Intravenous methadone causes acute toxic and delayed inflammatory encephalopathy with persistent neurocognitive impairments.

BACKGROUND: The mu-opioid agonist methadone is administered orally and used in opioid detoxification and in the treatment of moderate-to-severe pain. Acute oral methadone-use and -abuse have been associated with inflammatory and toxic central nervous system (CNS) damage in some cases and cognitive deficits can develop in long-term methadone users. In contrast, reports of intravenous methadone adverse effects are rare. CASE PRESENTATION: Here, we report a patient who developed acute bilateral hearing loss, ataxia and paraparesis subsequently to intravenous methadone-abuse. While the patient gradually recovered from these deficits, widespread magnetic resonance imaging changes progressed and delayed-onset encephalopathy with signs of cortical dysfunction persisted. This was associated with changes in the composition of monocyte and natural killer cell subsets in the cerebrospinal fluid. CONCLUSION: This case suggests a potential bi-phasic primary toxic and secondary inflammatory CNS damage induced by intravenous methadone.

Changes in Tinnitus by Cochlear Implantation: A Parametric Study of the Effect of Single-Electrode Stimulation.

INTRODUCTION: While cochlear implantation may have a positive effect on tinnitus, it is not effective in reducing tinnitus in all patients. This may be due to different patients requiring different strategies of electrical stimulation in order to obtain a positive effect on tinnitus. It is, therefore, important to identify the most effective stimulation strategies to reduce tinnitus. The simplest possible strategy is stimulation by only one electrode. In this study, we investigated tinnitus suppression by electrical stimulation via a single electrode of the cochlear implant. METHODS: We performed a listening experiment in 19 adult participants, who had received a unilateral cochlear implant (CI) because of severe bilateral hearing loss. All of these patients had indicated that they suffered from tinnitus. During a 300-s interval, patients listened to blocks of single-electrode stimulation and rated the loudness of the stimulus and any effects on their tinnitus. The 300-s interval included a block of single-electrode stimulation (duration 120 s). In consecutive intervals, the stimulus differed in its cochlear location (basal or apical), its pulse rate (720 or 725 Hz, 1,200 Hz, and 2,400 or 2,320 Hz), and amplitude (just above threshold or equivalent to moderate loudness). Thus, 2 × 3 × 2 = 12 stimulus conditions were tested in each participant, and each condition was presented only once. During the experiment, the participants promptly rated the loudness of the stimuli and the loudness of their tinnitus on a Visual Analogue Scale (10-point VAS). RESULTS: Significantly more tinnitus reduction was observed with stimuli at a moderate intensity level (30%) compared to stimuli at near-threshold level (18%) (χ2 [1, N = 222] = 14.115, p < 0.01). No significant differences in tinnitus levels resulted from the different pulse rates and stimulation sites. Eight participants reported an increase of tinnitus loudness under at least one stimulus condition. Changes in tinnitus loudness were generally minor, and never exceeded 3 points on the VAS. The overall effect of cochlear implantation on tinnitus, that is, the effect with full-array stimulation, was not correlated with the effectiveness of the single-electrode stimulation on tinnitus. CONCLUSION: In conclusion, the effect of single-electrode stimulation on tinnitus is relatively insignificant in comparison to the effect of full-array stimulation. However, in some individual cases, sustained single-electrode stimulation may be beneficial for tinnitus management.

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.

Cochlear implantation after traumatic brain injury without otic capsule fracture: A case report and literature review.

