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PubMed2004

Criteria of candidacy for unilateral cochlear implantation in postlingually deafened adults I: theory and measures of effectiveness.

OBJECTIVES: The objectives of this study were to distinguish the equivalent-effectiveness, health-economic, and actuarial approaches to specifying criteria of candidacy for medical interventions; to apply the equivalent-effectiveness approach to unilateral cochlear implantation for postlingually deafened adults; and to determine whether the criterion should take age at implantation and duration of profound deafness into account. DESIGN: The study was designed as a prospective cohort study in 13 hospitals with four groups of severely-profoundly hearing-impaired subjects distinguished by their preoperative ability to identify words in sentences when aided acoustically. The groups represent a progressive relaxation of criteria of candidacy: Group I (N=134) scored 0% correct without lipreading and did not improve their lipreading score significantly when aided; group II (N=93) scored 0% without lipreading but did improve their lipreading score significantly when aided; group III (N=53) scored 0% without lipreading when the to-be-implanted ear was aided but between 1% and approximately 50% when the other ear was aided. Group IV (N=31) scored between 1% and approximately 50% without lipreading when the to-be-implanted ear was aided. Measures of speech intelligibility, health utility, and otologically relevant quality of life were obtained before surgery and 9 mo after surgery from each subject. Measures of effectiveness were calculated as the difference between 9-mo and preoperative scores. RESULTS: Effectiveness differed only slightly between groups. Effectiveness was not strongly associated with age at the time of implantation. Greater effectiveness was associated with implantation in the ear with the shorter duration of profound deafness. Cochlear implantation was least effective when the preoperative audiological status of the better-hearing ear was good and the duration of profound deafness of the implanted ear was long. As a result, effectiveness was not significant for the subsets of groups III and IV, who were given implants in ears that had been profoundly deaf for more than 30 yr. CONCLUSIONS: The effectiveness of cochlear implantation differs little between groups of candidates who score zero with acoustic hearing aids before surgery and groups who score up to approximately 50% correct, thereby justifying a relaxation of the criterion of candidacy to embrace some members of the latter groups. The criterion should be based not only on preoperative speech intelligibility but also on duration of profound deafness in the to-be-implanted ear.

Adolescent↗
PubMed1987

Quantifying the contribution of vision to speech perception in noise.

The intelligibility of sentences presented in noise improves when the listener can view the talker's face. Our aims were to quantify this benefit, and to relate it to individual differences among subjects in lipreading ability and among sentences in lipreading difficulty. Auditory and audiovisual speech-reception thresholds (SRTs) were measured in 20 listeners with normal hearing. Sixty sentences, selected to range in the difficulty with which they could be lipread (with vision alone) from easy to hard, were presented for identification in white noise. Using the ascending method of limits, the SRT was defined as the lowest signal-to-noise ratio at which all three 'key words' in each sentence could be identified correctly. Measured as the difference in dB between auditory-alone and audiovisual SRTs, 'audiovisual benefit' averaged 11 dB, ranging from 6 to 15 dB among subjects, and from 3 to 22 dB among sentences. As predicted, audiovisual benefit is a measure of lipreading ability. It was highly correlated with visual-alone performance (n = 20, r = 0.86, P less than 0.01). Likewise, those sentences which were easiest to lipread gave a higher measure of benefit from vision in audiovisual conditions than did sentences that were hard to lipread (n = 60, r = 0.92, P less than 0.01). The results establish the basis of an efficient test of speech-reception disability in which measures are freed from the floor and ceiling effects encountered when percentage correct is used as the dependent variable.

Adult↗
PubMed1990

Psychoacoustic aspects of speech pattern coding for the deaf.

