Open-set Speech Perception Scores Research Articles

Critical Factors for Binaural Hearing in Children with Bilateral Sequential Cochlear Implantation: First Implant Performance and Inter-Implant Interval

Objectives: This study evaluated the influence of the performance of the first cochlear implant (CI-1) on the second implant (CI-2) and the significance of inter-implant intervals in children with sequential cochlear implantation. Method: Thirty-four patients were included for speech perception outcome and 38 patients were included for subjective hearing satisfaction in daily life in this study. The patients were classified into 3 groups according to inter-implant interval: group I, <4 years; group II, 4–7 years; group III, >7 years. Open-set speech perception scores before and at 3, 6, 12, and 24 months after the second implantation was compared among the CI-1, CI-2, and bilateral CI conditions. Subjective hearing benefits in daily life were measured using a questionnaire of Speech, Spatial, and Qualities of Hearing Scale (SSQ) for parents of children with impaired hearing, and device use and preference were evaluated (by phone interview.) Results: The speech perception of children using the CI-2 only improved quickly within 3 months postoperatively and were similar to those using the CI-1 only. The results of monosyllabic and disyllabic word tests using CI-2 at 3 months after second implantation were not significantly different from those in patients using the CI-1 only. In the sentence test, the scores using the CI-2 only were not significantly different from those using the first implant only at 6 months after second implantation. SSQ scores were similar among groups and the worst score in each section was shown from the questions about performance under noisy conditions in each section. Device usage habits showed that 17 (44.7%) and 16 (42.1%) patients preferred bilateral and the CI-1, respectively. Only 5 (13.2%) patients wanted the CI-2 rather than the CI-1. While group I and II showed a prominent positive attitude to bilateral use, group III, for which the inter-implant interval was 7 years or more, showed a definite preference for the CI-1 (p < 0.01). Conclusions: Functional binaural benefits were achieved in patients who were good performers with the CI-1 after the second implantation irrespective of the inter-implant interval. Sequential CI should be strongly recommended for patients with unilateral CI showing a good performance.

Rehabilitation and Psychosocial Determinants of Cochlear Implant Outcomes in Older Adults.

The cochlear implant (CI) has been shown to be associated with better hearing, cognitive abilities, and functional independence. There is variability however in how much benefit each recipient derives from his or her CI. This study's primary objective is to determine the effects of individual and environmental characteristics on CI outcomes. Seventy-six adults who developed postlingual severe to profound hearing loss and received their first unilateral CI at 65 years and older were eligible for the study. Fifty-five patients were asked to participate and the 33 (60%) with complete data were classified as "group 1." The remaining patients were placed in "group 2." Primary outcomes included changes in quality of life and open-set speech perception scores. Independent variables included age, health status, trait emotional intelligence (EI), comfort with technology, and living arrangements. Survey outcomes and audiological measurements were collected prospectively at 12 months after surgery, whereas preoperative data were collected retrospectively. Comparisons between groups 1 and 2 were made. Wilcoxon signed rank test, Spearman correlations, Mann-Whitney tests, Chi-square tests, and linear regressions were performed only on group 1 data. Having a CI was associated with improved quality of life and speech perception. Familiarity with electronic tablets was associated with increased 12-month postoperative AzBio gains when adjusted for preoperative AzBio scores (adjusted p = 0.019), but only marginally significant when a family-wise error correction was applied (p = 0.057). Furthermore, patients who lived with other people scored at least 20 points higher on the AzBio sentences than those who lived alone (adjusted p = 0.046). Finally, consultation with an auditory rehabilitation therapist was associated with higher self-reported quality of life (p = 0.035). This study suggests that in a cohort of older patients cochlear implantation is associated with a meaningful increase in both quality of life and speech perception. Furthermore, it suggests the potential importance of adjunct support and services, including the tailoring of CI rehabilitation sessions depending on the patient's familiarity with technology and living situation. Investment in rehabilitation and other services is associated with improvements in quality of life and may mitigate clinical, individual and social risk factors for poor communication outcome.

