Open-set Test Research Articles

Assessment of early language development in Turkish children with a cochlear implant using the TEDIL test

Objectives: To analyse language development of children with a cochlear implant (CI) in relation to length of CI use and age at implantation and to examine the suitability of the TEDIL as an assessment tool for measuring early language development in Turkish children.Methods: A total of 119 children implanted with a CI before 5 years of age were assessed acutely on sound field thresholds, speech recognition thresholds, open-set and closed-set monosyllabic word tests, the TEDIL, categories of auditory performance (CAP), and speech intelligibility rating (SIR). The outcome scores were analysed in relation to length of CI use (3, 4, and 5 years) and age at implantation (<24 months vs. >24 months). The TEDIL scores were compared to all other outcome measures.Results: Scores significantly increased with CI experience. CAP and SIR were significantly higher in the younger implanted group. No significant difference was observed between the younger and older implanted group on the closed-set and open-set monosyllabic tests and the TEDIL. The TEDIL scores significantly correlated with CAP, SIR, and the closed-set and open-set word scores. The mean TEDIL standard score was close to average.Conclusions: Performance of CI users improves with increased CI experience. CI users implanted <24 months tend to have better auditory skills and clearer speech than CI users implanted >24 months. CI users implanted between 24 months and 60 months tend to develop language similarly to CI users implanted <24 months. The TEDIL is a suitable tool for assessing early receptive and expressive language development in Turkish children.

Auditory Brainstem Implantation in Neurofibromatosis Type 2: Experience From the Manchester Programme.

To describe the experience of auditory brainstem implantation (ABI) in patients with Neurofibromatosis type 2 (NF2). Retrospective case review. Tertiary referral centre. Implanted with a Cochlear ABI22 or ABI24M between 1994 and 2009 because of NF2 disease. Rehabilitative. Surgical complication rate; audiological outcomes. There were 50 primary ABI insertions in 49 patients, including 16 inserted at the time of first side tumor removal as a sleeper, and two revision repositionings which failed to improve outcome. Postoperatively three patients had cerebrospinal fluid leaks which did not require reoperation, one patient had meningitis, and eleven patients suffered either temporary or permanent lower cranial nerve dysfunction. Twenty-nine patients became full time users; a further 12 patients became non-users. Three patients died while their device was inactive. Five patients retain serviceable contralateral hearing. Audiological open set testing of users showed means of: environmental sounds discrimination 51%; phoneme discrimination: with ABI alone 22%/lip reading (LR) 45%/ABI with LR 65%; sentence testing: with ABI alone 13%/LR 19%/ABI with LR 54%. The majority of patients with NF2 implanted with an ABI find the device a useful aid to communication in conjunction with LR and in recognizing common environmental sounds. A small proportion gain open set discrimination. Almost a third of patients may end up as non-users. There is probably an increased risk of postoperative lower cranial nerve dysfunction so careful preoperative assessment is advised.

A Sequential Sentence Paradigm Using Revised PRESTO Sentence Lists.

Listening in challenging situations requires explicit cognitive resources to decode and process speech. Traditional speech recognition tests are limited in documenting this cognitive effort, which may differ greatly between individuals or listening conditions despite similar scores. A sequential sentence paradigm was designed to be more sensitive to individual differences in demands on verbal processing during speech recognition. The purpose of this study was to establish the feasibility, validity, and equivalency of test materials in the sequential sentence paradigm as well as to evaluate the effects of masker type, signal-to-noise ratio (SNR), and working memory (WM) capacity on performance in the task. Listeners heard a pair of sentences and repeated aloud the second sentence (immediate recall) and then wrote down the first sentence (delayed recall). Sentence lists were from the Perceptually Robust English Sentence Test Open-set (PRESTO) test. In experiment I, listeners completed a traditional speech recognition task. In experiment II, listeners completed the sequential sentence task at one SNR. In experiment III, the masker type (steady noise versus multitalker babble) and SNR were varied to demonstrate the effects of WM as the speech material increased in difficulty. Young, normal-hearing adults (total n = 53) from the Purdue University community completed one of the three experiments. Keyword scoring of the PRESTO lists was completed for both the immediate- and delayed-recall sentences. The Verbal Letter Monitoring task, a test of WM, was used to separate listeners into a low-WM or high-WM group. Experiment I indicated that mean recognition on the single-sentence task was highly variable between the original PRESTO lists. Modest rearrangement of the sentences yielded 18 statistically equivalent lists (mean recognition = 65.0%, range = 64.4-65.7%), which were used in the sequential sentence task in experiment II. In the new test paradigm, recognition of the immediate-recall sentences was not statistically different from the single-sentence task, indicating that there were no cognitive load effects from the delayed-recall sentences. Finally, experiment III indicated that multitalker babble was equally detrimental compared to steady-state noise for immediate recall of sentences for both low- and high-WM groups. On the other hand, delayed recall of sentences in multitalker babble was disproportionately more difficult for the low-WM group compared with the high-WM group. The sequential sentence paradigm is a feasible test format with mostly equivalent lists. Future studies using this paradigm may need to consider individual differences in WM to see the full range of effects across different conditions. Possible applications include testing the efficacy of various signal-processing techniques in clinical populations.

