Hearing abilities measured with the Hearing in Noise Test (HINT). Studies on normal hearing and cochlear implant users

The Hearing-in-Noise test (HINT) uses calibrated sentences in background noise to measure the speech reception threshold. The main aim of the thesis was to develop adult and pediatric versions of the HINT in Norwegian, and apply the tests to normal hearing adults and children, aged 6–13 years, to obtain Norwegian norms and study maturation effects. The children achieved adult-like performance around the age of 9 years. When sentences were presented from the front and noise from the side, maturation effects were observed until the age of 13 years. A cochlear implant (CI) is a complex hearing device comprising an implantable part and an outer speech processor. The HINT was used in two different CI studies; “Sequential bilateral CI in children: Outcome of the second implant and long-term use” included 160 participants, and “Self-assessed Speech, Spatial, and Qualities of hearing scale scores (SSQ) and speech perception in adult CI recipients” included 152 participants. HINT is a test to assess hearing ability and is found to be a valuable parameter in CI research studies and in clinical practice. Results can be compared to age-dependent norms

Modelling of the Ultrasound Return from Albunex

A mathematical model that predicts the changes to the ultrasound frequency spectrum after passing through human tissue and Albunex â (a registered trademark of Molecular Biosystems Inc., San Diego, CA) microspheres is proposed. Changes in backscattered intensity and mean frequency of the reflected signal can be estimated as a function of imaging geometry, ultrasound frequency, and microsphere concentration and size distribution. An important result is that the frequency shifts and the intensity variations are caused both by the microspheres in the path between the transducer and the region of interest, and by the reflection properties of the contrast agent in the region of interest. The model enables one to explain and predict clinically observed intensity effects such as the shadow effect in the right ventricle, and the fact that received intensity increases with concentration up to a certain point where it falls off. The effect of the removal of the larger microspheres in the lungs..

Modelling of the Ultrasound Return from

Page 1 of 32 A mathematical model that predicts the changes to the ultrasound frequency spectrum after passing through human tissue and Albunex ® (a registered trademark of Molecular Biosystems Inc., San Diego, CA) microspheres is proposed. Changes in backscattered intensity and mean frequency of the reflected signal can be estimated as a function of imaging geometry, ultrasound frequency, and microsphere concentration and size distribution. An important result is that the frequency shifts and the intensity variations are caused both by the microspheres in the path between the transducer and the region of interest, and by the reflection properties of the contrast agent in the region of interest. The model enables one to explain and predict clinically observed intensity effects such as the shadow effect in the right ventricle, and the fact that received intensity increases with concentration up to a certain point where it falls off. The effect of the removal of the larger microspheres in the lungs is so significant that concentrations that give positive frequency shifts with increasing concentration in the right ventricle will give negative shifts in the left ventricle. The frequency shift is only a good indicator of concentration for ultrasound frequencies below 4 MHz, while the intensity is very sensitive to Albunex ® microsphere concentration and imaged depth also at the higher frequencies. It is also found that the periodic variation in heart muscle thickness during the heart cycle will affect the intensity and mean frequency of the backscattered ultrasound observed in the left ventricle significantly, and in such a way as to give them a periodic variation over the heart cycle. Suggested keywords: medical ultrasound, contrast agent, Albunex ® , radio frequency analysis

Speech-in-noise perception in children with cochlear implants, hearing aids, developmental language disorder and typical development: the effects of linguistic and cognitive abilities

Children with hearing loss, and those with language disorders, can have excellent speech recognition in quiet, but still experience unique challenges when listening to speech in noisy environments. However, little is known about how speech-in-noise perception relates to individual differences in cognitive and linguistic abilities in these children. The present study used the Norwegian version of the Hearing in Noise Test (HINT) to investigate speech-in-noise perception in 175 children aged 5.5-12.9 years, including children with cochlear implants (CI, n = 64), hearing aids (HA, n= 37), developmental language disorder (DLD, n = 16) and typical development (TD, n= 58). Further, the study examined whether general language ability, verbal memory span, nonverbal IQ and speech perception of monosyllables and sentences in quiet were predictors of performance on the HINT. To allow comparisons across ages, scores derived from age-based norms were used for the HINT and the tests of language and cognition. There were significant differences in speech-in-noise perception between all the groups except between the HA and DLD groups, with the CI group requiring the highest signal-to-noise ratios (i.e. poorest performance) and the TD group requiring the lowest signal-to-noise ratios. For the full sample, language ability explained significant variance in HINT performance beyond speech perception in quiet. Follow-up analyses for the separate groups revealed that language ability was a significant predictor of HINT performance for children with CI, HA and DLD, but not for children with TD. Memory span and IQ did not predict variance in speech-in-noise perception when language ability and speech perception in quiet were taken into account. The finding of a robust relation between speech-in-noise perception and general language skills in all three clinical groups call for further investigation into the mechanisms that underlie this association

