Quiet Test Research Articles

Schooling Relates to Mental Health Problems in Adolescents with Cochlear Implants-Mediation by Hearing and Family Variables.

Aim of this multicenter study was to investigate whether schooling relates to mental health problems of adolescents with cochlear implants (CI) and how this relationship is mediated by hearing and family variables. One hundred and forty secondary school students with CI (mean age = 14.7 years, SD = 1.5), their hearing parents and teachers completed the Strengths and Difficulties Questionnaire (SDQ). Additional audiological tests (speech comprehension tests in quiet and noise) were performed. Students of special schools for hearing impaired persons (SSHIs) showed significantly more conduct problems (p < 0.05) and a significantly higher total difficulty score (TDS) (p < 0.05) compared to students of mainstream schools. Mental health problems did not differ between SSHI students with sign language education and SSHI students with oral education. Late implanted students and those with indication for additional handicaps were equally distributed among mainstream schools and SSHIs. However, students in SSHIs were more restricted to understand speech in noise, had a lower social background and were more likely to come from single-parent families. These factors were found to be partial mediators of the differences in mental health problems between the two school types. However, no variable could explain comprehensively, why students of SSHIs have more mental health problems than mainstream pupils.

Inpatient rehabilitation of adult CI users: Results in dependency of duration of deafness, CI experience and age

Cochlear implants (CI) have proven to be a highly effective treatment for severe hearing loss or deafness. Inpatient rehabilitation therapy is frequently discussed as a means to increase the speech perception abilities achieved by CI. However, thus far there exists no quantitative evaluation of the effect of these therapies. A retrospective analysis of audiometric data obtained from 1355 CI users compared standardized and qualitative speech intelligibility tests conducted at two time points (admission to and discharge from inpatient hearing therapy, duration 3-5 weeks). The test battery comprised examination of vowel/consonant identification, the Freiburg numbers and monosyllabic test (65 and 80 dB sound pressure level, SPL, free-field sound level), the Hochmair-Schulz-Moser (HSM) sentence test in quiet and in noise (65 dB SPL speech level; 15 dB signal-to-noise ratio, SNR), and a speech tracking test with and without lip-reading. An average increase of 20 percentage points was scored at discharge compared to the admission tests. Patients of all ages and duration of deafness demonstrated the same amount of benefit from the rehabilitation treatment. After completion of inpatient rehabilitation treatment, patients with short duration of CI experience (below 4 months) achieved test scores comparable to experienced long-term users. The demonstrated benefit of the treatment was independent of age and duration of deafness or CI experience. The rehabilitative training program significantly improved hearing abilities and speech perception in CI users, thus promoting their professional and social inclusion. The present results support the efficacy of inpatient rehabilitation for CI recipients. Integration of this or similar therapeutic concepts in the German catalog of follow-up treatment measures appears justified.

Contralateral Routing of Signal Hearing Aid versus Transcutaneous Bone Conduction in Single-Sided Deafness

The aim of this study was to compare a contralateral routing of signal (CROS) hearing aid to a transcutaneous bone-anchored device in the same conditions. This prospective crossover study included 18 adult patients with a single-sided deafness (SSD). After a trial period of 60 days with CROS and 7 days with a transcutaneous bone-anchored device (Alpha 1®, Sophono, Boulder, Colo., USA) on a headband, 13 (72%) patients opted for Alpha 1, 2 patients for CROS, and 3 rejected both rehabilitation methods. Clinical tolerance, satisfaction, hearing performances (pure-tone audiometry, speech test in quiet and in noise, stereo audiometry, sound localization, and Hearing in Noise Test), and quality of life (Glasgow Benefit Inventory, Abbreviated Profile of Hearing Aid Benefit and Glasgow Hearing Aid Benefit questionnaires) were measured at 3 and 12 months after the implantation. Both devices improved equally the hearing in noise and the quality of life. Transcutaneous devices represent an effective option in SSD.

Improvement of cognitive function after cochlear implantation in elderly patients.

