cochlear implants: who, why and what are the results?

Some profound or totally deaf children cannot benefit from a hearing aid. In some cases a cochlear implant may be successful. The system compromises a small cable implanted into the inner ear, and externally-worn devices to collect and transmit the sounds to the ear. The cable consists of electrodes that respond to different frequencies of speech, imitating the action of the inner ear. It is not possible to predict the outcome in individual cases. At best, the child may subsequently be able to speak fluently and hear without lip-reading. At least, the child should be able to hear some background noise such as traffic, and be able to improve his or her lip-reading skills. It may take up to a year before improvements begin to show. The implant is intended to be permanent. Cochlear implants are still at a relatively early stage of development. Progress is cautious but the results so far are very encouraging. The entry gate is widening and the number of children being accepted for treatment is increasing.

Child↗

PubMed1998

Congenitally deaf children following cochlear implantation.

The aim of this study is to determine the auditory performance of congenitally deaf children following cochlear implantation. A prospective study is undertaken of 71 such children who have been implanted in a dedicated paediatric cochlear implant centre and who have been followed up to 3 years following implantation. All children are aged less than 8 years at the time of implantation and all receive a multichannel cochlear implant system. No child meeting these criteria has been excluded from the study. The average age at implantation is 56.5 months (range 27 to 93 months, standard deviation 15.9 months). Auditory performance is assessed by using the Categories of Auditory Perception (CAP) scale which is developed primarily as a clinical tool for evaluating profoundly deaf young children following cochlear implantation. The median score prior to implantation on this scale is Category 0 (no awareness of environmental sound), at the 1 year interval is Category 4 (discrimination some speech sounds without lip-reading), and at the 2 and 3 year interval, the median score on the CAP scale is Category 5 (understanding of common phrases without lip-reading). These results indicate the ability of cochlear implants to provide significant auditory receptive skills to young congenitally deaf children.

Child↗

PubMed1982

[On the improvement of discrimination of vibration stimuli by training in late aquired deafness (author's transl)].

Acoustic signals of low frequencies can be percepted by the tactile sense as vibrations to a limited extent. In educating deaf children one takes trouble to combine tactile and visual speech perception in order to improve speech discrimination. The question of this study was, whether an improvement of tactile discrimination can be achieved even by patients with late aquired deafness. In a 45 years old female patient who had become deaf after adolescence the tactile discrimination of instrumental sounds (electric organ) within the frequency area c3-c4 (131-262 cps) as well as of speech sounds (30 mono- and multisyllabic words) was trained by means of the SIEMENS-Fonator. After two training courses of ten hours each (à 45 min) the patient was not only able to recognize pitch differences of two half steps and more as well as the tones of the scale with few errors only, but could also identify the words to a high percentage; in monosyllables she reached an identification rate of 75.6% and in words with 3 syllables of 85%. Additionally, a marked improvement of speech discrimination by lip reading was observed when using the Fonator. Accordingly, even in patients with late aquired deafness it appears to be worthwhile to train the tactile discrimination of vibration stimuli as to support lip reading.

Child↗

PubMed2004

Digit representation is more than just hand waving.

Lip-reading and interpreting hand gestures help provide nonverbal information that aids speech comprehension in noisy environments and places emphasis on certain key utterances. In this fMRI study, we examined if viewing the similar semantic information presented by either finger movements or lip movements was processed by common or discrete brain regions. Subjects viewed videos of a hand conveying number information via finger movements and a face whose lip movements conveyed the same numerical information. Control stimuli consisted of meaningless finger and lip movements. Lip-reading numbers activated left posterior superior temporal sulcus (STS), while identifying numbers presented by fingers activated the intraparietal region (IPR) bilaterally. Conjunction analysis highlighted common activation in right IPR to numbers presented via fingers and lips. Our data indicate that left hemisphere decodes human movements conveying semantic information, although the specific brain region that is engaged may depend on the body part that is moving.

Adolescent↗

PubMed2006

The neural correlates of cross-modal interaction in speech perception during a semantic decision task on sentences: a PET study.

