A Comparative Study of Voice Characteristics in Children With Cochlear Implants and Typically Hearing Children: Insights From an Indian Context.

Purpose The aim of the study was to evaluate speech outcomes in children with cochlear implants compared to normally hearing children in terms of fundamental frequency, shimmer, and jitter. The study also aims to assess the intelligibility of speech in children with cochlear implants using a speech intelligibility rating scale. Methods This was a hospital-based comparative study conducted at JIPMER, a major tertiary referral center. A total of 25 prelingually deaf children with profound deafness, who underwent cochlear implantation at the institute, were recruited from the outpatient department of the Department of Otorhinolaryngology. Twenty-five children under seven years of age who underwent cochlear implantation and received a minimum of 36 speech therapy sessions were included in the study. Subjects with incomplete electrode array insertion and any neurological maldevelopment were excluded. Age- and gender-matched controls comprising 25 individuals were selected from the Ophthalmology Outpatient Department at JIPMER. Study procedure The study commenced in January 2019. Test subjects were asked to visit the Audiology and Speech and Language Pathology Department at JIPMER. Voice recordings were conducted in a soundproof room using a microphone, with the mouthpiece held at a distance of 10-15 cm from the patient. The patient was instructed to say "a" three times. Their voice was recorded and analyzed using Praat software (Version 6.1.15, developed by Paul Boersma and David Weenink, Phonetic Sciences, University of Amsterdam). Data were analyzed using IBM SPSS Statistics for Windows, Version 19 (Released 2010; IBM Corp., Armonk, New York) (Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA), and the results were derived. Results The mean fundamental frequency for Group 1 (CI) was 266.03 ± 57.46 Hz, compared to 312.97 ± 22.15 Hz for Group 2 (NH). There was a statistically significant difference between the values of both groups, indicating that cochlear implantation positively impacted the fundamental frequency of speech. The study revealed a significant change in the fundamental frequency when children were implanted at an early age and received effective speech therapy post-implantation. This change was assessed after one year post-implant. Perturbation measures such as shimmer and jitter were lower in the cochlear implant group but were not statistically significant. Conclusion Children with congenital bilateral severe to profound sensorineural hearing loss tend to have higher values of the fundamental frequency of speech. However, when implanted at an early age, they showed a significant difference in the fundamental frequency of speech (p < 0.001). Speech perturbation was lower in the post-cochlear implant group, with a statistically significant difference in the values of shimmer alone. The study concludes that children with cochlear implants can achieve normal voice parameters with early intervention and training. However, the variability range is much higher than in typically hearing individuals.

Assessment of auditory perception abilities using temporal envelope and fine structure processing in children with self-limited epilepsy with centrotemporal spikes.

OBJECTIVES: Children with self-limited epilepsy with centrotemporal spikes (SeLECTS) exhibit difficulty processing spoken messages without hearing loss. The temporal envelope and fine structure processing abilities are the fundamental aspects of the normal listening process. There is limited literature on the temporal envelope and fine structure processing in children with SeLECTS. We evaluated the temporal envelope and fine structure processing in children with SeLECTS. DESIGN: The study included 35 children with SeLECTS and 50 typically developing children (TDC). The temporal envelope processing was measured using the temporal modulation transfer function (TMTF) and temporal fine structure using the temporal fine structure low-frequency (TFS LF) test. The TMTF was measured for the modulation rates 4, 8, 16, 32, 64 and 128 Hz. The TFS LF was done for 250, 500 and 750 Hz. RESULTS: The difference in modulation detection thresholds at 4 Hz was not found to be significant, whereas there was a significant difference in modulation detection thresholds observed for all the other modulation frequencies (p < 0.05) between the children with SeLECTS and TDC. The thresholds at 250, 500 and 750 Hz were higher (poorer) for children with SeLECTS than the TDC and was significant (p < 0.05). CONCLUSIONS: The TMTF and TFS LF tests were of practical use in evaluating temporal envelope and fine structure processing abilities in children with SeLECTS. The results suggest that children with SeLECTS have a poor temporal envelope and fine structure processing compared to the TDC.

Evaluation of the Electrically-Evoked Stapedial Reflex Threshold in Pediatric Cochlear Implant Users with High-Frequency Probe Tones

Abstract Introduction Measurement of the electrically-evoked stapedial reflex threshold (ESRT) is an objective tool used to set the comfort levels in pediatric cochlear implant (PCI) users. The levels of ESRT have a strong correlation with comfort levels. However, the clinical utility of ESRT is limited because the ESRT response is not observed in all cochlear implant users. Objective To assess the effects of probe-tone frequency on ESRT and its relationship with the behavioral comfort levels in PCI users. Methods A total of 14 PCI users aged between 5 and 8 years participated in the study. The ESRT levels were measured using high-frequency probe tones (678 Hz and 1,000 Hz), and the default 226 Hz probe tone. The ESRT was measured with single-electrode stimulation across the three electrode locations (basal [E01]; middle [E11]; and apical [E22]). The ESRT levels measured with different probe tone frequencies were compared with the behavioral comfort levels. Results The mean ESRT levels using 1,000Hz and 678 Hz were lower than those measured using 226 Hz, but there was no main effect of probe-tone frequency (p > 0.05). A significantly high incidence of successful ESRT measurements occurred with higher-frequency probe tone (p < 0.039). Additionally, ESRT using higher probe tones significantly correlated with comfort levels. Conclusion The ESRT with higher probe tones was correlated with behavioral comfort levels and increased the success rate of the measurements. Higher-frequency probe tones may be useful whenever ESRT with 226 Hz is not measurable.

Evaluation of the Electrically-Evoked Stapedial Reflex Threshold in Pediatric Cochlear Implant Users with High-Frequency Probe Tones.

