Search

Background There is a growing number of pediatric procedures requiring sedation outside the operating room. Among these are auditory brainstem response (ABR) tests, the gold standard for objective hearing evaluation in infants and toddlers. Recently, a nurse-led pediatric sedation service based on a structured protocol has been developed for ABR testing. Objectives To retrospectively analyze the safety and efficacy of the pediatric nurse-led sedation protocol (PNLSP) in a tertiary medical center using Chloral Hydrate (CH) in children undergoing ABR testing. Methods Data from medical charts of children who underwent sedation for ABR testing between January 2014 and December 2017, were retrieved. Analysis of sedation success/failure rates, sleep induction time (SIT), sleep duration time (SDT), and adverse events (AE), was performed. Findings 1348 children with a mean age of 13.4 months (range 3–42 months), classified by the American Society of Anesthesiologists Physical Status Classification System (ASA score) 1–3, were included in the analysis. All children received a fixed dose of 75 mg / kg CH orally or rectally. Sedation success rate was 98.7% and enabled completion of ABR testing. Failure to sedate was evident in 17 children (1.3%), all classified as ASA score 1–2. Median SIT and SDT were 25 and 100 min, respectively. Mild AE occurred in 9 children (0.67%), none of which required further intervention. Conclusions Findings support the use of a structured PNLSP using CH as safe and efficient. The suggested protocol is an effective alternative for general anesthesia (GA) for ABR testing in healthy young children.

The Sheba Blue Dye Test Protocol (SBDTP) is a swallowing bedside evaluation for tracheotomized patients (TP). It is based on the Modified Evans’ Blue Dye Test (MEBDT), but includes several modifications that aim to overcome previously described caveats of the traditional MEBDT. These modifications include evaluating the patient three times, with increasing quantities of bolus. The purpose of this study was to examine the rates of positive and negative results of TP undergoing the SBDTP, in comparison to the MEBDT, which, generally, consists of a single evaluation. The study included a cohort of 39 TP admitted to the Sheba general hospital with various background diseases. Findings indicated that the percentage of positive results increased significantly from the first (18%) to the last stage (46.2%) of the SBDTP. This result demonstrated the advantage of the SBDTP as a more reliable evaluation for tracing aspiration among TP, especially in cases where access to instrumental examination is limited.

Despite growth of CI and widening of implantation criteria, penetration rates remain low and the clinical profile of adult CI candidates has not substantially changed. This study evaluated the demographic and auditory profiles of current adult CI candidates and identified factors affecting CI uptake.Preoperative data from patients who underwent CI candidacy evaluation between 2016-2018 were retrospectively reviewed. Data included demographics, medical reports, audiological results, and reasons for not pursuing implantation. Comparisons between candidates who pursued implantation and those who did not were performed.Ninety-five candidates (54 females), average age 52Most candidates exhibited post-lingual bilateral hearing loss with mean unaided PTA4 of 105dBHL and monosyllabic word score of 26%. Forty-nine candidates were implanted, and the main reason for not pursuing CI was candidates' reluctance. Candidates that pursued CI were mostly younger females with poorer unaided PTA4. Age was the only significant predictor of CI uptake.While current candidates demonstrated greater demographic diversity and better speech perception compared to previous findings, unaided thresholds are still within the profound range. Our findings indicate that eligible candidates face barriers to the utilisation of CI, some of which are modifiable by means of updated candidacy protocols.

Revision cochlear implant (RCI) is a growing burden on cochlear implant programs. While reports on RCI rate are frequent, outcome measures are limited. The objectives of the current study were to: (1) evaluate RCI rate, (2) classify indications, (3) delineate the pre-RCI clinical course, and (4) measure surgical and speech perception outcomes, in a large cohort of patients implanted in a tertiary referral center between 1989–2018. Retrospective data review was performed and included patient demographics, medical records, and audiologic outcomes. Results indicated that RCI rate was 11.7% (172/1465), with a trend of increased RCI load over the years. The main indications for RCI were device-related failures (soft-45.4%, hard-23.8%), medical failure (14%), trauma (8.1%), and surgical failure (6.4%). Success rate was 98.8%. Children comprised 78% (134) of the cohort and were more likely than adults to undergo RCI. Most (70%) of the RCIs were performed within 10 years from primary implantation. Speech perception outcome analysis revealed unchanged or improved performance in 85% of the cases and declined performance in 15%. Current findings confirm that RCI is a safe with high clinical efficacy, however, the non-negligible percentage of patients that exhibited declined performance post-RCI should be considered in decision-making processes regarding RCI. Routine follow-up during their first years post-implantation is warranted.

The Sheba Blue Dye Test Protocol (SBDTP) is a swallowing bedside evaluation for tracheotomized patients (TP). It is based on the Modified Evans' Blue Dye Test (MEBDT), but includes several modifications that aim to overcome previously described caveats of the traditional MEBDT. These modifications include evaluating the patient three times, with increasing quantities of bolus. The purpose of this study was to examine the rates of positive and negative results of TP undergoing the SBDTP, in comparison to the MEBDT, which, generally, consists of a single evaluation. The study included a cohort of 39 TP admitted to the Sheba general hospital with various background diseases. Findings indicated that the percentage of positive results increased significantly from the first (18%) to the last stage (46.2%) of the SBDTP. This result demonstrated the advantage of the SBDTP as a more reliable evaluation for tracing aspiration among TP, especially in cases where access to instrumental examination is limited.

Numerous studies have attempted to identify early physiological abnormalities in infants and toddlers who later develop autism spectrum disorder (ASD). One potential measure of early neurophysiology is the auditory brainstem response (ABR), which has been reported to exhibit prolonged latencies in children with ASD. We examined whether prolonged ABR latencies appear in infancy, before the onset of ASD symptoms, and irrespective of hearing thresholds. To determine how early in development these differences appear, we retrospectively examined clinical ABR recordings of infants who were later diagnosed with ASD. Of the 118 children in the participant pool, 48 were excluded due to elevated ABR thresholds, genetic aberrations, or old testing age, leaving a sample of 70 children: 30 of which were tested at 0-3 months, and 40 were tested at toddlerhood (1.5-3.5 years). In the infant group, the ABR wave-V was significantly prolonged in those who later developed ASD as compared with case-matched controls (n = 30). Classification of infants who later developed ASD and case-matched controls using this measure enabled accurate identification of ASD infants with 80% specificity and 70% sensitivity. In the group of toddlers with ASD, absolute and interpeak latencies were prolonged compared to clinical norms. Findings indicate that ABR latencies are significantly prolonged in infants who are later diagnosed with ASD irrespective of their hearing thresholds; suggesting that abnormal responses might be detected soon after birth. Further research is needed to determine if ABR might be a valid marker for ASD risk. Autism Res 2016, 9: 689-695. © 2015 The Authors Autism Research published by Wiley Periodicals, Inc. on behalf of International Society for Autism Research.

