Otogenic lateral sinus thrombosis in children: proposal of an experience-based treatment flowchart.

PURPOSE: To describe the prevalent clinical, laboratory, and radiological features of otogenic lateral sinus thrombosis (OLST) in children; to identify clinical predictors of outcome; to propose a management algorithm derived from experience. METHODS: A retrospective review was conducted of the clinical records of patients with OLST, treated in a single tertiary care referral center for pediatric disease from 2006 to 2017. The inclusion criteria were pediatric age (0-16 years) and OLST diagnosis confirmed by a pre- and post-contrast CT or venography-MRI scan. Primary outcome measures were early (1-2 months) and late (6 months) sinus recanalization assessed by means of neuroimaging. RESULTS: Twenty-five patients (8 females and 17 males; mean age = 6 ± 3 years) were included. A genetic abnormality associated with thrombophilia was found in 24 (96%) patients. At diagnosis, anticoagulant treatment with low-molecular-weight heparin (LMWH) was started in all subjects, while surgical treatment (mastoidectomy and tympanostomy tube insertion) was performed in 16/25 (64%) patients. Follow-up neuroimaging showed lateral sinus recanalization in 12/25 (48%) patients after 1-2 months and in 17/25 (68%) after 6 months. At multivariate logistic regression analysis, no significant predictors of the early and late neuroradiological outcome were found. CONCLUSIONS: All children with OLST should be screened for thrombophilia to decide on treatment duration and to assess the need for future antithrombotic prophylaxis. Immediately after diagnosis, anticoagulant treatment with LMWH should be started according to the international guidelines. Instead, our experience suggests that surgical treatment should not be indicated in all patients, but decided on a case-to-case basis.

Music perception improves in children with bilateral cochlear implants or bimodal devices.

The objectives of this study were to determine if music perception by pediatric cochlear implant users can be improved by (1) providing access to bilateral hearing through two cochlear implants or a cochlear implant and a contralateral hearing aid (bimodal users) and (2) any history of music training. The Montreal Battery of Evaluation of Musical Ability test was presented via soundfield to 26 bilateral cochlear implant users, 8 bimodal users and 16 children with normal hearing. Response accuracy and reaction time were recorded via an iPad application. Bilateral cochlear implant and bimodal users perceived musical characteristics less accurately and more slowly than children with normal hearing. Children who had music training were faster and more accurate, regardless of their hearing status. Reaction time on specific subtests decreased with age, years of musical training and, for implant users, better residual hearing. Despite effects of these factors on reaction time, bimodal and bilateral cochlear implant users' responses were less accurate than those of their normal hearing peers. This means children using bilateral cochlear implants and bimodal devices continue to experience challenges perceiving music that are related to hearing impairment and/or device limitations during development.

Steady state auditory evoked potentials in normal hearing subjects: evaluation of threshold and testing time.

BACKGROUND: Steady state responses (SSRs), between 75 and 110 Hz, evoked by auditory amplitude modulated single or multiple tone stimuli, may be used to estimate objective hearing threshold. METHODS: The aim of this study was to compare SSRs and click-evoked auditory brainstem responses (ABRs) in both ears of 20 adults (10 males and 10 females, aged between 24 and 36 years) with normal hearing threshold. RESULTS: Mean ABR threshold was found at 21.25 (± 5.9) dB nHL. Mean SSR threshold was found at 15.6 (± 9.6) dB nHL after a single frequency stimulus (1 kHz); at 10.5 (± 18.2) dB nHL and at 7.1 (± 12.4) dB nHL after bifrequency stimulation (0.5 and 2 kHz). SSR thresholds after multifrequency stimulation (0.5, 1, 2 and 4 kHz) were found, respectively, at 12.1 (± 12.9) dB nHL, 12.2 (± 12.8) dB nHL, 12.3 (± 8.3) dB nHL and 18.9 (± 17.2) dB nHL. Mean duration of the recording session was 6 min in the case of ABRs, while it was 25 min in the single frequency condition and 29 min in the multifrequency condition in the case of SSRs. CONCLUSION: SSRs can be used for frequency-specific objective audiometry. The multifrequency stimulation greatly reduces the whole testing time.

Improving melody recognition in cochlear implant recipients through individualized frequency map fitting.