OBJECTIVE: The aim of this study was to report a case of cochlear implantation (CI) for a patient with an otic capsule-sparing traumatic brain injury (TBI) and to review the relevant literature. METHODS: A patient with history of TBI received a CI for bilateral profound hearing loss. A systematic review of the literature was performed to identify and compare similar cases. RESULTS: A 36-year-old male with a history of hearing loss from right acute labyrinthitis was referred for bilateral profound sensorineural hearing loss (SNHL) after a fall with associated injury to the central auditory nervous system (CANS) including the brainstem. On the right, behavioral acoustic threshold measurements were in the profound range with absent OAEs. On the left, testing revealed no measurable behavioral acoustic thresholds and variable physiologic measures. A right unilateral cochlear implant was performed with most recent follow-up demonstrating speech awareness thresholds of 25 dB HL with excellent detection of all 6 Ling sounds. However, the patient also continues to suffer from other neurologic sequelae related to his TBI, which challenge his ability to demonstrate objective and subjective benefit. A systematic review of the literature demonstrates variable outcomes for patients with TBI and SNHL. CONCLUSIONS: Patients with profound SNHL and TBI present a distinct rehabilitative challenge for clinicians. CI may provide meaningful benefit in this population, though care should be taken in patient selection and counseling.

Evaluation of auditory temporal processing in patients fitted with bone-anchored hearing aids.

PURPOSE: The present study aimed to identify temporal processing abilities in users of bone-anchored hearing aid (BAHA). METHODS: Seventeen subjects with BAHA (SWB) users and 29 subjects with normal-hearing were compared using the frequency pattern test, duration pattern test, and speech-in-noise test. Besides behavioral temporal processing tests, a multi-feature mismatch negativity (MMN) test was performed in BAHA users to assess the accuracy of objective auditory discrimination at the cortical level, irrespective of the subjects' attention or behavioral task. RESULTS: The results of the multi-feature MMN test showed that BAHA users could perceive differences in frequency, duration, intensity. However, no response was elicited regarding localization of stimulus and gaps within tones. Word recognition performance in noise was significantly poorer compared with normal hearing groups. All age groups showed no differences in terms of temporal processing abilities except 30-39 years duration pattern ability weaker in SWB group. CONCLUSION: The present study was the first to indicate that the use of unilateral BAHA has no effect on the localization of auditory stimuli at the cortical level according to electrophysiological test. Although Baha users have near-normal levels of hearing thresholds and temporal ordering abilities with their devices, since they benefit from the unilateral device, they still have some difficulties in resolution, recognizing and distinguishing the spatial aspects of speech, especially in multiple and noisy listening environments.

Minimal invasive pocket technique for magnet bone implant hearing aid without fixation.

INTRODUCTION: The BAHA (bone-anchored hearing aid) Attract is a magnetic transcutaneous bone conduction device anchored into the temporal bone. The standard surgical technique for BAHA Attract is a multi-tools time-consuming process, which requires a large cutaneous incision. The objective of this study is to describe and test the feasibility of a minimally invasive pocket (MIP) technique for Magnet Bone Implant Hearing Aid (MBIHA) with a modified magnet of BAHA Attract without fixation and without any tissue reduction. We use a 3-cm vertical skin incision and a subperiosteal pocket. METHOD: A study of 10 patients with conductive or mixed hearing loss who benefited from a MBIHA using the MIP technique is presented. The pure tone average (PTA) (dB) for air-conduction thresholds and the speech recognition threshold (SRT) (dB) in speech audiometry in quiet are calculated. The Entific Medical Systems (EMS) questionnaire and the postoperative clinical outcomes are realized. RESULTS: We found a significant improvement of 33.8 dB on average for the PTA and 44.8 dB for the SRT with MBIHA at 3 months, compared with unaided situation. No implant was removed or displaced after 2 years of follow-up. The skin condition remains intact in all the cases. CONCLUSION: The minimally subperiosteal pocket surgical technique MIP without fixation and with tissue preservation for the MBIHA is safe, rapid and effective for patients with conductive or mixed hearing loss. It opens new perspectives of development and modify conventional concept in magnetic coupling of bone-conducted device.

The effect of an active transcutaneous bone conduction device on spatial release from masking.