Deafness affects ∼2 in 1000 children and is one of the most common congenital impairments. Permanent hearing loss can be treated by fitting hearing aids. More severe to profound deafness is an indication for cochlear implantation. Although newborn hearing screening programs have increased the identification of asymmetric hearing loss, parents and caregivers of children with single-sided deafness are often hesitant to pursue therapy for the deaf ear. Delayed intervention has consequences for recovery of hearing. It has long been reported that asymmetric hearing loss/single-sided deafness compromises speech and language development and educational outcomes in children. Recent studies in animal models of deafness and in children consistently show evidence of an “aural preference syndrome” in which single-sided deafness in early childhood reorganizes the developing auditory pathways toward the hearing ear, with weaker central representation of the deaf ear. Delayed therapy consequently compromises benefit for the deaf ear, with slow rates of improvement measured over time. Therefore, asymmetric hearing needs early identification and intervention. Providing early effective stimulation in both ears through appropriate fitting of auditory prostheses, including hearing aids and cochlear implants, within a sensitive period in development has a cardinal role for securing the function of the impaired ear and for restoring binaural/spatial hearing. The impacts of asymmetric hearing loss on the developing auditory system and on spoken language development have often been underestimated. Thus, the traditional minimalist approach to clinical management aimed at 1 functional ear should be modified on the basis of current evidence.

Highlights • Selective mutism (SM) is characterized by inability to speak in specific situations. • Auditory efferent function anomalies are evident in most children with SM. • Aberrant efferent activity during vocalization is implicated in SM maintenance. • Potential intervention and prevention strategies are discussed., Selective mutism (SM) is a relatively rare psychiatric disorder of childhood characterized by consistent inability to speak in specific social situations despite the ability to speak normally in others. SM typically involves severe impairments in social and academic functioning. Common complications include school failure, social difficulties in the peer group, and aggravated intra-familial relationships. Although SM has been described in the medical and psychological literatures for many years, the potential underlying neural basis of the disorder has only recently been explored. Here we explore the potential role of specific auditory neural mechanisms in the psychopathology of SM and discuss possible implications for treatment.

Objectives/Hypothesis We describe pain around the receiver/stimulator [RS] presenting months to years after implantation. Study Design A retrospective chart review. Methods We performed a retrospective review of all cochlear implant recipients complaining of pain around their RS through the years 2009 through 2013, with a follow-up of at least 6 months. Excluded from the study were patients with an identifiable cause for their pain such as trauma, local infection, or skin breakdown. The therapy regimen and outcomes were reviewed. Results Thirty patients complained of delayed pain over their RS, representing 2.8% of 1,044 implantations performed at the Sheba Medical Center, Tel Hashomer, Israel, as of 2013. The time from implantation to the presentation of pain ranged from 3 months to 12 years. The pain was perceptible even when the external magnet and processor were not used, and was usually most obvious in specific points around the RS. Seventy-seven percent of our patients responded well to conservative therapy. Fifteen (50%) responded to prolonged antibiotic treatment. Five patients (17%) responded to antiinflammatories alone. One patient (3%) responded to deactivation of two electrodes. Six patients (20%) required reimplantation, after which the pain resolved in all. At explantation, no signs of infection, foreign body reaction, or obvious device damage were found. Conclusion Delayed pain around the RS that is unrelated to use is a serious consequence of cochlear implantation, and in some cases, those necessitating reimplantation, should be considered a major complication. Level of Evidence 4. Laryngoscope, 125:1946–1951, 2015

Background: While hearing aids for a contralateral routing of signals (CROS-HA) and bone conduction devices have been the traditional treatment for single-sided deafness (SSD) and asymmetric hearing loss (AHL), in recent years, cochlear implants (CIs) have increasingly become a viable treatment choice, particularly in countries where regulatory approval and reimbursement schemes are in place. Part of the reason for this shift is that the CI is the only device capable of restoring bilateral input to the auditory system and hence of possibly reinstating binaural hearing. Although several studies have independently shown that the CI is a safe and effective treatment for SSD and AHL, clinical outcome measures in those studies and across CI centers vary greatly. Only with a consistent use of defined and agreed-upon outcome measures across centers can high-level evidence be generated to assess the safety and efficacy of CIs and alternative treatments in recipients with SSD and AHL. Methods: This paper presents a comparative study design and minimum outcome measures for the assessment of current treatment options in patients with SSD/AHL. The protocol was developed, discussed, and eventually agreed upon by expert panels that convened at the 2015 APSCI conference in Beijing, China, and at the CI 2016 conference in Toronto, Canada. Results: A longitudinal study design comparing CROS-HA, BCD, and CI treatments is proposed. The recommended outcome measures include (1) speech in noise testing, using the same set of 3 spatial configurations to compare binaural benefits such as summation, squelch, and head shadow across devices; (2) localization testing, using stimuli that rove in both level and spectral content; (3) questionnaires to collect quality of life measures and the frequency of device use; and (4) questionnaires for assessing the impact of tinnitus before and after treatment, if applicable. Conclusion: A protocol for the assessment of treatment options and outcomes in recipients with SSD and AHL is presented. The proposed set of minimum outcome measures aims at harmonizing assessment methods across centers and thus at generating a growing body of high-level evidence for those treatment options.

With the growing number of older adults receiving cochlear implants (CI), there is general agreement that substantial benefits can be gained. Nonetheless, variability in speech perception performance is high, and the relative contribution and interactions among peripheral, central-auditory, and cognitive factors are not fully understood. The goal of the present study was to compare auditory-cognitive processing in older-adult CI recipients with that of older normal-hearing (NH) listeners by means of behavioral and electrophysiologic manifestations of a high-load cognitive task. Auditory event-related potentials (AERPs) were recorded from 9 older postlingually deafened adults with CI (age at CI >60) and 10 age-matched listeners with NH, while performing an auditory Stroop task. Participants were required to classify the speaker's gender (male/female) that produced the words ‘mother' or ‘father' while ignoring the irrelevant congruent or incongruent word meaning. Older CI and NH listeners exhibited comparable reaction time, performance accuracy, and initial sensory-perceptual processing (i.e. N1 potential). Nonetheless, older CI recipients showed substantially prolonged and less efficient perceptual processing (i.e. P3 potential). Congruency effects manifested in longer reaction time (i.e. Stroop effect), execution time, and P3 latency to incongruent versus congruent stimuli in both groups in a similar fashion; however, markedly prolonged P3 and shortened execution time were evident in older CI recipients. Collectively, older adults (CI and NH) employed a combined perceptual and postperceptual conflict processing strategy; nonetheless, the relative allotment of perceptual resources was substantially enhanced to maintain adequate performance in CI recipients. In sum, the recording of AERPs together with the simultaneously obtained behavioral measures during a Stroop task exposed a differential time course of auditory-cognitive processing in older CI recipients that was not manifested in the behavioral end products of processing. These data may have implications regarding clinical evaluation and rehabilitation procedures that should be tailored specifically for this unique group of patients.