Recent research has shown that music perception remains very difficult for most cochlear implant (CI) users, who generally report being unsatisfied with the quality of music listening through the CI. In particular, the appreciation of the spectral features of music, which include pitch, melody and timbre, is widely known to be poorer than its rhythmic patterns. One of the possible causes for this may be the misalignment between the conventional frequency band allocation to the electrodes of the array (frequency-place function) and the distribution of pitch percepts generated by electrode stimulation along the array (electrode-pitch function). In this paper the authors investigate whether mismatch correction through individualized fitting of the processor's frequency maps can improve music understanding in ten Nucleus™ cochlear implant users, by comparing scores obtained with experimental and old map; both maps were tested before, immediately after and 1 month after the fitting through a music test battery designed for the purpose of the study.

Case of COVID-19-induced vestibular neuritis in a child.

Since the outbreak of the COVID-19 pandemic, there has been a growing need to fully understand all the possible clinical features of the epidemic, which often presents with unusual manifestations, especially in children. In this report, we describe the case of a child with a COVID-19 infection and suffering exclusively from vertigo and fever. Altogether, considering the clinical manifestation, laboratory tests and imaging, given the patient's positivity to SARS-CoV-2 infection and its neurotropic potential, we assumed that the child had COVID-19-induced vestibular neuritis, which, in consideration of the spontaneous improvement of symptoms, did not require any therapeutic adjustments, apart from the natural compensation of the central nervous system.This case suggests the importance of having an index of suspicion for a COVID-19 infection in patients with paediatrics presenting with vertigo and adds valuable information to the limited literature on COVID-19 presentation and management in children.

Interdisciplinary Approaches to the Study of Listening Effort in Young Children with Cochlear Implants.

Very early bilateral implantation is thought to significantly reduce the attentional effort required to acquire spoken language, and consequently offer a profound improvement in quality of life. Despite the early intervention, however, auditory and communicative outcomes in children with cochlear implants remain poorer than in hearing children. The distorted auditory input via the cochlear implants requires more auditory attention resulting in increased listening effort and fatigue. Listening effort and fatigue may critically affect attention to speech, and in turn language processing, which may help to explain the variation in language and communication abilities. However, measuring attention to speech and listening effort is demanding in infants and very young children. Three objective techniques for measuring listening effort are presented in this paper that may address the challenges of testing very young and/or uncooperative children with cochlear implants: pupillometry, electroencephalography, and functional near-infrared spectroscopy. We review the studies of listening effort that used these techniques in paediatric populations with hearing loss, and discuss potential benefits of the systematic evaluation of listening effort in these populations.

Higher Right Hemisphere Gamma Band Lateralization and Suggestion of a Sensitive Period for Vocal Auditory Emotional Stimuli Recognition in Unilateral Cochlear Implant Children: An EEG Study.

In deaf children, huge emphasis was given to language; however, emotional cues decoding and production appear of pivotal importance for communication capabilities. Concerning neurophysiological correlates of emotional processing, the gamma band activity appears a useful tool adopted for emotion classification and related to the conscious elaboration of emotions. Starting from these considerations, the following items have been investigated: (i) whether emotional auditory stimuli processing differs between normal-hearing (NH) children and children using a cochlear implant (CI), given the non-physiological development of the auditory system in the latter group; (ii) whether the age at CI surgery influences emotion recognition capabilities; and (iii) in light of the right hemisphere hypothesis for emotional processing, whether the CI side influences the processing of emotional cues in unilateral CI (UCI) children. To answer these matters, 9 UCI (9.47 ± 2.33 years old) and 10 NH (10.95 ± 2.11 years old) children were asked to recognize nonverbal vocalizations belonging to three emotional states: positive (achievement, amusement, contentment, relief), negative (anger, disgust, fear, sadness), and neutral (neutral, surprise). Results showed better performances in NH than UCI children in emotional states recognition. The UCI group showed increased gamma activity lateralization index (LI) (relative higher right hemisphere activity) in comparison to the NH group in response to emotional auditory cues. Moreover, LI gamma values were negatively correlated with the percentage of correct responses in emotion recognition. Such observations could be explained by a deficit in UCI children in engaging the left hemisphere for more demanding emotional task, or alternatively by a higher conscious elaboration in UCI than NH children. Additionally, for the UCI group, there was no difference between the CI side and the contralateral side in gamma activity, but a higher gamma activity in the right in comparison to the left hemisphere was found. Therefore, the CI side did not appear to influence the physiologic hemispheric lateralization of emotional processing. Finally, a negative correlation was shown between the age at the CI surgery and the percentage of correct responses in emotion recognition and then suggesting the occurrence of a sensitive period for CI surgery for best emotion recognition skills development.

