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C005 Short sequential bilateral cochlear implantation in children
International Journal of Pediatric Otorhinolaryngology 75 (2011) S1, 33–57
Contents lists available at ScienceDirect
International Journal of Pediatric Otorhinolaryngology journal homepage: www.elsevier.com/locate/ijporl
C – Outcome measures; Speech perception, production, language and cognition C001 Comparison of hearing tests to speech discrimination tests in prelingually deaf children with cochlear implants Z. Kabatov ´ a, ´ L’. Sˇ imkova, ´ M. Groma, M. Profant. University ORL Dept. Bratislava, Slovakia Aim: Cochlear implantation provides prelingually deaf children with adequate results. There are several factors that may influence outcomes of CI. The goal of this study is to compare hearing to speech understanding in children with CIs. Material and Methods: 80 prelingually deaf children with at least 5 years of CI experience were included in this study. The PTA evaluated hearing in the free field. Speech understanding was measured with open-set speech audiometry and monosyllabic words tests at one, three and five years following implantation. Results: Hearing does not always correlate with speech understanding. Good hearing in the first year after CI at 40 dB and better points towards better results in speech audiometry and monosyllabic tests. Conclusion: There is no exact prediction for hearing and speech discrimination in children with CIs. Early sound stimulation and good hearing in the first year after CI are positive prediction values for good speech discrimination. C002 Postlingual implantees: analysis of poor performers Z. Kabatov ´ a, ´ L’. Sˇ imkova, ´ M. Groma, M. Profant. University ORL Dept, Comenius University Medical School Bratislava, Slovakia Aim: Postlingually deaf patients often achieve excellent results with CIs. Factors that may negatively influence outcomes in this group were analyzed in this study. Material and Methods: 71 postlingually deaf CI patients (15 years or older) with at least 2 years’ experience with their implant were evaluated. They were divided into two groups: good performers (n = 50) and poor performers (n = 21; speech discrimination scores of 80% or less). The following factors were analyzed: etiology, age at the time of implantation and duration of hearing loss/deafness. Results: Three patients are now nonusers. Average age at the time of implantation was 41.1 in group 1 vs. 46.4 in group 2, and the duration of deafness was 3.5 years vs. 13 years respectively. The statistical analysis and a more detailed evaluation will be presented. Conclusion: Duration of deafness seems to be the most important factor influencing performance in postlingually deaf CI candidates. C003 Outcome in a group of children after simultaneous bilateral cochlear implantation within the age of one year A. Giourgas, Th. Lenarz, A. Lesinski-Schiedat. ENT of the Hannover Medical School, Germany Aim: To analyse the outcome of simultaneous bilaterally implanted children within the age of one year. Material and Methods: A group of 19 simultaneous bilaterally implanted children with a mean age at implantation of 0.97 years 0165-5876/$ – see front matter © 2011 Elsevier Ireland Ltd. All rights reserved.