KALAKA-3: a database for the assessment of spoken language recognition technology on YouTube audios

KALAKA-3 is a speech database specifically designed for the development and evaluation of Spoken Language Recognition (SLR) systems. The database provides TV broadcast speech for training, and audio data extracted from YouTube videos for tuning and testing. The database was created to support the Albayzin 2012 Language Recognition Evaluation (LRE), which featured two language recognition tasks, both dealing with European languages. The first one involved six target languages (Basque, Catalan, English, Galician, Portuguese and Spanish) for which there was plenty of training data, whereas the second one involved four target languages (French, German, Greek and Italian) for which no training data was provided. This second task tried to simulate the use case of low resource languages. Two separate sets of YouTube audio files were provided to test the performance of language recognition systems on both tasks. To allow open-set tests, these datasets included speech in 11 additional (Out-Of-Set) European languages. In this paper, we first discuss the design issues considered when creating the database and describe the data collection procedure. Then, we present the results attained in the Albayzin 2012 LRE, along with the performance of state-of-the-art systems on the four evaluation tracks defined on the database. Both series of results demonstrate the usefulness of KALAKA-3 as a challenging benchmark for the advancement of SLR technology. As far as we know, this is the first database specifically designed to benchmark SLR technology on YouTube audios.

Control strategy of physiological articulatory model for speech production

In speech production the articulatory apparatus includes the organs that execute efferent motor commands from the central nervous system. In order to simulate the behavior of the articulatory apparatus, computational modeling is a commonly-used method. We have constructed a full 3D physiological articulatory model that includes the tongue, jaw, hyoid bone and vocal-tract wall based on the continuum finite element method. This model comprises articulatory muscles with realistic properties and geometrical arrangements. The muscle activation patterns are used to control the movements of the model. In order to use the model to investigate the speech motor control mechanism, generate speech sounds, predict the effect of surgical operation, etc., we have to realize an automatic control strategy. The task of the control strategy is given a particular target, how to generate muscle activation patterns that can control the model to achieve the target. There are two main control strategies for the physiological articulatory model: feedforward control and feedback control. Feedforward control is a kind of mapping used to directly find muscle activation patterns according to the desired target, and feedback control is used to adjust muscle activation patterns to reduce the distance between the desired target and the realized position. In speech production, feedforward mapping is used to rapidly generate muscle activation patterns to control the articulators to produce fluent speech. Feedback control plays the role of learning and maintaining the feedforward mapping. When the degree of accuracy using feedforward mapping cannot satisfy the requirement, feedback control can be used to realize fine motor control. In this paper, we describe how to use feedback control as a learning loop to construct feedforward mapping. The constructed feedforward mapping was assessed through an open-set test, and reasonable articulatory positions were obtained by comparison with the desired targets. Furthermore, the ability of feedback control to improve control accuracy was proved by a large quantity of simulations. 提要: 在言語產生的過程中,發音器官是執行來自中樞神經系統的運動指令的 終端組織。電腦建模的方法常常被應用於模擬發音器官的行為。為此, 我們使用連續體有限元的方法建立了一個三維的發音器官的生理模型, 該模型包含舌、下頜、舌骨以及聲道壁等發音器官。該模型還包括了根 據其生理解剖屬性建立的用於控制發音器官運動的肌肉模型。為了將該 生理模型應用於探索發音器官的運動控制機制,產生自然流暢的語音, 對發音器官的手術後功能進行預測等,我們需要對模型建立一個自動的 控制機制。控制機制的任務在於給定一個發音目標,如何自動的產生肌 肉激活模式去控制模型到達目標。對於發音器官的生理模型而言,有兩 種主要的控制方式:前饋控制和回饋控制。前饋控制是一種從發音控制 目標到肌肉激活模式的映射,用於根據發音目標產生肌肉激活模式;而 回饋控制主要用於調整肌肉激活模式來減少模型實現的位置到目標之間 的距離,最終控制模型到達目標。在言語產生的過程中,前饋控制用於 快速的產生肌肉激活模式控制發音器官產生流暢的語音。回饋控制主要 用於學習前饋控制的映射,並且維持前饋控制可行性。當前饋控制的精 度不能滿足需求時,回饋控制可以用於提高控制精度以實現精確控制。 在本文中,我們將重點介紹如何使用回饋控制作為學習回路,建立前饋 控制的映射。對已建立的前饋映射的開集測試表明該映射可以用於控制 模型在誤差允許範圍內達到目標。而且,大量的模型模擬表明回饋控制 可用於改善前饋控制的控制精度。

