Long-term Speech Perception Research Articles

Speech Perception and Quality-of-Life Outcomes in Mandarin-Speaking Postlingual Deaf Adults With Cochlear Implant: Any Difference With the Intonation Language Users?

To evaluate the effects of related factors on long-term speech perception and quality-of-life (QoL) outcomes in postlingual deaf Mandarin-speaking adult cochlear implant (CI) recipients and to assess any differences between tone language and other intonation language CI adult users. Retrospective cases review. Tertiary referral center. Forty-five adult CI recipients (48 implanted ears). Post-CI outcomes were evaluated after follow-ups of more than 24 months using speech perception tests and QoL questionnaires. We analyzed the related factors affecting CI outcomes. A shorter duration of profound deafness was predictive factors for better post-CI speech perception. Earlier implantation and better performance of vowel scores were predictive of better subjective improvements in social and emotional life. Post-CI vowel scores of over 56% indicated promising improvements in QoL. Shorter duration of deafness could have better post-CI speech perception. Post-CI vowel scores instead of monosyllable words have the more potential to predict the QoL in Mandarin-speaking adult CI recipients.

Long-term speech perception performance in prelingually deafened adult cochlear implant recipients

Objective To investigate the postoperative long-term outcomes after an average of 9.2 years following cochlear implantation (CI) in prelingually deafened adults, along with preimplantation factors predicting postoperative outcomes. Methods Twenty-six prelingually deafened adults who underwent CI at >18 years were compared with those who had undergone CI in childhood (<9 years) and were >10 years old. Outcome measures includedhearing thresholds, preoperative and postoperative aided hearing level (HL), speech discrimination score (SDS), and Categories of Auditory Performance (CAP) scores. Correlation analyses were performed on the following: SDS results, aided HL, school attendant status, implant manufacturers, and speech processor models. Results Improvement was achieved in the aided HL and SDS results, although these results were not better than those of the child group. CAP score was also statistically significantly improved after CI. Statistically significant correlation between the preoperative SDS and postoperative HL with CI results was observed. In other words, the better the preoperative SDS results, the better the postoperative SDS results. Conclusion Prelingually deafened adults achieved considerable improvement through CI. It is important to understand that patients achieving better hearing with a well-fitted hearing aid and good SDS performance before surgery may be good candidates for CI.

Sequential bilateral cochlear implant: long-term speech perception results in children first implanted at an early age

PurposeThe study aims to assess the benefit of sequential bilateral cochlear implantation in children with congenital bilateral profound hearing loss, submitted to the first implant at an early age.MethodsWe enrolled all the bilateral sequential cochlear implanted children who received the first implant within 48 months and the second within 12 years of age at our Institution. The children were submitted to disyllabic word recognition tests and Speech Reception Threshold (SRT) assessment using the OLSA matrix sentence test with the first implanted device (CI1), with the second implanted device (CI2), and with both devices (CIbil). Furthermore, we measured the datalogging of both devices. Then we calculated the binaural SRT gain (b-SRTgain) and checked the correlations between speech perception results and the b-SRTgain with the child’s age at CI1 and CI2, DELTA and the datalogging reports.ResultsWith the bilateral electric stimulation, we found a significant improvement in disyllabic word recognition scores and in SRT. Moreover, the datalogging showed no significant differences in the time of use of CI1 and CI2. We found significant negative correlations between speech perception abilities with CI2 and age at CI2 and DELTA, and between the SRT with CI1 and the b-SRTgain.ConclusionsFrom this study we can conclude that in a sequential CI procedure, even if a short inter-implant delay and lower ages at the second surgery can lead to better speech perception with CI2, children can benefit from bilateral stimulation independently of age at the second surgery and the DELTA.

Cochlear Implantation in Patients with Mitochondrial Gene Mutation: Decline in Speech Perception in Retrospective Long-Term Follow-Up Study.