The association between hearing impairment and cognitive decline has been established; however, the effect of cochlear implantation on cognition in profoundly deaf elderly patients is not known. To analyze the relationship between cognitive function and hearing restoration with a cochlear implant in elderly patients. Prospective longitudinal study performed in 10 tertiary referral centers between September 1, 2006, and June 30, 2009. The participants included 94 patients aged 65 to 85 years with profound, postlingual hearing loss who were evaluated before, 6 months after, and 12 months after cochlear implantation. Cochlear implantation and aural rehabilitation program. Speech perception was measured using disyllabic word recognition tests in quiet and in noise settings. Cognitive function was assessed using a battery of 6 tests evaluating attention, memory, orientation, executive function, mental flexibility, and fluency (Mini-Mental State Examination, 5-word test, clock-drawing test, verbal fluency test, d2 test of attention, and Trail Making test parts A and B). Quality of life and depression were evaluated using the Nijmegen Cochlear Implant Questionnaire and the Geriatric Depression Scale-4. Cochlear implantation led to improvements in speech perception in quiet and in noise (at 6 months: in quiet, 42% score increase [95% CI, 35%-49%; P < .001]; in noise, at signal to noise ratio [SNR] +15 dB, 44% [95% CI, 36%-52%, P < .001], at SNR +10 dB, 37% [95% CI 30%-44%; P < .001], and at SNR +5 dB, 27% [95% CI, 20%-33%; P < .001]), quality of life, and Geriatric Depression Scale-4 scores (76% of patients gave responses indicating no depression at 12 months after implantation vs 59% before implantation; P = .02). Before cochlear implantation, 44% of the patients (40 of 91) had abnormal scores on 2 or 3 of 6 cognition tests. One year after implant, 81% of the subgroup (30 of 37) showed improved global cognitive function (no or 1 abnormal test score). Improved mean scores in all cognitive domains were observed as early as 6 months after cochlear implantation. Cognitive performance remained stable in the remaining 19% of the participants (7 of 37). Among patients with the best cognitive performance before implantation (ie, no or 1 abnormal cognitive test score), 24% (12 of 50) displayed a slight decline in cognitive performance. Multivariate analysis to examine the association between cognitive abilities before implantation and the variability in cochlear implant outcomes demonstrated a significant effect only between long-term memory and speech perception in noise at 12 months (SNR +15 dB, P = .01; SNR +10 dB, P < .001; and SNR +5 dB, P = .02). Rehabilitation of hearing communication through cochlear implantation in elderly patients results in improvements in speech perception and cognitive abilities and positively influences their social activity and quality of life. Further research is needed to assess the long-term effect of cochlear implantation on cognitive decline.

Outcomes after cochlear reimplantation in children

ObjectivesWith cochlear implantation now a routine procedure, reimplantation is becoming more commonplace for medical/surgical complications or device malfunctions. This study investigated the indications for reimplantation and the auditory outcomes following reimplantation surgery in prelingually-deafened children. MethodsOf the 539 prelingually deafened children implanted between 1990 and 2013, 45 were reimplanted (8.3% of implantations). Causes of reimplantation, type of device and angle of insertion at initial implantation were recorded, as well as type of implant reinserted, number of electrodes inserted and angle of insertion (calculated on cone beam computed tomography) on reimplantation, and finally any surgical findings. Speech perception test scores (phonetically balanced kindergarten (PBK) words, open-set sentence testing in quiet and in noise (S/N+ 10dB SNR), and speech tracking scores) were obtained 1, 2 and 3 years after reimplantation, and compared against the best speech recognition score obtained with the first implant before failure. ResultsMedical reasons for reimplantation were found in 10 cases (22.2%). A malfunctioning device had occurred in 35 cases (77.7%) including hard failure in 24 and soft failure in 11.Complete insertion was achieved in the scala tympani in 42 cases and in the scala vestibuli in one case; partial insertion occurred in the remaining two cases. In two cases, one or two electrode rings snatched off from the electrode array during removal. The mean insertion angle was 330.5° before surgery and 311.8° after reimplantation (no statistical difference p=0.48).The postoperative speech perception outcome measures showed no significant difference to the best score before reimplantation. Angle of insertion, type of device and etiology of deafness did not influence the results. The PBK performance improved over 10% in 43.2% of children, was similar in 40.5%, and showed a more than 10% decrease in 16.2% of children after reimplantation. The latter decline in performance was explained for some children by a partial insertion. ConclusionsReimplantation has no negative effect on auditory outcome. In rare cases, speech perception outcome may not improve, requiring a specific rehabilitation program.