The SiVo aid, which provides a sinusoidal signal indicating voice fundamental frequency and voicing information, was compared as an aid to lipreading to a conventional hearing aid having extended low-frequency output. Speech perceptual measures of consonant confusions in lipreading and the identification of a simple intonation contrast were collected from a group of 8 profoundly deaf adults. Audiometric and psychoacoustic measures were also collected. In the intonation task, 6 of the 7 patients tested performed better with the SiVo aid and the seventh scored perfectly with both aids. Four patients (out of 8) preferred to use the SiVo aid rather than the conventional aid, and 2 of these showed a significant advantage with the SiVo aid in the aided lipreading of consonants. The remaining 4 patients preferred the conventional aid, although none of these patients showed a significant advantage with the conventional aid in the lipreading of consonants. The 4 patients who preferred the SiVo aid over the conventional aid had very profound hearing loss and minimal dynamic range at 500 Hz and above, and those receiving the greatest benefit showed no measurable frequency selectivity. In the 2 patients who preferred the SiVo aid, yet showed no significant advantage for the SiVo aid in consonant lipreading, consonant confusions were also measured for aided lipreading, using a prototype aid providing both voice fundamental frequency and voiceless excitation patterns. Both patients showed additional and significant benefit from inclusion of the voiceless pattern element.

Audiometry, Pure-Tone↗
PubMed1995

Patient performance over eighteen months with the Ineraid intracochlear implant.

We present our results with an 18-month follow-up for 15 adult patients treated with the Ineraid (formerly Symbion) four-channel intracochlear implant. All were postlingually deaf with profound or total hearing loss. Performance was tested in lipreading, implant only, and combined lipreading and implant modes using Boothroyd word lists, Bamford-Kowal-Bench (BKB) sentences, and Connected Discourse Tracking. Assessments were made after 10 hours of training and again at 9 and 18 months postimplantation. Mean scores at 18 months in the implant only mode were for Boothroyd word lists 39%, for BKB sentences 47%, and for connected discourse tracking 31 words per minute. In the combined implant and lipreading mode the mean scores were for Boothroyd word lists 85%, for BKB sentences 96%, and for connected discourse tracking 75 words per minute. A profile of implant performance against time shows that after 10 hours' training, 12 of the 15 subjects had some speech discrimination in the implant only mode for all three tests. When using their implant combined with lipreading, all 15 subjects improved their speech discrimination scores over those obtained with lipreading alone after 10 hours' training. By 9 months, all subjects had some speech discrimination in the implant only mode on all three tests. Between 9 and 18 months there was a slight trend toward improvement in implant performance, both when the implant was used alone and when it was combined with lipreading.

Adolescent↗
PubMed2004

Criteria of candidacy for unilateral cochlear implantation in postlingually deafened adults II: cost-effectiveness analysis.

OBJECTIVES: The objectives of this study were to estimate the cost-effectiveness of unilateral cochlear implantation for postlingually deafened adults; to study the impact on cost-effectiveness of relaxing criteria of candidacy to include patients who benefit from acoustic hearing aids; and to study the further impact of age at implantation and duration of profound deafness before implantation. DESIGN: This prospective cohort study was carried out in 13 hospitals with four groups of severely to profoundly hearing-impaired subjects distinguished by their preoperative ability to identify words in prerecorded sentences when aided acoustically. The groups represent a progressive relaxation of criteria of candidacy: Group I (N=134) scored 0% correct without lipreading and did not improve their lipreading score significantly when aided; group II (N=93) scored 0% without lipreading but did improve their lipreading score significantly when aided; group III (N=53) scored 0% without lipreading when the ear to be given an implant was aided but between 1% and approximately 50% when the other ear was aided; and group IV (N=31) scored between 1% and approximately 50% without lipreading when the ear to be given an implant was aided. Lifetime costs to the UK National Health Service of providing and maintaining a cochlear implant were estimated for each subject. The gain in health utility from cochlear implantation was estimated with the Mark III Health Utilities Index and was combined with life expectancy to estimate the number of quality-adjusted life-years (QALYs) that would be gained from cochlear implantation. Cost/QALY ratios were calculated by means of the Net Benefit technique and were compared with an upper limit of acceptability of 50,000 euros/QALY. RESULTS: Averaged over the whole cohort, the cost of gaining a QALY was 27,142 euros (95% confidence interval, 24,532 euros to 30,323 euros); 203 of 311 (67%) of the cohort displayed cost/QALY ratios more favorable than 50,000 euros/QALY. The average cost of gaining a QALY increased from group I (24,032 euros) to groups II (27,062 euros) and IV (27,092 euros) to group III (39,009 euros). Cost/QALY varied with age at implantation from 19,223 euros for subjects who were younger than 30 yr of age to 45,411 euros for subjects who were older than 70 yr of age. Cost/QALY was unacceptable because of minimal gain in health utility for the subset of groups I and II, who were given implants in ears that had been profoundly deaf for more then 40 yr and for the subset of groups III and IV, who were given implants in ears that had been profoundly deaf for more than 30 yr. CONCLUSIONS: Cochlear implantation was a cost-effective intervention for the majority of subjects, including the group given implants when older than 70 yr of age. Relaxation of criteria of candidacy for cochlear implantation reduces cost-effectiveness. Prioritization of the provision of cochlear implantation should take duration of profound deafness in the ear to be given an implant into account, as well as preoperative word recognition performance.

