Guidelines of the French Society of Otorhinolaryngology-Head and Neck Surgery (SFORL) and the French Society of Audiology (SFA) for Speech-in-Noise Testing in Adults.

OBJECTIVES: This document presents the fundamentals of speech audiometry in noise, general requirements for implementation and criteria for choice among the tests available in French according to the health-professional's needs. MATERIAL AND METHODS: The recommendations are based on a systematic analysis of the literature carried out by a multidisciplinary group of doctors, audiologists and audioprosthetists from all over France. They are graded A, B, C or expert opinion according to decreasing level of scientific evidence. RESULTS: Eight tests of speech audiometry in noise can be used in France. CONCLUSION: To be complete, evaluation of hearing status requires testing understanding of speech in noise. The examination must begin with a minimum of two measurements familiarizing the subject with the test procedure. For initial diagnosis, adaptive procedures establishing the 50% speech reception threshold (SRT50) in noise are to be preferred in order to obtain a rapid and standardized measurement of perception of speech in noise. When the aim is to measure real-life speech comprehension, tests based on sentences, cocktail-party noise and free-field stimulation are to be preferred. Prosthetic gain is evaluated exclusively in free field. This is the only way to evaluate the contribution of binaurality and to measure perception in noise in an environment as close as possible to real life. In order to avoid acoustic interference in free field, at least five loudspeakers should be used, in particular for evaluating the effectiveness of directional microphones, CROS devices enabling sounds picked up in the damaged ear to be rerouted to the functional ear, or bimodal fitting (i.e., when hearing is enabled by two modalities: for example, hearing aid for one ear, cochlear implant for the other).

French Society of ENT (SFORL) guidelines (short version): Audiometry in adults and children.

INTRODUCTION: French Society of ENT (SFORL) good practice guidelines for audiometric examination in adults and children. METHODS: A multidisciplinary working group performed a review of the scientific literature. Guidelines were drawn up, reviewed by an independent reading group, and finalized in a consensus meeting. RESULTS: Audiometry should be performed in an acoustically controlled environment (<30dBA); audiometer calibration should be regularly checked; and patient-specific masking rules should be systematically applied. It should be ensured that masking is not overmasking. Adult pure-tone audiometry data should be interpreted taking account of clinical data, speech audiometry and impedancemetry. In case of discrepancies between clinical and pure-tone and speech audiometry data, objective auditory tests should be perform. In children aged 2 years or younger, subjective audiometry should be associated to behavioral audiometry adapted to the child's age. In suspected hearing impairment, behavioral audiometry should be systematically supplemented by objective hearing tests to determine and confirm the level and type of hearing impairment.

[Usher type I syndrome in children: genotype/phenotype correlation and cochlear implant benefits]. / Syndrome de Usher de type I chez l'enfant: corrlation génotype/phénotype et bénéfice de l'implant cochléaire.

OBJECTIVE: To assess the benefit of cochlear implant in children presenting an Usher type 1 syndrome (speech understanding, speech production intelligibility, academic performance) and to search any correlation between the phenotype and the genotype in this population. MATERIALS AND METHODS: Retrospective case series analysis about 13 implanted Usher type I children. Cochlear implantation was performed from 1995 to 2005. Our population was divided in three groups: group 1 (implantation between 1 and 3 years of age); group 2 (implantation between 4 and 7 years of age) and group 3 (implantation between 14 and 17 years of age). Postoperative speech perception, speech production intelligibility and education settings were evaluated. RESULTS: Molecular genetic analysis was performed in 11 patients and pathogenic mutations were identified in all cases: (mutation in myosin 7A gene in 5 cases; mutation in cadherin 23 gene in 6 cases). Four new mutations 2 in the MYO7A gene and 2 in the CDH23 gene never reported before were found. Walking delay and hearing level were not statistically correlated with the genotype abnormalities found. The speech discrimination skills, the speech production intelligibility and the academic performance were better in the group 1 children than the group 2 children after cochlear implantation. All the children of group 1 but one were in mainstreaming education. Specific language impairment was identified in two children of group 1. The group 3 children could not achieve open-set perceptive tasks after implantation--only closed-set word test can be done and their speech production remained unintelligible after cochlear implantation. CONCLUSION: Molecular analysis of Usher type I syndrome can ascertain the diagnosis in spite of the genetic heterogeneity. In this study, clinical symptoms weren't correlated with genotypic mutations. Speech discrimination skills, speech production quality, and academic performance were correlated with the age at implant.

Influence of communication mode on speech intelligibility and syntactic structure of sentences in profoundly hearing impaired French children implanted between 5 and 9 years of age.

