RESUMEN
People with single-sided deafness (SSD) or asymmetric hearing loss (AHL) have particular difficulty understanding speech in noisy listening situations and in sound localization. The objective of this multicenter study is to evaluate the effect of a cochlear implant (CI) in adults with single-sided deafness (SSD) or asymmetric hearing loss (AHL), particularly regarding sound localization and speech intelligibility with additional interest in electric-acoustic pitch matching. A prospective longitudinal study at 7 European tertiary referral centers was conducted including 19 SSD and 16 AHL subjects undergoing cochlear implantation. Sound localization accuracy was investigated in terms of root mean square error and signed bias before and after implantation. Speech recognition in quiet and speech reception thresholds in noise for several spatial configurations were assessed preoperatively and at several post-activation time points. Pitch perception with CI was tracked using pitch matching. Data up to 12 months post activation were collected. In both SSD and AHL subjects, CI significantly improved sound localization for sound sources on the implant side, and thus overall sound localization. Speech recognition in quiet with the implant ear improved significantly. In noise, a significant head shadow effect was found for SSD subjects only. However, the evaluation of AHL subjects was limited by the small sample size. No uniform development of pitch perception with the implant ear was observed. The benefits shown in this study confirm and expand the existing body of evidence for the effectiveness of CI in SSD and AHL. Particularly, improved localization was shown to result from increased localization accuracy on the implant side.
Asunto(s)
Implantación Coclear , Implantes Cocleares , Pérdida Auditiva Unilateral , Localización de Sonidos , Percepción del Habla , Humanos , Implantación Coclear/métodos , Masculino , Localización de Sonidos/fisiología , Femenino , Persona de Mediana Edad , Percepción del Habla/fisiología , Estudios Prospectivos , Pérdida Auditiva Unilateral/cirugía , Pérdida Auditiva Unilateral/rehabilitación , Pérdida Auditiva Unilateral/fisiopatología , Estudios de Seguimiento , Anciano , Adulto , Europa (Continente) , Estudios Longitudinales , Resultado del Tratamiento , Inteligibilidad del Habla/fisiología , Percepción de la Altura Tonal/fisiología , Sordera/cirugía , Sordera/rehabilitación , Sordera/fisiopatología , RuidoRESUMEN
PURPOSE: The Minimum Speech Test Battery (MSTB) for adults was introduced in 1996 (Nilsson et al., 1996) and subsequently updated in 2011 (Advanced-Bionics et al., 2011). The MSTB has been widely used by clinicians as a guide for cochlear implant (CI) candidacy evaluations and to document post-operative speech recognition performance. Due to changes in candidacy over the past 10 years, a revision to the MSTB was needed. METHOD: In 2022, the Institute for Cochlear Implant Training (ICIT) recruited a panel of expert CI audiologists to update and revise the MSTB. This panel utilized a modified Delphi consensus process to revise the test battery and to improve its applicability considering recent changes in CI care. RESULTS: This resulted in the MTSB-Version 3 (MSTB-3), which includes test protocols for identifying not only traditional CI candidates but also possible candidates for electric-acoustic stimulation and patients with single-sided deafness and asymmetric hearing loss. The MSTB-3 provides information that supplements the earlier versions of the MSTB, such as recommendations of when to refer patients for a CI, recommended patient-reported outcome measures, considerations regarding the use of cognitive screeners, and sample report templates for clinical documentation of pre- and post-operative care. Electronic versions of test stimuli, along with all the materials described above, will be available to clinicians via the ICIT website (https://www.cochlearimplanttraining.com). CONCLUSION: The goal of the MSTB-3 is to be an evidence-based test battery that will facilitate a streamlined standard of care for adult CI candidates and recipients that will be widely used by CI clinicians.
