Revision Cochlear Implantation With Device Manufacturer Conversion: Surgical Outcomes and Speech Perception Performance.

OBJECTIVE: Describe the clinical profile of revision cochlear implantation (RCI) cases involving device manufacturer conversion (RCImc+), compare them to cases without manufacturer conversion (RCImc-), and classify the reasons for manufacturer conversion (MC). STUDY DESIGN: Retrospective case review. SETTING: Tertiary academic center. METHODS: Data on demographics, RCI indications, medical background, surgical details, and the reasons for MC were collected for all RCIs from 1989 to 2020. Post-RCI speech perception performance was categorized as unchanged, improved, or declined, according to clinically based criteria. RESULTS: Of 185 RCIs, 39 (21%) involved MC, mostly in pediatric patients (67%). The leading RCImc+ indications were device-related (59%) and medical (31%) failures. Initial implant manufacturers were Advanced Bionics (49%), Cochlear (25.5%), or Medel (25.5%). Most MC reasons were patient-driven (64%) versus CI team recommendations (36%). The RCImc+ group demonstrated a 3-fold higher rate of medical indications than RCImc- (31% vs 11.5%, P = .007). The time interval from symptom onset to RCI was longer in RCImc+ (43 vs 20.3 months, P = .001), and the rate of multiple revisions in the same ear was higher (25.6% vs 8.2%, P = .009). Complete reinsertion rates were high in both RCImc+ and RCImc- (94.8% vs 94.5%, P = 1) without any complications. Speech perception improved or remained unchanged in most (84%) cases, with no significant difference between the groups (P = .183). CONCLUSION: This retrospective study showed that RCI involving MC is safe and beneficial. Although RCImc+ patients exhibited distinct clinical characteristics, MC did not impact surgical or speech perception outcomes. This provides evidence-based data to support informed decision-making by CI teams and patients.

The Prevalence of Hearing Impairments in Women with Silicone Breast Implants.

Many women with silicone breast implants (SBIs) report non-specific complaints, including hearing impairments. Hearing impairment appears to be associated with a number of autoimmune conditions. The current study aimed to evaluate the prevalence and severity of hearing impairments among women with SBIs and to explore potential improvements in their hearing capability following implant removal. Symptomatic women with SBIs (n = 160) underwent an initial anamnestic interview, and women who reported hearing impairments were selected for the study. These women completed self-report telephone questionnaires regarding their hearing difficulties. Some of these women underwent subjective and objective hearing tests. Out of 159 (50.3%) symptomatic women with SBIs, 80 reported hearing impairments, including hearing loss (44/80; 55%) and tinnitus (45/80; 56.2%). Five out of seven (71.4%) women who underwent an audiologic evaluation exhibited hearing loss. Of women who underwent silicone implant removal, 27 out of 47 (57.4%) reported the improvement or resolution of their hearing complaints. In conclusion, hearing impairment is a frequent complaint among symptomatic women with SBIs, and tinnitus was found to be the most common complaint. A significant reduction in hearing difficulties was observed following silicone implant removal. Further studies using larger populations are needed to verify the occurrence of hearing impairments in these women.

The safety and efficacy of a nurse-led sedation service using Chloral Hydrate for auditory brainstem response testing.

BACKGROUND: There is a growing number of pediatric procedures requiring sedation outside the operating room. Among these are auditory brainstem response (ABR) tests, the gold standard for objective hearing evaluation in infants and toddlers. Recently, a nurse-led pediatric sedation service based on a structured protocol has been developed for ABR testing. OBJECTIVES: To retrospectively analyze the safety and efficacy of the pediatric nurse-led sedation protocol (PNLSP) in a tertiary medical center using Chloral Hydrate (CH) in children undergoing ABR testing. METHODS: Data from medical charts of children who underwent sedation for ABR testing between January 2014 and December 2017, were retrieved. Analysis of sedation success/failure rates, sleep induction time (SIT), sleep duration time (SDT), and adverse events (AE), was performed. FINDINGS: 1348 children with a mean age of 13.4 months (range 3-42 months), classified by the American Society of Anesthesiologists Physical Status Classification System (ASA score) 1-3, were included in the analysis. All children received a fixed dose of 75 mg / kg CH orally or rectally. Sedation success rate was 98.7% and enabled completion of ABR testing. Failure to sedate was evident in 17 children (1.3%), all classified as ASA score 1-2. Median SIT and SDT were 25 and 100 min, respectively. Mild AE occurred in 9 children (0.67%), none of which required further intervention. CONCLUSIONS: Findings support the use of a structured PNLSP using CH as safe and efficient. The suggested protocol is an effective alternative for general anesthesia (GA) for ABR testing in healthy young children.