Adolescent↗
PubMed1985

Intermodal timing relations and audio-visual speech recognition by normal-hearing adults.

Audio-visual identification of sentences was measured as a function of audio delay in untrained observers with normal hearing; the soundtrack was replaced by rectangular pulses originally synchronized to the closing of the talker's vocal folds and then subjected to delay. When the soundtrack was delayed by 160 ms, identification scores were no better than when no acoustical information at all was provided. Delays of up to 80 ms had little effect on group-mean performance, but a separate analysis of a subgroup of better lipreaders showed a significant trend of reduced scores with increased delay in the range from 0-80 ms. A second experiment tested the interpretation that, although the main disruptive effect of the delay occurred on a syllabic time scale, better lipreaders might be attempting to use intermodal timing cues at a phonemic level. Normal-hearing observers determined whether a 120-Hz complex tone started before or after the opening of a pair of liplike Lissajou figures. Group-mean difference limens (70.7% correct DLs) were - 79 ms (sound leading) and + 138 ms (sound lagging), with no significant correlation between DLs and sentence lipreading scores. It was concluded that most observers, whether good lipreaders or not, possess insufficient sensitivity to intermodal timing cues in audio-visual speech for them to be used analogously to voice onset time in auditory speech perception. The results of both experiments imply that delays of up to about 40 ms introduced by signal-processing algorithms in aids to lipreading should not materially affect audio-visual speech understanding.

Adult↗
PubMed1985

Clinical results with a hearing aid and a single-channel vibrotactile device for profoundly deaf adults.

The speech perception of a group of 19 adults with post-lingual profound to total hearing loss was tested with nine closed-set speech tests without lipreading, two open-set tests without lipreading and two open-set speech tests with lipreading. The subjects were all prospective cochlear implant patients participating in a clinical trial of the implant and the results reported here were obtained as part of the pre-operative assessment. They were divided into groups on the basis of their prior experience with the aid(s), their speech detection thresholds with the two aids and their personal preferences. Seven of the subjects used a hand-held single-channel vibrotactile device and the other 12 used a powerful conventional hearing aid. Subjects from each group scored significantly better than chance on the closed set tests without lipreading. Training or regular hearing aid use was correlated with good performance on the closed-set tests. No subject showed a significant improvement of the lipreading score when the aid was used as a supplement. The use of sophisticated wearable tactile devices and extensive training may allow a better result, but in this clinical program, neither a hearing aid nor a single-channel vibrotactile device greatly benefited the postlingually profoundly deaf adults.

Adult↗
PubMed1981

A multiple-channel cochlear implant. Evaluation using speech tracking.

Two totally deaf patients who had received multiple-channel cochlear implants were tested using a speech "tracking" procedure in which they had to repeat verbatim passages of connected discourse. Their performance was assessed by calculating the tracking rate (words per minute) each session. Testing was carried out under two conditions--lipreading alone and lipreading in conjunction with a multiple-channel cochlear implant and laboratory speech processor. Lipreading with the cochlear implant increased the tracking rates by a factor of four for one patient and by a factor of two for the other when compared with lipreading alone.

