Audition and visual attention: the developmental trajectory in deaf and hearing populations

This study examined the development of visual attention in 5- to 13-year-olds who differed in their access to sound. Hearing children, deaf children with cochlear implants, and deaf children without implants participated in a task in which they were to respond to some visual signals and not others. The results of Experiment I indicated that the timing of developmental changes in visual selective attention was similar for all 3 groups, occurring around 8 years. The magnitude of age-related change differed among groups; hearing children and older deaf children using a cochlear implant reached higher levels of performance with age than did deaf children without enhanced access to sound. The results of Experiment 2 suggest that the developmental differences between deaf children with and without cochlear implants begin prior to 8 years and may be related to their use of environmental sounds to organize visual attention.     

Cochlear implants: selection criteria and shifting borders

Cochlear implants have proven to be effective and reliable in postlingually deaf adults. This is also true for congenitally deaf and perilingually deaf children up to the age of six years. Due to the increasing experience, the improvement of implant technology and the proven reliability the selection criteria are broadened with shifting borders. The main extensions are related to age, additional handicaps, residual hearing and special etiologies of deafness. Increasing evidence shows that very early implantation results in better performance and better hearing and speech development. Near-normal language acquisition can be achieved in children implanted under the age of four. Additional handicaps do not automatically exclude a candidate from cochlear implantation. A case-to-case decision has to be made based on additional diagnostics and the experience of the implant centre. A list of suitable handicaps is provided. Severely hearing impaired patients may also be considered for cochlear implantation if their residual hearing provides no benefit for speech discrimination. The same holds true for children. Cochlear implantation in obliterated cochleae and inner ear malformation requires a special surgical technique and special electrode arrays. In this way even difficult cases can be managed with remarkable outcome. Over all, the selection criteria have been broadened with increasing experience and technological improvement. This development may continue and the borderline between hearing aids and cochlear implants will shift further towards severe hearing loss. However, the basis for success still remains good rehabilitation, a team approach and the willingness of the patient to undergo the whole process of cochlear implantation.     

Sibling relationships for deaf children: The impact of child and family characteristics.

Objective: To examine factors that affect relationships between deaf children who use cochlear implants or hearing aids and their hearing siblings. Study Design: Qualitative analysis of interview data from parents of deaf children. Participants: Parents of 29 deaf children with at least 1 sibling; 20 children used cochlear implants and 9 used hearing aids. Main Outcome Measure: Quality of deaf-hearing sibling relationships as assessed by an ordinal scale developed by the authors. Results: Birth order, family size, parents' anxiety about deafness, and negative comparisons by parents of hearing and deaf siblings were key factors in sibling relationships. Conclusions: Family context is important in understanding experiences of deaf children and their hearing siblings. The model replaces assumptions of hearing loss as individual disability with an emphasis on the social determinants of managing differences in siblings' hearing status. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Improvements in speech perception by children with profound prelingual hearing loss: effects of device, communication mode, and chronological age

The present investigation expanded on an earlier study by Miyamoto, Osberger, Todd, Robbins, Karasek, et al. (1994) who compared the speech perception skills of two groups of children with profound prelingual hearing loss. The first group had received the Nucleus multichannel cochlear implant and was tested longitudinally. The second group, who were not implanted and used conventional hearing aids, was tested at a single point in time. In the present study, speech perception scores were examined over time for both groups of children as a function of communication mode of the child. Separate linear regressions of speech perception scores as a function of age were computed to estimate the rate of improvement in speech perception abilities that might be expected due to maturation for the hearing aid users (n=58) within each communication mode. The resulting regression lines were used to compare the estimated rate of speech perception growth for each hearing aid group to the observed gains in speech perception made by the children with multichannel cochlear implants. A large number of children using cochlear implants (n=74) were tested over a long period of implant use (m=3.5 years) that ranged from zero to 8.5 years. In general, speech perception scores for the children using cochlear implants were higher than those predicted for a group of children with 101-110 dB HL of hearing loss using hearing aids, and they approached the scores predicted for a group of children with 90-100 dB HL of hearing loss using hearing aids.     

