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Objectives : Aim 1 was to use parent ratings of performance to indicate the relative degree of difficulty experienced in different everyday listening scenarios by children using bilateral cochlear implants (CIs). Aim 2 was to compare ratings with those from parents of children with normal hearing (NH). Materials/Methods: 81 parents of children aged 7.5-9.5y, including 21 with NH, participated. Mean age at first and bilateral implantation was 1.4y and 3.3y. The Speech, Spatial and Qualities of Hearing Scale for Parents was administered. The 9 items in Section A focused on speech perception in single speaker or group conversations in varied backgrounds. The 6 items in Section B focused on spatial hearing (i.e., location and movement of sound sources). The 8 items in Section C focused on other qualities of hearing, including sound segregation and listening effort. Results/Conclusions : In Section A, the parent ratings for the CI group were high (mean 9.6 out of 10) for a single speaker in quiet but decreased with the addition of more speakers, background noise and an absence of visual cues. Mean ratings in the most difficult scenarios involving group conversation in background noise were only around 4 to 5. In Section B, the CI group demonstrated more difficulty in locating environmental sounds than locating speakers. In Section C, there was more variation, with the lowest ratings were for items related to listening effort, ignoring extraneous sounds and identifying or distinguishing between environmental sounds. Across all items, except a single speaker in quiet, the group ratings were significantly lower for the CI group; however, on each item, ≥50% of CI children were rated at least equal to the lowest-rated NH children, and many CI children were rated as performing exceptionally well. There was a significant correlation between ratings for each group, indicating a similar pattern of low and high performance ratings across scenarios. [ABSTRACT FROM AUTHOR]

The number of cochlear implant users is predicted to increase over time. A cochlear implant is generally programmed throughout the user's lifetime. When setting the frequency of programming sessions over time, there is currently very little consideration and understanding of the changes in programming levels over time. The primary aim was to provide an evidence-based schedule for programming. Methods: The schedule was developed using evidence of change in programming levels for a large cohort of 680 adult implant users. For each participant, changes in levels were investigated as a function of dynamic range over 2 years post implantation. In addition, for 128 implant users, patterns of change in levels were investigated over 10 years post implantation. Associations of change with demographic characteristics were also investigated. Results: Findings showed little change from 3 to 6 months out to 10 years post implantation for more than 75% of the participants. For all participants, regardless of demographic characteristics, the mean amount of change over 10 years post implantation was less than 11 current levels. Conclusion: Interestingly, findings from this study showed that levels vary in the first few months post implantation, but once levels stabilize, little change in levels is expected over the first decade of implant use. The integration of these findings provided sufficient evidence to develop one of the first evidence-based schedules for programming. The proposed schedule recommends 5 sessions over the first 6 months post implantation, and to program on patient and clinician request thereafter. The schedule recommends a 5-year check-up programming session, and for subsequent sessions to be based on the outcome of the 5-year session. Clinical application of the proposed evidence- based approaches will enable more efficient programming services for current and future implant users over time, without compromising patient care. [ABSTRACT FROM AUTHOR]

The Tickle Talker is an electrotactile speech perception device. Subjects were evaluated using the device in various tactile-alone and tactile-visual contexts to assess the generalization to other contexts of tactile-alone perceptual skills. The subjects were from a group of six normally hearing subjects who had previously received 12 to 33 h of tactile-alone word recognition training and had learned an average vocabulary of 50 words [Galvin et al., J. Acoust. Soc. Am. 106, 1084-1089 (1999)]. The tactile-alone evaluation contexts were sentences, unfamiliar talkers, and untrained words. The tactile-visual evaluation contexts were closed-set words, open-set words, and open-set sentences. Tactile-alone perceptual skills were generalized to unfamiliar speakers, sentences, and untrained words, though scores indicated that generalization was not complete. In contrast, the generalization of skills to tactile-visual contexts was minimal or absent. The potential value of tactile-alone training for hearing-impaired users of the Tickle Talker is discussed.

Tactile-alone word recognition training was provided to six normally hearing users of the Tickle Talker, an electrotactile speech perception device. A mean group tactile-alone vocabulary of 31 words was learned in 12 h of training. These results were comparable to, or superior to, those reported for other tactile devices and Tadoma. With increased training the group became faster at learning tactually new words, which were introduced in small training sets. However, as their tactile-alone vocabulary grew, subjects required more training time to reach the pass criterion when evaluated on their recognition of their whole vocabulary list. A maximum possible vocabulary size was not established. The application of tactile-alone training with hearing-impaired users of the device is discussed.

Objective: Many reports have established that hearing-impaired children using the Nucleus 22-channel cochlear implant may show both significant benefits to lipreading and significant scores on open-set words and sentences using electrical stimulation only. These findings have raised questions about whether severely or severely-to-profoundly deaf children should be candidates for cochlear implants. To study this question, postoperative results for implanted children with different levels of preoperative residual hearing were evaluated in terms of speech perception benefits., Study Design/setting: A retrospective study of the first 117 children, sequentially, to undergo implantation in the Melbourne and Sydney Cochlear Implant Clinics was undertaken. All children had been assessed by and received their implants in a tertiary referral centre., Main Outcome Measures: To assess aided residual hearing, the children were grouped into four categories of hearing on the basis of their aided residual hearing thresholds measured preoperatively. To assess benefits, the scores of children on standard speech perception tests were reviewed. As different tests were used for children with different ages and language skills, children were grouped into categories according to the level of postoperative speech perception benefit., Results: The results showed that children in the higher categories of aided preoperative residual hearing showed significant scores on open-set word and sentence perception tests using the implant alone. For children in lower categories of aided residual hearing, results were variable within the groups. More than 90% of children with implants with aided residual hearing thresholds in the speech range above 1 kHz achieved open-set understanding of words and sentences., Conclusion: While the results of this preliminary study confirm previous findings of differential outcomes for children with different levels of preoperative residual hearing, they suggest that children with severe to profound hearing impairments should be considered for cochlear implantation.