was tested on listening skills and speech production. Test battery included the understanding of poly- and monosyllabic words (open and closed set), the repetition of sentences (in quiet and in noise), and an evaluation of the children’s active vocabulary. Results were compared to 3 other groups of children, implanted either simultaneously or sequentially up to an age of 4 years at the initial implantation. Results: The group simultaneous bilaterally implanted children before the age of one year show the best performance overall. Advantages seem to emerge when it comes to the lexical development and the comprehension of speech under noisy conditions. Conclusions: Congenitally deaf children should receive an early simultaneous bilateral implantation whenever feasible. C004 Fricative spectra in normal and hearing impaired children with cochlear implant B. Coimbra1 , L.M.T. Jesus2,3 , P. Sa´ Couto4 . 1 Direcc˜ ¸ ao Regional da Educac˜ ¸ ao do Norte, Minist´erio da Educac˜ ¸ ao, Portugal; 2 Escola Superior de Sa´ ude da Universidade de Aveiro (ESSUA), Universidade de Aveiro, Aveiro, Portugal; 3 Instituto de Engenharia Electr´ onica e Telem´ atica de Aveiro (IEETA), Universidade de Aveiro, Aveiro, Portugal; 4 Center of Research and Development in Mathematics and Applications (CIDMA), Departamento de Matem´ atica, Universidade de Aveiro, Portugal Aim: Speech production in 25 dissyllabic words was analysed. Parameters previously developed as a potential tool for the classification of fricatives produced in natural speech were used to compare speech production mechanisms in four deaf children with cochlear implant and four normal listeners (age and gender matched). Material and Methods: Acoustic and EGG signals were recorded simultaneously for the fricatives /f, s, S, v, z, Z/. The fricative spectral slope was investigated by fitting the spectra with two linear regression lines. Results: Spectral slope parameters behaved similarly for both groups regarding changes in place and sibilance. However, voicing predictions (unvoiced fricatives possess a more intense sound source and therefore have higher spectral slope values) were only present in normal hearing children. Conclusions: Results showed the individual capabilities of deaf children with cochlear implant to correctly produce place and sibilance, and deviant (regarding voicing mechanisms) voiced fricative production. C005 Short sequential bilateral cochlear implantation in children 2 F. Bergeron1 , R. Bussieres ` , L. Duchesne3 , C. Losier2 , G. Tremblay3 . 1 Universit´e Laval, Canada; 2 Centre Hospitalier Universitaire de Qu´ebec, Canada; 3 Institut de r´eadaptation en d´eficience physique de Qu´ebec, Quebec City, Canada
Aim: This project proposes to bring additional evidence on the impact of bilateral implantation in children from an enlarged
34
Abstracts, ESPCI 2011 / International Journal of Pediatric Otorhinolaryngology 75 (2011) 33–57
perspective including medical, perceptual and communicative issues. Material and Methods: Twenty children aged 7 to 35 months received sequential cochlear implants within a 12 months maximal delay. Auditory benefits, speech, language and communication were assessed with IT-MAIS, MAIS, Little Ears, EARS, lateralisation test, MUSS, RDLS, MCDI and/or VABS. Testing was realized at 0 and 3 months (first implant), and at 6, 12 and 24 months (second implant). Results: At 6 months, no medical or vestibular complications were recorded. While objective assessments do not show clear advantages of bilateral implantation, tests based on parents’ report show significant benefits for speech recognition in quiet and in noise, and for localization of sound sources. Conclusions: Short term follow-up does not appear sufficient to confirm the perceptual and communicative benefits reported by parents. C006 Audiological evaluation of patients after re- implantation of MED-EL system cochlear implant H. Emamdjomeh1 , S. Hassanzadeh2 , A. Daneshi3 , M. Farhadi4 , Sh. Mohammadi5 . 