[Early language performance in the ELFRA questionnaire : Analysis of multicentre data from children with bilateral cochlear implants]. / Frühe Sprachleistungen im Fragebogen ELFRA : Auswertung multizentrischer Daten von Kindern nach bilateraler Cochleaimplantatversorgung.

BACKGROUND: Very early bilateral cochlear implant (CI) provision is today's established standard for children. Therefore, the assessment of preverbal and verbal performance in very early stages of development is becoming increasingly important. Performance data from cohorts of children were evaluated and presented based on diagnostic assessment using chronological age (CA) and hearing age (HA). METHODS: The present study, as part of a retrospective multicentre study, included 4 cohorts (N = 72-233) of children with bilateral CI without additional disabilities. Their results in the German parent questionnaires Elternfragebögen zur Früherkennung von Risikokindern(ELFRA­1 and ELFRA-2) subdivided for CA and HA were statistically analysed. The data were also analysed in terms of mono-/bilingualism and age at CI provision. RESULTS: Overall, verbal performance in relation to CA was lower than in relation to HA. Preverbal skills were largely CA appropriate. Children with bi-/multilingual language acquisition performed significantly lower. Verbal performance in ELFRA­2 referenced to CA was negatively correlated with age at CI provision. CONCLUSION: In the case of early CI provision, CA should be the preferred reference mark in preverbal and verbal assessment in order to obtain exact individual performance levels and avoid bias in results. The percentiles determined are of limited use as generally valid reference values to which the individual performance of bilaterally implanted children could be compared. Further multicentre studies should be initiated.

The correlation between ECochG parameters and early auditory behavior after cochlear implantation in children.

OBJECTIVE: The individual outcome after cochlear implantation in children with auditory synaptopathy/neuropathy (AS/AN) is difficult to predict. A tool for preoperative assessment would be helpful for counseling parents. This study evaluates the outcome after CI in children with AS/AN and with sensorineural hearing loss (SNHL), and correlates it with the preoperative ECochG results in order to find specific parameters of prognostic value. DESIGN: The improvement of auditory behavior after CI was retrospectively assessed using the LittlEARS questionnaire and quantified in a score (LS). This score was correlated with the CAP/SP ratio in the preoperative ECochG. The score was further correlated with the patient's age six months following CI. STUDY SAMPLE: Nine children with AS/AN were compared to nine children with SNHL. RESULTS: Both groups showed a significant improvement in LS following CI. There was a significant positive correlation between the CAP/SP ratio and the improvement in LS in all children. The correlation between age and LS was significantly negative in the SNHL group and positive in the AS/AN group. CONCLUSION: All children with AS/AN and SNHL benefit to a similar extent from CI. The preoperatively assessed CAP/SP ratio has a prognostic value for the development of auditory behavior following CI.

Speech perception in noise and sound localization using different microphone modes in pediatric bilateral cochlear implant users.

OBJECTIVE: The aim of the study was to investigate if a directional microphone mode improves speech perception in noise and sound localization in experienced pediatric bilateral cochlear implant users. METHODS: 15 bilaterally implanted children were included in the analysis. Speech perception in 4 noise conditions (S0N0, S0N90, S0N-90, S0N180) and sound localization were measured when using the OPUS 2 audio processor (omnidirectional mode) and the SONNET audio processor (omnidirectional and natural mode). RESULTS: Speech perception in all 4 noise conditions was better with the SONNET natural mode than with the omnidirectional mode of either SONNET or OPUS 2. The root-mean-square error of the sound localization test was smaller with the natural mode of SONNET than with the omnidirectional mode of either SONNET or OPUS 2. The performance of the audio processors in the omnidirectional mode did not differ significantly except in the S0N0 condition of the speech perception test. CONCLUSION: The natural microphone mode of the SONNET audio processor improved speech perception in noise and sound localization in bilaterally implanted children.

Letter to the Editor Concerning Skuk et al., "Parameter-Specific Morphing Reveals Contributions of Timbre and Fundamental Frequency Cues to the Perception of Voice Gender and Age in Cochlear Implant Users".

Purpose The purpose of this letter is to compare results by Skuk et al. (2020) with Meister et al. (2016) and to point to a potential general influence of stimulus type. Conclusion Our conclusion is that presenting sentences may give cochlear implant recipients the opportunity to use timbre cues for voice perception. This might not be the case when presenting brief and sparse stimuli such as consonant-vowel-consonant or single words, which were applied in the majority of studies.

The Use of Voice Cues for Speaker Gender Recognition in Cochlear Implant Recipients.