Serum fatty acids and cardiovascular risk factors in sudden sensorineural hearing loss: a case-control study.

OBJECTIVES: We analyzed the relationships between sudden sensorineural hearing loss (SSNHL) and serum levels of fatty acids, total cholesterol, low-density lipoproteins (LDLs), and the antioxidant coenzyme Q10. METHODS: Forty-three patients with SSNHL and 43 healthy subjects were enrolled in the study. The main outcome measures were serum levels of fatty acids, coenzyme Q10, total cholesterol, and LDLs. RESULTS: On univariate logistic regression analysis, high levels of total cholesterol (p < 0.001), LDLs (p = 0.024), behenic acid (p < 0.001), docosahexaenoic acid (p < 0.001), linolenic acid (p = 0.017), and oleic acid (p < 0.001) and low levels of coenzyme Q10 (p < 0.001) and nervonic acid (p < 0.001) were associated with an elevated risk of SSNHL. On multivariate analysis, only hypercholesterolemia (p = 0.15) and low levels of coenzyme Q10 (p = 0.02) and nervonic acid (p = 0.005) were significantly associated with SSNHL. CONCLUSIONS: This is the first report of low serum levels of nervonic acid as an independent risk factor for SSNHL. Considering that hypercholesterolemia, high serum levels of LDL, and low serum levels of the antioxidant coenzyme Q10 were associated with SSNHL as well, we hypothesize that saturated fatty acids may play a role in determining the dysmetabolic state in a subset of SSNHL patients. Together, these findings suggest that not only total cholesterol and LDL levels, but also fatty acid determination, may help identify SSNHL patients with cardiovascular risk factors.

Genetic identification and molecular modeling characterization of a novel POU3F4 variant in two Italian deaf brothers.

In this report, we describe a novel, probably pathogenic hemizygous variant c.870G > T (p.Lys290Asn) in the POU3F4 gene in two deaf brothers from one Italian family with identical inner ear abnormalities specific to X-linked deafness-2 (DFNX2). In addition, we performed homology modeling to predict the effect of the missense variant on the protein structure showing a possible disruption of the normal folding. The identification of pathogenic variants causing X-linked recessive deafness will improve molecular diagnosis, genetic counseling, and knowledge of the molecular epidemiology of hearing loss among Italian individuals. Taken together, we recommend preoperative gene mutation analysis in patients who have DFNX2 diagnosed on the basis of characteristic radiological findings, in order to provide with better prognostic information, the risk of recurrence, and improved rehabilitation options. Finally, the present work strengthens the hypothesis that DFNX-2 could be considered as a syndromic deafness, since mixed hearing loss is associated with other dysfunctions of the neuropsychological profile of the patients.

Transtympanic electrical stimulation for immediate and long-term tinnitus suppression.

Tinnitus is a common symptom which often becomes disabling, affecting the emotional and psychosocial dimensions of life. There are many reports describing tinnitus suppression or attenuation through electrical stimulation of the ear, provided either by cochlear implants or by transtympanic stimulation. Our study project aims to assess the effects of electrical promontory stimulation (EPS) on persistent disabling tinnitus. We enrolled 11 patients affected by postlingual monoaural or binaural profound hearing loss and disabling tinnitus in the worse ear. EPS was performed with direct continuous positive current delivered by an active platinum-iridium needle electrode connected to a promontory stimulator device. The short-term effect on tinnitus was assessed during and immediately after the stimulation. Long-term effects were estimated after one month by comparing pre- and post-EPS Tinnitus Handicap Inventory (THI) scores. Immediately after EPS, five patients (45.4%) reported complete suppression and four (36.4%) reported attenuation of tinnitus. Two patients (18.2%) said it was unchanged. After one month, the THI score was reduced in five patients (45.4%) and remained unchanged in the other six patients (54.6%). The beneficial effects of EPS on tinnitus might be explained by interference with tinnitus generating circuits such as the dorsal cochlear nucleus and the inferior colliculus and by modification of cortical activity. EPS is to be considered a worthwhile attempt at tinnitus suppression, and could help select candidates for the positioning of an implantable electrical stimulator that might provide longer-term beneficial effect on tinnitus.