1 Audiologist of Otolaryngology,ENT Research Center of Tehran University of Medical Sciences, Iran; 2 Speech therapist of Otolaryngology,ENT Research Center of Tehran University of Medical Sciences, Iran; 3 Professor of Otolaryngology,Department of Otolaringology & Research Center of Tehran University of Medical Sciences, Iran; 4 Professor of Otolaryngology,ENT Research Center of Tehran University of Medical Sciences, Iran; 5 Associate Professor of Otolaryngology,ENT Research Center of Tehran University of Medical Sciences, Iran Aim: This Study was undertaken to evaluate the audiological results after re- implantation of Cochlear implants due to device failure. Material and Methods: 55 patients in whom the MED-EL System Combi 40+ has been replaced by the pulsar and Sonata System of MED-EL. In each of these patients the surgery was done and in all cases Full insertion of the electrode was possible. The data analysis comprised evaluation of the free field thresholds and speech understanding result and CAP Tests. Results: The average free field thresholds were 40 dBHL after the re-implantation as same 40 dBHL. The Speech Audiometry Average 70% (Combi40+) and after the re implantation were 68%. None of the patents showed deterioration of the Auditory Performance after re- implantation. Conclusion and Outcome: Re implantation of CI’s is feasible without risk for deterioration of the auditory performance. The Audiological results observed in this Study parallel of the first implant. C007 Binaural results in children with bilateral implantation P. Govaerts, K. Daemers, G. De Ceulaer, K. Schauwers. The Eargroup, Antwerp, Belgium Aim: To asses binaural hearing in children with sequential bilateral implantation. Material and Methods: Seventy children underwent sequential bilateral implantation under the age of 16 years. We obtained audiogram, A§E spectral discrimination, A§E loudness scaling and speech audiometry in all. In 24 children, binaural tests (head shadow, squelsh, localization) could be performed. Results: The audiological benefit will be given. Squelch and localization are analyzed in view of age at implantation and at testing and the interval between the two implantations. Conclusions: The monaural benefit of the second implant is obvious at the level of detection, discrimination and identification and also as relief of head shadow. The binaural benefit is less obvious to demonstrate. At this moment, good binaural benefit is
only seen in children who received the first implant before the age of 2 years and with an interval of less than 2 years between the two implantations. C008 Advanced bionics cochlear implant patients using clearvoice with dynamic FM: System performance and clinical recommendations 2 A. Gault1 , H.E. Mulder ¨ , P. Govaerts3 , G. De Ceulaer, J. Wolfe4 . 1 Advanced Bionics, Niel, Belgium; 2 Phonak Communications, Murten, Switzerland; 3 Eargroup, Deurne, Antwerp, Belgium; 4 Hearts for Hearing, Oklahoma, USA Aim: Dynamic FM improves speech understanding in noise for hearing instrument users. As cochlear implant systems are built differently than hearing instruments, it was investigated whether similar benefits could be found with cochlear implant recipients. Material and Methods: The SII index was measured objectively for verifying the efficiency of Dynamic FM with ClearVoice. An evaluation with patients assessed the performance of Dynamic FM with and without ClearVoice in different noise levels. Results: The objective measurements showed significant enhancement of the effect of Dynamic FM when ClearVoice was enabled. These findings were confirmed by the clinical evaluation outcomes. Conclusions: Dynamic FM should be considered for use with persons with cochlear implants to improve speech recognition in noise. This recognition is improved by 10% when ClearVoice is enabled in very noisy situations (SNR of −10 dB). C009 Matched group comparisons for children using cochlear implants enrolled in auditory/verbal, aural/oral, or bilingual/bicultural early intervention S. Dettman, E. Wall, G. Constantinescu, D. Dornan, R. Dowell, K. Galvin. The University of Melbourne, Australia Aim: Speech perception and receptive vocabulary acquisition were examined in 39 children using CIs in Auditory/Verbal (n = 8 AV), Aural/Oral (n = 23 AO) or Bilingual/Bicultural (n = 8 BB) programs. Material and Methods: All groups were matched for gender, age at hearing-aid, PTA, IQ, and age at CI. Mean age at CI was 1.7 yrs (range 0.8–3.9; SD 0.7), mean test age was 5.4 yrs (range 2.5–10.1; SD 1.7) and mean device experience was 3.7 yrs (range 0.7–7.9; SD 1.8). CNC words, BKB sentences and PPVT were completed. Results: CNC scores of 60, 43 and 24%, and BKB scores of 77, 77 and 56% were obtained by the AV, AO and BB groups respectively. Mean PPVT delay was 13, 19 and 26 months for AV, AO and BB groups respectively. Conclusions: Results support consistent emphasis on oral and aural input to achieve optimum communication outcomes. C010 Construction of a global performance indicator derived from a statistical analysis of outcomes for cochlear implants 1 Th. Van Den Abbeele1 , J. Bestel2 , N. Noel-Petroff ¨ , P.L. Gonzalez3 . 1 Robert Debr´e Hospital, ENT department, Paris, France; 2 Advanced Bionics, Clinical Research department, Rixheim, France; 3 CNAM University, Applied Statistics department, Paris, France
