Phonological Awareness and Working Memory in Mandarin-Speaking Preschool-Aged Children With Cochlear Implants.

PURPOSE: Cochlear implants (CIs) provide significant benefits for profoundly deaf children in their language and cognitive development. However, it remains unclear whether Mandarin-speaking young children with early implantation can develop age-equivalent phonological awareness (PA) skill and working memory (WM) capacity as their normal hearing (NH) peers. The aim of this study was to investigate PA and WM in preschool-aged children with or without hearing loss and to examine the relationship between the two basic skills. METHOD: The data were collected from 16 Mandarin-speaking preschoolers with CIs and 16 age-matched children with NH. All preschool participants were instructed to complete four phonological detection tasks and four digit span tasks. Linear mixed-effects modeling was performed to evaluate PA and WM performances between two groups across different tasks. RESULTS: CI preschoolers showed comparable performances on par with NH controls in phonological detections and visual digit spans. In addition, Pearson correlation analysis revealed a positive relationship between phonological detections and auditory digit spans in preschool-aged children with CIs. CONCLUSION: With early implantation, the congenitally deaf children were capable of developing age-appropriate PA skill and WM capacity, which have practical implications for aural rehabilitation in this special pediatric population.

Parents' Perspectives on Cochlear Implantation Results for Deaf Children or Children With Hearing Loss in Saudi Arabia.

The purpose of the research was to understand the quality of life of children from Saudi Arabia with cochlear implants (CIs) from the parental perspective in terms of communication abilities, social skills, academic achievement, being well adapted for future life, rehabilitation knowledge, and stress due to hearing loss. A quantitative approach was used, in which a questionnaire was administered to 103 children with CIs. The results showed high levels of expectations with respect to communication abilities, social skills, academic achievement, being well adapted for future life, and rehabilitation knowledge. The parents were observed to be highly stressed by their children's disability. Pearson's correlation and linear regression analysis were used to test the association of the characteristics of the implanted children on factors of quality of life.

A Novel Bone Conduction Hearing System May Improve Memory Function in Children with Single Side Hearing loss: A Case-Control Study.

OBJECTIVES: To evaluate the effects of an adhesive adapter prosthesis (AAP) on memory function in pediatric subjects with single side hearing loss (SSHL). MATERIALS AND METHODS: Case-control study. 19 pediatric subjects with mild to moderate SSHL treated with AAP and 15 subjects with normal hearing (control group) were included in this study. Working and short-term memory functions were tested in all subjects, in silence and noise conditions. In SSHL subjects, tests were performed before the AAP was applied (T0) and at 1-month (T1) follow-up. The control group was tested once. RESULTS: AAP significantly improved working memory function in noise as measured at T1 (p<0.01) compared with T0, but T1 scores in children with SSHL remained significantly different from the ones of the control group (p<0.01). AAP also significantly improved short- term memory function test scores at T1 compared with T0 (p<0.01), but despite being in the normal range for the subjects' age, the scores remained significantly different from those of the control group (p<0.01). CONCLUSION: In pediatric subjects with mild, moderate, and moderate-severe SSHL, restoration of bilateral hearing through AAP improved short-term memory function and working memory function in noise, as measured at 1 month follow-up; however, AAP did not seem to lead to a full restoration of such functions as measured by a comparison with healthy controls. Further studies with longer follow-ups might help elucidate whether AAP can elicit further improvements in memory functions.

Translation and validation of parental perspective questionnaire for children with cochlear implant in persian language.

Objective: Parental views about the outcomes of implantation on the child's quality of life are valuable sources of information for implantation specialists. The aim at this study was to validate the "Parental Perspectives" questionnaire in Persian language.Design: The original questionnaire was translated from English to Persian language; the final Persian version of questionnaire was prepared and evaluated for validity and reliability. The internal consistency of the questionnaire and test-retest reliability were respectively evaluated by Cronbach's alpha and ICC index. Factor analysis was used to determine the construct validity.Study Sample: The participants of this study were 370 parents of CI children.Results: Sampling adequacy for executing of factor analysis was confirmed by the results of Kaiser-Meyer-Olkin (=0.84) and Bartlett test (p < .05). Three factors were extracted from exploratory factor analysis. Confirmatory factor analysis confirmed the accuracy of the three-dimensional structures. Principal component analysis revealed the structural validity of three factors. Correlation between questionnaire items was good (r = 0.76). Reliability coefficient was calculated as 0.93.Conclusions: The Persian version of the questionnaire has good validity and reliability and can be used to examine the perspectives of the parents about CI.

