Aligning Hearing Aid and Cochlear Implant Improves Hearing Outcome in Bimodal Cochlear Implant Users.

OBJECTIVE: Patients with unilateral deafness and residual hearing on the contralateral ear can benefit from a cochlear implant (CI) on one side and a hearing aid (HA) on the other. However, hearing improvement among these patients is heterogenous. Interindividual differences in bimodal benefit may be caused by a mismatch of CI and HA. The aim of this study was to clinically apply a HA fitting strategy and to evaluate hearing outcome with and without a dedicated bimodal fitting formula. STUDY DESIGN: Prospective non-randomized study. SETTING: Tertiary referral center. PATIENTS: Twelve patients using a CI processor and a conventional HA were enrolled. Before and after the new HA had been adjusted to the patient and linked to the CI, pure-tone audiometry and localization tests were performed. Speech perception was determined in quiet and noise. Tests were repeated after 6 and 12 weeks. To evaluate the subjective listening comfort two questionnaires (Oldenburg Inventory and HISQUI19) were assessed. INTERVENTION: Therapeutic. RESULTS MAIN OUTCOME MEASURE: Word recognition in quiet, sentence recognition in noise. Speech perception in noise improved significantly: directed suppression of noise helped to segregate the target speech signal from a mixture of sounds or competing speakers. Evaluation of the questionnaires revealed a positive subjective hearing experience compared with patients' initial settings of the devices. CONCLUSION: By linking CI and HA hearing and speech perception can be improved. However, good counselling at the outset is essential to obtain enhanced outcome.

[Multicentric analysis of the use behavior of cochlear implant users]. / Multizentrische Analyse des Nutzerverhaltens von Cochlea-Implantat-Trägern.

INTRODUCTION: Novel cochlear implant speech processors are capable of storing data logs. With the help of this information a more individualized patient care can be provided. However, standard data are missing to a greater extent to the individual usage behavior. MATERIALS AND METHODS: In a retrospective study, the use data of 2687 patients were evaluated. All patients had the Nucleus 6 system from Cochlear Ltd. RESULTS: The data allow a normal range to be defined for the duration of use of cochlear implant speech processors. Likewise, the identification of conspicuous usage behavior is possible.

Multicentre Evaluation of the Naída CI Q70 Sound Processor: Feedback from Cochlear Implant Users and Professionals.

The aim of this survey was to gather data from both implant recipients and professionals on the ease of use of the Naída CI Q70 (Naída CI) sound processor from Advanced Bionics and on the usefulness of the new functions and features available. A secondary objective was to investigate fitting practices with the new processor. A comprehensive user satisfaction survey was conducted in a total of 186 subjects from 24 centres. In parallel, 23 professional questionnaires were collected from 11 centres. Overall, there was high satisfaction with the Naída CI processor from adults, children, experienced and new CI users as well as from professionals. The Naída CI processor was shown as being easy to use by all ages of recipients and by professionals. The majority of experienced CI users rated the Naída CI processor as being similar or better than their previous processor in all areas surveyed. The Naída CI was recommended by the professionals for fitting in all populations. Features like UltraZoom, ZoomControl and DuoPhone would not be fitted to very young children in contrast to adults. Positive ratings were obtained for ease of use, comfort and usefulness of the new functions and features of the Naída CI sound processor. Seventy-seven percent of the experienced CI users rated the new processor as being better than their previous sound processor from a general point of view. The survey also showed that fitting practices were influenced by the age of the user.

Influence of etiologic factors on speech perception of cochlear-implanted children.

OBJECTIVE: Rehabilitation success in cochlear implant patients is influenced by many factors. Influence of different etiologies of deafness on rehabilitation outcome is assessed. STUDY DESIGN: Retrospective survey of patients. SETTING: University hospital. Secondary referral center. PATIENTS: One hundred and sixty-three between 1996 and 2008 implanted children (0-18 years, mean 5.17 years). INTERVENTIONS: Evaluation of patients' data: origin of deafness, hearing and speech test results. Access Data Base; Wilcoxon and t-test. RESULTS: Mean follow-up: 65.4 months. Etiology of deafness in children found in 104 cases: 69 (51.9%) suffered from hereditary hearing loss. All children showed improvement in their auditory performance, children with connexin-26 mutation performed significantly best, Usher and CHARGE-syndrome children significantly worst. Post-meningitic and post-septic children developed slower but reached same levels later. DISCUSSION: Primary cause of deafness, among other factors, has a considerable impact on outcome of rehabilitation. This offers possibilities to influence the outcome by etiology-adjusted therapy modules.

Suitability of auditory speech sound evaluation (A§E®) in German cochlear implant patients.

A§E® is an audiological evaluation tool based on speech sounds as stimuli and was developed by The Eargroup, Antwerp. It consists of three levels: detection, discrimination and identification of phonemes and is a sufficient tool to measure supraliminal auditory capacities in Flemish language of children 10 months and older as well as adults. The aim of this study was to test the suitability of patients for cochlear implant in Germany, using 245 consecutive measurements (141 adults, 79 children, 25 controls) in a standard test protocol for phoneme detection and discrimination, Mainzer and Göttinger in children and Freiburger in adults pre-, 3 and 6 months and 1 year after implantation. Results in detection and discrimination regarding frequency spectrum and fitting parameters were evaluated using the following statistical methods: t test and correlation analysis. Detection improves first, followed by numbers, phoneme discrimination and monosyllables. Test results compared pre- to 3, 6 months and later, postoperatively, differ significantly (p < 0.05). A "ceiling-effect" is obtained between 6 months and 1 year (reproduction in A§E® >90%). Development of detection and discrimination correlates directly with results in numbers and monosyllables (r = 0.92). Non-German speaking patients cope better with A§E® than with numbers and monosyllables. Evaluation of phoneme discrimination enables better frequency specific fitting. Results indicated that A§E® is a valuable diagnostic supplement in fitting and therapy of cochlear implant patients regardless of cognitive level, age and language. Important information on frequency-resolving power of cochlear nerve after implantation is gained. Use of A§E® enables comparability and evaluation of study results in different countries.

Speech development after cochlear implantation in children from bilingual homes.

OBJECTIVE: The aim of this study was to investigate whether exposure to a second language in bilingual families influences the spoken German skills after cochlear implantation. A further question was how many children with migration background are bilingual. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center; cochlear implant program. PATIENTS: Ninety-three profoundly hearing-impaired children; 52 of these children reside in bilingual and 41 in monolingual homes. INTERVENTION: Cochlear implantation before the age of 6 years, speech and language skills assessments. MAIN OUTCOME MEASURES: Standard speech perception and receptive and expressive language measures. Data on used primary and secondary languages were obtained by questionnaire. RESULTS: Children growing up in bilingual homes performed worse than children from monolingual homes in all performed speech tests. Almost all children with bilingual parents indicated German as their main language. In some cases, the second language is used actively, but in most children, the use is limited to single words and expressions. However, some children from bilingual homes achieve high skill level in German language and, furthermore, develop competency in second spoken language. CONCLUSION: Advanced language skills including the learning of a second spoken language are possible for children with cochlear implant living in bilingual homes, but that is the exception rather than the rule. It seems that other factors, such as spoken German language skills of the parents, integration of the family, and compliance with the rehabilitation program, play an important role. Therefore, a special support for children with cochlear implants from bilingual homes is needed.