Two efferent feedback pathways to the auditory periphery may play a role in monitoring self-vocalization: the middle-ear acoustic reflex (MEAR) and the medial olivocochlear bundle (MOCB) reflex. Since most studies regarding the role of auditory efferent activity during self-vocalization were conducted in animals, human data are scarce. The working premise of the current study was that selective mutism (SM), a rare psychiatric disorder characterized by consistent failure to speak in specific social situations despite the ability to speak normally in other situations, may serve as a human model for studying the potential involvement of auditory efferent activity during self-vocalization. For this purpose, auditory efferent function was assessed in a group of 31 children with SM and compared to that of a group of 31 normally developing control children (mean age 8.9 and 8.8 years, respectively). All children exhibited normal hearing thresholds and type A tympanograms. MEAR and MOCB functions were evaluated by means of acoustic reflex thresholds and decay functions and the suppression of transient-evoked otoacoustic emissions, respectively. Auditory afferent function was tested by means of auditory brainstem responses (ABR). Results indicated a significantly higher proportion of children with abnormal MEAR and MOCB function in the SM group (58.6 and 38%, respectively) compared to controls (9.7 and 8%, respectively). The prevalence of abnormal MEAR and/or MOCB function was significantly higher in the SM group (71%) compared to controls (16%). Intact afferent function manifested in normal absolute and interpeak latencies of ABR components in all children. The finding of aberrant efferent auditory function in a large proportion of children with SM provides further support for the notion that MEAR and MOCB may play a significant role in the process of self-vocalization.

To evaluate satisfaction ratings and use patterns of advanced digital hearing aids (HAs) in a group of hearing-impaired adults by means of self-report questionnaires.A self report questionnaire study.One hundred seventy-seven hearing-impaired adults who were fitted with advanced digital HAs at the Speech and Hearing Center at Sheba Medical Center were asked to participate in a structured telephone interview regarding HA satisfaction and use by means of the Satisfaction With Amplification in Daily Life (SADL) questionnaire. Patients who were not using their HAs completed a nonuse questionnaire.One hundred thirty-one patients participated in the survey, yielding a response rate of 74%. Eighty-three percent used their HAs regularly, whereas 17% were nonusers. Of the users, 92% were satisfied to some degree with their HAs. The global SADL score was 5.12 on a scale of 1 to 7. Background variables that were significantly associated with satisfaction ratings were hours of HA use per day, fitting mode (binaural vs. monaural), age, and degree of hearing loss. Although nonuse was not significantly associated with background variables, the main reasons for nonuse were excessive amplification in background noise and minimal functional benefit.High satisfaction and use rates were characteristic of adults fitted with advanced digital HAs. Patients should be advised that longer use of HAs per day may lead to higher satisfaction and that binaural amplification is advantageous, especially while communicating in noise. Finally, expectation from HA functionality in challenging listening situations should be realistic, as additional research and technology development is still needed.

Cochlear implants (CIs) are increasingly beingimplanted in both ears in an attempt to providehearing-impaired children with the advantages ofbinaural hearing. Considering the limitations of CIdevices that cannot mimic ‘normal’ cochlear function,and the deleterious effects of deafness and auditorydeprivation on the developing auditory system, it isunclear as to whether bilateral implantation canrestore binaural processing. Behavioral data from chil-dren have indicated improved speech perception innoise and sound localization abilities, both dependenton binaural processing, with two CIs compared to one(Litovsky et al., 2006; Van-Deun et al., 2010).Nonetheless, results are highly variable and affectedby factors such as age at first and second CI, inter-implant delay, and duration of bilateral CI use.In the intact auditory system integration of inputsfrom the two ears is known to manifest in binauralinteractions that occur along the ascending auditorypathways and can be documented by means ofevoked potentials (Dobie and Norton, 1980;McPherson and Starr, 1993). By subtracting theresponses elicited during binaural stimulation fromthe sum of responses elicited during monaural rightand left stimulation, a binaural interaction responseis derived. In normal hearing (NH) adults, robustbinaural interaction components (BICs) at the brain-stem and thalamo-cortical pathways are evidentand appear as a decrease (inhibition) of evoked poten-tials to binaural stimulation compared to the sumof the monaural responses (e.g. McPherson andStarr, 1993).In children with bilateral CIs, a BIC has been docu-mented at the brainstem level in a single study(Gordon et al., 2007). BICs were (1) detected onlyfrom an apical electrode and not from a basal elec-trode, and (2) prolonged in sequentially and not insimultaneously implanted children.To date, cortically driven mechanisms of binauralhearing have not been studied by means of evokedpotentials in bilaterally implanted children or in NHchildren. Clinically, an objective measure of binauralprocessing, elicited at cortical levels, has the potentialof becoming an appealing neural correlate of binauralbehavioral performance. Thus, the goal of the presentstudy was to investigate cortical manifestations ofbinaural speech processing in bilaterally implantedchildren and NH controls by means of auditoryevent-related potentials (AERPs), a source localiz-ation procedure (standardized low-resolution electro-magnetic tomography (sLORETA)), and behavioralmeasurements (reaction time (RT), performance accu-racy (PC)).

Evidence suggests that children with selective mutism (SM) display significant aberrations in auditory efferent activity at the brainstem level that may underlie inefficient auditory processing during vocalization, and lead to speech avoidance. The objective of the present study was to explore auditory filtering processes at the cortical level in children with SM. The classic paired-click paradigm was utilized to assess suppression of the P50 event-related potential to the second, of two sequentially-presented clicks, in ten children with SM and 10 control children. A significant suppression of P50 to the second click was evident in the SM group, whereas no suppression effect was observed in controls. Suppression was evident in 90% of the SM group and in 40% of controls, whereas augmentation was found in 10% and 60%, respectively, yielding a significant association between group and suppression of P50. P50 to the first click was comparable in children with SM and controls. The adult-like, mature P50 suppression effect exhibited by children with SM may reflect a cortical mechanism of compensatory inhibition of irrelevant repetitive information that was not properly suppressed at lower levels of their auditory system. The current data extends our previous findings suggesting that differential auditory processing may be involved in speech selectivity in SM.

Auditory event-related potentials (AERPs) and the simultaneously obtained behavioral measures (performance accuracy and reaction time) were used to study speech perception in postlingual adult cochlear implant (CI) recipients and in normal-hearing (NH) controls. AERPs were recorded while subjects were performing oddball discrimination tasks with increasing acoustic-phonetic demand. The tasks consisted of pairs of natural syllables that differed by one of the following phonetic contrasts: vowel place, voicing, vowel height, and place of articulation. Results indicated that the P3 potential was comparable in CI recipients and NH controls when the acoustic cues to the perception of the phonetic contrast were accessible. With the reduction in accessibility to the essential temporal and/or spectral cues, CI recipients exhibited delayed (prolonged P3 latency) and less synchronous (reduced amplitude) central speech-sound processing compared to NH controls. Among the phonetic contrasts used in the present study the place of articulation contrast yielded (1) the most prominent differences between CI recipients and NH controls across all measures, and (2) significant correlations between the neurophysiologic manifestation of speech discrimination (i.e. P3 latency), and conscious integration of perceptual information (i.e. performance accuracy and reaction time). Thus, P3 exposed the difficulties imposed on the impaired auditory system of CI recipients especially when elicited by speech contrasts that required processing of brief temporal-spectral cues. These findings support the P3 potential as a sensitive neural index of cortical processing that may provide information regarding accessibility and neural encoding of distinct acoustic-phonetic cues in CI recipients.