Effectiveness of cochlear implant in inner ear bone malformations with anterior labyrinth involvement

ObjectiveTo study electrical stimulation, auditory functionality, and language development in patients with inner ear malformations involving the anterior labyrinth who underwent cochlear implantation. Study designRetrospective case review. SettingReference hospital for cochlear implantation. PatientsReview of 14 cases of severe hearing loss with major (common cavity deformity and cochlear hypoplasia) or minor (e.g., incomplete partition and basal turn aplasia) malformations. InterventionsAfter cochlear implantation, data were gathered on the threshold (THR) and maximum comfort level (MCL) of the electrical stimulation and the number of functioning electrodes. Auditory responses to speech (EARS protocol) subtests were used to evaluate auditory functionality and language acquisition at 6, 12, and 24 months post-implantation. Tests used were: LIP profile, MTP (3, 6 and 12 words), OLD (open set test) and CLD (close set test). Results were compared with findings in a control group of 28 cochlear implantation patients without these malformations and with congenital hearing loss. ResultsThe mean THR was 11.02μC in patients with malformations versus 3.5μC in those without, a significant difference. The THR also significantly differed between groups with major and minor malformations. Fewer functioning electrodes were used in patients with malformations. Auditory functionality scores were best in controls than in patients with malformations, who scored ≤50%, finding the lowest scores in those with major malformations. ConclusionPatients with inner ear malformations undergoing cochlear implantation require greater stimuli to obtain an auditory response and have worse auditory functionality outcomes; these differences are greater in those with major versus minor malformations Nevertheless, cochlear implantation appears to be beneficial for all patients with these malformations to a greater or lesser extent.

Measurement and prediction of speech intelligibility in noise and reverberation for different sentence materials, speakers, and languages

The present study investigates the role of the speech material type, speaker, and language for speech intelligibility in noise and reverberation. The experimental data are compared to predictions of the speech transmission index. First, the effect of noise only, reverberation only, and the combination of noise and reverberation was systematically investigated for two types of sentence tests. The hypothesis to be tested was that speech intelligibility is more affected by reverberation when using an open-set speech material consisting of everyday sentences than when using a closed-set test with syntactically fixed and semantically unpredictable sentences. In order to distinguish between the effect of speaker and language on speech intelligibility in noise and reverberation, the closed-set speech material was recorded using bilingual speakers of German-Spanish and German-Russian. The experimental data confirmed that the effect of reverberation was stronger for an open-set test than for a closed-set test. However, this cannot be predicted by the speech transmission index. Furthermore, the inter-language differences in speech reception thresholds were on average up to 5 dB, whereas inter-talker differences were of about 3 dB. The Spanish language suffered more under reverberation than German and Russian, what again challenged the predictions of the speech transmission index.