Music Perception Testing Reveals Advantages and Continued Challenges for Children Using Bilateral Cochlear Implants.

A modified version of the child's Montreal Battery of Evaluation of Amusia (cMBEA) was used to assess music perception in children using bilateral cochlear implants. Our overall aim was to promote better performance by children with CIs on the cMBEA by modifying the complement of instruments used in the test and adding pieces transposed in frequency. The 10 test trials played by piano were removed and two high and two low frequency trials added to each of five subtests (20 additional). The modified cMBEA was completed by 14 children using bilateral cochlear implants and 23 peers with normal hearing. Results were compared with performance on the original version of the cMBEA previously reported in groups of similar aged children: 2 groups with normal hearing (n = 23: Hopyan et al., 2012; n = 16: Polonenko et al., 2017), 1 group using bilateral cochlear implants (CIs) (n = 26: Polonenko et al., 2017), 1 group using bimodal (hearing aid and CI) devices (n = 8: Polonenko et al., 2017), and 1 group using unilateral CI (n = 23: Hopyan et al., 2012). Children with normal hearing had high scores on the modified version of the cMBEA and there were no significant score differences from children with normal hearing who completed the original cMBEA. Children with CIs showed no significant improvement in scores on the modified cMBEA compared to peers with CIs who completed the original version of the test. The group with bilateral CIs who completed the modified cMBEA showed a trend toward better abilities to remember music compared to children listening through a unilateral CI but effects were smaller than in previous cohorts of children with bilateral CIs and bimodal devices who completed the original cMBEA. Results confirmed that musical perception changes with the type of instrument and is better for music transposed to higher rather than lower frequencies for children with normal hearing but not for children using bilateral CIs. Overall, the modified version of the cMBEA revealed that modifications to music do not overcome the limitations of the CI to improve music perception for children.

EEG rhythms lateralization patterns in children with unilateral hearing loss are different from the patterns of normal hearing controls during speech-in-noise listening.

Unilateral hearing loss constitutes a field of growing interest in the scientific community. In fact, this kind of patients represent a unique and physiological way to investigate how neuroplasticity overcame unilateral deafferentation by implementing particular strategies that produce apparently next- to- normal hearing behavioural performances. This explains why such patients have been underinvestigated for a long time. Thanks to the availability of techniques able to study the cerebral activity underlying the mentioned behavioural outcomes, the aim of the present research was to elucidate whether different electroencephalographic (EEG) patterns occurred in unilateral hearing loss (UHL) children in comparison to normal hearing (NH) controls during speech-in-noise listening. Given the intrinsic lateralized nature of such patients, due to the unilateral side of hearing impairment, the experimental question was to assess whether this would reflect a different EEG pattern while performing a word in noise recognition task varying the direction of the noise source. Results showed a correlation between the period of deafness and the cortical activity asymmetry toward the hearing ear side in the frontal, parietal and occipital areas in all the experimental conditions. Concerning alpha and beta activity in the frontal and central areas highlighted that in the NH group, the lateralization was always left-sided during the Quiet condition, while it was right-sided in noise conditions; this evidence was not, however, detected also in the UHL group. In addition, focusing on the theta and alpha activity in the frontal areas (Broca area) during noise conditions, while the activity was always left-lateralized in the NH group, it was ipsilateral to the direction of the background noise in the UHL group, and of a weaker extent than in NH controls. Furthermore, in noise conditions, only the UHL group showed a higher theta activity in the temporal areas ipsilateral to the side where the background noise was directed to. Finally, in the case of bilateral noise (background noise and word signal both coming from the same two sources), the theta and alpha activity in the frontal areas (Broca area) was left-lateralized in the case of the NH group and lateralized towards the side of the better hearing ear in the case of the UHL group. Taken together, this evidence supports the establishment of a particular EEG pattern occurrence in UHL children taking place in the frontal (Broca area), temporal and parietal lobes, probably physiologically established in order to deal with different sound and noise source directions.