Long-term Communication Outcomes for Children Receiving Cochlear Implants Younger Than 12 Months: A Multicenter Study.

Examine the influence of age at implant on speech perception, language, and speech production outcomes in a large unselected paediatric cohort. This study pools available assessment data (collected prospectively and entered into respective databases from 1990 to 2014) from three Australian centers. Children (n = 403) with congenital bilateral severe to profound hearing loss who received cochlear implants under 6 years of age (excluding those with acquired onset of profound hearing loss after 12 mo, those with progressive hearing loss and those with mild/moderate/severe additional cognitive delay/disability). Speech perception; open-set words (scored for words and phonemes correct) and sentence understanding at school entry and late primary school time points. Language; PLS and PPVT standard score equivalents at school entry, CELF standard scores. Speech Production; DEAP percentage accuracy of vowels, consonants, phonemes-total and clusters, and percentage word-intelligibility at school entry. Regression analysis indicated a significant effect for age-at-implant for all outcome measures. Cognitive skills also accounted for significant variance in all outcome measures except open-set phoneme scores. ANOVA with Tukey pairwise comparisons examined group differences for children implanted younger than 12 months (Group 1), between 13 and 18 months (Group 2), between 19 and 24 months (Group 3), between 25 and 42 months (Group 4), and between 43 and 72 months (Group 5). Open-set speech perception scores for Groups 1, 2, and 3 were significantly higher than Groups 4 and 5. Language standard scores for Group 1 were significantly higher than Groups 2, 3, 4, and 5. Speech production outcomes for Group 1 were significantly higher than scores obtained for Groups 2, 3, and 4 combined. Cross tabulation and χ2 tests supported the hypothesis that a greater percentage of Group 1 children (than Groups 2, 3, 4, or 5) demonstrated language performance within the normative range by school entry. Results support provision of cochlear implants younger than 12 months of age for children with severe to profound hearing loss to optimize speech perception and subsequent language acquisition and speech production accuracy.

Is there a deafness duration limit for cochlear implants in post-lingual deaf adults?

Conclusion: Patients with post-lingual deafness should not be excluded from cochlear implantation (CI) on the basis of duration of deafness. We found that the prognosis was favorable in patients who developed deafness after adolescence, even in those with extremely long-term deafness. Objectives: CI is an effective treatment for post-lingual deafness. However, it remains unclear whether CI would benefit patients with extremely long-term deafness. We evaluated the auditory performance after CI of patients who had been deaf for more than 30 years. Methods: The study enrolled 81 adults with post-lingual deafness. Speech perception tests were performed preoperatively and 12 months postoperatively, and factors affecting the postoperative auditory performance were investigated. The subjects were divided into groups according to the duration of deafness and the postoperative speech perception scores were compared. Results: A marked improvement in the open-set speech perception scores (mono/disyllabic words and sentences) after implantation was seen in all groups, and no significant difference in the improvement in speech perception scores was observed among the groups. Age at onset of deafness was closely related to the postoperative performance, and patients who had lost their hearing before adolescence performed poorly.

Communication Development in Children Who Receive a Cochlear Implant by 12 Months of Age

Describe the long-term benefits of early cochlear implantation. Provide a comprehensive description of outcomes, including: language, speech production, and speech perception. Compare the communication outcomes for the early implanted children to those of normally hearing children and children who received a cochlear implant at a comparatively older age. Retrospective review of the communication development of 35 children implanted between 6 and 12 months of age and 85 children implanted between 13 and 24 months of age. Audiologic assessments included unaided and aided audiograms, auditory brainstem response (ABR), auditory steady state response (ASSR), and otoacoustic emissons (OAEs). Formal language, speech production, and speech perception measures were administered, preimplant and at 1, 2, 3, and 5 years postimplant. The children who received their cochlear implant by 12 months of age demonstrated language growth rates equivalent to their normally hearing peers and achieved age appropriate receptive language scores 3 years postimplant. The children who received their cochlear implant between 13 and 24 months demonstrated a significant language delay at 3 years postimplant. Speech production development followed a similar pattern to that of normal-hearing children, although was delayed, for both groups of children. Mean open-set speech perception scores were comparable with previous reports for children and adults who use cochlear implants. Children implanted by 12 months of age demonstrate better language development compared with children who receive their cochlear implant between 13 and 24 months. This supports the provision of a cochlear implant within the first year of life to enhance the likelihood that a child with severe-to-profound hearing impairment will commence elementary school with age-appropriate language skills.