The Impact of Ethnicity on Cochlear Implantation in Norwegian Children

Objectives To explore the impact of parental ethnicity on cochlear implantation in children in Norway with regard to incidence rates of cochlear implants (CIs), comorbidies, age at onset of profound deafness (AOD), age at first implantation, uni- or bilateral CI, and speech recognition. Method This retrospective cohort study included all children (N = 278) aged <18 years in Norway who received their first CI during the years 2004-2010. Results 86 children (30.9%) in our study sample had parents of non-Nordic ethnicity, of whom 46 were born in Nordic countries with two non-Nordic parents. Compared with the background population, children with non-Nordic parents were 1.9 times more likely to have received CI than Nordic children (i.e., born in Nordic countries with Nordic parents). When looking at AOD, uni- vs. bilateral CIs, and comorbidities, no significant differences were found between Nordic children and children with a non-Nordic ethnicity. Among children with AOD <1 year (n = 153), those born in non-Nordic countries with two non-Nordic parents (n = 6) and adopted non-Nordic children (n = 6) received their first CI on average 14.9 and 21.1 months later than Nordic children (n = 104), respectively (p = .006 and .005). Among children with AOD <1 year, those born in Nordic countries with two non-Nordic parents (n = 31) received their CI at an older age than Nordic children, but this difference was not significant after adjusting for calendar year of implantation and excluding comorbidity as a potential cause of delayed implantation. The mean age at implantation for children with AOD <1 year dropped 2.3 months/year over the study period. The mean monosyllable speech recognition score was 84.7% for Nordic children and 76.3% for children born in Norway with two non-Nordic parents (p = .002). Conclusions The incidence of CI was significantly higher in children with a non-Nordic vs. a Nordic ethnicity, reflecting a higher incidence of profound deafness. Children born in Norway have equal access to CIs regardless of their ethnicity, but despite being born and receiving care in Norway, prelingually deaf children with non-Nordic parents are at risk of receiving CI later than Nordic children. Moreover, prelingually deaf children who arrive in Norway at an older age may be at risk for a worse prognosis after receiving a CI due to lack of auditory stimulation in early childhood, which is critical for language development and late implantation; this is a serious issue with regard to deafness among refugees. Amundsen, Viktoria Vedeler, et al. "The impact of ethnicity on cochlear implantation in Norwegian children." International journal of pediatric otorhinolaryngology 93 (2017): 30-36. © 2017. This manuscript version is made available under the CC-BY-NC-ND 4.0 license

Fusion of Technology in Cochlear Implantation Surgery: Investigation of Fluoroscopically Assisted Robotic Electrode Insertion

The HEARO cochlear implantation surgery aims to replace the conventional wide mastoidectomy approach with a minimally invasive direct cochlear access. The main advantage of the HEARO access would be that the trajectory accommodates the optimal and individualized insertion parameters such as type of cochlear access and trajectory angles into the cochlea. To investigate the quality of electrode insertion with the HEARO procedure, the insertion process was inspected under fluoroscopy in 16 human cadaver temporal bones. Prior to the insertion, the robotic middle and inner ear access were performed through the HEARO procedures. The status of the insertion was analyzed on the post-operative image with Siemens Artis Pheno (Siemens AG, Munich, Germany). The completion of the full HEARO procedure, including the robotic inner ear access and fluoroscopy electrode insertion, was possible in all 16 cases. It was possible to insert the electrode in all 16 cases through the drilled tunnel. However, one case in which the full cochlea was not visible on the post-operative image for analysis was excluded. The post-operative analysis of the electrode insertion showed an average insertion angle of 507°, which is equivalent to 1.4 turns of the cochlea, and minimal and maximal insertion angles were recorded as 373° (1 cochlear turn) and 645° (1.8 cochlear turn), respectively. The fluoroscopy inspection indicated no sign of complications during the insertion

Sustained Reduction of Tinnitus Several Years after Sequential Cochlear Implantation

Objective This study aimed to explore the short- and long-term effects of a second cochlear implant (CI-2) on the reduction of tinnitus annoyance and tinnitus handicap. Design In a combined retrospective and prospective cohort study, tinnitus annoyance was measured before receiving the CI-2 (Pre), more than two years after (Post1) and more than seven years after (Post2), using the Tinnitus Handicap Inventory (THI), the Visual Analog Scale for the assessment of perceived tinnitus loudness (VAS-L) and annoyance (VAS-A), and a self-report questionnaire. Study sample Twenty sequentially bilaterally implanted adults with bothersome tinnitus. Results CI-2 implantation resulted in a statistically significant reduction of tinnitus handicap from severe at Pre to mild at Post1 (THI mean score reduced from 61.3 [SD = 19.4] to 29.3 [SD = 23.5]). The reduction in tinnitus annoyance was statistically significant from Pre to Post 2 (VAS-A reduced from 7.1 [SD = 1.5] to 3.4 [SD = 2.2]). The reduction in tinnitus loudness was not statistically significant. Conclusions The provision of a CI-2 for severely and profoundly hearing-impaired individuals with bothersome tinnitus is an effective method of providing long-term tinnitus relief

Sustained Reduction of Tinnitus Several Years after Sequential Cochlear Implantation

Objective This study aimed to explore the short- and long-term effects of a second cochlear implant (CI-2) on the reduction of tinnitus annoyance and tinnitus handicap. Design In a combined retrospective and prospective cohort study, tinnitus annoyance was measured before receiving the CI-2 (Pre), more than two years after (Post1) and more than seven years after (Post2), using the Tinnitus Handicap Inventory (THI), the Visual Analog Scale for the assessment of perceived tinnitus loudness (VAS-L) and annoyance (VAS-A), and a self-report questionnaire. Study sample Twenty sequentially bilaterally implanted adults with bothersome tinnitus. Results CI-2 implantation resulted in a statistically significant reduction of tinnitus handicap from severe at Pre to mild at Post1 (THI mean score reduced from 61.3 [SD = 19.4] to 29.3 [SD = 23.5]). The reduction in tinnitus annoyance was statistically significant from Pre to Post 2 (VAS-A reduced from 7.1 [SD = 1.5] to 3.4 [SD = 2.2]). The reduction in tinnitus loudness was not statistically significant. Conclusions The provision of a CI-2 for severely and profoundly hearing-impaired individuals with bothersome tinnitus is an effective method of providing long-term tinnitus relief