Cochlear Implants in Single-Sided Deafness. Comparison Between Children and Adult Populations With Post-lingually Acquired Severe to Profound Hearing Loss

Objective: To determine audiological and clinical results of cochlear implantation (CI) comparing two populations with single-sided deafness (SSD): post-lingually deaf children between 6 and 12 years of age, and post-lingually deaf adults, in order to evaluate the effect of CI in different age groups.Design: Retrospective case review.Setting: Tertiary clinic.Patients and Method: Twenty-three children and twenty-one adult patients that were candidates for CI with single-side deafness were included. In all cases we evaluate: Speech perception thresholds; disyllabic words test (65 dB SPL) were performed in the modalities S0–SCI–SNH and Auditory Lateralization Test. The Speech, Spatial, and Qualities of Hearing Scale (SSQ) questionnaire was also used. All results were obtained after 12 months of CI activation.Results: In children, the most common etiology was idiopathic sensory-neural hearing loss. They showed positive results in the Auditory Lateralization Test. In the Speech Test, word recognition in noise improved from 2% preoperatively to 61.1% at a mean follow-up of 1 year (S0 condition) in children [test with signal in CI side 60% and signal normal hearing side (plugged) 31%]. The processor was used for >12 h in all cases. With respect to the SSQ questionnaire, parents were more satisfied within the postoperative period than within the preoperative period. For adults, the most common etiology was idiopathic sudden sensorineural hearing loss (SNHL). Positive results in the Auditory Lateralization Test were found. With respect to the Speech Test in quiet conditions: Word recognition in noise improved from 5.7% preoperatively to 71.8% at a mean follow-up of 1 year [test with signal in CI side 68% and signal normal hearing side (plugged) 41%]. The processor was used for >12 h. In the SSQ questionnaire, the post-operative results showed a beneficial effect of the CI. No adverse events were reported during the study period. No differences were found between children and adults in all tests in this study.Conclusions: Cochlear implantation in post-lingually deaf adults and children with SSD can achieve a speech perception outcome comparable with CI in conventional candidates. Improvements in spatial hearing were also observed. Careful patient selection and counseling regarding potential benefits are important to optimize outcomes.

Optimization of the Speech Test Material in a Group of Hearing Impaired Subjects: A Feasibility Study for Multilingual Digit Triplet Test Development

Background: The development of the global digit-in-noise test requires optimization of each language version on a group of normal-hearing native-speakers. An alternative solution may be an adaptive optimization during ongoing tests in a group of subjects with unknown hearing impairments. The objective of the research was to compare the optimization results between these groups. Methods: Digit triplets consisting of three pseudo-randomly selected digits were presented in speech-shaped noise at various signal-to-noise ratios (SNRs), according to the protocol of the final speech test. Digit-specific and position-specific speech reception thresholds (SRTs) were determined and compared between groups. Results: The study sample consisted of 82 subjects, 26 normal-hearing subjects and 56 patients with diverse hearing disorders. Statistically significant differences in digit-specific SRTs between the control and the investigated group were obtained for three digits in continuous noise (digits 0, 4, 6; p-value of 0.04, 0.03, 0.05) and two in modulated noise (digits 1 and 6; p-value of 0.05 and 0.01). An analysis including only ears with SRTs within the range of the normal hearing control group showed no statistically significant differences between digits. Conclusion: Optimization of speech material can be carried out in a group of subjects with unknown hearing impairments, provided the ears with scores outside normal range are rejected.