Clinical evidence of the effectiveness of cochlear implantation for hearing loss with mitochondrial DNA mutation is limited. Most reports have only described short-term postoperative speech perception, which may not reflect the limitations of cochlear implantation caused by progressive retrocochlear dysfunction. The present study aimed to investigate long-term speech perception after cochlear implantation in patients with severe to profound hearing loss associated with mitochondrial DNA mutation. A retrospective chart review was performed on patients with mitochondrial DNA mutation who had undergone cochlear implantation at the Department of Otolaryngology and Head and Neck Surgery at the University of Tokyo Hospital. We extracted data on causative mutations, clinical types, clinical course, perioperative complications, and short-term and long-term postoperative speech perception. Nine patients with mitochondrial DNA mutation underwent cochlear implantation. The mean observation period was 5.5 ± 4.2 years (range, 1–13 years), and seven patients were followed for more than 3 years. Two of the seven patients who initially showed good speech perception exhibited deterioration during long-term follow-up. The absence of an acute progression of cognitive decline in patients, showing a gradual decrease in speech perception, suggests that the deterioration of speech perception was caused by progressive retrocochlear degeneration. Although most patients with mitochondrial DNA mutation maintained good speech perception for more than 3 years after cochlear implantation, retrocochlear degeneration could cause the deterioration of speech perception during long-term follow-up.

Early Postimplant Speech Perception and Language Skills Predict Long-Term Language and Neurocognitive Outcomes Following Pediatric Cochlear Implantation.

We sought to determine whether speech perception and language skills measured early after cochlear implantation in children who are deaf, and early postimplant growth in speech perception and language skills, predict long-term speech perception, language, and neurocognitive outcomes. Thirty-six long-term users of cochlear implants, implanted at an average age of 3.4 years, completed measures of speech perception, language, and executive functioning an average of 14.4 years postimplantation. Speech perception and language skills measured in the 1st and 2nd years postimplantation and open-set word recognition measured in the 3rd and 4th years postimplantation were obtained from a research database in order to assess predictive relations with long-term outcomes. Speech perception and language skills at 6 and 18 months postimplantation were correlated with long-term outcomes for language, verbal working memory, and parent-reported executive functioning. Open-set word recognition was correlated with early speech perception and language skills and long-term speech perception and language outcomes. Hierarchical regressions showed that early speech perception and language skills at 6 months postimplantation and growth in these skills from 6 to 18 months both accounted for substantial variance in long-term outcomes for language and verbal working memory that was not explained by conventional demographic and hearing factors. Speech perception and language skills measured very early postimplantation, and early postimplant growth in speech perception and language, may be clinically relevant markers of long-term language and neurocognitive outcomes in users of cochlear implants. https://doi.org/10.23641/asha.5216200.

Hybrid cochlear implantation: quality of life, quality of hearing, and working performance compared to patients with conventional unilateral or bilateral cochlear implantation.

The objective of the present study is to evaluate the effect of hybrid cochlear implantation (hCI) on quality of life (QoL), quality of hearing (QoH), and working performance in adult patients, and to compare the long-term results of patients with hCI to those of patients with conventional unilateral cochlear implantation (CI), bilateral CI, and single-sided deafness (SSD) with CI. Sound localization accuracy and speech-in-noise test were also compared between these groups. Eight patients with high-frequency sensorineural hearing loss of unknown etiology were selected in the study. Patients with hCI had better long-term speech perception in noise than uni- or bilateral CI patients, but the difference was not statistically significant. The sound localization accuracy was equal in the hCI, bilateral CI, and SSD patients. QoH was statistically significantly better in bilateral CI patients than in the others. In hCI patients, residual hearing was preserved in all patients after the surgery. During the 3.6-year follow-up, the mean hearing threshold at 125-500Hz decreased on average by 15dB HL in the implanted ear. QoL and working performance improved significantly in all CI patients. Hearing outcomes with hCI are comparable to the results of bilateral CI or CI with SSD, but hearing in noise and sound localization are statistically significantly better than with unilateral CI. Interestingly, the impact of CI on QoL, QoH, and working performance was similar in all groups.