PURPOSE: The focus of this study was to examine the influence of fundamental frequency (F0) and vocal tract length (VTL) modifications on speaker gender recognition in cochlear implant (CI) recipients for different stimulus types. METHOD: Single words and sentences were manipulated using isolated or combined F0 and VTL cues. Using an 11-point rating scale, CI recipients and listeners with normal hearing rated the maleness/femaleness of the corresponding voice. RESULTS: Speaker gender ratings for combined F0 and VTL modifications were similar across all stimulus types in both CI recipients and listeners with normal hearing, although the CI recipients showed a somewhat larger ambiguity. In contrast to listeners with normal hearing, F0-VTL and F0-only modifications revealed similar ratings in the CI recipients when using words as stimuli. However, when sentences were used, a difference was found between F0-VTL-based and F0-based ratings. Modifying VTL cues alone did not affect ratings in the CI group. CONCLUSIONS: Whereas speaker gender ratings by listeners with normal hearing relied on combined VTL and F0 cues, CI recipients made only limited use of VTL cues, which might be one reason behind problems with identifying the speaker on the basis of voice. However, use of the voice cues depended on stimulus type, with the greater information in sentences allowing a more detailed analysis than single words in both listener groups.

Real-World Verbal Communication Performance of Children Provided With Cochlear Implants or Hearing Aids.

OBJECTIVE: To compare the real-world verbal communication performance of children provided with cochlear implants (CIs) with their peers with hearing aids (HAs). STUDY DESIGN: Cross-sectional study in university tertiary referral centers and at hearing aid dispensers. METHODS: Verbal communication performance was assessed by the Functioning after Pediatric Cochlear Implantation (FAPCI) instrument. The FAPCI was administered to 38 parents of children using CIs and 62 parents of children with HAs. According to the WHO classification, children with HAs were categorized into three groups (mild-moderate-severe hearing loss). Analysis of variance (ANOVA) was performed on the FAPCI scores, with study group, hearing age (i.e., device experience), and age at hearing intervention as sources of variation. RESULTS: ANOVA showed that hearing age and study group significantly contribute to the FAPCI outcome. In all study groups except the children with mild hearing loss, FAPCI scores increased alongside growing experience with the devices. Children with mild hearing loss using HAs showed higher scores than those with severe hearing loss or implanted children. There were no significant differences between the children with CIs and the children with moderate or severe hearing loss using HAs. CONCLUSION: Real-world verbal communication abilities of children with CIs are similar to those of children with moderate-to-severe hearing loss using amplification. Because hearing age significantly influences performance, children with moderate-to-severe hearing loss using HAs and implanted children catch up with children with mild hearing loss at a hearing age of approximately 3 years.

Examination of spectral timbre cues and musical instrument identification in cochlear implant recipients.

OBJECTIVES: To investigate the discrimination of two isolated spectral timbre cues, spectral centroid (Fc) and spectral irregularity (spIrr), in cochlear implant (CI) listeners. To examine whether the perception of Fc and spIrr changes is related to the perception of loudness and pitch and the identification of musical instruments. METHODS: Stimuli were based on French horn recordings which were artificially manipulated with respect to isolated changes in Fc and spIrr. Difference limens for Fc and spIrr were determined and changes in loudness and pitch perception based on these modifications were examined. Identification of musical instruments was additionally assessed. RESULTS: Mean difference limens were 161 Hz for Fc and 0.63 dB for spIrr. Modifications in spectral timbre cues caused changes in loudness and pitch perception. None of the timbre cues examined showed a significant correlation with musical instrument identification. In contrast, instrument identification was significantly related to the frequency of listening to music prior to onset of deafness. CONCLUSIONS: CI recipients are able to detect small modifications in spectral timbre cues which are in turn associated with changes in loudness and pitch. Variations of spectral centroid have a larger impact on loudness and pitch perception than variations of spectral irregularity. Music listening behaviour prior to onset of deafness is significantly associated with musical instrument identification.

Measuring communicative performance with the German version of the FAPCI-instrument: normative data and longitudinal results.

OBJECTIVE: The German version of the Functioning after Paediatric Cochlear Implantation (FAPCI) inventory was designed to capture the communicative performance of cochlear implanted children. In order to be able to compare cochlear-implanted children to their normal hearing peers, normative growth curves were designed. Furthermore it was of interest how the communicative performance develops over time and whether it is influenced by age at implantation. METHOD: A polynomial regression curve was fit to the data of 133 normal hearing children. This normative curve was compared to individual growth curves of 90 cochlear implanted children. The cochlear-implanted study sample was split up into four groups depending on the age at implantation. RESULTS: The normative growth curve increases from 1 year of age until saturation is reached with 3 years of age. The individual FAPCI trajectories of cochlear implanted children are heterogeneous, but in general they are delayed in comparison to the normative growth curve. "Early implanted children" follow the development of their normal hearing peers more closely than "later-implanted children". CONCLUSION: The German version of the FAPCI parental questionnaire constitutes an additional instrument in monitoring the communicative performance development of cochlear implanted children and allows for comparison to normal hearing peers.