Cochlear implantation in children with inner ear malformations

We performed a case study and intervention study, with follow-up of 1 to 5 years, in 4 children with inner ear malformations who underwent implantation of a multichannel cochlear implant (Nucleus, Cochlear Corporation) at ages 3 to 12 years. Malformations included a common cavity deformity, 2 incomplete partitions, and 1 case of isolated bilateral vestibular aqueduct enlargement. One child had a single-channel implant placed at 3 years of age, and this was exchanged for a 22-channel implant at age 9. One child had her implant placed at age 4.5 years, but due to complications from a cerebrospinal fluid (CSF) leak had the initial implant removed and replaced at age 5 years during repair of the CSF leak. Intraoperative findings included a CSF leak at the time of surgery in 3 patients. One patient contracted bacterial meningitis 7 months postimplantation that was thought to be secondary to acute otitis media in the unoperated ear. Bilateral CSF leaks were noted in the middle ear by a lumbar puncture radionuclide and fluorescein dye study. Successful repair of the CSF leaks and reimplantation of the cochlear implant was carried out in this patient. Mapping and programming of the implant was found to be challenging in each of these patients. All patients demonstrated improved performance after implantation. Two patients demonstrated some open-set speech perception. One patient demonstrates improved use of temporal cues in a structured closed set. One patient has achieved no significant speech recognition at this time, but does have improved sound detection and awareness. Cochlear implantation in children with congenital inner ear abnormalities can be a successful method of rehabilitation. It should be recognized that the postoperative speech perception results may be highly variable among patients, and that intraoperative complications may occur.     

Cochlear implantation in children younger than 2 years old

PURPOSE: This study recorded and compared the flexural elastic moduli and moduli of rupture of four materials (Provipont DC resin, Triad provisional restorative material, Jet acrylic resin, and a 50:50 mixture of Jet acrylic resin and orthodontic resin) used to make provisional restorations. MATERIAL AND METHODS: Thirty-nine identical 63 x 10 x 3 mm specimens were made from each of the four materials. After 24 hours, 30 days, and 60 days of water storage at 37 degrees C (13 specimens each), standard three-point bend tests were conducted on an Instron universal testing machine at a crosshead speed of 0.5 cm/minute. Stress strain curves were generated, and values for the flexural elastic moduli and moduli of rupture were calculated. Data were subjected to two-way and one-way analyses of variance (alpha = 0.05). RESULTS: Provipont DC resin exhibited significantly higher flexural elastic moduli and moduli of rupture values at the 24-hour test time. However, Provipont DC resin exhibited the greatest decrease in these values over time.     

Cochlear implantation in a patient with grand mal epilepsy

PURPOSE: The authors introduced a successful trial of a chemotherapy regimen to treat refractory thrombocytopenia and pain caused by a rare kaposiform hemangioendothelioma that had been refractory to corticosteroids. PATIENT AND METHOD: A 6-year-old Latina girl with diffuse petechiae, constant pain and edema in her right lower extremity, and severe thrombocytopenia was brought for treatment. Physical examination revealed a large mass in the right lower extremity. The surgical specimen resected earlier in Mexico showed kaposiform hemangioendothelioma, an extremely rare vascular tumor that is frequently associated with consumptive coagulopathy and lymphangiomatosis. Corticosteroid therapy in Mexico had been ineffective in controlling the tumor size, pain, or thrombocytopenia. The patient was brought to the United States because of a rapidly enlarging tumor and intractable leg pain, causing inability to ambulate. Laboratory examinations revealed profound thrombocytopenia and evidence of consumptive coagulopathy. Because of the rapidly enlarging lesion, it was decided to give six cycles of a chemotherapy regimen consisting of vincristine, cyclophosphamide, and actinomycin D (VAC). RESULT: The patient responded to the first cycle of chemotherapy with partial reversal of the thrombocytopenia. The additional five cycles of the same chemotherapy regimen resulted in complete resolution of thrombocytopenia and significant improvement of the pain and edema in the right lower extremity. A follow-up imaging study 9 months later revealed a marked decrease in size of the vascular tumor. CONCLUSION: Inoperable kaposiform hemangioendothelioma unresponsive to corticosteroids can be successfully treated with chemotherapy.     