The assembly of Ni2+-actin: some peculiarities

Cochlear implants have been very successful in restoring partial hearing to profoundly deaf people. Many individuals with implants are now able to communicate and understand speech without lip-reading, and some are able to talk over the phone. Children with implants can develop spoken-language skills and attend normal schools (i.e., schools with normal-hearing children). The greatest benefits with cochlear implantation have occurred in patients who (1) acquired speech and language before their hearing loss, and (2) have shorter duration of deafness. Gradual, but steady, improvements in speech production and speech perception have also occurred in prelingually deafened adults or children.     

Positron emission tomography of auditory sensation in deaf patients and patients with cochlear implants

The present study investigated the function of the auditory cortices in severely hearing-impaired or deaf patients and cochlear implant patients before and after auditory stimulation. Positron emission computed tomography (PET), which can detect brain activity by providing quantitative measurements of the metabolic rates of oxygen and glucose, was used. In patients with residual hearing, the activity of the auditory cortex measured by PET was almost normal. Among the totally deaf patients, the longer the duration of deafness, the lower the brain activity in the auditory cortex measured by PET. Patients who had been deaf for a long period showed remarkably reduced metabolic rates in the auditory cortices. However, following implantation of the cochlear device, the metabolic activity returned to near-normal levels. These findings suggest that activation of the speech comprehension mechanism of the higher brain system can be initiated by sound signals from the implant devices.     

Communication of oral deaf and normally hearing children at 36 months of age

Eighteen orally educated deaf and 18 normally hearing 36-month-old children were observed in a play session with their mother. Communicative behavior of the child was coded for modality and communicative function. Although the oral deaf children used a normal range of functions, both the quantity and proportions differed from normally hearing children. Whereas the normally hearing 3-year-olds used speech almost exclusively, the deaf children exhibited about equal use of speech, vocalizations, and gestures. Spoken language scores of the deaf children at 5 years of age were best predicted by (a) more frequent use of speech at age 36 months, (b) more frequent use of the Statement function, and (c) relatively infrequent use of the Directive function. It is suggested that some communicative functions are more informative or heuristic than others, and that the early use of these functions is most likely to predict later language competence.     

Speech perception test in Italian language for profoundly deaf children

Speech perception tests are an important part of procedures for diagnosing pre-verbal hearing loss. Merely establishing a child's hearing threshold with and without a hearing aid is not sufficient to ensure an adequate evaluation with a view to selecting cases suitable for cochlear implants because it fails to indicate the real benefit obtained from using a conventional hearing aid reliably. Speech perception tests have proved useful not only for patient selection, but also for subsequent evaluation of the efficacy of new hearing aids, such as tactile devices and cochlear implants. In clinical practice, the tests most commonly adopted with small children are: The Auditory Comprehension Test (ACT), Discrimination after Training (DAT), Monosyllable, Trochee, Spondee tests (MTS), Glendonald Auditory Screening Priocedure (GASP), Early Speech Perception Test (ESP), Rather than considering specific results achieved in individual cases, reference is generally made to the four speech perception classes proposed by Moog and Geers of the CID of St. Louis. The purpose of this classification, made on the results obtained with suitably differentiated tests according to the child's age and language ability, is to detect differences in perception of a spoken message in ideal listening conditions. To date, no italian language speech perception test has been designed to establish the assessment of speech perception level in children with profound hearing impairment. We attempted, therefore, to adapt the existing English tests to the Italian language taking into consideration the differences between the two languages. Our attention focused on the ESP test since it can be applied to even very small children (2 years old). The ESP is proposed in a standard version for hearing-impaired children over the age of 6 years and in a simplified version for younger children. The rationale we used for selecting Italian words reflect the rationale established for the original version, but the choice of single words follows different criteria from the original version. In fact, the two languages differ in important linguistic features so that the test can not be not adapted to the Italian language by simply translating the words involved. As currently there is no children's language dictionary in Italian arranged according to age bracket, we chose words used in children and in pre-school reading material.     

