==================================HSR38================================== 38. Cochlear implants. 1 UI - 87073698 AU - Danhauer JL ; Erratt JD ; Edgerton BJ TI - Auditory/visual speech perception by cochlear implant users and hearing aid wearers. AB - This study assessed the auditory/visual speech perception abilities of profoundly hearing-impaired subjects using the cochlear implant (CI) developed at the House Ear Institute with those of patients using traditional hearing aids (HA). Audio-video tape recordings of consonant-vowel-consonants (CVCs) consisting of: ten vowels in the context/mvm/, vowel-consonant-vowels (VCVs) consisting of twenty-four consonants in the context/ C /, and the CID Everyday Sentences were presented through auditory, visual, and auditory-visual modes. Subjects' verbal responses to the stimuli were transcribed by the experimenters. Statistical analyses of the data revealed significant differences for groups, stimuli, and conditions. Inspection of the subject's confusion matrices revealed that both groups used closed-bilabial, velar, dental, labial, and easy to see/hard to see features based on place of articulation in the visual mode. Salient features in the auditory mode for the CI group were duration, sonorancy, and some manner attributes, while the HA subjects used these features as well as sibilancy and voicing. Both groups integrated auditory and visual cues to improve scores in the auditory-visual condition. These findings have implications for future developments of auditory prostheses and auditory rehabilitation programs. MH - Adult ; Aged ; Analysis of Variance ; *Cochlear Implant ; Female ; *Hearing Aids ; Human ; Male ; Middle Age ; Speech Discrimination Tests ; *Speech Perception SO - Am J Otol 1986 Sep;7(5):354-60 2 UI - 87025075 AU - Leder SB ; Spitzer JB ; Milner P ; Flevaris-Phillips C ; Richardson F TI - Vibrotactile stimulation for the adventitiously deaf: an alternative to cochlear implantation. AB - Acoustic correlates of the prosodic features identifying English contrastive stress, ie, fundamental frequency (Fo), duration and intensity, and listener perceptions were investigated in a profoundly adventitiously deaf subject (D) pre/postvibrotactile stimulation, and in an age-peer normally-hearing person as a control (N). Stimuli were a group of general American English words in which a change of function from noun to verb was associated with a shift of stress from initial to final syllable, eg, CON'test vs conTEST'. Prior to vibrotactile stimulation, D was unable to produce contrastive stress correctly. Only final syllable intensity differences were noted, but proved to be inadequate cues for contrastive stress. Vibrotactile stimulation resulted in changes, specifically significantly higher Fo for initial stressed vs unstressed syllables, significantly louder intensity for final stressed vs unstressed syllables, and significantly longer duration for final stressed vs unstressed syllables. Perceptually, listeners judged D's contrastive stress placement as always occurring on the final syllable previbrotactile stimulation and as 78% correct postvibrotactile stimulation. N's contrastive stress placement was always correct. It was concluded that use of vibrotactile stimulation enhanced D's production and resulted in listeners' perceptions of correct prosody. MH - *Cochlear Implant ; Deafness/*REHABILITATION ; Human ; Male ; Middle Age ; *Sensory Aids ; Speech ; Support, U.S. Gov't, Non-P.H.S. ; *Touch ; *Vibration SO - Arch Phys Med Rehabil 1986 Oct;67(10):754-8 3 UI - 87013740 AU - Waltzman SB ; Cohen NL ; Shapiro WH TI - Long-term effects of multichannel cochlear implant usage. AB - A major concern regarding multichannel (multi-electrode) cochlear prosthesis usage has been the possibility of long-term deleterious physiological effects such as the degeneration of spiral ganglion cells, neuronal degeneration, and new bone formation. These effects, if present, would become evident in the deterioration of hearing sensation and performance of the cochlear implant recipient on a battery of audiologic tests. To date, five patients using the Australian multi-electrode multichannel cochlear implant have undergone a 1-year evaluation of the device. The assessment includes a check of electrical threshold and comfort levels for each electrode, sound field pure tone and speech thresholds, the MAC battery, vowel and consonant recognition tests, and speech tracking tasks. All results were compared to those obtained postoperatively following stimulation and a 3-month training period. Results to date have shown no deterioration in implant functioning in all patients tested. Periodic extensive monitoring of all implant recipients is advocated in order to evaluate the possibility of long-term effects. MH - Audiometry, Pure-Tone ; Auditory Threshold/PHYSIOLOGY ; *Cochlear Implant ; Deafness/REHABILITATION ; Electric Stimulation ; Follow-Up Studies ; Hearing/*PHYSIOLOGY ; Human ; Loudness Perception/PHYSIOLOGY ; Speech Discrimination Tests ; Support, Non-U.S. Gov't ; Time Factors SO - Laryngoscope 1986 Oct;96(10):1083-7 4 UI - 87013734 AU - Facer GW ; Rose DE ; McDonald TJ ; King AM ; Fabry DA TI - Individual data from the 3M/Vienna extracochlear implant. AB - Five patients who received the 3M/Vienna extracochlear implant were given a standard battery of tests before and after implantation. Pure-tone audiograms, hearing aid evaluation, and promontory threshold and dynamic range stimulation were conducted to evaluate implant candidacy and to determine whether a particular patient met the criteria for inclusion in the study. Speech reading tests were also given before implantation. Postimplantation testing consisted of thresholds and tolerance levels for pure tones and speech reading with and without acoustic stimulation. Tests on environmental sounds, speech discrimination, and word discrimination were scored. Minimal Auditory Capabilities (MAC) Battery scores were determined on MAC, I, II, IV, V, VII, VIII, and XII subtests over several time intervals (sessions). The hearing results varied greatly among patients. All five patients expressed satisfaction and are presently wearing their units. MH - Adult ; Audiometry, Pure-Tone ; *Cochlear Implant ; Deafness/ *REHABILITATION ; Evaluation Studies ; Female ; Human ; Loudness Perception ; Male ; Middle Age ; Speech Discrimination Tests ; Support, Non-U.S. Gov't SO - Laryngoscope 1986 Oct;96(10):1053-7 5 UI - 87000196 AU - Dowell RC ; Mecklenburg DJ ; Clark GM TI - Speech recognition for 40 patients receiving multichannel cochlear implants. AB - We collected data on 40 patients who received the Nucleus multichannel cochlear implant. Results were reviewed to determine if the coding strategy is effective in transmitting the intended speech features and to assess patient benefit in terms of communication skills. All patients demonstrated significant improvement over preoperative results with a hearing aid for both lipreading enhancement and speech recognition without lipreading. Of the patients, 50% demonstrated ability to understand connected discourse with auditory input only. For the 23 patients who were tested 12 months postoperatively, there was substantial improvement in open-set speech recognition. MH - Adult ; Aged ; *Cochlear Implant ; Deafness/REHABILITATION ; Evaluation Studies ; Female ; Human ; Male ; Middle Age ; Speech Discrimination Tests/METHODS ; *Speech Perception ; Support, Non-U.S. Gov't SO - Arch Otolaryngol Head Neck Surg 1986 Oct;112(10):1054-9 6 UI - 86320806 AU - Miller JM ; Sutton D ; Carlisle L TI - Brainstem auditory pathway degeneration associated with chronic cochlear implants in the monkey. AB - The form and pattern of first-order and transsynaptic degeneration in the central auditory pathway was studied in monkeys following inner ear stimulation by a cochlear implant. Multielectrode, scala tympani, and modiolar systems were implanted; in some cases, neomycin was perfused into the cochlea to destroy the organ of Corti at the time of implantation. The monkeys were maintained chronically for 5 to 120 weeks, then the cochleas and brainstems were examined histologically. The extent of spiral ganglion cell loss across animals showed variability, reflecting the different procedures and devices used. The degree and distribution of spiral ganglion cell loss was related to the degree and distribution of neural degeneration seen in the cochlear nucleus in all cases. Peripheral damage progressed toward the cochlear apex