Residual speech recognition and cochlear implant performance: effects of implantation criteria.

OBJECTIVE: This study aimed to determine the effects of preoperative speech reception on postoperative speech recognition with a cochlear implant and to develop a statistical index allowing prediction of postoperative speech recognition before implantation. STUDY DESIGN: The study design was a retrospective case review with statistical modeling. SETTING: The study was conducted at a tertiary referral center with an associated Veteran's Administration hospital. PATIENTS: Postlingually deafened adults with and without residual speech reception participated. INTERVENTION: Cochlear implantation with Cochlear Corporation CI-22 and CI-24 devices was performed. MAIN OUTCOME MEASURES: Monosyllabic word recognition was measured. RESULTS: Duration of deafness and preoperative sentence recognition are both significant predictors of word recognition with a cochlear implant and can account for 80% of the variance in word recognition. CONCLUSIONS: Cochlear implant outcomes are variable but predictable within specific ranges.

Management of cochlear implant infections.

OBJECTIVE: The aim of this study was to illustrate and discuss management of cochlear implant infections. STUDY DESIGN: The study design was a retrospective case review. SETTING: This study was performed at a tertiary referral center with an associated Veterans Administration Hospital. PATIENTS: Postlingually deafened adults who had revision surgery for delayed cochlear implant infections were included in this study. INTERVENTION: Medical and surgical management of device infection without explantation. MAIN OUTCOME MEASURES: Eradication of infection without loss of speech reception. RESULTS: All four patients were successfully managed without explantation. CONCLUSIONS: Explantation of an infected but functioning multichannel implant is not mandatory in the absence of systemic sepsis.

Speech perception performance in experienced cochlear-implant patients receiving the SPEAK processing strategy in the Nucleus Spectra-22 cochlear implant.

Sixteen experienced cochlear implant patients with a wide range of speech-perception abilities received the SPEAK processing strategy in the Nucleus Spectra-22 cochlear implant. Speech perception was assessed in quiet and in noise with SPEAK and with the patients' previous strategies (for most, Multipeak) at the study onset, as well as after using SPEAK for 6 months. Comparisons were made within and across the two test sessions to elucidate possible learning effects. Patients were also asked to rate the strategies on seven speech recognition and sound quality scales. After 6 months' experience with SPEAK, patients showed significantly improved mean performance on a range of speech recognition measures in quiet and noise. When mean subjective ratings were compared over time there were no significant differences noted between strategies. However, many individuals rated the SPEAK strategy better for two or more of the seven subjective measures. Ratings for "appreciation of music" and "quality of my own voice" in particular were generally higher for SPEAK. Improvements were realized by patients with a wide range of speech perception abilities, including those with little or no open-set speech recognition.

Single-channel to multichannel conversions in adult cochlear implant subjects.

OBJECTIVE: This study aimed to compare open-set speech perception of single-channel with multichannel cochlear implants in the same ear of postlingually deafened adults. STUDY DESIGN: The study design was a retrospective case and literature review. SETTING: The study was conducted at a tertiary referral center with an associated veterans administration hospital. PATIENTS: Postlingually deafened adults with at least 6 months of experience with a single-channel cochlear implant were studied. INTERVENTION: Replacement of a single-channel with a multichannel cochlear implant in the same ear was performed. MAIN OUTCOME MEASURES: Open-set word and sentence perception scores at least 6 months after single-channel implantation and multichannel reimplantation were measured. RESULTS: Six of six patients had substantial improvement in open-set speech recognition after reimplantation of the same ear. CONCLUSIONS: Removal of a functioning single-channel implant and replacement with a multichannel device are appropriate in postlingually deafened adults who desire better speech recognition.

Speech perception by prelingually deaf children and postlingually deaf adults with cochlear implant.

We review recent data from the University of Iowa obtained from prelingually deaf children over 3 years using feature-extraction versions of the Nucleus cochlear implant, and from postlingually deaf adults using the compressed-analog Ineraid, a feature-extraction version of Nucleus, and a continuous interleaved sampling version of the Clarion cochlear implant. Both adults and children were followed over a 3-year period. Average results are shown where each patient is represented at each point in time. Results for the children show continued improvement over the 3-year period, with some children obtaining maximum scores possible on the easier closed-set tests. Substantial improvements in audiovisual enhancement were provided by the cochlear implant. Results from the adults show maximum gains within the first year of implant use, although some patients show continued improvements after 2 years of implant use. Adults who have been deaf for several years and who receive their implant when they are older tend not to perform as well as adults who have been deaf for only a few years or receive their implant when they are younger.