Open-set Sentence Tests Research Articles

Hearing-impaired Children and Adults in Need of Cochlear Implant- A Hospital Based Cross-sectional Study

Introduction: Hearing is essential to learn language and speech and to develop cognitive skills. According to World Health Organisation (WHO), world-wide approximately 350 million people have hearing disorder. The performance of some moderately severe hearing-impaired adults and children using hearing aids is poorer than that of even profoundly hearing-impaired individuals using cochlear implants with advanced speech processing strategies. Aim: To find out the appropriate candidates in need of cochlear implantation in Prayagraj district of Uttar Pradesh, India. Materials and Methods: This cross-sectional study was conducted on hearing impaired patients attending Ear Nose Throat (ENT) Out Patient Department (OPD) of tertiary health care center in Prayagraj Uttar Pradesh from August 2011 to July 2012. The study population consisted of 95 patients categorised into four groups (pre-lingual children and adults, post-lingual children and adults) who presented with the chief complaints of impaired hearing and delayed speech. A detailed history, clinical and other relevant systemic examination and investigations were done. Patients were subjected to free field audiometry, pure tone audiometry and Brainstem-Evoked Response Audiometry (BERA) for assessment of hearing threshold level. Patients used hearing aid for six months and after hearing aid use, their hearing threshold and speech discrimination scores were estimated. Patients, whose aided score on open-set sentence test was less than 50%, were selected as candidate for cochlear implants, as they were not significantly benefited by hearing aids. Results: Out of the 95 cases, 48 were found to be suitable for cochlear implantation, which formed 50.5% of the study group. Pre-lingual hearing impaired adults had the highest percentage i.e., 86.7%, fulfilling the criteria for cochlear implantation followed by pre-lingual children, in whom 46.7% fell in this category. A 26.7% of postlingual children and 20% of postlingual adults were found suitable for cochlear implantation. Conclusion: The pre-lingual hearing impaired children and adults are more in need for cochlear implantation than the postlingual hearing-impaired children and adults. Approximately, 134,501 cases were estimated to be, in need of cochlear implantation in Prayagraj district based on the census estimate of 2011.

Development of a modified open set sentence test for assessment of speech perception skills in Hindi preschool children

Introduction: Clinical assessment of speech perception skills is very important for several reasons. However, it is routinely assessed in older children and adults but not in very young children mainly due to lack of appropriate tools, especially in Indian languages. Considering the limitations of closed-set and open-set tests for young children modified open set test would be appropriate. Aim: To develop a modified open set sentence test in Hindi based on the Mr. Potato Head Test framework using appropriate toy and sentence material and employ the developed test to assess children with normal hearing in the age range of 18 to 48 months. Method: Two sentence lists with ten sentences each and one practice list with five sentences were developed. The test was recorded in a professional studio by a sound engineer and sentences were calibrated using the Bruel & Kjaer-Type-2250 sound level meter (SLM) so that the test could be administered via speakers using a laptop. The test was administered in a quiet room, directly through a laptop connected to speakers on 200 Hindi speaking children with normal motor and speech developmental milestones and bilateral pass result on OAE screening. Results and discussion: There was a significant difference in the scores between the 5 age groups of children with normal hearing. There was an increase in scores as age increased, thus indicating improved performance with increasing age. There was also no significant difference in the performance on List 1 and List 2 for all age groups indicating that the two lists were equivalent. Item reliability was also observed to be high. Conclusion: The developed Modified Open Set Sentence Test can be successfully used to assess speech perception skills in young children with normal hearing. This test has a potential to be a useful clinical tool when used as a part of a test battery and also play a role in monitoring the progress of an intervention program.

Cochlear Implantation in Ménière's Disease With and Without Labyrinthectomy.