Objective: The aim was to quantify the effect of the experimental active transcutaneous Bone Conduction Implant (BCI) on spatial release from masking (SRM) in subjects with bilateral or unilateral conductive and mixed hearing loss.Design: Measurements were performed in a sound booth with five loudspeakers at 0°, +/-30° and +/-150° azimuth. Target speech was presented frontally, and interfering speech from either the front (co-located) or surrounding (separated) loudspeakers. SRM was calculated as the difference between the separated and the co-located speech recognition threshold (SRT).Study Sample: Twelve patients (aged 22-76 years) unilaterally implanted with the BCI were included.Results: A positive SRM, reflecting a benefit of spatially separating interferers from target speech, existed for all subjects in unaided condition, and for nine subjects (75%) in aided condition. Aided SRM was lower compared to unaided in nine of the subjects. There was no difference in SRM between patients with bilateral and unilateral hearing loss. In aided situation, SRT improved only for patients with bilateral hearing loss.Conclusions: The BCI fitted unilaterally in patients with bilateral or unilateral conductive/mixed hearing loss seems to reduce SRM. However, data indicates that SRT is improved or maintained for patients with bilateral and unilateral hearing loss, respectively.

Cortical deafness of following bilateral temporal lobe stroke.

Cortical deafness is an extremely rare clinical manifestation that originates mainly from bilateral cortical lesions in the primary auditory cortex. Its main clinical manifestation is the bilateral sudden loss of hearing. Diagnosis is difficulty due to its rarity and similarity with other language and communication disorders, such as Wernicke's aphasia, auditory agnosia or verbal deafness. Herein, we present a case report of a young woman with a sudden bilateral loss of auditory comprehension. Initially, a psychiatric nature of the disorder was considered, but the persistence of the symptoms, lead to the diagnosis of cortical deafness secondary to bilateral ischemic lesions in both temporal lobes. Progressive improvement occurred and three months after the initial manifestations she manifested pure verbal deafness. Cortical deafness usually has a poor functional prognosis, with limited therapeutic options. Rehabilitation and speech therapy is recommended to improve the chance of patients achieving communication skills.

Data Logging Evidence of Cochlear Implant Use in Single-Sided and Bilateral Deafness.

PURPOSE: This study analyses data logs in order to investigate the usage pattern of cochlear implant (CI) recipients with single-sided deafness (SSD-CI) and bilaterally deaf, uni- or bilaterally implanted CI recipients (Uni-CI and Bil-CI). Data logging is available from SCAN, an automated auditory scene classifier which categorizes auditory input into 6 listening environments. METHODS: CI usage data were retrospectively available from data logs of 206 CI recipients using the Nucleus 6 system obtained between January 2013 and June 2015. For all recipients, we analysed time on air and time spent in the listening environments. For statistical analysis, we matched the CI recipients according to age and duration of CI experience and classified them into 4 age groups. RESULTS: SSD-CI showed a similar time on air compared to Uni- and Bil-CI. Usage behaviour of SSD-CI was comparable to Uni- and Bil-CI regarding exposure to music, speech in quiet and speech in noise. With increasing age, exposure to quiet increased and exposure to music decreased across all CI recipient groups in relation to time on air. CONCLUSION: In total, the CI usage pattern of SSD-CI is comparable for the majority of listening environments and age groups to that of Uni- and Bil-CI. The results of our study show that SSD-CI benefit equally from CI implantation.

Music Appreciation of Adult Hearing Aid Users and the Impact of Different Levels of Hearing Loss.