Incorporating ceiling effects during analysis of speech perception data from a paediatric cochlear implant cohort

Objective: To compare speech perception between children with a different age at cochlear implantation. Design: We evaluated speech perception by comparing consonant–vowel–consonant (auditory) (CVC(A)) scores at five-year follow-up of children implanted between 1997 and 2010. The proportion of children from each age-at-implantation group reaching the 95%CI of CVC(A) ceiling scores (>95%) was calculated to identify speech perception differences masked by ceiling effects. Study sample: 54 children implanted between 8 and 36 months. Results: Although ceiling effects occurred, a CVC(A) score difference between age-at-implantation groups was confirmed (H (4) = 30.36; p < 0.001). Outperformance of early (<18 months) compared to later implanted children was demonstrated (p <0.001). A larger proportion of children implanted before 13 months compared to children implanted between 13 and 18 months reached ceiling scores. Logistic regression confirmed that age at implantation predicted whether a child reached a ceiling score. Conclusions: Ceiling effects can mask thorough delineation of speech perception. However, this study showed long-term speech perception outperformance of early implanted children (<18 months) either including or not accounting for ceiling effects during analysis. Development of long-term assessment tools not affected by ceiling effects is essential to maintain adequate assessment of young implanted infants.

Cochlear implants in children deafened by congenital cytomegalovirus and matched Connexin 26 peers

ObjectiveTo compare the long-term speech perception and production outcomes after cochlear implantation (CI) in children deafened by congenital cytomegalovirus (cCMV) with a matched group of Cx26-CI children by controlling for chronological age and magnetic resonance imaging (MRI) findings. MethodsRetrospective review of 12 cCMV-CI children and matched Cx26-CI children for speech perception and speech production outcomes. ResultsTwo trends were seen in our data. First, cCMV-CI children with normal MRI scans perform equally or even slightly better on speech perception tests compared to their Cx26-CI peers during the first three years. The majority of cCMV-CI children with normal MRI scans (5 out of 7), suffered from a delayed-onset SNHL. Their mean age at first implantation (2y9m, range 15–82m) was higher compared to their matched Cx26 peers (9m, range 7–12m). Before being implanted, the majority of these delayed-onset hearing impaired children had benefited from a certain period of normal hearing (with or without amplification of a hearing aid). Possibly, this input might have led to an advantage the first three years after CI. Second, results between cCMV-CI children with and cCMV-CI children without MRI abnormalities and their matched Cx26-CI counterparts tentatively suggest that, over a 5-yr follow-up period, cCMV-CI children with abnormalities on MRI scans catch up for speech perception, but lag behind for speech production. ConclusioncCMV-CI children with normal MRI scans perform equally or even slightly better on speech perception tests compared to their Cx26-CI peers during the first three years, whereas results between cCMV-CI children with and cCMV-CI children without MRI abnormalities and their matched Cx26-CI counterparts tentatively suggest that, over a 5-yr follow-up period, cCMV-CI children with abnormal MRI scans catch up for speech perception, but lag behind for speech production. In future, the inclusion of MRI results may assist in improved counseling of parents with cCMV deafened children seeking CI.

Auditory neuropathy spectrum disorder: predictive value of radiologic studies and electrophysiologic tests on cochlear implant outcomes and its radiologic classification

Conclusion: The width of the bony cochlear nerve canal (BCNC) and the size of the cochlear nerve are reliable predictors of long-term speech perception abilities for children with auditory neuropathy spectrum disorder (ANSD) after cochlear implantation (CI). In addition, electrical stapedial reflex (ESR) and electrical compound action potential (ECAP) also have considerable value in predicting postoperative speech perception abilities in these children. Objectives: To assess whether speech perception abilities after CI in children with ANSD can be predicted from the results of radiologic studies and electrophysiologic tests. Methods: Fifteen children with ANSD underwent CI. The width of the BCNC and the size of the cochlear nerve were measured using preoperative CT and MRI. The results of early postoperative ESR, ECAP, and implant evoked electrical auditory brainstem response were reviewed. The latest speech perception test scores were also reviewed. Results: Radiologic findings of normal BCNC and normal cochlear nerve correlated with excellent speech perception abilities after CI. A narrow or obliterated BCNC and a deficient cochlear nerve correlated with poor speech perception abilities. Children with good speech perception abilities showed robust responses on ESR and ECAP, but there were no responses from any of the children with poor speech perception abilities.