as survival time increased, and this progression was reflected in the cochlear nucleus by a ventrolateral shift in the locus of degeneration over time. In addition, evidence for transneuronal degeneration was seen at the superior olive, the lateral lemniscus and the inferior colliculus. Our findings indicate that several factors inherent in the use of a cochlear prosthesis, i.e., insertion trauma, host reaction, and/or electrical stimulation, may be associated with a long-term, continuing process of central degeneration visible at several levels of the auditory system. MH - Animal ; Auditory Pathways/PATHOLOGY/*PHYSIOPATHOLOGY ; Brain Stem/ PATHOLOGY/*PHYSIOPATHOLOGY ; Cochlear Implant/*ADVERSE EFFECTS ; Cochlear Nerve/PATHOLOGY/PHYSIOPATHOLOGY ; Comparative Study ; Disease Models, Animal ; Electric Stimulation ; Macaca ; Neomycin/TOXICITY ; Nerve Degeneration ; Organ of Corti/DRUG EFFECTS ; Spiral Ganglion/PATHOLOGY/ PHYSIOPATHOLOGY SO - Am J Otolaryngol 1986 Jul-Aug;7(4):239-49 7 UI - 86311911 AU - Pelizzone M ; Hari R ; M:akel:a J ; Kaukoranta E ; Montandon P TI - Activation of the auditory cortex by cochlear stimulation in a deaf patient. AB - We have recorded cerebral electric and magnetic responses to electric stimulation of the auditory nerve in a deaf patient with multichannel cochlear prosthesis. The electric response peaked with a vertex-negative deflection at 65 ms. Clear magnetic responses, coinciding with the vertex potential, were obtained only over the hemisphere ipsilateral to the stimulation; the field pattern indicated activation of the auditory cortex within the Sylvian fissure. The results suggest modification of the central auditory pathways in this patient deaf from early childhood. MH - Acoustic Nerve/*PHYSIOPATHOLOGY ; Auditory Cortex/*PHYSIOPATHOLOGY ; Auditory Pathways/PHYSIOPATHOLOGY ; *Cochlear Implant ; Deafness/ *PHYSIOPATHOLOGY/REHABILITATION ; Evoked Potentials, Auditory ; Female ; Human ; Middle Age ; Support, Non-U.S. Gov't SO - Neurosci Lett 1986 Jul 24;68(2):192-6 8 UI - 86309947 AU - Miyamoto RT ; Myres WA ; Pope ML ; Carotta CC TI - Cochlear implants for deaf children. AB - Fifteen profoundly deaf patients under the age of 18 years have received a 3M/House cochlear implant. The surgical procedure employed is essentially the same as that used in adults with a few modifications to accommodate for the smaller dimensions of the mastoid process and the thinness of the scalp and temporal squama. Pediatric subjects receive timing and intensity information at similar thresholds as adults implanted with this device which contributes to improvement in speech production to various degrees. All subject groups demonstrated significant language delays as a result of their profound hearing losses. Postimplantation, more growth was seen in receptive than in expressive language skills. However, the growth observed did not exceed that expected in profoundly deaf children as reported in the literature. Language growth as a result of the cochlear implant alone is yet to be documented in our patients. MH - Adolescence ; Child ; Child, Preschool ; *Cochlear Implant ; Deafness/ *REHABILITATION ; Female ; Human ; Language Development ; Male ; Speech Perception ; Speech Production Measurement ; Support, Non-U.S. Gov't SO - Laryngoscope 1986 Sep;96(9 Pt 1):990-6 9 UI - 86297228 AU - Thornton AR TI - Estimation of the number of patients who might be suitable for cochlear implant and similar procedures. AB - Data have been drawn from four sources to estimate the number of profoundly, bilaterally hearing impaired in Britain who might benefit from a rehabilitational programme which would include cochlear implants and other specialised aids. The sources were: the IHR National Study of Hearing; a total ascertainment survey of General Practitioners, ENT Consultants, Health Visitors etc. in the Wessex Health Region, which requested basic data on their profoundly, bilaterally hearing impaired patients; more detailed questionnaire data obtained directly from a subset of the patients identified in the ascertainment study; and the experience of various cochlear implant centres. Criteria are proposed to select candidates suitable for the initial research and development work on implant devices and to select those who might later be suitable for a routine clinical service with an established technique. Estimates of the corresponding numbers are given. Guidelines for identifying those who might benefit from acoustical aids are offered. MH - Auditory Threshold/PHYSIOLOGY ; *Cochlear Implant ; Cochlear Nerve/ PHYSIOPATHOLOGY ; Deafness/PHYSIOPATHOLOGY/*THERAPY ; Human ; Prognosis ; Referral and Consultation SO - Br J Audiol 1986 Aug;20(3):221-9 10 UI - 86294084 AU - Eby TL ; Nadol JB Jr TI - Postnatal growth of the human temporal bone. Implications for cochlear implants in children. AB - Recent interest in cochlear implantation for children has made it important to understand how postnatal growth of the ear will affect such devices. In this study, the postnatal growth of the labyrinth, middle ear, and mastoid was measured in three dimensions using radiographic and temporal bone data. Measurements were made from histologic sections of 48 temporal bones from children and compared to adult temporal bones. Radiographic measurements were made from 253 sets of skull radiographs of children and compared to adult skull series. In the three dimensions measured, there was no postnatal growth of the labyrinth and little variation in size between individuals. Measurements of the middle ear showed greater variation between individuals than measurements of the inner ear, but growth only in the distance from stapes footplate to the tympanic membrane. The mastoid showed growth in all three dimensions: length, width, and depth. The pattern of growth for mastoid length and width appears to follow a double logistic model, with differences between males and females. The growth in mastoid depth is smaller and appears to follow a single exponential curve. The implications for cochlear implantation in children are discussed. MH - Child ; Child, Preschool ; *Cochlear Implant ; Female ; Human ; Infant ; Infant, Newborn ; Labyrinth/GROWTH & DEVELOPMENT ; Male ; Mastoid/GROWTH & DEVELOPMENT ; Temporal Bone/*GROWTH & DEVELOPMENT SO - Ann Otol Rhinol Laryngol 1986 Jul-Aug;95(4 Pt 1):356-64 11 UI - 86293242 AU - Miyamoto RT ; Robbins AJ ; Myres WA ; Pope ML TI - Cochlear implantation in the Mondini inner ear malformation. AB - We report the case of a profoundly deaf 4-year-old boy with congenital deafness as a result of Mondini's dysplasia. The Mondini inner ear malformation is the result of arrested labyrinthine development during embryogenesis and is characterized by both bony and membranous anomalies of the inner ear. The dysplastic cochlear anatomy does not preclude successful cochlear implantation, and electrical threshold measurements are similar to those recorded in pediatric subjects deafened as a result of other causes. MH - Case Report ; Child, Preschool ; Cochlea/*ABNORMALITIES ; *Cochlear Implant ; Deafness/*CONGENITAL/REHABILITATION ; Human ; Male ; Support, Non-U.S. Gov't SO - Am J Otol 1986 Jul;7(4):258-61 12 UI - 86293239 AU - Belal A TI - Cochlear implantation in developing countries. AB - A cochlear implant program was started in Jeddah, Saudi Arabia, in September 1983. Three totally deaf adult patients have received implants so far, with encouraging results. The problems of cochlear implantation in developing countries are discussed with regard to the patient, team, and device. The rationale, stages, and future of the program are outlined. MH - Adult ; *Cochlear Implant ; Deafness/REHABILITATION ; *Developing Countries ; Female ; Hearing Aids ; Human ; Male ; Saudi Arabia SO - Am J Otol 1986 Jul;7(4):244-7 13 UI - 86292161 AU - O'Donoghue GM ; Jackler RK ; Schindler RA TI - Observations on an experimental expansile electrode for use in cochlear implantation. AB - Cochlear implants in children must be designed to allow for a child's growth and maturation. An experimental animal study was performed to document the influence of head growth on a prototype expansile electrode system. Seven kittens were implanted with a stimulated electrode which had been coiled to allow for a two-to-one expansion in length. Head growth was monitored both by direct skull measurements and by serial radiography. The animals were sacrificed when they had reached maturity and the implanted devices were studied. When implanted in subcutaneous