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INTRODUCTION: Cochlear implant (CI) users differ greatly in their rehabilitation outcomes, including speech understanding in noise. This variability may be related to brain changes associated with intact senses recruiting cortical areas from stimulation-deprived senses. Numerous studies have demonstrated such cross-modal reorganization in individuals with untreated hearing loss. How it is affected by regular use of hearing devices remains unclear, however. To shed light on this, the current study measured cortical responses reflecting comprehension abilities in experienced CI users and normal-hearing controls. METHODS: Using multichannel electroencephalography, we tested CI users who had used their devices for at least 12 months and closely matched controls (N = 2 × 13). Cortical responses reflecting comprehension abilities - the N400 and late positive complex (LPC) components - were evoked using congruent and incongruent digit-triplet stimuli. The participants' task was to assess digit-triplet congruency by means of timed button presses. All measurements were performed in speech-shaped noise 15 dB above individually measured speech recognition thresholds. Three stimulus presentation modes were used: auditory-only, visual-only, and visual-then-auditory. RESULTS: The analyses revealed no group differences in the N400 and LPC responses. In terms of response times, the CI users were slower and differentially affected by the three stimulus presentation modes relative to the controls. CONCLUSION: Compared to normal-hearing controls, experienced CI users may need more time to comprehend speech in noise. Response times can serve as a proxy for speech comprehension by CI users.

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BACKGROUND: Although good speech perception in quiet is achievable with cochlear implants (CIs), speech perception in noise is severely impaired compared to normal hearing (NH). In the case of a bimodal CI fitting with a hearing aid (HA) in the opposite ear, the amount of residual acoustic hearing influences speech perception in noise. OBJECTIVE: The aim of this work was to investigate speech perception in noise in a group of bimodal CI users and compare the results to age-matched HA users and people without subjective hearing loss, as well as with a young NH group. MATERIALS AND METHODS: Study participants comprised 19 bimodal CI users, 39 HA users, and 40 subjectively NH subjects in the age group 60-90 years and 14 young NH subjects. Speech reception thresholds (SRTs) in noise were adaptively measured using the Oldenburg Sentence Test for the two spatial test conditions S0N0 (speech and noise from the front) and multisource-noise field (MSNF; speech from the front, four spatially distributed noise sources) in continuous noise of the Oldenburg Sentence Test (Ol-noise) and amplitude-modulated Fastl noise (Fastl-noise). RESULTS: With increasing hearing loss, the median SRT worsened significantly in all conditions. In test condition S0N0, the SRT of the CI group was 5.6 dB worse in Ol-noise than in the young NH group (mean age 26.4 years) and 22.5 dB worse in Fastl-noise; in MSNF, the differences were 6.6 dB (Ol-noise) and 17.3 dB (Fastl-noise), respectively. In the young NH group, median SRT in condition S0N0 improved by 11 dB due to gap listening; in the older NH group, SRTs improved by only 3.1 dB. In the HA and bimodal CI groups there was no gap listening effect and SRTs in Fastl-noise were even worse than in Ol-noise. CONCLUSION: With increasing hearing loss, speech perception in modulated noise is even more impaired than in continuous noise.

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BACKGROUND: Although good speech perception in quiet is achievable with cochlear implants (CIs), speech perception in noise is severely impaired compared to normal hearing (NH). In the case of a bimodal CI fitting with a hearing aid (HA) in the opposite ear, the amount of residual acoustic hearing influences speech perception in noise. OBJECTIVE: The aim of this work was to investigate speech perception in noise in a group of bimodal CI users and compare the results to age-matched HA users and people without subjective hearing loss, as well as with a young NH group. MATERIALS AND METHODS: Study participants comprised 19 bimodal CI users, 39 HA users, and 40 subjectively NH subjects in the age group 60-90 years and 14 young NH subjects. Speech reception thresholds (SRTs) in noise were adaptively measured using the Oldenburg Sentence Test for the two spatial test conditions S0N0 (speech and noise from the front) and multisource-noise field (MSNF; speech from the front, four spatially distributed noise sources) in continuous noise of the Oldenburg Sentence Test (Ol-noise) and amplitude-modulated Fastl noise (Fastl-noise). RESULTS: With increasing hearing loss, the median SRT worsened significantly in all conditions. In test condition S0N0, the SRT of the CI group was 5.6 dB worse in Ol-noise than in the young NH group (mean age 26.4 years) and 22.5 dB worse in Fastl-noise; in MSNF, the differences were 6.6 dB (Ol-noise) and 17.3 dB (Fastl-noise), respectively. In the young NH group, median SRT in condition S0N0 improved by 11 dB due to gap listening; in the older NH group, SRTs improved by only 3.1 dB. In the HA and bimodal CI groups there was no gap listening effect and SRTs in Fastl-noise were even worse than in Ol-noise. CONCLUSION: With increasing hearing loss, speech perception in modulated noise is even more impaired than in continuous noise.