Current demographic and auditory profiles of adult cochlear implant candidates and factors affecting uptake.

OBJECTIVES: Despite growth of CI and widening of implantation criteria, penetration rates remain low and the clinical profile of adult CI candidates has not substantially changed. This study evaluated the demographic and auditory profiles of current adult CI candidates and identified factors affecting CI uptake. DESIGN: Preoperative data from patients who underwent CI candidacy evaluation between 2016-2018 were retrospectively reviewed. Data included demographics, medical reports, audiological results, and reasons for not pursuing implantation. Comparisons between candidates who pursued implantation and those who did not were performed. STUDY SAMPLE: Ninety-five candidates (54 females), average age 52 years. RESULTS: Most candidates exhibited post-lingual bilateral hearing loss with mean unaided PTA4 of 105dBHL and monosyllabic word score of 26%. Forty-nine candidates were implanted, and the main reason for not pursuing CI was candidates' reluctance. Candidates that pursued CI were mostly younger females with poorer unaided PTA4. Age was the only significant predictor of CI uptake. CONCLUSIONS: While current candidates demonstrated greater demographic diversity and better speech perception compared to previous findings, unaided thresholds are still within the profound range. Our findings indicate that eligible candidates face barriers to the utilisation of CI, some of which are modifiable by means of updated candidacy protocols.

The Sheba Medical Center Protocol for Bedside Evaluation of Swallowing Disorders Among Tracheotomized Patients.

The Sheba Blue Dye Test Protocol (SBDTP) is a swallowing bedside evaluation for tracheotomized patients (TP). It is based on the Modified Evans' Blue Dye Test (MEBDT), but includes several modifications that aim to overcome previously described caveats of the traditional MEBDT. These modifications include evaluating the patient three times, with increasing quantities of bolus. The purpose of this study was to examine the rates of positive and negative results of TP undergoing the SBDTP, in comparison to the MEBDT, which, generally, consists of a single evaluation. The study included a cohort of 39 TP admitted to the Sheba general hospital with various background diseases. Findings indicated that the percentage of positive results increased significantly from the first (18%) to the last stage (46.2%) of the SBDTP. This result demonstrated the advantage of the SBDTP as a more reliable evaluation for tracing aspiration among TP, especially in cases where access to instrumental examination is limited.

Rates, Indications, and Speech Perception Outcomes of Revision Cochlear Implantations.

Revision cochlear implant (RCI) is a growing burden on cochlear implant programs. While reports on RCI rate are frequent, outcome measures are limited. The objectives of the current study were to: (1) evaluate RCI rate, (2) classify indications, (3) delineate the pre-RCI clinical course, and (4) measure surgical and speech perception outcomes, in a large cohort of patients implanted in a tertiary referral center between 1989-2018. Retrospective data review was performed and included patient demographics, medical records, and audiologic outcomes. Results indicated that RCI rate was 11.7% (172/1465), with a trend of increased RCI load over the years. The main indications for RCI were device-related failures (soft-45.4%, hard-23.8%), medical failure (14%), trauma (8.1%), and surgical failure (6.4%). Success rate was 98.8%. Children comprised 78% (134) of the cohort and were more likely than adults to undergo RCI. Most (70%) of the RCIs were performed within 10 years from primary implantation. Speech perception outcome analysis revealed unchanged or improved performance in 85% of the cases and declined performance in 15%. Current findings confirm that RCI is a safe with high clinical efficacy; however, the non-negligible percentage of patients that exhibited declined performance post-RCI should be considered in decision-making processes regarding RCI. Routine follow-up during their first years post-implantation is warranted.

Evidence for a Right-Ear Advantage in Newborn Hearing Screening Results.