Auditory Outcome After Cochlear Implantation in Patients With Congenital Nonsyndromic Hearing Loss

To compare the audiologic outcome after cochlear implantation between 2 groups of patients with congenital nonsyndromic sensorineural hearing loss. Retrospective cohort study. Department of Otorhinolaryngology, University hospital (tertiary referral center). From a bigger pool of implanted patients, 2 groups, each numbering 30 were enrolled. The patients from the first group were diagnosed with a Connexin 26 mutation (GJB2), whereas all of the patients from the second cohort were with a wild type genotype. Both groups were age matched, 1 to 7 years old at the age of implantation, with diagnosed congenital nonsyndromic sensorineural hearing loss. Both groups were evaluated with the help evaluation of auditory responses to speech/EARS/test battery - LiP test (Listening Progress Profile), MTP tests 3,6,12 (Monosyllabic-Trochee-Polysyllabic Test), GASP test (Glendonald Auditory Screening Procedure), and others. Follow-up period was at least 36 months. Mean test scores were compared at the 1st, 6th, 12th, 24th, and 36th month. LiP outcome was significantly better (p < 0.05) for the GJB2-related cohort for the whole follow-up period except at the first month. MTP3, 6, and 12 tests displayed the same statistically significant outcome in favor of the first group. In the open-set test GASP, the difference was apparent: 1.22, 2.40, 5.59, and 7.40 mean scores at the 6th, 12th, 24, and 36th months for the first cohort versus 0.00, 0.07, 0.81, and 1.74 for the GJB2-unrelated patients. The results from our study suggest that children with GJB2-related deafness show better auditory performance after cochlear implantation than age-matched children with GJB2-nonrelated sensorineural hearing loss.

Maximizing Phoneme Recognition Accuracy for Enhanced Speech Intelligibility in Noise

An effective measure of speech intelligibility is the probability of correct recognition of the transmitted message. We propose a speech pre-enhancement method based on matching the recognized text to the text of the original message. The selected criterion is accurately approximated by the probability of the correct transcription given an estimate of the noisy speech features. In the presence of environment noise, and with a decrease in the signal-to-noise ratio, speech intelligibility declines. We implement a speech pre-enhancement system that optimizes the proposed criterion for the parameters of two distinct speech modification strategies under an energy-preservation constraint. The proposed method requires prior knowledge in the form of a transcription of the transmitted message and acoustic speech models from an automatic speech recognition system. Performance results from an open-set subjective intelligibility test indicate a significant improvement over natural speech and a reference system that optimizes a perceptual-distortion-based objective intelligibility measure. The computational complexity of the approach permits use in on-line applications.

A Case Study Assessing the Auditory and Speech Development of Four Children Implanted with Cochlear Implants by the Chronological Age of 12 Months

Children with severe hearing loss most likely receive the greatest benefit from a cochlear implant (CI) when implanted at less than 2 years of age. Children with a hearing loss may also benefit greater from binaural sensory stimulation. Four children who received their first CI under 12 months of age were included in this study. Effects on auditory development were determined using the German LittlEARS Auditory Questionnaire, closed- and open-set monosyllabic word tests, aided free-field, the Mainzer and Göttinger speech discrimination tests, Monosyllabic-Trochee-Polysyllabic (MTP), and Listening Progress Profile (LiP). Speech production and grammar development were evaluated using a German language speech development test (SETK), reception of grammar test (TROG-D) and active vocabulary test (AWST-R). The data showed that children implanted under 12 months of age reached open-set monosyllabic word discrimination at an age of 24 months. LiP results improved over time, and children recognized 100% of words in the MTP test after 12 months. All children performed as well as or better than their hearing peers in speech production and grammar development. SETK showed that the speech development of these children was in general age appropriate. The data suggests that early hearing loss intervention benefits speech and language development and supports the trend towards early cochlear implantation. Furthermore, the data emphasizes the potential benefits associated with bilateral implantation.

