A longitudinal study of cortical auditory maturation and implications of the short inter-implant delay in children with bilateral sequential cochlear implants

© 2023 Elsevier B.V.Objective: This longitudinal study aimed to investigate the maturational development of P1 latency and the effects of a short inter-implant delay in children who received bilateral sequential cochlear implants. Materials and methods: Fourteen children (first CI mean age: 1.4 ± 0.4 years and Second CI mean age: 3.3 ± 0.5 years) who had received sequential bilateral cochlear implants during the sensitive period for auditory maturation participated in our study. The speech-evoked cortical P1 response was recorded after the activation of the second CI at four intervals (implant activation, 3 months, 6 months, 12 months) under three listening conditions (first CI, second CI, binaural). Results: Our results showed that the P1 latencies of the second CI reached normative values within 3 months, but did not reach the P1 latency of the first CI until 12 months. We found a strong negative correlation between the inter-implant delay and the P1 latencies of the second CI when the second CI was activated. Conclusion: Changes in cortical auditory responses over time resulted in normal auditory maturation in children with sequential bilateral cochlear implants during the sensitive period. The results also provide evidence that the timing of auditory experience in the first ear during the sensitive period may influence the speed of compensation in children receiving sequential cochlear implants

The Relationship between Electrical Stapedius Reflex Thresholds and Behaviorally Most Comfortable Levels in Experienced Cochlear Implant Users

OBJECTIVES: Programming the cochlear implant's speech processor with subjective methods in young, uncooperative children is difficult. Since young children cannot provide adequate feedback to the clinician, objective methods which do not require patient's response were often used. Electrical Stapedius Reflex Test is one of the most common procedures used. The goal of this study was to investigate the relationship between electricalstapedius reflex thresholds and behaviorally most comfortable levels in experienced cochlear implant users. MATERIALS and METHODS: The patients implanted with two brands of cochlear implants were compared in terms of electrical stapedius reflex thresholds versus most comfortable levels. Speech tests results were also compared between the two groups. 46 cochlear Implanted patients who had at least 1 year of cochlear implant experience were included in the study. 28 patients were implanted with Nucleus, 18 patients with Med-El devices. RESULTS: Moderate correlations were obtained between Electrical Stapedius Reflex (ESR) thresholds and the comfort (C) levels in Nucleus users; higher correlations were obtained for Med-El patients. ESR thresholds were present at higher levels than the most comfortable and the comfort (MCUC) levels in both Nucleus and Med-El users. No significant difference was obtained between the two groups in terms of speech tests. CONCLUSION: ESR test can be very informative for programming young and uncooperative patients

Koklear implant programı ace konuşma stratejisinin parametrelerinin optimizasyonu.

Bu araştırmada postlingual koklear implant kullanıcılarında, koklear implant programlamasında kullanılan konuşma stratejilerinden Advanced Combination Encodres'ın ( ACE ) uyarım hızı, maksima hızı, jitter oranı ve frekans dağılım tabloları gibi parametrelerini değiştirerek en optimal programı bulmak ve programlama yapmada kullanılan bu parametelein implant ile konuşmayı anlama erformansı üzerine etkilerini incelemek amaçlanmıştır. Çalışmaya dahil edilen 14 postlingual hastaya uyarım hızı 720 Hz,900 Hz,1200 Hz,ve 1800 Hz , maksima sayısı 8,12 ve 16, jitter oranı 0,%10,%20 , frekans dağılım tabloları no.1 ve no.7 olarak değiştirilip , açık ve kapalı uçlu konuşma testleriyle karşılaştırıldı.Her parametrenin test edilmesinden sonra hastalar,farklı dinleme durumlarındaki tercihlerini belirtmeleri istenen anket formlarını cevapladılar. Farklı uyarım hızları kullanılması sadece kelime sonu ünsüzünü ayırdetme testi üzerinde anlamlı farklılık yaratttığı , 1800 Hz kullanılarak yapılan programla diğer uyarılma hızlarına göre konuşma testlerinden daha düşük neticeler alındığı saptandı.1800 Hz dışındaki diğer uyarım hızları ,maksima sayıları ve jitter oranları arasında konuşma testlerinde fark elde edilmedi. Frekans dağılım tabloları karşılaştırıldığında ise 7 no.lu frekans tablosu ile hastaların daha iyi performans gösterdiği saptandı.Anket formundan elde edilen cevaplar , farklı dinleme durumlarında değişik uyarım hızlarını tercih ettiklerini ,jitter ve maksimada standart ayarları seçtiklerini , frekans dağılım tablosunda ise 7 no.lu tablonun tercih edildiğini göstermiştir. Frekans dağılım tabloları ve 1800 Hz'lik uyarım hızı dışında , programlama da kullanılan parametrelerin anlamlı farklılık yaratmadıkları için kullanılabileceği sonucuna varılmıştır ancak programlama sırasında kişisel farklılıkların gözönünde tutulması gerekmektedir ve implant programları ile konuşmayı anlama performansı düşük olan hastalara farklı program seçenekleri sunulmalıdır. SUMMARY The aim of this study was to investigate the effect of variations in stimulation rate,maxima, jitter and frequency allocation tables on speech understanding in 14 postlingual cochlear implant patients who use Abvanced Combination Encoders ( ACE ) as a speech coding strategy and to find out the optimal programming parameters. Open and closed set speech tests results obtained when the stimulation rate is varied to 720 Hz , 900 Hz, 1200 Hz 1800 Hz, maxima to 8,12,16, jitter to 0, %10,%20 and frequency allocation table to No.1 and No.7, were compared. Subjective preferences were assessed using a comparative questionnaire at the end of each evaluation period. No statistical difference in group performance between maxima, jitter and stimulation rates except 1800 Hz in identification of consonant at the end of the word test , were observed in speech tests. Significatly poorer performance was observed when frequency table No.1 was compared with frequency table No.7 on speech tests. Responses to the comparative questionnaire indicated that patients preferred diffrent stimulation rates for different listening situations ,mostly default settings for jitter , maxima and frequency table no.7. As conclusion , except stimulation rate of 1800 Hz and frequency table No.1 , all the other parameters can be chosen to program the speech processor since no statistical diffrenece was obtained. But individual variations should be kept in mind while programming,and diffrent programming options should be offered especially to patients with poor speech understanding