The aim of the present study was to investigate the effect of ear asymmetry, order of testing, and gender on transient-evoked otoacoustic emission (TEOAE) pass rates and response levels in newborn hearing screening. The screening results of 879 newborns, of whom 387 (study group) passed screening successfully in only one ear in the first TEOAE screening, but passed screening successfully in both ears thereafter, and 492 (control group) who passed screening successfully in both ears in the first TEOAE, were retrospectively examined for pass rates and TEOAE characteristics. Results indicated a right-ear advantage, as manifested by significantly higher pass rates in the right ear (61% and 39% for right and left ears, respectively) in the study group, and in 1.75 dB greater TEOAE response amplitudes in the control group. The right-ear advantage was enhanced when the first tested ear was the right ear (76%). When the left ear was tested first, pass rates were comparable in both ears. The right-ear advantage in pass rates was similar in females versus males, but manifested in 1.5 dB higher response amplitudes in females compared with males, regardless of the tested ear and order of testing in both study and control groups. The study provides further evidence for the functional lateralization of the auditory system at the cochlear level already apparent soon after birth in both males and females. While order of testing plays a significant role in the asymmetry in pass rates, the innate right-ear advantage seems to be a more dominant contributor.

Prolonged auditory brainstem responses in infants with autism.

Numerous studies have attempted to identify early physiological abnormalities in infants and toddlers who later develop autism spectrum disorder (ASD). One potential measure of early neurophysiology is the auditory brainstem response (ABR), which has been reported to exhibit prolonged latencies in children with ASD. We examined whether prolonged ABR latencies appear in infancy, before the onset of ASD symptoms, and irrespective of hearing thresholds. To determine how early in development these differences appear, we retrospectively examined clinical ABR recordings of infants who were later diagnosed with ASD. Of the 118 children in the participant pool, 48 were excluded due to elevated ABR thresholds, genetic aberrations, or old testing age, leaving a sample of 70 children: 30 of which were tested at 0-3 months, and 40 were tested at toddlerhood (1.5-3.5 years). In the infant group, the ABR wave-V was significantly prolonged in those who later developed ASD as compared with case-matched controls (n = 30). Classification of infants who later developed ASD and case-matched controls using this measure enabled accurate identification of ASD infants with 80% specificity and 70% sensitivity. In the group of toddlers with ASD, absolute and interpeak latencies were prolonged compared to clinical norms. Findings indicate that ABR latencies are significantly prolonged in infants who are later diagnosed with ASD irrespective of their hearing thresholds; suggesting that abnormal responses might be detected soon after birth. Further research is needed to determine if ABR might be a valid marker for ASD risk. Autism Res 2016, 9: 689-695. © 2015 The Authors Autism Research published by Wiley Periodicals, Inc. on behalf of International Society for Autism Research.

Towards a Unified Testing Framework for Single-Sided Deafness Studies: A Consensus Paper.

BACKGROUND: While hearing aids for a contralateral routing of signals (CROS-HA) and bone conduction devices have been the traditional treatment for single-sided deafness (SSD) and asymmetric hearing loss (AHL), in recent years, cochlear implants (CIs) have increasingly become a viable treatment choice, particularly in countries where regulatory approval and reimbursement schemes are in place. Part of the reason for this shift is that the CI is the only device capable of restoring bilateral input to the auditory system and hence of possibly reinstating binaural hearing. Although several studies have independently shown that the CI is a safe and effective treatment for SSD and AHL, clinical outcome measures in those studies and across CI centers vary greatly. Only with a consistent use of defined and agreed-upon outcome measures across centers can high-level evidence be generated to assess the safety and efficacy of CIs and alternative treatments in recipients with SSD and AHL. METHODS: This paper presents a comparative study design and minimum outcome measures for the assessment of current treatment options in patients with SSD/AHL. The protocol was developed, discussed, and eventually agreed upon by expert panels that convened at the 2015 APSCI conference in Beijing, China, and at the CI 2016 conference in Toronto, Canada. RESULTS: A longitudinal study design comparing CROS-HA, BCD, and CI treatments is proposed. The recommended outcome measures include (1) speech in noise testing, using the same set of 3 spatial configurations to compare binaural benefits such as summation, squelch, and head shadow across devices; (2) localization testing, using stimuli that rove in both level and spectral content; (3) questionnaires to collect quality of life measures and the frequency of device use; and (4) questionnaires for assessing the impact of tinnitus before and after treatment, if applicable. CONCLUSION: A protocol for the assessment of treatment options and outcomes in recipients with SSD and AHL is presented. The proposed set of minimum outcome measures aims at harmonizing assessment methods across centers and thus at generating a growing body of high-level evidence for those treatment options.

