BACKGROUND AND OBJECTIVES: Given that only a few studies have focused on the bimodal benefits on objective and subjective outcomes and emphasized the importance of individual data, the present study aimed to measure the bimodal benefits on the objective and subjective outcomes for adults with cochlear implant. SUBJECTS AND METHODS: Fourteen listeners with bimodal devices were tested on the localization and recognition abilities using environmental sounds, 1-talker, and 2-talker speech materials. The localization ability was measured through an 8-loudspeaker array. For the recognition measures, listeners were asked to repeat the sentences or say the environmental sounds the listeners heard. As a subjective questionnaire, three domains of Korean-version of Speech, Spatial, Qualities of Hearing scale (K-SSQ) were used to explore any relationships between objective and subjective outcomes. RESULTS: Based on the group-mean data, the bimodal hearing enhanced both localization and recognition regardless of test material. However, the inter- and intra-subject variability appeared to be large across test materials for both localization and recognition abilities. Correlation analyses revealed that the relationships were not always consistent between the objective outcomes and the subjective self-reports with bimodal devices. CONCLUSIONS: Overall, this study supports significant bimodal advantages on localization and recognition measures, yet the large individual variability in bimodal benefits should be considered carefully for the clinical assessment as well as counseling. The discrepant relations between objective and subjective results suggest that the bimodal benefits in traditional localization or recognition measures might not necessarily correspond to the self-reported subjective advantages in everyday listening environments.
Adult ; Cochlear Implants ; Counseling ; Hearing ; Hearing Aids ; Humans

Cochlear Implants ; Congresses as Topic ; Hearing ; Hearing Aids ; Humans

Between one and three of every 1,000 neonates have sensorineural hearing loss (SNHL). It is of utmost importance to minimize the duration of auditory deprivation between the onset of bilateral deafness and intervention using hearing devices such as hearing aids and cochlear implants for achieving the best speech percpetion ability. To fit amplification accurately for children with SNHL, hearing thresholds for frequencies in the range of human communication should be evaluated. However, infants and young children are difficult to test using conventional behavioral tests, and hearing thresholds of them can be predicted using auditory brainstem response (ABR) and auditory steady-state response (ASSR). ABR is best evoked by applying a click stimulus, which allows an estimate over a broad range of high frequencies. ABR elicited by tone burst stimulus provides frequency-specific audiometric information. However, it can be difficult to record and observe at near-threshold levels, especially at lower frequencies. ABR thresholds for click and tone burst stimuli are highly correlated with behavioral thresholds, and often give an idea of the shape of an audiogram. ASSR is an auditory evoked potential, elicited with modulated tones. It provides frequency-specific hearing thresholds across the audiometric frequencies, which are well correlated with behavioral thresholds. However, the accuracy of threshold prediction decreases directly with the decrease of degree of hearing loss, and hearing thresholds cannot be predicted for auditory neuropathy. ASSR is most useful for estimating auditory thresholds for patients with no evidence of auditory neuropathy by the click ABR and OAEs, and who have an ABR only at high intensities or no ABR at a maximum stimulus level. Even if hearing thresholds are predicted through ABR and ASSR, behavioral testing including behavioral observation audiometry, visual reinforcement audiometry, or play audiometry should be employed repeatedly to verify the predicted thresholds, becasue the thresholds of ABR and ASSR are not true measure of hearing acuity but just responses generated at the brainstem.
Audiometry ; Auditory Threshold ; Brain Stem ; Child ; Cochlear Implants ; Deafness ; Evoked Potentials, Auditory ; Evoked Potentials, Auditory, Brain Stem ; Hearing ; Hearing Aids ; Hearing Loss ; Hearing Loss, Central ; Hearing Loss, Sensorineural ; Humans ; Infant ; Infant, Newborn ; Reinforcement (Psychology)

Hearing Aids

Auditory neuropathy is a hearing disorder characterized by an absent or severely abnormal auditory brainstem response, with preservation of the cochlear microphonics and otoacoustic emissions. This suggests that outer hair cell (OHC) function is normal but that auditory function proximal to the OHCs is impaired. These patients demonstrate mild to severe hearing loss for pure tones and impaired word discrimination out of proportion to pure tone loss. Hearing aid alone is of little or no benefit in patients with auditory neuropathy. Visual support via cued speech or signed language can be a fail-safe method for insuring language development. Recently, there are some reports that cochlear implantation is highly successful in patients with auditory neuropathy. We report three cases (two children and one woman) with auditory neuropathy. Each patient was tested with cochlear microphonics, otoacoustic emissions, auditory brainstem response and middle latency response, etc. All three patients had normal cochlear microphonics or otoacoustic emissions with absent auditory brainstem response. Two of them had evidence of a peripheral neuropathy. We should be aware of auditory neuropathy and implications for its management, which differs from treatment of sensorineural hearing loss. Auditory neuropathy also raises a concern about the risk of false-negative findings when newborn hearing screening is restricted to otoacoustic emissions.
Child ; Cochlear Implantation ; Cochlear Implants ; Discrimination (Psychology) ; Evoked Potentials, Auditory, Brain Stem ; Hair ; Hearing ; Hearing Aids ; Hearing Disorders ; Hearing Loss ; Hearing Loss, Sensorineural ; Humans ; Infant, Newborn ; Language Development ; Mass Screening ; Peripheral Nervous System Diseases