Cochlear Implantation versus Hearing Amplification in Patients with Auditory Neuropathy Spectrum Disorder

Patients with auditory neuropathy spectrum disorder (ANSD) exhibit altered neural synchrony in response to auditory stimuli. Cochlear implantation (CI) is thought to improve neural synchrony in response to auditory stimuli and improve speech perception relative to conventional hearing amplification (HA). Retrospective review. Tertiary otologic practice. Subjects included patients with ANSD treated at Vanderbilt University from 1999 to 2011. Sixteen patients underwent CI, and 10 received binaural HAs. Pretreatment performance was assessed through speech reception thresholds and parent questionnaire (Infant-Toddler Meaningful Auditory Integration Scale [IT-MAIS]). Posttreatment outcomes were assessed using IT-MAIS and closed-/open-set speech perception scores. Two HA users underwent neuromaturation and were excluded from further analysis. For the remaining patients, median duration of device use was 48 months. All CI patients had a prior binaural HA trial with failure of auditory skills development. Median available pretreatment IT-MAIS score was 13 and 30 for CI and HA groups, respectively (rank sum test, P = .32). Posttreatment, 6 of 16 CI patients and 4 of 8 HA patients achieved open-set speech perception scores ≥ 60%. No differences between groups were found in posttreatment IT-MAIS scores (rank sum test, P = .11) or the percentage of patients achieving the above levels of open-set speech perception (Fisher exact test, P = .67). A wide range of speech perception outcomes are observed in ANSD patients. In our ANSD population, patients who exhibited failure of auditory skills development with HAs were able to achieve comparable overall speech perception outcomes after CI relative to those who continued to make appropriate auditory progress with HAs alone.

Internet Video Telephony Allows Speech Reading by Deaf Individuals and Improves Speech Perception by Cochlear Implant Users

ObjectiveTo analyze speech reading through Internet video calls by profoundly hearing-impaired individuals and cochlear implant (CI) users.MethodsSpeech reading skills of 14 deaf adults and 21 CI users were assessed using the Hochmair Schulz Moser (HSM) sentence test. We presented video simulations using different video resolutions (1280×720, 640×480, 320×240, 160×120 px), frame rates (30, 20, 10, 7, 5 frames per second (fps)), speech velocities (three different speakers), webcameras (Logitech Pro9000, C600 and C500) and image/sound delays (0–500 ms). All video simulations were presented with and without sound and in two screen sizes. Additionally, scores for live Skype™ video connection and live face-to-face communication were assessed.ResultsHigher frame rate (>7 fps), higher camera resolution (>640×480 px) and shorter picture/sound delay (<100 ms) were associated with increased speech perception scores. Scores were strongly dependent on the speaker but were not influenced by physical properties of the camera optics or the full screen mode. There is a significant median gain of +8.5%pts (p = 0.009) in speech perception for all 21 CI-users if visual cues are additionally shown. CI users with poor open set speech perception scores (n = 11) showed the greatest benefit under combined audio-visual presentation (median speech perception +11.8%pts, p = 0.032).ConclusionWebcameras have the potential to improve telecommunication of hearing-impaired individuals.