Long-term Speech Perception in Elderly Cochlear Implant Users

A review of a test battery presented in both quiet and noise may clarify what the progression of speech perception abilities is in older adult cochlear implant users and whether the performance declines with advancing age. To examine whether older adults (≥65 years) with cochlear implants maintain stable speech perception performance after at least 10 years of listening experience with an external speech processor. Retrospective analysis performed in an academic tertiary care center. Fourteen older adult cochlear implant recipients with at least 10 years of listening experience. Speech perception outcomes as measured with Consonant-Nucleus-Consonant words in quiet and Hearing in Noise Test sentences in quiet and steady-state noise were analyzed retrospectively at the 6-month and 1-, 5-, and 10-year postoperative follow-up intervals. Consonant-Nucleus-Consonant word scores remained stable between 6 months and 1 year of listening experience, improved significantly (P < .001) between 1 year and 5 years, and remained stable between 5 years and 10 years. Hearing in Noise Test sentence scores in quiet and noise showed a similar pattern, with stability in performance between the 6-month to 1-year and 5-year to 10-year follow-up intervals, and significantly improved performance (P = .04) between the 1-year and 5-year follow-up intervals. On average, patients who undergo cochlear implantation at age 65 years or older do not experience a decline in speech perception performance with extended listening experience and may potentially continue to see improvements beyond the 1-year follow-up interval.

Long-term Speech Perception in Elderly Cochlear Implant Users

Long-term Speech Perception in Elderly Cochlear Implant Users

Does Cause of Deafness Influence Outcome After Cochlear Implantation in Children?

The objective of this study was to evaluate long-term speech perception abilities of comparable groups of postmeningitic and congenitally deaf children after cochlear implantation. This prospective longitudinal study comprised 46 postmeningitic deaf children and 83 congenitally deaf children with age at implantation of < or = 5.6 years. Both groups were comparable with respect to educational setting and mode of communication and included children with additional disabilities. Both postmeningitic and congenitally deaf children showed significant progress after implantation. Most (73% and 77%, respectively) could understand conversation without lip-reading or use the telephone with a known speaker 5 years after implantation, whereas none could do so before implantation. At the same interval, the postmeningitic and congenitally deaf children scored a mean open-set speech perception score of 47 (range: 0-91) and 46 (range: 0-107) words per minute, respectively, on connected discourse tracking. The respective mean scores at the 3-year interval were 22 and 29 correct words per minute, respectively. None of these children could score a single correct word per minute before implantation. The progress in both groups was statistically significant. When the 2 groups were compared, there was no statistically significant difference. Postmeningitic and congenitally deaf children showed significant improvement in their auditory receptive abilities at the 3- and 5-year intervals after cochlear implantation. There was no statistically significant difference between the outcomes of the 2 groups, suggesting that, provided that children receive an implant early, cause of deafness has little influence on outcome. Although the prevalence of other disabilities was similar in both groups, for individual children, their presence may have profound impact. The study supports the concept of implantation early in life, irrespective of the cause of deafness.

Outcomes and achievement of students who grew up with access to cochlear implants.

To provide long-term speech perception and production, educational, vocational, and achievement outcome data for pediatric cochlear implant recipients. This is a retrospective study using consecutive referrals of prelingually, profoundly deaf children at the University of Iowa Hospitals and Clinics. Twenty-seven prelingually deaf young adults who received a cochlear implant between the ages of 2 and 12 years participated. Outcome measures included device-use information, perceptual information, reading results for all participants and educational achievement results for 17 of 27 participants, educational placement information/vocational information for all students, as well as a comparison of the child's educational/vocational outcome with that of the parent's educational/vocational outcome. Speech perception and production scores were highly correlated. Achievement test results indicated that scores were within 1 SD from normative data based on hearing individuals. Over 50% of the college-age eligible students enrolled in college. This initial group of implant users had a nonuse rate of 11% in the first 3 years. Eighty-nine percent of the users maintained full-time use for 7 years, and 71% of this group have maintained full-time use to date. This cohort of cochlear implant users compared favorably with their hearing peers on academic achievement measures. Although there was a wide distribution of educational and vocational outcomes, the children tended to follow the educational/vocational patterns of their parents. As age of implantation decreases, it will be important to compare achievement outcomes of this first generation with those of subsequent generations of cochlear implant users.