Asunto(s)
Implantación Coclear , Implantes Cocleares , Consenso , Percepción del Habla , Humanos , Adulto , Técnica Delphi , Pérdida Auditiva/diagnóstico , Pérdida Auditiva/rehabilitación , Sordera/rehabilitaciónRESUMEN
OBJECTIVE: This study aimed to elucidate the long-term impact of prelingual deafness and elderly age at cochlear implantation on cochlear implant (CI) programming parameters and CI thresholds METHODS: We retrospectively reviewed patients who underwent cochlear implantation less than 5 years (Prelingual group) and equal and more than 18 years in our institute. The latter group was further divided into Adult and Elderly groups according to whether the patient was younger or older than 65 at implantation. From 152, 69, and 55 patients in the Prelingual, Adult, and Elderly groups, 242, 92, and 58 ears were included. We compared CI thresholds and CI programming parameters, including impedances, T/C levels, and dynamic ranges for 8 years after implantation between the Prelingual, Adult, and Elderly groups. RESULTS: The Prelingual group showed consistently lower CI thresholds than the Adult and Elderly groups during the postoperative 2-8 years, but no difference was detected between the Elderly and Adult groups, except at the postoperative 4 years. The elderly group's CI thresholds did not deteriorate until postoperative 8 years. The Prelingual group showed consistently larger T/C levels (minimum/maximum current strength from CI), especially C levels, than the other two groups. At the same time, there was no significant difference between the Elderly and Adult groups except for smaller dynamic ranges in the Elderly group until postoperative 2 years. These results in the CI programming parameters might explain the lower CI thresholds in the Prelingual group than in the other groups. Focusing on CI maps 1 and 3 years after implantation, the strength of the T/C levels was similar for all channels in the Prelingual group, but the Adult and Elderly groups showed larger electrical stimuli in channels responsible for the middle frequencies than those for the lower or higher frequencies. CONCLUSIONS: Our results suggest a significant influence of prelingual deafness but less impact of elderly age at implantation on long-term CI programming parameters and CI thresholds. The larger C levels and lower CI thresholds in the Prelingual group than in the Adult and Elderly groups implied that CI children with prelingual deafness tolerate and prefer larger CI stimuli, which may reflect the CI-dependent development of their auditory system before the critical period. No age-related reduction in hearing thresholds was observed in the Elderly group, probably because the CI compensates for age-related dysfunction of the peripheral auditory system.
Asunto(s)
Umbral Auditivo , Implantación Coclear , Implantes Cocleares , Sordera , Humanos , Anciano , Sordera/cirugía , Sordera/rehabilitación , Estudios Retrospectivos , Masculino , Femenino , Factores de Edad , Adulto , Persona de Mediana Edad , Preescolar , Adolescente , Adulto Joven , Psicoacústica , Anciano de 80 o más Años , Niño , Lactante , Impedancia EléctricaRESUMEN
The matter of raising and educating deaf children has been caught up in percepts of development that are persistently inaccurate and at odds with scientific research. These percepts have negatively impacted the health and quality of life of deaf children and deaf people in general. The all too prevalent advice is to raise the child strictly orally and wait to see what happens. Only when the child is seriously behind is a completely accessible language - a sign language - introduced, and that is far too late for protecting cognitive health. The medical profession, along with others, needs to offer parents better advice and better supports so that neither the children nor their parents wait and watch as the oral-only method fails. All must take responsible action to assure an approach that succeeds.
Asunto(s)
Sordera , Padres , Lengua de Signos , Humanos , Niño , Sordera/psicología , Sordera/rehabilitación , Padres/psicología , Personas con Deficiencia Auditiva , Crianza del Niño/psicología , PreescolarRESUMEN
PURPOSE: The present study evaluated the applicability of the sentence-focused framework to Mandarin-speaking children with cochlear implants (CIs) by examining the relative contribution of receptive/expressive noun and verb lexicon sizes to later grammatical complexity. METHOD: Participants were 51 Mandarin-speaking children who received cochlear implantation before 30 months of age. At 12 months after CI activation, parents were asked to endorse words that their child could understand only or understand and say using the infant version of the Early Vocabulary Inventory. At 24 months after CI activation, parents were asked to endorse the grammatical structures that their children were able to say using the Grammatical Complexity subtest in the Mandarin Communicative Development Inventory-Taiwan. Children's receptive/expressive noun and verb lexicon sizes and grammatical complexity scores were computed from these parent checklists. RESULTS: Correlational analyses showed that children's receptive/expressive noun and verb lexicon sizes at 12 months after CI activation were all highly correlated with their grammatical complexity scores at 24 months after CI activation (ρs = .52-.63, ps < .001). Regression analyses further revealed that verb lexicon sizes at 12 months after CI activation outweighed noun lexicon sizes in accounting for grammatical complexity at 24 months after CI activation. CONCLUSIONS: Our findings supported the prediction of the sentence-focused framework. Emphasizing the role of verbs in early intervention has the potential to enhance grammatical outcomes in Mandarin-speaking children with CIs. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.26129044.