To investigate outcomes of cochlear implantation (CI) in patients with Ménière's disease (MD) with and without surgical labyrinthectomy. Retrospective study. Multiple tertiary referral centers. Thirty one ears from 27 patients (17 men, 10 women, aged 42-84) with CI in ipsilateral MD ear. CI in ears with intact labyrinths (Group 1), CI with simultaneous surgical labyrinthectomy (Group 2), and CI sequential to surgical labyrinthectomy (Group 3). Within-subject improvement on Bamford Kowal Bench test or City University of New York open set sentence tests. Majority of ears achieved excellent open-set speech recognition by 12 months post-CI, irrespective of intervention group. Preoperative details including patient age and sex, implant, MD and previous intervention, and audiological test results did not significantly affect outcomes. Patients with MD undergoing CI only may experience vestibular dysfunction which may cause long-term concerns. Incidental finding was noted of eight ears with fluctuating symptoms in ipsilateral ear during 12-month period post-CI, with five of eight ears showing objective fluctuating impedances and mapping. CI in MD can yield good hearing outcomes in all three groups and this is possible even after a long delay after labyrinthectomy. Bilateral MD patients are complex and prospective quality of life (QoL) measures would be beneficial in being better able to manage the vestibular outcomes as well as the audiological ones.

Task- and Talker-Specific Gains in Auditory Training.

This investigation focused on generalization of outcomes for auditory training by examining the effects of task and/or talker overlap between training and at test. Adults with hearing loss completed 12 hr of meaning-oriented auditory training and were placed in a group that trained on either multiple talkers or a single talker. A control group also completed 12 hr of training in American Sign Language. The experimental group's training included a 4-choice discrimination task but not an open-set sentence test. The assessment phase included the same 4-choice discrimination task and an open-set sentence test, the Iowa Sentences Test (Tyler, Preece, & Tye-Murray, 1986). Improvement on 4-choice discrimination was observed in the experimental group as compared with the control group. Gains were (a) highest when the task and talker were the same between training and assessment; (b) second highest when the task was the same but the talker only partially so; and (c) third highest when task and talker were different. The findings support applications of transfer-appropriate processing to auditory training and favor tailoring programs toward the specific needs of the individuals being trained for tasks, talkers, and perhaps, for stimuli, in addition to other factors.

Objective and Subjective Improvement of Hearing in Noise After Surgical Correction of Unilateral Congenital Aural Atresia in Pediatric Patients

The aim of this study was to assess the objective and subjective long-term binaural benefits of surgical correction in children with unilateral congenital aural atresia, using an open-set sentence test in noise and subjective questionnaires. A prospective study was performed between August 2010 and February 2013. This study included pediatric patients who had unilateral conductive hearing loss (normal bone conduction hearing) on the atretic side but normal air conduction hearing on the normal side and were scheduled to undergo a primary canaloplasty. Pure-tone audiometry, the hearing in noise test (HINT), and questionnaires (Sound-Spatial-Qualities of Hearing Scale; Glasgow Benefit Inventory [GBI]) were administered preoperatively and at 6 and 12 months postoperatively. Among 34 consecutive patients who initially met enrollment criteria, 26 subjects (23 boys and 3 girls) aged 10 to 16 years (mean 12.3 years) completed this study. Canaloplasty and hearing restoration procedures were performed uneventfully in all patients. The mean air conduction thresholds were significantly improved from 63.9 to 35.0 dB (6 months) and 39.4 dB (12 months) after surgery (p < 0.001). In HINT, speech understanding in noise that was presented toward the newly opened atretic ear significantly improved at 1 year postoperatively (p = 0.014). In noise toward the normal ear, speech understanding significantly improved after surgery, from -0.1 dB preoperatively to -2.0 dB at 6 months (p = 0.002) and -1.8 dB at 12 months (p = 0.005) (p for quadratic trend = 0.036). The composite score improved from -2.6 dB preoperatively to -3.4 dB at 6 months and -3.6 dB at 12 months (p = 0.045; p for linear trend = 0.005). The Sound-Spatial-Qualities of Hearing Scale scores in all domains significantly improved 1 year after surgery (p < 0.034). The mean GBI scores in each domain ranged from 14.2 to 49.4. Total GBI score was correlated with better signal to noise ratio in noise toward the atretic ear as measured by HINT at postoperative 1 year (Spearman ρ = 0.482, p = 0.013). Teenaged patients with unilateral congenital aural atresia showed satisfactory hearing improvement after canaloplasty with hearing restoration surgery. In a serial long-term follow-up, speech understanding in noise measured by HINT improved over time. One year after surgery, teenaged children acquired binaural hearing (binaural squelch), as measured by the HINT with noise presented to the newly opened atretic ear. Subjective questionnaires also showed improvements in binaural hearing function and quality of life.