Asymmetric Hearing During Development: The Aural Preference Syndrome and Treatment Options.

Deafness affects ∼2 in 1000 children and is one of the most common congenital impairments. Permanent hearing loss can be treated by fitting hearing aids. More severe to profound deafness is an indication for cochlear implantation. Although newborn hearing screening programs have increased the identification of asymmetric hearing loss, parents and caregivers of children with single-sided deafness are often hesitant to pursue therapy for the deaf ear. Delayed intervention has consequences for recovery of hearing. It has long been reported that asymmetric hearing loss/single-sided deafness compromises speech and language development and educational outcomes in children. Recent studies in animal models of deafness and in children consistently show evidence of an "aural preference syndrome" in which single-sided deafness in early childhood reorganizes the developing auditory pathways toward the hearing ear, with weaker central representation of the deaf ear. Delayed therapy consequently compromises benefit for the deaf ear, with slow rates of improvement measured over time. Therefore, asymmetric hearing needs early identification and intervention. Providing early effective stimulation in both ears through appropriate fitting of auditory prostheses, including hearing aids and cochlear implants, within a sensitive period in development has a cardinal role for securing the function of the impaired ear and for restoring binaural/spatial hearing. The impacts of asymmetric hearing loss on the developing auditory system and on spoken language development have often been underestimated. Thus, the traditional minimalist approach to clinical management aimed at 1 functional ear should be modified on the basis of current evidence.

Perceived loudness of self-generated sounds is differentially modified by expected sound intensity.

Performing actions with sensory consequences modifies physiological and behavioral responses relative to otherwise identical sensory input perceived in a passive manner. It is assumed that such modifications occur through an efference copy sent from motor cortex to sensory regions during performance of voluntary actions. In the auditory domain most behavioral studies report attenuated perceived loudness of self-generated auditory action-consequences. However, several recent behavioral and physiological studies report enhanced responses to such consequences. Here we manipulated the intensity of self-generated and externally-generated sounds and examined the type of perceptual modification (enhancement vs. attenuation) reported by healthy human subjects. We found that when the intensity of self-generated sounds was low, perceived loudness is enhanced. Conversely, when the intensity of self-generated sounds was high, perceived loudness is attenuated. These results might reconcile some of the apparent discrepancies in the reported literature and suggest that efference copies can adapt perception according to the differential sensory context of voluntary actions.

Hearing with Two Ears: Evidence for Cortical Binaural Interaction during Auditory Processing.