Asunto(s)
Implantes Cocleares , Vocabulario , Humanos , Masculino , Femenino , Preescolar , Lactante , Desarrollo del Lenguaje , Lenguaje Infantil , Sordera/rehabilitación , Sordera/psicología , Implantación Coclear , Taiwán , Lingüística , Pruebas del Lenguaje , LenguajeRESUMEN
The researchers examined the associations between thinking styles and grit. A cross-sectional design was adopted, with two weeks of data collection. The Thinking Styles Inventory-Revised II and the Grit Scale were administered to 365 signing deaf or hard-of-hearing (DHH) Arts and Design students and 443 hearing university students in mainland China. CFA, MANOVA, hierarchical multiple regression analyses, and a multi-group analysis were executed for data analysis. DHH and hearing students with Type I styles (i.e., more creativity-generating, less structured, and cognitively more complex) had higher grit levels, with large effect sizes for the identified relationships. There were no differences in the relations for either group. The associations between thinking styles and grit may protect against psychological pressure and rehabilitation problems and enable university/school administrators, counselors, social workers, teachers, parents, and students to enhance the grit of students who are deaf or hard of hearing.
Asunto(s)
Sordera , Personas con Deficiencia Auditiva , Estudiantes , Pensamiento , Humanos , Masculino , Femenino , Estudios Transversales , Adulto Joven , Estudiantes/psicología , Personas con Deficiencia Auditiva/psicología , China , Sordera/psicología , Sordera/rehabilitación , Adolescente , Creatividad , Adulto , Educación de Personas con Discapacidad Auditiva/métodosRESUMEN
Accessible and inclusive participation in sport can provide significant physical, psychological, and social benefits to Deaf or hard of hearing (D/HH) athletes. To understand how to facilitate these benefits, the researchers explored the lived physical education and sport experiences of D/HH collegiate athletes. Six athletes representing six sports were recruited and interviewed. Utilizing an interpretative phenomenological analysis approach to guide data collection, analysis, and interpretation, the researchers found five major themes: Self-Advocating for Awareness, Finding Meaningful Conversations, Overcoming Challenges, Seeking Community Connection, and Escaping Through Physical Activity. These themes illustrate the influence of accessibility and inclusion on the participants' sport experiences as well as the impact of the disability awareness of their coaches and peers. D/HH athletes and their coaches and teammates should work to overcome barriers to accessibility and inclusion to ensure the maximum benefit of being on a college sports team.
Asunto(s)
Personas con Deficiencia Auditiva , Deportes para Personas con Discapacidad , Humanos , Masculino , Personas con Deficiencia Auditiva/psicología , Femenino , Adulto Joven , Deportes para Personas con Discapacidad/psicología , Atletas/psicología , Universidades , Sordera/psicología , Sordera/rehabilitación , Concienciación , Adolescente , Estudiantes/psicología , Inclusión Social , Educación y Entrenamiento Físico , Deportes/psicología , Investigación CualitativaRESUMEN
As part of a longitudinal study regarding the benefit of early cochlear implantation for children with single-sided deafness, the current work explored the children's daily device use, potential barriers to full-time device use, and the children's ability to understand speech with the cochlear implant (CI). Data were collected from 20 children with prelingual SSD who received a CI before the age of 2.5 years, from the initial activation of the sound processor until the children were 4.8 to 11.0 years old. Daily device use was extracted from the CI's data logging, while word perception in quiet was assessed using direct audio input to the children's sound processor. The children's caregivers completed a questionnaire about habits, motivations, and barriers to device use. The children with SSD and a CI used their device on average 8.3 h per day, corresponding to 63 % of their time spent awake. All children except one could understand speech through the CI, with an average score of 59 % on a closed-set test and 73 % on an open-set test. More device use was associated with higher speech perception scores. Parents were happy with their decision to pursue a CI for their child. Certain habits, like taking off the sound processor during illness, were associated with lower device use. Providing timely counselling to the children's parents, focused on SSD-specific challenges, may be helpful to improve daily device use in these children.