OBJECTIVES: The main aim of this study was to collect information on music listening and music appreciation from postlingually deafened adults who use hearing aids (HAs). It also sought to investigate whether there were any differences in music ratings from HA users with different levels of hearing loss (HL; mild, versus moderate to moderately-severe, versus severe or worse. DESIGN: An existing published questionnaire developed for cochlear implant recipients was modified for this study. It had 51 questions divided into seven sections: (1) music listening and music background; (2) sound quality; (3) musical styles; (4) music preferences; (5) music recognition; (6) factors affecting music listening enjoyment; and (7) music training program. The questionnaire was posted out to adult HA users, who were subsequently divided into three groups: (i) HA users with a mild HL (Mild group); (ii) HA users with a moderate to moderately-severe HL (Moderate group); and (iii) HA users with a severe or worse (Severe group) HL. RESULTS: One hundred eleven questionnaires were completed; of these, 51 participants had a mild HL, 42 had a moderate to moderately-severe loss, and 18 a severe or worse loss. Overall, there were some significant differences noted, predominantly between the Mild and Severe groups, with fewer differences between the Mild and Moderate groups. The respondents with the greater levels of HL reported a greater reduction in their music enjoyment as a result of their HL and that HAs made music sound significantly less melodic for them. It was also observed that the Severe group's mean scores for both the pleasant rating as well as the combined rating for the six different musical styles were lower than both the Mild and Moderate groups' ratings for every style, with just one exception (pop/rock pleasantness rating). There were significant differences between the three groups for the styles of music that were reported to sound the best with HA(s), as well as differences between the ratings on more specific timbre rating scales used to rate different elements of each style. In rating the pleasantness and naturalness of different musical instruments or instrumental groups, there was no difference between the groups. There were also significant differences between the Mild and Severe groups in relation to musical preferences for the pitch range of music, with the Severe group significantly preferring male singers and lower pitched instruments. CONCLUSIONS: The overall results indicated little difference in music appreciation between those with a mild versus moderate loss. However, poorer appreciation scores were given by those with a severe or worse HL. This would suggest that HAs or HL have a negative impact on music listening, particularly when the HL becomes more significant. There was a large degree of variability in ratings, though, with music listening being satisfactory for some listeners and largely unsatisfactory for others, in all three groups. Music listening preferences also varied significantly, and the reported benefit (or otherwise) provided by the HA for music was also mixed. The overriding variability in listening preferences and ratings leads to the question as to the benefit and effectiveness of generic, manufacturer-derived music programs on HAs. Despite the heterogeneity in the listening habits, preferences, and ratings, it is clear that music appreciation and enjoyment is still challenging for many HA users and that level of HL is one, but not the only factor that impacts on music appreciation.

The Effects of Dynamic-range Automatic Gain Control on Sentence Intelligibility With a Speech Masker in Simulated Cochlear Implant Listening.

OBJECTIVES: "Channel-linked" and "multi-band" front-end automatic gain control (AGC) were examined as alternatives to single-band, channel-unlinked AGC in simulated bilateral cochlear implant (CI) processing. In channel-linked AGC, the same gain control signal was applied to the input signals to both of the two CIs ("channels"). In multi-band AGC, gain control acted independently on each of a number of narrow frequency regions per channel. DESIGN: Speech intelligibility performance was measured with a single target (to the left, at -15 or -30°) and a single, symmetrically-opposed masker (to the right) at a signal-to-noise ratio (SNR) of -2 decibels. Binaural sentence intelligibility was measured as a function of whether channel linking was present and of the number of AGC bands. Analysis of variance was performed to assess condition effects on percent correct across the two spatial arrangements, both at a high and a low AGC threshold. Acoustic analysis was conducted to compare postcompressed better-ear SNR, interaural differences, and monaural within-band envelope levels across processing conditions. RESULTS: Analyses of variance indicated significant main effects of both channel linking and number of bands at low threshold, and of channel linking at high threshold. These improvements were accompanied by several acoustic changes. Linked AGC produced a more favorable better-ear SNR and better preserved broadband interaural level difference statistics, but did not reduce dynamic range as much as unlinked AGC. Multi-band AGC sometimes improved better-ear SNR statistics and always improved broadband interaural level difference statistics whenever the AGC channels were unlinked. Multi-band AGC produced output envelope levels that were higher than single-band AGC. CONCLUSIONS: These results favor strategies that incorporate channel-linked AGC and multi-band AGC for bilateral CIs. Linked AGC aids speech intelligibility in spatially separated speech, but reduces the degree to which dynamic range is compressed. Combining multi-band and channel-linked AGC offsets the potential impact of diminished dynamic range with linked AGC without sacrificing the intelligibility gains observed with linked AGC.

Effect of Audibility and Suprathreshold Deficits on Speech Recognition for Listeners With Unilateral Hearing Loss.