OBJECTIVE: The purpose of this study was to examine the speech production in French profoundly hearing impaired children, focusing on word intelligibility, sentences syntax, and sentence pattern stages, by incorporating direct comparisons between speech production skills and communication modes in the same children. DESIGN: The design of the study incorporated a within-subject, repeated measures design for assessing speech production intelligibility and syntax. SETTING: Montpellier Pediatric Cochlear Implant Center. SUBJECTS: Twelve prelingually deafened French children who received a Nucleus multichannel cochlear implant (mean age at the time of implantation was 7 years 2 months) served as subjects for the speech production assessment. MAIN OUTCOME MEASURES: Speech production intelligibility, syntax, and sentence pattern stages were assessed at 1, 2 and 3 years postimplant. Speech production skills were related to the communication mode of the children (auditory-oral, four children; cued-speech, four children; sign-language, four children). RESULTS: Scores on word intelligibility steadily improved with increased experience with the implant, ranging from 18% before implantation to 54.5% at 36 months postimplantation in the overall population. The highest scores were found in the cued-speech group with an averaged score of 66.8% at 36 months postimplant. The number of syntactic elements increased over time with implant experience. Children receiving cued-speech education had higher scores by 3 years postimplantation than children receiving either auditory-oral or sign-language modes of communication. Language level (sentence pattern stages) also improved with increased experience with the device. By 3 years postimplantation, children receiving auditory-oral or cued-speech instruction were able to produce sentences; however, the sign-language children failed to do so at a rate comparable to the other children. Language level was significantly higher in the oralist or cued-speech educated children than in the sign-language group. CONCLUSIONS: Speech production skills improved with increased experience using a cochlear implant. Word intelligibility, syntactic structure of sentences, sentence pattern stages improved gradually over time. Production skills were greater in the cued-speech educated children group than in the auditory oral or sign-language groups. Statistically better sentence pattern stages were found in the auditory oral and sign-language groups.

Speech perception skills and speech production intelligibility in French children with prelingual deafness and cochlear implants.

OBJECTIVE: To examine speech perception and production intelligibility in French children with prelingual deafness who received multichannel cochlear implants. DESIGN: Within-subject, repeated-measures design for assessing speech perception and a cross-sectional design for assessing overall speech intelligibility. SETTING: A pediatric cochlear implant center. SUBJECTS: Sixty-four French children with prelingual deafness who received multichannel cochlear implants (mean age at time of implantation, 3 years 11 months) underwent assessment for speech perception. A subset of 16 children who received implants by 3 years of age underwent assessment for speech intelligibility. MAIN OUTCOME MEASURES: Speech perception skills were assessed using phoneme detection, closed-set word and sentence recognition, and modified open-set (MOS) recognition. Speech intelligibility was assessed by asking 50 listeners to identify recorded speech samples from the subjects. Dependent variables for the studies consisted of percent of correct items. RESULTS: After implantation, all children were able to detect phonemes by 3 months. Closed-set word and sentence identification reached 100% accuracy by 48 months (7 children with 4 years of implantation experience). Some children (8 of 48) demonstrated some MOS recognition after 1 year. Modified open-set recognition averaged 67.9% by 42 months (12 children available) and 80% by 48 months (7 children available). Overall speech intelligibility was 4.2% after 1 year, 30.7% after 2 years, 55.2% after 3 years, and 74.2% after 4 years. Within-subject comparison of MOS recognition and overall speech intelligibility scores revealed an insignificant trend for high perceptual performance to be associated with higher speech intelligibility scores (P = .17). There also was a tendency for higher performance to be associated with longer implantation experience. CONCLUSIONS: Speech perception scores appear to increase with increased experience using a cochlear implant. Overall speech intelligibility appears to steadily improve with increased experience and appears to be poorly related to perceptual performance on MOS recognition tasks.

Speech-perception performance in prelingually deafened French children using the nucleus multichannel cochlear implant.

PURPOSE: The speech-perception abilities of 36 French children, whose onset of deafness occurred before 2 years of age, was longitudinally examined after they received a Nucleus multichannel cochlear implant. METHODS: Speech perception was assessed in four areas: phoneme detection, closed-set word and sentence recognition; and modified open-set recognition. RESULTS: All children achieved phoneme detection by 3 months after implantation. Closed-set word and sentence recognition appeared initially less accurate in children with congenital deafness than in the prelingually deafened children; however, these differences disappeared by 18 months after implantation. Some modified open-set recognition was evident by 12 months after implantation and continued to improve 3 years after implantation. CONCLUSIONS: Data demonstrate significant improvements in speech perception with implant experience: 15 (60%) of 25 of the children identified sentences in closed sets, 22 (88%) of 25 identified words in closed sets after 12 months' experience, and 13 (81%) of 16 demonstrated open-set recognition after 24 months of implant use.