Speech perception and production in children with inner ear malformations after cochlear implantation

ObjectiveThe aim of this study was to assess the speech perception and speech intelligibility outcome after cochlear implantation in children with malformed inner ear and to compare them with a group of congenitally deaf children implantees without inner ear malformation. MethodsSix deaf children (five boys and one girl) with inner ear malformations who were implanted and followed in our clinic were included. These children were matched with six implanted children with normal cochlea for age at implantation and duration of cochlear implant use. All subjects were tested with the internationally used battery tests of listening progress profile (LiP), capacity of auditory performance (CAP), and speech intelligibility rating (SIR). A closed and open set word perception test adapted to the Modern Greek language was also used. In the dysplastic group, two children suffered from CHARGE syndrome, another two from mental retardation, and two children grew up in bilingual homes. ResultsAt least two years after switch-on, the dysplastic group scored mean LiP 62%, CAP 3.8, SIR 2.1, closed-set 61%, and open-set 49%. The children without inner ear dysplasia achieved significantly better scores, except for CAP which this difference was marginally statistically significant (p=0.009 for LiP, p=0.080 for CAP, p=0.041 for SIR, p=0.011 for closed-set, and p=0.006 for open-set tests). ConclusionAll of the implanted children with malformed inner ear showed benefit of auditory perception and speech production. However, the children with inner ear malformation performed less well compared with the children without inner ear dysplasia. This was possibly due to the high proportion of disabilities detected in the dysplastic group, such as CHARGE syndrome and mental retardation. Bilingualism could also be considered as a factor which possibly affects the outcome of implanted children. Therefore, children with malformed inner ear should be preoperatively evaluated for cognitive and developmental delay. In this case, counseling for the parents is mandatory in order to explain the possible impact of the diagnosed disabilities on performance and habilitation.

Cochlear Implantation in Children with Anomalous Cochleovestibular Anatomy

Our aim was to determine the influence of inner-ear anomalies on surgical difficulty and postoperative audiologic outcomes among pediatric cochlear implant (CI) recipients at our institution. We reviewed medical and audiologic records from 78 consecutive pediatric CI cases between 1985 and June 2009. Thirty patients had high-resolution temporal bone computed tomography imaging available for retrospective interpretation. Seven of these 30 patients (23%) had cochleovestibular dysplasia. Fifty percent of patients with severe dysplasia had a cerebrospinal fluid gusher intraoperatively, compared with 13% of patients with no dysplasia. Of patients with available audiologic outcome data, 17 of 26 patients with normal/mild/moderate dysplasia were able to complete CNC testing, whereas neither of the 2 patients with severe dysplasia could complete the open set test. Our experience suggests that surgical difficulty and audiologic outcomes in pediatric CI recipients may be affected by the presence and severity of a cochleovestibular anomaly.

Recovery function of electrically evoked compound action potential in implanted children with auditory neuropathy: preliminary results

Conclusion: The results of this study show that the temporal processing ability in children with auditory neuropathy (AN) can be restored to some degree by electrical stimulation through a cochlear implant. In addition, the electrically evoked compound action potential (ECAP) may be a useful index to predict outcomes in implanted children with AN. Objectives: The purpose of this study was to evaluate restoration of the temporal processing abilities in implanted children with AN using ECAP recovery function and speech perception. Methods: Ten children who had received cochlear implantations participated in this study, including six with AN and four with sensorineural hearing loss (SNHL). ECAP recovery functions were measured, and the slopes of ECAP recovery functions in implanted children with AN were compared with those of implanted children with SNHL. Open-set speech perception test scores of implanted children with AN were compared with those of 78 implanted children with SNHL. Results: The slopes of the ECAP recovery function in children with AN did not differ significantly from those in children with SNHL. The group of children with robust ECAPs showed good postoperative performance. However, the group with no ECAPs showed poor performance.

