Impact of Hearing Aids on Language Outcomes in Preschool Children With Mild Bilateral Hearing Loss.

This study aimed to investigate the role of hearing aid (HA) usage in language outcomes among preschool children aged 3-5 years with mild bilateral hearing loss (MBHL). The data were retrieved from a total of 52 children with MBHL and 30 children with normal hearing (NH). The association between demographical, audiological factors and language outcomes was examined. Analyses of variance were conducted to compare the language abilities of HA users, non-HA users, and their NH peers. Furthermore, regression analyses were performed to identify significant predictors of language outcomes. Aided better ear pure-tone average (BEPTA) was significantly correlated with language comprehension scores. Among children with MBHL, those who used HA outperformed the ones who did not use HA across all linguistic domains. The language skills of children with MBHL were comparable to those of their peers with NH. The degree of improvement in audibility in terms of aided BEPTA was a significant predictor of language comprehension. It is noteworthy that 50% of the parents expressed reluctance regarding HA use for their children with MBHL. The findings highlight the positive impact of HA usage on language development in this population. Professionals may therefore consider HAs as a viable treatment option for children with MBHL, especially when there is a potential risk of language delay due to hearing loss. It was observed that 25% of the children with MBHL had late-onset hearing loss. Consequently, the implementation of preschool screening or a listening performance checklist is recommended to facilitate early detection.

The Influence of Forced Social Isolation on the Auditory Ecology and Psychosocial Functions of Listeners With Cochlear Implants During COVID-19 Mitigation Efforts.

OBJECTIVES: The impact of social distancing on communication and psychosocial variables among individuals with hearing impairment during COVID-19 pandemic. It was our concern that patients who already found themselves socially isolated (Wie et al. 2010) as a result of their hearing loss would be perhaps more susceptible to changes in their communication habits resulting in further social isolation, anxiety, and depression. We wanted to better understand how forced social isolation (as part of COVID-19 mitigation) effected a group of individuals with hearing impairment from an auditory ecology and psychosocial perspective. We hypothesized that the listening environments would be different as a result of social isolation when comparing subject's responses regarding activities and participation before COVID-19 and during the COVID-19 pandemic. This change would lead to an increase in experienced and perceived social isolation, anxiety, and depression. DESIGN: A total of 48 adults with at least 12 months of cochlear implant (CI) experience reported their listening contexts and experiences pre-COVID and during-COVID using Ecological Momentary Assessment (EMA; methodology collecting a respondent's self-reports in their natural environments) through a smartphone-based app, and six paper and pencil questionnaires. The Smartphone app and paper-pencil questionnaires address topics related to their listening environment, social isolation, depression, anxiety, lifestyle and demand, loneliness, and satisfaction with amplification. Data from these two-time points were compared to better understand the effects of social distancing on the CI recipients' communication abilities. RESULTS: EMA demonstrated that during-COVID CI recipients were more likely to stay home or be outdoors. CI recipients reported that they were less likely to stay indoors outside of their home relative to the pre-COVID condition. Social distancing also had a significant effect on the overall signal-to-noise ratio of the environments indicating that the listening environments had better signal-to-noise ratios. CI recipients also reported better speech understanding, less listening effort, less activity limitation due to hearing loss, less social isolation due to hearing loss, and less anxiety due to hearing loss. Retrospective questionnaires indicated that social distancing had a significant effect on the social network size, participant's personal image of themselves, and overall loneliness. CONCLUSIONS: Overall, EMA provided us with a glimpse of the effect that forced social isolation has had on the listening environments and psychosocial perspectives of a select number of CI listeners. CI participants in this study reported that they were spending more time at home in a quieter environments during-COVID. Contrary to our hypothesis, CI recipients overall felt less socially isolated and reported less anxiety resulting from their hearing difficulties during-COVID in comparison to pre-COVID. This, perhaps, implies that having a more controlled environment with fewer speakers provided a more relaxing listening experience.