Pallister-Killian syndrome: A case with sensorineural hearing loss

Pallister-Killian syndrome (PKS) is a rare disorder caused by tetrasomy 12p mosaicism. Pallister-Killian syndrome (PKS) is characterized by multiple congenital anomalies including pigmentary skin changes, mental retardation, and the mosaic presence of a tissue-limited isochromosome 12p [i(12p)]. Hearing loss is not reported very often in PKS patients. The purpose of the study is to present a Pallister-Killian syndrome patient with severe sensorineural hearing loss. Bilateral severe sensorineural hearing loss was diagnosed in a child of 28-month old with PKS. The child was fitted with hearing aids and began to receive auditory habilitation. The child benefited from the amplification. Hearing screening is recommended for children with multiple anomalies including PKS in order to prevent the harmful effects of the hearing loss. © 2006 Elsevier Ireland Ltd. All rights reserved

Prognostic value of auditory brainstem response for neurologic outcome in patients with neonatal indirect hyperbilirubinemia

To investigate the value of the auditory brainstem response as a reliable test for the neurologic prognosis. of infants. with neonatal indirect hyperbilirubinemia, auditory brainstem response studies were performed in 22 infants. The patients were followed up until 12 months of age. Two patients demonstrated pathologic auditory brainstem response consistent with auditory neuropathy but had no neurologic finding except a lack of speech at 12 months of age. Two other patients had neurologic sequelae, one showing severe dyskinetic cerebral palsy, the other mild hypotonia and motor retardation, but their auditory brainstem response results were normal. These results suggested that auditory brainstem response examination might not provide reliable information for the neurologic prognosis. Neurologic disturbances resulting from bilirubin neurotoxicity can be seen in patients with a normal auditory brainstem response, but patients with an abnormal auditory brainstem response may not have any neurologic dysfunction apart from speech retardation

A Case with Brown-Vialetto-Van Laere Syndrome: A Sudden Onset Auditory Neuropathy Spectrum Disorder

The Brown-Vialetto-Van Laere syndrome (BVVLS) is a rare neurological disorder that may present at all ages with sensorineural hearing loss, bulbar palsy and respiratory compromise. We describe a 6-yearold male patient who suffered bilateral sudden onset severe hearing loss for two years. Audiological investigations revealed sudden onset auditory neuropathy spectrum disorder bilaterally. He also had neurological complaints. During riboflavin therapy an improvement in hearing loss and the benefit of hearing aids were observed. In BVVLS, it is difficult to plan and apply auditory rehabilitation interventions and the results vary from patient to patient. In audiological evaluation, it should be borne in mind that subjective and objective tests are complemental. Early medical intervention and regular audiological follow-up are very important for effective hearing rehabilitation in the patients with BVVLS

Evaluation of gap filling skills and reading mistakes of cochlear implanted and normally hearing students

Objective: This study aimed to (1) evaluate the gap filling skills and reading mistakes of students with cochlear implants, and to (2) compare their results with those of their normal-hearing peers. The effects of implantation age and total time of cochlear implant use were analyzed in relation to the subjects' reading skills development. Methods: The study included 19 students who underwent cochlear implantation and 20 students with normal hearing, who were enrolled at the 6th to 8th grades. The subjects' ages ranged between 12 and 14 years old. Their reading skills were evaluated by using the Informal Reading Inventory. Results: A significant relationship were found between implanted and normal-hearing students in terms of the percentages of reading error and the percentages of gap filling scores. The average order of the reading errors of students using cochlear implants was higher than that of normal-hearing students. As for the gap filling, the performances of implanted students in the passage are lower than those of their normal-hearing peers. No significant relationship was found between the variables tested in terms of age and duration of implantation on the reading performances of implanted students. Conclusion: Even if they were early implanted, there were significant differences in the reading performances of implanted students compared with those of their normal-hearing peers in older classes

Effects of spatial separation with better- ear listening on N1-P2 complex

Objective: The purpose of this study was to determine better-ear listening effect on spatial separation with the N1-P2 complex. Methods: Twenty individuals with normal hearing participated in this study. The speech stimulus /ba/ was presented in front of the participant (0 degrees). Continuous Speech Noise (5 dB signal-to-noise ratio) was presented either in front of the participant (0 degrees), left-side (-90 degrees), or right-side (+ 90 degrees). N1-P2 complex has been recorded in quiet and three noisy conditions. Results: There was a remarkable effect of noise direction on N1, P2 latencies. When the noise was separated from the stimulus, N1 and P2 latency increased in terms of when noise was co-located with the stimulus. There was no statistically significant difference in N1-P2 amplitudes between the stimulus-only and co-located condition. N1-P2 amplitude was increased when the noise came from the sides, according to the stimulus-only and co-located conditions. Conclusion: These findings demonstrate that the latency shifts on N1-P2 complex explain cortical mechanisms of spatial separation in better-ear listening. (C) 2021 Oto-Rhino-Laryngological Society of Japan Inc. Published by Elsevier B.V. All rights reserved