Effects of nonlinear frequency compression on Mandarin speech and sound-quality perception in hearing-aid users.

Objective: The purpose of the present study was to examine the effects of NLFC fitting in hearing aids and auditory acclimatisation on speech perception and sound-quality rating in hearing-impaired, native Mandarin-speaking adult listeners.Design: Mandarin consonant, vowel and tone recognition were tested in quiet and sentence recognition in noise (speech-shaped noise at a +5 dB signal-to-noise ratio) with NLFC-on and NLFC-off. Sound-quality ratings were collected on a 0-10 scale at each test session. A generalised linear model and correlational analyses were performed.Study sample: Thirty native Mandarin-speaking adults with moderate-to-severe sensorineural hearing loss were recruited.Results: The hearing-impaired listeners showed significantly higher accuracy with NLFC-on than with NLFC-off for consonant and sentence recognition and the recognition performance improved with both NLFC-on and off as a function of increased length of use. The satisfaction score of sound-quality ratings for different types of sounds significantly increased with NLFC-on than with NLFC-off. The speech recognition results showed moderate to strong correlation with the unaided hearing thresholds.Conclusion: For native Mandarin-speaking listeners with hearing loss, the NLFC technology provided modest but significant improvement in Mandarin fricative and sentence recognition. Subjectively, the naturalness and overall preference of sound-quality satisfaction judgement also improved with NLFC.

Validation of the Manchester spoken language development scale (MSLDS).

Introduction: Standardized outcome measures are importantfor accurately monitoring the language development of pre-lingually deaf children receiving auditory implants. Current commonly used outcome measures are time-consuming,limiting the practicality of regular testing. To address these limitations, the Manchester Spoken Language Development Scale (MSLDS) was developed as a quick and easily applicable interim measurement. This is an 11-point scale designed to provide a streamlined overview of a child's expressive language development. This study describes the MSLDS, evaluates its ease of use and inter-rater reliability, and outlines its application in the paediatric auditory implant population. Methods: Sixteen speech therapists and teachers for the deaf reviewed videos of paediatric cochlear implant assessmentsand rehabilitation sessions at a UK auditory implant centre. Twenty-five videos from fourteen children were used in this validation study. Reviewers were asked to evaluate a child's language development using the MSLDS by assigning a score for each video and to evaluate the ease of use of the scale. Each video wasrated by three different reviewers. Results: MSLDS scores showed a high degree of consistency between raters for each child. 8/25 (32%) videos demonstrated perfect agreement on the MSLDS. In 15/25 (60%) videos, there was a one-point difference between MSLDS scores. The remaining 2/25 (8%) videos varied by 2 points. Statistical analysis demonstrated an intra-class correlation coefficient (ICC) of 0.987, indicating a high level of agreement between users of the scale. Qualitative feedback from the raters suggested further modifications which have been incorporated into the scale. Conclusion: The high inter-rater agreement reflects the potential for the MSLDS to be a reliable tool for monitoring language development in the paediatric auditory implant population.

Identifying clients' readiness for hearing rehabilitation within initial audiology appointments: a pilot intervention study.