Cochlear implantation in children with postlingual hearing loss

Although it is clear that early auditory stimulation through cochlear implantation (CI) has been shown to improve speech and language development trajectories for children with prelingual hearing loss, data supporting implantation in postlingual children are mostly lacking. The purpose of this study was to characterize speech perception abilities following CI in a group of children with previously well-developed language abilities. Retrospective analysis. Twenty-eight hearing-impaired children who received CIs were selected for study based on the presence of well-developed spoken language skills before implantation. Fifteen children with prelingual hearing loss served as a control group. Speech perception skills were assessed using developmentally appropriate measures. Children with postlingual hearing loss showed a statistically significant improvement in open-set speech perception scores as early as 6 months following CI, whereas prelingual children demonstrated significant improvements only after 24 months of use. Despite these early disparities in performance, the two groups were similar 36 months after implantation and beyond (60 months of implant use). Children with well-developed language abilities before CI showed substantial (and statistically significant) early improvements in open-set speech perception abilities following implantation that continued beyond 2 years of follow-up. These results suggest that postlingual children are excellent candidates for CI.

Auditory performance after cochlear implantation in late septuagenarians and octogenarians.

Previous studies have demonstrated consistent benefit in older adults undergoing cochlear implantation as compared with younger control groups, with age category thresholds between 60 and 70 years. The objective of this study is to report auditory performance in implant recipients older than 75 years, a cohort for which few data have been reported. Retrospective chart review. Academic cochlear implant program in a tertiary-care hospital. : Twenty-eight cochlear implant recipients were subdivided into implant users older than 80 years (Group 1) and recipients currently older than 75 years (Group 2). Cochlear implantation. Open-set speech perception scores. : Postoperative open-set speech perception scores were compared with preoperative scores in the best-aided condition. Criteria were developed to define situations where the implant was considered to be nonbeneficial or less beneficial than amplification, and those data were then subjected to Kaplan-Meier analysis. Group 1 included 13 patients with mean age of 80.7 years at the time of implantation. Group 2 included 15 patients with a mean age of 71.6 years. Scores were significantly better postoperatively at 6 months (p < 0.01) for Group 2 and at 12 months (p < 0.01) for both Groups 1 and 2. Kaplan-Meier curves were constructed for both groups. Cochlear implantation in patients older than 75 years is beneficial, and Kaplan-Meier analysis demonstrates that the clinical benefit is durable over time. Patients older than 80 years obtain similar benefit, although auditory performance was less robust.

Importance of Age and Postimplantation Experience on Speech Perception Measures in Children With Sequential Bilateral Cochlear Implants

Clinical trials in which children received bilateral cochlear implants in sequential operations were conducted to analyze the extent to which bilateral implantation offers benefits on a number of measures. The present investigation was particularly focused on measuring the effects of age at implantation and experience after activation of the second implant on speech perception performance. Thirty children aged 3 to 13 years were recipients of 2 cochlear implants, received in sequential operations, a minimum of 6 months apart. All children received their first implant before 5 years of age and had acquired speech perception capabilities with the first device. They were divided into 3 age groups on the basis of age at time of second ear implantation: Group I, 3 to 5 years; Group II, 5.1 to 8 years; and Group III, 8.1 to 13 years. Speech perception measures in quiet included the Multisyllabic Lexical Neighborhood Test (MLNT) for Group I, the Lexical Neighborhood Test (LNT) for Groups II and III, and the Hearing In Noise Test for Children (HINT-C) sentences in quiet for Group III. Speech perception in noise was assessed using the Children's Realistic Intelligibility and Speech Perception (CRISP) test. Testing was performed preoperatively and again postactivation of the second implant at 3, 6, and 12 months (CRISP at 3 and 9 mo) in both the unilateral and bilateral conditions in a repeated-measures study design. Two-way repeated-measures analysis of variance was used to analyze statistical significance among device configurations and performance over time. US Multicenter. Results for speech perception in quiet show that children implanted sequentially acquire open-set speech perception in the second ear relatively quickly (within 6 mo). However, children younger than 8 years do so more rapidly and to a higher level of speech perception ability at 12 months than older children (mean second ear MLNT/LNT scores at 12 months: Group I, 83.9%; range, 71-96%; Group II, 59.5%; range, 40-88%; Group III, 32%; range, 12-56%). The second-ear mean HINT-C score for Group III children remained far less than that of the first ear even after 12 months of device use (44 versus 89%; t, 6.48; p<0.001; critical value, 0.025). Speech intelligibility for spondees in noise was significantly better under bilateral conditions than with either ear alone when all children were analyzed as a single group and for Group III children. At the 9-month test interval, performance in the bilateral configuration was significantly better for all noise conditions (13.2% better for noise at first cochlear implant, 6.8% better for the noise front and noise at second cochlear implant conditions, t=2.32, p=0.024, critical level=0.05 for noise front; t=3.75, p<0.0001, critical level=0.05 for noise at first implant; t=2.73, p = 0.008, critical level=0.05 for noise at second implant side). The bilateral benefit in noise increased with time from 3 to 9 months after activation of the second implant. This bilateral advantage is greatest when noise is directed toward the first implanted ear, indicating that the head shadow effect is the most effective binaural mechanism. The bilateral condition produced small improvements in speech perception in quiet and for individual Group I and Group II patient results in noise that, in view of the relatively small number of subjects tested, do not reach statistical significance. Sequential bilateral cochlear implantation in children of diverse ages has the potential to improve speech perception abilities in the second implanted ear and to provide access to the use of binaural mechanisms such as the head shadow effect. The improvement unfolds over time and continues to grow during the 6 to 12 months after activation of the second implant. Younger children in this study achieved higher open-set speech perception scores in the second ear, but older children still demonstrate bilateral benefit in noise. Determining the long-term impact and cost-effectiveness that results from such potential capabilities in bilaterally implanted children requires additional study with larger groups of subjects and more prolonged monitoring.