An Influence of Directional Microphones on the Speech Intelligibility and Spatial Perception by Cochlear Implant Users

Abstract The objective of the study is to assess the hearing performance of cochlear implant users in three device microphone configurations: omni-directional, directional, and beamformer (BEAMformer two-adaptive noise reduction system), in localization and speech perception tasks in dynamically changing listening environments. Seven cochlear implant users aided with Cochlear CM-24 devices with Freedom speech processor participated in the study. For the localization test in quiet and in background noise, subjects demonstrated significant differences between different microphone settings. Confusion matrices showed that in about 70% cases cochlear implant subjects correctly localized sounds within a horizontal angle of 30-40◦ (±1◦ loudspeaker apart from signal source). However localization in noise was less accurate as shown by a large number of considerable errors in localization in the confusion matrices. Average results indicated no significant difference between three microphone configurations. For speech presented from the front 3 dB SNR improvements in speech intelligibility in three subjects can be observed for beamforming system compared to directional and omni-directional microphone settings. The benefits of using different microphone settings in cochlear implant devices in dynamically changing listening conditions depend on the particular sound environment

Assessing speech perception in children with hearing loss: what conventional clinical tools may miss.

This study tested the hypothesis that word recognition in a complex, two-talker masker is more closely related to real-world speech perception for children with hearing loss than testing performed in quiet or steady-state noise. Sixteen school-age hearing aid users were tested on aided word recognition in noise or two-talker speech. Unaided estimates of speech perception in quiet were retrospectively obtained from the clinical record. Ten parents completed a questionnaire regarding their children's ease of communication and understanding in background noise. Unaided performance in quiet was correlated with aided performance in competing noise, but not in two-talker speech. Only results in the two-talker masker were correlated with parental reports of their children's functional hearing abilities. Speech perception testing in a complex background such as two-talker speech may provide a more accurate predictor of the communication challenges of children with hearing loss than testing in steady noise or quiet.

Bone conductive implants in single-sided deafness

Conclusion: Bone conduction implants (BCIs) have been shown to partially restore some of the functions lost when binaural hearing is missing, such as in subjects with single-sided deafness (SSD). The use of a single BCI needs to be recommended by a clinician based on thorough counselling with the SSD subject. Objectives: To perform an overview of the present capabilities of BCIs for SSD and to evaluate the reliability of the audiological evaluation for assessing speech recognition in noise and sound localization cues, which are major problems related to the loss of binaural hearing. Methods: Nine subjects with SSD who received BCI implants underwent a preoperative audiological evaluation that included sound field speech audiometry, word recognition score (WRS) testing and sound localization testing in quiet and in noise. They were also tested for the accuracy of their directional word recognition in noise and their subjective perceptions of their hearing difficulties using the APHAB questionnaire. Results: The mean maximum accuracy of word discrimination was 65.5% in the unaided condition and 78.9% in the BCI-aided condition. Sound localization in noise was better with the BCI than in the unaided condition, especially when the stimulus and noise were presented on the same side as the implanted ear. The accuracy of directional word recognition showed an improvement with the BCI with respect to the unaided condition on the BCI side, with either the stimulus in the implanted ear and the noise in the contralateral ear or with both the stimulus and noise presented to the implanted ear.

The NTID speech recognition test: NSRT®

Objective: The purpose of this study was to collect and analyse data necessary for expansion of the NSRT item pool and to evaluate the NSRT adaptive testing software. Design: Participants were administered pure-tone and speech recognition tests including W-22 and QuickSIN, as well as a set of 323 new NSRT items and NSRT adaptive tests in quiet and background noise. Performance on the adaptive tests was compared to pure-tone thresholds and performance on other speech recognition measures. The 323 new items were subjected to Rasch scaling analysis. Study sample: Seventy adults with mild to moderately severe hearing loss participated in this study. Their mean age was 62.4 years (sd = 20.8). Results: The 323 new NSRT items fit very well with the original item bank, enabling the item pool to be more than doubled in size. Data indicate high reliability coefficients for the NSRT and moderate correlations with pure-tone thresholds (PTA and HFPTA) and other speech recognition measures (W-22, QuickSIN, and SRT). Conclusion: The adaptive NSRT is an efficient and effective measure of speech recognition, providing valid and reliable information concerning respondents’ speech perception abilities.

Validation of a screening test of auditory function using the telephone.