Early Intervention, Parent Talk, and Pragmatic Language in Children With Hearing Loss.

BACKGROUND AND OBJECTIVES: Pragmatic language skills form the foundation for conversational competence, whereas deficits in this area are associated with behavioral problems and low literacy skills. Children who are deaf or hard of hearing demonstrate significant delays in this critical area of language. Our purpose with this research was to identify variables associated with pragmatic language ability in children who are deaf or hard of hearing. METHODS: This was a longitudinal study of 124 children with bilateral hearing loss between 4 and 7 years of age living in Colorado. As part of a comprehensive speech and language assessment, pragmatic language skills were evaluated annually by using the Pragmatics Checklist. RESULTS: The children's pragmatic skills increased significantly with age. Higher levels of pragmatic language ability at 7 years of age were predicted by (1) meeting Early Hearing Detection and Intervention 1-3-6 guidelines (hearing screening by 1 month, identification of hearing loss by 3 months, and receiving intervention by 6 months of age), (2) greater quantity of parent talk, (3) higher nonverbal intelligence, (4) lesser degrees of hearing loss, and (5) higher maternal education. CONCLUSIONS: With the findings of this study, we underscore the importance of pediatricians and other health care professionals counseling parents about the value of adherence to the Early Hearing Detection and Intervention 1-3-6 guidelines with regard to intervention outcomes. The strong association between amount of child-directed parent talk in the first 4 years of life and pragmatic language outcomes at 7 years of age emphasizes the need for professionals to encourage parents to talk to their children as much as possible.

The influence of age and language on developmental trajectory of theory of mind in children with cochlear implants.

OBJECTIVE: The present study investigates if children with cochlear implants (CI) are associated with delayed development of Theory of Mind (ToM) and the differences in gain of ToM ability with respect to age, language and other aspects of CI. METHODS: One-hundred-eleven children with participation of their hearing parents, aged between 36 months and 132 months, who had congenital profound bilateral deafness and were unilateral CI users; plus 99 healthy children underwent 'Peabody Picture Vocabulary' and 'Sally-Anne' tests. A total of 77 children with CI (mean age: 76.51 months, 31 girls and 46 boys) and 82 healthy children (mean age: 72.41 months, 47 girls and 35 boys) were included in the analyses. Analytic comparisons were created between the controls and children with CI and between subgroups of CI users by univariate and multivariate analysis. The effects of age of hearing aid use, age of CI surgery, duration of CI use, language scores and the presence of risk factors, early rehabilitation with hearing aid and CI on the ToM development were analyzed. RESULTS: The Sally-Anne test success rates of 67.1% were significantly higher in controls than that of children with CI (49.4%) (p < 0.05). The mean age difference of the children, who were successful in Sally-Anne test was 5.33 months in favor of healthy controls. The ToM task success rates were 57.1% (24/42) and 40% (14/35) in children with early CI and late CI respectively. The children, who were good at language, were also better in Sally-Anne tests, but the mean Peabody Picture Vocabulary test scores were indifferent in the same age group with respect to the presence of CI use (p > 0.05). However, multivariate analysis presented the higher language scores as the only significant independent variable that has impact on the success in Sally-Anne test (p < 0.05). CONCLUSION: The results revealed that among all children, who did better in ToM were older in age and better in language skills. Children with CI also performed better in false-belief test depending on their language scores. Early CI surgery, older age, and hence longer CI use can provide a well-developed ToM for children with CI.

Bilateral bone conduction stimulation provides reliable binaural cues for localization.