Speech perception and speech intelligibility in children after cochlear implantation

Objective: This study aimed to evaluate the long-term speech perception and speech intelligibility of congenitally and prelingually deaf children after cochlear implantation. It was a longitudinal study following 63 congenitally or prelingually deaf children up to 5 years after implantation. They each received a nucleus multichannel cochlear implant before they were 10 years old. Methods: Perception is evaluated using the Test for the Evaluation of Voice Perception and Production (TEPP) and concerns closed- and open-set word and sentence perception without lip-reading. The intelligibility is classified according to the Speech Intelligibility Rating (SIR). The evaluations have been made every 3 months for 1 year, then at 18 months, 2 years, 3 years and 5 years after the cochlear implantation. Results: After 5 years of implantation, the median percentage of closed-words speech perception (CSW) is 95.5%—93.67% for closed-sentence speech perception (CSS) and 76.3% for open-sentence speech perception (OSS); the median Speech Intelligibility Rating is 3.83. Conclusions: Congenitally and prelingually deaf children who receive cochlear implant before the age of 10 years develop speech perception and speech intelligibility abilities. The closed-set perception progresses quickly and seems to reaching a plateau at 5 years post implantation. The improvement of open-sentence perception is not significant until the first year post implantation. The speech intelligibility improves regularly the five first year post implantation.

Speech Perception after Cochlear Implantation over a 4-Year Time Period

Objective – To evaluate the long-term speech perception of cochlear implantees and to compare the developing auditory performance patterns of prelingual children and postlingual deaf adults.Material and Methods – Twenty-nine prelingually deaf children and 17 postlingually deaf adults who had been followed up for 4 years were included in the study. Speech perception ability was assessed by means of vowel and consonant confusion tests and the Korean version of the Central Institute of Deafness (K-CID) test (performed without visual cues). The test results were analyzed at 3 and 6 months after implantation and then annually.Results – In the prelingually deaf children, the average results continuously improved over the 4-year period. In the postlingually deaf adults, the average results did not improve further after the first 2 years. Individuals with <5 years of deafness had a faster rate of recovery of speech perception than those who had been deaf for >5 years. The K-CID scores were negatively correlated with age at implantation for the prelingually deaf group and with the duration of deafness in the postlingually deaf group. Children fitted with implants at a younger age showed better speech perception ability than those fitted with implants at an older age. Interestingly, prelingually deaf children aged 5–7 years at implantation showed the widest variation in individual outcomes. Amongst this group of children with highly variable outcomes, the metabolic status of brain cortices determined by means of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) was available for three patients. The individual with the widest hypometabolic area had the best speech perception ability.Conclusion – The extent of hypometabolism as assessed by FDG-PET seemed to be one of the major factors predicting the outcome of cochlear implantation.

Speech perception results - the first 10 years of a cochlear implant program

Long-term speech perception test results for prelingually deaf children were compared with those of postlingually deafened adults, both groups having undergone cochlear implant at our Center. Average open-set score results of adults were similar to those of the children. However, some qualitative differences were demonstrated on the perception of phonological contrasts between the groups.

The relation between age at the time of cochlear implantation and long-term speech perception abilities in congenitally deaf subjects

The issue of whether an upper age limit should be set for cochlear implantation in congenitally deaf subjects has often been debated. To gain more insight, the speech perception abilities were analyzed of 12 congenitally deaf subjects whose age at the time of cochlear implantation ranged from 4 to 33 years. Subjects implanted during adulthood only showed progress during the first few months after the speech processor had been fitted and their long-term results were poor compared to those of children implanted early in life. This latter group showed steady improvement over the whole evaluation period. The present results support the notion that the earlier in life implantation is performed, the better the development of speech perception. Based on the progress-over-time profiles and data on actual daily use of the cochlear implant, it can be suggested that implantation of congenitally deaf subjects during or after puberty offers only limited benefit.