This study evaluated the cognitive profiles of children with idiopathic generalized epilepsy (IGE), uniformly treated with valproic acid with well-controlled seizures. Twenty-four were neuropsychologically evaluated. They comprised: 14 females, 10 males: 12 with generalized tonic-clonic seizures (GTCS), mean age 14y 4mo, SD ly 7mo, range 12y to 16y 4 mo; 12 with absence seizures (AS]) mean age 14y 5mo, SD ly 10mo, range 11y to 16y 4mo, with intellectual abilities within the normal range and age-appropriate scholastic skills, and 20 healthy controls (12 females, 8 males; mean age 14y 5mo, SD 1y 10mo, range 10y 7mo to 16y 7mo). As a group, children with IGE performed significantly poorer in all tests (non-verbal and verbal attention, verbal learning and memory, word fluency, and controlled sequential fine motor responses) excluding non-verbal memory. Analysis according to type of seizure revealed that both patient groups (AS and GTCS) had an attention deficit, whereas only children with AS showed deficits in verbal learning and memory, word fluency, and controlled fine motor responses. These results suggest a long-term risk of learning impairment for children with IGE, even if they have normal intelligence and their seizures are well controlled.

Background: Integration of information presented to the two ears has been shown to manifest in binaural interaction components (BICs) that occur along the ascending auditory pathways. In humans, BICs have been studied predominantly at the brainstem and thalamocortical levels; however, understanding of higher cortically driven mechanisms of binaural hearing is limited. Purpose: To explore whether BICs are evident in auditory event-related potentials (AERPs) during the advanced perceptual and postperceptual stages of cortical processing. Research Design: The AERPs N1, P3, and a late negative component (LNC) were recorded from multiple site electrodes while participants performed an oddball discrimination task that consisted of natural speech syllables (/ka/ vs. /ta/) that differed by place-of-articulation. Participants were instructed to respond to the target stimulus (/ta/) while performing the task in three listening conditions: monaural right, monaural left, and binaural. Study Sample: Fifteen (21–32 yr) young adults (6 females) with normal hearing sensitivity. Data Collection and Analysis: By subtracting the response to target stimuli elicited in the binaural condition from the sum of responses elicited in the monaural right and left conditions, the BIC waveform was derived and the latencies and amplitudes of the components were measured. The maximal interaction was calculated by dividing BIC amplitude by the summed right and left response amplitudes. In addition, the latencies and amplitudes of the AERPs to target stimuli elicited in the monaural right, monaural left, and binaural listening conditions were measured and subjected to analysis of variance with repeated measures testing the effect of listening condition and laterality. Results: Three consecutive BICs were identified at a mean latency of 129, 406, and 554 msec, and were labeled N1-BIC, P3-BIC, and LNC-BIC, respectively. Maximal interaction increased significantly with progression of auditory processing from perceptual to postperceptual stages and amounted to 51%, 55%, and 75% of the sum of monaural responses for N1-BIC, P3-BIC, and LNC-BIC, respectively. Binaural interaction manifested in a decrease of the binaural response compared to the sum of monaural responses. Furthermore, listening condition affected P3 latency only, whereas laterality effects manifested in enhanced N1 amplitudes at the left (T3) vs. right (T4) scalp electrode and in a greater left–right amplitude difference in the right compared to left listening condition. Conclusions: The current AERP data provides evidence for the occurrence of cortical BICs during perceptual and postperceptual stages, presumably reflecting ongoing integration of information presented to the two ears at the final stages of auditory processing. Increasing binaural interaction with the progression of the auditory processing sequence (N1 to LNC) may support the notion that cortical BICs reflect inherited interactions from preceding stages of upstream processing together with discrete cortical neural activity involved in binaural processing. Clinically, an objective measure of cortical binaural processing has the potential of becoming an appealing neural correlate of binaural behavioral performance.

In patients with total sudden sensorineural hearing loss (SSNHL), oral prednisone (OP) alone or intratympanic dexamethasone (ITD) alone have comparable results. The addition of salvage ITD following OP does not seem to add over either single modality treatment.To study the effect of steroid-based treatments in patients with total SSNHL.The medical charts of 59 patients with total loss of hearing, defined as pure tone thresholds in the profound range (90 dB) with an unobtainable speech reception threshold (SRT) that were treated with OP (n = 20), ITD (n = 13), or OP followed by salvage ITD (n = 26) were analyzed. Response to treatment was evaluated by means of pure tone thresholds, SRT, and speech discrimination score (SDS), immediately after treatment and on a follow-up visit.Forty-nine patients (83%) responded to treatment, with mean significant improvements of 36, 34, 31, and 25 dB at 500, 1000, 2000, and 4000 Hz, respectively. The mean improvement in SRT was 33 dB, and SDS improved by 32%. There were no differences in improvement in pure tone thresholds and SRT among the three treatment groups. The late effect of OP was similar to the effect of salvage ITD.

We describe pain around the receiver/stimulator [RS] presenting months to years after implantation.A retrospective chart review.We performed a retrospective review of all cochlear implant recipients complaining of pain around their RS through the years 2009 through 2013, with a follow-up of at least 6 months. Excluded from the study were patients with an identifiable cause for their pain such as trauma, local infection, or skin breakdown. The therapy regimen and outcomes were reviewed.Thirty patients complained of delayed pain over their RS, representing 2.8% of 1,044 implantations performed at the Sheba Medical Center, Tel Hashomer, Israel, as of 2013. The time from implantation to the presentation of pain ranged from 3 months to 12 years. The pain was perceptible even when the external magnet and processor were not used, and was usually most obvious in specific points around the RS. Seventy-seven percent of our patients responded well to conservative therapy. Fifteen (50%) responded to prolonged antibiotic treatment. Five patients (17%) responded to antiinflammatories alone. One patient (3%) responded to deactivation of two electrodes. Six patients (20%) required reimplantation, after which the pain resolved in all. At explantation, no signs of infection, foreign body reaction, or obvious device damage were found.Delayed pain around the RS that is unrelated to use is a serious consequence of cochlear implantation, and in some cases, those necessitating reimplantation, should be considered a major complication.4.