A functional and anatomical comparison between two passive transcutaneous bone conduction implants in children.

OBJECTIVE: To compare anatomical and functional outcomes of two passive transcutaneous bone conduction implant systems: Sophono™ and BAHA Attract™. MATERIALS AND METHODS: Twenty patients, affected by bilateral conductive hearing loss, underwent unilateral transcutaneous bone conduction implant surgery. Ten children received a Sophono™ implant (6 males, 4 females, mean age 11 years, mean unaided Pure Tone Average (PTA) 0.25-4kHz = 69.70dB HL) and 10 a BAHA Attract™ system (7 males, 3 females, mean age 19 years, mean unaided PTA0.25-4kHz = 66.40dB HL). The following outcomes were considered: incidence of local complications, hearing aid benefit, hearing aid gain and changes in quality of life (QOL), as measured by the Glasgow Children's Benefit Inventory (GCBI). RESULTS: One patient in the Sophono group experienced magnet-related skin decubitus, while two patients (one per group) had skin hyperemia in the area overlying the magnet. The mean BAHA-aided threshold was 23.70dB, whereas the mean Sophono-aided threshold was 31.60dB. The mean gain was significantly different for lower frequencies, the BAHA having better functional outcomes. All patients reported an improvement in their QOL. CONCLUSION: Given the lower thickness of the internal magnet, the Sophono™ system might be more suitable for younger children, whereas BAHA offered better functional results. Both systems can be considered valid and safe options for the functional rehabilitation of conductive hearing loss in children, provided that precautions are observed, such as a gradual use of the device and use of the least powerful magnets in the first months after the activation.

Universal newborn hearing screening in the Lazio region, Italy.

BACKGROUND: The introduction of Universal Newborn Hearing Screening (UNHS) programs has drastically contributed to the early diagnosis of hearing loss in children, allowing prompt intervention with significant results on speech and language development in affected children. UNHS in the Lazio region has been initially deliberated in 2012; however, the program has been performed on a universal basis only from 2015. The aim of this retrospective study is to present and discuss the preliminary results of the UNHS program in the Lazio region for the year 2016, highlighting the strengths and weaknesses of the program. METHODS: Data from screening facilities in the Lazio region for year 2016 were retrospectively analyzed. Data for Level I centers were supplied by the Lazio regional offices; data for Level II and III centers were provided by units that participated to the study. RESULTS: During 2016, a total of 44,805 babies were born in the Lazio region. First stage screening was performed on 41,821 children in 37 different birth centers, with a coverage rate of 93.3%. Of these, 38.977 (93.2%) obtained a "pass" response; children with a "refer" result in at least one ear were 2844 (6.8%). Data from Level II facilities are incomplete due to missing reporting, one of the key issues in Lazio UNHS. Third stage evaluation was performed on 365 children in the three level III centers of the region, allowing identification of 70 children with unilateral (40%) or bilateral (60%) hearing loss, with a prevalence of 1.6/1000. CONCLUSIONS: The analysis of 2016 UNHS in the Lazio region allowed identification of several strengths and weaknesses of the initial phase of the program. The strengths include a correct spread and monitoring of UNHS among Level I facilities, with an adequate coverage rate, and the proper execution of audiological monitoring and diagnosis among Level III facilities. Weakness, instead, mainly consisted in lack of an efficient and automated central process for collecting, monitoring and reporting of data and information.

EEG activity as an objective measure of cognitive load during effortful listening: A study on pediatric subjects with bilateral, asymmetric sensorineural hearing loss.