tissue, the coils became encased in fibrous tissue, while within air-containing spaces, such as the bulla, they distended freely. This suggested that a route which maximized the amount of air-containing space traversed by an electrode should be the preferred route for a cochlear implant in children. MH - Animal ; Cats ; Cochlea/PATHOLOGY ; *Cochlear Implant ; *Electrodes, Implanted ; Evaluation Studies ; Head/GROWTH & DEVELOPMENT/RADIOGRAPHY ; Prosthesis Design ; Support, Non-U.S. Gov't SO - Acta Otolaryngol (Stockh) 1986 Jul-Aug;102(1-2):1-6 14 UI - 86255473 AU - Tyler RS ; Preece JP ; Lansing CR ; Otto SR ; Gantz BJ TI - Previous experience as a confounding factor in comparing cochlear-implant processing schemes. AB - It is of great importance to compare the relative merits of different cochlear-implant speech-processing strategies. Some groups have compared different strategies within single subjects, but usually the subject has prior experience with one strategy, and no allowance is made for this prior experience. We show in the present study that this is inappropriate. We tested one subject using the Melbourne (Cochlear Corp.) multichannel implant with the device set to process sounds in two different ways. In the first processing scheme, the device functioned normally, extracting information about voicing frequency, amplitude and second-formant frequency. This information activated the 21-channel device, determining pulse rate, pulse amplitude and electrode position (respectively). In the second processing scheme, a single electrode (with the largest dynamic range) was activated. This electrode coded overall amplitude and voicing frequency. The subject was tested on an audiovisual test of a 14-choice consonant recognition in the form /iCi/ over a period of over 4 months. During this time the subject used the 21-channel processor outside of the laboratory. Upon initial connection, there was little difference between the results obtained with the two schemes when tested in sound alone or in sound plus vision. However, after about 4 months, scores obtained with the 21-channel processor in sound plus vision were superior to the scores obtained with the one channel. This advantage came from a superiority in the features of voicing and nasality, but not place. Scores for sound-alone conditions between the two processing schemes remained similar for the 4-month period.(ABSTRACT TRUNCATED AT 250 WORDS) MH - Auditory Threshold ; Case Report ; Cochlear Implant/*STANDARDS ; Comparative Study ; Deafness/*THERAPY ; Female ; Human ; Meniere's Disease/COMPLICATIONS ; Middle Age ; Phonetics ; Prosthesis Design ; Set (Psychology) ; Speech Reception Threshold Test SO - J Speech Hear Res 1986 Jun;29(2):282-7 15 UI - 86255462 AU - Doyle KJ ; Danhauer JL ; Edgerton BJ TI - Vowel perception: experiments with a single-electrode cochlear implant. AB - We investigated vowel perception by 15 subjects using the single-electrode cochlear implant used at the House Ear Institute in Los Angeles. Subjects were postlingually deaf adults having histories of unsuccessful hearing aid use and a minimum of 6 to 12 months experience with the implant. Eleven American English vowels spoken by a male talker were tape recorded, digitized, analyzed, and controlled for the experiments. The stimuli were audio-recordings of both natural and loudness-matched vowels. Subjects rated the dissimilarity of both the naturally spoken and the loudness-matched vowels, and performed identification of the latter. Two normal-hearing subjects served as controls for the dissimilarity tasks. Multidimensional scaling, hierarchical clustering, and percent correct identification analyses were used to help determine the perceptual features used by the subjects in their judgments. Generally, the normal-hearing subjects took advantage of second formant (F2) frequency information. The cochlear-implant users relied primarily upon fundamental (F0) and first formant (F1) frequency information and demonstrated difficulty in vowel identification. No major differences were noted for the natural versus loudness-matched vowels. F2 information, requisite for accurate vowel recognition, did not correspond to any of the perceptual dimensions discerned in the results obtained from implant subjects. MH - Adult ; Aged ; Auditory Threshold ; *Cochlear Implant ; Deafness/*THERAPY ; Human ; Loudness Perception ; Middle Age ; *Phonetics ; Psychoacoustics ; Sound Spectrography ; Speech Discrimination Tests/*METHODS ; Support, Non-U.S. Gov't SO - J Speech Hear Res 1986 Jun;29(2):179-92 16 UI - 86253925 AU - Hirshorn MS ; Mecklenburg DJ ; Brimacombe JA TI - Nucleus 22-channel cochlear implant: preliminary observations. AB - A carefully designed study was undertaken in 1982 to evaluate the performance of individuals who received the Nucleus 22-channel cochlear implant. All patients were profound-totally deaf, adults with a postlingual onset of impairment. The preoperative evaluation, prosthesis fitting, training, and postoperative testing were consistent across clinics. Single-subject studies, where each patient acted as his/her own control, revealed that of the 37 subjects, 16-24 obtained significant improvement (P less than or equal to 0.001) on unpracticed, unfamiliar recorded speech tests from the Minimal Auditory Capabilities (MAC) Battery, when using hearing alone (no lipreading). In addition, virtually all patients showed improvement in recognition of speech material with lipreading. The data support the efficacy of a feature extraction coding system where specific formant and amplitude information are transmitted via direct electrical stimulation to the cochlea. MH - Adult ; Aged ; Cochlear Implant/*INSTRUMENTATION ; Comparative Study ; Deafness/*REHABILITATION ; Electrodes ; Female ; Human ; Lipreading ; Male ; Microcomputers ; Middle Age ; Software ; Speech Discrimination Tests SO - J Rehabil Res Dev 1986 Apr;23(2):27-33 17 UI - 86251764 AU - Leder SB ; Spitzer JB ; Milner P ; Flevaris-Phillips C ; Richardson F ; Kirchner JC TI - Reacquisition of contrastive stress in an adventitiously deaf speaker using a single-channel cochlear implant. AB - Acoustic correlates of contrastive stress, i.e., fundamental frequency (F0), duration, and intensity, and listener perceptions of stress, were investigated in a profoundly deaf subject (RS) pre/post single-channel cochlear implant and longitudinally, and compared to the overall patterns of age-peer profoundly deaf (JM) and normally hearing subjects (DL). The stimuli were a group of general American English words in which a change of function from noun to verb is associated with a shift of stress from initial to final syllable, e.g., CON'trast versus conTRAST'. Precochlear implant, RS was unable to produce contrastive stress correctly. Hearing one day post-stimulation resulted in significantly higher F0 for initial and final stressed versus unstressed syllables. Four months post-stimulation, RS maintained significantly higher F0 on stressed syllables, as well as generalization of significantly increased intensity and longer syllable duration differences for all stressed versus unstressed syllables. Perceptually, listeners judged RS's contrastive stress placement as incorrect precochlear implant and as always correct post-cochlear implant. JM's contrastive stress was judged as 96% correct, and DL's contrastive stress placement was 100% correct. It was concluded that RS reacquired all acoustic correlates needed for appropriate differentiation of contrastive stress with longitudinal use of the cochlear implant. MH - Acoustic Stimulation ; Case Report ; *Cochlear Implant ; Deafness/ PHYSIOPATHOLOGY/*REHABILITATION/THERAPY ; Follow-Up Studies ; Hearing Loss, Sensorineural/PHYSIOPATHOLOGY/*REHABILITATION ; Human ; Male ; Middle Age ; *Speech ; Support, U.S. Gov't, Non-P.H.S. SO - J Acoust Soc Am 1986 Jun;79(6):1967-74 18 UI - 86239555 AU - Belal A Jr TI - Contraindications to cochlear implantation. AB - Cochlear implantation is still a controversial surgical procedure because its results in providing hearing for the deaf patient are far from ideal. The possible benefits of implantation should be carefully weighed against the complications that might arise. Many individuals with profound deafness are candidates for this procedure; however, there are some patients who are not. Contraindications to cochlear implantation, absolute and relative, systemic and local, are discussed. The surgeon's decision to withhold surgery is based on these contraindications. MH - Age Factors ; Aged ; Child ; Child, Preschool ; *Cochlear Implant ; Deafness/CLASSIFICATION/*SURGERY ; Dizziness/THERAPY ; Ear/PATHOLOGY ; Health Status ; Human ; Infant ; Language Development ; Prognosis SO - Am J Otol 1986 May;7(3):172-5 19 UI - 86229699 AU - Schindler RA ; Kessler DK ; Rebscher SJ ; Yanda JL ; Jackler RK TI - The UCSF/Storz multichannel cochlear implant: patient results. AB - Using the four channel cochlear implant system with a vocoder-based processor developed at UCSF over an extensive period of research, clinical trials of the UCSF/Storz device were initiated in February 1985, under the sponsorship of Storz Instrument Company. To date, 13 patients have been implanted with this device, nine of whom have been fitted with their external processor and transmitter and have received at least their initial postoperative evaluation. Patient results have been extremely promising, with eight of the nine patients obtaining some open-set auditory only speech understanding. Most patients have demonstrated improvement over time and all patients have attained an enhancement in lipreading ability with the use of the UCSF/Storz device. MH - Adult ; Aged ; *Cochlear Implant ; Deafness/PHYSIOPATHOLOGY/*SURGERY ; Female ; Hearing Loss, Partial/PHYSIOPATHOLOGY/SURGERY ; Hearing Tests/ METHODS ; Human ; Lipreading ; Loudness Perception ; Male ; Middle Age ; Phonetics ; Postoperative Period ; Prosthesis Design ; Speech Discrimination Tests ; Speech Perception SO - Laryngoscope 1986 Jun;96(6):597-603 20 UI - 86232095 AU - Balkany T ; Reite M ; Rasmussen K ; Stypulkowski PH TI - Behavioral effects of cochlear prosthesis on deafened monkeys. AB - No deleterious effects of electrical stimulation on deafened young monkeys were noted using the behavioral techniques described. Due to the small size of this study and the variability of individual monkey behavior, it is impossible to draw definitive conclusions from this study. However, the results strongly suggest that deafened young monkeys with functioning cochlear implants showed apparent improvement in social behavior over deafened nonimplanted subjects. These changes may result from environmental and vocalization sound awareness and/or prevention of auditory deprivation provided by the prosthesis. MH - Animal ; Audiometry, Evoked Response ; *Behavior, Animal ; *Cochlear Implant ; Deafness/*PSYCHOLOGY/REHABILITATION ; Evoked Potentials, Auditory ; Female ; Grooming ; Human ; Macaca nemestrina ; Male ; Play and Playthings ; Social Behavior ; Support, Non-U.S. Gov't SO - Otolaryngol Clin North Am 1986 May;19(2):435-46 21 UI - 86232094 AU - Yin L ; Segerson DA TI - Cochlear implants: overview of safety and effectiveness. The FDA evaluation. AB - Under authority of the Federal Food, Drug, and Cosmetic Act, as amended in 1976, the Food and Drug Administration requires manufactures of new medical devices, such as cochlear implants, to demonstrate the safety and effectiveness of their devices before marketing them. This article describes the FDA review process and the kinds of data the FDA is looking for in premarket approval applications for cochlear implants. It also discusses some of the issues surrounding the premarket approval applications which have already been approved. MH - Clinical Trials ; *Cochlear Implant/STANDARDS ; Equipment Safety ; Follow-Up Studies ; Human ; Product Surveillance, Postmarketing ; Prosthesis Design ; United States ; *United States Food and Drug Administration SO - Otolaryngol Clin North Am 1986 May;19(2):423-33 22 UI - 86232093 AU - Eisenberg LS ; Kirk KI ; Thielemeir MA ; Luxford WM ; Cunningham JK TI - Cochlear implants in children: speech production and auditory discrimination. AB - This article presents a statistical analysis of factors which may be predictive of improved speech and audiologic performance for implanted children. Such findings provide some prognostic indicators for identifying children who may have greater potential for success with the implant. MH - Auditory Perception ; Child ; Child, Preschool ; *Cochlear Implant ; Deafness/*REHABILITATION ; Human ; Infant ; *Speech Intelligibility ; *Speech Perception ; Speech Production Measurement SO - Otolaryngol Clin North Am 1986 May;19(2):409-21 23 UI - 86232092 AU - Banfai P ; Karczag A ; Kubik S ; L:uers P ; S:urth W TI - Extracochlear sixteen-channel electrode system. AB - This article summarizes 10 years of work by the Cologne-D:uren Research Group. The purpose of our research was to develop a noninvasive operation technique and to avoid opening the inner ear cavities (extracochlear technique). On the basis of empiric experience, a 16-channel electrode system was developed. The electrodes were fixed on a "hedgehog: contact plate with an arrangement corresponding to the projection of the cochlea. A microprocessor, which enables individual programmability in the different groups of deaf persons (prelingual, postlingual deafness), was integrated into the speech processor. Experience to date was summarized in statistical data. Not only the results of the psychoacoustic tests, but also the applicability of the cochlear implant as seen by the patients were considered. We next plan to miniaturize the system. MH - Acoustic Nerve/PHYSIOPATHOLOGY ; Adolescence ; Adult ; Audiometry, Evoked Response ; Auditory Threshold ; Child ; Child, Preschool ; Cochlea/ ANATOMY & HISTOLOGY ; *Cochlear Implant ; Deafness/DIAGNOSIS/ *REHABILITATION ; Electrodes, Implanted ; Evoked Potentials, Auditory ; Hearing Aids ; Human ; Middle Age ; Prosthesis Design ; Psychoacoustics ; Speech Discrimination Tests ; Support, Non-U.S. Gov't SO - Otolaryngol Clin North Am 1986 May;19(2):371-408 24 UI - 86232091 AU - Chouard CH ; Fugain C ; Meyer B ; Chabolle F TI - The Chorimac 12. A multichannel intracochlear implant for total deafness. AB - In all of our cases, phonetic discrimination has been obtained without the help of lip-reading. Speech intelligibility is generally better in postlingual deafness that in prelingual deafness. We believe this method, despite the size of the external transmitter, is best for rehabilitation of totally deaf patients. MH - Adult ; Child ; Child, Preschool ; Clinical Trials ; *Cochlear Implant ; Deafness/DIAGNOSIS/PSYCHOLOGY/*REHABILITATION ; Human ; Lipreading ; Prosthesis Design ; Speech Acoustics ; Speech Discrimination Tests ; Speech Intelligibility ; Time Factors SO - Otolaryngol Clin North Am 1986 May;19(2):355-70 25 UI - 86232090 AU - Clark GM TI - The University of Melbourne/Cochlear Corporation (Nucleus) program. AB - The Nucleus multichannel cochlear prosthesis has been implanted in over 100 patients. Speech discrimination improved greatly in most patients. Overall, the results with this type of implant are very satisfactory. MH - Adolescence ; Adult ; Aged ; Animal ; Australia ; Biocompatible Materials ; Cats ; Clinical Trials ; Cochlea/INJURIES ; *Cochlear Implant/ADVERSE EFFECTS ; Deafness/DIAGNOSIS/*REHABILITATION ; Equipment Safety ; Human ; Labyrinth Diseases/ETIOLOGY ; Middle Age ; Otitis Media/ETIOLOGY ; Postoperative Care ; Postoperative Complications/ETIOLOGY ; Prosthesis Design ; Risk ; Speech Discrimination Tests ; Speech Perception ; Staphylococcal Infections/ETIOLOGY SO - Otolaryngol Clin North Am 1986 May;19(2):329-54 26 UI - 86232089 AU - Burian K ; Hochmair-Desoyer IJ ; Eisenwort B TI - The Vienna cochlear implant program. AB - The cochlear implant program in Vienna has now gathered 160 patient years of experience with 25 patients who have received an extracochlear implant prosthesis and 31 patients who have received an intracochlear implant prosthesis. The sound processor avoids the transformation of speech into pulses and provides a processed analog broad-band stimulation signal. Approximately one half of the patients are prelingually deaf. The selection criteria include electrical promontory stimulation and acoustic and electrical brain-stem audiometry. The rehabilitation program consisting of counseling, communication training, and auditory training is considered an important part of the program. The results are assessed using the Vienna Auditory Test battery. Sixty per cent of the postlingually deafened patients achieve some open-set speech understanding without lip-reading. Sixty-five per cent of the users show a substantial improvement in aided speech understanding versus lip-reading alone. MH - Audiometry, Evoked Response ; Austria ; *Cochlear Implant ; Counseling ; Cues ; Deafness/PHYSIOPATHOLOGY/*REHABILITATION ; Electrodes, Implanted ; Evoked Potentials, Auditory ; Human ; Lipreading ; Preoperative Care ; Prosthesis Design ; Speech Discrimination Tests ; Speech Perception SO - Otolaryngol Clin North Am 1986 May;19(2):313-28 27 UI - 86232088 AU - Portmann M ; Cazals Y ; Negrevergne M TI - Extracochlear implants. AB - A unichannel extracochlear implant designed and made in our laboratory was tried on several patients. Results to date are very similar in all cases. Very rudimentary auditory information is provided, which can help totally deaf patients. MH - *Cochlear Implant ; Deafness/*REHABILITATION ; Human ; Loudness Perception ; Prosthesis Design ; Speech Perception SO - Otolaryngol Clin North Am 1986 May;19(2):307-12 28 UI - 86232087 AU - Schindler RA ; Kessler DK ; Rebscher SJ ; Yanda J TI - The University of California, San Francisco/Storz cochlear implant program. AB - Using a four-channel implant system with a vocoder-based processor developed at UCSF over an extensive period of research, clinical trials of the UCSF/Storz device were initiated in February 1985 under the sponsorship of Storz Instrument Company. To date, 13 patients have been implanted with the UCSF/Storz device, 10 of whom have been fitted with their external processor and transmitter and have received at least their initial postoperative evaluations. Of these 10 patients, nine are able to use all four channels of their implant system. The device fitting/adjusting process for these patients has been remarkably easy, requiring only approximately 30 to 60 minutes. Patient results have been extremely good, with eight of the 10 patients obtaining some open-set auditory only speech understanding. Without extensive rehabilitation and training, most patients have demonstrated an improvement in speech reception over time. Lip-reading and tracking results indicate that all patients have attained an enhancement of lip-reading ability with the use of the device, suggesting that improved general communication skills have been provided for each UCSF/Storz patient. MH - Adult ; Aged ; Biocompatible Materials ; California ; Clinical Trials ; Cochlea/INJURIES ; *Cochlear Implant ; Comparative Study ; Deafness/ *REHABILITATION ; Electrodes, Implanted ; Female ; Human ; Lipreading ; Male ; Middle Age ; Postoperative Care ; Postoperative Complications/ ETIOLOGY ; Prosthesis Design ; Silicone Elastomers ; Speech Discrimination Tests ; Speech Perception SO - Otolaryngol Clin North Am 1986 May;19(2):287-305 29 UI - 86232086 AU - House WF ; Berliner KI TI - Safety and efficacy of the House/3M cochlear implant in profoundly deaf adults. AB - The House/3M cochlear implant system is no longer considered investigational. Many years of clinical experience led to development of a clinically feasible program for selecting patients, fitting the device, training patients in its use, and evaluating results. Both laboratory and clinical data support the conclusion that this device is safe and provides significant benefits for profoundly deaf adults. The House/3M cochlear implant has had a significant impact in the treatment of the profoundly deaf, even while in the investigational stage. First and foremost, patients who were previously turned away as "untreatable: were provided with a new option. Furthermore, the professionals--otologists and audiologists--had a new set of tools, including assessment and rehabilitation materials, to use in dealing with the profoundly deaf patient. These patients can now be provided more effective care whether they obtain an implant or a hearing aid. Finally, the introduction of this device stimulated the development of better devices, better assessment tools, and other alternatives. The future calls for device improvements, objective methods for selection of candidates, and expansion of the application of electrical stimulation of hearing to children, to patients with more residual hearing, and to those who require a central electroauditory prosthesis for stimulation in the brain stem. Cochlear implants are rapidly becoming a part of clinical otology and audiology. It is important that accurate information be disseminated among these professionals, that professional training programs teach their students about this area, and that other professionals, such as educators of the deaf, speech/language pathologists, and psychologists who deal with the hearing impaired, become knowledgeable in dealing effectively with the implanted child or adult. MH - Adult ; Auditory Perception ; *Cochlear Implant/ADVERSE EFFECTS ; Deafness/*REHABILITATION ; Equipment Safety ; Follow-Up Studies ; Human ; Postoperative Complications/ETIOLOGY ; Prosthesis Design ; Questionnaires ; Speech Perception ; Tinnitus/ETIOLOGY ; Vestibular Apparatus/ PHYSIOPATHOLOGY SO - Otolaryngol Clin North Am 1986 May;19(2):275-86 30 UI - 86232085 AU - Maddox HE 3d ; Stout GG ; Jorgensen S TI - Educational aspects of cochlear implants in children. AB - An overview of deaf education as it relates to the needs of the cochlear implant child is given. More specific information concerning the developmental approach to successful listening is described. The progress of specific youngsters is discussed following application of this "approach:. MH - Case Report ; Child ; *Cochlear Implant ; *Curriculum ; Deafness/ *REHABILITATION ; *Education, Special ; Female ; Human ; Speech Intelligibility ; Speech Perception SO - Otolaryngol Clin North Am 1986 May;19(2):267-74 31 UI - 86232084 AU - Alpiner JG TI - Rehabilitation concepts with the cochlear implant. AB - In some ways, it appears that rehabilitation for cochlear implant patients is following the early rehabilitation trends of this century. In the early part of the 1900's, emphasis was on lip-reading, since we did not have amplification as we now know it. With the refinements in amplification, there was less emphasis on analytic lip-reading (exact identification of sounds and words). The trend was to counsel individuals on the benefits and limitations of amplification; lip-reading was regarded as something hearing-impaired individuals would learn anyway. Aural rehabilitation now emphasizes hearing aids. Twenty-five years ago, the emphasis was on lip-reading, with or without amplification. It would appear that rehabilitation for cochlear implant patients is following the same trend. As we learn more about cochlear implants, the trends for rehabilitation will become more clear. MH - *Cochlear Implant ; Deafness/*REHABILITATION ; Human ; Lipreading ; Speech Perception SO - Otolaryngol Clin North Am 1986 May;19(2):259-65 32 UI - 86232083 AU - Stypulkowski PH ; van den Honert C ; Kvistad SD TI - Electrophysiologic evaluation of the cochlear implant patient. AB - Electrically evoked auditory brain stem responses (EABRs) have been measured in experimental animals and human subjects. The EABR may hold promise as a clinical tool in the evaluation of the auditory system in candidates or users of cochlear prostheses. MH - Animal ; Auditory Pathways/*PHYSIOPATHOLOGY ; Brain Stem/PHYSIOLOGY ; Cats ; *Cochlear Implant ; Deafness/*PHYSIOPATHOLOGY/REHABILITATION ; Electrophysiology ; *Evoked Potentials, Auditory ; Human SO - Otolaryngol Clin North Am 1986 May;19(2):249-57 33 UI - 86232082 AU - Burgio P TI - Safety considerations of cochlear implantation. AB - This article reviews past research on the safety of surgical techniques, cell response to implants, and electrode design. New information obtained from animal studies and from in vitro observations of human temporal bones is also presented. MH - Animal ; Biocompatible Materials ; Cats ; Chinchilla ; Cochlea/PATHOLOGY ; *Cochlear Implant/ADVERSE EFFECTS ; Dogs ; Electrodes, Implanted ; Equipment Safety ; Human ; Labyrinth/PATHOLOGY ; Postoperative Complications/ETIOLOGY ; Prosthesis Design ; Risk SO - Otolaryngol Clin North Am 1986 May;19(2):237-47 34 UI - 86232081 AU - Pfingst BE TI - Stimulation and encoding strategies for cochlear prostheses. AB - This article reviews the various stimulation and encoding strategies currently used in hearing prostheses for profoundly deaf individuals. Various designs for implanted electrode arrays, electrode drivers, and systems for transmitting signals are described. The various strategies for encoding acoustic signals for delivery as electrical stimuli to the auditory nerve are reviewed. Finally, applications of these various stimulation and encoding strategies are described using examples from different groups worldwide which have developed their own unique prosthetic devices. MH - *Cochlear Implant ; Electrodes, Implanted ; Electronics, Medical/METHODS ; Human ; Prosthesis Design ; Review ; Support, U.S. Gov't, P.H.S. ; Transducers SO - Otolaryngol Clin North Am 1986 May;19(2):219-36 35 UI - 86232080 AU - House WF TI - Cochlear implants. Present and future. AB - The perfect cochlear implant has eluded the many research teams around the world that are studying it. In the hope that someone may develop one system that is clearly better than the others, I believe that each team should pursue its own ideas and methods. We have at least another 20 years of step-by-small step development if we are to continue to improve the cochlear implant. MH - *Cochlear Implant ; Human SO - Otolaryngol Clin North Am 1986 May;19(2):217-8 36 UI - 86232078 AU - Fravel RP TI - Cochlear implant electronics made simple. AB - Electronics used in cochlear implants are relatively straightforward. While all cochlear implants process signals by amplifying, compressing, filtering, and encoding them for transmission to and use by the receiver, there are significant electronic variations amongst cochlear implant systems. The evolving nature of cochlear implant research and development makes it difficult, at the least, to predict the optimum electronic configuration. Since the biologic system which this prosthesis replaces is subject to so many forms and degrees of pathology, there is likely no one best answer. Since their first use in 1957, cochlear implants have steadily evolved to their current state. Much is still unknown about the biologic system on which they operate. It is exciting to contemplate that this biologic system, even though damaged, may be made more understandable by the same device which restores some hearing function. MH - *Cochlear Implant ; Electrodes ; Electronics, Medical ; Human ; Prosthesis Design SO - Otolaryngol Clin North Am 1986 May;19(2):xi-xxii 37 UI - 86193179 AU - Pope ML ; Miyamoto RT ; Myres WA ; Robbins AM ; Punch JL TI - Cochlear implant candidate selection. AB - In recent years there has been an increased acceptance of the cochlear implant as an appropriate sensory aid for selected hearing-impaired individuals with profound losses. With the Food and Drug Administration's release of the 3M/House single channel cochlear implant on November 29, 1984 and the Nucleus 22-channel cochlear implant on October 31, 1985 it is anticipated that many new groups of otologists and audiologists will have direct involvement in this exciting new approach to the management of patients with profound hearing impairments. This report reviews our cochlear implant selection protocol for the severe to profound adult hearing-impaired population. MH - Adult ; Audiometry/METHODS ; *Cochlear Implant ; Deafness/PHYSIOPATHOLOGY/ REHABILITATION ; Hearing Aids ; Hearing Disorders/PSYCHOLOGY/ REHABILITATION ; Human ; Support, Non-U.S. Gov't SO - Ear Hear 1986 Apr;7(2):71-3 38 UI - 86185212 AU - Duckert LG ; Miller JM TI - Mechanisms of electrically induced damage after cochlear implantation. AB - This report is the fourth in a series of parametric studies designed to evaluate and define conditions that may produce histological damage by means of electrical stimulation from cochlear prostheses. Earlier studies established damage thresholds for both acute (400 microA rms or 70 microC/cm(2)0) and chronic (100 microA rms or 15 to 20 microC/cm(2)0) stimulation with continuous sinusoidal current of 1,000 Hz. In a subsequent study, a tenfold reduction in the stimulation frequency (to 100 Hz) resulted in a 50% reduction in the acute damage threshold (200 microA rms), which was a smaller reduction than anticipated if damage is dependent only on charge density. This finding and the damage patterns observed in the preceding studies suggested that multiple mechanisms are responsible for the sensory and supporting cell degeneration induced by the electrical stimulus. A similar pattern of structural changes has been observed by other investigators after acoustic stimulation of the cochlea, suggesting that common mechanisms may be involved. With electrical stimulation, electrophoretic effects have been implicated; like acoustic trauma, however, mechanical, biochemical, and metabolic processes may also be involved. This investigation was designed to identify and analyze better the damage mechanisms active in acute stimulation. Sixteen normal guinea pigs were implanted and stimulated using an interrupted 1,000-Hz signal at 500 microA for three hours. Duty cycle was reduced to 50% and signal periodicity ranged from 100 to 1,000 ms.(ABSTRACT TRUNCATED AT 250 WORDS) MH - Animal ; Auditory Threshold/PHYSIOLOGY ; Cilia/ULTRASTRUCTURE ; Cochlea/ PHYSIOPATHOLOGY/*ULTRASTRUCTURE ; Cochlear Implant/*ADVERSE EFFECTS ; Electric Stimulation/METHODS ; Guinea Pigs ; Hair Cells/ULTRASTRUCTURE ; Organ of Corti/ULTRASTRUCTURE ; Support, Non-U.S. Gov't ; Support, U.S. Gov't, P.H.S. SO - Ann Otol Rhinol Laryngol 1986 Mar-Apr;95(2 Pt 1):185-9 39 UI - 86185204 AU - Jerger J ; Jenkins H ; Fifer R ; Mecklenburg D TI - Stapedius reflex to electrical stimulation in a patient with a cochlear implant. AB - In a patient with a multichannel cochlear implant, it was possible to demonstrate stapedius reflex contraction to intracochlear electrical stimulation. Using a standard immittance measurement technique, characteristics of the electrically evoked reflex were compared to analogous characteristics of the acoustically evoked reflex. Latency-intensity functions were similar for the two modes of excitation, but reflex waveform morphology and amplitude growth functions were different. MH - Acoustic Stimulation ; Acoustics ; Adult ; Case Report ; *Cochlear Implant ; Comparative Study ; Electric Stimulation/METHODS ; Female ; Human ; Male ; Middle Age ; Muscle Contraction ; Muscles/*PHYSIOLOGY ; Reaction Time ; *Reflex, Acoustic ; Stapedius/*PHYSIOLOGY SO - Ann Otol Rhinol Laryngol 1986 Mar-Apr;95(2 Pt 1):151-7 40 UI - 86171429 AU - Pickett JM TI - Speech communication for the deaf: visual, tactile, and cochlear-implant. AB - A review is given of current research and development on electronic devices to aid speech communication for the deaf. Visual and tactile displays are compared with stimulation of hearing via electrodes implanted in the cochlea. Specific comparative performance data are given for cochlear electrical implants versus tactile aids. MH - *Audio-Visual Aids ; *Cochlear Implant ; Communication ; Deafness/ *REHABILITATION ; Human ; *Nonverbal Communication ; Patient Education ; *Sensory Aids ; *Speech ; Support, Non-U.S. Gov't ; Support, U.S. Gov't, Non-P.H.S. ; Touch SO - J Rehabil Res Dev 1986 Jan;23(1):95-9 41 UI - 86171422 AU - White MW TI - Compression systems for hearing aids and cochlear prostheses. AB - Audio and speech compression systems have suffered several characteristic deficiencies. Single-channel compression systems cannot compress wideband signals without suffering from either spectral distortion or the inability to respond quickly to fast transients. When the input signal contains noise in addition to the desired speech signal, single-channel systems unnecessarily attenuate speech information. Single-channel compressors cannot compress the input signal differentially as a function of frequency. Multichannel compressors are capable of different levels of compression as a function of frequency. However, standard multichannel compressors unnecessarily attenuate important information about the shape of the short-term speech spectrum. This has resulted in poorer speech perception when using standard multichannel systems as compared with single-channel compression systems. A more general form of multichannel compression can emphasize information about the shape of the short-term speech spectrum. Susceptibility to many forms of noise is also reduced with such multichannel systems. Spectral distortion and undesired rapid overshoots and undershoots of signal level, characteristic of many single- and multi-channel systems, can be substantially reduced with such systems. MH - *Cochlear Implant ; Comparative Study ; Evaluation Studies ; *Hearing Aids ; Human ; Sound ; Speech Perception ; Technology SO - J Rehabil Res Dev 1986 Jan;23(1):25-39 42 UI - 86171420 AU - Levitt H ; Waltzman SB ; Shapiro WH ; Cohen NL TI - Evaluation of a cochlear prosthesis using connected discourse tracking. AB - A multichannel cochlear prosthesis was evaluated using the method of Connected Discourse Tracking. Data were obtained from five subjects over a 10-week