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Bioelectronic medicines (BEMs) constitute a branch of bioelectronic devices (BEDs), which are a class of therapeutics that combine neuroscience with molecular biology, immunology, and engineering technologies. Thus, BEMs are the culmination of thought processes of scientists of varied fields and herald a new era in the treatment of chronic diseases. BEMs work on the principle of neuromodulation of nerve stimulation. Examples of BEMs based on neuromodulation are those that modify neural circuits through deep brain stimulation, vagal nerve stimulation, spinal nerve stimulation, and retinal and auditory implants. BEDs may also serve as diagnostic tools by mimicking human sensory systems. Two examples of in vitro BEDs used as diagnostic agents in biomedical applications based on in vivo neurosensory circuits are the bioelectronic nose and bioelectronic tongue. The review discusses the ever-growing application of BEDs to a wide variety of health conditions and practices to improve the quality of life.

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OBJECTIVES: Cochlear implantation (CI) is a well-established treatment for sensorineural hearing loss. Due in part to a lack of referral guidelines, CI technology remains underutilized, and many patients who could benefit from CI may not be referred for evaluation. This study aimed to develop a model for predicting CI candidacy using routine audiometric measures, with the goal of providing guidance to clinicians regarding when to refer a patient for CI evaluation. METHODS: Unaided three-frequency pure tone average (PTA), unaided speech discrimination score (SDS), and best-aided sentence recognition testing with AZBio sentence lists were collected from 252 subjects undergoing CIE. Candidacy was defined by meeting traditional (AZBio score ≤ 60%), or Medicare criteria (≤40%). A logistic regression model was developed to predict candidacy. Confusion matrices were plotted to determine the sensitivity and specificity at various probability thresholds. RESULTS: Logistic regression models were capable of predicting probability of candidacy for traditional criteria (P < .001) and Medicare criteria (P < .001). PTA and SDS were significant predictors (P < .001). Using a probability cutoff of .5, the models yielded a sensitivity rate of 91% and 78% for traditional and Medicare criteria, respectively. CONCLUSION: Probability of CI candidacy may be determined using a novel screening tool for referral. This tool supports individualized counseling, serves as a proof of concept for candidacy prediction, and could be modified based on an institution's philosophy regarding an acceptable false positive rate of referral. LEVEL OF EVIDENCE: 4.

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OBJECTIVES: Minimizing soft tissue reduction during the placement of percutaneous implants has been encouraged to improve cosmesis and perhaps decrease soft tissue complications. However, the fidelity of sound transmission and retention of transcutaneous magnet devices relates to the intervening soft tissue thickness. The objective of this study was to examine age-related variability in scalp thickness in patients receiving either percutaneously implanted or transcutaneous magnet-retained auditory prostheses. METHODS: Children undergoing percutaneous implant retained prostheses or cochlear implantation underwent two scalp thickness measurements: 1) a superior measurement at the conventional marked site for cochlear implant receiver stimulator and 2) an inferior measurement 1.5 cm below the superior measurement representing the conventional marked site for cochlear implant fantail. Linear regression was used for statistical analysis. RESULTS: Eighty-five children (median age 6 years; range 9 months-17 years) were examined. Scalp thickness at the two sites ranged from 1 to 10 mm (superior mean = 4.1 mm; inferior mean = 4.3 mm). A strong correlation was observed between age and scalp thickness at the superior (R = 0.62, p < 0.01) measurement, while a moderate correlation was observed at the inferior (R = 0.45, p < 0.01) sites. Children younger than 7 years displayed little variability in scalp thickness, and no correlation between age and scalp thickness (R = 0.002, p = 0.74). CONCLUSION: In older children, scalp thickness varies significantly with age. However, children younger than 7 years consistently have scalp thicknesses of 3-4 mm. Lack of variability in scalp thickness in children younger than 7 years argues against the use of an age-adjusted approach to soft tissue management in this age group.

