RESUMEN
Speech perception test results were obtained from a group of 40 pediatric cochlear implant users. Half of the children participated in oral-only habilitation programs, which included both traditional oral and auditory-verbal approaches, and half participated in programs that used a combination of oral and manual communication referred to as total communication (TC). Analysis of the scores showed that children enrolled in oral-only habilitation programs scored significantly higher on the speech perception measures than did children who were enrolled in total communication based programs. These results were inconsistent with those of other reports, which suggested that communication methods had little effect on implant outcomes. To further examine the reasons for the differences in performance, we analyzed 7 additional factors, including length of implant use, age at surgery, device type, socioeconomic status, bilingualism, school setting, and participation in private therapy, which may affect implant performance. Multiple-regression analysis again showed communication mode to be the factor most highly correlated with speech perception abilities among this group of children.
Asunto(s)
Implantes Cocleares , Percepción del Habla , Adolescente , Factores de Edad , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Masculino , Factores Socioeconómicos , Factores de TiempoRESUMEN
This article presents case studies in which single-channel mapping was used with patients who were experiencing discomfort while using their cochlear implant devices. Repeated psychophysical testing together with integrity testing had failed to locate the source of the problem in each of the described cases. Single-channel mapping was then used as another means of device troubleshooting. Single-channel maps were created for each electrode across the array. In each case, the patient was able to identify the offending electrode(s) during the presentation of speech stimuli, whereas the problem had not been evident during psychophysical testing with pulse stimuli. Eliminating these electrodes from the map alleviated the problems experienced by these implant users in each case.
Asunto(s)
Implantación Coclear , Sordera/cirugía , Adulto , Estimulación Eléctrica/instrumentación , Electrodos , Femenino , Humanos , Percepción Sonora , Falla de PrótesisRESUMEN
Programming of multichannel cochlear implants (CIs) requires subjective responses to a series of sophisticated psychophysical percepts. It is often difficult for young prelinguistically deaf children to provide adequate responses for device fitting. This is especially true in setting levels of maximum comfortable loudness, whereby failure to indicate growth of loudness may result in elevation of stimulus levels to the threshold of pain. The acoustic or stapedial muscle reflex has been used previously to provide objective confirmation of acoustic stimulation, and there have been attempts to use the reflex in hearing aid fitting. It has also been suggested that electrically elicited middle ear muscle reflexes (eMEMR) may have applicability in confirming and quantifying electrical stimulation through a CI. To assess the relationship between eMEMR characteristics and levels of loudness perception with CIs, determine reliability of the response, and investigate potential use of eMEMR in CI programming, 25 postlinguistically deafened adult CI users were evaluated. Reflexes have also been attempted on 40 children, with responses present in 31 (71%). Comfort levels predicted by eMEMR were highly correlated with those obtained through subjective judgments in the adult subjects. The eMEMR provides an objective, accurate, and rapid method of estimating maximum comfortable loudness levels, which may be useful in the initial programming of young implant recipients.
Asunto(s)
Implantes Cocleares , Percepción Sonora/fisiología , Diseño de Prótesis , Reflejo Acústico/fisiología , Estribo/fisiología , Estimulación Acústica , Adulto , Anciano , Anciano de 80 o más Años , Umbral Auditivo/fisiología , Niño , Implantación Coclear , Sordera/fisiopatología , Sordera/cirugía , Estimulación Eléctrica , Estudios de Evaluación como Asunto , Femenino , Predicción , Audífonos , Humanos , Masculino , Persona de Mediana Edad , Umbral del Dolor/fisiología , Satisfacción del Paciente , Psicofísica , Reproducibilidad de los Resultados , Umbral Sensorial/fisiología , Percepción del Habla/fisiologíaRESUMEN
HYPOTHESIS: The goals of this work were (a) to review the pre- and postsurgical auditory thresholds in a consecutive sample of cochlear implant recipients to determine the fate of residual hearing, and (b) to obtain preliminary indication of the value of a multicenter longitudinal study of residual hearing in implant patients. BACKGROUND: Indications for cochlear implantation have been expanded to include severely hearing impaired (SHI) adults and may someday include SHI children. Implantation of individuals with more residual hearing is a concern owing to the possible development of better devices that may make use of residual hearing within the lifetime of implanted children if not that of adults. Preservation of residual hearing would be a desirable outcome of implant surgery; however, conventional thought is that implantation destroys any remaining hearing. This study was undertaken to assess if and how often conservation of hearing occurred after implantation in a sample of multichannel implant recipients. METHODS: Records of 50 profoundly hearing impaired consecutively implanted patients were examined for pre- and post-surgical audiometric results. Standard audiometric techniques were used for all testing procedures. Forty patients were considered to have some hearing conserved based on a response obtained at any one of the three speech frequencies prior to implantation. The most recent postimplantation audiometric results were used providing data from users with 1-41 months of use. RESULTS: Twenty-one of 40 implanted subjects were found to have responses in at least one of the speech frequencies both pre- and postsurgery, with the majority of those displaying responses at all three frequencies. In this preliminary retrospective study, it did not appear that duration of cochlear implant use, gender, level of preoperative hearing, or length of electrode insertion were related to outcome. There were insufficient data to draw conclusions on individual devices. CONCLUSIONS: Conservation of hearing occurred in approximately half of the subjects reviewed. There is no indication of what factors contributed to the preservation of hearing in those with postsurgical residual hearing or if that hearing is usable. The study does suggest that a larger multicenter longitudinal study would be of value of determine what factors may be related to conserved hearing in implanted patients.
Asunto(s)
Implantes Cocleares , Sordera/rehabilitación , Adulto , Anciano , Audiometría , Sordera/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prueba del Umbral de Recepción del HablaRESUMEN
Fifty children who received a cochlear implant between 1991 and 1995 were evaluated for incidence of acute otitis media (AOM). Thirty-seven (74%) children had AOM before implantation and 8 (16%) after implantation. All children who had AOM after implantation had a history of AOM. A subgroup of 14 children required ventilating tubes for recurrent AOM before implantation. Five (35.7%) in this group had AOM after implantation. The incidence and severity of AOM decreased after implantation. All episodes of postimplant AOM were successfully treated with routine oral antibiotics, and no infectious complications occurred. A history of recurrent AOM should not inordinately delay cochlear implantation.