This study aimed to characterize binaural hearing abilities with bone conduction stimulation in simulated conductive hearing loss. Bone conduction hearing devices (BCDs) are a common method of rehabilitating conductive hearing loss. However, little is known about the access these devices provide to binaural cues. To study the ability of BCDs to restore access to binaural cues in conductive loss, normal hearing listeners were plugged unilaterally and bilaterally and localization ability was assessed using a non-surgical BCD attached to the mastoid/s via an adhesive (MED-EL, Corp). The results demonstrate that 1) application of the BCD in simulated unilateral conductive hearing loss does not restore access to binaural cues, evidenced by poor localization abilities. 2) bilateral application of BCDs in simulated bilateral conductive hearing loss provides access to binaural cues, 2) unilateral application of BCDs in simulated bilateral conductive hearing loss disrupts these cues and impairs localization performance, The transcutaneous stimulation of the adhesive BCD resulted in decreased access to sound compared to the normal open ear, resulting in asymmetries in aided versus non-aided hearing thresholds. Symmetrical hearing results in improved localization abilities, while asymmetric hearing disrupts sound localization abilities.

Contributions to Speech-Cue Weighting in Older Adults With Impaired Hearing.

Purpose In a previous paper (Souza, Wright, Blackburn, Tatman, & Gallun, 2015), we explored the extent to which individuals with sensorineural hearing loss used different cues for speech identification when multiple cues were available. Specifically, some listeners placed the greatest weight on spectral cues (spectral shape and/or formant transition), whereas others relied on the temporal envelope. In the current study, we aimed to determine whether listeners who relied on temporal envelope did so because they were unable to discriminate the formant information at a level sufficient to use it for identification and the extent to which a brief discrimination test could predict cue weighting patterns. Method Participants were 30 older adults with bilateral sensorineural hearing loss. The first task was to label synthetic speech tokens based on the combined percept of temporal envelope rise time and formant transitions. An individual profile was derived from linear discriminant analysis of the identification responses. The second task was to discriminate differences in either temporal envelope rise time or formant transitions. The third task was to discriminate spectrotemporal modulation in a nonspeech stimulus. Results All listeners were able to discriminate temporal envelope rise time at levels sufficient for the identification task. There was wide variability in the ability to discriminate formant transitions, and that ability predicted approximately one third of the variance in the identification task. There was no relationship between performance in the identification task and either amount of hearing loss or ability to discriminate nonspeech spectrotemporal modulation. Conclusions The data suggest that listeners who rely to a greater extent on temporal cues lack the ability to discriminate fine-grained spectral information. The fact that the amount of hearing loss was not associated with the cue profile underscores the need to characterize individual abilities in a more nuanced way than can be captured by the pure-tone audiogram.

Hearing Aid Use and Auditory Verbal Therapy Improve Voice Quality of Deaf Children.

BACKGROUND: Adequate phonation is self-regulated by auditory feedback. Children with bilateral profound hearing loss (PHL) lack this feedback resulting in abnormal voice. Adequate hearing aid use and auditory-verbal therapy (AVT) may improve voice quality in deaf children. OBJECTIVE: To study whether hearing aid use and AVT approach improve acoustic parameters of voice of children with bilateral PHL. MATERIALS AND METHODS: Nineteen children with bilateral PHL were studied. Age range 2-5 years (X = 53.04 months; SD = 9.54). All children were fitted with hearing aids according to auditory testing and they underwent a 1-year auditory habilitation period using the AVT approach. Acoustic analysis of voice including F0, shimmer, and jitter was performed at the onset and at the end of the auditory habilitation period. Final acoustic data were compared to a matched control group of 19 children, age range 2-5 years (X = 52.85; SD = 9.74) with normal hearing. RESULTS: Mean fundamental frequency (F0) was significantly increased after AVT intervention. Shimmer and jitter significantly (P < 0.05) improved after the intervention period. However, despite the improvements, mean F0 at the end of the intervention period was still significantly (P < 0.05) decreased as compared to controls. Also, mean shimmer and jitter at the end of the habilitation period were still significantly (P < 0.05) higher as compared to controls. CONCLUSIONS: The results of this preliminary study suggest that hearing aid use and auditory habilitation with AVT approach improved acoustic voice parameters of children with PHL. However, acoustic parameters persisted abnormal as compared to matched normal hearing controls. AVT approach and regular hearing aid use seem to be safe and reliable clinical tools for improving voice quality of children with PFL.

