The Role of Autosensitivity Control (ASC) in Cochlear Implant Recipients

The purpose of the study was to examine the subjective and objective potential advantage for speech understanding in noise achieved by cochlear implant (CI) recipients when using the autosensitivity control (ASC) input signal processing in combination with the adaptive dynamic range optimization (ADRO). Eighteen subjects (8 females, 10 males, mean age 17.7 ± 6.7) were enrolled in a prospective open blinded comparative study between the ASC + ADRO condition vs. the ADRO alone; 16 were sequential binaural and 2 were monoaural CI recipients. All patients had been wearing their CI for at least 3 years, had no additional disabilities, had an age-appropriate receptive and expressive language. Word recognition performances in noise (at signal-to-noise ratio +5 dB HL) were significantly better in the ADRO-alone condition than in the ADRO + ASC condition. (p = 0.03) These objective outcomes were in agreement with the subjective reports. No significant difference was found in quiet. Our results, apparently in contrast with other reports in the literature, suggest that the decision of adding the slow-acting automatic reduction in microphone sensitivity provided by ASC should be limited to selected CI recipients

The effect of language structure on linguistic strengths and weaknesses in children with cochlear implants: Evidence from Italian

Previous studies have found that the early fitting of cochlear implants in children has beneficial effects on their expressive and receptive language. However, different ages are identified in different studies, and some studies present contradictory results. Starting from these observations, our study suggests that at least two additional factors play an important role in determining linguistic outcomes. The first is the area of language under investigation: lexicon, phonology, morphosyntax, semantics, and pragmatics. The second factor is the typological features of the child’s target language. Our study, which involved 33 Italian-speaking children who received a cochlear implant and 33 age and gender matched controls, reveals that lexical, semantic, pragmatic, and phonological knowledge are not particularly vulnerable in these children. By contrast, one area of morphosyntax (production of clitic pronouns) is especially challenging. In addition, an effect of age of implantation was found only in this morphosyntactic area. This is the first study on language development in Italian-speaking children with cochlear implants

NARRATIVE SKILLS IN ITALIAN PRE-SCHOOL CHILDREN WITH COCHLEAR IMPLANTS. EFFECTS OF LATE LINGUISTIC EXPOSURE ON A LATE ACQUIRED DOMAIN

Children with severe/profound hearing impairment (SPHI) learning a spoken language have shown narrative development delays, although the advent of cochlear implants (CIs) significantly contributed to enhance language and the narrative ability of those children. In the present study we investigated narrative skills in 27 Italian pre-school children with SPHI (mean age = 61.44 months) fitted with CI before the age of three years and in 27 typically developing (TD) hearing children matched by age. Our goals were: i) to compare the performances of children with CI to those of TD children so to shed light on the effects of a delay in first language exposure on the early development of narrative skills and ii) to establish the linguistic predictors of early narrative skills in children with CI that could be boosted in rehabilitation programs. As for goal i), results indicated that the narratives produced by the present sample of children with CI included fewer words than those of TD children; nevertheless, the two groups of children had comparable proficiency in structuring narratives. At the group level, children with CI were impaired in the use of pronouns, even though at the individual level, some children revealed an adequate performance. Considering goal ii), the standardized test assessing lexical comprehension was a predictor of lexical abilities in a narrative context, but only in those children whose lexical ability was high. Children with CI with high lexical comprehension scores produced narratives with a richer vocabulary than children with CI with low lexical comprehension scores, although this was not the case in children with low pragmatics abilities. Considering overall narrative abilities, neither pragmatics nor grammatical abilities were predictors of the NAS score. We hypothesize that such a link will emerge at a later stage, when narratives become richer and more complex. All in all, we showed that it is important to assess narrative skills: In narratives, lexical, grammatical and pragmatics skills interact: a single impairment in one of those areas might result in impairments in some components of narratives. Moreover, as the group performance of children with CI was characterized by great variability, we suggest the necessity to consider strengths and weakness case-by-case in order to offer an efficient therapeutic intervention

Tavolo epidemiologia (H.E.A.R.I.N.G. package of interventions, WHO 2021)