OBJECTIVES: Deaf subjects with hearing aids or cochlear implants generally find it challenging to understand speech in noisy environments where a great deal of listening effort and cognitive load are invested. In prelingually deaf children, such difficulties may have detrimental consequences on the learning process and, later in life, on academic performance. Despite the importance of such a topic, currently, there is no validated test for the assessment of cognitive load during audiological tasks. Recently, alpha and theta EEG rhythm variations in the parietal and frontal areas, respectively, have been used as indicators of cognitive load in adult subjects. The aim of the present study was to investigate, by means of EEG, the cognitive load of pediatric subjects affected by asymmetric sensorineural hearing loss as they were engaged in a speech-in-noise identification task. METHODS: Seven children (4F and 3M, age range = 8-16 years) affected by asymmetric sensorineural hearing loss (i.e. profound degree on one side, mild-to-severe degree on the other side) and using a hearing aid only in their better ear, were included in the study. All of them underwent EEG recording during a speech-in-noise identification task: the experimental conditions were quiet, binaural noise, noise to the better hearing ear and noise to the poorer hearing ear. The subjects' Speech Recognition Thresholds (SRT) were also measured in each test condition. The primary outcome measures were: frontal EEG Power Spectral Density (PSD) in the theta band and parietal EEG PSD in the alpha band, as assessed before stimulus (word) onset. RESULTS: No statistically significant differences were noted among frontal theta power levels in the four test conditions. However, parietal alpha power levels were significantly higher in the "binaural noise" and in the "noise to worse hearing ear" conditions than in the "quiet" and "noise to better hearing ear" conditions (p < 0.001). SRT scores were consistent with task difficulty, but did not correlate with alpha and theta power level variations. CONCLUSION: This is the first time that EEG has been applied to children with sensorineural hearing loss with the purpose of studying the cognitive load during effortful listening. Significantly higher parietal alpha power levels in two of three noisy conditions, compared to the quiet condition, are consistent with increased cognitive load. Specifically, considering the time window of the analysis (pre-stimulus), parietal alpha power levels may be a measure of cognitive functions such as sustained attention and selective inhibition. In this respect, the significantly lower parietal alpha power levels in the most challenging listening condition (i.e. noise to the better ear) may be attributed to loss of attention and to the subsequent fatigue and "withdrawal" from the task at hand.

Bimodal Stimulation in Prelingually Deaf Children: Lessons from a Cross-sectional Survey.

OBJECTIVE: (1) To survey the use of bimodal stimulation by prelingually deaf children receiving unilateral cochlear implantation and (2) to investigate demographic and audiologic factors explaining the use of bimodal stimulation. STUDY DESIGN: Cross-sectional survey. SETTING: Tertiary care institution. SUBJECTS AND METHODS: The study included 44 unilaterally implanted prelingually deaf children from a single institution, with a minimum follow-up of 1 year. During routine follow-up visits, an examiner interviewed parents on their children's use of bimodal stimulation. At the same time, residual hearing and hearing aid gain in the contralateral ear were assessed. RESULTS: Approximately half of patients (52%) used bimodal stimulation. On average, bimodal users showed better mean unaided and aided thresholds than nonbimodal users (P < .001). A mean 250- to 500-Hz unaided threshold ≤90 dB HL in the contralateral, nonimplanted ear was associated with a higher probability of bimodal use (P = .008). Parental satisfaction with the contralateral hearing aid was inversely correlated with mean 125- to 500-Hz and 1000- to 4000-Hz unaided thresholds (P < .001) and mean 250- to 500-Hz and 1000- to 4000-Hz aided thresholds (P < .001). CONCLUSIONS: A mean 250- to 500-Hz unaided threshold ≤90 dB HL is associated with a higher probability of bimodal use by prelingually deaf children. Better residual hearing is associated with a higher degree of parental satisfaction with the contralateral hearing aid. This information could be useful to counsel parents of prelingually deaf children, when deciding between bimodal stimulation and simultaneous bilateral cochlear implantation.

Prelingual auditory-perceptual skills as indicators of initial oral language development in deaf children with cochlear implants.