Auditory Brainstem Implantation Improves Speech Recognition in Neurofibromatosis Type II Patients

This prospective study aimed to determine speech understanding in neurofibromatosis type II (NF2) patients following implantation of a MED-EL COMBI 40+ auditory brainstem implant (ABI). Patients (n = 32) were enrolled postsurgically. Nonauditory side effects were evaluated at fitting and audiological performance was determined using the Sound Effects Recognition Test (SERT), Monosyllable-Trochee-Polysyllable (MTP) test and open-set sentence tests. Subjective benefits were determined by questionnaire. ABI activation was documented in 27 patients, 2 patients were too ill for testing and 3 patients were without any auditory perception. SERT and MTP outcomes under auditory-only conditions improved significantly between first fitting and 12-month follow-up. Open-set sentence recognition improved from 5% at first fitting to 37% after 12 months. The number of active electrodes had no significant effect on performance. All questionnaire respondents were ‘satisfied' to ‘very satisfied' with their ABI. An ABI is an effective treatment option in NF2 patients with the potential to provide open-set speech recognition and subjective benefits. To our knowledge, the data presented herein is exceptional in terms of the open-set speech perception achieved in NF2 patients.

Cochlear Implantation in Adults

Sensorineural hearing loss is the third leading cause of years lived with disability worldwide. Cochlear implants may provide a viable alternative to hearing aids for this type of hearing loss. The Coverage and Analysis Group at the Centers for Medicare & Medicaid Services was interested in an evaluation of recently published literature on this topic. In addition, this meta-analysis is to our knowledge the first to evaluate quality-of-life (QOL) outcomes in adults with cochlear implants. To evaluate the communication-related outcomes and health-related QOL outcomes after unilateral or bilateral cochlear implantation in adults with sensorineural hearing loss. MEDLINE, Cochrane Central Register of Controlled Trials, Scopus, and previous reports from January 1, 2004, through May 31, 2012. Published studies of adult patients undergoing unilateral or bilateral procedures with multichannel cochlear implants and assessments using open-set sentence tests, multisyllable word tests, or QOL measures. Five researchers extracted information on population characteristics, outcomes of interest, and study design and assessed the studies for risk of bias. Discrepancies were resolved by consensus. A total of 42 studies met the inclusion criteria. Most unilateral implant studies showed a statistically significant improvement in mean speech scores as measured by open-set sentence or multisyllable word tests; meta-analysis revealed a significant improvement in QOL after unilateral implantation. Results from studies assessing bilateral implantation showed improvement in communication-related outcomes compared with unilateral implantation and additional improvements in sound localization compared with unilateral device use or implantation only. Based on a few studies, the QOL outcomes varied across tests after bilateral implantation. Unilateral cochlear implants provide improved hearing and significantly improve QOL, and improvements in sound localization are noted for bilateral implantation. Future studies of longer duration, higher-quality reporting, and large databases or registries of patients with long-term follow-up data are needed to yield stronger evidence.