Effects of rime-based orthographic analogy training on the word recognition skills of children with reading disability.

The aim of this study was to determine whether metacognitive strategy training in the use of rime spelling units would be an effective intervention strategy for children with reading disability. Thirty-six disabled readers were randomly assigned to 1 of 2 training groups, a rime analogy training group or an item-specific training group. Posttreatment measures were taken at the completion of the training, and 1-year follow-up data were obtained from the 2 training groups and a sample of 20 normally developing readers. Systematic strategy training in the use of rime spelling units produced generalized achievement gains and transfer to uninstructed materials and was more effective than training that focused on item-specific learning and sentence-level strategies. The superior posttreatment performance of the rime analogy group over the item-specific group was maintained. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cochlear assessment before cochlear implantation by computer tomography with a modified Stenvers projection

OBJECTIVE: To compare ratings of the necessity of drugs in the daily practice of experienced primary care doctors in Estonia and Finland to find out the differences and similarities in the therapeutic traditions of the two different societies. METHODS: A questionnaire was sent to all Estonian district doctors born in the 1940s and to all Finnish specialized general practitioners born in the 1940s, who then evaluated the necessity of the listed drugs on a visual analogue scale. The ratings, from 0 to 100, were entered into a computer, using a graphic tablet and a pressure sensitive pointer. RESULTS: The six most highly-evaluated drugs among the Estonian respondents were digoxin, glyceryl trinitrate, aspirin, calcium-channel blockers, beta-adrenoceptor blockers and frusemide; and among the Finnish general practitioners (GPs) were penicillin, insulin, glyceryl trinitrate, beta-adrenoceptor blockers, frusemide and angiotensin-converting enzyme (ACE) inhibitors. The ratings of 15 out of 33 drugs/drug groups were very similar both in Estonia and Finland. The biggest differences between the opinions of the Estonian and Finnish doctors appeared in the ratings regarding the necessity of antacids, cimetidine, insulin, sulphonylureas, reserpine. ACE inhibitors, oral contraceptives, penicillin, metronidazole, trimethoprim, indomethacin, phenobarbital and theophylline. CONCLUSION: The revealed differences are suggested to be related to the different health care systems (different task profiles of doctors, different pharmaceutical services), different education of doctors, different availability of drugs in the past and different prices, all of which influence therapeutic traditions.     

Training the word recognition skills of reading disabled children: Treatment and transfer effects.

54 disabled readers were randomly assigned to 1 of 2 word recognition and spelling training programs or to a problem solving and study skills training program. One word-training program taught orthographically regular words by whole word methods alone; the other trained constituent grapheme–phoneme correspondences. The word-training groups made significant gains in word recognition accuracy and speed and in spelling. Significant transfer was observed on uninstructed spelling content but not on uninstructed reading vocabulary. In general, the word-training programs were equally effective for instructed content, but the whole-word group was superior on some transfer measures at posttest. Although the results demonstrate that dyslexic readers can be instructed successfully, the children did not profit differentially from letter-sound over whole-word training in the present context. We speculate that severely disabled readers may require either a more extended period of letter–sound instruction to reliably adopt an alphabetic decoding strategy or additional specific training in phonological awareness and subsyllabic segmentation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Optimizing the reliability of speech recognition scores

Speech recognition assessment involves a dilemma because clinicians want a test that is short and reliable, but statistical principles dictate that a short test is unreliable. Curves representing the variability of test scores based on the binomial model reveal that approximately 450 scorable items are needed in order to optimize the reliability of a speech recognition test. A testing approach was developed to achieve this sample size while retaining the principal features of the most commonly accepted speech recognition tests (i.e., monosyllabic words presented in an open-set format, verbal responses, and right/wrong scoring). It involves the use of an interactive computer program to present CNC words in 50 three-word groups, which are scored phonemically, resulting in 450 scorable items. Normal performance is described as a function of both presentation level and signal-to-noise ratio. Comparisons of test and retest scores for 100 individuals with normal hearing and 100 persons with sensorineural losses revealed that the approach achieves the degree of reliability predicted by the binomial model for both groups. Phoneme scores accounted for 99% of the variance of word scores for most of the performance range encountered in clinical practice, making it possible for test outcomes based on phonemic scoring to be expressed in terms of equivalent word recognition scores.     