BACKGROUND: Integration of information presented to the two ears has been shown to manifest in binaural interaction components (BICs) that occur along the ascending auditory pathways. In humans, BICs have been studied predominantly at the brainstem and thalamocortical levels; however, understanding of higher cortically driven mechanisms of binaural hearing is limited. PURPOSE: To explore whether BICs are evident in auditory event-related potentials (AERPs) during the advanced perceptual and postperceptual stages of cortical processing. RESEARCH DESIGN: The AERPs N1, P3, and a late negative component (LNC) were recorded from multiple site electrodes while participants performed an oddball discrimination task that consisted of natural speech syllables (/ka/ vs. /ta/) that differed by place-of-articulation. Participants were instructed to respond to the target stimulus (/ta/) while performing the task in three listening conditions: monaural right, monaural left, and binaural. STUDY SAMPLE: Fifteen (21-32 yr) young adults (6 females) with normal hearing sensitivity. DATA COLLECTION AND ANALYSIS: By subtracting the response to target stimuli elicited in the binaural condition from the sum of responses elicited in the monaural right and left conditions, the BIC waveform was derived and the latencies and amplitudes of the components were measured. The maximal interaction was calculated by dividing BIC amplitude by the summed right and left response amplitudes. In addition, the latencies and amplitudes of the AERPs to target stimuli elicited in the monaural right, monaural left, and binaural listening conditions were measured and subjected to analysis of variance with repeated measures testing the effect of listening condition and laterality. RESULTS: Three consecutive BICs were identified at a mean latency of 129, 406, and 554 msec, and were labeled N1-BIC, P3-BIC, and LNC-BIC, respectively. Maximal interaction increased significantly with progression of auditory processing from perceptual to postperceptual stages and amounted to 51%, 55%, and 75% of the sum of monaural responses for N1-BIC, P3-BIC, and LNC-BIC, respectively. Binaural interaction manifested in a decrease of the binaural response compared to the sum of monaural responses. Furthermore, listening condition affected P3 latency only, whereas laterality effects manifested in enhanced N1 amplitudes at the left (T3) vs. right (T4) scalp electrode and in a greater left-right amplitude difference in the right compared to left listening condition. CONCLUSIONS: The current AERP data provides evidence for the occurrence of cortical BICs during perceptual and postperceptual stages, presumably reflecting ongoing integration of information presented to the two ears at the final stages of auditory processing. Increasing binaural interaction with the progression of the auditory processing sequence (N1 to LNC) may support the notion that cortical BICs reflect inherited interactions from preceding stages of upstream processing together with discrete cortical neural activity involved in binaural processing. Clinically, an objective measure of cortical binaural processing has the potential of becoming an appealing neural correlate of binaural behavioral performance.

Steroid-based treatments for patients with total sudden sensorineural hearing loss.

CONCLUSIONS: In patients with total sudden sensorineural hearing loss (SSNHL), oral prednisone (OP) alone or intratympanic dexamethasone (ITD) alone have comparable results. The addition of salvage ITD following OP does not seem to add over either single modality treatment. OBJECTIVES: To study the effect of steroid-based treatments in patients with total SSNHL. METHODS: The medical charts of 59 patients with total loss of hearing, defined as pure tone thresholds in the profound range (> 90 dB) with an unobtainable speech reception threshold (SRT) that were treated with OP (n = 20), ITD (n = 13), or OP followed by salvage ITD (n = 26) were analyzed. Response to treatment was evaluated by means of pure tone thresholds, SRT, and speech discrimination score (SDS), immediately after treatment and on a follow-up visit. RESULTS: Forty-nine patients (83%) responded to treatment, with mean significant improvements of 36, 34, 31, and 25 dB at 500, 1000, 2000, and 4000 Hz, respectively. The mean improvement in SRT was 33 dB, and SDS improved by 32%. There were no differences in improvement in pure tone thresholds and SRT among the three treatment groups. The late effect of OP was similar to the effect of salvage ITD.

Pain in cochlear implant recipients: an uncommon, yet serious, consequence of cochlear implantation.

OBJECTIVES/HYPOTHESIS: We describe pain around the receiver/stimulator [RS] presenting months to years after implantation. STUDY DESIGN: A retrospective chart review. METHODS: We performed a retrospective review of all cochlear implant recipients complaining of pain around their RS through the years 2009 through 2013, with a follow-up of at least 6 months. Excluded from the study were patients with an identifiable cause for their pain such as trauma, local infection, or skin breakdown. The therapy regimen and outcomes were reviewed. RESULTS: Thirty patients complained of delayed pain over their RS, representing 2.8% of 1,044 implantations performed at the Sheba Medical Center, Tel Hashomer, Israel, as of 2013. The time from implantation to the presentation of pain ranged from 3 months to 12 years. The pain was perceptible even when the external magnet and processor were not used, and was usually most obvious in specific points around the RS. Seventy-seven percent of our patients responded well to conservative therapy. Fifteen (50%) responded to prolonged antibiotic treatment. Five patients (17%) responded to antiinflammatories alone. One patient (3%) responded to deactivation of two electrodes. Six patients (20%) required reimplantation, after which the pain resolved in all. At explantation, no signs of infection, foreign body reaction, or obvious device damage were found. CONCLUSION: Delayed pain around the RS that is unrelated to use is a serious consequence of cochlear implantation, and in some cases, those necessitating reimplantation, should be considered a major complication. LEVEL OF EVIDENCE: 4.