Introduction Measurement of the electrically-evoked stapedial reflex threshold (ESRT) is an objective tool used to set the comfort levels in pediatric cochlear implant (PCI) users. The levels of ESRT have a strong correlation with comfort levels. However, the clinical utility of ESRT is limited because the ESRT response is not observed in all cochlear implant users. Objective To assess the effects of probe-tone frequency on ESRT and its relationship with the behavioral comfort levels in PCI users. Methods A total of 14 PCI users aged between 5 and 8 years participated in the study. The ESRT levels were measured using high-frequency probe tones (678 Hz and 1,000 Hz), and the default 226 Hz probe tone. The ESRT was measured with single-electrode stimulation across the three electrode locations (basal [E01]; middle [E11]; and apical [E22]). The ESRT levels measured with different probe tone frequencies were compared with the behavioral comfort levels. Results The mean ESRT levels using 1,000Hz and 678 Hz were lower than those measured using 226 Hz, but there was no main effect of probe-tone frequency ( p > 0.05). A significantly high incidence of successful ESRT measurements occurred with higher-frequency probe tone ( p < 0.039). Additionally, ESRT using higher probe tones significantly correlated with comfort levels. Conclusion The ESRT with higher probe tones was correlated with behavioral comfort levels and increased the success rate of the measurements. Higher-frequency probe tones may be useful whenever ESRT with 226 Hz is not measurable.

Evaluation of auditory spectral resolution abilities in children with benign epilepsy with centrotemporal spikes using spectral temporally modulated ripple test.

PURPOSE: Spectral resolution is imperative for complex listening tasks such as understanding speech in the presence of background noise and has a significant role in children, particularly classroom learning. The present study evaluated the auditory spectral resolution abilities of children with Benign epilepsy with centrotemporal spikes (BECTS). METHOD: This cross-sectional study conducted from August 2017 to March 2020 recruited 23 children with clinical and electrographic features consistent with BECTS as cases. Fifteen age and sex matched typically developing children (TDC) were taken as controls. Spectral resolution abilities were evaluated using the recently developed Spectral temporally modulated Ripple test (SMRT). RESULTS: The mean age of the cases was 10.63 ±â€¯1.91 years with a slight male preponderance (69%). The mean (±SD) SMRT thresholds in the cases and controls were 5.90 (±1.91) and 7.21 (±1.03) respectively. The auditory spectral resolution threshold measured by SMRT in children with BECTS was observed to be significantly lower when compared to the controls (p of 0.021). CONCLUSION: Children with BECTS have a lower spectral resolution threshold by SMRT.

Measuring Binaural Temporal-Fine-Structure Sensitivity in Hearing-Impaired Listeners, Using the TFS-AF Test.

BACKGROUND: Various methods have been used to measure temporal-fine-structure (TFS) sensitivity in hearing-impaired (HI) listeners. A new method called TFS-adaptive frequency (TFS-AF) test, tracks the highest frequency up to which a person can detect a given interaural phase difference (IPD) in bursts of pure tones. So far, the test was only administered to listeners with normal hearing (NH) or impaired low-frequency hearing. It is currently not known if this test can also be used for listeners with different configurations of hearing losses. PURPOSE: To investigate whether the TFS-AF test can also be used on listeners with a larger diversity of hearing losses and what would be the best fixed IPD value to conduct the test. RESEARCH DESIGN: Using a cross-sectional study design, we compared the thresholds of TFS-AF test between the NH and HI listeners at three different IPDs (90°, 60°, and 30°). STUDY SAMPLE: Thirty NH (mean age = 37.9; range 19-53 years) and thirty HI (mean age = 38.6; range 19-53 years) with different configurations of hearing losses were tested. RESULTS: The listeners were able to complete the TFS-AF test at larger values of IPD. Average thresholds were lower (i.e., worse) in the HI listeners than in the NH listeners. Threshold did not correlate with the listeners' age in each group. CONCLUSION: This test can be used clinically as it provides a graded measure of TFS ability for young to young-old adult listeners with a variety of hearing losses.

The Clinical Utility of Vestibular Evoked Myogenic Potentials in Patients of Benign Paroxysmal Positional Vertigo.

CONTEXT: Vestibular Evoked Myogenic Potentials (VEMP) is an emerging tool to diagnose Benign Paroxysmal Positional Vertigo (BPPV). The clinical utility of VEMP has been reported only in small accord in Indian literature. AIM: To study the latency and amplitude of VEMP in patients with BPPV and compare it with that of normal subjects. SETTINGS AND DESIGN: The study included two groups. Group one (control group) were 18 normal subjects. Group two (test group) were 15 subjects with unilateral BPPV. MATERIALS AND METHODS: Those subjects who fulfilled the selection criteria based on case history and audiological assessment were taken for the VEMP recording. The VEMP response consist of positive and negative successive waves (pI-nI), with latency values in adults about 13 and 23 milliseconds respectively. STATISTICAL ANALYSIS: Data was analysed using Statistical Package for Social Sciences (SPSS) version 12 (Chicago, IL, USA). Unpaired t-test was employed to measure the statistical difference between control group and test group. RESULTS: The difference in n23 and the peak to peak amplitude between the ipsilateral and contralateral ears of the test group were statistically significant, whereas such a difference in the p13 latency turned out to be statistically insignificant. It should be noted that, out of 15 patients in the test group, five patients showed only artifact tracer recordings in both the ears which is considered as no response. The heterogeneity of the results extended from absence of VEMP to prolongation of both p13, n23; prolongation of p13 alone; and even side to side variations. CONCLUSION: Absent response from the ipsilateral ear, prolonged latency of n23 and decreased peak to peak amplitude (p13, n23), indicates the disease pathology. However, large sample size is required to draw further conclusions and to consolidate the usage of VEMP in the diagnosis of BPPV.