Audiologic evaluation of deaf children

This paper describes an audiologic test battery for hearing-impaired children which includes otoscopic examination, tympanometry, pure-tone audiometry, speech perception testing, and hearing aid evaluation. Several of the procedures and modifications to apparatus have been developed specifically for use with deaf children. Clinical data are presented from 160 hearing-impaired children (age range three-16 years). Eighteen percent of their ears were found to contain excessive cerumen and to require ear canal irrigation. The incidence of abnormal tympanograms was high for young children but decreased with increasing age. A simple auditory speech perception test designed for use with both severely and profoundly deaf children is described, which provides for evaluation of a child's ability to recognize words, categorize them into stress patterns, or both. The children's word recognition and word categorization scores were found to relate to their audiometric averages. The overall test battery is easy to administer and also is efficient, in that considerable audiologic information can be obtained quickly.     

Implant cochléaire et développement des échanges conversationnels.

Most researches conducted in the field of postimplant assessment have focused on the restoration of perceptual capabilities and the development of verbal language. In contrast, only very few studies have examined the impact of a cochlear implantation on children's overall development and, in particular, on their conversational language abilities. However, some previous works on the preverbal development revealed the recurrent difficulties experienced by deaf children in acquiring knowledge of social rules and social skills relative to speech activities. In children with profound bilateral deafness, a conventional hearing aid is not enough to provide sufficiently relevant information for a satisfactory development of oral communication. In such situations, the most suitable way of improving hearing is the use of a cochlear implant. The authors therefore hypothesized that access to oral perception will not only improve implanted children's social skills, but will also increase their rate of participation and the use of verbal language in their interaction with a familiar adult (mother or father). Their communication skills profile would resemble that of younger normal hearing children. Using conversational samples from a video-filming protocol at specific intervals, the authors monitored the development of communication skills in a group of 20 prelingually, profoundly deaf children (mean age: 3.7 years). Results corroborated our hypothesis. They indicated that children using cochlear implants increased their overall performance in communication skills, quantitatively and qualitatively speaking, even at the first year postimplantation stage. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Premature introduction of progestin-only contraceptive methods during lactation

INTRODUCTIONS: Cochlear implants are used for the rehabilitation of bilaterally deaf patients. Due to the improvements in speech processing they might be also useful for patients with residual hearing and some speech understanding. METHODS: Pre- and postoperative speech understanding scores in 26 patients receiving implants were evaluated in a retrospective study. RESULTS: The preoperative pure-tone threshold in the implanted ear was between 80 and 115 dB in the frequency range of 500 to 2000 Hz. On the contralateral side the mean threshold was 10 dB better. The mean score for the number test was 11.3%, for the monosyllables below 5%. Postoperatively speech understanding improved significantly up to 97% for numbers and 48% for monosyllables (tested with the Freiburger Speech Test). Cochlear implantation also benefits patients with residual hearing and some speech understanding with hearing aids under optimum conditions. The speech understanding scores must be below certain limits. General selection criteria cannot yet be specified. The individual decision must be based upon several criteria, especially the speech understanding scores in quiet and noise under optimum conditions. A prospective study is needed to develop generally applicable criteria.     

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.     

Mother father deaf: the heritage of difference

Almost 90% of the children born to life-long profoundly deaf parents are hearing. Within this extraordinary family setting, hearing children of deaf parents are exposed to and interact with two differing cultural, social and linguistic systems: that of their deaf parents and the Deaf community, and that of hearing peers and adults. The present paper focuses on cultural identity and affiliation of hearing children of deaf parents--a population whose lives incorporate the paradox of being culturally 'Deaf' and yet functionally hearing. Data reported here are primarily based on interviews and life histories with 150 adult hearing children of deaf parents throughout the United States. The informants in this study provide an opportunity to explore the parameters and norms of Deaf culture as it contrasts and conflicts with those of Hearing culture.     