Several European countries have demonstrated successful use of telephone screening tests for auditory function. The screening test consists of spoken three-digit sequences presented in a noise background. The speech-to-noise ratios of the stimuli are determined by an adaptive tracking method that converges on the level required to achieve 50% correct recognition. A version of the three-digit telephone screening protocol for the United States was developed: the US National Hearing Test (NHT). The objective of the current study was to determine the sensitivity and specificity as well as the feasibility of the NHT for use within the Department of Veterans Affairs (VA). Research Design and Study Sample: Using a multisite study design with convenience sampling, we used the NHT to collect data from 693 participants (1379 ears) from three geographical areas of the United States (Florida, Tennessee, and California). The NHT procedures were as follows: the participants (1) called a toll-free telephone number, (2) entered their assigned ear-specific identification code, (3) listened to 40-sets of digit triplets presented in speech-spectrum background noise, and (4) entered in the numbers that they heard on the telephone key pad. The NHT was performed on each ear, either at home or in a VA clinic. In addition to collecting data from the experimental task, we gathered demographic data and the data from other standard-of-care tests (i.e., audiometric thresholds and speech recognition tests in quiet and in noise). A total of 505 participants completed the NHT at a VA clinic, whereas 188 completed the test at home. Although the ear-specific NHT and mean pure-tone threshold all correlated significantly (p < 0.001), there were more modest correlations in the low- and high-frequency ranges with the highest correlation seen with the 2000 Hz mean pure-tone threshold. When the NHT 50% point or threshold was compared with the three-frequency PTA at 500, 1000, and 2000 Hz, the sensitivity was 0.87 and specificity was 0.54. When comparing the NHT with the four-frequency PTA at 500, 1000, 2000, and 4000 Hz, the sensitivity was 0.81 and specificity increased to 0.65. The NHT also correlated strongly with other speech-in-noise measures. The NHT was found to correlate with other audiometric measures, including pure-tone thresholds and speech recognition tests in noise, at sufficiently high correlation values to support its use as a screening test of auditory function.

Conversion of adult Nucleus® 5 cochlear implant users to the Nucleus® 6 system

ObjectivesCochlear's new sound processor system (Nucleus® 6) features a new noise reduction algorithm called SNR-NR (signal-to-noise ratio), and an environmental classifier called SCAN, which activates the appropriate sound coding algorithms for a given listening environment. In addition, the sound processors (CP910 and CP920) have a data logging feature with data visually summarized using clinical programing software and come with two remote controls, CR210 and CR230. The objective of this clinical study was to conduct a field acceptance study comparing the user experience with the Nucleus® 6 to the Nucleus® 5 system and to evaluate the benefits of Nucleus® 6 in an adult population currently equipped with the previous generation Nucleus® 5 sound processor. Our primary objective was to compare speech recognition in speech-weighted noise using Nucleus® 6 with SCAN (activating SNR-NR) with the default Nucleus® 5 ‘Noise’ Program. Secondary objectives included comparisons of speech recognition in quiet, subjective performance feedback via questionnaires and diaries, and recipient preference for device and program type.MethodsA prospective controlled trial was conducted with 30 adult Nucleus CI recipients using the Nucleus® 5 sound processor (condition A). The Nucleus® 6 sound processor (condition B) was evaluated in a within-subject ABBA design, with repeated speech in noise (S0N0, LIST sentence test), and speech in quiet testing (S0, NVA words). The remote controls were randomly given during the two B intervals. In addition, recipients had to complete questionnaires and diaries on the use of their current as well as new sound processors and remotes.ResultsThe group mean speech reception threshold in noise (SRT50) with Nucleus® 6 SCAN was significantly better (1.2 dB SNR) than with the Nucleus® 5 ‘Noise’ Program. Mean speech recognition scores in quiet were not significantly different between the processors. Subjective performance feedback (APHAB) did not show a significant difference between Nucleus® 6 and Nucleus® 5 with high satisfaction scores being reported for both sound processors. Recipients preferred the SCAN program in noise and reported a clear overall preference for the Nucleus® 6 system. Clinicians were satisfied with the conversion process from Nucleus® 5 to Nucleus® 6.Discussion and conclusionSNR-NR provides a significant benefit in noise. Recipients were easily converted from Nucleus® 5 to Nucleus® 6 requiring little or no sound quality adjustment period. The Nucleus® 6 SCAN program was well accepted by the majority of recipients for use during their daily life.