OBJECTIVES: We examined the influence of impaired processing (audibility and suprathreshold processes) on speech recognition in cases of sensorineural hearing loss. The influence of differences in central, or top-down, processing was reduced by comparing the performance of both ears in participants with a unilateral hearing loss (UHL). We examined the influence of reduced audibility and suprathreshold deficits on speech recognition in quiet and in noise. DESIGN: We measured speech recognition in quiet and stationary speech-shaped noise with consonant-vowel-consonant words and digital triplets in groups of adults with UHL (n = 19), normal hearing (n = 15), and bilateral hearing loss (n = 9). By comparing the scores of the unaffected ear (UHL+) and the affected ear (UHL-) in the UHL group, we were able to isolate the influence of peripheral hearing loss from individual top-down factors such as cognition, linguistic skills, age, and sex. RESULTS: Audibility is a very strong predictor for speech recognition in quiet. Audibility has a less pronounced influence on speech recognition in noise. We found that, for the current sample of listeners, more speech information is required for UHL- than for UHL+ to achieve the same performance. For digit triplets at 80 dBA, the speech recognition threshold in noise (SRT) for UHL- is on average 5.2 dB signal to noise ratio (SNR) poorer than UHL+. Analysis using the speech intelligibility index (SII) indicates that on average 2.1 dB SNR of this decrease can be attributed to suprathreshold deficits and 3.1 dB SNR to audibility. Furthermore, scores for speech recognition in quiet and in noise for UHL+ are comparable to those of normal-hearing listeners. CONCLUSIONS: Our data showed that suprathreshold deficits in addition to audibility play a considerable role in speech recognition in noise even at intensities well above hearing threshold.

Cognitive Abilities Contribute to Spectro-Temporal Discrimination in Children Who Are Hard of Hearing.

OBJECTIVES: Spectral ripple discrimination tasks have received considerable interest as potential clinical tools for use with adults and children with hearing loss. Previous results have indicated that performance on ripple tasks is affected by differences in aided audibility [quantified using the Speech Intelligibility Index, or Speech Intelligibility Index (SII)] in children who wear hearing aids and that ripple thresholds tend to improve over time in children with and without hearing loss. Although ripple task performance is thought to depend less on language skills than common speech perception tasks, the extent to which spectral ripple discrimination might depend on other general cognitive abilities such as nonverbal intelligence and working memory is unclear. This is an important consideration for children because age-related changes in ripple test results could be due to developing cognitive ability and could obscure the effect of any changes in unaided or aided hearing over time. The purpose of this study was to establish the relationship between spectral ripple discrimination in a group of children who use hearing aids and general cognitive abilities such as nonverbal intelligence, visual and auditory working memory, and executive function. It was hypothesized that, after controlling for listener age, general cognitive ability would be associated with spectral ripple thresholds and performance on both auditory and visual cognitive tasks would be associated with spectral ripple thresholds. DESIGN: Children who were full-time users of hearing aids for at least 1 year (n = 24, ages 6 to 13 years) participated in this study. Children completed a spectro-temporal modulated ripple discrimination task in the sound field using their personal hearing aids. Threshold was determined from the average of two repetitions of the task. Participants completed standard measurements of executive function, nonverbal intelligence, and visual and verbal working memory. Real ear verification measures were completed for each child with their personal hearing aids to determine aided SII. RESULTS: Consistent with past findings, spectro-temporal ripple thresholds improved with greater listener age. Surprisingly, aided SII was not significantly correlated with spectro-temporal ripple thresholds potentially because this particular group of listeners had overall better hearing and greater aided SII than participants in previous studies. Partial correlations controlling for listener age revealed that greater nonverbal intelligence and visual working memory were associated with better spectro-temporal ripple discrimination thresholds. Verbal working memory, executive function, and language ability were not significantly correlated with spectro-temporal ripple discrimination thresholds. CONCLUSIONS: These results indicate that greater general cognitive abilities are associated with better spectro-temporal ripple discrimination ability, independent of children's age or aided SII. It is possible that these relationships reflect the cognitive demands of the psychophysical task rather than a direct relationship of cognitive ability to spectro-temporal processing in the auditory system. Further work is needed to determine the relationships of cognitive abilities to ripple discrimination in other populations, such as children with cochlear implants or with a wider range of aided SII.