Cochlear Implants↗
PubMed2000

Functional differentiation of the auditory association area in prelingually deaf subjects.

BACKGROUND: it is believed that the number of neurons of the human cortex increases rapidly in the first postnatal year, and then decreases gradually towards adult level as their functions are revised up to 11 years of age ('synaptic revision'). It is also confirmed that regional cerebral blood flow (rCBF) at rest represents the density of the neurons and decreases in accordance with the synaptic revision in process. If synaptic revision does not occur, rCBF remains at high level. Thus, we can evaluate whether functional differentiation has occurred in the human cortex by measuring rCBF at resting state. OBJECTIVE: to examine functional differentiation of the auditory association area (A2) in prelingually deaf subjects. METHODS: six postlingually and six prelingually deaf subjects who had undergone cochlear implant (CI) were involved in the current study. All prelingually deaf subjects underwent CI over 8 years old. The rCBF in A2 was examined during resting and listening to speech sounds using positron emission tomography (PET) and H2(15)O intravenous injection. Twelve normal subjects' rCBFs were also measured as control. Furthermore, three prelingually deaf subjects underwent follow up PET studies in which cortical activities in A2 for listening and lipreading were examined. RESULTS: in the examination of rCBF at rest, rCBFs of prelingually deaf subjects in A2 showed significantly higher than those of either the postlingually deaf subjects or normal subjects. During listening, rCBFs in A2 increased in postlingually deaf subjects and normal subjects, while there was no significant rCBF increase in the prelingually deaf. High rCBF level in A2 at rest observed in prelingually deaf subjects implied a lack of synaptic revision, and it was suggested that the functional differentiation for auditory processing was little in the A2 of prelingually deaf subjects. In the follow up study for three prelingually deaf subjects, activation of A2 was observed during lipreading but not during listening in two cases, who had developed the skill of lipreading while speech recognition was not improved by CI. In contrast, the other case had not used any visual clues in daily communication prior to CI, and the hearing acuity was well improved by CI. This case demonstrated an activity in A2 during listening, while lipreading induced no activation. CONCLUSION: it is suggested that functional differentiation of A2 should differ according to which of visual and auditory clue is chiefly used during critical periods for speech acquisition. The findings are thought to be important for us to schedule the education and treatment for prelingually deaf children.

Adolescent↗
PubMed1989

Prosodic and segmental aspects of speech perception with the House/3M single-channel implant.

Four adult users of the House/3M single-channel cochlear implant were tested for their ability to label question and statement intonation contours (by auditory means alone) and to identify a set of 12 intervocalic consonants (with and without lipreading). Nineteen of 20 scores obtained on the question/statement task were significantly better than chance. Simplifying the stimulating waveform so as to signal fundamental frequency alone sometimes led to an improvement in performance. In consonant identification, lipreading alone scores were always far inferior to those obtained by lipreading with the implant. Phonetic feature analyses showed that the major effect of using the implant was to increase the transmission of voicing information, although improvements in the appropriate labelling of manner distinctions were also found. Place of articulation was poorly identified from the auditory signal alone. These results are best explained by supposing that subjects can use the relatively gross temporal information found in the stimulating waveforms (periodicity, randomness and silence) in a linguistic fashion. Amplitude envelope cues are of significant, but secondary, importance. By providing information that is relatively invisible, the House/3M device can thus serve as an important aid to lipreading, even though it relies primarily on the temporal structure of the stimulating waveform. All implant systems, including multi-channel ones, might benefit from the appropriate exploitation of such temporal features.

Adult↗
PubMed1979

Investigating the MESA (multipoint electrotactile speech aid): the transmission of connected discourse.