period. Significant learning effects were obtained both with and without the prosthesis. The method of orthogonal polynomials was used to obtain a statistically precise fit for each learning curve. The curves differed both in terms of shape and average rate of learning. The two best subjects showed substantial improvements, reaching tracking rates in excess of 90 words-per-minute. A method for representing prosthesis-based improvements, which takes learning effects into account, is developed and discussed. MH - Analysis of Variance ; *Cochlear Implant ; Comparative Study ; Deafness/ REHABILITATION ; Evaluation Studies ; Hearing ; Human ; Interpersonal Relations ; Learning ; Patient Education/*METHODS ; Sensory Aids ; Support, Non-U.S. Gov't ; Support, U.S. Gov't, P.H.S. SO - J Rehabil Res Dev 1986 Jan;23(1):147-54 43 UI - 86160449 AU - Fraser JG ; Cooper HR ; Hazell JW ; Phelps PD ; Lloyd GA TI - The UCH/RNID cochlear implant programme: patient selection. AB - After an initial postal questionnaire, patients undergo a series of tests and assessments designed to establish their suitability for implantation. The following criteria should be met: Total or profound post-lingual hearing loss. Sufficient age to give informed consent. General good health. Psychological stability. Unable to benefit from hearing aids. Free from middle ear or mastoid disease. Detailed medical, audiometric, vestibular and psychological investigations are performed, as well as acute electrical stimulation of the cochlea, and a hearing aid trial in those subjects with some measurable hearing. Fifty-two applicants have so far been assessed and of these 14 have been found to be suitable for implantation and seven have received implants. MH - *Cochlear Implant ; Human ; Medical History Taking ; Patient Compliance ; Physical Examination ; Questionnaires SO - Br J Audiol 1986 Feb;20(1):9-17 44 UI - 86160447 AU - Rosen S ; Ball V TI - Speech perception with the Vienna extra-cochlear single-channel implant: a comparison of two approaches to speech coding. AB - Although it is generally accepted that single-channel electrical stimulation can significantly improve a deafened patient's speech perceptual ability, there is still much controversy surrounding the choice of speech processing schemes. We have compared, in the same patients, two different approaches: (1) The speech pattern extraction technique of the EPI group, London (Fourcin et al., British Journal of Audiology, 1979,13,85-107) in which voice fundamental frequency is extracted and presented in an appropriate way, and (2) The analogue 'whole speech' approach of Hochmair and Hochmair-Desoyer (Annals of the New York Academy of Sciences, 1983, 405, 268-279) of Vienna, in which the microphone-sensed acoustic signal is frequency-equalized and amplitude-compressed before being presented to the electrode. With the 'whole-speech' coding scheme (which they used daily), all three patients showed an improvement in lipreading when they used the device. No patient was able to understand speech without lipreading. Reasonable ability to distinguish voicing contrasts and voice pitch contours was displayed. One patient was able to detect and make appropriate use of the presence of voiceless frication in certain situations. Little sensitivity to spectral features in natural speech was noted, although two patients could detect changes in the frequency of the first formant of synthesised vowels. Presentation of the fundamental frequency only generally led to improved perception of features associated with it (voicing and intonation). Only one patient consistently showed any advantage (and that not in all tests) of coding more than the fundamental alone. MH - Adult ; Case Report ; *Cochlear Implant ; Comparative Study ; Deafness/ SURGERY ; Evaluation Studies ; Female ; Follow-Up Studies ; *Hearing ; Human ; Middle Age ; Sound ; *Speech ; Support, Non-U.S. Gov't SO - Br J Audiol 1986 Feb;20(1):61-83 45 UI - 86160446 AU - East CA ; Cooper HR TI - Extra-cochlear implants: the patient's viewpoint. AB - A subjective questionnaire has been used for assessing cochlear implantees. It provides information on the benefits and the problems found after one year's use as viewed by the patients. This information is important to the management of future subjects for implantation. In three patients with a year's experience of implant use provision of environmental sound and improved speech loudness modulation were the most appreciated benefits. Improved speech reading ability did not emerge as the greatest benefit, except in one case in good listening conditions. Alleviation of tinnitus occurred only to a limited extent, in one patient out of the three. MH - Adult ; Auditory Threshold ; Case Report ; Cochlear Implant/ *REHABILITATION ; Female ; Follow-Up Studies ; Human ; Middle Age ; Questionnaires ; Speech ; Tinnitus/ETIOLOGY/PHYSIOPATHOLOGY SO - Br J Audiol 1986 Feb;20(1):55-9 46 UI - 86160444 AU - Hochmair-Desoyer IJ TI - Fitting of an analogue cochlear prosthesis--introduction of a new method and preliminary findings. AB - A new method is suggested for the fitting of a broad-band analogue cochlear prosthesis in terms of frequency response adjustment. This 'frequency-stepped sweep' (FSS) method employs a feedback loop including the patient's loudness judgement to determine a frequency response for the patient's sound processor with which a continuous sinusoidal stimulus with constant amplitude and small increments in frequency can be heard equally loud at the most comfortable loudness level. The FSS-method has been successfully used for the fitting of the sound processors of 40 cochlear implant users. An evaluation of the FSS-method through speech tests employing five different frequency response adjustments with two implant patients confirms its appropriateness. The importance of proper fitting in terms of the frequency response adjustment for a cochlear prosthesis based on broad-band analogue stimulation is demonstrated. The necessary accuracy for the frequency response adjustment is approximately +/- 2 to +/- 5 dB (depending on the dynamic range of the patient) over the frequency range between 100 and 3000 Hz. For the proper adjustments no significant difference has been found between the results for a male and a female speaker. MH - Acoustic Stimulation ; Auditory Threshold ; *Cochlear Implant ; Evaluation Studies ; Female ; Hearing Tests ; Human ; Male ; Sound ; Speech ; Support, Non-U.S. Gov't SO - Br J Audiol 1986 Feb;20(1):45-53 47 UI - 86160443 AU - Waters T TI - Speech therapy with cochlear implant wearers. AB - The speech production of three post-lingually deafened adults, who derived no benefit from wearing hearing aids, was assessed. Individual therapy programmes were devised based on these assessments and the subjects participated in a course of speech therapy. They then received cochlear implants and had a further course of speech therapy using their implants. Changes in speech production were judged by trained listeners, who heard tape-recorded samples of the subjects' speech. These samples were taken at various intervals before and after therapy alone, and with the cochlear implant. Significant improvement was heard in the speech production of two of the subjects following speech therapy alone. All three subjects were judged to have improved production of speech after using their cochlear implants for 6 months. MH - Cochlear Implant/*REHABILITATION ; Follow-Up Studies ; Human ; Speech ; *Speech Therapy SO - Br J Audiol 1986 Feb;20(1):35-43 48 UI - 86160442 AU - McKenna L TI - The psychological assessment of cochlear implant patients. AB - The use of a cochlear implant (CI) to restore some acoustical input to patients with complete acquired hearing loss may be expected to result in changes in their psychological functioning. CI programmes should therefore include a careful psychological screening of all candidates and subsequent psychological assessments of patients who receive implants. Procedures used in the psychological assessment of CI candidates and patients outlined in the literature, as well as those used in the Royal Ear Hospital (REH) programme, are discussed. It is concluded that standard psychological tests of personality and intellectual functioning are of limited value in the screening of CI candidates and the postoperative evaluation of patients. It is proposed that more useful information be obtained by an analysis of the possible functional value of the implant to each individual