Aim: This retrospective study aims at transforming a performance indicator (APCEI) made up with 5 ordinal criteria (Acceptance, Perception, Comprehension, Expression and intelligibility) into a unique indicator. Material and Methods: We applied an Interactive Clustering Tree on APECI files of 101 children implanted with an Advanced Bionics cochlear implant. Results: The modalities of K are naturally ordered, from subjects with poor performers (K = 1) to star patients (K = 5). The proportion of subjects in each category of K follows the expected tendency over time: the “good” categories are filled with the usage duration,
Contents lists available at ScienceDirect
International Journal of Pediatric Otorhinolaryngology journal homepage: www.elsevier.com/locate/ijporl
C – Outcome measures; Speech perception, production, language and cognition C001 Comparison of hearing tests to speech discrimination tests in prelingually deaf children with cochlear implants Z. Kabatov ´ a, ´ L’. Sˇ imkova, ´ M. Groma, M. Profant. University ORL Dept. Bratislava, Slovakia Aim: Cochlear implantation provides prelingually deaf children with adequate results. There are several factors that may influence outcomes of CI. The goal of this study is to compare hearing to speech understanding in children with CIs. Material and Methods: 80 prelingually deaf children with at least 5 years of CI experience were included in this study. The PTA evaluated hearing in the free field. Speech understanding was measured with open-set speech audiometry and monosyllabic words tests at one, three and five years following implantation. Results: Hearing does not always correlate with speech understanding. Good hearing in the first year after CI at 40 dB and better points towards better results in speech audiometry and monosyllabic tests. Conclusion: There is no exact prediction for hearing and speech discrimination in children with CIs. Early sound stimulation and good hearing in the first year after CI are positive prediction values for good speech discrimination. C002 Postlingual implantees: analysis of poor performers Z. Kabatov ´ a, ´ L’. Sˇ imkova, ´ M. Groma, M. Profant. University ORL Dept, Comenius University Medical School Bratislava, Slovakia Aim: Postlingually deaf patients often achieve excellent results with CIs. Factors that may negatively influence outcomes in this group were analyzed in this study. Material and Methods: 71 postlingually deaf CI patients (15 years or older) with at least 2 years’ experience with their implant were evaluated. They were divided into two groups: good performers (n = 50) and poor performers (n = 21; speech discrimination scores of 80% or less). The following factors were analyzed: etiology, age at the time of implantation and duration of hearing loss/deafness. Results: Three patients are now nonusers. Average age at the time of implantation was 41.1 in group 1 vs. 46.4 in group 2, and the duration of deafness was 3.5 years vs. 13 years respectively. The statistical analysis and a more detailed evaluation will be presented. Conclusion: Duration of deafness seems to be the most important factor influencing performance in postlingually deaf CI candidates. C003 Outcome in a group of children after simultaneous bilateral cochlear implantation within the age of one year A. Giourgas, Th. Lenarz, A. Lesinski-Schiedat. ENT of the Hannover Medical School, Germany Aim: To analyse the outcome of simultaneous bilaterally implanted children within the age of one year. Material and Methods: A group of 19 simultaneous bilaterally implanted children with a mean age at implantation of 0.97 years 0165-5876/$ – see front matter © 2011 Elsevier Ireland Ltd. All rights reserved.
was tested on listening skills and speech production. Test battery included the understanding of poly- and monosyllabic words (open and closed set), the repetition of sentences (in quiet and in noise), and an evaluation of the children’s active vocabulary. Results were compared to 3 other groups of children, implanted either simultaneously or sequentially up to an age of 4 years at the initial implantation. Results: The group simultaneous bilaterally implanted children before the age of one year show the best performance overall. Advantages seem to emerge when it comes to the lexical development and the comprehension of speech under noisy conditions. Conclusions: Congenitally deaf children should receive an early simultaneous bilateral implantation whenever feasible. C004 Fricative spectra in normal and hearing impaired children with cochlear implant B. Coimbra1 , L.M.T. Jesus2,3 , P. Sa´ Couto4 . 