Evaluation of the bimodal benefit in a large cohort of cochlear implant subjects using a contralateral hearing aid.

To investigate the benefit of contralateral residual hearing in a large group of cochlear implant recipients with different degrees of residual hearing. One hundred and forty-one adult patients (age in years: mean 58.82, min 16.27, max 88.20) wearing a cochlear implant and a contralateral hearing aid, bimodal. Rehabilitative. All 141 patients underwent speech perception testing in quiet and noise with cochlear implant (CI) alone, and with CI and hearing aid (HA). Additionally, pure-tone air conduction threshold levels were measured in all subjects. The bimodal benefit was analyzed and correlations to the hearing threshold for different audiometric frequencies were calculated. Comparison between the scores for CI alone and CI + HA showed statistically significant advantages (p < 0.0001) in all four tests. The benefit for sentences in noise to each individual patient showed a negative correlation with the hearing threshold level of 125 Hz and 250 Hz, using a linear regression analysis applying the Spearman's rho correlation coefficient (r = -0.32, -0.232), and a significant difference at p = 0.006, p = 0.007. The correlations involving speech understanding in sentences in noise, and the hearing level of 500 Hz and above, are not significant for the benefit obtained with a contralateral hearing aid. The benefit of combined electric and acoustic hearing in bimodally fitted subjects depends mainly on residual hearing in the low-frequency range below 500 Hz. For bimodal fitting to yield significant benefits, hearing loss in the contralateral ear should not exceed 80 dB HL in the low frequencies.

Outcomes of Cochlear Reimplantation in Adults

To determine the indications for, and auditory outcomes following, cochlear reimplantation in adults and investigate factors influencing outcome. Retrospective case series. Cochlear implant program in a tertiary care hospital. Thirty adults (32 ears) who have undergone cochlear reimplantation in the ipsilateral ear. Explantation and reimplantation of cochlear implant. Speech discrimination as measured using Bamford-Kowal Bench sentence testing in quiet (BKBq) and noisy (BKBn) environments. Best BKBq improved from 58.5% to 71.4% (p = 0.0242), and BKBn improved from 60.9% to 67.2% (p = 0.826) after reimplantation. Device failure was the most common indication for reimplantation. There was no significant difference in failure rate or outcome between implant manufacturers. The mean time to reimplantation was 4.7 years, and this was not related to auditory outcome. Otosclerosis and Ménière's disease may predispose to a worse auditory outcome after reimplantation. Cochlear reimplantation does not have a detrimental effect on auditory outcomes and in some cases results in improved speech perception.

Can Routine Office‐Based Audiometry Predict Cochlear Implant Evaluation Results?

Objectives: Determining cochlear implant candidacy status requires a specific sentence-level testing paradigm in best-aided conditions. Correlation of the findings on routine audiometry with those of formal cochlear implant (CI) evaluation has not been performed. Our objective was to determine if findings on routine office-based audiometry could predict the results of a formal CI candidacy evaluation. Methods: The charts of all adult patients who were evaluated for CI candidacy at a tertiary care center from June 2008 through June 2013 were included. Routine, unaided audiologic measures (pure-tone hearing thresholds and recorded monosyllabic word recognition test [MWRT] results) were then correlated with best-aided sentence-level word discrimination test (SWDT) results using either the Hearing in Noise Test (HINT) or AzBio sentences. Results: The degree of hearing loss at 250 to 4000 Hz significantly correlated with SWDT results. Additionally, 87% of patients who scored &lt;30% in MWRT qualified for implantation using HINT sentences. Similarly, in patients whose MWRT scores were &lt;35%, 81%, and 93% met CI candidacy criteria when using AZBio sentence testing in quiet and noise, respectively. Conclusions: Routine office-based audiometry can be used to identify patients who would highly likely meet CI candidacy upon formal testing. For example, a pure tone threshold of ≥55 dB at 250 Hz and a MWRT score of ≤35% when evaluating using AzBio sentences collectively identifies a patient who is likely to meet candidacy criteria. Using these predictive patterns during routine audiometry may assist hearing health professionals in deciding when to refer patients for a formal CI evaluation.