Vowel confusion patterns in adults during initial 4 years of implant use

This study investigated adult cochlear implant users' (n = 39) vowel recognition and confusions by an open-set syllable test during 4 years of implant use, in a prospective repeated-measures design. Subjects' responses were coded for phoneme errors and estimated by the generalized mixed model. Improvement in overall vowel recognition was highest during the first 6 months, showing statistically significant change until 4 years, especially for the mediocre performers. The best performers improved statistically significantly until 18 months. The poorest performers improved until 12 months and exhibited more vowel confusions. No differences were found in overall vowel recognition between Nucleus24M/24R and Med-ElC40+ device users (matched comparison), but certain vowels showed statistically significant differences. Vowel confusions between adjacent vowels were evident, probably due to the implant users' inability to discriminate formant frequencies. Vowel confusions were also dominated by vowels whose average F1 and/or F2 frequencies were higher than the target vowel, indicating a basalward shift in the confusions.

Intraoperative Neural Response Telemetry as a Predictor of Performance

To determine whether intraoperative neural response telemetry (tNRT) is predictive of postoperative speech perception. Retrospective review. Tertiary referral center. Children (n = 24) aged between 5 and 17 years and adults 18 years and older (n = 73) with severe-to-profound hearing loss and implanted with the Nucleus Freedom device between 2005 and 2008 and observed at least 1 year were included. Intraoperative neural response telemetry after insertion of the electrode array. Measures included 1) intraoperative tNRT measurements and 2) preoperative and 1-year postoperative open-set word recognition scores using age-appropriate open-set tests for children and adults. Intraoperative neural response telemetry levels for electrodes E20, E15, E10, and E5 in each patient were correlated to performance at the 1-year evaluation interval. No correlation existed between tNRT responses and open-set speech performance at the 1-year evaluation. Several patients had absent tNRT in the OR but developed speech recognition abilities, whereas the remaining patients had intraoperative responses with levels of postoperative performance ranging from 0% to 100%. This study suggests that there is no significant correlation between intraoperative tNRT and speech perception performance at 1 year. At the time of surgery, tNRT provides valuable information regarding the electrical output of the implant and the response of the auditory system to electrical stimulation and preliminary device programming data; however, it is not a valuable predictor of postoperative performance. Furthermore, the absence of tNRT does not necessarily indicate a lack of stimulation.

Bilateral Cochlear Implantation in Children With Anomalous Cochleovestibular Anatomy

To outline clinical experience with bilateral cochlear implantation in children with cochleovestibular anomalies. A prospective cohort study with a mean follow-up of 12 months. An academic, pediatric, tertiary referral center. All eligible children were prospectively recruited from January 1, 2007, through October 31, 2008. Ten children aged 9 to 33 months who had congenital inner ear malformations, including common cavity, incomplete partition, and cochleovestibular hypoplasia, participated. Bilateral cochlear implantation was performed sequentially with an interimplantation delay greater than 2 years in 7 children and less than 1 year in 1 child. Bilateral simultaneous implantation was performed in 2 children. Complications, hearing outcomes, and balance outcomes. All children underwent successful implantation. Five children had a perilymph "gusher" (on 1 side only), and there were no other complications. All children had 22 active electrodes bilaterally and achieved speech reception. All 8 children who underwent closed-set speech perception testing scored above 75%, and 5 of the 7 children who underwent open-set testing achieved scores above 75%. Despite variable vestibular function before bilateral implantation, no prolonged imbalance occurred, although 3 children (30%) had transient unsteadiness for up to 2 weeks after the second implantation. Bilateral cochlear implantation was performed safely and successfully in children with a spectrum of bilaterally anomalous cochleovestibular anatomy. Hearing outcomes suggest that these children should not be excluded from undergoing bilateral implantation. This study provides guidance on candidacy issues, surgical decision making, and surgical techniques in this group.

Auditory performance and central auditory processing after cochlear implantation in patients deafened by meningitis

The objective of this study was to describe the auditory performance of patients deafened by meningitis in closed-set, open-set and language tests (Luria's test). Ten paediatric subjects deafened by meningitis were compared with a peer group of ten paediatric congenitally deaf subjects. All the subjects had a full insertion of a Nucleus device. Three of the subjects in each group had a longer follow-up period and were selected to perform the Luria test. The closed-set tests did not show statistically significant differences between the two groups (p < 0.21) but comparative results of open-set bisyllabic tests did show statistically significant differences (p < 0.003). It was concluded that meningitis might affect the central auditory processing and acquisition process of language. Copyright © 2009 John Wiley & Sons, Ltd.