Asunto(s)
Implantación Coclear , Implantes Cocleares , Percepción del Habla , Humanos , Implantación Coclear/instrumentación , Femenino , Masculino , Niño , Preescolar , Factores de Tiempo , Estudios Longitudinales , Personas con Deficiencia Auditiva/psicología , Personas con Deficiencia Auditiva/rehabilitación , Encuestas y Cuestionarios , Inteligibilidad del Habla , Pérdida Auditiva Unilateral/rehabilitación , Pérdida Auditiva Unilateral/psicología , Pérdida Auditiva Unilateral/fisiopatología , Pérdida Auditiva Unilateral/cirugía , Comprensión , Resultado del Tratamiento , Lenguaje Infantil , Sordera/psicología , Sordera/rehabilitación , Sordera/fisiopatología , Sordera/diagnóstico , Sordera/cirugía , Factores de Edad , Conducta Infantil , Motivación , LactanteRESUMEN
Brain plasticity refers to the brain's ability to reorganize its structure or function in response to experiences, learning, and environmental influences. This phenomenon is particularly significant in individuals with deafness, as the brain adapts to compensate for the lack of auditory stimulation. The aim of this study is to investigate whether cochlear implantation can restore a normal pattern of brain activation following auditory stimulation in cases of asymmetric hearing loss. We used a PET-scan technique to assess brain activity after cochlear implantation, specifically during an auditory voice/non-voice discrimination task. The results indicated a nearly normal pattern of brain activity during the auditory discrimination task, except for increased activation in areas related to attentional processes compared to controls. Additionally, brain activity at rest showed significant changes in implanted participants, including cross modal visuo-auditory processing. Therefore, cochlear implants can restore the brain's activation pattern through long-term adaptive adjustments in intrinsic brain activity.
Asunto(s)
Estimulación Acústica , Adaptación Fisiológica , Implantación Coclear , Implantes Cocleares , Plasticidad Neuronal , Tomografía de Emisión de Positrones , Humanos , Implantación Coclear/instrumentación , Masculino , Femenino , Persona de Mediana Edad , Adulto , Mapeo Encefálico/métodos , Personas con Deficiencia Auditiva/psicología , Personas con Deficiencia Auditiva/rehabilitación , Encéfalo/diagnóstico por imagen , Encéfalo/fisiopatología , Audición , Estudios de Casos y Controles , Percepción Auditiva , Pérdida Auditiva Unilateral/fisiopatología , Pérdida Auditiva Unilateral/rehabilitación , Pérdida Auditiva Unilateral/diagnóstico por imagen , Pérdida Auditiva Unilateral/psicología , Sordera/fisiopatología , Sordera/diagnóstico por imagen , Sordera/rehabilitación , Sordera/cirugía , Anciano , Corrección de Deficiencia Auditiva , Discriminación en PsicologíaRESUMEN
Spoken language development after pediatric cochlear implantation requires rapid and efficient processing of novel, degraded auditory signals and linguistic information. These demands for rapid adaptation tax the information processing speed ability of children who receive cochlear implants. This study investigated the association of speed of information processing ability with spoken language outcomes after cochlear implantation in prelingually deaf children aged 4-6 years. Two domain-general (visual, non-linguistic) speed of information processing measures were administered to 21 preschool-aged children with cochlear implants and 23 normal-hearing peers. Measures of speech recognition, language (vocabulary and comprehension), nonverbal intelligence, and executive functioning skills were also obtained from each participant. Speed of information processing was positively associated with speech recognition and language skills in preschool-aged children with cochlear implants but not in normal-hearing peers. This association remained significant after controlling for hearing group, age, nonverbal intelligence, and executive functioning skills. These findings are consistent with models suggesting that domain-general, fast-efficient information processing speed underlies adaptation to speech perception and language learning following implantation. Assessment and intervention strategies targeting speed of information processing may provide better understanding and development of speech-language skills after cochlear implantation.