1 Direcc˜ ¸ ao Regional da Educac˜ ¸ ao do Norte, Minist´erio da Educac˜ ¸ ao, Portugal; 2 Escola Superior de Sa´ ude da Universidade de Aveiro (ESSUA), Universidade de Aveiro, Aveiro, Portugal; 3 Instituto de Engenharia Electr´ onica e Telem´ atica de Aveiro (IEETA), Universidade de Aveiro, Aveiro, Portugal; 4 Center of Research and Development in Mathematics and Applications (CIDMA), Departamento de Matem´ atica, Universidade de Aveiro, Portugal Aim: Speech production in 25 dissyllabic words was analysed. Parameters previously developed as a potential tool for the classification of fricatives produced in natural speech were used to compare speech production mechanisms in four deaf children with cochlear implant and four normal listeners (age and gender matched). Material and Methods: Acoustic and EGG signals were recorded simultaneously for the fricatives /f, s, S, v, z, Z/. The fricative spectral slope was investigated by fitting the spectra with two linear regression lines. Results: Spectral slope parameters behaved similarly for both groups regarding changes in place and sibilance. However, voicing predictions (unvoiced fricatives possess a more intense sound source and therefore have higher spectral slope values) were only present in normal hearing children. Conclusions: Results showed the individual capabilities of deaf children with cochlear implant to correctly produce place and sibilance, and deviant (regarding voicing mechanisms) voiced fricative production. C005 Short sequential bilateral cochlear implantation in children 2 F. Bergeron1 , R. Bussieres ` , L. Duchesne3 , C. Losier2 , G. Tremblay3 . 1 Universit´e Laval, Canada; 2 Centre Hospitalier Universitaire de Qu´ebec, Canada; 3 Institut de r´eadaptation en d´eficience physique de Qu´ebec, Quebec City, Canada
Aim: This project proposes to bring additional evidence on the impact of bilateral implantation in children from an enlarged
34
Abstracts, ESPCI 2011 / International Journal of Pediatric Otorhinolaryngology 75 (2011) 33–57
perspective including medical, perceptual and communicative issues. Material and Methods: Twenty children aged 7 to 35 months received sequential cochlear implants within a 12 months maximal delay. Auditory benefits, speech, language and communication were assessed with IT-MAIS, MAIS, Little Ears, EARS, lateralisation test, MUSS, RDLS, MCDI and/or VABS. Testing was realized at 0 and 3 months (first implant), and at 6, 12 and 24 months (second implant). Results: At 6 months, no medical or vestibular complications were recorded. While objective assessments do not show clear advantages of bilateral implantation, tests based on parents’ report show significant benefits for speech recognition in quiet and in noise, and for localization of sound sources. Conclusions: Short term follow-up does not appear sufficient to confirm the perceptual and communicative benefits reported by parents. C006 Audiological evaluation of patients after re- implantation of MED-EL system cochlear implant H. Emamdjomeh1 , S. Hassanzadeh2 , A. Daneshi3 , M. Farhadi4 , Sh. Mohammadi5 . 1 Audiologist of Otolaryngology,ENT Research Center of Tehran University of Medical Sciences, Iran; 2 Speech therapist of Otolaryngology,ENT Research Center of Tehran University of Medical Sciences, Iran; 3 Professor of Otolaryngology,Department of Otolaringology & Research Center of Tehran University of Medical Sciences, Iran; 4 Professor of Otolaryngology,ENT Research Center of Tehran University of Medical Sciences, Iran; 5 Associate Professor of Otolaryngology,ENT Research Center of Tehran University of Medical Sciences, Iran Aim: This Study was undertaken to evaluate the audiological results after re- implantation of Cochlear implants due to device failure. Material and Methods: 55 patients in whom the MED-EL System Combi 40+ has been replaced by the pulsar and Sonata System of MED-EL. In each of these patients the surgery was done and in all cases Full insertion of the electrode was possible. The data analysis comprised evaluation of the free field thresholds and speech understanding result and CAP Tests. Results: The average free field thresholds were 40 dBHL after the re-implantation as same 40 dBHL. The Speech Audiometry Average 70% (Combi40+) and after the re implantation were 68%. None of the patents showed deterioration of the Auditory Performance after re- implantation. Conclusion and Outcome: Re implantation of CI’s is feasible without risk for deterioration