An auditory-neuroscience perspective on the development of selective mutism.

Selective mutism (SM) is a relatively rare psychiatric disorder of childhood characterized by consistent inability to speak in specific social situations despite the ability to speak normally in others. SM typically involves severe impairments in social and academic functioning. Common complications include school failure, social difficulties in the peer group, and aggravated intra-familial relationships. Although SM has been described in the medical and psychological literatures for many years, the potential underlying neural basis of the disorder has only recently been explored. Here we explore the potential role of specific auditory neural mechanisms in the psychopathology of SM and discuss possible implications for treatment.

Lateralized enhancement of auditory cortex activity and increased sensitivity to self-generated sounds.

Performing actions with auditory consequences modulates the response in auditory cortex to otherwise identical stimuli passively heard. Such modulation has been suggested to occur through a corollary discharge sent from the motor cortex during voluntary actions. However, the relationship between the effector used to generate the sound, type of modulation and changes in perceptual sensitivity are unclear. Here we use functional magnetic resonance imaging on healthy subjects and demonstrate bilateral enhancement in the auditory cortex to self-generated versus externally generated sounds. Furthermore, we find that this enhancement is stronger when the sound-producing hand is contralateral to the auditory cortex. At the behavioural level, binaural hearing thresholds are lower for self-generated sounds and monaural thresholds are lower for sounds triggered by the hand ipsilateral to the stimulated ear. Together with functional connectivity analysis, our results suggest that a corollary discharge sent from active motor cortex enhances activity in the auditory cortex and increases perceptual sensitivity in a lateralized manner.

Evidence for a right cochlear implant advantage in simultaneous bilateral cochlear implantation.

OBJECTIVES/HYPOTHESIS: To compare speech perception performance with right versus left cochlear implants (CIs) in children with bilateral CIs implanted simultaneously. STUDY DESIGN: Prospective case series of patients undergoing simultaneous bilateral cochlear implantation. METHODS: Speech perception performance was tested in 10, right-handed children who received bilateral CIs simultaneously between 11 and 36 months (mean, 21 months), had at least 18 months of bilateral CI use, and were 5.3 years of age during testing. All children exhibited bilateral symmetrical severe-to-profound hearing loss prior to implantation and did not benefit from hearing aids. Speech perception performance was evaluated with the right CI and the left CI by means of an open-set monosyllabic word test in quiet presented at 45 dB HL in a sound field. RESULTS: All children exhibited higher performance with the right CI compared to the left CI. Group mean performance with the right CI was 66.5% compared to 52% with the left CI (P = .002), yielding a 14.5% difference. With increasing duration of bilateral CI use and age at evaluation, the right-left difference increased (r = 0.72, P = .019 and r = 0.74, P = .014, respectively). CONCLUSIONS: Current preliminary data indicate that children with bilateral CIs implanted simultaneously exhibit a significant right ear advantage for speech. Similarly to reports on normal-hearing children, right ear preference for speech increased with increasing age and auditory-linguistic experience. Thus, simultaneous bilateral cochlear implantation may lead to normal development of auditory pathways and may be an important contributor to the superior auditory, language, and communication skills reported in children with bilateral versus unilateral CIs.

Neural correlates of auditory-cognitive processing in older adult cochlear implant recipients.