OBJECTIVES: To assess when prelingually deaf children with a cochlear implant (CI) achieve the First Milestone of Oral Language, to study the progression of their prelingual auditory skills in the first year after CI and to investigate a possible correlation between such skills and the timing of initial oral language development. METHODS: The sample included 44 prelingually deaf children (23 M and 21 F) from the same tertiary care institution, who received unilateral or bilateral cochlear implants. Achievement of the First Milestone of Oral Language (FMOL) was defined as speech comprehension of at least 50 words and speech production of a minimum of 10 words, as established by administration of a validated Italian test for the assessment of initial language competence in infants. Prelingual auditory-perceptual skills were assessed over time by means of a test battery consisting of: the Infant Toddler Meaningful Integration Scale (IT-MAIS); the Infant Listening Progress Profile (ILiP) and the Categories of Auditory Performance (CAP). RESULTS: On average, the 44 children received their CI at 24±9 months and experienced FMOL after 8±4 months of continuous CI use. The IT-MAIS, ILiP and CAP scores increased significantly over time, the greatest improvement occurring between baseline and six months of CI use. On multivariate regression analysis, age at diagnosis and age at CI did not appear to bear correlation with FMOL timing; instead, the only variables contributing to its variance were IT-MAIS and ILiP scores after six months of CI use, accounting for 43% and 55%, respectively. CONCLUSION: Prelingual auditory skills of implanted children assessed via a test battery six months after CI treatment, can act as indicators of the timing of initial oral language development. Accordingly, the period from CI switch-on to six months can be considered as a window of opportunity for appropriate intervention in children failing to show the expected progression of their auditory skills and who would have higher risk of delayed oral language development.

Experience Changes How Emotion in Music Is Judged: Evidence from Children Listening with Bilateral Cochlear Implants, Bimodal Devices, and Normal Hearing.

Children using unilateral cochlear implants abnormally rely on tempo rather than mode cues to distinguish whether a musical piece is happy or sad. This led us to question how this judgment is affected by the type of experience in early auditory development. We hypothesized that judgments of the emotional content of music would vary by the type and duration of access to sound in early life due to deafness, altered perception of musical cues through new ways of using auditory prostheses bilaterally, and formal music training during childhood. Seventy-five participants completed the Montreal Emotion Identification Test. Thirty-three had normal hearing (aged 6.6 to 40.0 years) and 42 children had hearing loss and used bilateral auditory prostheses (31 bilaterally implanted and 11 unilaterally implanted with contralateral hearing aid use). Reaction time and accuracy were measured. Accurate judgment of emotion in music was achieved across ages and musical experience. Musical training accentuated the reliance on mode cues which developed with age in the normal hearing group. Degrading pitch cues through cochlear implant-mediated hearing induced greater reliance on tempo cues, but mode cues grew in salience when at least partial acoustic information was available through some residual hearing in the contralateral ear. Finally, when pitch cues were experimentally distorted to represent cochlear implant hearing, individuals with normal hearing (including those with musical training) switched to an abnormal dependence on tempo cues. The data indicate that, in a western culture, access to acoustic hearing in early life promotes a preference for mode rather than tempo cues which is enhanced by musical training. The challenge to these preferred strategies during cochlear implant hearing (simulated and real), regardless of musical training, suggests that access to pitch cues for children with hearing loss must be improved by preservation of residual hearing and improvements in cochlear implant technology.

Mental workload estimations in unilateral deafened children.

Despite of technological innovations, noisy environments still constitute a challenging and stressful situation for words recognition by hearing impaired subjects. The evaluation of the mental workload imposed by the noisy environments for the recognition of the words in prelingually deaf children is then of paramount importance since it could affect the speed of the learning process during scholar period.The aim of the present study was to investigate different electroencephalographic (EEG) power spectral density (PSD) components (in theta 4-8 Hz - and alpha - 8-12 Hz - frequency bands) to estimate the mental workload index in different noise conditions during a word recognition task in prelingually deaf children, a population not yet investigated in relation to the workload index during auditory tasks. A pilot study involving a small group of prelingually deaf children was then subjected to EEG recordings during an auditory task composed by a listening and a successive recognition of words with different noise conditions. Results showed that in the pre-word listening phase frontal EEG PSD in theta band and the ratio of the frontal EEG PSD in theta band and the parietal EEG PSD in alpha band (workload index; IWL) reported highest values in the most demanding noise condition. In addition, in the phase preceding the word forced-choice task the highest parietal EEG PSD in alpha band and IWL values were reported at the presumably simplest condition (noise emitted in correspondence of the subject's deaf ear). These results could suggest the prominence of EEG PSD theta component activity in the pre-word listening phase. In addition, a more challenging noise situation in the pre-choice phase would be so "over-demanding" to fail to enhance both the alpha power and the IWL in comparison to the already demanding "simple" condition.