This study was designed to characterize the effect of background noise on the identification of syllables using behavioral and electrophysiological measures. Twenty normal-hearing adults (18-30 years) performed an identification task in a two-alternative forced-choice paradigm. Stimuli consisted of naturally produced syllables [da] and [ga] embedded in white noise. The noise was initiated 1000 ms before the onset of the speech stimuli in order to separate the auditory event related potentials (AERP) response to noise onset from that to the speech. Syllables were presented in quiet and in five SNRs: +15, +3, 0, -3, and -6 dB. Results show that (1) performance accuracy, d', and reaction time were affected by the noise, more so for reaction time; (2) both N1 and P3 latency were prolonged as noise levels increased, more so for P3; (3) [ga] was better identified than [da], in all noise conditions; and (4) P3 latency was longer for [da] than for [ga] for SNR 0 through -6 dB, while N1 latency was longer for [ga] than for [da] in most listening conditions. In conclusion, the unique stimuli structure utilized in this study demonstrated the effects of noise on speech recognition at both the physical and the perceptual processing levels.

Summary Objective To examine the incidence of acute otitis media (AOM) and mastoiditis in children after cochlear implantation (CI) and to evaluate the role of mastoidectomy in decreasing the rate of AOM in implanted children by comparing two surgical techniques: the Posterior tympanotomy approach (MPTA, with mastoidectomy) and the Suprameatal approach (SMA, without mastoidectomy). Methods A retrospective study was conducted on 234 children up to 16 years of age who underwent CI between 1993 and 2003 in our department. The children were divided into two groups according to the surgical technique that had been used for the implantation: the MPTA group and the SMA group. Results Part of the children with a history of pre-implantation AOM (22 of 29 in MPTA group and 26 of 38 in SMA group) did not suffer from AOM post-CI (p = 0.59), and an incidence of AOM after CI in children who did not have history of AOM prior to implantation (13 patients of MPTA group and 15 patients of SMA group) was unrelated to surgical approach (p = 0.65). The incidence of pre-implantation AOM was similar for the two groups and declined after CI unrelated to performing of mastoidectomy in surgical technique. Overall, 47 children (20.1%) had post-CI AOM compared to 67 children (28.6%) who had pre-CI AOM. Mastoiditis developed in 11 children (4.7%), all 11 in the MPTA group. A subperiosteal abscess was incised and drained with the retroauricular approach in three of these children and the others were managed with intravenously administered ceftriaxone 50 mg/kg/day for 3–5 consecutive days, followed by a course of oral cephalexin until there is complete clinical resolution of the effusion in the middle ear. The implants were preserved in all cases. Seven out of 11 children with mastoiditis had no history of AOM prior to implantation. Conclusions AOM and mastoiditis represent common complications of CI that can be successfully treated with the prompt use of antibiotics. However, the subperiosteal abscess could require surgical drainage. In our opinion, the decrease of incidence of AOM in implanted children is the result of natural history of otitis media and is unrelated to the surgical approach.

Children with Waardenburg's syndrome (WS) derive significant benefit from cochlear implantation (CI) and do so to an extent that is comparable to that of the general population of implanted children. Although we report on a relatively small cohort, our data are useful for counseling the parents of children with WS considering CI.To present our experience with CI in patients with WS.A retrospective record review was conducted for five children who underwent CI in our department between 1993 and 2004.Children with WS comprised 1.9% of our entire pediatric CI population: four girls had a familial history of WS and the phenotype of WS Type I, and one boy met the criteria for WS Type II. They were all diagnosed as having bilateral profound sensorineural hearing loss 4-24 weeks after birth. Rehabilitation was initiated immediately and included bilateral fitting of hearing aids and intensive speech and language therapy. Otoscopic and temporal bone high-resolution CT findings were normal in all patients. At surgery, all children were found to have a patent cochlea, and the electrodes were implanted into the scala tympani without difficulty. After 1.3-10.2 years of implant use all children achieved open-set recognition of 2-syllable words, with an average score of 81%. Four of the 5 children achieved open-set recognition of monosyllabic words (average score 40%) and 3 achieved open-set recognition of words in sentences (average score 81%).

Osteogenesis imperfecta (OI) is a hereditary disease of connective tissue and affects bone, dentine, sclera, joint, tendon, blood vessels, heart valves, and skin. Approximately 50% of the adult patients with OI have associated hearing impairment. To date, only three cases of cochlear implantation in adults with OI have been reported, but none in children. We present a case of cochlear implantation in a congenitally deaf 6-year-old boy with OI. The Nucleus 24 Contour device was successfully implanted using the suprameatal approach (SMA). At 6 months post-initial stimulation there was no evidence of non-acoustic nerve excitation (i.e. facial twitching) or discomfort, and significant progress in auditory abilities was manifested by open set word identification.

Information regarding typical changes in electrical stimulation levels during different stages post-implantation in children is scarce. Clinically, this information can serve as a general guideline to the nature and frequency of these changes, and consequently help to determine programming schedules that would optimize performance with the implant. Furthermore, it may have implications for the design of cochlear implants, and for monitoring the condition of the implanted cochlea. The main goal of the present study was, therefore, to evaluate changes over time in psycho-electric parameters, i.e. threshold levels, comfortable levels, and dynamic range, in children with the Nucleus 22 cochlear implant system. The maps of 37 prelingual children were examined at five time intervals: 1, 6, 12, 18 and 24 months post-connection. Maps were analyzed according to three cochlear segments: basal, medial, and apical. The results indicated significant changes in the psycho-electric parameters during the first 2 years post-implantation. Specifically, threshold (T) levels increased significantly during the first year and stabilized during the second year, whereas comfort (C) levels and dynamic range (DR) increased significantly during the entire 2-year follow-up. In addition, psycho-electric parameters varied among the different cochlear segments, resulting in a narrower DR in the basal one. Regardless of the underlying cause for these changes, the results of the present study suggest that, in children, the stabilization of psycho-electric parameters is a prolonged, gradual process. Since psycho-electric parameters play an important role in speech perception, these findings emphasize the need for frequent programming in the first 2 years of implant use in children.

This study was designed to follow the time course of different levels of linguistic processing using auditory event-related potentials (AERPs). A hierarchical set of acoustically controlled stimuli was used to elicit AERPs in 20 normal children who performed discrimination tasks involving pure tones, phonetic ‘easy’ and ‘difficult’ stimuli and semantic stimuli. Results show that (1) AERP latencies were similar for phonetic ‘easy’ and ‘difficult’ stimuli, (2) prolonged P2, N2 and P3 latencies characterized semantic processing compared to phonetic processing, (3) a late negativity was elicited during semantic processing only, (4) P3 amplitudes were larger over the left compared to right scalp during linguistic processing (phonetic and semantic) but were similar during nonlinguistic processing (pure tones) and (5) reaction time was found to be longest for semantic processing whereas performance accuracy was found to be an insensitive measure. These results provide insight into brain processes underlying the perception of speech. Furthermore, they support a dual model of speech perception that includes parallel and serial processing.

