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.     

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)     

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.     

Psychophysical and speech perception studies: a case report on a binaural cochlear implant subject

Further improvements in speech perception for cochlear implant patients in quiet and in noise should be possible with speech processing strategies using binaural implants. For this reason, presented here is a series of initial psychophysical and speech perception studies on the authors' first binaural cochlear implant patient. For an approximate matching of the places of stimulation on the two sides, the patient usually reported a single percept when the two sides were simultaneously stimulated. Lateralization was strongly influenced by amplitude differences between the electrical stimuli on the two sides, but only weakly by interaural time delays. Speech testing, comparing monaural with binaural electrical stimulation, showed a binaural advantage particularly in noise.     

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.     

Hearing capacity and speech production in 417 children with facial cleft abnormalities

Children with cleft palates often suffer from chronic conductive hearing losses, delayed language acquisition and speech disorders. This study presents results of speech and language outcomes in relation to hearing function and types of palatal malformations found. 417 children with cleft palates were examined during followup evaluations that extended over several years. Disorders were studied as they affected the ears, nose and throat, audiometry and speech and language pathology. Children with isolated cleft lips were excluded. Among the total group, 8% had normal speech and language development while 92% had speech or language disorders. 80% of these latter children had hearing problems that predominantly consisted of fluctuating conductive hearing losses caused by otitis media with effusion. 5% had sensorineural hearing losses. Fifty-eight children (14%) with rhinolalia aperta were not improved by speech therapy and required velopharyngoplasties, using a cranial-based pharyngeal flap. Language skills did not depend on the type of cleft palate presents but on the frequency and amount of hearing loss found. Otomicroscopy and audiometric follow-ups with insertions of ventilation tubes were considered to be most important for language development in those children with repeated middle ear infections. Speech or language therapy was necessary in 49% of the children.     

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.     

Human abilities revealed through auditory tests.

Used established findings from studies of visual, musical, and speech perception abilities to guide the construction of auditory ability tests. 44 measures based on these tests were obtained from a sample of 241 adult males (mean age 25.64 yrs). Correlation and factorial analyses were used to indicate structural interrelationships and relationships with education, musical experience, general intelligence, and age. The results indicate separate capacities for Auditory Verbal Comprehension, Auditory Immediate Memory, Temporal Tracking, Auditory Cognition of Relationships, Discrimination Among Sound Patterns, Speech Perception Under Distraction/Distortion, and Maintaining and Judging Rhythm. (61 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cochlear implants in children

Cochlear implants allow the rehabilitation of children with severe to profound hearing loss. They are beneficial for not only postlingual children with hearing loss but also for children with congenital or prelingual hearing loss. Issues regarding cochlear implant candidacy and surgery are discussed. The results of cochlear implants in children and the complications related to cochlear implant surgery in children are reviewed.     

An adaptive noise canceller for hearing aids using two nearby microphones

An adaptive noise cancellation scheme based on two-stage adaptive filtering as proposed by Van Compernolle [Proceedings of the IEEE International Conference on Acoustics, Speech and Signal Processing (IEEE, New York, 1990)] was tested for two identical directional microphones mounted in an endfire configuration within a single behind-the-ear (BTE) hearing aid. Speech intelligibility tests were carried out with two normal hearing subjects and three hearing aid users with moderate hearing losses, in a realistic test environment using open set words and sentences. A significant improvement, on average more than 5 dB, of speech reception threshold (SRT) in background noise was obtained.     

A modification of play audiometry to assess speech discrimination ability in severe-profoundly deaf 2- to 4-year-old children

OBJECTIVE: The aim was to develop an assessment procedure that was independent of language and speech production ability, to test speech feature discrimination in severe-profoundly deaf children 2 to 4 yr of age. DESIGN: The procedure being trialed was adapted from existing procedures. The child was required to respond with a game-like motor response to a "change" in a speech stimulus that was being presented repeatedly through a speaker. The change occurred at randomly determined times, and false alarm responses were measured during the waiting periods (while the child waited for the change). Two- to four-yr-old normally hearing children and hearing-impaired children using hearing aids and a group of 4-yr-old hearing-impaired children using cochlear implants were assessed on the task. RESULTS: More than 82% of the 3- and 4-yr-old normally hearing and hearing-impaired children were able to complete the testing for the eight speech sound contrasts within three 20 minute sessions. Fifty percent of the 2-yr-old normally hearing and hearing-impaired children were able to condition and complete the task. All of the normally hearing children who completed the task successfully discriminated all speech sound contrasts. The performance of the hearing-impaired children using hearing aids was influenced by the degree of hearing loss and the type of speech contrast being tested. Similarly, the average performance of the children using cochlear implants was better for easier contrasts such as /ba/bi/ with contrasting vowel formant cues. CONCLUSIONS: This procedure has potential for use as a reliable clinical and research tool for assessing the development of auditory discrimination ability in 2- to 4-yr-old severe-profoundly deaf children.     

Perceptual learning of noise vocoded words: Effects of feedback and lexicality.