La sordità è una condizione invalidante molto frequente che impatta fortemente sulla qualità di vita e sul potenziale di sviluppo dell’individuo. Essa inoltre implica un costo notevole per i sistemi sociosanitari che, tuttavia, sembra operino azioni non sempre congrue o coordinate per limitarne gli effetti. Per tali ragioni l’OMS nel suo ‘World Report on Hearing’ del 2021 ha individuato 7 aree tematiche principali meritorie di interventi sociosanitari per una governance sostenibile ed efficace del problema sordità. Esse sono identificate dall’acronimo H.E.A.R.I.N.G. Il report dell’OMS dimostra come l’investimento in ciascuna di queste aree sia costo-efficace nel medio periodo: ad una unità monetaria investita oggi corrisponderebbe un risparmio di 18 unità dopo dieci anni laddove si considerino sia i costi diretti sia quelli indiretti complessivamente generati dalla sordità. Il presente lavoro costituisce senz’altro una novità nel panorama medico-scientifico otorinolaringoiatrico e audiologico. Promosso dalla Società Italiana di Otorinolaringoiatria e Chirurgia Cervico-Facciale (SIOeChCF) cui si è prontamente affiancata la Società Italiana di Audiologia e Foniatria (SIAF), esso ha visto l’entusiastica adesione di ben 23 sigle del mondo Associativo dei pazienti ipoudenti e dei loro familiari. L’intento è stato quello di recepire immediatamente le raccomandazioni dell’OMS per realizzare una ‘fotografia’ della situazione italiana in ciascuna area tematica, cui si è aggiunta una revisione delle principali fonti di epidemiologia del problema. Difficoltà di accesso alle banche dati - quando esistenti, scadente tracciabilità di alcune attività, sorprendenti variegature territoriali e altri fattori fanno si che la ‘nitidezza’ della fotografia non sempre sia elevata; tuttavia, il quadro che ne deriva è pur sempre orientativo dello ‘stato attuale delle politiche sanitarie italiane sulla sordità’. Esso è il frutto di un lavoro corale articolato su otto tavoli tematici cui hanno contribuito in maniera paritetica decine di medici e pazienti. La collaborazione è stata molto favorevole tanto da condurre sia alla produzione del presente resoconto sia alla consapevole necessità di proseguire con una fase propositiva. L’auspicio è che la presente ‘fotografia’ sia diffusamente discussa e che la stessa possa essere tradotta in un adeguato documento di ‘policy brief’ da condividere con le competenti Autorità (Ministeri, Conferenza Stato-Regioni, Assessorati alla Sanità) prima di procedere con la necessaria fase propositiva di miglioramento. Medici e pazienti sono pronti e disponibili per tutte le iniziative che dovessero scaturire da questo approccio

Early cochlear implantation in prelingual profound hearing loss in Italy, analyzed by means of a social media survey

Objective: To assess newborn hearing screening (NHS) impact on timing of cochlear implant (CI) surgery of patients with prelingual bilateral profound hearing impairment (BPHI), in order to evaluate whether the NHS ultimately serves the needs of the target population in Italy. Methods: An online questionnaire was created to survey subjects affected by prelingual BPHL born between 1990 and 2018. Questions focused on age at BPHI diagnosis, first and second CI surgery (if performed), and the region in which the surgery was performed. The survey was distributed to potential participants via social media communities used by hearing impaired people or their family members for sharing advice and offering support. Responses were analyzed using descriptive statistics. Results: Among the 318 respondents who completed the questionnaire, 276 (87%) reported having chosen CI surgery, 2/3 of them bilaterally. In the vast majority (97%) of cases the CI is used on a daily basis. Most of the people residing in the center (65%) and southern Italy (71%) had to move from their region of residence to perform the surgery. Late CI surgery was associated with failure to perform NHS (p = 0.007), birth before 2011 (p = 0.009), definitive diagnosis of BPHI after 6 months of life (p = 0.002), and progressive hearing impairment (p < 0.001). Conclusion: The worldwide scientific approval of the NHS as the current best opportunity for early diagnosis and CI treatment for prelingual BPHI is confirmed by what patients and families reported via the online questionnaire used for this study. In recent years, early bilateral cochlear implantation has become increasingly available in Italy, but late diagnosis, progressive hearing loss, failure to perform the NHS and lack of follow-up are still open questions. A large proportion of families had to move from the region of residence to have their child undergo CI surgery, revealing inequalities in terms of geographical disparities. Social media has proved to be a valuable, fast and inexpensive tool for gathering information on the effectiveness of health prevention programs, involving a large sample of individuals in a short amount of time

Clinical evaluation of cochlear implant sound coding taking into account conjectural masking functions, MP3000™

Efficacy of the SPEAK and ACE coding strategies was compared with that of a new strategy, MP3000™, by 37 European implant centers including 221 subjects. The SPEAK and ACE strategies are based on selection of 8-10 spectral components with the highest levels, while MP3000 is based on the selection of only 4-6 components, with the highest levels relative to an estimate of the spread of masking. The pulse rate per component was fixed. No significant difference was found for the speech scores and for coding preference between the SPEAK/ACE and MP3000 strategies. Battery life was 24% longer for the MP3000 strategy. With MP3000 the best results were found for a selection of six components. In addition, the best results were found for a masking function with a low-frequency slope of 50 dB/Bark and a high-frequency slope of 37 dB/Bark (50/37) as compared to the other combinations examined of 40/30 and 20/15 dB/Bark. The best results found for the steepest slopes do not seem to agree with current estimates of the spread of masking in electrical stimulation. Future research might reveal if performance with respect to SPEAK/ACE can be enhanced by increasing the number of channels in MP3000 beyond 4-6 and it should shed more light on the optimum steepness of the slopes of the masking functions applied in MP3000