Asunto(s)
Implantación Coclear , Implantes Cocleares , Sordera , Función Ejecutiva , Percepción del Habla , Humanos , Masculino , Niño , Femenino , Preescolar , Sordera/psicología , Sordera/rehabilitación , Sordera/fisiopatología , Sordera/cirugía , Implantación Coclear/instrumentación , Estudios de Casos y Controles , Lenguaje Infantil , Personas con Deficiencia Auditiva/psicología , Personas con Deficiencia Auditiva/rehabilitación , Comprensión , Desarrollo del Lenguaje , Vocabulario , Factores de Tiempo , Resultado del Tratamiento , Inteligencia , Factores de Edad , Pruebas del LenguajeRESUMEN
There are few studies that have explored the Quality of Life (QoL) for deaf adolescents in high school (13-18 years). Following the PRISMA guidelines, this systematic literature review examined peer-reviewed research that has explored QoL for deaf adolescents in high school by using databases such as Science Citation Index, Scopus and Social Science Citation Index in addition to some related journals such as American Annals of the Deaf, the Journal of Deaf Studies and Deaf Education, Ear and Hearing, and Deafness and Education International spanning 14 years (2010-2024). By analysing the titles, abstracts, and keywords and reading full manuscripts, only seven were deemed appropriate for inclusion in this systematic review. All seven studies used quantitative research. This systematic review found that there is a discrepancy between the studies included in the use of measures. The results of the studies are different and some are contradictory. The QoL concept also differed amongst the studies. This study concluded that there is a great need to conduct more research into the QoL of deaf adolescents in high school with diverse research methods and the use of qualitative or mixed research, as well as expanding the scope of studies to include more dimensions in the concept of QoL.
Asunto(s)
Sordera , Personas con Deficiencia Auditiva , Calidad de Vida , Instituciones Académicas , Humanos , Adolescente , Sordera/psicología , Sordera/rehabilitación , Personas con Deficiencia Auditiva/psicologíaRESUMEN
PURPOSE: This study aimed to investigate family resilience-defined as the capacity of a family to harness its collective strengths and resources to recover from and adapt to significant adversities or crises effectively-in primary caregivers of children who are deaf and hard of hearing (cDHH) and its association with quality of life, life satisfaction, perceived social support, and loneliness. METHOD: The study involved 108 primary caregivers of cDHH and 139 primary caregivers of children with normal hearing. Participants underwent psychometric evaluations including the Family Resilience Scale, World Health Organization Quality of Life Assessment-Brief Form, Satisfaction with Life Scale, UCLA Loneliness Scale, and Multidimensional Scale of Perceived Social Support. RESULTS: Significant differences were found in almost every scale and its subdimension between the two groups (p < .05). Correlation analysis revealed significant correlations between all scale total scores for both groups (p < .05, .153 < | r | < .737). Quality of life was found to be a significant predictor of family resilience, F(1, 139) = 41.824, R2 = .279, B = 0.495, t = 6.467, p < .001. CONCLUSIONS: Our study highlights the significant impact of having cDHH on caregivers' family resilience, quality of life, life satisfaction, feelings of loneliness, and perceived social support. The results underscore the importance of enhancing caregivers' quality of life as a potential strategy to improve their family resilience. Further research is needed to understand the complex interplay of factors influencing these outcomes.
Asunto(s)
Cuidadores , Sordera , Calidad de Vida , Resiliencia Psicológica , Apoyo Social , Humanos , Masculino , Femenino , Cuidadores/psicología , Calidad de Vida/psicología , Niño , Adulto , Sordera/psicología , Sordera/rehabilitación , Satisfacción Personal , Persona de Mediana Edad , Pérdida Auditiva/psicología , Pérdida Auditiva/rehabilitación , Soledad/psicología , Psicometría , Preescolar , Adolescente , Familia/psicología , Personas con Deficiencia Auditiva/psicologíaRESUMEN