Three normal-hearing young adults were tested in their reception of connected discourse materials under two receiving conditions; visual-reception alone (lipreading) and visual reception in conjunction with an electrotactile speech aid (MESA). Subjects were artificially deafened with earplugs and white noise; all stimuli were delivered live-voice using a special tracking procedure. Analysis of the data suggests that after an initial period of learning, combined visual and electrotactile receptive performance exceeds lipreading-alone performance. After extensive learning however, performance in lipreading alone or MESA plus lipreading is practically equivalent.

Adult↗
PubMed1992

Audiovisual integration in perception of real words.

Three experiments follow up on Easton and Basala's (1982) report that the "McGurk effect" (an influence of a visibly mouthed utterance on a dubbed acoustic one) does not occur when utterances are real words rather than nonsense syllables. In contrast, with real-word stimuli, Easton and Basala report a strong reverse effect whereby a dubbed soundtrack strongly affects identification of lipread words. In Experiment 1, we showed that a strong McGurk effect does obtain when dubbed real words are discrepant with observed words in consonantal place of articulation. A second experiment obtained only a weak reverse effect of dubbed words on judgments of lipread words. A final experiment was designed to provide a sensitive test of effects of lipread words on judgments of heard words and of heard words on judgments of lipread words. The findings reinforced those of the first two experiments that both effects occur, but, with place-of-articulation information discrepant across the modalities, the McGurk effect is strong and the reverse effect weak.

Attention↗
PubMed1989

UCH/RNID single channel extracochlear implant: results in thirty profoundly deafened adults.

The University College Hospital/Royal National Institute for the Deaf (UCH/RNID) Cochlear Implant Programme has now given single channel extracochlear implants to forty profoundly deafened adults. Audiological, psychophysical, speech perceptual and subjective results for the first thirty cases are described. The main findings can be summarised as follows: 1. Users of the single channel extracochlear implant gained considerable improvements in their lipreading and communication ability, as assessed by both objective testing and by the patients' own reports. All acquired useful awareness of environmental sounds and an improvement in their quality of life; some also showed improvements in their own speech. A small number were capable of some open-set speech discrimination without lipreading. 2. Extracochlear implantation was not found to destroy residual hearing, although it did cause slight deterioration in hearing thresholds in some cases. 3. Our results so far suggest that patients deafened by meningitis are likely to obtain less benefit from a single channel cochlear implant than those deafened by other causes. Better results were also achieved by younger, more recently deafened patients and those who were good lipreaders. Despite the emergence of these trends we have not yet found a reliable way to predict benefit from an implant on the basis of preoperative variables. 4. Self-reported measures of the benefits of the implant correlated well with the objective test results, but also revealed important information that was not available from the objective tests. In particular, they showed that the improvement in lipreading provided by the implant was reduced in noisy conditions.

Acoustic Stimulation↗
PubMed1985

Clinical trials with a 22-channel cochlear prosthesis.

During 1984, six patients have been implanted with a 22-channel cochlear prosthesis. The device features a programmable wearable speech processor using a speech feature encoding strategy. A strict clinical protocol was followed, and no patients have been lost to follow-up. All patients are regular users of the device and have shown a restoration of hearing sensation in response to acoustic stimuli. Pure tone averages ranged from 20 to 47 dB HL and speech detection thresholds varied from 15 to 32.5 dB HL. All patients have shown a recognition of a large variety of environmental sounds, and an improvement in speech recognition ability when the device is used in conjunction with lipreading. Speech reception thresholds using spondee words without lipreading were obtained in three patients at levels of 27.5 to 55 dB HL and one patient had an open-set speech discrimination score (w-22 word list) of 42% without lipreading. In addition, two of the patients show an ability to have limited interactive conversation without the use of lipreading.

Adult↗
PubMed1984

Clinical trial of a multi-channel cochlear prosthesis: results on 10 postlingually deaf patients.