Performing actions with auditory consequences modulates the response in auditory cortex to otherwise identical stimuli passively heard. Such modulation has been suggested to occur through a corollary discharge sent from the motor cortex during voluntary actions. However, the relationship between the effector used to generate the sound, type of modulation and changes in perceptual sensitivity are unclear. Here we use functional magnetic resonance imaging on healthy subjects and demonstrate bilateral enhancement in the auditory cortex to self-generated versus externally generated sounds. Furthermore, we find that this enhancement is stronger when the sound-producing hand is contralateral to the auditory cortex. At the behavioural level, binaural hearing thresholds are lower for self-generated sounds and monaural thresholds are lower for sounds triggered by the hand ipsilateral to the stimulated ear. Together with functional connectivity analysis, our results suggest that a corollary discharge sent from active motor cortex enhances activity in the auditory cortex and increases perceptual sensitivity in a lateralized manner.

Objectives/Hypothesis To compare speech perception performance with right versus left cochlear implants (CIs) in children with bilateral CIs implanted simultaneously. Study Design Prospective case series of patients undergoing simultaneous bilateral cochlear implantation. Methods Speech perception performance was tested in 10, right-handed children who received bilateral CIs simultaneously between 11 and 36 months (mean, 21 months), had at least 18 months of bilateral CI use, and were 5.3 years of age during testing. All children exhibited bilateral symmetrical severe-to-profound hearing loss prior to implantation and did not benefit from hearing aids. Speech perception performance was evaluated with the right CI and the left CI by means of an open-set monosyllabic word test in quiet presented at 45 dB HL in a sound field. Results All children exhibited higher performance with the right CI compared to the left CI. Group mean performance with the right CI was 66.5% compared to 52% with the left CI (P = .002), yielding a 14.5% difference. With increasing duration of bilateral CI use and age at evaluation, the right–left difference increased (r = 0.72, P = .019 and r = 0.74, P = .014, respectively). Conclusions Current preliminary data indicate that children with bilateral CIs implanted simultaneously exhibit a significant right ear advantage for speech. Similarly to reports on normal-hearing children, right ear preference for speech increased with increasing age and auditory–linguistic experience. Thus, simultaneous bilateral cochlear implantation may lead to normal development of auditory pathways and may be an important contributor to the superior auditory, language, and communication skills reported in children with bilateral versus unilateral CIs. Level of Evidence 4. Laryngoscope, 124:1937–1941, 2014

Background Because abnormal Auditory Efferent Activity (AEA) is associated with auditory distortions during vocalization, we tested whether auditory processing is impaired during vocalization in children with Selective Mutism (SM). Methods Participants were children with SM and abnormal AEA, children with SM and normal AEA, and normally speaking controls, who had to detect aurally presented target words embedded within word lists under two conditions: silence (single task), and while vocalizing (dual task). To ascertain specificity of auditory-vocal deficit, effects of concurrent vocalizing were also examined during a visual task. Results Children with SM and abnormal AEA showed impaired auditory processing during vocalization relative to children with SM and normal AEA, and relative to control children. This impairment is specific to the auditory modality and does not reflect difficulties in dual task per se. Conclusions The data extends previous findings suggesting that deficient auditory processing is involved in speech selectivity in SM.

The aim of the present study was to investigate the effect of ear asymmetry, order of testing, and gender on transient-evoked otoacoustic emission (TEOAE) pass rates and response levels in newborn hearing screening. The screening results of 879 newborns, of whom 387 (study group) passed screening successfully in only one ear in the first TEOAE screening, but passed screening successfully in both ears thereafter, and 492 (control group) who passed screening successfully in both ears in the first TEOAE, were retrospectively examined for pass rates and TEOAE characteristics. Results indicated a right-ear advantage, as manifested by significantly higher pass rates in the right ear (61% and 39% for right and left ears, respectively) in the study group, and in 1.75 dB greater TEOAE response amplitudes in the control group. The right-ear advantage was enhanced when the first tested ear was the right ear (76%). When the left ear was tested first, pass rates were comparable in both ears. The right-ear advantage in pass rates was similar in females versus males, but manifested in 1.5 dB higher response amplitudes in females compared with males, regardless of the tested ear and order of testing in both study and control groups. The study provides further evidence for the functional lateralization of the auditory system at the cochlear level already apparent soon after birth in both males and females. While order of testing plays a significant role in the asymmetry in pass rates, the innate right-ear advantage seems to be a more dominant contributor.

The aim of this study was to characterize the auditory brainstem responses (ABRs) of young children with suspected autism spectrum disorders (ASDs) and compare them with the ABRs of children with language delay and with clinical norms. The ABRs of 26 children with suspected ASDs (21 males, five females; mean age 32.5 mo) and an age- and sex-matched group of 26 children with language delay (22 males, four females) were analysed. All children had normal hearing. The absolute latencies of waves I, III, and V, and interpeak latencies (IPLs) I to III, I to V, and III to V of the group with ASDs and the group with language delay were compared. Data from both groups were further compared with clinical norms. All absolute latencies and IPLs were significantly prolonged in the group with suspected ASDs compared with the group with language delay, excluding IPL III-V (all p-values0.05) and with clinical norms (all p-values0.001; IPL III-V, p0.05). Significant prolongation of absolute and IPLs was also evident in the group with language delay compared with clinical norms, excluding IPL III to V (all p-values0.001). The prevalence of abnormal findings in two or more absolute latencies was found to be significantly higher in the group with ASDs (50%) than in the group with language delay (8%; p=0.002). The results provide first-time evidence for a neurodevelopmental brainstem abnormality that is already apparent in young children with suspected ASD and language delay. The overlap in ABR findings supports the assertion that an auditory processing deficit may be at the core of these two disorders.

Objectives:We sought to assess the associations between self-reported listening habits and enjoyment of music, and the following variables: Age at implantation, gender, prelingual versus postlingual deafness, duration of deafness, duration of cochlear implant (CI) use, type of CI, speech coding strategy, and speech perception abilities.Methods:A questionnaire on listening habits and enjoyment of music before the onset of deafness and after implantation was sent to 85 adult CI recipients who had been using the devices for at least 6 months.Results:Of the 53 responders, 39 (73.6%) listened to music after implantation. Listening to music was not significantly related to age at implantation, gender, duration of deafness, duration of CI use, type of CI device, speech coding strategy, or open-set speech perception abilities. The 14 nonlisteners were postlingually deafened. The ratings of enjoyment were the same for 22.6% of patients, improved for 26.4%, and worse for 50.9%. Only 2 of 13 patients who played a musical instrument and 14 of 24 patients who sang before the onset of deafness resumed their musical activities.Conclusions:Despite the decline in listening habits and in the enjoyment of music after cochlear implantation, most patients do listen to music. The changes in listening habits and enjoyment were not related to the selected background variables.

The mechanism by which noise damages the inner ear has not as yet been fully elucidated. Experiments were done to study the influence of the sedation in temporary threshold shift (TS) induced by acoustic overstimulation, as barbiturates were found to improve the brain's tolerance to ischemia. Four groups of guinea pigs (GP) were used. The temporary TS was decreased with the reduction of the temperature in awake, as well as sedated, sound-exposed GP. However, the temporary TS in the sedated, but normothermic GP was as great as in the awake, normothermic group. The high temperature counteracts the protection effect of the sedation in noise-induced hearing loss.