Classroom Performance of Children with Cochlear Implants in Mainstream Education

We compared classroom performance of children with a cochlear implant (CI) with that of their normal-hearing peers in mainstream education. Thirty-two CI children in mainstream education, congenitally or prelingually deaf, participated in this study, as did 37 hearing classmates. Their teachers filled out 2 questionnaires: the Assessment of Mainstream Performance (AMP) and the Screening Instrument for Targeting Educational Risk (SIFTER). A high Fletcher index and open-set speech perception scores were obtained. The children with CIs scored above average on the AMP and sufficiently well in all but one area (communication) of the SIFTER questionnaire. Class rankings did not differ significantly between the CI students and their normal-hearing peers. Overall, the normal-hearing group outperformed the CI group. The classroom performance of CI children correlated negatively with duration of deafness and age at implantation. All longitudinal audiological data of the CI children showed improvement in open-set speech recognition. Although the results are encouraging, the CI group scored significantly less well than their normal-hearing peers on most questionnaire domains of both the AMP and the SIFTER. The most important variables for the outcome in this study were age at implantation and duration of deafness.

Connexin-Associated Deafness and Speech Perception Outcome of Cochlear Implantation

To compare performance after cochlear implantation in children with mutations in connexin (Cx) 26 (GJB2) or Cx30 (GJB6) and children with deafness of unknown etiology. Genetic analysis and speech perception evaluation was performed in the children with and without Cx mutations who had undergone cochlear implantation. Speech perception performance was retrospectively analyzed 6, 12, 24, 36, and 48 months after implantation. Test material was selected according to the child's age and cognitive and language abilities. The study took place at speech and hearing and genetic centers of a hospital in the central part of Israel and the genetics departments of 3 additional centrally located hospitals. A total of 30 children who had undergone cochlear implantation were selected for the study, with control patients matched according to age at implantation, duration of implant use, and mode of communication. There was no evidence for additional disabilities or handicaps in either group. Speech perception measurements included a questionnaire, as well as closed and open-set tests. Overall, the 2 groups showed significant improvement in speech perception results after implantation. Four years after implantation, both groups achieved mean open-set speech perception scores of approximately 60%, 75%, and 90% for monosyllabic, 2 syllables, and words in sentences tests, respectively. There were no apparent differences in speech perception performance after implantation between the children with Cx mutations and children with deafness of unknown etiology. These data have important implications as a prognostic indicator when counseling candidates for cochlear implantation.