Speech perception in face-to-face conversation involves processing of speech sounds (auditory) and speech-associated mouth/lip movements (visual) from a speaker. Using PET where no scanner noise was present, brain regions involved in speech cue processing were investigated with the normal hearing subjects with no previous lip-reading training (N = 17) carrying out a semantic plausibility decision on spoken sentences delivered in a movie file. Multimodality was ensured at the sensory level in all four conditions. Sensory-specific speech cue of one sensory modality, i.e., auditory speech (A condition) or mouth movement (V condition), was delivered with a control stimulus of the other modality whereas speech cues of both sensory modalities (AV condition) were delivered during bimodal condition. In comparison to the control condition, extensive activations in the superior temporal regions were observed bilaterally during the A condition but these activations were reduced in extent and left lateralized during the AV condition. Polymodal region such as left posterior superior temporal sulcus (pSTS) involved in cross-modal interaction/integration of audiovisual speech was found to be activated during the A and more so during the AV conditions but not during the V condition. Activations were observed in Broca's (BA 44), medial frontal (BA 8), and anterior ventrolateral prefrontal (BA 47) regions in the left during the V condition, where lip-reading performance was less successful. Results indicated that the speech-associated lip movements (visual speech cue) rendered suppression on the activity in the right auditory temporal regions. Overadditivity (AV > A + V) observed in the right postcentral region during the bimodal condition relative to the sum of unimodal speech conditions was also associated with reduced activity during the V condition. These findings suggested that visual speech cue could exert an inhibitory modulatory effect on the brain activities in the right hemisphere during the cross-modal interaction of audiovisual speech perception.

Adult↗

PubMed1986

Developmental changes in visual and auditory contributions to speech perception.

Previous research has demonstrated that listeners make use of both auditory and visual information in bimodal speech perception. Preschool children appear to evaluate and integrate the two sources of information in the same manner as adults, but the children are less influenced by the visual source. The current experiments test a possible explanation of this difference and extend the question to younger children. It is possible that children are poorer lip-readers than adults and thus have less complete information about the visual source. Children and adults were tested with both auditory and visual sources and were also required to identify speech events on the basis of only the visual source. In addition to replicating the previous findings in the bimodal situation, the current experiments found that children are poorer lip-readers than adults. Furthermore, a positive correlation was observed between lip-reading ability and the size of the visual contribution to bimodal speech perception. A fuzzy logical model of speech perception provided a good quantitative description of the results even with the assumption that the visual information was equivalent in both the bimodal and lip-reading conditions. The results also contradict the categorical perception of speech events and any nonindependence in the evaluation of auditory and visual information in speech perception.

Adolescent↗

PubMed1993

Profound deafness treated by the Ineraid multichannel intracochlear implant.

Twelve deaf adults and two deaf children were treated with the Ineraid (formerly Symbion) four channel intracochlear implant between September 1989 and October 1991 at Addenbrooke's Hospital in Cambridge. All were post-lingually totally deaf and had found themselves beyond the reach of hearing aids. The effect of the implant upon the patients ability to lip-read was tested with the speech tracking test, BKB sentences (comparable to CID sentences) and Boothroyd word lists (comparable to NU6 word lists). All patients showed an improvement in their ability to understand speech with the help of the implant. Discrimination of speech without lip-reading was tested with Boothroyd word lists and BKB sentences, eight patients (57 per cent) demonstrated some 'open set' speech discrimination. The acceptability of the carbon percutaneous pedestal is discussed from the patient's, audiologist's and surgeon's points of view.

Adolescent↗

PubMed2002

Auditory brainstem implant part II: subjective assessment of functional outcome.