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.

Quality of Life in Children with Sensorineural Hearing Loss.

OBJECTIVE: To assess quality of life (QOL) in pediatric patients with sensorineural hearing loss (SNHL) with the Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0) and the Hearing Environments and Reflection on Quality of Life 26 (HEAR-QL-26) and HEAR-QL-28 surveys. STUDY DESIGN: Prospective longitudinal study. SETTING: Tertiary care center. SUBJECTS AND METHODS: Surveys were administered to patients with SNHL (ages 2-18 years) from July 2016 to December 2018 at a multidisciplinary hearing loss clinic. Patients aged >7 years completed the HEAR-QL-26, HEAR-QL-28, and PedsQL 4.0 self-report tool, while parents completed the PedsQL 4.0 parent proxy report for children aged ≤7 years. Previously published data from children with normal hearing were used for controls. The independent t test was used for analysis. RESULTS: In our cohort of 100 patients, the mean age was 7.7 years (SD, 4.5): 62 participants had bilateral SNHL; 63 had mild to moderate SNHL; and 37 had severe to profound SNHL. Sixty-eight patients used a hearing device. Mean (SD) total survey scores for the PedsQL 4.0 (ages 2-7 and 8-18 years), HEAR-QL-26 (ages 7-12 years), and HEAR-QL-28 (ages 13-18 years) were 83.9 (14.0), 79.2 (11.1), 81.2 (9.8), and 77.5 (11.3), respectively. Mean QOL scores for patients with SNHL were significantly lower than those for controls on the basis of previously published normative data (P < .0001). There was no significant difference in QOL between children with unilateral and bilateral SNHL or between children with SNHL who did and did not require a hearing device. Low statistical power due to small subgroup sizes limited our analysis. CONCLUSION: It is feasible to collect QOL data from children with SNHL in a hearing loss clinic. Children with SNHL had significantly lower scores on validated QOL instruments when compared with peers with normal hearing.

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.

Cochlear implants in single-sided deafness - clinical results of a Swiss multicentre study.

AIM OF THE STUDY: The aim of this multicentre, prospective, open, nonrandomised clinical trial was to demonstrate the clinical efficiency and outcomes of cochlear implants (CIs) in adult patients with post-lingual single-sided deafness (SSD). METHODS: A group of five left and five right SSD participants were investigated with various clinical tests and questionnaires before and 12 months after CI activation. Changes in hearing thresholds, speech understanding in noise, sound localisation, tinnitus (Tinnitus Handicap Inventory; THI), subjective hearing ability (Speech, Spatial and Qualities of Hearing Scale; SSQ), and quality of life (WHOQOL-BREF) were assessed. In addition, the pre- and postoperative results of the SSD patients were compared with an age- and gender-matched normal hearing control group. RESULTS: Surgery was uncomplicated in all patients. Two years after implantation, 9 of the 10 patients used their CI regularly for an average of more than 11 hours a day. A significant improvement in speech understanding in noise measured in the sound field using the Oldenburg sentence test could be demonstrated in the two situations in which patients with SSD experience the greatest difficulty: speech from the front and noise at the healthy ear, and speech to the implanted ear and noise from the front. The sound localisation test showed significant improvement of the mean localisation error and the root mean square error after CI activation. Furthermore, a significant reduction of the THI was measured, and the SSQ showed a significant improvement in the subscale speech comprehension and in the subscale spatial hearing. Also, quality of life measured with the WHOQOL-BREF showed a general improvement, which was significant in the global subscale. For this questionnaire, there was no significant difference between the normal-hearing control group and the patients after 12 months of CI use. CONCLUSION: This study confirmed the clinical benefit of cochlear implantation in patients with SSD. The significant improvement of speech understanding in noise, sound localisation, tinnitus perception, subjective hearing ability, and in particular the improved quality of life support the recommendation that patients with recently acquired SSD should be offered a CI. (Clinical trial registration number on clinicaltrial.gov: NCT01749592).