Speech comprehension is resistant to acoustic distortion in the input, reflecting listeners' ability to adjust perceptual processes to match the speech input. This adjustment is reflected in improved comprehension of distorted speech with experience. For noise vocoding, a manipulation that removes spectral detail from speech, listeners' word report showed a significantly greater improvement over trials for listeners that heard clear speech presentations before rather than after hearing distorted speech (clear-then-distorted compared with distorted-then-clear feedback, in Experiment 1). This perceptual learning generalized to untrained words suggesting a sublexical locus for learning and was equivalent for word and nonword training stimuli (Experiment 2). These findings point to the crucial involvement of phonological short-term memory and top-down processes in the perceptual learning of noise-vocoded speech. Similar processes may facilitate comprehension of speech in an unfamiliar accent or following cochlear implantation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

External sources of individual differences? A cross-linguistic analysis of the phonetics of mothers' speech to 1-yr-old children.

Wide individual differences in early word production characterize children learning the same language, but the role of specific adult input in this interchild variability is unknown. Sampling the speech of American, French, and Swedish mothers (5 in each language group) to their 1-yr-old children, this study analyzed the distribution of consonantal categories, word length, and final consonants in running speech, content words, initial consonant of content words, and target words (adult models of words attempted by the children) as well as the children's own early words (from age 9 mo to about 18 mo). Variability is greater in child words than adult speech, and individual mother–child dyads show no evidence of specific maternal influence on the phonetics of the child's speech. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physical diagnostic procedures: whispered speech and tuning fork test]

Hearing impairment occurs in 10% of the Dutch population and may lead to major communication problems and even social isolation. A good method to detect hearing loss in a general practice is the screening audiometer. The treating physician may further use the whispered speech test and tuning fork tests which together give a good impression of the severity and the nature of the hearing loss if any. The whispered speech test is best performed in the standardized form according to the guideline 'Slechthorendheid' [hardness of hearing] of the Dutch College of General Practitioners (NHG), in which certain combinations of letters are recommended. The tuning fork tests according to Rinne and Weber indicate a difference in perception and conduction deafness, and are decisive for any hearing asymmetry. Use of the whispered speech test and of the tuning fork tests is recommended for adults and children from the age of 7.     

Cochlear implants in children

Cochlear implants are no longer considered new or experimental technology. Difficulty in evaluating the degree of hearing loss and response to traditional forms of amplification in young children makes pediatric cochlear implant candidacy a complex issue. Cochlear implantation and, in particular, pediatric cochlear implantation, requires a team commitment with contributions from surgeons, audiologists, speech pathologists, psychologists, and special educators. Elements discussed include assessment and candidacy issues, surgical technique, elements of a cochlear implant team, outcome assessment, and potential complications. The decision to perform pediatric cochlear implantation should not be undertaken without serious consideration to the enormous commitment required in both financial and personnel terms.     

Preliminary field-testing of The Physician's Developmental Quick Screen for Speech Disorders ("PDQ"). A 5-minute procedure for testing children six months to six years

This report describes the development of The Physician's Developmental Quick Screen for Speech Disorders (the PDQ), a screening test designed for use by nonspeech pathologists with children aged six months to six years. Disorders of language, articulation, voice, rhythm of speech, and the speaking mechanism are considered by the PDQ. Validation studies resulted in 90 per cent agreement (p less than .001) between nonspeech pathologists utilizing the PDQ and speech pathologists employing a battery of more established tests.     

Resource allocation and resident outcomes in nursing homes: comparisons between the best and worst

This article examines ethical dilemmas related to cochlear implant surgery in children. These dilemmas arise from the existence of a linguistic and cultural minority called the Deaf World. Organizations of culturally Deaf adults in the United States and abroad, as well as the World Federation of the Deaf, have, on ethical grounds, strongly criticized the practice of cochlear implant surgery in children. Three ethical dilemmas are examined. (1) The surgery is of unproven value for the main significant benefit sought, language acquisition, whereas the psychological, social, and linguistic risks have not been assessed. Thus the surgery appears to be innovative, but innovative surgery on children is ethically problematic. (2) It is now widely recognized that the signed languages of the world are full-fledged natural languages, and the communities that speak those languages have distinct social organizations and cultures. Deaf culture values lead to a different assessment of pediatric cochlear implant surgery than do mainstream (hearing) values, and both sets of values have standing. (3) The fields of otology and audiology want to provide cochlear implants to Deaf children but also, their leaders say, want to protect Deaf culture; those appear to be conflicting goals in principle because, if there were perfect implants, the ranks of the Deaf World would diminish.     

Hearing handicap--an addition to audiometric hearing loss. Results of an exploratory study of auditory communication disorders in the elderly

Hearing problems in elderly patients cannot be evaluated completely with conventional audiological tests in most cases. Two hundred and one subjects aged 60 years or more complaining of hearing problems were studied. The following tests were employed: pure-tone audiometry, the "Basler Satztest" (a German version of the SPIN-test assessing speech perception in noise), and a German version of a "Hearing Handicap Inventory for the Elderly" (HHIE). These latter versions were developed in our institution. An auditory handicap was found in one-third of subjects with mild hearing losses (PTA < 30 dB; n = 135) and in two-thirds of subjects with greater hearing losses (PTA > and = 30 dB; n = 65). The relatively weak correlations of the pure-tone audiogram (r = 0.49) or speech audiometry (r = 0.41) with HHIE indicate that more than 50% of the variance of the hearing handicap was due to non-audiologic factors. For this reason, we recommend that the handicap questionnaire be added to the audiometric evaluation.