Comparison of Preferred Real-Ear Insertion Gain between Open- and Closed-Canal Fitting Hearing Aids

Purpose: To calculate the real-ear insertion gain (REIG) according to the types of hearing aids, we evaluated the preferred REIGs of Korean hearing-impaired listeners and psychoacoustic differences between open-canal fitting (OF) and closed-canal fitting (CF).Methods: The subjects with sensorineural hearing loss were divided into OF group (4 monaural fittings, 15 binaural fittings with 34 ears), and CF group (8 monaural fittings, 13 binaural fittings with 34 ears). There were no statistical differences in hearing threshold level (HTL) at each octave frequencies, word recognition score (WRS) and Korean Adaptation of the International Outcome Inventory for Hearing Aids (K-IOI-HA) between the two groups. When there was no need for further electroacoustic adjustment of the hearing aid, sharpness and occlusion of amplified sound, clarity of sentence, and loudness of noise were evaluated based on the everyday experience. And REIGs with international speech test signal and WRS in sound-treated room were measured.Results: Preferred REIG for HTL was low for OF compared to CF in 0.5 kHz and 0.75 kHz at input SPL of 55 dB, 0.5 kHz at 60 dB SPL, 0.25 kHz and 0.5 kHz at 80 dB SPL. However, there were no differences in aided WRS and psychoacoustics between the two groups.Conclusion: In this study, the preferred REIG of OF and CF groups showed a difference under 0.75 kHz although there were no psychoacoustic differences between the two groups. Therefore, the results of this study should be considered when formulating Korean-type hearing aid fitting formula.

Evaluation of hearing preservation in adults with a slim perimodiolar electrode

Purpose Numerous endeavors have been undertaken to preserve hearing in cochlear implant (CI) patients. Particularly, optimization of electrode array design aims at preservation of residual hearing (RH). This study examines whether a slim perimodiolar (PM) electrode array could bear the capability to preserve hearing. Methods A total of 47 patients underwent cochlear implantation receiving the PM electrode. (i) Patients with pure tone audiogram (PTA) thresholds better than 85 dB and/or hearing loss for Freiburg speech test numbers less than 60 dB and more than 50% maximum monosyllabic understanding were assigned to the RH group (n = 17), while all others belonged to the noRH group (n = 30). (ii) Another group implanted with a slim straight, lateral wall (LW) electrode was recruited for comparison. Results We compared 17 RH–30 noRH patients all receiving the PM electrode. RH in PM recipients decreased faster than in LW recipients. No significant differences were observed between both (RH v/s noRH) groups in NRT thresholds, Freiburg speech test and A§E® phonemes. Analogous satisfaction levels were indicated through the questionnaires in terms of sound quality, hearing in silence, noise and directional hearing in both groups. Conclusions The results suggest that hearing preservation is influenced not only by electrode shape but various factors. This study opens an avenue for further investigations to elucidate and enumerate the causes for progressive hearing loss.

An Effective Learning Method for Automatic Speech Recognition in Korean CI Patients’ Speech

The automatic speech recognition (ASR) model usually requires a large amount of training data to provide better results compared with the ASR models trained with a small amount of training data. It is difficult to apply the ASR model to non-standard speech such as that of cochlear implant (CI) patients, owing to privacy concerns or difficulty of access. In this paper, an effective finetuning and augmentation ASR model is proposed. Experiments compare the character error rate (CER) after training the ASR model with the basic and the proposed method. The proposed method achieved a CER of 36.03% on the CI patient’s speech test dataset using only 2 h and 30 min of training data, which is a 62% improvement over the basic method.

The approach of speech proficiency in edentulous patients- “Solution to Elocution”

Speech is considered as a basic fundamental means of communication, which makes the human being superior than other forms of life. Speech and language therapist judgement of speech is consider as the most perfect because the assessment is mainly subjective and it depends on the perception of individual. This will involve both assessment of the intelligibility and quality of the patient’s speech, and observation of the visible aspects of articulation. The best way is to use perpetual assessment, to highlight potential areas of difficulty, then objective, instrumental assessment of these areas, to confirm the nature and severity of their involvement. Correlation of the vocal signal changes with the characteristics of the prosthesis and the specific types of errors in the prosthetic act would be an essential achievement in the way of improving the outcome of the prosthetic action. It is the responsibility of the prosthodontist to construct dentures as accurately as possible, so as to improve speech sound production with dentures, minimize the period of adaptation and thereby, increase the self-confidence of the patient. For this its very important to have knowledge about assessment of speech. Since past many years clinicians have faced problems in assessing speech. In this article clinical application of speech test in relation to complete dentures have been highlighted.