of the auditory performance. The Audiological results observed in this Study parallel of the first implant. C007 Binaural results in children with bilateral implantation P. Govaerts, K. Daemers, G. De Ceulaer, K. Schauwers. The Eargroup, Antwerp, Belgium Aim: To asses binaural hearing in children with sequential bilateral implantation. Material and Methods: Seventy children underwent sequential bilateral implantation under the age of 16 years. We obtained audiogram, A§E spectral discrimination, A§E loudness scaling and speech audiometry in all. In 24 children, binaural tests (head shadow, squelsh, localization) could be performed. Results: The audiological benefit will be given. Squelch and localization are analyzed in view of age at implantation and at testing and the interval between the two implantations. Conclusions: The monaural benefit of the second implant is obvious at the level of detection, discrimination and identification and also as relief of head shadow. The binaural benefit is less obvious to demonstrate. At this moment, good binaural benefit is
only seen in children who received the first implant before the age of 2 years and with an interval of less than 2 years between the two implantations. C008 Advanced bionics cochlear implant patients using clearvoice with dynamic FM: System performance and clinical recommendations 2 A. Gault1 , H.E. Mulder ¨ , P. Govaerts3 , G. De Ceulaer, J. Wolfe4 . 1 Advanced Bionics, Niel, Belgium; 2 Phonak Communications, Murten, Switzerland; 3 Eargroup, Deurne, Antwerp, Belgium; 4 Hearts for Hearing, Oklahoma, USA Aim: Dynamic FM improves speech understanding in noise for hearing instrument users. As cochlear implant systems are built differently than hearing instruments, it was investigated whether similar benefits could be found with cochlear implant recipients. Material and Methods: The SII index was measured objectively for verifying the efficiency of Dynamic FM with ClearVoice. An evaluation with patients assessed the performance of Dynamic FM with and without ClearVoice in different noise levels. Results: The objective measurements showed significant enhancement of the effect of Dynamic FM when ClearVoice was enabled. These findings were confirmed by the clinical evaluation outcomes. Conclusions: Dynamic FM should be considered for use with persons with cochlear implants to improve speech recognition in noise. This recognition is improved by 10% when ClearVoice is enabled in very noisy situations (SNR of −10 dB). C009 Matched group comparisons for children using cochlear implants enrolled in auditory/verbal, aural/oral, or bilingual/bicultural early intervention S. Dettman, E. Wall, G. Constantinescu, D. Dornan, R. Dowell, K. Galvin. The University of Melbourne, Australia Aim: Speech perception and receptive vocabulary acquisition were examined in 39 children using CIs in Auditory/Verbal (n = 8 AV), Aural/Oral (n = 23 AO) or Bilingual/Bicultural (n = 8 BB) programs. Material and Methods: All groups were matched for gender, age at hearing-aid, PTA, IQ, and age at CI. Mean age at CI was 1.7 yrs (range 0.8–3.9; SD 0.7), mean test age was 5.4 yrs (range 2.5–10.1; SD 1.7) and mean device experience was 3.7 yrs (range 0.7–7.9; SD 1.8). CNC words, BKB sentences and PPVT were completed. Results: CNC scores of 60, 43 and 24%, and BKB scores of 77, 77 and 56% were obtained by the AV, AO and BB groups respectively. Mean PPVT delay was 13, 19 and 26 months for AV, AO and BB groups respectively. Conclusions: Results support consistent emphasis on oral and aural input to achieve optimum communication outcomes. C010 Construction of a global performance indicator derived from a statistical analysis of outcomes for cochlear implants 1 Th. Van Den Abbeele1 , J. Bestel2 , N. Noel-Petroff ¨ , P.L. Gonzalez3 . 1 Robert Debr´e Hospital, ENT department, Paris, France; 2 Advanced Bionics, Clinical Research department, Rixheim, France; 3 CNAM University, Applied Statistics department, Paris, France
Aim: This retrospective study aims at transforming a performance indicator (APCEI) made up with 5 ordinal criteria (Acceptance, Perception, Comprehension, Expression and intelligibility) into a unique indicator. Material and Methods: We applied an Interactive Clustering Tree on APECI files of 101 children implanted with an Advanced Bionics cochlear implant. Results: The modalities of K are naturally ordered, from subjects with poor performers (K = 1) to star patients (K = 5). The proportion of subjects in each category of K follows the expected tendency over time: the “good” categories are filled with the usage duration,