Sequential stream segregation with bilateral cochlear implants.

Sequential stream segregation on the basis of binaural 'ear-of-entry', modulation rate and electrode place-of-stimulation cues was investigated in bilateral cochlear implant (CI) listeners using a rhythm anisochrony detection task. Sequences of alternating 'A' and 'B' bursts were presented via direct electrical stimulation and comprised either an isochronous timing structure or an anisochronous structure that was generated by delaying just the 'B' bursts. 'B' delay thresholds that enabled rhythm anisochrony detection were determined. Higher thresholds were assumed to indicate a greater likelihood of stream segregation, resulting specifically from stream integration breakdown. Results averaged across subjects showed that thresholds were significantly higher when monaural 'A' and 'B' bursts were presented contralaterally rather than ipsilaterally, and that diotic presentation of 'A', with a monaural 'B', yielded intermediate thresholds. When presented monaurally and ipsilaterally, higher thresholds were also found when successive bursts had mismatched rather than matched modulation rates. In agreement with previous studies, average delay thresholds also increased as electrode separation between bursts increased when presented ipsilaterally. No interactions were found between ear-of-entry, modulation rate and place-of-stimulation. However, combining moderate electrode difference cues with either diotic-'A' ear-of-entry cues or modulation-rate mismatch cues did yield greater threshold increases than observed with any of those cues alone. The results from the present study indicate that sequential stream segregation can be elicited in bilateral CI users by differences in the signal across ears (binaural cues), in modulation rate (monaural cues) and in place-of-stimulation (monaural cues), and that those differences can be combined to further increase segregation.

Improving Localization and Speech Reception in Noise for Bilateral Cochlear Implant Recipients.

This study looked at different methods to preserve interaural level difference (ILD) cues for bilateral cochlear implant (BiCI) recipients. One possible distortion to ILD is from automatic gain control (AGC). Localization accuracy of BiCI recipients using default versus increased AGC threshold and linked AGCs versus independent AGCs was examined. In addition, speech reception in noise was assessed using linked versus independent AGCs and enabling and disabling Autosensitivity™ Control. Subjective information via a diary and questionnaire was also collected about maps with linked and independent AGCs during a take-home experience. Localization accuracy improved in the increased AGC threshold and the linked AGCs conditions. Increasing the AGC threshold resulted in a 4° improvement in root mean square error averaged across all speaker locations. Using linked AGCs, BiCI participants experienced an 8° improvement for all speaker locations and a 19° improvement at the speaker location most affected by the AGC. Speech reception threshold in noise improved by an average of 2.5 dB when using linked AGCs versus independent AGCs. In addition, the effect of linked AGCs on speech in noise was compared with that of Autosensitivity™ Control. The Speech, Spatial, and Qualities of Hearing Scale-12 question comparative survey showed an improvement when using maps with linked AGCs. These findings support the hypothesis that ILD cues may be preserved by increasing the AGC threshold or linking AGCs.

Remote microphone systems for preschool-age children who are hard of hearing: access and utilization.

OBJECTIVES: Children who are hard of hearing (CHH) have restricted access to auditory-linguistic information. Remote-microphone (RM) systems reduce the negative consequences of limited auditory access. The purpose of this study was to characterise receipt and use of RM systems in young CHH in home and school settings. DESIGN: Through a combination of parent, teacher, and audiologist report, we identified children who received RM systems for home and/or school use by 4 years of age or younger. With cross-sectional surveys, parents estimated the amount of time the child used RM systems at home and school per day. STUDY SAMPLE: The participants included 217 CHH. RESULTS: Thirty-six percent of the children had personal RMs for home use and 50% had RM systems for school. Approximately, half of the parents reported that their children used RM systems for home use for 1-2 hours per use and RM systems for school use for 2-4 hours per day. CONCLUSIONS: Results indicated that the majority of the CHH in the current study did not receive RM systems for home use in early childhood, but half had access to RM technology in the educational setting. High-quality research studies are needed to determine ways in which RM systems benefit pre-school-age CHH.