Cochlear Implants and Remote Microphone Technology

Advances in cochlear implant (CI) technology have allowed for impressive outcomes for implant recipients. In fact, many CI recipients achieve ceiling-level scores (i.e., near 100%) on sentence-recognition tests in quiet used in clinical settings. It is, however, well known that CI users often continue to experience difficulty with speech understanding in noisy and reverberant environments (e.g., classroom, restaurant, etc.). Recent research has indicated that performance in these difficult situations may be improved through the use of wireless remote microphone technology. In this article, a review will be provided of several studies that have explored the use of wireless remote microphones for CI users. Specifically, this review will focus on studies that have addressed both induction neckloop and directly coupled radiofrequency (RF) systems, fixed receiver gain settings, audio mixing ratio, adaptive frequency-modulated (FM) systems, cochlear implant signal processing, and digital RF systems. The effect of each of these items on a CI recipient's performance will be discussed. Additionally, clinical tips to optimize hearing assistance technology benefit for CI users will be provided as well as a protocol for fitting and verifying the appropriateness of wireless remote microphone technology for CI users and for optimizing user benefit.

Reconocimiento auditivo musical y melódico en pacientes con implante coclear, mediante nuevo método de programación de asignación frecuencial

Introduction and objectiveMusic is a universal, cross-cultural phenomenon. Perception and enjoyment of music are still not solved with current technological objectives of cochlear implants. The objective of this article was to advance the development and validation of a method of programming of cochlear implants that implements a frequency allocation strategy. We compared standard programming vs frequency programming in every subject. MethodsWe studied a total of 40 patients with cochlear implants. Each patient was programmed with a optimal version of the standard program, using the Custom Sound Suite 3.2 cochlear platform. Speech tests in quiet were performed using syllable word lists from the protocol for the assessment of hearing in the Spanish language. Patients implanted bilaterally were tested in both ears at the same time. For assessing music listening habits we used the Munich Music Questionnaire and «MACarena»(minimum auditory capability) software. ResultsAll patients achieved better results in recognition, instrument tests and tonal scales with frequency programming (P<.005). Likewise, there were better results with frequency programming in recognising harmonics and pitch test (P<.005). ConclusionsFrequency programming achieves better perception and recognition results in patients in comparison with standard programming. Bilateral stimulation patients have better perception of musical patterns and better performance in recognition of tonal scales, harmonics and musical instruments compared with patients with unilateral stimulation. Modification and frequency allocation during programming allows decreased levels of current intensity and increase the dynamic range, which allows mapping of each audio band less obtrusively and improves the quality of representation of the signal.

Ocena percepcji słuchowej u dzieci z obustronnym głębokim niedosłuchem odbiorczym implantowanych obustronnie i jednostronnie

AimsFirst, to investigate speech perception in bilaterally and monaurally implanted children with prelingual deafness. Second, to evaluate speech understanding in the second implant itself after 12 months of use compared to the aided results in the ear that was implanted first. Material and methodsThis study analyzes results of speech perception in two groups of children: implanted bilaterally (10 patients) and monaurally (10 patients in the same age as the first group). Children were given their first cochlear implant at the mean age of 2.6 years old (2–4 years old), the second at the age between 5 and 9 years (mean 8.7 years old). The average interval between the first and second implantation was 3.7 years. The monosyllabic word recognition test in free field at the level of 65dB SPL was used. ResultsThere were no statistically significant differences in speech perception scores between monaurally and bilaterally implanted children, 76.0% vs. 87.0%, respectively (p>0.05). After 12 months of the device used, in the group of bilaterally implanted children, the speech perception in the first implanted ear scored 86.43% compared to 55.71% in the later implanted. This difference was found to be significant. ConclusionsThe analysis showed that the second implant just slightly improved speech understanding (test in quiet) compared to the unilaterally implanted children. In addition, in the group of bilaterally implanted children after 12 months of implants use, the performance in the later implanted ear was still worse compared to the initially implanted ear.