OBJECTIVES: Speech intelligibility is severely affected in children with congenital profound hearing loss. Hypernasality is a problem commonly encountered in their speech. Auditory information received from cochlear implants is expected to be far superior to that from hearing aids. Our study aimed at comparing the percentages of nasality in the speech of the cochlear implantees with hearing aid users and also with children with normal hearing. METHODS: Three groups of subjects took part in the study. Groups I and II comprised 12 children each, in the age range of 4-10 years, with prelingual bilateral profound hearing loss, using multichannel cochlear implants and digital hearing aids respectively. Both groups had received at least one year of speech therapy intervention since cochlear implant surgery and hearing aid fitting respectively. The third group consisted of age-matched and sex-matched children with normal hearing. The subjects were asked to say a sentence which consisted of only oral sounds and no nasal sounds ("Buy baby a bib"). The nasalance score as a percentage was calculated. RESULTS: Statistical analysis revealed that the children using hearing aids showed a high percentage of nasalance in their speech. The cochlear implantees showed a lower percentage of nasalance compared to children using hearing aids, but did not match with their normal hearing peers. CONCLUSION: The quality of speech of the cochlear implantees was superior to that of the hearing aid users, but did not match with the normal controls. The study suggests that acoustic variables still exist after cochlear implantation in children, with hearing impairments at deviant levels, which needs attention. Further research needs to be carried out to explore the effect of the age at implantation as a variable in reducing nasality in the speech and attaining normative values in cochlear implantees, and also between unilateral versus bilateral implantees.
Acoustics ; Child ; Cochlear Implantation ; Cochlear Implants ; Hearing ; Hearing Aids ; Hearing Loss ; Humans ; Speech Intelligibility ; Speech Therapy

BACKGROUND AND OBJECTIVES: In this study, we compared the postoperative open-set speech perception abilities of children using implants against their preoperative residual hearing abilities and also compared the performance of cochlear implant users with that of age-matched hearing aid users. SUBJECTS AND METHOD: Ninety-nine prelingually deaf children who have used implants over 1 year were grouped based on the unaided pure tone audiometry (PTA) thresholds into 3 groups: CI91-100(91-100 dB HL), CI101-110 (101-110 dB HL) and CI>111 (over 111 dB HL). Ninety-eight prelingually deaf children with hearing aids were divided into 4 groups also based on the unaided PTA thresholds: HA71-80 (71-80 dB HL), HA81-90 (81-90 dB HL), HA91-100 (91-100 dB HL) and HA101-110 (101-110 dB HL). Children with implants were tested by open-set speech perception tests (Monosyllabic Word, Common Phrases) before implantation and at 6, 12, 18, 24, 36, 48, and 60 months after implantation. Children with hearing aids were tested once or more times using open-set speech perception tests. The open-set speech perception abilities of children with implants and hearing aids were compared before implantation and at 30 months after implantation. RESULTS: The speech perception scores of CI91-100 were higher than those of CI101-110 and CI>111 for the first 2 years of implant use (p<0.05), and were higher than those of CI>111 at 3 years after implantation (p<0.01). Speech-perception scores of CI91-100 were lower than those of HA71-80, HA81-90 and HA91-100 before implantation, but were superior to those of HA91-100 and HA101-110 at 30 months after implantation (p<0.05). Performance of CI101-110 and CI>111 were poorer than that of HA71-80, HA81-90 and HA91-100 before implantation, but exceeded that of HA101-110 at 30 months after implantation (p<0.05). CONCLUSION: Open-set speech perception performance of children with cochlear implants was better than that of hearing aid users of the corresponding hearing level and was similar to at least that of hearing aid users with PTAs of 81-90 dB HL. Therefore, some of children with severe hearing loss may become good candidates for cochlear implantation.
Audiometry ; Child* ; Cochlear Implantation ; Cochlear Implants* ; Hearing Aids* ; Hearing Loss ; Hearing* ; Humans ; Speech Perception*