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.

Comparison of Neural Response Telemetry (NRT) results of cochlear implanted children in view of pre-operative Auditory Brainstem Response (ABR).

OBJECTIVES: To compare the Neural Response Telemetry (NRT) results of the cochlear implanted children who showed wave 5 and who could not, in preimplantation ABR. MATERIAL AND METHOD: 24 children (11 boys, 13 girls) with bilateral profound sensorineural hearing loss participated in this study. Age of children ranged between 13 and 60 months (mean 30 months). All participated children were implanted with Cochlear® Nucleus brand devices. In preoperative ABR evaluation with click stimulus in 100 dBnHL intensity level, 9 children showed wave V and 15 children did not. We compared intraoperative NRT results of 1st, 6th, 11th, 16th and 22nd electrodes, those were selected from 22 electrodes, of the two groups. RESULTS: There was no statistically significant difference between the children who showed wave V and who did not in preoperative ABR, when compared the intraoperative NRT results of 1st, 6th, 11th, 16th and 22nd electrodes (p>0,05). CONCLUSION: intraoperative NRT was obtained in all the implanted children with bilateral profound sensorineural hearing loss, even if they received wave V or not in preoperative ABR. There was no difference between any of the parameters of the test results of the two groups. Normal NRT results can be achievable when there is no wave V in preoperative ABR.

Looking Behavior and Audiovisual Speech Understanding in Children With Normal Hearing and Children With Mild Bilateral or Unilateral Hearing Loss.

OBJECTIVES: Visual information from talkers facilitates speech intelligibility for listeners when audibility is challenged by environmental noise and hearing loss. Less is known about how listeners actively process and attend to visual information from different talkers in complex multi-talker environments. This study tracked looking behavior in children with normal hearing (NH), mild bilateral hearing loss (MBHL), and unilateral hearing loss (UHL) in a complex multi-talker environment to examine the extent to which children look at talkers and whether looking patterns relate to performance on a speech-understanding task. It was hypothesized that performance would decrease as perceptual complexity increased and that children with hearing loss would perform more poorly than their peers with NH. Children with MBHL or UHL were expected to demonstrate greater attention to individual talkers during multi-talker exchanges, indicating that they were more likely to attempt to use visual information from talkers to assist in speech understanding in adverse acoustics. It also was of interest to examine whether MBHL, versus UHL, would differentially affect performance and looking behavior. DESIGN: Eighteen children with NH, eight children with MBHL, and 10 children with UHL participated (8-12 years). They followed audiovisual instructions for placing objects on a mat under three conditions: a single talker providing instructions via a video monitor, four possible talkers alternately providing instructions on separate monitors in front of the listener, and the same four talkers providing both target and nontarget information. Multi-talker background noise was presented at a 5 dB signal-to-noise ratio during testing. An eye tracker monitored looking behavior while children performed the experimental task. RESULTS: Behavioral task performance was higher for children with NH than for either group of children with hearing loss. There were no differences in performance between children with UHL and children with MBHL. Eye-tracker analysis revealed that children with NH looked more at the screens overall than did children with MBHL or UHL, though individual differences were greater in the groups with hearing loss. Listeners in all groups spent a small proportion of time looking at relevant screens as talkers spoke. Although looking was distributed across all screens, there was a bias toward the right side of the display. There was no relationship between overall looking behavior and performance on the task. CONCLUSIONS: The present study examined the processing of audiovisual speech in the context of a naturalistic task. Results demonstrated that children distributed their looking to a variety of sources during the task, but that children with NH were more likely to look at screens than were those with MBHL/UHL. However, all groups looked at the relevant talkers as they were speaking only a small proportion of the time. Despite variability in looking behavior, listeners were able to follow the audiovisual instructions and children with NH demonstrated better performance than children with MBHL/UHL. These results suggest that performance on some challenging multi-talker audiovisual tasks is not dependent on visual fixation to relevant talkers for children with NH or with MBHL/UHL.

Hearing aid fitting and developmental outcomes of children fit according to either the NAL or DSL prescription: fit-to-target, audibility, speech and language abilities.