Cochlear implantation of children with minimal open-set speech recognition skills

OBJECTIVE: The purpose of this study was to evaluate the postoperative performance of 12 children who demonstrated some open-set speech recognition skills before receiving a Nucleus multichannel cochlear implant with a view toward expanding the selection criteria for cochlear implant candidacy to include children who derive minimal benefit from amplification. DESIGN: Pre- and postoperative performance of two groups of children were compared. Group 1 consisted of 12 children who demonstrated some open-set speech recognition skills before receiving a Nucleus multichannel cochlear implant (Borderline group). Group 2 consisted of 12 children who demonstrated no open-set speech recognition skills before implantation with a Nucleus device (Traditional group). In all children, candidacy was determined based on preimplant binaural aided performance. For most subjects, the poorer ear was selected for implantation. Mean pre- and postoperative speech recognition scores of the Borderline subjects were compared to determine the benefit provided by their cochlear implants. Secondly, matched-pair analyses were used to compare the mean speech recognition scores obtained by the Borderline and Traditional subjects. RESULTS: The scores of the Borderline group improved significantly on five of six speech recognition measures when 6 mo postoperative scores obtained with the implant were compared with preoperative test scores obtained with hearing aids. By the 12 mo postoperative interval, the scores of the Borderline group had improved significantly (p < 0.05) on all six measures. In contrast, scores obtained by the Traditional group had improved significantly on three of six measures at both the 6 and 12 mo postoperative intervals. Comparison of postoperative test scores revealed that the Borderline group scored significantly higher than the Traditional group on three of six measures at the 6 mo test interval and on six of six measures at the 12 mo test interval (p < 0.05). CONCLUSIONS: The findings of this study indicate that both groups derive significant benefit from their cochlear implants. Although the mean preoperative audiograms for the implanted ears did not differ significantly for the two groups of subjects, members of the Borderline group exhibited significantly better speech recognition skills than the Traditional group during the first year after implantation. These findings suggest that the increased auditory experience of the Borderline subjects positively influenced their performance with a cochlear implant. The authors advocate that the selection criteria used to determine pediatric cochlear implant candidacy be broadened to include consideration of children who demonstrate minimal open-set speech recognition skills.     

Communication between deaf children and their hearing mothers: the role of language, gesture, and vocalizations

In the present longitudinal study, 20 deaf and 20 hearing children were observed during free play with their hearing mothers when the children were 22 months and 3 years of age. Compared to hearing children, deaf children were severely language delayed, with deaf 3-year-olds using less language (speech or sign) than hearing 22-month-olds. Deaf children communicated primarily through nonlinguistic vocalizations, with increasing use of gesture from 22 months to 3 years of age. Although mothers of deaf children used more visual communication than mothers of hearing children, they still primarily communicated through speech. In addition, deaf children did not visually attend to much of their mothers' communication. Therefore, deaf children received much less communication than hearing children. These results suggest that intervention efforts should be focused on increasing the quantity of perceived linguistic input by the child.     

Active electronic cochlear implants for middle and inner ear hearing loss--a new era in ear surgery. I: Basic principles and recommendations on nomenclature

Hearing aids have fundamental disadvantages: (1) stigmatization of the patient; (2) the sound is often found to be unsatisfactory due to the limited frequency range and undesired distortion; (3) in many patients, the ear canal fitting device generally necessary leads to an occlusion effect; (4) acoustic feedback when amplification is high. Conventional hearing aids transmit sound into the ear canal via a small microphone. Sound has the disadvantage of requiring high output sound pressure levels for its transmission. This along with the necessary miniaturization of the loudspeaker as well as the resonances and reflections in the closed ear canal contribute to the disadvantages mentioned. In contrast, implantable hearing aids do not make sound signals but micromechanical vibrations. An implantable hearing aid has an electromechanical transducer instead of the loudspeaker of a conventional hearing aid. The hearing signal does not leave the transducer as sound but as a mechanical vibration which is directly coupled to the auditory system bypassing the air. This implantable hearing aid is either coupled to the tympanic membrane, the ossicular chain, the perilymph of the inner ear, or the skull. An implantable hearing aid is expected to have: 1 Better sound fidelity than a hearing aid 2 No ear canal fitting device, free ear canal 3 No feedback 4 Invisibility Requirements on electronic hearing implants designed for patients with conductive hearing loss differ from those on implants for sensorineural hearing loss. Conductive hearing loss requires the implant to replace the impedance transformation, thus being an impedance transformation implant (ITI). In various respects, the demands on an ITI are lower than the demands on an electronic hearing aid for patients with sensorineural hearing loss. The latter are mostly patients with a failure of the cochlea amplifier (CA). A damage to the CA is clinically discernible by a positive recruitment and loss of otoacoustic emissions (OAE). Since these patients form the majority of cases with sensorineural hearing loss, an active hearing implant for such patients should partially replace the function of the CA. Therefore, the suggestion is to refer to a CAI (cochlea amplifier implant). The implant expressions ITI (for patients with conductive hearing loss) and CAI (for patients with sensorineural hearing loss) used in this context allow nomenclatural association with the CI (cochlear implant) for complete inner ear failure as well as with the BSI (brainstem implant) in the case of hearing nerve failure.     