UNLABELLED: OBJECTIVE The purpose of this study was to present the patients' recommendations and judgments about their hearing and communication abilities with the help of the auditory brainstem implant. STUDY DESIGN: Prospective study. SETTING: Tertiary referral center. PATIENTS AND METHODS: This evaluation was based on the data obtained by the self-administered questionnaires designed for the European Auditory Brainstem Implant Multicenter Clinical Trial. Eleven patients who had used their auditory brainstem implant for a minimum of 6 months to a maximum of 41 months were evaluated with the help of these questionnaires. RESULTS: All the patients had used their implant on a regular daily basis for an average of 13 hours per day. None of them experienced any side effects during the daily use of the device. Nine patients (82%) used their auditory brainstem implant in both quiet and noisy surroundings. The most common cause of disturbance was a noisy surrounding. All the patients were able to distinguish speech from environmental sounds. The role of the auditory brainstem implant in differentiating various environmental sounds was considered to be very useful by 9 patients (82%). As an adjuvant to lip-reading, the auditory brainstem implant was considered most useful for understanding speech in quiet surroundings. DISCUSSION AND CONCLUSION: It was concluded that the auditory brainstem implant is an effective support for receiving and, to some degree, differentiating environmental sounds, and that as an adjuvant to lip-reading, it enhances speech perception, especially in quiet surroundings. A comparison between the results of this study and the results of the audiologic tests presented in Part I of this study (published earlier) revealed that patient satisfaction was not directly correlated with the results of the objective auditory tests. In general, patients' judgments of their individual hearing and communication abilities usually rated higher than could have been predicted by the objective audiometric data.

Auditory Brain Stem Implants↗

PubMed1979

Speech intelligibility in and speech interference levels of traffic noise in hearing-impaired and normal listeners.

Speech intelligibility (phonetically balanced monosyllables = PB words) in traffic-like noise (random noise) as well as the speech interference levels (75% intelligibility) of this noise were investigated in three common listening situations, two indoors and one outdoors. A total of 279 persons were examined; 56 had normal hearing, 90 a presbycusic-type hearing loss, 95 noise-induced hearing loss, and 38 conductive hearing loss. In the indoor situation the hearing-impaired groups mainly retained their intelligibility in 40 dBA. Lowering of the noise level to less than 40 dBA resulted in only a minor, mostly insignificant improvement in speech intelligibility. Normal-hearing listeners maintained good speech intelligibility in the outdoor listening situation with noise levels up to 60 dBA, without lip-reading. For hearing-impaired groups, representing more than 1/2 million (8% of the population) people in Sweden, with hearing loss due to age and/or noise, the noise level outdoors must be lowered to 45 dBA in order to achieve good speech intelligibility at 1 m, without lip-reading.

Adolescent↗

PubMed1998

[Special schools for deaf children. Their status of hearing, speech and clinical history].

170 deaf school children were described with respect to the following conditions: depth of the hearing impairment, phonic speech ability and lip reading possibility. The anamnesis data were also analyzed. All children disclosed a profound hearing impairment. 60 from 170 (35%) had deaf parents. The phonic speech ability was possessed in an unsufficient degree by only 128 (75%) children. 69 (40%) children passed 3 years of speech and hearing rehabilitation before entering the school. 58 (34%) showed good lip reading ability.

Adolescent↗

PubMed2001

Accessibility of spoken, written, and sign language in Landau-Kleffner syndrome: a linguistic and functional MRI study.

Landau-Kleffner syndrome (LKS) is an acquired aphasia which begins in childhood and is thought to arise from an epileptic disorder within the auditory speech cortex. Although the epilepsy usually subsides at puberty, a severe communication impairment often persists. Here we report on a detailed study of a 26-year old, left-handed male, with onset of LKS at age 5 years, who is aphasic for English but who learned British Sign Language (BSL) at age 13. We have investigated his skills in different language modalities, recorded EEGs during wakefulness, sleep, and under conditions of auditory stimulation, measured brain stem auditory-evoked potentials (BAEP), and performed functional MRI (fMRI) during a range of linguistic tasks. Our investigation demonstrated severe restrictions in comprehension and production of spoken English as well as lip-reading, while reading was comparatively less impaired. BSL was by far the most efficient mode of communication. All EEG recordings were normal, while BAEP showed minor abnormalities. fMRI revealed: 1) powerful and extensive bilateral (R > L) activation of auditory cortices in response to heard speech, much stronger than when listening to music; 2) very little response to silent lip-reading; 3) strong activation in the temporo-parieto-occipital association cortex, exclusively in the right hemisphere (RH), when viewing BSL signs. Analysis of these findings provides novel insights into the disturbance of the auditory speech cortex which underlies LKS and its diagnostic evaluation by fMRI, and underpins a strategy of restoring communication abilities in LKS through a natural sign language of the deaf (with Video)

Adult↗

PubMed1998

Cochlear implant performance and electrically-evoked auditory brain-stem response characteristics.