Objective: The current study sought to explore audiologists' use of the Ida Institute Motivation Tools to help them identify clients' readiness for change within initial assessment appointments.Design: The study involved a mixed methods intervention design. Data were collected pre- and post-training audiologists to use the Ida Motivation tools in their appointments. Appointments were video-recorded and analysed using conversation analysis. Clients and audiologists also completed questionnaires within each appointment to measure clients' readiness-for-change.Study sample: Participants included 5 audiologists and 22 adult clients from two Audiology clinics.Results: Audiologists incorporated the Ida Motivation tools into the post-training appointments without a significant increase in appointment time. The Ida tools solicited responses from clients that displayed their ambivalence regarding hearing rehabilitation/aids within their talk. Post-training, audiologists' perceptions of clients' stage of readiness were not significantly more likely to match clients' self-reported stage on the URICA.Conclusions: The Ida Motivation tools may be useful to solicit clients' ambivalent feelings towards hearing rehabilitation/aids, however, it is important for audiologists to actively listen for ambivalence within clients' interactional responses to the tools in order judge clients' readiness.

What can we learn from adult cochlear implant recipients with single-sided deafness who became elective non-users?

Objective: This retrospective study investigates the incidence of elective cochlear implant (CI) non-use amongst a cohort of adult CI recipients with single-sided deafness (SSD), identifies the causes that led to non-use, and assesses how non-use could be prevented. Methods: All adults with SSD who received a CI between 2008 and 2018 and who became elective CI non-users were included. Elective non-users were defined as CI recipients who decided to stop using their CI or, if explantation was necessary, refused reimplantation. Results: 5/114 (4.4%) adults with SSD who received a CI became elective non-users. The 5 non-users were a mean 44.2 years old (range 33-70 years) at implantation, had a mean duration of deafness of 7.1 years (range 0.5-20 years) at implantation, and used their CI for a mean 11.5 months (range 1.5-60 months) before (fully) discontinuing use. The primary cause of elective non-use was postoperative discouragement due to unrealistic expectations (4 participants) regarding sound perception with the CI or about the greater than expected level of commitment necessary for rehabilitation. Conclusions: Elective non-use among adult CI recipients with single-sided deafness was very rare and could be further prevented by comprehensive counselling to ensure that candidates have realistic expectations about the rehabilitation requirements and the outcomes with the CI.

Adaptation and validation of the Spanish version of the Parents' Evaluation of Aural/Oral Performance of Children (PEACH) rating scale.

Objetive: To linguistically adapt and validate the Spanish version of the PEACH rating scale and identify the variables associated.Design: A transversal study of parents/guardians of infants and children with either normal hearing or hearing impairment.Study sample: The protocol included translation into Spanish and adapted linguistically. Regression models were constructed using logistic regression, obtaining the respective areas under the ROC curve. Validity was studied through an exploratory factor analyses and reliability analysis was carried out using Cronbach's Alpha.Results: The PEACH rating scale was carried out on 297 parents. There was a high degree of reliability for both children with hearing impairment (Cronbach's Alpha: 0.93) and for those with normal hearing (Cronbach's Alpha: 0.82). The exploratory factor analysis showed the existence of one factor (unidimensional). In relation to the variables associated with the global scores of the scale, the type of hearing loss and laterality impact on the score. The area under the ROC curve was 0.89, showing elevated sensitivity and specificity.Conclusions: The adapted version can be used to evaluate the effectiveness of amplification for infants and children with hearing impairment in Spanish-speaking children. The PEACH rating scale to Spanish has validity indicators similar to the original.

Development and validation of the audio processor satisfaction questionnaire (APSQ) for hearing implant users.

Objective: The satisfaction experienced with using an audio processor is very important to hearing implant system users. Currently there are no measures that can be used to assess user satisfaction with an audio processor. This study aims to develop and validate a specific and standardised questionnaire that focuses on user satisfaction with their audio processor.Design: A preliminary version of the questionnaire was initially developed by experts in the field. Following validation of these results, the final version of the Audio Processor Satisfaction Questionnaire (APSQ) was developed consisting of 15 items. Item analyses and questionnaire validation measurements were assessed.Study sample: Sixty-nine subjects were recruited and asked to complete the APSQ twice within 2-4 weeks.Results: Subjects reported a high user satisfaction with the questionnaire and with their audio processor. The questionnaire had good reliability and results for test-retest reliability were high and significant across all items and across subscale analyses.Conclusion: Item analyses and reliability analyses show that the questionnaire is a valid and reliable tool to assess user satisfaction across different audio processors and hearing implant systems. The APSQ is a quick and easy tool to measure user satisfaction with their audio processor.