Wireless binaural hearing aid technology for telephone use and listening in wind noise.

OBJECTIVE: To assess the speech perception benefits of binaural streaming technology for bilateral hearing aid users in two difficult listening conditions. DESIGN: Two studies were conducted to compare hearing aid processing features relating to telephone use and wind noise. Speech perception testing was conducted in four different experimental conditions in each study. STUDY SAMPLE: Ten bilaterally-aided children in each study. RESULTS: Significant improvements in speech perception were obtained with a wireless feature for telephone use. Significant speech perception benefits were also obtained with wireless hearing aid features when listening to speech in simulated wind noise. CONCLUSIONS: Binaural signal processing algorithms can significantly improve speech perception for bilateral hearing aid users in challenging listening situations.

Differential effects of hearing impairment and age on electrophysiological and behavioral measures of speech in noise.

Understanding speech in background noise is difficult for many listeners with and without hearing impairment (HI). This study investigated the effects of HI on speech discrimination and recognition measures as well as speech-evoked cortical N1-P2 and MMN auditory event-related potentials (AERPs) in background noise. We aimed to determine which AERP components can predict the effects of HI on speech perception in noise across adult listeners with and without HI. The data were collected from 18 participants with hearing thresholds ranging from within normal limits to bilateral moderate-to-severe sensorineural hearing loss. Linear mixed effects models were employed to examine how hearing impairment, age, stimulus type, and SNR listening condition affected neural and behavioral responses and what AERP components were correlated with effects of HI on speech-in-noise perception across participants. Significant effects of age were found on the N1-P2 but not on MMN, and significant effects of HI were observed on the MMN and behavioral measures. The results suggest that neural responses reflecting later cognitive processing of stimulus discrimination may be more susceptible to the effects of HI on the processing of speech in noise than earlier components that signal the sensory encoding of acoustic stimulus features. Objective AERP responses were also potential neural predictors of speech perception in noise across participants with and without HI, which has implications for the use of AERPs as a potential clinical tool for assessing speech perception in noise.

A "Buildup" of Speech Intelligibility in Listeners With Normal Hearing and Hearing Loss.

The perception of simple auditory mixtures is known to evolve over time. For instance, a common example of this is the "buildup" of stream segregation that is observed for sequences of tones alternating in pitch. Yet very little is known about how the perception of more complicated auditory scenes, such as multitalker mixtures, changes over time. Previous data are consistent with the idea that the ability to segregate a target talker from competing sounds improves rapidly when stable cues are available, which leads to improvements in speech intelligibility. This study examined the time course of this buildup in listeners with normal and impaired hearing. Five simultaneous sequences of digits, varying in length from three to six digits, were presented from five locations in the horizontal plane. A synchronized visual cue at one location indicated which sequence was the target on each trial. We observed a buildup in digit identification performance, driven primarily by reductions in confusions between the target and the maskers, that occurred over the course of three to four digits. Performance tended to be poorer in listeners with hearing loss; however, there was only weak evidence that the buildup was diminished or slowed in this group.

Cognitive outcomes after cochlear implantation in older adults: A systematic review.

