Faculty Bibliography

OBJECTIVE: To explore the possibility of expanding implantation guidelines to include the multiply handicapped population and to determine the pattern of development of perceptual skills in deaf children who have other impairments. PATIENTS AND SETTING: The study group consisted of 31 profoundly deaf children with documented impairments in addition to deafness who were consecutively implanted. Twenty-nine of the children underwent implantation and were followed at NYU Medical Center for at least 1 year. INTERVENTIONS AND MAIN OUTCOME MEASURES: Routine audiometric measurements and closed- and open-set measures of speech perception were performed at the phoneme, word, and sentence level pre- and postoperatively. Analyses of variance were performed when possible. RESULTS: The study population showed substantial improvement after implantation in the ability to perceive phonemes, words, and sentences using audition alone. CONCLUSIONS: Multiply handicapped children obtain demonstrable benefit from cochlear implantation, with no increase in surgical complications, although the rate of growth of perceptual skills is slower than for deaf child with no additional complicating factors

OBJECTIVE: To compare the short-term development of open-set speech perception between implementations of the spectral peak (SPEAK) strategy in adults using the Nucleus 22 (N22) Spectra processor and the Nucleus 24 (N24) system with the SPrint processor. STUDY DESIGN: Two sets of patients with a follow-up period of 3 months were compared. SETTING: This study was conducted at the New York University (NYU) Medical Center. PATIENTS: Thirty-six profoundly hearing-impaired adults were included in this study. INTERVENTION: Sixteen adults received the N22 cochlear implant with the Spectra speech processor and twenty adults received the N24 cochlear implant with the SPrint speech processor. MAIN OUTCOME MEASURES: Open-set speech perception for the patients with N22 implants was evaluated preoperatively and postoperatively using the following measures: NU-6 monosyllabic words, Iowa sentences, and CID sentences. CNC words, CUNY sentences, and HINT sentences were used to assess the patients with N24 implants. RESULTS: Results revealed that the N22 and N24 cochlear implant recipients had significant open-set speech recognition 3 and 6 months after implantation. The apparent favorable absolute scores for the patients with N24 implants were equalized when a multivariate analysis was performed to account for their younger age at time of implantation and shorter length of deafness. CONCLUSIONS: The growth of open-set word and sentence recognition in similar between the N22 and N24 cochlear implants. Longitudinal studies are needed to determine if higher ceiling scores are present in the N24. Further exploration of monopolar versus bipolar stimulation is warranted

The purpose of this paper is to provide performance data on long-term congenitally and prelingually deafened children and adults who are implanted with the CLARION Multi-Strategy Cochlear Implant and who use the Continuous Interleaved Sampler (CIS) speech processing strategy. Open-set speech perception was assessed preoperatively and postoperatively with word and sentence recognition tests. Results indicate that a majority of subjects showed improvement from preoperative performance to the last available postoperative evaluation. These results represent a change from previously reported data on a similar population who used earlier speech processing strategies

OBJECTIVE: To report early postimplantation speech recognition results in children who received Nucleus CI24M cochlear implants. STUDY DESIGN: The study group consisted of 19 consecutively implanted children. PATIENTS AND SETTING: Congenitally deaf children (20 months to 15 years old) were implanted with the Nucleus CI24M and followed-up at New York University Medical Center for a period of 3 to 12 months. MAIN OUTCOME MEASURES: Speech perception was evaluated preoperatively and postoperatively using the Early Speech Perception (ESP) test, the Glendonald Auditory Screening Procedure (GASP) word and sentence tests, Phonetically Balanced Kindergarten (PBK) monosyllabic word lists, Common Phrases test, the Multisyllabic and Lexical Neighborhood (MLNT, LNT) tests, and the Banford-Kowal-Bench (BKB) sentence test. RESULTS: One-way analyses of variance revealed significant improvement in open-set speech recognition in children able to perform measurement tasks. CONCLUSIONS: The Nucleus CI24M cochlear implant provides significant benefit to children after short-term use

OBJECTIVE: To determine cochlear implant electrode stability in the young patient. Electrode migration due to future skull growth was a concern that led to prohibiting implantation in children less than 2 years of age. Recently, the high level of performance achieved by young implantees has led to a re-evaluation of this lower age limit, requiring an assessment of the effects of skull growth over time. STUDY DESIGN: Prospective radiographic analysis of electrode position of cochlear implants in young children. METHODS: Twenty-seven children implanted with the Nucleus (Cochlear Corp., Denver, CO) or Clarion (Advanced Bionics Inc., Sylmar, CA) multi-channel cochlear prostheses were subjects for this study. Follow-up radiographic studies were obtained for a period of 1 month to 5 years after implantation. The age at time of implantation ranged from 14 months to 5 years. An intraoperative modified Stenver's view plain radiograph was obtained as a baseline. After implantation, on a yearly basis transorbital Stenver's and base views were obtained for comparative purposes. Additional radiographs were obtained whenever a change in performance or electrode map caused suspicion for extrusion. Electrode position was determined using a computer graphics enhancement technique whereby image contrast filters enhanced the visibility of the electrode array and surrounding bony structures. RESULTS: An analysis of the data revealed no migration of the electrode array over time. CONCLUSIONS: The confirmation of the stability of the electrode array alleviates the concern of the effects of skull growth on cochlear implantation in young children

OBJECTIVE: To determine the viability of giving implants to children <2 years old and to assess the development of speech perception. STUDY DESIGN: A prospective study with a follow-up period of 1-5 years. SETTING: New York University Medical Center. PATIENTS: The patients consisted of 11 consecutive profoundly deaf children, aged 14-23 months, who were given the Nucleus cochlear implant. METHODS: Closed- and open-set speech perception were assessed preoperatively and postoperatively using the following measures: Early Speech Perception (ESP) test, the Northwestern University children's perception of speech test (NU-CHIPS), the Glendonald auditory screening procedure (GASP) word and sentence tests, the phonetically balanced kindergarten (PBK) word test, common phrases test, the multisyllabic lexical neighborhood test (MLNT), and the lexical neighborhood test (LNT). RESULTS: Paired t test was used to examine changes in scores from the preoperative test interval to the last available postoperative assessment. Results indicate that all patients had significant improvement from preoperative performance to the last postoperative evaluation and were using oral language as their means of communication. There were no medical or surgical complications. CONCLUSIONS: Children <2 years old receive substantial benefit from a multichannel cochlear implant with no increase in risk when compared with older children

OBJECTIVE: This study aimed to evaluate the change in performance when the Speak processing strategy replaced the Mpeak strategy. SUBJECTS: Twenty-one veterans who participated in the original Department of Veterans Affairs Multicenter Cochlear Implant Study, received the Nucleus F0F1F2 processor (Cochlear Corp., Englewood, CO, U.S.A.) (WSP) and were subsequently upgraded to the Mpeak (MSP) processing strategy. METHODS: Closed- and open-set speech recognition in quiet and in noise in auditory only conditions at the phoneme, word, and sentence levels were evaluated. RESULTS: Changes in audiologic parameters were evaluated using a paired t-test for related samples. Statistically significant improvements in mean scores were found for all tests and were greatest for the speech-in-noise conditions. An examination of individual data revealed that 61% of the subjects improved for tests administered in quiet, whereas up to 69% of the subjects had improved performance in noise. Subjects with no open set speech discrimination using the Mpeak strategy showed no improvement with the Speak strategy. CONCLUSIONS: Cochlear implants can provide improved performance using modifications to external speech processor hardware and software without changing the internal implant