OBJECTIVE: This study examined the influence of prescription on hearing aid (HA) fitting characteristics and 5-year developmental outcomes of children. DESIGN: A randomised controlled trial implemented as part of a population-based study on Longitudinal Outcomes of Children with Hearing Impairment (LOCHI). STUDY SAMPLE: Two-hundred and thirty-two children that were fit according to either the National Acoustic Laboratories (NAL) or Desired Sensation Level (DSL) prescription. RESULTS: Deviation from targets and root-mean-square error in HA fitting revealed no significant difference between fitting prescriptions. Aided audibility quantified by using the Speech Intelligibility Index (SII) model showed that DSL provided higher audibility than NAL at low and medium input levels but not at high input level. After allowing for hearing loss desensitisation, differences in audibility between prescription groups were significant only at low input level. The randomised trial of prescription that was implemented for 163 children revealed no significant between-group differences in speech production, perception, and language; but parent-rated functional performance was higher for the DSL than for the NAL group. CONCLUSIONS: Proximity to prescriptive targets was similar between fitting prescriptions. The randomised trial revealed differences in aided audibility at low input level between prescription groups, but no significant differences in speech and language abilities.

Active transcutaneous bone conduction implant: audiological results in paediatric patients with bilateral microtia associated with external auditory canal atresia.

OBJECTIVE: To describe, in terms of functional gain and word recognition, the audiological results of patients under 18 years of age implanted with the active bone conduction implant, Bonebridge™. DESIGN: Retrospective case studies conducted by reviewing the medical records of patients receiving implants between 2014 and 2016 in the public health sector in Chile. STUDY SAMPLE: All patients implanted with the Bonebridge were included (N = 15). Individuals who had bilateral conductive hearing loss, secondary to external ear malformations, were considered as candidates. RESULTS: The average hearing threshold one month after switch on was 25.2 dB (95%CI 23.5-26.9). Hearing thresholds between 0.5 and 4 kHz were better when compared with bone conduction hearing aids. Best performance was observed at 4 kHz, where improvements to hearing were observed throughout the adaptation process. There was evidence of a significant increase in the recognition of monosyllables. CONCLUSIONS: The Bonebridge implant showed improvements to hearing thresholds and word recognition in paediatric patients with congenital conductive hearing loss.

[Auditory evoked potentials in children with auditory neuropathy spectrum disorder]. / Slukhovye vyzvannye potentsialy u detei s zabolevaniem spektra auditornykh neiropatii.

The objective of the present study was to estimate peculiarities of the auditory brainstem evoked potentials (ABR), auditory steady-state responses (ASSR) and cortical auditory evoked potentials (CAEP) in the children presenting with bilateral auditory neuropathy spectrum disorder (ANSD). The study included 100 patients with bilateral ANSD diagnosed based on the positive response of otoacoustic emissions (OAEs) and/or cochlear microphonic (CM) detection, while no synchronous neural activity was detected in the ABR test. Cochlear microphonic was the main clue for the ANSD diagnosing, because OAE was absent in both ears of 49 children. ABR testing revealed no response bilaterally in 72 cases (out of 100). In contrast to ABR, the ASSR thresholds were detectable at all the four main frequencies in both ears in 73 % of the cases (47 out of the 64 tested ones). Both ABR and ASSR in most cases were incomparable with the behavioral audiometric thresholds. 28 children underwent CAEP testing. In 7 cases out of 8 with mild hearing loss detectable CAEP were recorded. CAEP registration in l7 children making use of the hearing aids and in 3 children after cochlear implantation revealed, in the majority of the cases, the concordance between CAEP detectability with behavioral thresholds and rehabilitation outcomes with fairly good speech intelligibility. It is concluded that the ABR registration with CM evaluation is the most informative test for ANSD diagnosis. However, ABR as well as ASSR is useless for the estimation of the behavioral thresholds. The results of this study suggest that the presence or absence of CAEPs can provide some indication of the audibility of a speech sound in the children with ANSD; however this method requires further investigation.