Revision Cochlear Implantation Surgery in Adults

To assess the efficacy, risks, and indications of revision cochlear implantation (RCI) and to identify the clinical, audiologic, and device-related characteristics that predict outcome. Retrospective case series. Academic tertiary referral center. Adults (> or = 18 yr) who underwent RCI at Johns Hopkins University. Revision cochlear implant surgery. Speech perception by open-set testing and patient report and patient report of symptom resolution. During the 16-year period of this study, 4.8% of all adults implanted at our center have required 1 or more RCI surgeries. A total of 48 RCIs have been performed. The indications for RCI included infection (12%), electrode extrusion (15%), hard failure (23%), suspected device failure (42%), and isolated facial nerve stimulation (8%). Overall, successful resolution of the implant-related or medical condition was achieved with RCI in 83% of cases. Speech perception was lower in only 1 (2.1%) of 48 cases. Satisfactory preoperative speech recognition was preserved or surpassed in 5 of 6 infection cases and 8 cases with progressive symptoms of tinnitus and facial nerve stimulation. All cases of hard failure regained or surpassed previous peak performance. Improved speech recognition was experienced by 75% of cases with suspected device failure. Of cases in which RCI failed to restore previous functional benefit, there was a significant association with advanced age (> 70 yr). Whereas an abnormal integrity test was predictive of favorable outcome after RCI, a negative test was not predictive of outcome. A similar pattern of results was observed with respect to ex vivo device analysis. Revision cochlear implantation can be safely performed to restore lost benefit in appropriately selected cases. When properly performed after medical and audiologic options have been exhausted, RCI rarely compromises previous function and, in most cases, can resolve functional complaints and distracting symptoms. When positive, integrity testing is a useful screen for the presence of a device defect. In cases in which device integrity is uncertain, clinical judgment guided by longitudinal assessment can help determine whether RCI is likely to be beneficial.

Is There a Right Cochlear Implant Advantage?

To compare behavioral speech perception performance of children with right versus left cochlear implants (CIs). A retrospective cohort study. Academic university medical center. Seventy-one prelingually deafened children that obtained a CI device at 48 months or younger. Cochlear implantation with Cochlear, Advanced Bionics, and Med-El devices. Patients were divided into 2 groups according to ear of implant (right, n = 30; left, n = 41) and matched in age at implantation and preoperative audiologic results. Multivariate analysis of variance was used to evaluate the effects of 1) side of CI, 2) age at implantation, 3) time with CI (T1, 18-24 mo; T2, 36-42 mo), and 4) dominance (i.e., compatibility between CI side and handedness) on performance in a monosyllabic open-set test scored for words and phonemes. A small yet significant "right CI advantage" was evident throughout the study follow-up and was independent of age at implantation. The performance of children implanted at 24 months or younger was significantly higher than that of children implanted between 25 and 48 months. Regardless of CI side and age at implantation, all children exhibited improvement in speech perception with continuous use. The present study provides first-time evidence for a right CI advantage for speech perception in prelingually deafened children that can be taken into account when selecting side of CI in candidates with similar residual hearing in both ears and no anatomic constraints. The present data lend further support to the notions that greater gains in speech perception are associated with earlier age at implantation and continuous use.

Implanting outside the Guidelines: A Case Study

An 81-year-old female was referred for cochlear implantation due to difficulty communicating in her daily activities despite the use of appropriate amplification. The poorer ear was unable to tolerate amplification for the past 15 years. The open-set sentence-recognition test score in quiet in her "good" ear was 85 percent correct, indicating that the patient was not a traditional cochlear implant candidate. However, the sentence-recognition score in noise at +10 dB signal-to-noise ratio was 0 percent, demonstrating a significant breakdown in the patient's speech understanding in more difficult listening situations. This speech-in-noise score appeared to correlate with the patient's reported communication difficulties as well as with the communicative breakdowns that were observed clinically. The patient underwent cochlear implantation in the better ear. Cochlear implantation in this nontraditional patient provided objective and subjective benefit over hearing aid use.