Cochlear implantation: a review of the literature and the Nijmegen results

The field of cochlear implantation is developing rapidly. In subjects with bilateral profound deafness who gain no benefit from conventional hearing aids the aim of cochlear implantation is to provide a means for them to receive auditory sensations. Throughout the world, most cochlear implant centres are still continuing their research efforts to improve the results with this technique. Although it is still difficult to predict how an individual will perform with a cochlear implant, the success of cochlear implantation can no longer be denied. In this paper, we review some recent papers and reports, and the results of the various Nijmegen cochlear implant studies. Data about subject selection, examinations, surgery and the outcome are discussed. Our results were in good agreement with those of other authors. It can be concluded once again that cochlear implantation is an effective treatment for postlingually deaf adults and children, and for prelingually (congenital or acquired) deaf children with profound bilateral sensorineural deafness.     

Reading speech and hearing print: Constraining models of visual word recognition by exploring connections with speech perception.

Current models of reading and speech perception differ widely in their assumptions regarding the interaction of orthographic and phonological information during language perception. The present experiments examined this interaction through a 2-alternative, forced-choice paradigm, and explored the nature of the connections between graphemic and phonemic processing subsystems. Exps 1 and 2 demonstrated a facilitation-dominant influence (i.e., benefits exceed costs) of graphemic contexts on phoneme discrimination, which is interpreted as a sensitivity effect. Exps 3 and 4 demonstrated a symmetrical influence (i.e., benefits equal costs) of phonemic contexts on grapheme discrimination, which can be interpreted as either a bias effect, or an equally facilitative/inhibitory sensitivity effect. General implications for the functional architecture of language processing models are discussed, as well as specific implications for models of visual word recognition and speech perception. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cepstral representation of speech motivated by time-frequency masking: an application to speech recognition

A new spectral representation incorporating time-frequency forward masking is proposed. This masked spectral representation is efficiently represented by a quefrency domain parameter called dynamic-cepstrum (DyC). Automatic speech recognition experiments have demonstrated that DyC powerfully improves performance in phoneme classification and phrase recognition. This new spectral representation simulates a perceived spectrum. It enhances formant transition, which provides relevant cues for phoneme perception, while suppressing temporally stationary spectral properties, such as the effect of microphone frequency characteristics or the speaker-dependent time-invariant spectral feature. These features are advantageous for speaker-independent speech recognition. DyC can efficiently represent both the instantaneous and transitional aspects of a running spectrum with a vector of the same size as a conventional cepstrum. DyC is calculated from a cepstrum time sequence using a matrix lifter. Each column vector of the matrix lifter performs spectral smoothing. Smoothing characteristics are a function of the time interval between a masker and a signal. DyC outperformed a conventional cepstrum parameter obtained through linear predictive coding (LPC) analysis for both phoneme classification and phrase recognition by using hidden Markov models (HMMs). Compared with speaker-dependent recognition, an even greater improvement over the cepstrum parameter was found in speaker-independent speech recognition. Furthermore, DyC with only 16 coefficients exhibited higher speech recognition performance than a combination of the cepstrum and a delta-cepstrum with 32 coefficients for the classification experiment of phonemes contaminated by noises.     