OBJECTIVES: To compare narrative skills between fourth and fifth grades of Persian-speaking students with hearing impairments and typical hearing students of the same grade and also to evaluate the effects of group, sex, hearing age, and educational grade of the students on their spoken/written narrative performance. METHODS: The subjects were 174 students aged 10–13 years, 54 of whom wore cochlear implants, 60 suffered from moderate to severe hearing losses and wore hearing aids, with the remaining 60 students being typical hearing in terms of the sense of hearing. The micro- and macrostructure components of spoken and written narrative were elicited from a pictorial story (The Playful Little Elephant) and then scored by raters. RESULTS: Compared to the typical hearing, the students with hearing impairments had significantly lower scores in all of the microstructure components of narratives. However, the findings showed no significant difference among different groups in macrostructure components of narratives. It was also revealed that the students had equal performance in spoken and written narrative. Finally, factor analysis manifested that group, sex, hearing age, and educational level of children might alter the outcome measures in various interactions. CONCLUSION: Although cochlear implantation was more effective than hearing aid on spoken and written narrative skills, the Persian-speaking students with hearing impairments were seen to need additional trainings on microstructure components of spoken/written narrative.
Child ; Cochlear Implantation ; Cochlear Implants* ; Hearing Aids* ; Hearing Loss ; Hearing* ; Humans ; Narration ; Outcome Assessment (Health Care)

OBJECTIVE: To study the effect of binaural bi-modal fitting (one cochlear implant and a contralateral hearing aid) on speech recognition of cochlear implant recipients with low frequency electrodes incompletely implanted. METHOD: A total of 15 cochlear implant(CI) users who have low residual hearing (250 Hz 45-90 dBHL, 500 Hz 75 - 100 dBHL) of their non surgery ears. We closed the top three electrodes to simulate the state of low-frequency electrodes incompletely implanted by fitting software. (1) The same tester received twice speech recognition tests in incompletely implanted state, one test used single CI model and the other used binaural bi-modal fitting model. (2)The same tester received above twice speech recognition tests again, but in completely implanted state. Then we compared the results of tests. RESULT: The CI users used binaural bi-modal fitting have higher speech recognition score than the same users used unilateral cochlear implant model in low-frequency electrodes incompletely implanted state(P<0. 05). The gap between the scores of the tests by using two usage patterns in low frequency electrodes incompletely implanted state was more than that in completely implanted state (P<0. 05). CONCLUSION Binaural bi-modal fitting can help CI users to improve their speech recognition ability in low-frequency electrodes incompletely implanted state.
Cochlear Implantation ; methods ; Cochlear Implants ; Electrodes, Implanted ; Hearing ; Hearing Aids ; Hearing Tests ; Humans ; Speech ; Speech Perception

OBJECTIVES: In order to understand the communicative abilities of hearing impaired children in noisy situations and their communication problems, this study was undertaken to examine speech recognition at different background noise levels, and to compare how context cues in noisy situations affect speech recognition. METHODS: Thirty-four children with severe/profound hearing impairment were enrolled. Fifteen children had cochlear implants (CIs) and 19 used hearing aids (HAs). The Mandarin Speech Perception in Noise (SPIN) test was performed under two levels of background noise, signal-to-noise ratio (SNR) 10 dB and SNR 0 dB (high and low levels, respectively). High predictive (HP) and low predictive (LP) sentences SPIN test scores were recorded to test the effect of context cues on speech recognition. RESULTS: Performance was significantly better in children with CIs (SNR 10: mean, 49.44, standard deviation [SD], 13.90; SNR 0: mean, 31.95, SD, 15.72) than in children with HAs (SNR 10: mean, 33.33, SD, 9.72; SNR 0: mean, 19.52, SD, 6.67; P<0.05) in both noise backgrounds, but no significant interaction was found between devices and background noise level. Hearing-impaired children performed better at SNR 10 dB (mean, 40.44; SD, 14.12) than at SNR 0 dB (mean, 25.0; SD, 12.98), significantly (P<0.001). Performance for HP sentences (mean, 38.6; SD, 12.66) was significantly (P<0.001) better than that for LP sentences (mean, 25.25; SD, 12.93). An interaction was found to between background noise level and contextual cues in sentences (F=8.47, P<0.01). CONCLUSION: The study shows that SNR conditions significantly influence speech recognition performance in children with severe/profound hearing impairment. Under better SNR listening situations, children have better speech recognition when listening to sentences with contextual cues. Children with CIs perform better than children with HAs at both noise levels.
Child ; Cochlear Implants ; Cues ; Hearing ; Hearing Aids ; Hearing Loss ; Humans ; Noise ; Signal-To-Noise Ratio ; Speech Perception