The clinical trial of a multi-channel cochlear prosthesis has been carried out on 10 profoundly-totally deaf adult patients. Speech perception tests have shown that all the patients received significant benefit from the device. They obtained improvements in understanding running speech from 47% to 550% when using the device in conjunction with lipreading compared to lipreading alone. With an open-set CID sentence test, three patients obtained scores showing an ability to understand speech without the need to lipread, and a further three patients had scores indicating they could also receive useful information without lipreading. In two patients, very limited open-set scores for electrical stimulation alone were obtained. This was most probably due to the fact that only a few channels of stimulation were possible due to cochlear disease, and they were therefore receiving information more like a single-channel device. The prosthesis has also been found to provide considerable help in hearing and recognizing everyday sounds.

Adult↗
PubMed1988

Preliminary evaluation of a multichannel electrotactile speech processor.

Speech discrimination testing, using both open- and closed-set materials, was carried out with four severely to profoundly hearing impaired adults and seven normally hearing subjects to assess performance of a wearable eight-channel electrotactile aid (Tickle Talker). Significant increases in speechtracking rates were noted for all subjects when using the electrotactile aid. After 70 h of training, mean tracking rate in the tactile plus lipreading condition was 55 words per minute (wpm), as compared with 36 wpm for lipreading alone, for the normally hearing group. For the hearing impaired group, the mean tracking rate in the aided condition was 37 wpm, as compared with 24 wpm for lipreading alone, following 35 h of training. Performance scores on Central Institute for the Deaf (CID) everyday sentences, Consonant Nucleus Consonant (CNC) words, and closed-set vowel and consonant identification were significantly improved when using the electrotactile aid. Performance scores, using the aid without lipreading, were well above chance on consonant and vowel identification and on elements of the Minimal Auditory Capabilities Battery. Two hearing impaired subjects have used the device satisfactorily in the home environment.

Adult↗
PubMed1989

Evaluation of two multichannel tactile aids for the hearing impaired.

Two multichannel tactile devices for the hearing impaired were compared in speech perception tasks of varying levels of complexity. Both devices implemented the "vocoder" principle in their stimulus processing: One device had a 16-element linear vibratory array worn on the forearm and displayed activity in 16 overlapping frequency channels; the other device delivered tactile stimulation to a linear array of 16 electrodes worn on the abdomen. Subjects were tested in several phoneme discrimination tasks, ranging from discrimination of pairs of words differing in only one phoneme under tactile aid alone conditions to identification of stimuli in a larger set under tactile aid alone, lipreading alone, and lipreading plus tactile aid conditions. Results showed both devices to be better transmitters of manner and voicing features of articulation than of place features, when tested in single-item tasks. No systematic differences in performance with the two devices were observed. However, in a connected discourse tracking task, the vibrotactile vocoder in conjunction with lipreading yielded much greater improvements over lipreading alone than did the electrotactile vocoder. One possible explanation for this difference in performance, the inclusion of a noise suppression circuit in the electrotactile aid, was evaluated, but did not appear to account for the differences observed. Results are discussed in terms of additional differences between the two devices that may influence performance.

Adolescent↗
PubMed1986

Continuing evaluation of the Queen's University tactile vocoder II: Identification of open set sentences and tracking narrative.

Identification of open set words by an experienced normal hearing subject using the tactile vocoder developed at Queen's University was examined. The tactile vocoder filters and processes the acoustic waveform into 16 filter channels each of which activates a vibrator on the skin surface. After acquiring a 250-word vocabulary through the tactile vocoder, the subject was presented with 1000 different open set sentences in two reception conditions. The percentages of words correctly identified within the sentences in the lipreading (L) and lipreading plus tactile vocoder (L + TV) conditions were 57.8 percent and 79.6 percent, respectively. After two presentations of the stimulus sentences, the number of sentences repeated verbatim in the L + TV condition was 58.4 percent, which was 27.8 percent higher than scores obtained in the L condition. Performance on the tactile vocoder was also evaluated using the "tracking procedure," in which phrases of text are read to the subject who attempts to repeat the material verbatim. The final tracking rate obtained using lipreading was 15.3 words per minute, which was considerably lower than the L + TV tracking rate of 49.3 words per minute. The tactile vocoder provided valuable information which improved the subject's lipreading ability.

Evaluation Studies as Topic↗