Aided speech recognition abilities of adults with a severe or severe-to-profound hearing loss

Adults with severe or severe-to-profound hearing losses constitute between 11% and 13.5% of the hearing-impaired population. A detailed investigation of the speech recognition of adults with severe (n = 20) or severe-to-profound (n = 14) hearing loss was conducted at The University of Melbourne. Each participant took part in a series of speech recognition tasks while wearing his or her currently fitted hearing aid(s). The assessments included closed-set tests of consonant recognition and vowel recognition, combined with open-set tests of monosyllabic word recognition and sentence recognition. Sentences were presented in quiet and in noise at +10 dB SNR to replicate an environment more typical of everyday listening conditions. Although the results demonstrated wide variability in performance, some general trends were observed. As expected vowels were generally well perceived compared with consonants. Monosyllabic word recognition scores for both the adults with a severe hearing impairment (M = 67.2%) and the adults with a severe-to-profound hearing impairment (M = 38.6%) could be predicted from the segmental tests, with an allowance for lexical effects. Scores for sentences presented in quiet showed additional linguistic effects and a significant decrease in performance with the addition of background noise (from 82.9% to 74.1% for adults with a severe hearing loss and from 55.8% to 34.2% for adults with a severe-to-profound hearing loss). Comparisons were made between the participants and a group of adults using a multiple-channel cochlear implant. This comparison indicated that some adults with a severe or severe-to-profound hearing loss may benefit from the use of a cochlear implant. The results of this study support the contention that cochlear implant candidacy should not rely solely on audiometric thresholds.     

基于语音识别的救援机器人听觉导航方法

在发生火灾或地震的建筑物内,由于烟雾或墙体倒塌等原因,救援机器人往往无法通过视觉、超声和红外等传感器直接发现建筑物内不可见区域或者其他房间中呼救的目标.利用声音信号波长较长可以衍射绕过障碍物传播的特性,结合现有的语音识别技术,开发出基于听觉的救援机器人导航系统.该系统使机器人可以在全局运动控制中跟踪幸存者的呼救声并向幸存者移动.通过相关实验验证了基于听觉的救援机器人导航方法的可行性.     

Influences of spoken word planning on speech recognition.

In 4 chronometric experiments, influences of spoken word planning on speech recognition were examined. Participants were shown pictures while hearing a tone or a spoken word presented shortly after picture onset. When a spoken word was presented, participants indicated whether it contained a prespecified phoneme. When the tone was presented, they indicated whether the picture name contained the phoneme (Experiment 1) or they named the picture (Experiment 2). Phoneme monitoring latencies for the spoken words were shorter when the picture name contained the prespecified phoneme compared with when it did not. Priming of phoneme monitoring was also obtained when the phoneme was part of spoken nonwords (Experiment 3). However, no priming of phoneme monitoring was obtained when the pictures required no response in the experiment, regardless of monitoring latency (Experiment 4). These results provide evidence that an internal phonological pathway runs from spoken word planning to speech recognition and that active phonological encoding is a precondition for engaging the pathway. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Results of systematic speech sound monitoring in children with cleft palate

Two potent inhibitors of nitric oxide synthase (NOS), namely, NG-nitro-L-arginine (NNA) and NG-monomethyl-L-arginine (NMMA) were administered intracerebroventricularly (i.c.v.) in morphine-dependent mice to investigate their effects on abrupt withdrawal and naltrexone-precipitated abstinence signs. Male Swiss-Webster mice were rendered dependent on morphine by subcutaneous implantation of a morphine pellet containing 75 mg of morphine base. Mice implanted with placebo pellets served as controls. NMMA or NNA administered i.c.v. had minimal effects on body weight loss and hypothermia that occur during abrupt withdrawal of morphine. When administered i.c.v., both NNA or NMMA (0.1, 1 and 10 micrograms/mouse) dose-dependently inhibited naltrexone-induced stereotyped jumping behavior in mice. I.c.v. administration of NMMA also attenuated withdrawal induced fecal pellet formation. This effect, however, was not dose-dependent. In conclusion, these results suggest that brain NO plays an important role in the expression of behavioral signs of morphine withdrawal syndrome. In addition, these results support the idea that NOS inhibitors may be potentially useful in the treatment of opioid withdrawal syndrome.