Cochlear Implants and SSD: Initial Findings With Adults: Implications for Children Doug Sladen, Ph.D. 14 th Symposium on Cochlear Implants in Children December 10-13, 2014 2014 MFMER slide-1
Ann Peterson, M.A. Becky Baas, M.S. Lee Belf, Au.D. Melissa DeJong, Au.D. Ruth Stoeckel, Ph.D. Chuck Beatty, M.D. Alyce Breneman, Au.D. Amy Olund, Au.D. Brian Neff, M.D. Colin Driscoll, M.D.. Matt Carlson, M.D. 2014 MFMER slide-2
Disclaimer I declare that I have no proprietary interest in any product, instrument, device, service, or material related to this presentation. I will be discussing off-label use of a cochlear implant 2014 MFMER slide-3
Overview Results of prospective study of adults with SSD and CI Results of retrospective case analysis of children with assymetric hearing loss 2014 MFMER slide-4
SSD and CI Binaural advantage Two ears are better than one for listening in noisy situations Binaural disadvantage, interference Binaural performance is equal to or worse than performance with the better ear alone 14 th Symposium on Cochlear Implants in Children December 10-13, 2014 2014 MFMER slide-5
Test Measures Pre- and postoperative Speech understanding Postoperative, device on, device off Speech understanding Speech Spatial Hearing Questionnaire- Comparative (SSQ-C) Listening effort 14 th Symposium on Cochlear Implants in Children December 10-13, 2014 2014 MFMER slide-6
Mayo Clinic study of SSD and CI > 6 months and < 2 years moderate to severe sensorineural hearing loss < 50% CNC word understanding in the ear to be implanted, in the aided condition Words presented in a sound field at 60 db SPL(A), contralateral ear masked Enrolled 16, 11 have been implanted 14 th Symposium on Cochlear Implants in Children December 10-13, 2014 2014 MFMER slide-7
Speech understanding Preoperative and postoperative at 6 months Preoperative Ear to be implanted, aided, contra ear, masked CNC words (Peterson & Lehiste, 1952) AzBio sentences (Spahr & Dorman, 2012) Speech presented from 0 o azimuth at 60 db SPL(A) Postoperative Ear implanted using direct audio input cable 14 th Symposium on Cochlear Implants in Children December 10-13, 2014 2014 MFMER slide-8
Speech understanding Postoperative, device on, device off HINT sentences, R-SPACE 8-speaker array Restaurant noise at 72 db SPL(A) Speech varied adaptively to find SNR needed for 50% correct 14 th Symposium on Cochlear Implants in Children December 10-13, 2014 2014 MFMER slide-9
Speech in Noise, Listening Effort 2014 MFMER slide-10
Study Participants 0 20 Ear to be implanted 250 500 750 1K 2K 3K 4K 6K 8K 0 20 Ear NOT to be implanted 250 500 750 1K 2K 3K 4K 6K 8K 40 40 60 60 80 100 120 140 80 100 120 140 14 th Symposium on Cochlear Implants in Children December 10-13, 2014 2014 MFMER slide-11
Subject Age Ear Implanted Device CNC 1 32 Right Flex28 0 2 29 Left Flex24 0 3 59 Right CI512 22 4 55 Left Flex28 0 5 63 Right CI422 44 6 40 Right Flex28 4 7 39 Left Flex24 0 8 49 Left CI422 0 9 47 Right Flex28 0 10 35 Left CI422 0 2014 MFMER slide-12
100 N = 7 90 CNC words 80 AzBio Sentences 70 Percent Correct 60 50 40 30 20 10 0 Pre Post 14 th Symposium on Cochlear Implants in Children December 10-13, 2014 2014 MFMER slide-13
HINT SENTENCES, R-SPACE 8-speaker array 5 4 3 N = 7 2 1 db SNR 0-1 -2-3 -4-5 Device on Device off 14 th Symposium on Cochlear Implants in Children December 10-13, 2014 2014 MFMER slide-14
Listening effort 4 CI participants, 4 NH controls Dual task paradigm Primary task (speech in noise) CNC words, 0 o azimuth Restaurant babble, R-SPACE 8-speaker array, 60 db SPL(A) -2 db SNR (noise at 60 db SPL, speech at 58 db SPL) Secondary task (reaction time) button response to light presented directly in front 2014 MFMER slide-15
Listening effort 2014 MFMER slide-16
Device Off Device ON 0 10 20 30 40 50 60 70 80 90 100 Percent Correct Device Off Device ON Baseline 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1 Reaction Time (ms) 2014 MFMER slide-17
SSQ-C 5 4 n=5 3 2 1 0-1 Speech Hearing Spatial Hearing Qualities -2-3 -4-5 2014 MFMER slide-18
SSD/Asymmetric HL & CI: pediatric results Frequency (Hz) Frequency (Hz) 0 20 250 500 1000 2000 4000 8000 n=7 0 20 250 500 1000 2000 4000 8000 n=7 decibels (db HL) 40 60 80 100 Decibels (db HL) 40 60 80 100 120 120 140 140 2014 MFMER slide-19
SSD/Asymmetric HL & CI: pediatric results Single word score (% correct) 100 90 80 70 60 50 40 30 20 Ear implanted Ear not implanted 10 0 2014 MFMER slide-20
SSD/Asymmetric HL & CI: pediatric results 100 90 80 Percent (%) correct 70 60 50 40 30 20 10 0 CI only - words Bimodal - sentences 2014 MFMER slide-21
Summary Adults with SSD show strong improvement in speech understanding for ear implanted Binaural benefit is present, though not robust, in behavioral tasks Perceived benefit using QoL scales is key Preliminary results with children who have asymmetric hearing loss improved hearing on the ear implanted 2014 MFMER slide-22
Questions & Discussion 2014 MFMER slide-23