Hearing aid review appointment: clients' reasons for attendance and non-attendance.

Objective: To investigate hearing aid owners' decisions to attend or not to attend an annual hearing aid review (HAR) appointment. To investigate the possible factors associated with appointment attendance, including age, gender, transportation, travel time, and hearing aid outcomes.Design: A prospective cohort study. Potential participants were notified of their annual HAR appointment in the usual process employed by their clinic. Two months later, potential participants were identified as those who had attended and those who had not attended an appointment.Study sample: One hundred and twenty adult hearing aid users ranging in age from 26 to 100 (M = 74, SD = 11) years recruited from a single hearing clinic in Perth, Western Australia.Results: Factors found to be significantly associated with attendance at an annual HAR appointment included hearing aid funding source (government subsidised), participants valuing the importance and benefit of the appointment, and superior hearing aid outcomes.Conclusions: Within a controlled practice setting, appointment attendance is influenced by some factors modifiable by the clinician, including providing better education about the process and purpose of the HAR appointment. The value of the HAR appointment was emphasised by the positive association between better hearing aid outcomes HAR appointment attendance.

Clinicians' views of using cortical auditory evoked potentials (CAEP) in the permanent childhood hearing impairment patient pathway.

Objective: To obtain clinicians' views on the use of cortical auditory evoked potentials (CAEP) in the clinical pathway.Design: A questionnaire aimed at clinicians who use the HEARLab system with the Aided Cortical Assessment (ACA) Module. Results compared for Australians (where HEARLab produced) to other countries.Sample: The questionnaire was completed by 49 clinicians; 33 from Australia and 13 clinicians outside of Australia and 3 clinicians, destination unknown.Results: The findings of this research demonstrated that clinicians using CAEPs found them valuable for clinical practice. CAEPs were used to verify or modify hearing aid fittings and were used for counselling parents to reinforce the need for hearing aids. With the use of speech token as the stimulus clinicians had more relevant information to increase confidence in decision-making on paediatric hearing management.Conclusions: The main benefit from the use of CAEPs (using speech token stimuli) was for infant hearing aid fitting programmes, to facilitate earlier decisions relating to hearing aid fitting, for fine-tuning the aids and as an additional measure for cochlear implant referrals.

Hearing Aid Problems in Elderly Populations.

The use of hearing aid (HA) may improve the hearing performance and ease the perceived negative consequences of hearing difficulties in elderly individuals. The aim of this study was to determine the problems experienced by elderly individuals with HA and to investigate the factors that could increase the use of HA. A total of 122 female and 127 male patients with a mean age of 76.79 ± 6.91 years who were recommended HA were evaluated. The following details were taken from the patients: age, gender, duration of hearing complaint, whether or not they received HA, number of family members, number of hours they used HA in a day, type of device, number of ears with HA, educational status, whether they continued to work, whether they were tested before taking the device, the reasons for not taking HA, and the reasons that reduce their use of HA. A total of 18 patients did not receive HA for the following reasons: 9 considered HA too expensive, 8 thought it would be difficult to use HA, and 1 did not like it because of its appearance. No significant difference was found in the patients' daily HA use duration, age, sex, number of immediate family members, education level, type of device, test before taking the device, and use of HA in single ear or bilateral ears. There was a significant difference in the daily HA use duration and whether the patients continued to work. We need to help reduce the problems associated with the use of HA to help older individuals have a more active role in society and help them in their health problems.

Auditory brainstem implantation (ABI) in children without neurofibromatosis type II (NF2): communication performance and safety after 24 months of use.