candidate and by assessment of actual postoperative changes in the patient's behaviour. Unless an implant leads to improvements in the patient's psychosocial functioning, the device is unlikely to be used. Examples of this approach in assessing the REH candidates and patients are given. MH - Cochlear Implant/*PSYCHOLOGY/REHABILITATION ; Deafness/*PSYCHOLOGY/ SURGERY ; Human ; Intelligence Tests ; MMPI ; Personality SO - Br J Audiol 1986 Feb;20(1):29-34 49 UI - 86160441 AU - Rothera M ; Conway M ; Brightwell A ; Graham J TI - Evaluation of patients for cochlear implant by promontory stimulation. Psychophysical responses and electrically evoked brainstem potentials. AB - The protocol for assessing patients for cochlear implantation at University College Hospital and the Royal National Institute for the Deaf, London, includes a session of electrophysiological tests and electrical stimulation of the cochlea. Electrocochleography is performed with the object of excluding non-organic hearing loss and of clarifying the site of deafness. Using the same transtympanic needle, AC and DC electrical stimulation is performed to establish whether patients perceive a sensation of sound, dynamic range and ability to detect frequency shifts. Tinnitus suppression was produced by AC and DC stimulation. It is likely that AC suppression of tinnitus occurs by a masking effect. Electrically evoked auditory brainstem potentials were recorded in one patient. MH - Brain Stem/*PHYSIOPATHOLOGY ; *Cochlear Implant ; Electric Stimulation ; *Evoked Potentials, Somatosensory ; Hearing Loss, Partial/PHYSIOPATHOLOGY/ SURGERY ; *Hearing Tests ; Human ; Tinnitus/PHYSIOPATHOLOGY SO - Br J Audiol 1986 Feb;20(1):25-8 50 UI - 86160440 AU - King AB ; Martin MC TI - Audiological assessment in the selection of cochlear implant candidates. AB - In the UCH/RNID Cochlear Implant Programme, patients referred for further audiological assessment are all post-lingually deafened adults with bilateral hearing losses in excess of 90 dB HL in the frequency range 500 Hz to 4 kHz. The purpose of this assessment as part of the selection procedure for implant candidates is to ascertain whether or not the patient has any residual auditory function which can be aided by conventional means. The procedure includes measurement of thresholds of sensation (whether auditory or vibrotactile) for pure tones, and testing for Uncomfortable Loudness Levels up to 130 dB HL. It also includes measurements of frequency discrimination and abnormal adaptation, and assessment of the effect of acoustic stimulation on tinnitus if present. Those with measurable hearing are further tested for discrimination of simple sound patterns related to the perception of speech. Results of assessment, and criteria of suitability for a trial with a high-powered hearing aid are discussed in this paper. Of the 29 patients tested to date, 14 were judged to have sufficient residual auditory function to justify a hearing aid trial. In 10 cases the trial was successful and these people were then no longer considered to be potential candidates for cochlear implantation. MH - Acoustic Stimulation ; *Audiometry ; Auditory Threshold ; *Cochlear Implant ; Hearing Loss, Bilateral/DIAGNOSIS/*SURGERY ; Hearing Loss, Partial/*SURGERY ; *Hearing Tests ; Human SO - Br J Audiol 1986 Feb;20(1):19-23 51 UI - 86155298 AU - Ball JB Jr ; Miller GW ; Hepfner ST TI - Computed tomography of single-channel cochlear implants. AB - Computed tomographic (CT) examinations were performed in seven patients after cochlear implant surgery. Preimplantation CT demonstrated the petrous anatomy well and revealed an abnormality in one case. Postimplantation CT adequately assessed electrode position in all cases. Malposition of the active electrode was identified in one patient. Electrode position was correlated with postimplantation audiometric testing. A "transpetrous: projection was used to image perpendicular to the active electrode within the basal turn of the cochlea. A potential pitfall was identified where the ground electrode tip appeared to be embedded in the carotid canal cortex due to partial-volume averaging. With further experience, the clinical utility of CT in cochlear implantation patients will be better defined. MH - Acoustic Impedance Tests ; Adult ; Aged ; Cochlea/*RADIOGRAPHY ; *Cochlear Implant ; Deafness/PHYSIOPATHOLOGY/SURGERY ; Electrodes, Implanted ; Female ; Human ; Male ; Middle Age ; Prosthesis Design ; Temporal Bone/*RADIOGRAPHY ; *Tomography, X-Ray Computed SO - AJNR 1986 Jan-Feb;7(1):41-7 52 UI - 86148044 AU - O'Donoghue GM ; Jackler RK ; Jenkins WM ; Schindler RA TI - Cochlear implantation in children: the problem of head growth. AB - Successful implantation in children requires that provision be made for later head growth. The timing and magnitude of this growth was determined by measurements made from high-resolution computerized tomographic images of developing temporal bones. The temporal bone scans of 103 children of varying ages were studied. The development of the petrous and squamous portion of the temporal bone was at its greatest in the first 2 years of life. The order of magnitude of growth varied with the different axes measured. MH - Adolescence ; Adult ; Age Factors ; Child ; Child, Preschool ; *Cochlear Implant ; Female ; Human ; Infant ; Infant, Newborn ; Male ; Support, Non-U.S. Gov't ; Temporal Bone/*GROWTH & DEVELOPMENT/RADIOGRAPHY/SURGERY ; Tomography, X-Ray Computed SO - Otolaryngol Head Neck Surg 1986 Jan;94(1):78-81 53 UI - 86128885 AU - Jackler RK ; O'Donoghue GM ; Schindler RA TI - Cochlear implantation: strategies to protect the implanted cochlea from middle ear infection. AB - A cochlear implant for use in children must take into account the high incidence of middle ear infection in this age group. A scala tympani electrode that traverses the middle ear and round window will likely act as a conduit by which infection can spread to the inner ear and potentially to the CNS. In this study an attempt was made to reestablish a separation of the cochlea from the middle ear by developing a seal around the implant at the level of the round window. A series of cats were implanted with simulated cochlear prostheses consisting of either a plain Silastic cylinder, a Silastic cylinder wrapped with autogenous fascia, or a Silastic cylinder with a cuff of bioactive ceramic. Middle ear infection was induced, followed by histologic examination. Bioactive ceramic appears to have some merit as a round window sealing material, while fascia was shown to be of no value. Intracochlear infection, when it did occur, was limited to the basal regions of the cochlea. MH - Animal ; Cats ; Ceramics ; Cochlea/PATHOLOGY/*SURGERY ; *Cochlear Implant ; Equipment Design ; Fascia ; Labyrinth Diseases/PATHOLOGY/*PREVENTION & CONTROL ; Models, Biological ; Otitis Media/*COMPLICATIONS/PATHOLOGY ; Silicone Elastomers ; Support, Non-U.S. Gov't SO - Ann Otol Rhinol Laryngol 1986 Jan-Feb;95(1 Pt 1):66-70 54 UI - 86117488 AU - Miyamoto RT TI - Electrically evoked potentials in cochlear implant subjects. AB - A series of experiments was performed to study electrically evoked potentials as indicators of subject response to cochlear implantation. 1. Brain stem evoked responses to electrical stimulation were compared to those obtained by acoustic stimulation in guinea pigs. The response pattern was similar and was independent of the site of placement of the stimulus electrode (cochlear base or apex) or of the extracochlear ground electrode (eustachian tube or temporalis muscle) when evoked electrically. 2. Electrically evoked middle latency responses were recorded and compared to subjective behavioral thresholds in patients who had received a single channel cochlear implant (House-Urban). The behavioral responses to the same stimuli were similar. 3. Electrically evoked auditory brain stem responses were studied in single channel cochlear implant subjects (3M/House). When evoked electrically, potential latencies were shorter and interpeak intervals narrower than acoustically evoked potentials. MH - Acoustic Stimulation/METHODS ; Adolescence ; Adult ; Aged ; Animal ; Brain Stem/PHYSIOLOGY ; Child ; Child, Preschool ; *Cochlear Implant ; *Cochlear Microphonic Potentials ; Comparative Study ; Deafness/ PHYSIOPATHOLOGY/THERAPY ; Electric Stimulation/METHODS ; *Evoked Potentials, Auditory ; Female ; Guinea Pigs ; Human ; Male ; Middle Age ; Reaction Time/PHYSIOLOGY ; Support, Non-U.S. Gov't SO - Laryngoscope 1986 Feb;96(2):178-85