Objectives: To investigate the effect of increasing acoustic-phonetic difficulty in children with cochlear implants (CI) by means of auditory event-related potentials (AERPs). Design: AERPs were recorded from a group of ten 9-to 14-year-old prelingually deafened children who exhibited open-set speech recognition, using the Nucleus 22 CI for at least 5 years. AERPs were recorded in sound field while children were performing oddball discrimination tasks with increasing acoustic-phonetic demand. The tasks consisted pairs of naturally produced stimuli that differed by one phonetic feature: vowel place (/ki/ versus /ku/), vowel height (/ki/ versus /ke/), voicing (/ka/ versus /ga/), and place of articulation (/ka/ versus /ta/). Using a repeated measure design, the effect of increasing acoustic-phonetic difficulty on P3 latency, amplitude, and scalp distribution as well as on the simultaneously obtained behavioral measures, performance accuracy, and reaction time was evaluated. Results: AERPs elicited in the range of 350 msec poststimulus onset were contaminated by the CI stimulus artifact, thus enabling reliable identification of the P3 component only. Increasing acoustic-phonetic difficulty was manifested in all measures in a hierarchical manner: P3 latency and reaction time increased, whereas P3 amplitude and performance accuracy decreased. The correlations, however, between behavioral and electrophysiological measures were not significant. Further support for P3 sensitivity to increasing acoustic-phonetic demand was its absence in four of the 10 children, but only in the most difficult place of articulation task. P3 amplitude was maximal at the midline parietal cite, with equal amplitudes over the right and left scalp regardless of side of implant. Conclusions: The results underscore the significant value of the P3 potential as a sensitive neural index of speech-sound processing in children with CI. The similar hierarchy of acoustic-phonetic demand manifested in both behavioral and electrophysiological measures suggests that speech perception performance relates to neurophysiologic responses at cortical levels of the auditory system. Thus, recording the P3 potential to distinct phonetic contrasts may be useful for studying accessibility and neural encoding at the cortical level in CI recipients.

*Department of Communication Disorders, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv;and ÞSpeech and Hearing Center and þDepartment of Otolaryngology, Sheba Medical Center,Tel Hashomer, IsraelObjective: To compare behavioral speech perception perfor-mance of children with right versus left cochlear implants (CIs).Study Design: A retrospective cohort study.Setting: Academic university medical center.Subjects: Seventy-one prelingually deafened children thatobtained a CI device at 48 months or younger.Intervention: Cochlear implantation with Cochlear, AdvancedBionics, and Med-El devices.Main Outcome Measurements: Patients were divided into 2groups according to ear of implant (right, n = 30; left, n = 41)and matched in age at implantation and preoperative audiolo-gic results. Multivariate analysis of variance was used to eval-uate the effects of 1) side of CI, 2) age at implantation, 3) timewith CI (T1, 18Y24 mo; T2, 36Y42 mo), and 4) dominance(i.e., compatibility between CI side and handedness) on per-formance in a monosyllabic open-set test scored for words andphonemes.Results: A small yet significant Bright CI advantage^ was evi-dent throughout the study follow-up and was independent ofage at implantation. The performance of children implanted at24 months or younger was significantly higher than that ofchildren implanted between 25 and 48 months. Regardless ofCI side and age at implantation, all children exhibited improve-ment in speech perception with continuous use.Conclusion: The present study provides first-time evidence fora right CI advantage for speech perception in prelingually deaf-ened children that can be taken into account when selectingside of CI in candidates with similar residual hearing in bothears and no anatomic constraints. The present data lend furthersupport to the notions that greater gains in speech perceptionare associated with earlier age at implantation and continuoususe. Key Words: Age at implantationVChildrenVCochlearimplantVEar/side of implantVSpeech perception.Otol Neurotol 00:00Y00, 2008.

The use of bilateral hearing aids is based on the assumption that the human auditory system functions best when both ears receive incoming acoustic information. There is evidence, however, that some elderly individuals perform better while using unilateral as opposed to bilateral amplification. The main objective of the present study was to compare speech recognition in noise in elderly hearing-impaired patients initially fitted with bilateral hearing aids while they used unilateral versus bilateral amplification. A secondary goal was to investigate the association between performance with one versus two hearing aids and central auditory function as measured by a dichotic test, and to evaluate the effect of increasing age on these two measures. Twenty-eight patients (mean age 72.8 years, range: 62-86) with bilateral symmetrical mild-to-severe sensorineural hearing loss fitted with digital hearing aids, participated in the study. Speech recognition in noise was assessed in three conditions: (1) aided right ear, (2) aided left ear, (3) aided bilaterally, using the AB open-set monosyllabic word test at a signal-to-noise ratio of +10 dB. Speech stimuli were presented at 70 dB SPL via a loudspeaker located at 0 degree azimuth and the noise was presented via a second loudspeaker located at 180 degrees azimuth. In addition, dichotic listening abilities were evaluated using the threshold-of-interference test. The results of the present study indicated comparable mean group performance while using unilateral versus bilateral amplification. For the most of the patients (71%), however, speech recognition in noise was better while using unilateral amplification to the 'better' ear compared to bilateral amplification. While the performance in the dichotic test was not correlated with speech recognition in noise with bilateral versus unilateral amplification, the performance in these two tests deteriorated significantly with increasing age. Our results suggest that for elderly patients, bilateral amplification may not always be advantageous for speech recognition in noise. As most patients continue to use bilateral amplification, it is clear that there are listening situations in which bilateral amplification provides benefit. Sensitive performance measures that will tap critical aspects of daily binaural listening situations are therefore required. Finally, the deterioration in performance of the aging auditory system underscores the need to 'tailor' auditory habilitation to individual needs.

Performing actions with sensory consequences modifies physiological and behavioral responses relative to otherwise identical sensory input perceived in a passive manner. It is assumed that such modifications occur through an efference copy sent from motor cortex to sensory regions during performance of voluntary actions. In the auditory domain most behavioral studies report attenuated perceived loudness of self-generated auditory action-consequences. However, several recent behavioral and physiological studies report enhanced responses to such consequences. Here we manipulated the intensity of self-generated and externally-generated sounds and examined the type of perceptual modification (enhancement vs. attenuation) reported by healthy human subjects. We found that when the intensity of self-generated sounds was low, perceived loudness is enhanced. Conversely, when the intensity of self-generated sounds was high, perceived loudness is attenuated. These results might reconcile some of the apparent discrepancies in the reported literature and suggest that efference copies can adapt perception according to the differential sensory context of voluntary actions.