Objectives: To assess the safety and communication performance of auditory brainstem implant (ABI) provision in children who were contraindicated for cochlear implantation and do not have neurofibromatosis type II (NF2).Methods: Communication performance was assessed via a battery of tests up to 24 months after first fitting. Safety was assessed intra-operatively and via post-operative adverse event reports.Results: Ten children participated in the study. The mean communication skills on all 8 tests for which inferential statistics were possible increased significantly from pre-operatively to 12 months and either again increased significantly or remained stable from 12 to 24 months. Communication development was variable: some children achieved high scores while others did not. Two serious adverse events that were device or procedure-related were reported and successfully resolved.Discussion: ABI provision in this population group was safe. Participants' auditory abilities were significantly better after 24 months of ABI use than at pre-implantation. Development was slower than that of children with a cochlear implant but may continue progressing after 24 months of use.Conclusion: ABI provision and use is safe and allows significant auditory development in children without NF2 who are contradicted for cochlear implantation.

Pediatric cochlear implant wear time and early language development.

Objectives: The purpose of this study is to analyze spoken language development in the first year of cochlear implant device use for pediatric recipients under five, and to determine the impact of device wear time on receptive and expressive spoken language outcomes using objective datalogging measures.Methods: Retrospective review of 37 children utilizing Cochlear™ processors capable of datalogging, who had completed speech and language testing before implantation and one year post. Hearing Hour Percentage (HHP) was created from datalogging results and two multiple regression analysis were performed including HHP and standard language scores.Results: HHP was found to be a predictor for receptive language outcomes one year after cochlear implant use. HHP was not found to be predictive of expressive language outcomes one year after cochlear implant use.Discussion: Datalogging is a vital objective measure that yields powerful data regarding a child's device use and early receptive spoken language development.Conclusion: In the first year of cochlear implant use, datalogging using the HHP significantly predicted receptive language scores. Increased HHP yielded higher receptive language standard scores. Continued research is needed to see if HHP is predictive of expressive language outcomes after a longer period of cochlear implant use.

Self-reported hearing quality of life measures in pediatric cochlear implant recipients with bilateral input.

Objective: Self-reported hearing quality of life (QoL) for pediatric cochlear implant (CI) recipients was examined, asking whether 1) children with CIs have similar QoL as those with less severe hearing loss (HL); 2) children with different bilateral CI (BCI) device configurations report different QoL; and 3) do audiological, demographic and spoken language factors affect hearing QoL?Design: One hundred four children (ages 7-11 years) using bimodal devices or BCIs participated. The Hearing Environments and Reflection of Quality of Life (HEAR-QL) questionnaire, receptive language and speech perception tests were administered. HEAR-QL scores of CI recipients were compared to scores of age-mates with normal hearing and mild to profound HL.Results: HEAR-QL scores for CI participants were similar to those of children with less severe HL and did not differ with device configuration. Emotion identification and word recognition in noise correlated significantly with HEAR-QL scores.Discussion: CI recipients reported that HL hinders social participation. Better understanding of speech in noise and emotional content was associated with fewer hearing-related difficulties on the HEAR-QL.Conclusions: Noisy situations encountered in educational settings should be addressed for children with HL. The link between perception of emotion and hearing-related QoL for CI recipients should be further examined.

Preferences for digital noise reduction and microphone mode settings in hearing-impaired listeners with low and high tolerances for background noise.

Objective: To examine whether people with low and high acceptable noise levels (ANLs) have different preferences for aggressiveness of noise reduction (NR) and microphone mode, and whether they get different noise tolerance benefit with these two features.Design: Participants completed laboratory tests of unaided ANL and aided modified ANLs (with speech fixed at two levels) and preferences (at two SNRs) while listening to four levels of NR, three microphone modes and four combinations of NR/directionality.Study sample: Twenty adults with hearing loss; 10 with low ANLs and 10 with high ANLs.Results: Seven individuals with low ANLs and 10 individuals with high ANLs preferred the maximum NR setting; the remaining three individuals with low ANLs had inconsistent preference for NR. Eight people in each ANL group preferred the maximum directional setting (broadband (BB) directionality), the remaining two people in each group had inconsistent preferences for microphone mode.Conclusions: Because most participants preferred the maximum NR and directionality settings, ANLs could not be used to differentially prescribe these hearing aid settings.

Cognitive function and quality of life in older adult patients with cochlear implants.