OBJECTIVES: Electrocochleography (ECochG) appears to offer the most accurate prediction of post-cochlear implant hearing outcomes. This may be related to its capacity to interrogate the health of underlying cochlear tissue. The four major components of ECochG (cochlear microphonic [CM], summating potential [SP], compound action potential [CAP], and auditory nerve neurophonic [ANN]) are generated by different cochlear tissue components. Analyzing characteristics of these components can reveal the state of hair and neural cell in a cochlea. There is limited evidence on the characteristics of intracochlear (IC) ECochG recordings measured across the array postinsertion but compared with extracochlear recordings has better signal to noise ratio and spatial specificity. The present study aimed to examine the relationship between ECochG components recorded from an IC approach and postoperative speech perception or audiometric thresholds. DESIGN: In 113 human subjects, responses to 500 Hz tone bursts were recorded at 11 IC electrodes across a 22-electrode cochlear implant array immediately following insertion. Responses to condensation and rarefaction stimuli were then subtracted from one another to emphasize the CM and added to one another to emphasize the SP, ANN, and CAP. Maximum amplitudes and extracochlear electrode locations were recorded for each of these ECochG components. These were added stepwise to a multi-factor generalized additive model to develop a best-fit model predictive model for pure-tone audiometric thresholds (PTA) and speech perception scores (speech recognition threshold [SRT] and consonant-vowel-consonant phoneme [CVC-P]) at 3- and 12-month postoperative timepoints. This best-fit model was tested against a generalized additive model using clinical factors alone (preoperative score, age, and gender) as a null model proxy. RESULTS: ECochG-factor models were superior to clinical factor models in predicting postoperative PTA, CVC-P, and SRT outcomes at both timepoints. Clinical factor models explained a moderate amount of PTA variance ( r2 = 45.9% at 3-month, 31.8% at 12-month, both p < 0.001) and smaller variances of CVC-P and SRT ( r2 range = 6 to 13.7%, p = 0.008 to 0.113). Age was not a significant predictive factor. ECochG models explained more variance at the 12-month timepoint ( r2 for PTA = 52.9%, CVC-P = 39.6%, SRT = 36.4%) compared with the 3-month one timepoint ( r2 for PTA = 49.4%, CVC-P = 26.5%, SRT = 22.3%). The ECochG model was based on three factors: maximum SP deflection amplitude, and electrode position of CM and SP peaks. Adding neural (ANN and/or CAP) factors to the model did not improve variance explanation. Large negative SP deflection was associated with poorer outcomes and a large positive SP deflection with better postoperative outcomes. Mid-array peaks of SP and CM were both associated with poorer outcomes. CONCLUSIONS: Postinsertion IC-ECochG recordings across the array can explain a moderate amount of postoperative speech perception and audiometric thresholds. Maximum SP deflection and its location across the array appear to have a significant predictive value which may reflect the underlying state of cochlear health.
Asunto(s)
Audiometría de Respuesta Evocada , Umbral Auditivo , Implantación Coclear , Implantes Cocleares , Percepción del Habla , Humanos , Percepción del Habla/fisiología , Persona de Mediana Edad , Femenino , Masculino , Anciano , Adulto , Adulto Joven , Cóclea , Periodo Posoperatorio , Anciano de 80 o más Años , Adolescente , Potenciales Microfónicos de la Cóclea/fisiología , Nervio Coclear/fisiopatología , Nervio Coclear/fisiología , Niño , Sordera/rehabilitación , Sordera/fisiopatologíaRESUMEN
PURPOSE: Perceived social support has been shown to positively correlate with health-related quality of life (HR-QoL) in a variety of conditions. This study investigated whether perceived social support is affecting HR-QoL of patients who receive a cochlear implant (CI) for deafness. METHODS: Eighty eight adults (56 males, 32 females; mean age: 60 years) with a uni- or bilateral CI for bilateral high-grade hearing loss were administered two questionnaires: a questionnaire for perceived social support (FSU-14) and the Nijmegen Cochlear Implant Questionnaire (NCIQ) for hearing-specific HR-QoL. Administration of the questionnaires occurred at four points in time: before implantation and three, 12 and 24 months after implant activation. RESULTS: The CI patients had quite high levels of perceived social support (mean percentile rank: 71), which remained stable at all four measurement points. Multivariate Analysis showed a significant interaction between perceived social support and HR-QoL indicating that higher perceived social support lead to higher improvement of HR-QoL after cochlear implantation. CONCLUSION: The CI patients in this study had higher than average levels of perceived social support, which did not change before and after cochlear implantation. Perceived social support and HR-QoL were related such that patients with high levels of perceived social support experienced greater improvement of their HR-QoL after cochlear implantation than patients with low levels of perceived social support. Based on this finding, perceived social support must be considered as an important factor for HR-QoL after cochlear implantation.