OBJECTIVES: The purpose of this study was to find a correlation between cochlear implant performances in phoneme discrimination and activity of the brain-stem. METHODS: Electrically-evoked auditory brain-stem responses (EABRs) and speech recognition performances were measured in 17 patients implanted with an MXM Digisonic DX10 cochlear implant. Speech recognition performances without lip-reading were tested using lists of isolated French words containing 3 phonemes. RESULTS: The results indicated statistically significant correlations between phoneme correct-identification scores and the following EABR variables: wave V latency, wave II-V latency interval and wave III-V latency interval. These results, indicate that up to about 48% of the variance in isolated word recognition without lip-reading can be accounted for by EABR variables. CONCLUSION: The quality of brain-stem functioning influences central processes in phoneme discrimination.

Adult↗

PubMed1999

Multi-channel cochlear implantation in patients with a post-traumatic sensorineural hearing loss.

There are few accounts of cochlear implantation in adults with post-traumatic sensorineural hearing loss. We report our experience with multichannel implantation in three such patients. Two patients experienced no cognitive or communication deficits as a result of their head injury. At nine months post-implant, compared with our experience of non-head-injured implantees, these patients achieved average or above average scores on audiological performance tests. The third patient presented with cognitive, behavioural and communicative deficits. The level of improvement achieved by this patient, when lip-reading was supplemented with electrical stimulation, in both BKB sentence and connected discourse tracking (CDT) tests was comparable with that of the non-head-injured group. However, his absolute performance at nine months post-implant was well below average. Performance at 18 months on BKB sentences and environmental sound recognition showed little change, and was again well below average, however his score on CDT with lip-reading and electrical stimulation improved considerably and was similar to the average achieved by the non-head-injured group. The major difficulties experienced with this patient were increasing depression and low implant use. Considerably more time was spent in the assessment and rehabilitation of this patient and involved liaison with a number of other agencies. When considering such patients for cochlear implantation it is strongly recommended that these additional requirements are taken into account.

Adult↗

PubMed1988

[Testing and re-education of candidates for the SIVO prosthesis].

The SIVO prosthesis, developed by Pr A. Fourcin (London), is an aid to lip reading for profoundly deaf patients with residual hearing at low frequencies below 500 Hz. This prosthesis reduces the complexity of the acoustic wave of speech to sa simple sinusoidal wave, allowing better perception of the fundamental frequency of the voice and its variations, i.e. pitch and intonation. The inclusion assessment of patients is twofold: evaluation of the perception of language (audiometry and computerised video tests evaluating the capacities for recognition of sounds and for lip reading), evaluation of voice production and language. Orthophonic re-education depends on the results of the various tests performed and is based on computer programmes, allowing better feed-back by visual control. As a result of the progress in computer and video technology, these tests can be standardised and used not only for candidates for the SIVO prosthesis, but also for all profoundly deaf subjects.

Audiometry↗

PubMed2002

Rehabilitation of hearing and communication functions in patients with NF2.

Most patients with neurofibromatosis type 2 (NF2) lose hearing either spontaneously or after removal of their neurofibromas. The patient may benefit from conventional hearing aids if, due to modern microsurgery and intraoperative monitoring the integrity of the cochlea and the 8th nerve is preserved. With lost auditory function but preserved electrical stimulibility of the 8th nerve a cochlear implant may be appropriate. But if the patients have no remaining 8th nerve to stimulate, there is no benefit from cochlear implants. Until some years ago, vibrotactile aids, lip-reading, and sign language have been the only communication modes available to these patients. With auditory brain stem implants it is now possible to bypass both the cochlea and the 8th nerve and to stimulate the cochlear nucleus directly. Stimulation of the devices produces useful auditory sensations in almost all patients. Testing of perceptual performance indicated significant benefit from the device for communication purposes, including sound-only sentence recognition scores and the ability to converse on the telephone. Also lip-reading is significantly improved with brain stem implants. The successful work of an auditory brainstem program center depends very much on the close interdisciplinary collaboration between the Departments of Neurosurgery and ENT-surgery. In the future new developments like speech processing strategies and new designed electrodes accessing the complex tonotopic organization of the cochlear nucleus may further improve rehabilitation in these patients who would have been deaf some years ago.

Auditory Pathways↗