The Tickle Talker, an eight-channel electrotactile speech processor, has been developed from continuing research at the University of Melbourne. The development of the device has focused on production of reliable speech-processing hardware, design of cosmetically and ergonometrically acceptable electrode transducers, implementation of acute and chronic biomedical studies demonstrating device safety, design and testing of alternative speech-encoding strategies to provide benefit to speech perception and production, and design and testing of appropriate training methods for optimizing benefits. The Tickle Talker has been shown to provide benefits in supplementing lipreading or aided residual hearing for hearing-impaired adults and children. Improvements in speech processing have resulted in an increase in benefits to speech perception, and open the way for more flexible approaches to encoding speech input. Continuing development of the electrode circuitry has now produced a device that is robust and has an extended battery life. Safety studies have clearly demonstrated that there are no long-term contraindications to device use. The results suggest that the device has a role to play in rehabilitation programs for severely and profoundly hearing-impaired adults and children.

The Speak speech-processing strategy, developed by the University of Melbourne and commercialized by Cochlear Pty Limited for use in the new Spectra 22 speech processor, has been shown to provide improved speech perception for adults in both quiet and noisy situations. The present study evaluated the ability of children experienced in the use of the Multipeak (Mpeak) speech-processing strategy (implemented in the Nucleus Minisystem-22 cochlear implant) to adapt to and benefit from the advanced Speak speech-processing strategy (implemented in the Nucleus Spectra 22 speech processor). Twelve children were assessed using Mpeak and Speak over a period of 8 months. All of the children had over 1 year's previous experience with Mpeak, and all were able to score significantly on open-set word and sentence tests using the cochlear implant alone. Children were assessed with both live-voice and recorded speech materials, including Consonant-Nucleus-Consonant monosyllabic words and Speech Intelligibility Test sentences. Assessments were made in both quiet and in noise. Assessments were made at 3-week intervals to investigate the ability of the children to adapt to the new speech-processing strategy. For most of the children, a significant advantage was evident when using the Speak strategy as compared with Mpeak. For 4 of the children, there was no decrement in speech perception scores immediately following fitting with Speak. Eight of the children showed a small (10% to 20%) decrement in speech perception scores for between 3 and 6 weeks following the changeover to Speak. After 24 weeks' experience with Speak, 11 of the children had shown a steady increase in speech perception scores, with final Speak scores higher than for Mpeak. Only 1 child showed a significant decrement in speech perception with Speak, which did not recover to original Mpeak levels.

This study examined differential performance of normally hearing subjects using a tactile device on the dominant versus non-dominant hand. The study evaluated whether tactual sensitivity for non-speech stimuli was greater for the dominant hand as compared with the non-dominant hand, and secondly, whether there was an advantage for speech presented tactually to the dominant hand, resulting from a preferential pathway to the language processing area in the left cerebral hemisphere. Evaluations of threshold pulse width, dynamic ranges, paired electrode identification, and a closed-set tactual pattern discrimination test battery showed no difference in tactual sensitivity measures between the two hands. Speech perception was assessed with closed sets of vowels and consonants and with open-set Harvey Gardner (HG) words and Arthur Boothroyd (AB) words. Group mean scores were higher in each of the tactually aided conditions as compared with the unaided conditions for speech tests, with the exception of AB words in the tactile plus lip-reading plus audition/lip-reading plus audition condition on the right hand. Overall mean scores on the closed-set vowel test and on open-set HG and AB words were significantly higher for the tactually aided condition as compared with the unaided condition. Comparison of performance between the dominant and non-dominant hand showed a significant advantage for the dominant hand on the closed-set vowel test only. No significant differences between hands in either tactually aided or unaided conditions were evident for any of the other speech perception tests. Factors influencing this result could have been variations in degree of difficulty of the tests, the amount of training subjects received, or the training strategy employed. Although an advantage to presenting speech through the dominant hand may exist, it is unlikely to be great enough to outweigh possible restrictions on everyday use.

As part of a larger subject group, four profoundly hearing-impaired children enrolled in a total communication educational program were fitted with the University of Melbourne's multichannel electrotactile speech processor (Tickle Talker). Sound detection thresholds for pure tones were at lower levels with the tactile device than with hearing aids, especially for high frequency sounds above 2 kHz. Two of the children also detected all speech sounds of the Ling five-sound test at normal conversational levels using only the Tickle Talker. The children were able to use tactile input to achieve higher scores on three speech feature subtests of the PLOTT test when using the Tickle Talker plus hearing aids as compared to hearing aids alone. Mean improvements were 22.4 percent on vowel length, 28 percent on vowel identification, and 35 percent on consonant manner. Improvements were also shown by individual children on the closed-set WIPI and open-set PBK word tests, and on the open-set BKB sentence test, when the Tickle Talker was combined with hearing aids, and with hearing aids and lipreading. Comparisons of these results with those of children using the Tickle Talker in other educational settings show that children in a total communication environment can potentially benefit to a similar degree from use of tactual input. Anecdotal reports from the children and school staff members indicated that daily use of the Tickle Talker did not interfere with the signing aspects of total communication.