Second formant transitions of selected consonant-vowel combinations in the speech of deaf and normal-hearing children

Although it is well known that the speech produced by the deaf is generally of low intelligibility, the sources of this low speech intelligibility have generally been ascribed either to aberrant articulation of phonemes or inappropriate prosody. This study was designed to determine to what extent a nonsegmental aspect of speech, formant transitions, may differ in the speech of the deaf and of the normal hearing. The initial second formant transitions of the vowels /i/ and /u/ after labial and alveolar consonants (/b, d, f/) were compared in the speech of six normal-hearing and six hearing-impaired adolescents. In the speech of the hearing-impaired subjects, the second formant transitions may be reduced both in time and in frequency. At its onset, the second formant may be nearer to its eventual target frequency than in the speech of the normal subjects. Since formant transitions are important acoustic cues for the adjacent consonants, reduced F2 transitions may be an important factor in the low intelligibility of the speech of the deaf.     

Predictive factors for speech perception in patients with cochlear implant

Cochlear implant therapy is an epoch-making advance in artificial sensory organ transplants, but the positive effects on speech perception vary. Quantification theory type I, a multivariate analysis, was used to determine predictive factors for speech perception in patients with cochlear implants. Fifty-one postlingual deaf adults (18 male and 33 female, mean age, 53.4, mean duration of deafness, 8.6 years) were tested for speech perception three or more months after a Nucleus 22 channels cochlear implant. The cause of deafness in nine patients was labyrinthitis, ototoxicity in five, meningitis in three and unknown in the remaining 34. Speech perception was measured by vowel, consonant and word recognition using a live voice, and monosyllable, word and sentence recognition using a videodisc. All tests were administered in a sound only condition. Results of the univariate analysis indicated that age at implantation was correlated with monosyllable recognition, and duration of deafness was correlated with live voice word recognition. Residual hearing and coding strategy were both correlated with all outcome measures. The multivariate analysis revealed that coding strategy, duration of deafness, residual hearing and the number of electrodes were significant predictors of live voice word recognition in that order.     

A comparative study of speech perception in young severely retarded children and normally developing infants

The discrimination of minimally paired speech sounds by seven retarded children with a mean age of 3 years, 2 months and a mean IQ of 38.4 was compared with the discrimination performance of eight normally developing 7-month-old infants. Children and infants were tested using the Visually Reinforced Infant Speech Discrimination (VRISD) paradigm in which they were taught to respond with a head turn to a change in a repeating background auditory stimulus. Responses were reinforced by activation of an animated toy. All children proved to be conditionable and both groups evidenced discrimination of the speech contrasts tested. The data suggest that the retarded children have moree difficulty processing a contrast cued by rapid spectral changes (often associated with consonant discrimination) than they do a contrast cued by steady-state spectral information (often associated with the perception of slowly articulated vowels). The normally developing infants did not find rapid spectral cues mor difficult than steady-state cues These results parallel those of Tallal (1976) who found that dynamic cues were specifically difficult for dysphasic children (with normal nonverbal intelligence), but not for linguistically-normal elementary school children.