OBJECTIVES: To critically assess the current status of the literature on cognitive outcomes after cochlear implantation in older adults. METHODS: Studies were identified by searching MEDLINE (PubMed) and Cochrane Library, and checking reference lists of relevant articles. No restrictions were imposed regarding language, publication date, or publication status. Eligibility criteria were as follows: (1) the study sample included older adults aged 50 or over with severe to profound bilateral hearing loss, (2) the participants received a multi-electrode cochlear implant, and (3) a cognitive test was performed before and after implantation. Risk of bias was assessed with respect to: (A) the suitability of the cognitive tests to examine cognition in hearing-impaired (HI) subjects, (B) the control of practice effects, (C) statistical methods, and (D) other sources of bias. RESULTS: Out of 2716 retrieved records, 6 were found eligible, examining a total of 166 patients. Five of these studies reported improvements in cognition postimplantation and one study did not observe significant changes. Control of practice effects and the statistical methods were the most common origin of observed bias. DISCUSSION: The currently reviewed studies performed pioneering work and are indispensable for the field. However, they do not provide conclusive evidence of improved cognitive outcomes after cochlear implantation in older adults. CONCLUSION: Well-designed studies with long follow-up periods are imperative to verify whether cochlear implantation influences cognition in older adults. New research is stimulated to use appropriate cognitive assessment tools for HI individuals, to control for practice effects, and to perform appropriate statistical tests.

Patterns of Aided Loudness Growth in Experienced Adult Listeners with Early-Onset Severe-Profound Hearing Loss.

BACKGROUND: Individuals with early-onset severe-profound bilateral hearing loss (S/PHL) manifest diverse levels of benefit and satisfaction with hearing aids (HAs), even with prescriptive HA fitting. Such fittings incorporate normal loudness values, but little is known about aided loudness outcomes in this population and how those outcomes affect benefit or satisfaction. PURPOSE: To describe aided loudness growth and satisfaction with aided listening in experienced adult HA users with S/PHL. RESEARCH DESIGN: The Contour Test of loudness perception was administered to listeners with S/PHL in the aided sound field using broadband speech, band-limited speech, and warble tones. Patterns and slopes of resultant loudness growth functions were referenced to sound field results from listeners with normal hearing (NH). S/PHL listeners also rated their aided listening satisfaction. It was expected that (1) most S/PHL listeners would demonstrate steeper than normal aided loudness growth, (2) loudness normalization would be associated with better high-frequency detection thresholds and speech recognition, and (3) closer approximation to normal would yield greater satisfaction. STUDY SAMPLE: Participants were paid college-student volunteers: 23 with S/PHL, long-term aided listening experience, and new HAs; 15 with NH. DATA COLLECTION AND ANALYSIS: Participants rated loudness on four ascending runs per stimulus (5-dB increments) using categories defined in 1997 by Cox and colleagues. The region between the 10th and 90th percentiles of the NH distribution constituted local norms against which location and slope of the S/PHL functions were examined over the range from Quiet to Loud-but-OK. S/PHL functions were categorized on the basis of their configurations (locations/slopes) relative to the norms. RESULTS: Pattern of aided loudness was normalized or within 5 dB of the normal region on 37% of trials with sufficient data for analysis. Only one of the 23 S/PHL listeners did not demonstrate Normal/Near-normal loudness on any trials. Four nonnormal patterns were identified: Steep (recruitment-like; 38% of trials); Shifted right, with normal growth rate (10%); Hypersensitive, with most intensities louder than normal (10%); and Shallow, with decreasing growth rate (7%). Listeners with high-frequency average thresholds above 100 dB hearing loss or no phonemic-based speech-discrimination skill were less likely to display normalized loudness. Slope was within norms for 52% of S/PHL trials, most also having a Normal/Near-normal growth pattern. Regardless of measured loudness results, all but four listeners with S/PHL reported satisfactory hearing almost always or most of the time with their HAs in designated priority need areas. CONCLUSIONS: The variety of aided loudness growth patterns identified reflects the diversity known to characterize individuals with early-onset S/PHL. Loudness rating at the validation stage of HA fit with these listeners is likely to reveal nonnormal loudness, signaling need for further HA adjustment. High satisfaction, however, despite nonnormal loudness growth, suggests that listeners with poor auditory speech recognition may benefit more from aided loudness that supports pattern perception (via the time-intensity waveform of speech), different from most current-day prescription fits.