Cochlear Implant Outcomes in Adults and Adolescents With Early-Onset Hearing Loss

The aims of the study were to investigate (1) speech perception outcomes in people with an early-onset hearing loss (HL) who received a cochlear implant as an adolescent or adult, (2) prognostic factors associated with positive speech perception outcomes, and (3) self-report outcomes in these participants. Outcomes for 38 implant recipients with a Nucleus device were investigated retrospectively. All participants were diagnosed with a bilateral HL at age #3 yr and were implanted at age 14 yr or older. Nineteen participants had confirmed bilateral, severe to profound HL at age #12 mo (prelingual); nine had confirmed bilateral, severe to profound HL at age.12 mo and #3 yr (perilingual); and the remaining 10 had a diagnosis of bilateral sensorineural HL at age #3 yr which progressed to severe to profound HL after 3 yrs of age (progressive). There were 24 females and 14 males, and the average age at implantation was 33 yr (range 5 14-65 yr). Closed-set and open-set speech perception tests administered pre- and postimplant were analyzed for all participants, in addition to self-report survey measures of benefit, satisfaction, and implant usage. Participants were placed into one of five hierarchic categories of speech perception performance preimplantation and at 12 mo postimplantation. The categories ranged from sound detection only (category 1) to excellent open-set speech perception (category 5). To be in category 4 or 5, the participant had to score.30% words correct on a recorded version of either the Central Institute for the Deaf Everyday Sentence Lists or the City University of New York Sentences. Before implantation, two recipients (5%) were in category 4 or 5 compared with 20 (53%) at 12 mo postimplant. Consistent with previous studies, there was large intersubject variability in speech scores. Three factors accounted for 63% of the variance on open-set sentence test scores, postimplant: mode of communication in childhood (oral versus total communication/sign), stable as opposed to progressive loss, and time without a hearing aid on the implant ear. More than 80% of survey respondents used their device.8 hr a day, and 90% reported that their ability to understand speech with visual cues was "much better" with the implant. In addition, all reported being satisfied with the device. These results indicate that a cochlear implant should be considered as an option for adults and adolescents with early-onset HL. The majority of participants gained benefit from the device and were satisfied with it. In addition, a substantial number gained good open-set speech perception ability, postimplant. Recipients who used oral communication in childhood, had a progressive loss, and wore a hearing aid on the implant ear up to the time of surgery were more likely to obtain better speech perception outcomes.

Cochlear implantation in patients with autoimmune inner ear disease including cogan syndrome: A comparison with age‐ and sex‐matched controls

Evaluate the characteristics and outcomes of patients with autoimmune inner ear disease (AIED) who have undergone cochlear implantation (CI) and compare post-CI performance in AIED to matched controls. Retrospective case control study. Study cohort was comprised of 25 adult implantees (AIED [n = 18], Cogan syndrome [n = 7]). The AIED group was defined by rapidly progressive bilateral sensorineural hearing loss leading to unusable hearing within weeks to months. Patients with Cogan syndrome, the archetypal inner ear autoimmune disease, were also examined and used for within-cohort comparison. Clinical and operative records were reviewed. Post-CI performance was assessed using open-set sentence tests. Age- and sex-matched individuals deafened by other postlingual causes were used as controls. Of 25 patients, 24 had uneventful, full electrode insertions. One AIED patient had partial insertion due to cochlear ossification and did not achieve open-set speech perception post-CI. Mean open-set sentence scores for study patients with uneventful insertions were 92.8%, 97.3%, and 96.4% at 6 months, 1 year, and ≥ 2 years, respectively. Compared to matched controls, patients deafened by autoimmune causes had significantly higher post-CI performance at all postoperative test intervals (P < .05). There was no significant difference in postimplantation performance between Cogan syndrome and AIED patients. To our knowledge this was the largest study of cochlear implantation in AIED and Cogan syndrome patients. In our experience, both groups generally attained high levels of post-CI speech perception and performed above average. Cochlear ossification affecting implantation in Cogan syndrome patients was not observed in our series, contrary to some reports.