Electrical stimulation levels and electrode impedance values (EIVs) in children using the Clarion cochlear implant (CI) programmed with CIS strategy stabilized after 3 months of implant use. The data presented here may be useful as a general guideline for the programming of infants and young children and may further be of help for the identification of patients who fall outside the "average" range.The purpose of the present study was to evaluate changes in electrical stimulation levels, i.e. threshold (T) levels, comfortable (M) levels, dynamic range (DR), and EIVs during the first 18 months of implant use, in children using the Clarion CI.The maps of 18 pre-lingual children (mean age at implantation 4.2 years; range 1-8), using the Enhanced Bipolar 1.2 or Bipolar standard electrode with the S-Series speech processor programmed with CIS strategy, were examined at five time points: connection, and 3, 6, 12, and 18 months post-initial stimulation. T levels, M levels, DR and EIVs were analyzed according to four cochlear segments: apical, apical-medial, medial-basal, and basal.During the first 3 months of implant use T levels increased to some extent, whereas M levels and DR increased significantly. From 3 months and through the entire follow-up, T and M levels as well as DR were stable. EIVs of current carrying electrodes decreased significantly from connection to the 3-month visit; thereafter a stabilization of values was evident. Electrical stimulation levels and EIVs did not differ among the cochlear segments during the entire follow-up.

The present study was designed to follow changes in electrical stimulation levels and electrode impedance values (EIV) in children using the Med-El Combi 40+ cochlear implant (CI) during the first 12 months of implant use. The maps of 24 prelingually deaf children implanted at a mean age of 5.9 years (range 1-15.9 years) using the TEMPO+ speech processor programmed with CIS+ strategy were examined at five time points: initial stimulation, and 1, 3, 6, and 12 months post-initial stimulation. Most comfortable levels (M) and electrode impedance values (EIV) were analyzed according to three cochlear segments: apical, medial, and basal. Results indicated a significant increase in M levels until the 3-month time point, thereafter stabilization was evident. Furthermore, M levels in the apical segment were lower than those in the medial and basal segments. EIV decreased from initial stimulation to the 3-month time point and was then stable through the study follow up. Interestingly, the finding of higher EIV in the apical segment may be attributed to the physical characteristics of the Med-El electrode. In conclusion, the pattern of stabilization of M levels found in the present study is similar to that reported for children using other devices. The data presented here may be useful as a guideline for programming M levels and monitoring EIV in infants and young children. They may further help clinicians to identify those children that fall outside the 'typical' range.

The current preliminary report describes the utilization of low-resolution electromagnetic tomography (LORETA) in a small group of highly performing children using the Nucleus 22 cochlear implant (CI) and in normal-hearing (NH) adults. LORETA current density estimations were performed on an averaged target P3 component that was elicited by non-speech and speech oddball discrimination tasks. The results indicated that, when stimulated with tones, patients with right implants and NH adults (regardless of stimulated ear) showed enhanced activation in the right temporal lobe, whereas patients with left implants showed enhanced activation in the left temporal lobe. When stimulated with speech, patients with right implants showed bilateral activation of the temporal and frontal lobes, whereas patients with left implants showed only left temporal lobe activation. NH adults (regardless of stimulated ear) showed enhanced bilateral activation of the temporal and parietal lobes. The differences in activation patterns between patients with CI and NH subjects may be attributed to the long-term exposure to degraded input conditions which may have resulted in reorganization in terms of functional specialization. The difference between patients with right versus left implants, however, is intriguing and requires further investigation.

The present study was designed to evaluate the effect of neural response telemetry (NRT)-based cochlear implant (CI) programming versus behavioral-based programming on electrical stimulation parameters (MAP) threshold (T) and comfortable (C) levels and speech perception abilities in young children, during the first year of implant use. Ten congenitally deaf children at the age of 12-39 months (mean age: 25.2 months) implanted with the Nucleus 24R(CS) CI participated in the study. The group was randomly divided into two: (1) NRT-based MAP group (n = 5) consisted of children who were programmed using intra-operative NRT measurements; (2) behavioral-based MAP group (n = 5) consisted of children who were programmed using the behavioral responses of the patients. MAP parameters as well as sound-field aided thresholds and speech perception abilities were compared between the two groups at consecutive programming sessions: 1, 3, 6, and 12 months post initial stimulation. Results indicated no significant differences among NRT-based MAPs and behavioral-based MAPs. Although MAP profiles at initial stimulation differed in the apical region, these differences decreased with time. In addition, a gradual increase of T and C levels of NRT-based MAPs as well as those of behavioral-based MAPs was evident until the 1-month time point, thereafter stabilization occurred. Sound-field aided thresholds improved with time for both groups; however, they were found to be significantly better for the NRT-based MAP group. Despite these differences, speech perception abilities were comparable among groups at 12 months post initial stimulation. NRT-based programming was found to be significantly shorter than behavioral-based programming. In conclusion, for this small group of children, our findings support the use of NRT for programming of young children during the initial period after implantation.

Background Selective mutism is a psychiatric disorder of childhood characterized by consistent inability to speak in specific situations despite the ability to speak normally in others. The objective of this study was to test whether reduced auditory efferent activity, which may have direct bearings on speaking behavior, is compromised in selectively mute children. Methods Participants were 16 children with selective mutism and 16 normally developing control children matched for age and gender. All children were tested for pure-tone audiometry, speech reception thresholds, speech discrimination, middle-ear acoustic reflex thresholds and decay function, transient evoked otoacoustic emission, suppression of transient evoked otoacoustic emission, and auditory brainstem response. Results Compared with control children, selectively mute children displayed specific deficiencies in auditory efferent activity. These aberrations in efferent activity appear along with normal pure-tone and speech audiometry and normal brainstem transmission as indicated by auditory brainstem response latencies. Conclusions The diminished auditory efferent activity detected in some children with SM may result in desensitization of their auditory pathways by self-vocalization and in reduced control of masking and distortion of incoming speech sounds. These children may gradually learn to restrict vocalization to the minimal amount possible in contexts that require complex auditory processing.

Objective: The present study was designed to evaluate changes in psycho-electric parameters, i.e. threshold levels, comfortable levels, dynamic range, and electrode impedance values during the 1st year post-implantation, in children using the Nucleus 24M cochlear implant system. Methods: The maps of 25 pre-lingual children programmed with ACE strategy in Monopolar 1+2 mode were examined at five time points: connection, 1, 3, 6, and 12 months post-initial stimulation. Maps and electrode impedance values were analyzed according to three cochlear segments: basal, medial, and apical. Results: Significant elevations of thresholds, comfortable levels, and dynamic range were found during the first few months of implant use. Specifically, threshold increased and dynamic range widened until the 3 months visit, whereas comfortable levels continued to increase until the 6 months visit, thereafter levels stabilized. Electrode impedance values decreased significantly from connection to the 1-month visit thereafter a stabilization of values was evident. In addition, thresholds and comfortable levels were found to be significantly lower in the apical segment, whereas dynamic range and electrode impedance values did not differ among the cochlear segments. Conclusions: Significant changes in psycho-electric parameters and electrode impedance values were evident during the first 6 months of implant use. Given the important role of an optimal map for speech perception, frequent programming sessions during the first few months of implant use are essential.