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Presbycusis, or age-related hearing loss (ARHL), is the result of physiologic and pathologic changes associated with advancing age. ARHL presents typically with a high-frequency hearing loss, which contributes to greater trouble hearing consonants within words. Consonants convey the bulk of meaning within a word, and this loss of linguistic information results in complaints associated with ARHL. Hearing aids and cochlear implants significantly improve the lives of older adults with hearing loss, in particular, those with depression and dementia. Successful current research in gene therapy, pharmacotherapy, and stems cells holds the promise of being able to restore native cochlear function.

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Objective:To evaluate the efficacy of soft or implanted BAHA in the patients of Treacher Collins syndrome(TCS).Method:Six patients of TCS were studied. The Teber scoring system was used to evaluate the deformity degree. The air and bone auditory thresholds were assessed by auditory brain stem response(ABR). The infant-toddler meaningful auditory integration scale(IT-MAIS) was used to assess the auditory development at three time levels: baseline,3 months and 6 months. The hearing threshold and speech recognition score were measured under unaided and aided conditions. Result:The average score of deformity degree was 14.0±0.6. The TCOF1 gene was tested in two patients. The bone conduction hearing thresholds of patients was（18.0±4.5）dBnHL and the air conduction hearing thresholds was （70.5±7.0）dBnHL. The IT-MAIS total, detection and perception scores were improved significantly after wearing softband BAHA and approached the normal level in the 2 patients under 2 years old. The hearing thresholds of 6 patients in unaided and softband BAHA conditions were（65.8±3.8）dBHL and （30.0±3.2）dBHL (P<0.01) respectively, and 1 implanted BAHA was 15 dBHL. The speech recognition scores of 3 patients in unaided and softband BAHA conditions were（31.7±3.5）% and（86.0±1.7）%(P<0.05) respectively, and 1 implanted BAHA was 96%. Conclusion:Whenever the patient was diagnosed as TCS by the clinical manifestations and genetic testing, BAHA system could help to rehabilitate the hearing to a normal condition.

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In recent years, with the emergence and clinical application of a series of artificial auditory implantation technologies, surgically hard-treated conductive hearing loss treatment has made great progress and development. In this paper, research progress of bone conduction implant aids and middle ear implant devices treatment of conductive hearing loss are reviewed.

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CONCLUSIONS: The satisfaction rate of the subjects with an auditory implant appears strictly related to the resulting auditory improvement, and the surgical variables would play a prevailing role in respect to the esthetic factors. OBJECTIVES: To assess the rate of satisfaction in subjects who underwent the surgical application of an auditory device at a single Implanting Center Unit. METHOD: A series of validated questionnaires has been administered to subjects who underwent the surgical application of different auditory devices. The Glasgow Benefit Inventory (GBI), the Visual Analog Scale (VAS), and the Abbreviated Profile of Hearing Aid Benefit (APHAB) have been used to compare the implanted situation with the hearing-aided one; a percutaneous bone conductive implant (pBCI) with an active middle ear implant (AMEI) on the round window in mixed hearing loss; and an invisible, fully-implantable device with a frankly and bulky semi-implantable device. RESULTS: The mean GBI scores were higher in Vibrant Soundbridge (VSB)® and Bonebridge® subjects, without significant differences among the various devices. The mean VAS score increased for all the devices in comparison with the conventional hearing aid. The mean APHAB score was similarly better in the implanted condition as total and partial scores.

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Our two ears do not function as fixed and independent sound receptors; their functioning is coupled and dynamically adjusted via the contralateral medial olivocochlear efferent reflex (MOCR). The MOCR possibly facilitates speech recognition in noisy environments. Such a role, however, is yet to be demonstrated because selective deactivation of the reflex during natural acoustic listening has not been possible for human subjects up until now. Here, we propose that this and other roles of the MOCR may be elucidated using the unique stimulus controls provided by cochlear implants (CIs). Pairs of sound processors were constructed to mimic or not mimic the effects of the contralateral MOCR with CIs. For the non-mimicking condition (STD strategy), the two processors in a pair functioned independently of each other. When configured to mimic the effects of the MOCR (MOC strategy), however, the two processors communicated with each other and the amount of compression in a given frequency channel of each processor in the pair decreased with increases in the output energy from the contralateral processor. The analysis of output signals from the STD and MOC strategies suggests that in natural binaural listening, the MOCR possibly causes a small reduction of audibility but enhances frequency-specific inter-aural level differences and the segregation of spatially non-overlapping sound sources. The proposed MOC strategy could improve the performance of CI and hearing-aid users.

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