Efeitos do potencial de ação neural sobre a percepção de fala em usuários de implante coclear

O Potencial de Ação Composto Evocado Eletricamente reflete a atividade do nervo auditivo, podendo ser registrado através dos eletrodos do implante coclear. A determinação dos elementos neurais estimuláveis pode contribuir para explicar a variabilidade de desempenho entre indivíduos implantados. OBJETIVO: Comparar o desempenho nos testes de percepção da fala entre pacientes que apresentaram e que não apresentaram potencial de ação composto evocado eletricamente no momento intra-operatório. MATERIAL E MÉTODO: Estudo prospectivo no qual 100 indivíduos usuários do implante coclear Nucleus 24 foram divididos em dois grupos de acordo com a presença ou ausência do potencial de ação intra-operatório. Após 6 meses de uso do dispositivo, os resultados dos testes de percepção de fala foram comparados entre os grupos. RESULTADOS: O potencial foi observado em 72% dos pacientes. A percepção no teste de frases em formato aberto foi melhor nos indivíduos com presença de potencial (média 82,8% contra 41,0%, p = 0,005). Houve associação entre ausência do potencial e etiologia da surdez por meningite. CONCLUSÃO: Ausência de potencial neural intraoperatório esteve associada ao pior desempenho na percepção da fala e à etiologia da surdez por meningite. Por outro lado, a presença do potencial de ação intraoperatório sugere ótimo prognóstico.

Influence of Evoked Compound Action Potential on Speech Perception in Cochlear Implant Users

SummaryElectrically Evoked Compound Action Potential is a measure of synchronous cochlear nerve fibers activity elicited by electrical stimulation of the cochlear implant. The electrophysiological nerve responses may contribute to explain the variability in individual performance of cochlear implant recipients.AimTo compare speech perception tests’ performances of cochlear implant users according to the presence or absence of intraoperative neural telemetry responses.Material and MethodProspective study design with 100 “Nucleus 24” cochlear implant users divided in two groups according to the presence or absence of intraoperative neural telemetry responses. Speech perception tests were performed after 6 months of continuous use of the device and compared among groups.ResultsIntraoperative action potentials were observed in 72 % of individuals. Open-set sentence test results were better in implant users who had neural telemetry responses when compared to implant users in whom this potential was absent (averages 82.8 % versus 41 %, p = 0.005). There was a strong association between post meningitis-related deafness and absence of intraoperative potentials.ConclusionThe absence of intraoperative neural telemetry responses was associated with worse performances in speech perception tests and meningitis as etiology of deafness. On the other hand, the presence of these potentials suggests excellent prognosis.

Results of the MXM Digisonic auditory brainstem implant clinical trials in Europe.

To assess the potential benefit of the MXM auditory brainstem implant for patients with neurofibromatosis type 2. Retrospective case review. Tertiary referral centers. Fourteen patients with neurofibromatosis type 2 and bilateral acoustic neuromas underwent implantation with the MXM auditory brainstem implant during surgery to remove the second-side tumor. There were no complications related to the auditory brainstem implantation. Auditory sensations were present for 12 of 14 patients (86%). Global results indicated an improved quality of life for the patients receiving auditory sensations, in part because of their auditory orientation within the environment. Eighty-nine percent of patients tested with an open-set sentence test demonstrated enhancement of speech understanding as a result of lip-reading improvement when auditory brainstem implant sound was combined with lip-reading. A few patients (36%) had some speech understanding in sound-only mode. One patient was able to have limited phone conversations. These results indicate that significant auditory benefit can be derived from the MXM auditory brainstem implant.

Emphasis of short-duration acoustic speech cues for cochlear implant users.

A new speech-coding strategy for cochlear implant users, called the transient emphasis spectral maxima (TESM), was developed to aid perception of short-duration transient cues in speech. Speech-perception scores using the TESM strategy were compared to scores using the spectral maxima sound processor (SMSP) strategy in a group of eight adult users of the Nucleus 22 cochlear implant system. Significant improvements in mean speech-perception scores for the group were obtained on CNC open-set monosyllabic word tests in quiet (SMSP: 53.6% TESM: 61.3%, p<0.001), and on MUSL open-set sentence tests in multitalker noise (SMSP: 64.9% TESM: 70.6%, p<0.001). Significant increases were also shown for consonant scores in the word test (SMSP: 75.1% TESM: 80.6%, p<0.001) and for vowel scores in the word test (SMSP: 83.1% TESM: 85.7%, p<0.05). Analysis of consonant perception results from the CNC word tests showed that perception of nasal, stop, and fricative consonant discrimination was most improved. Information transmission analysis indicated that place of articulation was most improved, although improvements were also evident for manner of articulation. The increases in discrimination were shown to be related to improved coding of short-duration acoustic cues, particularly those of low intensity.