Objective: This study aimed to evaluate the benefits of cochlear implant (CI) on speech perception, quality of life (QoL), and cognitive function in profoundly deafened older adults.Design: Longitudinal and cross-sectional cohort study.Study sample: Participants in this study were CI recipients aged 65 years or older (experimental group), CI recipients aged 50 years or younger (control group 1), and normal-hearing participants aged 65 years or older (control group 2).Results: Speech perception significantly improved in both groups of implanted patients (preoperative vs. 1-year median [IQR] sentence recognition: older patients, 0 (0-20) vs. 90 (70-95), p = 0.001; younger patients, 35 (0-50) vs. 90 (80-100), p = 0.001). There were no significant differences in QoL (Glasgow Benefit Inventory) between younger and older patients (median [IQR] overall benefit score, 42 (31-64) vs. 53 (39-69), p = 0.2). Mini-Mental State Examination scores showed no significant differences between elderly CI recipients and normal-hearing participants (median [IQR], 28 (26-28) vs. 28 (27-29), p = 0.5).Conclusions: Cochlear implantation rehabilitation allows the profoundly deafened older adult to lead a QoL comparable to that of a younger patient. The correlation between hearing restoration and cognitive function preservation in older adults suggest a possible role for CI as a useful resource in limiting age-related cognitive decline.

Short and long term preservation of hearing thresholds corrected for natural hearing loss in cochlear implant recipients using a straight electrode.

Objectives: The aim of this study is to investigate short and long term residual hearing preservation (HP), corrected for the natural progress of hearing loss, in cochlear implant (CI) patients receiving a straight electrode array using a round window (RW) approach.Methods: A retrospective and cross-sectional analysis on patients who received a CI with a straight electrode using a RW approach (n = 60) was performed. Audiometric data were obtained at three time points, preoperatively, at first fitting, and one year or more postoperatively. The HP outcome was calculated according to the HP definition as reported by Skarzynski with a PTA of 250, 500, and 1000 Hz (PTA3) and a PTA of 250, 500, 1000, and 2000 Hz (PTA4).Results: The HP outcome at first fitting and at long term follow up fell into the partial HP category, 63.5% (PTA3) and 40.5% (PTA4), respectively according to the Skarzynski definition. A decline in pure-tone average (PTA) was found in the CI ear and in the contralateral ear over time (p < 0.05). Interaural differences remained relatively stable at all frequencies on the long term, except for the frequency 250 Hz (p < 0.05).Discussion: After the initial loss of residual hearing, the hearing thresholds of the CI ear remain relatively stable at long term follow up when corrected for the natural course of hearing loss, except at 250 Hz.Conclusion: CI candidates should be counseled on the risk of long term deterioration of the residual hearing in both the CI ear and the contralateral ear.

Improving self-efficacy for hearing aid self-management: the early delivery of a multimedia-based education programme in first-time hearing aid users.

Objectives: This study examined the effect of a multimedia educational programme for first-time hearing aid users (C2Hear reusable learning objects, RLOs), delivered at the hearing assessment on (1) self-efficacy for hearing aids (primary outcome), and (2) readiness for hearing rehabilitation and hearing aid knowledge (secondary outcomes).Design: A single-centre, prospective, pre-post, randomised controlled trial with two arms. The intervention group (n = 24) received RLOs, and the waitlist control group (n = 23) received a printed booklet on hearing aids. Outcomes were measured at the hearing assessment and hearing aid fitting appointments.Study sample: Fifty-six adult first-time hearing aid users attending a publicly funded audiology service.Results: The RLO group showed significantly greater improvement in self-efficacy and knowledge of hearing aids than the control group. A borderline effect of readiness for hearing rehabilitation was also found. Potential links between hearing aid self-efficacy and knowledge were identified.Conclusions: Early delivery of the RLOs results in greater hearing aid self-efficacy and knowledge at the hearing aid fitting appointment, with indications that RLOs increase readiness for hearing rehabilitation. As knowledge, self-efficacy and readiness are cornerstones of self-management, the C2Hear RLOs can prime first-time hearing aid users to better self-manage their hearing aids before they receive them.