With the growing number of older adults receiving cochlear implants (CI), there is general agreement that substantial benefits can be gained. Nonetheless, variability in speech perception performance is high, and the relative contribution and interactions among peripheral, central-auditory, and cognitive factors are not fully understood. The goal of the present study was to compare auditory-cognitive processing in older-adult CI recipients with that of older normal-hearing (NH) listeners by means of behavioral and electrophysiologic manifestations of a high-load cognitive task. Auditory event-related potentials (AERPs) were recorded from 9 older postlingually deafened adults with CI (age at CI >60) and 10 age-matched listeners with NH, while performing an auditory Stroop task. Participants were required to classify the speaker's gender (male/female) that produced the words 'mother' or 'father' while ignoring the irrelevant congruent or incongruent word meaning. Older CI and NH listeners exhibited comparable reaction time, performance accuracy, and initial sensory-perceptual processing (i.e. N1 potential). Nonetheless, older CI recipients showed substantially prolonged and less efficient perceptual processing (i.e. P3 potential). Congruency effects manifested in longer reaction time (i.e. Stroop effect), execution time, and P3 latency to incongruent versus congruent stimuli in both groups in a similar fashion; however, markedly prolonged P3 and shortened execution time were evident in older CI recipients. Collectively, older adults (CI and NH) employed a combined perceptual and postperceptual conflict processing strategy; nonetheless, the relative allotment of perceptual resources was substantially enhanced to maintain adequate performance in CI recipients. In sum, the recording of AERPs together with the simultaneously obtained behavioral measures during a Stroop task exposed a differential time course of auditory-cognitive processing in older CI recipients that was not manifested in the behavioral end products of processing. These data may have implications regarding clinical evaluation and rehabilitation procedures that should be tailored specifically for this unique group of patients.

Abnormalities in auditory efferent activities in children with selective mutism.

Two efferent feedback pathways to the auditory periphery may play a role in monitoring self-vocalization: the middle-ear acoustic reflex (MEAR) and the medial olivocochlear bundle (MOCB) reflex. Since most studies regarding the role of auditory efferent activity during self-vocalization were conducted in animals, human data are scarce. The working premise of the current study was that selective mutism (SM), a rare psychiatric disorder characterized by consistent failure to speak in specific social situations despite the ability to speak normally in other situations, may serve as a human model for studying the potential involvement of auditory efferent activity during self-vocalization. For this purpose, auditory efferent function was assessed in a group of 31 children with SM and compared to that of a group of 31 normally developing control children (mean age 8.9 and 8.8 years, respectively). All children exhibited normal hearing thresholds and type A tympanograms. MEAR and MOCB functions were evaluated by means of acoustic reflex thresholds and decay functions and the suppression of transient-evoked otoacoustic emissions, respectively. Auditory afferent function was tested by means of auditory brainstem responses (ABR). Results indicated a significantly higher proportion of children with abnormal MEAR and MOCB function in the SM group (58.6 and 38%, respectively) compared to controls (9.7 and 8%, respectively). The prevalence of abnormal MEAR and/or MOCB function was significantly higher in the SM group (71%) compared to controls (16%). Intact afferent function manifested in normal absolute and interpeak latencies of ABR components in all children. The finding of aberrant efferent auditory function in a large proportion of children with SM provides further support for the notion that MEAR and MOCB may play a significant role in the process of self-vocalization.

Hearing aid satisfaction and use in the advanced digital era.

OBJECTIVES/HYPOTHESIS: To evaluate satisfaction ratings and use patterns of advanced digital hearing aids (HAs) in a group of hearing-impaired adults by means of self-report questionnaires. STUDY DESIGN: A self report questionnaire study. METHODS: One hundred seventy-seven hearing-impaired adults who were fitted with advanced digital HAs at the Speech and Hearing Center at Sheba Medical Center were asked to participate in a structured telephone interview regarding HA satisfaction and use by means of the Satisfaction With Amplification in Daily Life (SADL) questionnaire. Patients who were not using their HAs completed a nonuse questionnaire. RESULTS: One hundred thirty-one patients participated in the survey, yielding a response rate of 74%. Eighty-three percent used their HAs regularly, whereas 17% were nonusers. Of the users, 92% were satisfied to some degree with their HAs. The global SADL score was 5.12 on a scale of 1 to 7. Background variables that were significantly associated with satisfaction ratings were hours of HA use per day, fitting mode (binaural vs. monaural), age, and degree of hearing loss. Although nonuse was not significantly associated with background variables, the main reasons for nonuse were excessive amplification in background noise and minimal functional benefit. CONCLUSIONS: High satisfaction and use rates were characteristic of adults fitted with advanced digital HAs. Patients should be advised that longer use of HAs per day may lead to higher satisfaction and that binaural amplification is advantageous, especially while communicating in noise. Finally, expectation from HA functionality in challenging listening situations should be realistic, as additional research and technology development is still needed.