Comparative speech recognition results in eight subjects using two different coding strategies with the Nucleus 22 channel cochlear implant

This study was designed to compare the results of several speech tests administered to eight subjects who used two types of speech-coding strategies with the Nucleus 22 channel cochlear implant. The subjects had an average experience of 40 months with the F0F1F2 coding strategy implemented in their previous wearable speech processor. Three subjects were good performers (showing significant open-set understanding without lip-reading) and five were moderate performers (not able to do speech-tracking by auditory means alone). All subjects were evaluated again after 1 month and 6 months of experience with the MULTIPEAK coding strategy of the miniature speech processor. The test materials included vowel and consonant identification, monosyllabic words, everyday sentences and numbers in noise. All eight subjects showed an improvement on more than three of five measures. The group of moderate performers showed a larger improvement in vowel (+16%) and consonant (+17%) identification scores than the group of good performers. For the open-set sentence test, the better patients were able to increase their score from 52% to 80% correct; two of the moderate performers did not improve. Six subjects achieved significantly higher scores at moderate signal-to-noise ratios (up to 10 dB S/N) in the (Freiburger) number test. Results of information transmission analysis are also discussed.

Results for Chinese and English in a Multichannel Cochlear Implant Patient

A multichannel cochlear prosthesis was implanted in a Chinese patient who suffered from profound sensory hearing loss. The preoperative Minimal Auditory Capabilities (MAC) battery tests in English, as well as an open set bisyllable word test, an open set sentence test, and speech tracking in Chinese indicated significant improvement of speech perception for both English and Chinese after the operation. Substantial understanding of running speech was possible in both languages without the help of lipreading.

Clinical Results for Postlingually Deaf Patients Implanted with Multichannel Cochlear Prostheses

Clinical results for 24 patients using the Nucleus 22-channel cochlear prosthesis have shown the device to be successful in presenting amplitude, fundamental frequency, and second formant information to patients with acquired hearing loss. For all patients, this has meant a significant improvement in their communication ability when using lipreading and some ability to understand unknown speech without lipreading or contextual cues. Approximately 40% of patients are able to understand running speech in a limited fashion without lipreading, and this ability has been evaluated using the speech-tracking technique for a number of patients. Many patients are able to have limited conversations on the telephone without using a special code. Although the prosthesis has been designed with the presentation of speech signals in mind, recognition and discrimination of environmental sounds has also been very encouraging with patients scoring 70% to 80% correct for closed set environmental sound testing. Follow-up testing has indicated that the ability to understand open set speech without lipreading continues to improve up to at least 12 months postoperatively. Open set sentence test results improved from an average of 20% at 3 months to 40% at 12 months.

Preliminary speech comprehension results with the single‐channel cochlear implant

Four scala tympani implant subjects, two with multiple‐electrode prostheses and two with single‐electrode implants, were tested with a single‐channel wearable sound processor after 0–8 months' use. A comparison between pre‐ and post‐implant scores on the Minimal Auditory Capabilities (MAC) Test showed little difference, except that all subjects improved on the postoperative lipreading test when electrical stimulation was added (“aided” condition). Improvement was noted in aided over unaided performance on videotaped tests, including a medial consonant test, two‐digit numerals test, and an open set sentence test. Subjects showed a two‐ to fourfold increase in speech tracking rates in the aided over the unaided condition. These baseline observations indicate that subjects quickly begin to experience improvement in face‐to‐face communication skills even during the first months of using a single‐channel cochlear prosthesis. [Work supported by NIH.]