Effect of interstimulus interval and age on cortical auditory evoked potentials in 10–22-week-old infants

This study compares cortical auditory evoked potentials (CAEPs) at different interstimulus intervals (ISIs) in infants to determine the impact of stimulus rate on wave morphology. Infant CAEPs are dominated by a positive peak P1. We hypothesized that infant CAEPs would be more adult-like at longer ISI with P1, followed by negativity (labelled N450). Participants were 10 typically developing infants aged 10-13 weeks (N=4) and 20-22 weeks (N=6). CAEPs were measured in one recording session for /da/ in quiet at 55 dB SPL for ISIs of 910, 1820, 3640 and 4550 ms in a randomized order. Recordings were complete at each ISI for 7-10 infants. Seven infants who completed all testing in quiet were also tested in continuous white noise (+5 dB signal-to-noise ratio) for the shortest ISI. P1 was observable in all infants; N450 was only present in the older infants. There appeared to be no ISI effect for younger or older infants, which is not consistent with ISI findings for adults and older children. The presence of N450 in the older infants only suggests that cortical maturational differences are evident in speech-evoked CAEPs in young infants. There were minimal effects of noise on P1 latency and amplitude. Results suggest different effects of ISI for very young infants than those observed in older infants and children. CAEPs are being used to measure hearing aid effectiveness in young infants and hence it is imperative that the effects of factors such as ISI are better understood.

A Comparative Study on Speech in Noise Understanding with a Direct Acoustic Cochlear Implant in Subjects with Severe to Profound Mixed Hearing Loss

The aim of this study was to investigate the efficacy of a direct acoustic cochlear implant (DACI) for speech understanding in noise in patients suffering from severe to profound mixed hearing loss (MHL) due to various etiologies compared to the preoperative best-aided condition. The study was performed at five tertiary referral centers in Europe (Belgium, Germany, Poland and Spain). Nineteen adult subjects with severe to profound MHL due to (advanced) otosclerosis, ear canal fibrosis, chronic otitis media, tympanosclerosis or previous cholesteatoma were implanted with a DACI (Codacs™ Investigational Device) combined with a conventional stapes prosthesis. Unaided and aided speech reception scores in quiet and in noise, preoperative and postoperative air and bone conduction thresholds and aided and unaided sound field thresholds were measured prospectively during the study. Subjective benefit analysis was determined through the Abbreviated Profile of Hearing Aid Benefit questionnaire. Quality of life was measured by the Health Utilities Index. All subjects were fitted preoperatively with hearing aids and/or a bone conduction implant on a headband before DACI implantation. This allows direct comparison between different hearing rehabilitation solutions. The mean speech reception threshold in noise improved significantly by 7.9 dB signal-to-noise ratio (SNR) after activation of the DACI compared to the preoperative best-aided condition. For all 19 subjects, a mean postoperative aided speech reception threshold of 2.6 dB SNR (standard deviation: 8.3 dB) was measured. On average, no significant shift in the bone conduction thresholds was noted 4-5 months after implantation. A mean sound field threshold improvement of 46 and 16 dB was measured compared to the preoperative unaided and best-aided condition, respectively. Speech perception tests in quiet showed a mean improvement of the word recognition scores by 65 and 48% at 65 dB SPL compared to the preoperative unaided and best-aided condition, respectively. In summary, DACI provides an effective improvement of the speech perception in noise compared to the best-aided condition in subjects suffering from severe to profound MHL.

Sprawozdanie z corocznego posiedzenia Sekcji Otorynolaryngologii Europejskiej Unii Lekarzy Specjalistów (ORL Section UEMS) Genewa 4–6.10.2013 r.

First, to investigate speech perception in bilaterally and monaurally implanted children with prelingual deafness. Second, to evaluate speech understanding in the second implant itself after 12 months of use compared to the aided results in the ear that was implanted first.This study analyzes results of speech perception in two groups of children: implanted bilaterally (10 patients) and monaurally (10 patients in the same age as the first group). Children were given their first cochlear implant at the mean age of 2.6 years old (2–4 years old), the second at the age between 5 and 9 years (mean 8.7 years old). The average interval between the first and second implantation was 3.7 years. The monosyllabic word recognition test in free field at the level of 65 dB SPL was used.There were no statistically significant differences in speech perception scores between monaurally and bilaterally implanted children, 76.0% vs. 87.0%, respectively (p > 0.05). After 12 months of the device used, in the group of bilaterally implanted children, the speech perception in the first implanted ear scored 86.43% compared to 55.71% in the later implanted. This difference was found to be significant.The analysis showed that the second implant just slightly improved speech understanding (test in quiet) compared to the unilaterally implanted children. In addition, in the group of bilaterally implanted children after 12 months of implants use, the performance in the later implanted ear was still worse compared to the initially implanted ear.