Asunto(s)
Implantación Coclear , Implantes Cocleares , Calidad de Vida , Apoyo Social , Humanos , Masculino , Femenino , Persona de Mediana Edad , Encuestas y Cuestionarios , Anciano , Implantes Cocleares/psicología , Adulto , Implantación Coclear/psicología , Anciano de 80 o más Años , Sordera/psicología , Sordera/cirugía , Sordera/rehabilitaciónRESUMEN
OBJECTIVES: The aim of the present study was to investigate whether prediction models built by de Graaff et al. (2020 ) can be used to improve speech recognition in experienced adult postlingual implanted Cochlear CI users. de Graaff et al. (2020 ) found relationships between elevated aided thresholds and a not optimal electrical dynamic range (<50 CL or >60 CL), and poorer speech recognition in quiet and in noise. The primary hypothesis of the present study was that speech recognition improves both in quiet and in noise when the sound processor is refitted to match targets derived from the prediction models from de Graaff et al. (2020 ). A second hypothesis was that subjectively, most of the CI users would find the new setting too loud because of an increase in C levels, and therefore, prefer the old settings. DESIGN: A within-participant repeated measures design with 18 adult Cochlear CI users was used. T- and C-levels were changed to "optimized settings," as predicted by the model of de Graaff et al. (2020 ). Aided thresholds, speech recognition in quiet, and speech recognition in noise were measured with the old settings and after a 4-week acclimatization period with the optimized settings. Subjective benefit was measured using the Device Oriented Subjective Outcome Scale questionnaire. RESULTS: The mean electrical dynamic range changed from 41.1 (SD = 6.6) CL to 48.6 (SD = 3.0) CL. No significant change in aided thresholds was measured. Speech recognition improved for 16 out of 18 participants and remained stable for 2 participants. Average speech recognition scores in quiet significantly improved by 4.9% (SD = 3.8%). No significant change for speech recognition in noise was found. A significant improvement in subjective benefit was found for one of the Device Oriented Subjective Outcome subscales (speech cues) between the old and optimized settings. All participants chose to keep the optimized settings at the end of the study. CONCLUSIONS: We were able to improve speech recognition in quiet by optimizing the electrical dynamic range of experienced adult CI users, according to the prediction models built by de Graaff et al. (2020 ). There was no significant change in aided thresholds nor in speech recognition in noise. The findings of the present study suggest that improved performance for speech recognition in quiet in adult Cochlear CI users can be achieved by setting the dynamic range as close as possible to values between 50 and 60 CL when the volume level is at 10.
Asunto(s)
Implantación Coclear , Implantes Cocleares , Ruido , Percepción del Habla , Humanos , Masculino , Persona de Mediana Edad , Femenino , Anciano , Adulto , Sordera/rehabilitación , Umbral Auditivo , Ajuste de PrótesisRESUMEN
OBJECTIVES: Children with cochlear implants (CIs) face challenges in perceiving fundamental frequency (F0) information because CIs do not transmit F0 effectively. In Mandarin, F0 can contrast meanings at the word level, that is, via lexical tones with distinct F0 contours, and signal contrastive relations between words at the utterance-level, that is, via contrastive focus with expanded F0 range and longer duration. Mandarin-speaking children with CIs have been reported to face challenges in producing distinct F0 contours across tones, but early implantation facilitates tonal acquisition. However, it is still unclear if utterance-level prosody, such as contrastive focus, is also challenging for these children, and if early implantation also offers benefits for focus production. Therefore, this study asked how accurately children with CIs can produce contrastive focus, and if early implantation leads to more accurate focus production, with acoustic patterns approaching that of children with typical hearing (TH). DESIGN: Participants included 55 Mandarin-speaking children (3 to 7 years) with CIs and 55 age-matched children with TH. Children produced noun phrases with and without contrastive focus, such as RED-COLORED cat versus red-colored cat . Three adult native listeners perceptually scored the productions as correct or incorrect. The "correct" productions were then acoustically analyzed in terms of F0 range and duration. RESULTS: Based on the perceptual scores, children with CIs produced focus with significantly lower accuracy (38%) than their TH peers (84%). The acoustic analysis on their "correct" productions showed that children with TH used both F0 and duration to mark focus, producing focal syllables with an expanded F0 range and long duration, and postfocal syllables with a reduced F0 range and short duration. However, children with CIs differed from children with TH in that they produced focal syllables with long duration but not an expanded F0 range, although they produced postfocal syllables with a reduced F0 range and short duration like their TH peers. In addition, early implantation correlated with the percept of more accurate focus productions and better use of F0 range in focal marking. CONCLUSIONS: This study finds that Mandarin-speaking children with CIs are still learning to apply appropriate acoustic cues to contrastive focus. The challenge appears to lie in the use of an expanded F0 range to mark focus, probably related to the limited transmission of F0 information through the CI devices. These findings thus have implications for parents and those working with children with CIs, showing that utterance-level prosody also requires speech remediation, and underscores the critical role of identifying problems early in the acquisition of F0 functions in Mandarin, not only at the word level but also at the utterance-level.